Introduction:
Violence against women has been a part of the world due to the unequal relationship between men and women. Women are subjected to different range of violence, including rape, domestic violence, sexual harassment, dowry torture and acid attacks. One such act of violence against women is acid attack in India. It involves the use of acid, a corrosive substance that is thrown on the victims, leading to burning sensation and permanent damage to their body. It is done for taking revenge, for jealousy, hatred, for breaking of relationship due to unfaithfulness or rejection. These victims are the victims of severe trauma that have long term physical and psychological consequences. These traumatic events could never be assimilated into the schemas of the victims, making them feel as victims to injustice (1). They often experience extreme feelings of frustration, anger, helplessness and even depression. They are also distressed due to loss of physical mobility, unemployment and financial and relationship problems.
Even though it is widespread crime in India, limited literature is available for the acid attack survivors. With more than 500 cases every year, out of which 85% of victims being females, it has become a gendered violence (2). There is limited research to show how trauma victims coped from the attack, maintained their strengths and virtues or psychological interventions undertaken with these survivors. The focus after the attack is on physical recovery as victims undergo multiple reconstructive surgeries but there is hardly any focus on psychological rehabilitation. For this, there is a need for more positive psychology interventions, aimed at individuals attaining meaning out of the event; be guided to develop awareness, to challenge the negative self-schemas and to foster growth (3).
For fostering such growth, there is an urgent need to understand the current status of their mental state and what are the other ways that one can possibly deal with a traumatizing experience of acid attack. One such variable that can help to deal with such trauma is by gratefulness. Being grateful is the feeling of thankfulness one receives or gives back. Expression of gratitude validates others' efforts and reinforces further behaviors (4). When faced with any traumatic event, grateful people are more likely to adapt, use new coping strategies and realize their hidden strengths (5). Following any trauma, gratitude transforms an individual as it provides meaning and help people see their life as a gift (6). In research done on traumatic spinal cord injury patients, there was an increase in gratitude for their everyday life as they found great appreciation for their life and considered their lives as the second chance. They expressed their gratitude for new opportunities and expressed their gratitude towards God (7). In post-trauma recovery, gratitude can help strengthen the trauma survivors and deal with their negative experiences and restoration of cognitive flexibility (8).
Many studies also point out that gratitude is a close predictor of life satisfaction (9) and both of these components may operate in a “cycle of virtue”. Life satisfaction is a cognitive component of subjective well-being. Research has shown that individuals who are exposed to prolong violence and in cases of rape and sexual assaults, the victims have low life satisfaction (10). Interventions such as writing gratitude letters over 3 week period is seen to increase participants’ happiness and life satisfaction (11). Survivors of any kind of trauma with higher levels of gratitude are likely to see ‘life as a gift’, which would in turn foster life satisfaction (12). A person with greater gratefulness trait will have higher life satisfaction as they have better access to positive memories (13). The reverse correlation of life satisfaction increasing gratitude is also true, as people with high levels of life satisfaction value the ‘gift’ more, which makes them more grateful (14).
When any violence or trauma happens, there are obvious psychological, physical, and emotional outcomes, other than feeling grateful and satisfied despite the trauma. Few reactions to trauma include anger, hatred, withdrawal, and desire for revenge. Another response can be forgiveness as well. Enright and the Human Development Study Group (15) defined forgiveness as a gift the offender is given by the injured victim, even though he/she may not deserve it. In forgiveness studies, there are some common attributes of the definitions. Firstly, there is an injured person, who was physically, socially, or psychologically harmed and this damage is long lasting and deeply scaring for the victim. Second, there is someone who had done the wrong (16). Third, the injured tries to forgive the offender willingly to decrease the negative effect (17). Lastly, the injured victim chooses to forgive without any direct apology from the offender, but an apology makes the forgiveness process easy (16). Forgiving someone for their offences can be beneficial to the victim as well. In research it was found that forgiveness leads one to have better physical well-being (18). It enables one to cope up with the trauma and injury (19). However, forgiveness is not tolerating the mistake or reconciliation or forgetting the mistake. It is also not same as legal pardon (11). Forgiving someone often leads to increase in life satisfaction (12). In a series of studies using Heartland Forgiveness Scale, it was found that higher forgiveness leads one to have low depression, anxiety, and high satisfaction with life (20). Gratitude and forgiveness are closely related concepts, as forgiveness being the flip side of gratitude. In this, one offers mercy over vengeance to the transgressors. Gratitude also comprises of the willingness of an individual to forgive (21).
The current study
In the recent times, the field of Psychology has started to focus more on improving the quality of life and well-being, as compared to the focus on the psychopathology. The field of Positive Psychology is popularly being accepted as an area that increases health promoting behaviors and happiness. Other character strength like forgiveness and transcendence (gratitude) is associated with well-being and happiness (22). Many interventions to improve quality of life, optimism and gratitude have emerged, which are based on the principles of Positive Psychology. In fact, many interventions are also designed with respect to trauma victims, especially the patients with traumatic brain injury, victims of child-abuse, victims of Intimate Partner Violence to name a few. However, very few research have been done to analyze how the acid attack victims have coped up with their trauma, on their psychological rehabilitation and interventions focusing on improving their life. Most research which focuses on acid attack victims is about the descriptive nature of their pain and about their statistical and political support they have.
Thus, this research is a step for psychological rehabilitation by making them focus on the positive aspects of their lives, despite the trauma they had undergone in their lives. It uses a daily-diary task as previously used by researchers Emmons & McCullough (9), where they had asked to write about three good-things that happened to them throughout the day, for the period of 14-days. The greater goal was to see if this exercise improved their gratitude levels, life satisfaction and forgiveness, with pre and post-assessment scores being measured for these three variables.
Researcher’s Positionality
As women, the first author herself had experienced many instances where she was subjected to remarks of sexuality and patriarchal norms of the Indian society. As a part of her research, when the first author took up this as an area of interest to explore more about women in abuse or traumatic relationships, she discovered that even though women who raise complains against their criminals may get physical and legal aid, but their psychological rehabilitation still remains a grey area. The acid attack survivors are also trauma victims, who receive financial, legal and physical treatment support from various governmental & non-governmental organizations. However, what remains a miss is the psychological support and rehabilitation. For this reason, the first author took up a 6-month long rehabilitation program with the survivors, where the goal was to provide psychological rehabilitation to these survivors. This study was the part of the 6-month intervention, where they were asked to keep a diary for all the good things that happened with them in the day, for 14-days.
Method
Objective
- To study the relationship between gratitude, life satisfaction and forgiveness among the acid attack victims before the intervention.
- To study the relationship between gratitude, life satisfaction and forgiveness among the acid attack victims after the intervention.
- To study the change in the levels of gratitude, life satisfaction and forgiveness in the pre and post-intervention stage.
Hypothesis
- There will be no significant relationship between gratitude, life satisfaction and forgiveness before the intervention.
- There will be a significant relationship between gratitude, life satisfaction and forgiveness after the intervention.
- There will be significant increase in the mean scores of gratitude, life satisfaction and forgiveness after the intervention.
Participants
The participants from this study were 25 acid attack survivors, who were working in Sheores Hangout Café, Agra & Lucknow, via the Chhanv Foundation, an NGO working towards their rehabilitation. They were in the age range from 18-35 years, and belonged to various parts of India. Some of them were from urban and some were from rural setting. Some had finished high school and few others had finished graduation.
Instruments
The Gratitude Questionnaire – Six Item Form (23).
In GQ-6, there are 6-items that are designed to assess the individual’s levels of gratitude in their own lives, on a daily basis. The scale is based on 7-point Lickert scale, with 1 as strongly disagree and 7 as strongly agree. Out of the 6 items, items 3 and 6 are reverse scored. A robust one-factor scale was developed by the authors. Cronbach alpha was found between the ranges of .76 to .84. Internal consistency (.92) and test-retest reliability (.86) was found to be good, in a Japanese college student sample (24).
Satisfaction with Life Scale (25).
Satisfaction with Life Scale is 5-item scale, which is a global measure of the global cognitive judgment of one’s life satisfaction. The items have a Lickert scale of 7 points from 1 to 7, with 7 being strongly agree to 1 being strongly disagree. Satisfaction with Life Scale showed convergent validity and higher internal consistency reliability at .87 and test-retest reliability at .82.
Heartland Forgiveness Scale (HFS) (26).
HFS is an 18-item self-report questionnaire, where it is a measure for person’s general tendency to forgiveness, rather than any particular event or person. It tends to measure the person’s ability to forgive himself or herself, other people and the situations that were not in anyone’s control.
There are three subscales of the HFS. The first one is the forgiveness of self (item 1 to 6), second is the forgiveness of others (items 7 to 12) and the last one is the forgiveness of situations (13 to 18). The higher the score, the higher is the forgiveness. The average score on the subscales is 31 and the average score on the total scale in 93.
Procedure
For this research, the participants were informed that they would be part of a research study. The 25 participants were selected based on homogenous purposive sampling. They were given an information sheet and consent form was duly signed by them before the assessment. Pre-assessment was done using these scales, followed by the 14-day intervention where they were asked to write 3 good things that happened to them during the entire day, each day for 14-days. Later, post-assessment was done using the same scales to check if there is any change in their scores at the end of the intervention. For analysis, SPSS was run and the results were found.
Ethical Considerations
For this study, the acid attack survivors were reached out via their employment organization, an NGO working towards the rehabilitation of these survivors. Prior details of the research and benefits of the intervention were explained and approval was sorted from the Founder & Director of Sheroes Hangout Café, Agra. Participants were then explained about the purpose of the study and written consent from each of the participant was taken in advance. The participants were ensured that the personal details that they write for next 14-days were not meant to be shared with anyone, not even with the researcher.
Results
| Table 1: Socio-demographic details of the acid attack survivors |
| Variable |
Description |
No. of Respondents |
Percentage (%) |
Education |
Less than High School |
20 |
80 |
Graduation |
5 |
20 |
Background |
Rural |
16 |
64 |
Urban |
9 |
36 |
Age |
18-25 years |
13 |
52 |
26-35 years |
12 |
48 |
Years from Attack |
1-3 years |
4 |
16 |
3-6 years |
14 |
56 |
6 years & above |
7 |
28 |
Marital Status |
Married |
9 |
36 |
Unmarried |
6 |
24 |
Divorced/Separated |
10 |
40 |
Table 1 showed the distribution of the participants of the acid attack victims who took part in the intervention: their education levels, their background, age, years from attack and marital status of the survivors.
| Table 2: Correlation between scores on gratitude, life satisfaction and forgiveness, before and after the intervention. |
| Pre Score |
Variables |
Gratitude |
Life Satisfaction |
Forgiveness of Self |
Forgiveness of Others |
Forgiveness of Situations |
Total Forgiveness |
Gratitude |
1 |
|
|
|
|
|
Life Satisfaction |
.007 |
1 |
|
|
|
|
Forgiveness of Self |
.242 |
.258 |
1 |
|
|
|
Forgiveness of Others |
.366 |
.038 |
.324 |
1 |
|
|
Forgiveness of Situations |
.008 |
.025 |
.101 |
.111 |
1 |
|
Total Forgiveness |
.245 |
.151 |
.673** |
.689** |
.447* |
1 |
Post Score |
Gratitude |
1 |
|
|
|
|
|
Life Satisfaction |
.421* |
1 |
|
|
|
|
Forgiveness of Self |
.462* |
.588** |
1 |
|
|
|
Forgiveness of Others |
.508** |
.452* |
.536** |
1 |
|
|
Forgiveness of Situations |
.055 |
.183 |
.051 |
.400* |
1 |
|
Total Forgiveness |
.172 |
.112 |
.002 |
.750** |
.666** |
1 |
*Correlation is significant at 0.05 level.
**Correlation is significant at 0.01 level. |
Table 2 showed that there is no significant correlation between gratitude, life satisfaction and forgiveness in the pre-intervention phase. However, in the post-intervention scores, gratitude had significant correlation with life satisfaction (.421, p<0.05), forgiveness of self (.462, p<0.050) and forgiveness of others (.508, p<0.01). Life satisfaction also had significant correlation with forgiveness of self (.588, p<0.01) and forgiveness of others (.452, p<0.05).
| Table 3: Mean Comparison of Scores before and after Intervention on Gratitude, Life Satisfaction and Forgiveness. |
| Variable |
N |
Before Intervention |
After Intervention |
t-score |
Sig. |
r |
Cohen’s d |
M |
S.D |
M |
S.D |
Gratitude |
25 |
32 |
4.38 |
38.48 |
2.87 |
7.320 |
.000 |
.314 |
1.75 |
Life Satisfaction |
25 |
24.88 |
6.10 |
32.88 |
7.52 |
5.569 |
.000 |
.461* |
1.16 |
Total Forgiveness |
25 |
79.36 |
9.60 |
105.68 |
3.84 |
14.670 |
.000 |
.360* |
3.59 |
Forgiveness of Self |
25 |
26.80 |
3.84 |
32.72 |
3.00 |
8.212 |
.000 |
.468 |
1.72 |
Forgiveness of Others |
25 |
28.96 |
5.01 |
35.92 |
4.24 |
5.505 |
.000 |
.074 |
1.50 |
Forgiveness of Situations |
25 |
23.60 |
5.22 |
37.04 |
1.42 |
12.717 |
.000 |
.097 |
3.51 |
Table 3 revealed mean comparison of the scores on Gratitude, Life Satisfaction and Forgiveness before and after the intervention given to the acid attack victims. Findings indicated that there is significant mean differences on Gratitude with t= 7.320, p<001. Moreover, the scores on Life Satisfaction also showed significant difference, t= 5.569, p<0.001 and also on forgiveness, t= 14.670, p<0.001, respectively.
Discussion
Acid attack is a heinous crime being committed in rampant amount in India and other South-Asian countries and women are the main victims who are subjected to it because of patriarchal system of the society. Some of the common reasons for such attack are the availability of acid, rejection in relationships, interpersonal conflict, and suspicion of infidelity and dowry demands. Some of the attackers are either very closely related to the victim or are complete strangers to them. The victims become traumatized as they are impacted physically and psychologically. Many victims develop psychological responses such as hatred, fear and anger, helplessness and fear (27) as a common response to the attack. Moreover, they may also develop phobias, depression, substance abuse and even Post-Traumatic Stress Disorder (PTSD) (28). Acid attack can act as turning point in one’s life, as they become compelling experiences from which they try to attain some meaning out of it (29). Political studies are often being done to analyze the reasons and the number of acid attacks. However, no study was found by this researcher which actively used any psychological intervention with the acid attack victims.
The current intervention was aimed at increasing the levels of gratitude, life satisfaction and forgiveness among the acid attack survivors. At the beginning of this research, scores of the participants were checked on these three components. Then the intervention was done using the daily diary exercise of writing Three Good Things (9), where the participants were asked to write three good things that happened to them every day, for a period of 14 days. Post that, their scores were again taken to check if the intervention improved their gratitude, life satisfaction and forgiveness. The scores on these three variables were measured using Spearman’s correlation and paired samples t-test.
The participants in this study were from an NGO where they were employed to run a café. Out of the 25 survivors, 20 of them had not finished high school and only 5 had completed their Graduation. 16 were from the rural and 9 from urban settings belonging to different parts of the country.
As seen on Table 2, in the correlation scores between the variables, before the intervention, there was no significant correlation between the scores of gratitude, life satisfaction and forgiveness. After any trauma, most people undergo a lot of anxiety and fear and their environment can act as a trigger. They may also re-experience the trauma and may have unwanted thoughts and flashbacks. Their views of self and the world become very negative. They may develop trust issues, problems in forming and maintaining relationships. Thus, with these experiences of acid attack, it becomes very difficult for them to develop feelings of being grateful and appreciating their life. Moreover, they blame the transgressor for their appearance and condition, for which their levels of forgiveness for the attacker seems very minimal, and is not associated with their life satisfaction.
The goal of this intervention was to improve the levels of gratitude, life satisfaction and forgiveness and to see if this intervention made them correlated to each other. In the scores after the intervention taken after 14-days, there were significant correlation established between gratitude and life satisfaction (.421, p<0.05). Similar research showed that there was a direct effect of writing gratitude letters on increasing levels of life satisfaction (11). Inducing gratitude in fact increase life satisfaction (9). Gratitude serves as the way of noticing the positives of life, which may lead people to experience life satisfaction. Moreover, they gave a few psychological mechanisms to show that gratitude and life satisfaction is linked to one another. When any benefit is seen as a ‘gift’, they are more likely to enjoy that benefit. It removes our attention from comparing ourselves to people who have more than us and helps us to focus on things that are available. It helps in coping, as people who practice gratitude have better social support and more accessibility to positive memories making it easy to solve problems, thus increasing our life satisfaction. Grateful people value things more often and appreciate the giver more. Thus, it is correct to say that gratitude and life satisfaction function in the ‘cycle of virtue’, where there is a bi-directional association between gratitude and life satisfaction (14).
After the intervention, it was seen that there was significant correlation between gratitude and forgiveness of self (.462, p<0.050). Often after any trauma, when a person becomes more grateful for her life & things around, they are more likely to report positive emotions for themselves as well. They are more forgiving of their own mistakes and make themselves focus on the positives of life. There is lack of literature in this area, but it is quite evident from the intervention that writing 3 good things for 14 days made each of the acid attack survivor focus more on the present and how much one has attained in the current situation, despite their mistakes and struggles post the attack. Moreover, gratitude helps to cope with trauma by focusing on reinterpretation of the negative life events (30) and thus, traumatic memories are less likely to resurface or maybe less intense (31). In acid attack survivors, gratitude can lead to have downward counterfactual thinking, where they may compare themselves to what worse could have happened. This thinking leads one to become more grateful & reduce negative emotions towards self, like bitterness and anger, thereby increasing self-forgiveness (32).
Gratitude in the post intervention stage also had a significant relationship with forgiveness of others (.508, p<0.01). Both of them are positive responses: gratitude is for interpersonal benefits and forgiveness is for interpersonal harm (9). In fact, forgiveness is a fundamental step to experience gratitude again after an incident (33). Gratitude leads one to have the willingness to forgive others (34).
There was also significant correlation between life satisfaction and forgiveness of self (.588, p<0.01). Survivors of trauma mostly consider it to be their own fault and hold on to the angry memories. They are more prone to feelings of guilt & regret (35). This leads them to be in a continuous loop, where they are not able to forgive themselves, leading them to feel less satisfied with their lives. Thus, it is important for the acid attack victims to forgive themselves as it would lead them to think, feel and act constructively towards their own self and see themselves as worthy. Most often, they carry shame and guilt for trusting or going against their attacker for which they might have been attacked. Self-forgiveness will help them to remove shame and guilt and move on to have a more satisfied life (21).
Moreover, life satisfaction had a significant correlation with forgiveness of others (.452, p<0.05). In a study done on childhood sexual abuse victims, they found that forgiving others increased the levels of life satisfaction (36). In the current study, the gratitude intervention increased the forgiveness of others and their life satisfaction, as this intervention focused on increasing the appreciation for one’s own life, which is in fact a basis for life satisfaction. Forgiving the offenders led to decrease depressive symptoms and elevated life satisfaction (37). Victims often hold onto the anger towards their offender because it makes them believe that they are keeping them in ‘jail’ symbolically in their thoughts (38). Some victims do see forgiveness as a response of increased feelings of peace, healing and self-worth.
Forgiveness of self and forgiveness of others also significantly correlated with each other (.536**, p<0.01) after the 14-day period of gratitude journaling. Gratitude and forgiveness are both kind of meaning-making process, where people try to draw out meanings out of different instances happening in their life. A lot of the times, forgiveness involves seeing beyond the painful aspect of the trauma and feelings of victimization. Gratitude enables generation of lot of empathy for people around, including the people who did injustice to us. Individuals who are high on empathy are likely to forgive others & self (39). Both of them tend to increase physical and psychological benefits for individuals (40).
After the intervention was done, it was seen that the mean scores of gratitude increased from 32 (SD= 4.38) to 38.48 (SD= 2.87), with t-score of 7.32 (p<0.01). Similar results were found in a study done in Malaysia (41). Using ‘three good things’ intervention, it was found that there was an increase in life satisfaction and gratitude. They also found that people who have motivation and put an effort into gratitude-inducing activity has an increase in the level of gratefulness.
In life satisfaction, there is a difference in the mean scores from 24.88 (SD= 6.10) to 32.88 (SD= 7.52). In a study done, writing letters of gratitude for a period of 3-weeks increased life satisfaction and happiness (11). People with high levels of gratitude experience higher life satisfaction because they are more capable of adjusting to their positive social environment (33).
With the gratitude intervention, it was noticed that the participants had an increase in the forgiveness as well. The levels of forgiveness increased from 79.36 (SD= 9.60) to 105.68 (SD= 3.84). Gratitude and forgiveness together enhance interpersonal and intrapersonal relationships. Gratitude is useful in increasing forgiveness because it reduces the individual’s pessimistic affects such as stress, anxiety and depression (42). Gratitude and forgiveness together boost subjective well-being because individuals with these character strengths have more empathy, acceptance and self-compassion (43).
Gratitude is a fundamental component that increases self-forgiveness. A lot of the trauma victims blame themselves for the trauma they had to undergo. These victims consider that they could have avoided the attack, leading them to blame themselves for the consequences. However, once they are become thankful for what they currently have, they start developing self-forgiveness. With the acid attack victims as well, the intervention had an effective result as the self-forgiveness increased in the post-assessment score (mean= 32.72, SD= 3.00). With gratitude, they became thankful for the fact that they are alive, are working and have financial stability.
Forgiving others after an acid attack is a tough job, but the gratitude intervention increased forgiveness of the others significantly. Gratitude and forgiveness are both an inner experience. Moreover, researchers (44) mentioned in their work that gratitude is a pro-social behavior, as it prompts one to benefit the other. When gratitude as a measure was used, it is seen that granting forgiveness becomes easy for the victims or the trauma survivors. Gratitude is an ‘empathetic emotion’ that increases concern and sensitivity for others. Grateful people are less likely to respond with anger when hurt by others, in turn becoming more forgiving of the transgressor (23). Gratitude also leads one to have an upward spiral for optimal functioning and emotional well-being. Forgiving someone else becomes a part of this spiral, as it leads them to move upwards for better stability and functioning.
Forgiving the situations in which they faced the trauma becomes difficult as most people do not forgive the situations like illnesses and natural disasters (45). During the intervention, it was noticed that most of the acid attack survivors have also forgiven their situations. This could be the attack situation, their treatment or recovery phase. The mean scores increased from 23.60 to 37.04 for all the survivors. In some instances when the victim does not know the perpetrator, situational forgiveness becomes even more important (46). Even in cases of childhood abuse, forgiveness of situations becomes more important (47).
Conclusion
Trauma like an acid attack produces a lot of emotional and cognitive disruptions. These victims are survivors of severe trauma, whose quality of life deteriorated after the attack and they continued to suffer due to physical, social and emotional pain treatment meted by the society. With this intervention where all the acid attack survivors wrote about their three-good things that happened to them for 14-days, it was seen that the survivors had a significant change in their levels of forgiveness, gratitude and life satisfaction. Their ordinary life events written by them on their diaries became attached to a positive meaning (48) thereby increasing their life satisfaction and all kinds of forgiveness.
Strengths of the Study
This present study was done with the difficult to reach and often ignored group of trauma survivors, the acid attack victims. It successfully implemented a 14-day gratitude increasing intervention, which also increased the life satisfaction and forgiveness among the participants.
Limitations of the Study
In this study, sampling was mostly done by homogenous purposive sampling. The participants were from one organization only. The sample size of the participants was quite small for statistical analysis. If the post-scores were taken after a gap of few more days, then the effectiveness of the intervention could have been checked more appropriately. Moreover, the qualitative data from their diaries could have been used further for strengthen the dataset.
Implications
The aim of this study was to increase the levels of gratitude, life satisfaction and forgiveness among the acid attack survivors through writing of three-good things intervention, for a period of 14 days. This intervention can be used as reference for helping more trauma victim at large scale, in order to improve their quality of life and positive emotions. Qualitative analysis of such diary-writing exercise would provide more insight for further studies. More psychological intervention and research into the lives of acid attack survivors needs to be done.
Acknowledgments
We express our gratitude to all the survivors who took part in this intervention and made this program a great success. We are also thankful to Chhanv Foundation management who helped us in implementation of the intervention.
Financial support:
Nil
Conflict of Interest:
The author(s) declare no conflict of interest.
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