Divine Forgiveness Helps Fibromyalgia Patients Adapt Psychologically

In a finding that is already drawing attention across pain research and psychology of religion communities, a team of scientists at Mayo Clinic and partner institutions has shown that forgiveness—particularly the feeling of being forgiven by God—may play a surprising protective role in how women with fibromyalgia cope psychologically with their illness. Fibromyalgia, a chronic condition characterized by widespread musculoskeletal pain, persistent fatigue, disturbed sleep, and cognitive difficulties often described as “fibro fog,” affects roughly 2 to 4 percent of the global population and is diagnosed overwhelmingly in women, who make up as much as 90 percent of clinical samples. Because the condition has no definitive cure and resists purely biomedical treatment, researchers have long searched for psychosocial resources that can soften its impact. The new study, published in the journal Pastoral Psychology, suggests that a forgiving disposition—especially toward the divine—may be one such resource.

The research, led by Loren L. Toussaint of Luther College and Sebastian Binyamin Skalski-Bednarz of the Catholic University of Eichstätt-Ingolstadt and Ignatian University in Cracow, together with colleagues at Mayo Clinic in Rochester, Minnesota, took an unusually rigorous person-centered approach. Rather than simply averaging forgiveness scores across participants, the team used a statistical technique known as latent profile analysis, which sorts individuals into subgroups based on their patterns of responses across multiple dimensions. In this case, the researchers measured four distinct targets of forgiveness: forgiveness of oneself, forgiveness of others, forgiveness of uncontrollable situations, and divine forgiveness—the sense of being forgiven by God. Participants were 236 women with a clinically confirmed fibromyalgia diagnosis, recruited from the Mayo Clinic Fibromyalgia and Chronic Fatigue Clinic patient registry between fall 2024 and spring 2025, with a response rate of approximately 41 percent. Because only 25 men responded, their data were excluded from analysis, a decision consistent with the extreme sex imbalance characteristic of the condition.

The methodological toolkit of the study was comprehensive. Divine forgiveness was assessed with the four-item Divine Forgiveness Scale, which asks respondents to rate how strongly they perceive themselves as forgiven by God on a seven-point scale. Human forgiveness was measured with the 18-item Heartland Forgiveness Scale, which yields separate subscales for self, others, and situations. Psychological outcomes were captured with well-validated clinical instruments: the Patient Health Questionnaire-9 for depression, the Generalized Anxiety Disorder-7 scale for anxiety, and the Dimensions of Anger Reactions-5 for anger. Fibromyalgia severity and impact were quantified using the Revised Fibromyalgia Impact Questionnaire, a 21-item instrument covering functional difficulty, overall life impact, and symptom intensity, with scores ranging from 0 to 100. All internal consistency values were strong, with Cronbach’s alpha ranging from 0.75 to 0.95, indicating that each scale measured its construct reliably within this sample.

The latent profile analysis identified four distinct forgiveness subgroups within the sample. The first group, comprising 46 women, scored low on both divine and human forgiveness. The second group of 69 women showed high divine forgiveness combined with moderate human forgiveness. The third and largest group, 76 women, reported high levels of both divine and human forgiveness across all domains. The fourth group of 45 women presented a striking paradox: very low divine forgiveness but relatively high forgiveness of self, others, and situations. Model fit statistics favored the four-class solution decisively, with the Bayesian information criterion and sample-adjusted BIC reaching their lowest values at four classes, and classification entropy of 0.84 indicating that participants were assigned to their profiles with reasonable confidence. Each model was estimated with 500 random start values, retaining the 50 best solutions, followed by 1,500 additional random starts to avoid local optima.

When the four profiles were compared on health outcomes using Welch’s analysis of variance—an approach chosen because the assumption of homogeneity of variances was violated—the differences were significant and clinically meaningful. Women low in both divine and human forgiveness reported the highest levels of depression, anxiety, and anger. Those high in both domains fared best, with the lowest scores on all three negative emotional measures. The intermediate groups told an instructive story: the high divine–moderate human forgiveness group showed reasonably good psychological adjustment, while the low divine–high human forgiveness group did not enjoy the full protective benefit seen in the high-divine profiles, despite their strong human forgiveness. For anger specifically, the effect was most robust, with the low-forgiveness group scoring significantly higher than all three other profiles. Notably, fibromyalgia severity and impact itself did not differ significantly across profiles, suggesting that forgiveness shapes psychological adaptation rather than the raw intensity of the disease.

The theoretical backbone of the interpretation is the stress-and-coping model of forgiveness, which builds on Lazarus and Folkman’s classic framework of stress appraisal. According to this model, unforgiveness functions as a chronic stressor, sustaining rumination, hostility, and heightened psychophysiological arousal. Forgiveness, by contrast, operates as an emotion-focused coping strategy that regulates negative affect, dampens sympathetic nervous system activation, and allows cognitive reappraisal of painful events in less threatening terms. This framework is especially pertinent to fibromyalgia, which is increasingly understood as a disorder of stress dysregulation. Prior research has documented alterations in the hypothalamic–pituitary–adrenal axis and autonomic nervous system in patients, and daily stressors, interpersonal conflict, and life difficulties have been shown to trigger symptom flares, partly mediated by cortisol and alpha-amylase responses. Forgiveness, in this light, may interrupt a feedback loop in which emotional distress amplifies central pain sensitization.

The correlational analysis added nuance to the profile findings. All four forgiveness dimensions showed small to moderate negative associations with depression, anxiety, anger, and fibromyalgia severity, and forgiveness of self, others, and situations correlated negatively with illness impact even though profile-level differences on that outcome did not reach significance. The authors attribute this discrepancy to methodological factors: correlations capture linear associations across the entire sample, while latent profiles group individuals by response pattern and permit substantial variability within each group. The study was also powered to detect only medium-sized effects, meaning subtle differences in disease severity may have gone undetected. Age emerged as an interesting correlate, being positively associated with divine and self-forgiveness and negatively associated with all outcome measures, echoing earlier findings that forgiveness tends to increase with age while symptom burden in fibromyalgia paradoxically decreases in older patients. Higher body mass index, meanwhile, tracked with greater depression, anxiety, and illness severity.

What elevates this study beyond prior forgiveness research is the spotlight on divine forgiveness. Much of the existing literature has emphasized self-forgiveness as the strongest predictor of health and well-being, and earlier fibromyalgia studies confirmed that self-forgiveness relates to acceptance, active coping, and lower catastrophizing. Yet emerging evidence suggests a distinctive role for feeling forgiven by God. A longitudinal study of older adults found that divine forgiveness predicted physical health more strongly than forgiveness of self or others, particularly among those with strong beliefs in God-mediated control. Other work has shown that the stress-buffering benefits of self-forgiveness are amplified when individuals also feel forgiven by God, and that divine forgiveness appears to precede and predict later interpersonal forgiveness rather than the reverse. In Christian theology, divine forgiveness is described as liberation from guilt and shame and restoration of relationship; comparable themes of divine mercy and forgiveness of the repentant appear in Islamic and Jewish traditions. The authors suggest that experiencing such grace may allow patients to frame their suffering in redemptive terms, fostering resilience, hope, and trust.

The study is not without limitations, and the researchers are candid about them. The cross-sectional design precludes causal conclusions—women who feel better may simply find it easier to forgive, or some third variable such as overall religiosity may drive both. Indeed, the study did not measure religiosity, denominational affiliation, or spiritual practice, leaving open the question of how belief context shapes the experience of divine forgiveness. The exclusion of men limits generalizability, although it reflects the demographic reality of the disease. Future longitudinal work, including latent transition analyses, could clarify whether changes in forgiveness precede changes in psychological health, and the inclusion of biomarkers or functional assessments could illuminate whether forgiveness effects extend to physical illness mechanisms.

Even so, the practical implications are considerable. Structured forgiveness interventions, such as the internationally tested REACH forgiveness program, have already demonstrated efficacy in reducing anger, rumination, and maladaptive cognition across cultures, and qualitative work with fibromyalgia patients has shown that forgiveness education is acceptable, feasible, and perceived as helpful for managing emotional distress. The new findings suggest such programs could be adapted to address divine forgiveness specifically—through guided conversations about guilt and spiritual struggle, facilitated prayer or meditation focused on receiving compassion, reflective reading of sacred texts, or practices such as writing a letter to God. The authors note that these approaches can be translated for nontheistic contexts as well, using compassion meditation, narrative reframing, or rituals of letting go that serve functionally similar purposes. Chaplains and spiritual care providers, they argue, could play a concrete role in fibromyalgia care teams.

For a condition that afflicts millions of women worldwide and resists pharmacological solutions, the message of this research is quietly radical: an inner disposition as seemingly intangible as forgiveness, and above all the sense of being forgiven by a higher power, may measurably shape the emotional landscape of chronic illness. While forgiveness is no substitute for medical treatment, the study positions it as a complementary dispositional resource—one that clinicians, psychologists, and spiritual caregivers alike may want to take seriously in the holistic management of fibromyalgia.