DOCSLIB.ORG

Emotional Responses to Psychiatric Hospitalization Suicidality

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Emotional Responses to Psychiatric Hospitalization Suicidality Suicidology Online 2020; VOL. 11:1 ISSN 2078-5488 Original Research Emotional Responses to Psychiatric Hospitalization among Inpatients Admitted With and Without Suicidality Rivka T. Cohen ,1, Michelle Schoenleber 2, Kim L. Gratz 3, and Matthew T. Tull 3 1 Department of Psychology, University of Pennsylvania, Philadelphia, PA 2 Department of Psychology, St. Norbert College, De Pere, WI 3 Department of Psychology, University of Toledo, Toledo, OH Submitted: April 1st, 2019; Accepted: April 28th, 2020; Published: June 4th, 2020 Abstract: Although commonly used to stabilize individuals reporting suicide risk, psychiatric hospitalization can heighten suicidality following discharge, and unpleasant emotions elicited by hospitalization could contribute to increased risk for suicidal behaviors. However, limited research has examined the relation between suicidality and emotional responses to psychiatric hospitalization. This preliminary investigation examined differences in emotional responses to psychiatric hospitalization both during hospitalization and post-discharge among 21 inpatients admitted with and without suicidality. Participants reported levels of trait emotions and state emotional responses to hospitalization at intake (retrospectively), on-unit, and at 1-2 weeks post-discharge. Results indicated that hospitalization elicited more varied unpleasant emotions for inpatients with versus without suicidality. Additionally, inpatients with suicidality reported a post-discharge rebound in hospitalization- related anger and minimal alleviation of hospitalization-related guilt. Results suggest that more direct means of targeting these emotions during and shortly after hospitalization may be beneficial for patients admitted with suicidality. Keywords: Emotion, Suicide, Suicidality, Inpatient, Hospitalization Copyrights belong to the Author(s). Suicidology Online (SOL) is a peer-reviewed open-access journal publishing under the Creative Commons Licence 4.0. Suicide is the second leading cause of death for approximately 7 and 3 times higher for male and Americans aged 10-34 and remains a major health female patients, respectively, in the first 28 days concern throughout the lifespan (Centers for Disease following discharge from inpatient psychiatric care, Control, 2014). Brief psychiatric hospitalization is relative to the remaining 48 weeks of the first year commonly used for crisis management for acutely post-discharge. Moreover, at least within some suicidal individuals and can promote short-term patient populations (i.e., patients with borderline stabilization (Mellesdal, Mehlum, Wentzel-Larsen, personality disorder), there is evidence that the use Kroken, & Arild Jørgensen, 2010). Yet, despite of inpatient psychiatric hospitalization and crisis potential benefits, evidence suggests that patients services is associated with increased risk for suicide may be at elevated risk for suicide following attempts (Coyle, Shaver, & Linehan, 2018; see also inpatient psychiatric hospitalization. Specifically, in a Paris, 2004). population-based study, Goldacre, Seagroatt, and One understudied factor that may potentially Hawton (1993) found that the suicide rate was contribute to heightened post-discharge suicide risk is the emotionally evocative and sometimes stigmatizing nature of psychiatric hospitalization Rivka T. Cohen itself (Link, 1987; Moses, 2011; Paris, 2004). Address: University of Pennsylvania Psychiatric hospitalization may elicit unpleasant 425 S. University Ave. Philadelphia, PA 19104 emotions that are themselves associated with E-mail: [email protected] suicidality (including suicidal ideation, plans, or 53 Suicidology Online 2020; VOL. 11:1 ISSN 2078-5488 attempts), including self-conscious emotions (e.g., in the development of hypotheses for future guilt, shame; Hendin & Haas, 1991) and high-arousal research. unpleasant emotions (e.g., anger, anxiety; Hendin, Maltsberger, Haas, Szanto, & Rabinowicz, 2004). This Method may be especially true for patients admitted with suicidality, given demonstrated associations Participants between suicidal thoughts and behaviors and both Twenty-four patients (61.9% female; mean age = heightened emotional reactivity (Nock, Wedig, 38.9±12.3) were recruited from an inpatient Holmberg, & Hooley, 2008) and the tendency to psychiatric unit in the southern United States. experience anger, guilt, and shame (Brezo, Paris, & Patients identified by unit nursing staff as not having Turecki, 2006; Kelley et al., 1996). Thus, in addition experienced symptoms of psychosis in the last 24 to having a recent history of suicidality, this subset of hours were approached by study personnel. All 24 patients may be prone to hospitalization-related patients who were approached and participated unpleasant emotions that further exacerbate suicide were also screened for the presence of psychosis in risk. Unfortunately, research has yet to explore the past 24-hours by study personnel; no patients psychiatric hospitalization-related emotions or their screened positive for those symptoms. Two patients persistence post-discharge among patients with and were excluded for random responding (i.e., selecting without suicidality. numbers at random on the measures without The goal of this study was to conduct an initial reading the items). A third patient withdrew during investigation comparing emotional responses to the initial assessment, resulting in a final sample of psychiatric hospitalization among two groups of 21. Included participants were 66.7% White and patients: those admitted for suicidality (including 33.3% African-American. Although 61.9% completed suicidal ideation, plans, and/or attempts) and those at least some college/technical school, participants admitted for reasons unrelated to suicide. We also were predominantly unemployed (61.9%) and low- examined changes in emotions over time during income (66.6% earning <$19,999/year). hospitalization and post-discharge, hypothesizing Based on chart review, 13 participants were that psychiatric hospitalization would prompt more admitted for suicidal ideation/intent/attempts intense self-conscious and high-arousal unpleasant (Suicidality Group) and 8 participants were admitted emotions for patients admitted with versus without for other reasons and denied suicidality at admission suicidality. Further, we predicted that unpleasant (Non-suicidality Group). Additional documented hospitalization-related emotions would be more reasons for admission in both groups included persistent (i.e., remain higher post-discharge) among depression, mania, substance misuse, and psychosis patients admitted with suicidality. Given the dearth at the time of admission (see Table 1), though, as of research in this area, it was our hope that this detailed above, individuals reporting active study would provide preliminary data that could aid psychosis in the past 24 hours were excluded. Table 1. Diagnoses within Suicidality vs. Non-Suicidality Groups. Suicidality Group Non-Suicidality Group Diagnosis N = 13; n (%) N = 8; n (%) Unipolar Depression 7 (53.8%) 3 (37.5%) Any Anxiety Disorder 5 (38.5%) 0 (0.0%) Bipolar Spectrum Disorder 4 (30.8%) 2 (25.0%) Substance Use Disorder 4 (30.8%) 3 (37.5%) Posttraumatic Stress Disorder 2 (15.4%) 0 (0.0%) Schizophrenia 1 (7.7%) 2 (25.0%) Borderline Personality Disorder 1 (7.7%) 0 (0.0%) Note: Diagnoses obtained from information available in participants’ hospital charts. Percentages do not add up to 100% due to comorbid diagnoses. Measures analyses, composites were created (c.f. Schoenleber Trait emotions. The negative affect subscale of the et al., 2016) assessing trait anger (hostile, irritable; Positive and Negative Affect Schedule (PANAS-NA; α=.58), anxiety (nervous, scared, afraid; α=.66), guilt Watson, Tellegen, & Clark, 1988), supplemented (blameworthy, guilty about my actions; α=.46), with 6 additional items (indicated in italics below), sadness (sad), and shame (worthless, inadequate, was used to assess trait unpleasant emotions. In flawed, dissatisfied with myself, ashamed of myself; order to include trait emotions as covariates in α=.63). 54 Suicidology Online 2020; VOL. 11:1 ISSN 2078-5488 State hospitalization-related emotions. The Topic- current version of the T-REX to assess state Related Emotion Examination (T-REX) was used to hospitalization-related emotions following assess state hospitalization-related emotions of discharge. anger (αs=.47-.54), anxiety (α=.58-.82), guilt (α=.31- .62), sadness (α=.68-.74), and shame (α=.58-.86). Data Analytic Plan The T-REX is a modified version of the state emotion One-way analyses of variance (ANOVAs) examined questionnaire used to assess emotional responding between-group differences in each emotion at each during a test of pain pressure perception, which time-point, and paired-sample t-tests examined demonstrated acceptable internal consistency within-group emotion changes. Moreover, a set of 2 (Schoenleber, Berenbaum, & Motl, 2014). Each X 2 (Time X Group) mixed repeated-measures emotion was assessed via 3 items capturing the analyses of covariance (ANCOVAs) examined subjective, cognitive, and behavioral components of between-group differences in emotion trajectories, the emotion. All items were rated on a 0 (not at all) accounting for trait levels of the emotion. ANCOVAs to 4 (extremely) scale, with the middle of the scale (a were conducted for each pair of time points (i.e., rating of 2) corresponding to a moderate level of the intake to on-unit, on-unit to follow-up), separately, reported
Load more

Recommended publications
  • Some Facts About Suicide and Depression
    Some Facts About Suicide and Depression WHAT IS DEPRESSION? Depression is the most prevalent mental health disorder. The lifetime risk for depression is 6 to 25%. According to the National Institute of Mental Health (NIMH), 9.5% or 18.8 million American adults suffer from a depressive illness in any given year. There are two types of depression. In major depression, the symptoms listed below interfere with one’s ability to function in all areas of life (work, family, sleep, etc). In dysthymia, the symptoms are not as severe but still impede one’s ability to function at normal levels. Common symptoms of depression, reoccurring almost every day: o Depressed mood (e.g. feeling sad or empty) o Lack of interest in previously enjoyable activities o Significant weight loss or gain, or decrease or increase in appetite o Insomnia or hypersomnia o Agitation, restlessness, irritability o Fatigue or loss of energy o Feelings of worthlessness, hopelessness, guilt o Inability to think or concentrate, or indecisiveness o Recurrent thoughts of death, recurrent suicidal ideation, suicide attempt or plan for completing suicide A family history of depression (i.e., a parent) increases the chances (by 11 times) than a child will also have depression. The treatment of depression is effective 60 to 80% of the time. However, according the World Health Organization, less than 25% of individuals with depression receive adequate treatment. If left untreated, depression can lead to co-morbid (occurring at the same time) mental disorders such as alcohol and substance abuse, higher rates of recurrent episodes and higher rates of suicide.
    [Show full text]
  • Perceived Social Rank, Social Expectation, Shame and General Emotionality Within Psychopathy
    Perceived social rank, social expectation, shame and general emotionality within psychopathy Sarah Keen D. Clin.Psy. Thesis (Volume 1), 2008 University College London UMI Number: U591545 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI U591545 Published by ProQuest LLC 2013. Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 Overview Within the psychological literature, the self-conscious emotion of shame is proving to be an area of growing interest. This thesis addresses the application of this emotion, as well as self and social evaluative processes, to our understanding of offenders, specifically those high in psychopathic traits. Part 1 reviews the literature concerning emotionality within psychopathy, in order to assess the capabilities, as well as the deficits that people with psychopathic traits demonstrate. Emotions classified as ‘moral’ or ‘self-conscious’, namely empathy, sympathy, guilt, remorse, shame, embarrassment and pride, are investigated. From the review it is clear that psychopaths are not the truly unemotional individuals that they are commonly portrayed as being, but instead experience many emotions to varying degrees. This paper concludes by highlighting possible areas for further exploration and research.
    [Show full text]
  • The Effect of Opioids on Emotional Reactivity
    The Effect of Opioids on Emotional Reactivity Steven M. Savvas, BHSc (Hons) Discipline of Pharmacology, School of Medical Sciences, Faculty of Health Sciences University of Adelaide August, 2013 A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy i Steven M. Savvas, PhD Thesis, 2013 TABLE OF CONTENTS Abstract .................................................................................................................................... xi Declaration ............................................................................................................................ xiii Acknowledgements ............................................................................................................... xiv CHAPTER 1 - INTRODUCTION ...................................................................................... 1 1.1 OPIOIDS AND OPIOID MAINTENANCE TREATMENT ...................................... 1 1.1.1 A BRIEF HISTORY OF OPIOIDS .......................................................................... 1 1.1.2 OPIOID RECEPTORS ............................................................................................ 1 1.1.3 ADAPTATION TO OPIOIDS.................................................................................. 3 1.1.3.1 Tolerance ........................................................................................................ 4 1.1.3.2 Withdrawal ...................................................................................................... 4 1.1.3.3 Dependence
    [Show full text]
  • Surviving Suicide Loss
    Surviving Suicide Loss ISSUE NO 1 | SPRING 2021 | VOLUME 1 IN THIS ISSUE Letter from the Chair ………….……….……….……………….……….………. 1 AAS Survivor of the Year ……….……….…………………..……….……..…. 1 Editor’s Note ....……………………….……….……………….……….…………... 2 Surviving Suicide Loss in the Age of Covid ……….……….…………...…. 2 What the Latest Research Tells Us ……………….…….……….……………. 3 Waiting for the Fog to Clear ……………….…………………..……….…..…… 4 AAS Survivor-Related Events ……………….…..……….…………………..…. 4 In the Early Morning Hours …………………………………………………..…... 6 IN SEARCH OF NEW BEGINNINGS Letter from the Chair I clearly remember attending my first AAS conference in 2005. Six months after losing my sister, I was scared, confused, thirsty for knowledge and ever so emotional. There I met so many people who are near and dear to me today. They welcomed me, remi- nisced with me and, most of all, inspired me. On my flight back, I had many thoughts and feelings. As I am Building Community sure many of you have experienced, writing was both helpful Seeing my article made me feel a part of this community in and healing. So I wrote down my musings from the conference and when back at home, I edited the piece and sent it to Ginny the best ways, surrounded by supportive and like-minded Sparrow. minded folks. As you may remember, Ginny was the extraordinary editor of the Thus, I am happy to have a part in reviving “Surviving Suicide” print newsletter Surviving Suicide, a publication sent to AAS Loss in digital form. I hope it will be a place where all of us can Division members from approximately 1998 through 2007. share our thoughts, our news, our hopes and fears, while hon- oring our loved ones and further building our community.
    [Show full text]
  • Abc's of Suicidology
    ABC’S OF SUICIDOLOGY: THE ROLE OF AFFECT IN SUICIDAL BEHAVIORS AND COGNITIONS A Dissertation Presented to The Graduate Faculty of The University of Akron In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Cynthia Ann Yamokoski August 2006 ABC’S OF SUICIDOLOGY: THE ROLE OF AFFECT IN SUICIDAL BEHAVIORS AND COGNITIONS Cynthia Ann Yamokoski Dissertation Approved: Accepted: _____________________________ ______________________________ Advisor Department Chair Karen R. Scheel Sajit Zachariah _____________________________ ______________________________ Committee Member Dean of the College Sharon Kruse Patricia A. Nelson _____________________________ ______________________________ Committee Member Dean of the Graduate School James Rogers George R. Newkome _____________________________ _______________________________ Committee Member Date Robert Schwartz _____________________________ Committee Member Linda Subich ii ABSTRACT The study of affect and cognition has been important in understanding suicide; however, the research and literature historically have placed more emphasis upon cognitive factors. Clearly, cognitive processes play a significant role in suicidal thoughts and behaviors, but it is also important to increase the focus on affect. There is support for the role of affect and the fact that cognition and affect combine with one another to impact suicidal behaviors. These findings may be advanced through the application of a theoretical model of affect in order to gain insight into the manner in which cognition and affect specifically relate to one another to impact suicidal thoughts and behaviors. Other goals of the current study were to examine the relationship between affect and cognition in suicidal individuals, to determine if different patterns of affect exist for different subtypes of suicidal individuals (i.e., no suicidality, suicidal ideation only, suicidal behaviors), and to assess the unique role of affect in relation to cognition.
    [Show full text]
  • Critical Suicidology Transforming Suicide Research and Prevention for the 21St Century
    Critical Suicidology Transforming Suicide Research and Prevention for the 21st Century Edited by Jennifer White, Ian Marsh, Michael J. Kral, and Jonathan Morris Sample Material © 2016 UBC Press © UBC Press 2016 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without prior written permission of the publisher, or, in Canada, in the case of photocopying or other reprographic copying, a licence from Access Copyright, www.accesscopyright.ca. 23 22 21 20 19 18 17 16 15 5 4 3 2 1 Printed in Canada on FSC-certified ancient-forest-free paper (100% post-consumer recycled) that is processed chlorine- and acid-free. Library and Archives Canada Cataloguing in Publication Critical suicidology : transforming suicide research and prevention for the 21st century / edited by Jennifer White, Ian Marsh, Michael J. Kral, and Jonathan Morris. Includes bibliographical references and index. Issued in print and electronic formats. ISBN 978-0-7748-3029-4 (bound).—ISBN 978-0-7748-3031-7 (pdf).— ISBN 978-0-7748-3032-4 (epub) 1. Suicide. 2. Suicide—Prevention. 3. Suicide—Sociological aspects. 4. Suicidal behavior. I. White, Jennifer, editor HV6545.C75 2015 362.28 C2015-905396-X C2015-905397-8 UBC Press gratefully acknowledges the financial support for our publishing program of the Government of Canada (through the Canada Book Fund), the Canada Council for the Arts, and the British Columbia Arts Council. UBC Press The University of British Columbia 2029 West Mall Vancouver, BC V6T 1Z2 www.ubcpress.ca Sample Material © 2016 UBC Press Contents Introduction: Rethinking Suicide / 1 JENNIFER WHITE, IAN MARSH, MICHAEL J.
    [Show full text]
  • The Lived Experience of Being Born Into Grief
    The lived experience of being born into grief Michelle Holt A thesis submitted to Auckland University of Technology in partial fulfilment of the requirements of the degree of Doctor of Health Science (DHSc) 2018 School of Public Health and Psychosocial Studies Faculty of Health and Environmental Sciences Primary Supervisor: Dr Jacqueline Feather Abstract This study explores the meaning of the lived experience of being born into grief. Using a phenomenological hermeneutic methodology, informed by the writings of Martin Heidegger [1889-1976] and Hans-George Gadamer [1900-2002], this research provides an understanding of the lived experience of having been a baby when one or both parents were grieving (born into grief). The review of the literature identified physical effects of being born when a mother was stressed but no literature was found which discussed emotional effects that a baby may incur due to stress or grief of a parent. The notion of grief was explored and literature pertaining to early childhood adversity reviewed as a possible resource for bringing light to how it may be for babies born into grief. The literature indicated that possible long term complications such as rebellious behaviour, poor relationships, poor mental and physical health, could be a result of early adversity. The literature on understanding effects of grief from a conceptual perspective, rather than from the lived experience perspective, provided a platform for this study. In this study nine New Zealand participants told their stories about the grief situation they were born into and how they thought it had affected them. Data were gathered in the form of semi structured interviews which were audio recorded and transcribed verbatim.
    [Show full text]
  • National Guidelines: Responding to Grief, Trauma, and Distress After a Suicide
    Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines Survivors of Suicide Loss Task Force April 2015 Blank page Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines Table of Contents Front Matter Acknowledgements ...................................................................................................................................... i Task Force Co-Leads, Members .................................................................................................................. ii Reviewers .................................................................................................................................................... ii Preface ....................................................................................................................................................... iii National Guidelines Executive Summary ..................................................................................................................................... 1 Introduction ................................................................................................................................................ 4 Terminology: “Postvention” and “Loss Survivor” ....................................................................................... 4 Development and Purpose of the Guidelines ............................................................................................. 6 Audience of the Guidelines ........................................................................................................................
    [Show full text]
  • Reduced Emotional Empathy in Adults with Subclinical ADHD Groen, Y.; Den Heijer, A.E.; Fuermaier, A.B.M.; Althaus, M.; Tucha, O
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by University of Groningen University of Groningen Reduced emotional empathy in adults with subclinical ADHD Groen, Y.; den Heijer, A.E.; Fuermaier, A.B.M.; Althaus, M.; Tucha, O. Published in: ADHD Attention Deficit and Hyperactivity Disorders DOI: 10.1007/s12402-017-0236-7 IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2018 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Groen, Y., den Heijer, A. E., Fuermaier, A. B. M., Althaus, M., & Tucha, O. (2018). Reduced emotional empathy in adults with subclinical ADHD: Evidence from the empathy and systemizing quotient. ADHD Attention Deficit and Hyperactivity Disorders, 10(2), 141–150. https://doi.org/10.1007/s12402-017-0236-7 Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum.
    [Show full text]
  • Medical Aid in Dying Is NOT Suicide, Assisted Suicide Or Euthanasia
    Medical Aid in Dying Is NOT Suicide, Assisted Suicide or Euthanasia Medical aid in dying is fundamentally stricken with life-ending illnesses. They feel different from euthanasia. While both deeply offended when the medical practice is practices are designed to bring about a referred to as suicide or assisted suicide. peaceful death, the distinction between the two comes down to who administers the means to Leading medical organizations reject that peaceful death. Euthanasia is an intentional the term “physician-assisted suicide.” act by which another person (not the dying The American Academy of Hospice and person) administers the medication. By contrast, Palliative Medicine, American Medical Women’s medical aid in dying requires the patient to be Association, American Medical Student Associa- able to take the medication themselves and tion, American Academy of Family Physicians and therefore always remain in control. Euthanasia is American Public Health Association have all illegal throughout the United States. adopted policies opposing the use of the terms “suicide” and “assisted suicide” to describe the State legislatures and courts in states medical practice of aid in dying. The American where the practice is authorized Association of Suicidology, a nationally recognized recognize medical aid in dying as organization that promotes prevention of suicide differing from suicide, assisted suicide or through research, public awareness programs, euthanasia. Euthanasia and assisted suicide are education and training comprised of respected
    [Show full text]
  • Indiana Suicide Prevention Resources Toolkit
    Indiana Suicide Prevention Resources Toolkit Suicide Learning Collaborative 2 North Meridian Street Indianapolis, IN 46204 0 Published December 2020 Table of Contents Collaborative Members ................................................................................................................................ 5 Introduction .................................................................................................................................................. 2 Data ............................................................................................................................................................... 3 Healthcare ................................................................................................................................................... 11 Warning Signs of Suicide ........................................................................................................................ 12 Screening Tools Guide ............................................................................................................................ 13 Safety Planning Guide ........................................................................................................................... 17 Suicide Safety Planning Template .......................................................................................................... 19 Discharge Protocol .................................................................................................................................. 21 After
    [Show full text]
  • Models of Forgiveness
    RT3335_half title page 4/24/06 12:58 PM Page 1 Forgiveness and Reconciliation RT3335.indb 2 4/28/06 11:32:56 AM RT3335_title page 4/24/06 12:57 PM Page 1 Forgiveness and Reconciliation Theory and Application Everett L. Worthington, Jr. New York London Routledge is an imprint of the Taylor & Francis Group, an informa business RT3335_Discl.fm Page 1 Wednesday, November 23, 2005 1:02 PM Published in 2006 by Published in Great Britain by Routledge Routledge Taylor & Francis Group Taylor & Francis Group 270 Madison Avenue 2 Park Square New York, NY 10016 Milton Park, Abingdon Oxon OX14 4RN © 2006 by Taylor & Francis Group, LLC Routledge is an imprint of Taylor & Francis Group Printed in the United States of America on acid-free paper 10987654321 International Standard Book Number-10: 1-58391-333-5 (Hardcover) International Standard Book Number-13: 978-1-58391-333-8 (Hardcover) Library of Congress Card Number 2005033905 No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data Worthington, Everett L., 1946- Forgiveness and reconciliation : theory and application / Everett L. Worthington, Jr. p. cm. Includes bibliographical references (p. ) and index. ISBN 1-58391-333-5 (hb : alk.
    [Show full text]