International REACH forgiveness intervention: a multisite randomised controlled trial

To determine whether a brief self-directed forgiveness workbook intervention could alter forgiveness, depression symptoms, and anxiety symptoms.

A multisite randomised waitlist-controlled trial was conducted among 4598 participants. Recruitment occurred from 11 February 2020 to 30 September 2021. Final follow-up occurred on 25 October 2021.

Participants were recruited from community-based samples in sites in Colombia, Hong Kong, Indonesia, South Africa, and Ukraine.

Individuals (n=7837) were screened for eligibility. For inclusion, participants needed to be ≥18 years and have experienced an interpersonal transgression. The analytic sample consisted of n=4598 participants, median age 26 and 73% female.

At each site, participants were randomly assigned to either immediate receipt of a self-directed forgiveness workbook intervention, or to receipt after a 2 week delay.

The primary outcomes were unforgiveness (Transgression-Related Interpersonal Motivations Inventory-18), depression symptoms, and anxiety symptoms (Brief Symptom Inventory-18) measured at 2 weeks following intervention assignment.

At 2 weeks follow-up, unforgiveness was lower among the immediate-treatment group compared with the delayed-treatment group (standardised mean difference=-0.53 (95% CI=-0.58 to -0.47)); similar patterns were found for depression (standardised mean difference=-0.22 (95% CI=-0.28 to -0.16)) and anxiety symptoms (standardised mean difference=-0.21 (95% CI=-0.27 to -0.15)).

A brief workbook intervention promoted forgiveness and reduced depression and anxiety symptoms. The promotion of forgiveness with such workbooks has the potential for widespread dissemination to improve global mental health.

NCT04257773.