Anger, negative affect, PTSD and transgression- related characteristics among sexual assault victim- survivors: The moderating role of forgiveness and value of forgiveness. Felicity Saunders D. Clin. Psy. Thesis (Volume 1), 2019 University College London UCL Doctorate in Clinical Psychology Thesis declaration form I confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. Signature: Name: Felicity Saunders Date: 19.05.2019 2 Overview This thesis explores forgiveness and value of forgiveness as potential moderators in the relationship between anger, negative affect, transgression-related characteristics and post-traumatic stress disorder (PTSD) with those who have experienced a sexual assault (SA). Part One is a conceptual introduction. It presents a summary of the literature exploring the forgiveness-PTSD relationship and suggests other factors which may be important to this dyad, such as the relationship with the perpetrator, religion, and value of forgiveness. Gaps in the research are identified, before presenting the clinical implications of the research. Part Two is the empirical paper which presents the moderating role of forgiveness and value of forgiveness in the relationship between anger, negative affect, transgression-related characteristics and PTSD among SA victim-survivors. The results established some bivariate relationships between, negative affect, anger, PTSD symptoms, and forgiveness, yet a moderation relationship between these variables was not found. Contrary to expectation, a moderating relationship between trait forgiveness, value of forgiveness and PTSD symptoms was not found. However, it was found that the more severe the transgression, the greater PTSD symptoms, and that this association is moderated by forgiveness. Finally, it was found that forgiveness moderated the relationship between the familiarity of the perpetrator and PTSD symptoms. This empirical research was part of a joint research project (Rankin, 2019). Part Three is the critical appraisal, which considers: the motivation for the research, certain methodological issues, personal influences on the study’s design, and the adaption of forgiveness within traditional therapeutic models. It concludes with personal reflections of the research area and conducting research. 3 Impact statement This thesis presents a conceptual introduction and empirical paper which both have the potential to impact the academic field of forgiveness and beyond. The conceptual introduction explored the concepts of forgiveness and post- traumatic stress disorder and the research exploring their relationship. The findings emphasised the number of factors which may influence the development of trauma symptoms and also the limited populations with whom the forgiveness-PTSD relationship has been studied in. With regards to the impact of this within academia, it is hoped that this research will highlight the need for further work exploring this relationship with other at-risk populations, such as women who have been sexually assaulted, as well as the impact of forgiveness on other transgression-related characteristics. The empirical paper, within this thesis, explored forgiveness and value of forgiveness as potential moderators in the relationship between anger, negative affect, transgression-related characteristics, and PTSD symptoms. Being the first study to explore and find that forgiveness was found to be a significant moderator between, the severity of the transgression, relationship with the perpetrator and PTSD symptoms, it is hoped that this will inspire further research within this field with this population. This thesis will be accessible to other researchers through UCL Discovery and a further aim is to publish the findings in a peer-reviewed journal, to reach a wider academic audience. With increased interest within the western world into “third wave” CBT approaches, it is hoped that, with further research within the field, forgiveness interventions, where appropriate, may be more widely accepted and integrated into existing PTSD treatments. Based on this thesis specifically, this would be particularly true for women who had a particularly severe sexual assault and did not have a close relationship with the perpetrator. From what the academic world already understands about forgiveness, it is hoped that this could be integrated into 4 clinical practise, and that this has the potential to help women make sense of, and process, the distressing transgressions they were subjected to. This thesis has also highlighted the contrast between the definition of forgiveness within academia, compared to the media and general population. It is hoped that with further research and wider dissemination that these two concepts may eventually share more characteristics and the processes behind forgiveness become more transparent. This study also found that Christians, who were found to significantly value forgiveness more than other participants, had significantly higher PTSD symptoms than those identifying as having no religion. This may have an impact on how we understand forgiveness within the context of religion, as the research suggests that if a person highly values forgiveness, but perhaps does not act in agreement with those beliefs, this may be a potential risk factor to developing traumatic symptoms. This has implications for how forgiveness is discussed clinically, especially those who may be spiritual/religious. 5 Table of contents Overview ................................................................................................................ 3 Impact statement .................................................................................................... 4 Table of contents ................................................................................................... 6 Index of Tables ....................................................................................................... 6 Index of Figures ...................................................................................................... 7 Acknowledgements ................................................................................................ 7 Chapter 1: Conceptual Introduction ....................................................................... 9 Abstract .................................................................................................................. 9 Introduction ........................................................................................................... 10 Method of Literature Review ................................................................................ 11 References ........................................................................................................... 41 Chapter 2: Empirical Paper. .................................................................................. 57 Abstract ................................................................................................................ 58 Introduction ........................................................................................................... 59 Methodology ......................................................................................................... 64 Results ................................................................................................................. 74 Discussion ............................................................................................................ 83 References ........................................................................................................... 96 Chapter 3: Critical Appraisal ............................................................................... 106 References ......................................................................................................... 122 Appendix A- Ethical approval letter ........................................................................ 127 Appendix B- Participant Information Sheet- Focus Group ..................................... 129 Appendix C- Participant Consent Form- Focus Group ........................................... 134 Appendix D- Participant Information Sheet ............................................................ 137 Appendix E- Participant Consent Form .................................................................. 141 Appendix F- Debrief Form ...................................................................................... 144 Appendix G- Details of Collaboration in Joint Project ............................................ 147 Index of Tables Table 1. The study’s proposed hypothesis. .............................................................. 63 Table 2. Variables and measures used in each of the hypotheses. ......................... 68 Table 3. Means, standard deviations, and correlations for the study variables used in hypothesis 5 ......................................................................................................... 79 Table 4. Means, standard deviations, and correlations for the study variables. ...... 81 Table 5. Forgiveness as a moderator of the studies variables both with and without the potential influential case. .................................................................................... 82 6 Index of Figures Chapter 1: Conceptual Introduction Figure 1. The effect of forgiveness on mental health… ...........................................