Forgiveness pills alleviate emotional and physical pain


Most everyone experiences the pain of social rejection at some point in their lives.

It can be triggered by the end of a romantic relationship, losing a job or being excluded by friends.

The emotional distress that often accompanies these experiences is called social pain, and it may cause sadness, depression and loneliness, as well as actual physical pain, research has shown.

A study, published recently in the Annals of Behavioral Medicine may have found an antidote – forgiveness combined with acetaminophen, the active ingredient in Tylenol.

For the study, researchers followed a group of healthy adults for three weeks and randomly assigned them to receive daily doses of either 1,000 mg of acetaminophen, 400 mg of a placebo potassium pill, or no pill.

They also measured their levels of forgiveness on a daily basis using a questionnaire.

For example, participants were asked to rate how strongly they agree or disagree with statements, such as, “I hope this person gets what’s coming to them for what he/she did to me.”

George Slavich, PhD, director of the UCLA Laboratory for Stress Assessment and Research, a senior author on the study discussed the results.

What is the key takeaway from this study?

When combined with a tendency to forgive, taking acetaminophen substantially reduced how much social pain people felt over time.

More specifically, participants taking acetaminophen who were high in forgiveness exhibited an 18.5% reduction in social pain over the 20-day study period.

What made researchers think that acetaminophen and forgiveness might ease the pain of rejection?

Research has shown that physical pain and social pain are influenced by some of the same biological processes in the brain and body.

Based on this research, we thought that acetaminophen, which is commonly used to treat physical pain, might also be able to reduce social pain.

Based on the study’s findings, what is it about acetaminophen and forgiveness that help alleviate social pain? Do they act synergistically?

We think they help reduce experiences of social pain in different ways.

For example, acetaminophen likely reduces social pain by influencing pain signaling in the brain through its effects on specific brain pathways.

On the other hand, forgiveness has been found to lessen peoples’ feelings of stress and anger following experiences of social rejection and exclusion.

Based on the findings from our study, it appears as though acetaminophen acts synergistically with peoples’ ability to forgive to alleviate the feelings of social pain that are commonly associated with rejection and exclusion.

Research has shown that physical pain and social pain are influenced by some of the same biological processes in the brain and body.

How does social pain affect people emotionally?

Experiencing a socially painful life event, like a relationship break-up, is one of the strongest predictors of developing depression in adolescence and adulthood.

Social pain is also associated with decreased cognitive functioning and increased aggression and engagement in self-defeating behaviors, like excessive risk taking and procrastination.

Why does social rejection also cause physical pain?

We can only speculate about why social rejection causes physical pain, but one possibility is that physical pain alerts the person to the fact that an important social relationship has been threatened or lost. This may motivate the person to try to rekindle the relationship or form other relationships to help ensure continued safety and survival.

Are there further studies planned?

Looking forward, we hope to better understand the mechanisms underlying how acetaminophen and forgiveness alleviate social pain and, most importantly, how we can use this knowledge to enhance human health and wellbeing.

Links between Social and Physical Pain

Given this latter evidence linking experiences of social rejection and connection with physical pain, studies have begun investigating cognitive, emotional, and neural processes that may underlie associations between social and physical pain (e.g., [15–17]).

It has been observed, for example, that people often use physical pain-related terms, such as “broke,” “hurt,” and “burn,” to describe situations involving social pain and rejection—for example, “He broke my heart” or “She hurt my feelings” [1819].

Beyond simply adding richness to descriptions of socially painful events, this linguistic overlap may make adaptive sense if physical and social pain share a common evolutionary function, as has been suggested [20].

From this evolutionary perspective, separation or exclusion from a group of protective conspecifics would have historically represented a life-threatening challenge [6].

Consequently, animals that were able to form and maintain strong social bonds were more likely to survive and reproduce than those who were excluded, and the motivation to maintain strong social bonds was thus conserved [56].

As animals became increasingly social over the course of evolution, instead of creating a new system for detecting social pain and exclusion, it has been hypothesized that the brain began using the response system designed for physical pain to respond to social rejection and exclusion [7].

Consistent with this formulation, research has indicated that the social attachment system grew out of existing regulatory systems that were used for attachment, thermoregulation, and physical pain (for a review, see [6]).

Several lines of research have examined these ideas and the resulting evidence suggests that physical pain and social pain appear to share some of the same neurobiological, immunologic, and genetic roots. At the level of the brain, for example, neuroimaging studies have shown that social and physical pain engage some of the same neural regions, including the anterior insula, dorsal anterior cingulate cortex, thalamus, and periaqueductal gray [2122], although these patterns of activation can also be distinguished depending on the neuroimaging analysis performed [17].

In addition, positron emission tomography studies have shown that thinking about interpersonal loss and rejection alters central μ-opioid signaling, which also modulates experiences of physical pain [2324].

At the level of the immune system, in turn, inflammation is known as one of the body’s primary responses to physical pain and injury [2526], but studies have shown that social evaluation and rejection also strongly activate inflammatory processes at the level of both proteins [27] and gene expression [2829].

Finally, at the genetic level, a functional single nucleotide polymorphism that is well-known to regulate the experienced intensity of physical pain (i.e., the A/G transition [A118G] within OPRM1) has also been found to influence neural responses to social rejection in the laboratory [30] as well as emotional responses to social rejection in daily life [8].

Antidotes for Social Pain

Given these effects, researchers have sought to identify strategies that may help reduce social pain and its associated risk for negative emotional and physical health. These strategies have included both social-psychological interventions and psychopharmacological approaches.

One popular social-psychological intervention has involved reducing experiences of social pain by promoting forgiveness, which is commonly defined as having both decisional and emotional dimensions.

Whereas decisional forgiveness is a cognitive process motivated by a principle or religious belief, emotional forgiveness involves the reduction of negative emotions related to an offense or offender and the possible replacement of negative emotions with positive ones.

We focused on emotional forgiveness in the present study, which is one strategy that individuals can use to help reduce unforgiveness and potentially increase positive, altruistic emotions toward an offense or offender [3132].

Emotional forgiveness is thought to promote better health by reducing negative emotions involved in stress and by inducing positive emotions that enhance well-being [33].

For example, given that forgiveness mitigates the effects of both weekly perceived stress and lifetime stress exposure on mental health problems [3435], researchers have examined whether interventions that boost forgiveness might reduce negative effects caused by social pain and rejection.

The consensus from this body of work is that forgiveness interventions can be effective for lessening levels of perceived stress, anger, negative feelings, and myocardial perfusion defects induced by hurtful interpersonal transgressions [3637].

Therefore, forgiveness may help people manage feelings of anger and resentment toward an offender and may, therefore, be beneficial for reducing negative emotional and health consequences associated with social pain.

Researchers have also tested the efficacy of psychopharmacological interventions for reducing social pain that are informed by the mechanistic research described above. Most notably, several studies have examined whether acetaminophen, which is commonly used to treat physical pain, also alleviates social pain [22].

Although the exact mechanisms underlying acetaminophen’s effect on physical pain are not fully understood, cyclooxygenase enzyme inhibition and serotonergic, cannabinoid, and opioidergic neural pathways have been implicated [3839].

Moreover, acetaminophen appears to modulate central nervous system pathways that mediate physical pain and social pain [3839]. Consistent with these effects, daily consumption of acetaminophen for 3 weeks has been found to reduce daily experiences of social pain, as well as neural responding to a brief, laboratory-based episode of social rejection in brain areas previously associated with processing the affective component of physical pain [40].

Acetaminophen has also been shown to reduce individuals’ emotional reactions to others’ social and physical pain [41], suggesting that it broadly modulates social pain-related responding.

Interactive Effects of Forgiveness and Acetaminophen

If forgiveness reduces social pain through psychological processes and acetaminophen through neurochemical pathways, one possibility is that the greatest reductions in social pain over time may be evident for individuals taking acetaminophen who also exhibit positive psychological characteristics, such as being highly forgiving.

Several lines of research converge to support this possibility. First, both forgiveness and acetaminophen have independently been shown to reduce social pain [3740]. Second, acetaminophen may help blunt negative emotions that could prevent the development of forgiveness [4243]—and/or reduce the ability for unforgiveness to promote rumination about socially painful events—thereby making forgiveness-related reductions in social pain more possible [3244].

Third, experiences of social pain and forgiveness of others appear to have some of the same neural substrates. For example, both social pain and forgiveness have been associated with insular engagement [4045].

Additionally, the anterior cingulate cortex has been implicated in both social pain and forgiveness [404647], and ruminating on experiences of social pain appears to activate the medial prefrontal cortex, as does forgiveness [46–50]. Considered together, then, it is possible that the greatest reductions in social pain over time may be evident for individuals taking acetaminophen who also possess positive attributes, such as being highly forgiving.

Present Study

To test this hypothesis, we conducted a double-blind, randomized, placebo-controlled trial in which we randomly assigned participants to an acetaminophen condition (two 500 mg doses of acetaminophen daily), placebo-control condition (two 200 mg doses of potassium daily), or empty-control (no pill) condition.

Given prior studies showing that social pain and forgiveness both fluctuate on a daily basis [4051], we followed participants longitudinally for 21 days and assessed how their levels of forgiveness changed over time and predicted their next-day feelings of social pain. Based on the research summarized above, we hypothesized that acetaminophen-related reductions in social pain across the 21-day study period would be greatest on days that were preceded by high levels of forgiveness. We specifically examined the effects of forgiveness on next-day social pain to ensure temporal precedence (i.e., forgiveness reducing social pain)



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