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Restoring mission in higher education. By Tyler J. VanderWeele Ph.D. Key points Many colleges and universities aspire to grand visions of the transformation of students. College life has the potential to help students flourish academically and in life. Assessing flourishing has the potential to change our discussions and focus. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. University Vision and Mission Many of our colleges and universities put forward admirable mission and vision statements. Harvard University states on its website, “The mission of Harvard College is to educate the citizens and citizen-leaders for our society. We do this through our commitment to the transformative power of a liberal arts and sciences education.” As part of its mission, William and Mary states, “Through close mentoring and collaboration, we inspire lifelong learning, generate new knowledge, and expand understanding. We cultivate creative thinkers, principled leaders, and compassionate global citizens equipped for lives of meaning and distinction.” What many of these colleges and universities are aspiring to is the transformation of students, the enabling of their flourishing, and the empowering of them to help society flourish. For many students, these institutions may well succeed at accomplishing this. For others, college life may be a struggle. Colleges and universities of course carefully track graduation rates, along with the employment and income of their graduates. During university life, surveys are often administered on mental health and on instances of bias and discrimination. Prior to students’ arrival on campus, considerable attention may be given to standardized test scores and grade point averages. All of these things are undoubtedly important, and many of them form the basis of college rankings. However, the aggregation of these various matters still seems to miss the grander visions of flourishing and transformation often embedded in the mission statements of our institutions of higher education. One way to broaden the focus and aims of our colleges and universities is to also broaden the assessments being used. We can better assess whether students are flourishing. We can better assess whether our colleges and universities are flourishing as communities. We can better assess whether university life is helping students to grow in wisdom and in justice, and whether students are being prepared for leadership and citizenship so as to bring about a more flourishing world. Academic Flourishing At the Human Flourishing Program at Harvard, we are making efforts to bring about such expanded assessments to college and university campuses. Our own flourishing measure, focused around the six domains of happiness, health, meaning, character, relationships, and financial security has been used now on numerous campuses, including either campus-wide efforts or more specific studies at University of Michigan, Johns Hopkins, West Point, Yale University, Harvard University, University of North Carolina Chapel Hill, and several others. We have, more recently, also been carrying out assessments on whether colleges and universities are flourishing as a community, and we’ve adapted our community well-being measure to college and university contexts. Such assessments include evaluating whether there are good relationships within the community; proficient leadership to provide vision and direction; healthy structures and practices to sustain the life of the community and to resolve conflict; a sense of belonging, welcome, and satisfaction; and a shared common mission. Most recently, in a newly published paper on academic flourishing, we have further developed a series of questions on student formation, evaluating their perceptions on the extent to which university life has helped them to find meaning and purpose, to grow in character, to develop the capacity for critical thought and for leadership, and to flourish as a person. The questions cover a broad range of matters, but matters concerning which many colleges and universities rightly aim at transformation. As we've argued elsewhere, even the pursuit of the cognitive and epistemic aims of colleges and universities require some degree of character formation. The 24 questions we currently are using in this regard—questions we think students and university staff alike would benefit from reflecting on—are as follows (each is self-rated from 0=“Has not helped” to 10=“Has helped a lot”): Cognitive and Epistemic Capacities: To what extent has university life helped you to increase your knowledge? To what extent has university life helped you to think clearly? To what extent has university life helped you to pursue truth? To what extent has university life helped you to recognize when you are in error so as to be able to change your understanding? To what extent has university life helped you understand perspectives different from your own? To what extent has university life helped you learn how to express yourself well? Virtues for Academic Flourishing: To what extent has university life helped you to become more honest? To what extent has university life helped you to develop courage? To what extent has university life helped you to have a love of learning? To what extent has university life helped you to become more wise? To what extent has university life helped you to become more just? To what extent has university life helped you to better lead a moral life? Citizenship and Societal Contribution: To what extent has university life helped you develop character strengths in order to make meaningful contributions to society? To what extent has university life helped you understand what you can contribute to your country? To what extent has university life helped equip you to positively change the world? To what extent has university life helped you to treat everyone respectfully? To what extent has university life helped you in creative problem solving when working with others? To what extent has university life helped you to work with people with diverse political and religious beliefs? Meaning and Growth: To what extent has university life helped you to find meaning in life? To what extent has university life helped you to appreciate beauty? To what extent has university life helped you to flourish as a person? To what extent has university life helped you to pursue your goals? To what extent has university life helped you learn how to live your life in a healthy way? To what extent has university life helped you learn how to have good relationships with others? We have piloted these questions with a number of colleges and universities this academic year, including campus-wide data collection at the University of North Carolina Chapel Hill, to help understand in what ways students perceive university life as having contributed to their own personal and character development, and how this might vary across students and institutions. In fact, through our collaboration with the Oxford Character Project, four of these questions (on growth in wisdom, justice, contributing to society, and positively changing the world) were embedded in the Wall Street Journal’s Annual College Rankings this past year so as to better take into account these matters of character. Examining how students perceive their institutions as contributing in these ways provides an alternative view of college life. We'll be analyzing this data further in the months ahead but, perhaps unsurprisingly, even a crude comparison of means of different institutions on these questions gives a rather different perspective than most traditional college rankings as we've described in our recent op-ed! Broadening Our Focus We are expanding this work on academic flourishing in the year ahead and inviting colleges and universities everywhere to join this Academic Flourishing Initiative. We've prepared a brief two-page description of the initiative, and more information in a longer brochure, and on our website. We'll also be hosting a webinar at 1:00pm EST on August 20th, 2025, for more information as well. If your college or university might be interested in participating in this work on student flourishing, community flourishing, and academic flourishing, please do contact Brendan Case (brendan_case@fas.harvard.edu) and our Associate Director for Impact Reece Brown (reece_brown@fas.harvard.edu) for further information, or write to us at academicflourishing@fas.harvard.edu. These academic flourishing assessments are intended to supplement, not replace, more traditional metrics. Our conventional college assessments of graduation and income, of mental health and discrimination, and of academic test scores are all critical, and should not be neglected, but we should also broaden our focus. We should consider flourishing both academically and in life more generally. What we measure shapes what we discuss, what we know, what we aim for, and the policies put in place to achieve those aims. We hope that this work will help enable the flourishing of students and perhaps also help restore a focus to the beautiful mission and vision statements of so many of our colleges and universities around the world. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. References VanderWeele, T.J. and Case, B. (2025). Academic flourishing and student formation. International Journal of Wellbeing, 15(2),5003, 1-29. Case, B. W. and VanderWeele, T. J. (2025). Virtues for academic flourishing: an argument for the importance of character in higher education. British Journal of Educational Studies, 73:637-654. Kristjánsson, K. and VanderWeele, T.J. (2025). The proper scope of education for flourishing. Journal of Philosophy of Education, 3-4:634-650. VanderWeele, T.J. and Hinton, C. (2024). Metrics for education for flourishing: A framework. International Journal of Wellbeing, 14, Article 3197: 1–35. VanderWeele, T.J. (2022). The importance, opportunities, and challenges of empirically assessing character for the promotion of flourishing. Journal of Education, 202:170–180. VanderWeele, T.J. (2019). Measures of community well-being: a template. International Journal of Community Well-Being, 2:253–275. VanderWeele, T.J. (2017). On the promotion of human flourishing. Proceedings of the National Academy of Sciences of the United States of America, 31:8148–8156.

New horizons in caregiving. By Tyler J. VanderWeele Ph.D. and Jennifer Wortham Key points Our moral understanding is a central part of who we are. When our moral understanding is severely disrupted we can experience moral injury. Assessments of moral trauma can help us understand and treat such issues. A newly introduced moral problem DSM code will better allow for patient care. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. Our moral understanding of right and wrong, and good and evil, is fundamental to who we are. Such understanding guides our actions and evaluations and shapes our sense of integrity and wholeness. When our moral understanding is severely disrupted by something we have done, witnessed, or been subject to, we can feel torn apart by the resulting feelings of guilt, shame, and confusion. A sense of “moral injury” arising from committing or experiencing or witnessing wrongdoing are common in many societies, and are given vivid expression in the world’s great literature, from Oedipus to Lady Macbeth and beyond. Only in recent decades, however, have psychologists begun to use the term “moral injury” to speak of a distinct condition, caused by the disruption of one’s moral understanding. Early descriptions were given by Jonathan Shay in documenting the experience among veterans. The idea was developed further in the scientific literature by Brett Litz and colleagues who conceptualized moral injury as involving an act of transgression (either perpetrated, witnessed, or experienced as an act of betrayal) that violated deeply held assumptions and beliefs about right and wrong or personal goodness. The symptoms that some veterans were experiencing seemed distinct from post-traumatic stress disorder (PTSD), and treatment for PTSD was sometimes insufficient to address the difficulties. The distinctively moral aspects of betrayal, or of having committed a wrong act, needed to be dealt with. A somewhat related phenomenon, described as “moral distress,” was also documented in the nursing literature. Nurses may sometimes feel that they know the right thing to do to care for patients, but institutional constraints may prevent them from acting accordingly. Not being able to act rightly can likewise give rise to severe distress of a moral nature. While a lot has been written in the past decades on moral injury and moral distress, and numerous definitions and assessments have been put forward, often the work in these two areas have developed separately. Additionally, much of the work on moral injury has focused on the context of perpetrating a wrong act, or being witness to such an act and feeling betrayed. Less has been written on the experience of moral injury that may sometimes arise from being a victim of such an act. However, in some cases, such experiences can fundamentally shake one’s sense of right and wrong or of goodness. Over the past several years, some of us at the Human Flourishing Program at Harvard have been wrestling with these issues, and have been trying to develop a more unified approach to moral injury and to moral distress that would be applicable to perpetrators, witnesses, and victims. We have brought together a number of experts on this topic to work with us, and earlier this year together published a paper on moral trauma laying out this vision, and one we hope will ultimately lead to better clinical attention to these matters as well. Moral Trauma Spectrum, Definitions, and Assessments In trying to bring these concepts together, we conceived of such moral distress as lying on a “moral trauma spectrum” that included matters of both the severity and the persistence of distress. After months of synthesis of prior work, we defined “moral distress” as “distress that arises because personal experience disrupts or threatens: (a) one’s sense of the goodness of oneself, of others, of institutions, or of what are understood to be higher powers, or (b) one’s beliefs or intuitions about right and wrong, or good and evil.” When that distress became sufficiently persistent it would constitute “moral injury.” For such moral distress or moral injury, it was not only that some moral code was violated, but rather that whatever took place somehow challenged one’s whole understanding of right and wrong, or of good and evil, or of the goodness of oneself, others, institutions, or even the divine. That disruption of one’s moral understanding would then give rise to, sometimes severe, distress. When that distress was persistent and would not go away it would be appropriate to speak of “moral injury.” When the distress was sufficiently severe so as to seriously impair functioning over extended periods of time, it might sometimes even be appropriate to speak of "moral injury" disorder. These definitions, drawing on and synthesizing the work of others, were sufficiently general so as to be applicable to perpetrators, witnesses, and victims; and also so as to capture a diverse range of phenomena from the institutional moral distress of nurses, to the experiences of veterans, to that of the victims of other immoral acts, such as in cases of sexual abuse. The generality of the definitions also allowed for a common assessment of such moral trauma including definitional assessments concerning confusions, doubts, and concerns about the very notions of right and wrong, and good and evil, or the goodness of oneself or others, but also moral symptoms that may arise from such moral trauma including guilt, shame, betrayal, anger, powerlessness, hopelessness, loss of meaning, struggles with faith, struggles with forgiveness, and loss of trust. Our paper provides more detail on the conceptual background, the assessment itself, and distinctions from PTSD. While further work is needed on psychometric validation and assessing the scale’s clinical utility, our hope for this unified assessment is that it would help advance our understanding of moral distress and moral injury. Our hope for this work was also that it would influence the provision of clinical care. Recognition in the DSM-5 In parallel with the conceptual and assessment work, members of our collaborative team also worked with the American Psychiatric Association (APA) to provide recognition of these phenomena of moral distress and moral injury in the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). In December 2024, the APA took an historic step by approving the addition of “Moral” to the existing “Religious or Spiritual Problem” category in the “Section of Other Conditions That May Be a Focus of Clinical Attention” in the DSM-5-TR. The revised Z-code was just published in the September 2025 DSM-5-TR Update Supplement and incorporates aspects of our moral distress definition above, stating “Moral problems include experiences that disrupt one’s understanding of right and wrong, or sense of goodness of oneself, others or institutions.” A paper is forthcoming that describes the process and documentation for this addition to the DSM. Our hope is that this new DSM Z-code opens important opportunities for awareness and treatment of moral trauma, moral distress, and moral injury. Acknowledging the Whole Person As human persons, we are not only physical and mental creatures, but social, moral, and spiritual as well. Our capacity to treat physical and mental ailments has expanded dramatically over the past decades. However, more attention needs to be given to the social, moral, and spiritual aspects of our lives. While addressing our social, moral and spiritual challenges requires efforts that extend far beyond the clinical sphere, these issues should not be ignored in patient care. If we are to truly provide person-centered care, the very real possibility of moral distress and moral injury needs to be acknowledged. The present recognition within psychiatry is a step forward in this regard, and greater moral reflection and awareness throughout society, and perhaps especially when dealing with trauma, will better enable us to foster flourishing amidst the suffering that confronts us individually and as a society. Jennifer Wortham is a Research Associate in the Human Flourishing Program at Harvard University. The Human Flourishing Program grants reporters and journalists permission to re-use and quote any of the above material, provided proper attribution is given. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. References VanderWeele, T.J., Wortham, J.S., Carey, L.B., Case, B.W., Cowden, R.G., Duffee, C., Jackson-Meyer, K., Lu, F., Mattson, S.A., Padgett, R.N., Peteet, J.R., Rutledge, J., Symons, X., and Koenig., H.G. (2025). Moral trauma, moral distress, moral injury and moral injury disorder: definitions and assessments. Frontiers in Psychology, 16:1422441.

How to find meaning and growth when time is short. By Tyler J. VanderWeele Ph.D. Key points Flourishing is multi-dimensional. While health will be declining at the end of life, a person might flourish in other ways. Meaning, relationships, and character can be realized in unique ways even as death approaches. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. The definition of flourishing we have used at the Human Flourishing Program at Harvard is “the relative attainment of a state in which all aspects of a person’s life are good, including the contexts in which that person lives.” Understood thus, flourishing is an ideal. It is not something we ever attain perfectly in this life. Flourishing is also multi-dimensional. We may be flourishing in certain ways, but not in others. These aspects of this conceptualization of flourishing are especially important if we are to consider the notion of flourishing at the end of life. In many ways, the notion may seem paradoxical. The very etymology of the word “flourishing” is related to blossoming or flowering – it presupposes life, and suggests a state of abundant health. At the end of life, health is in decline, and death is approaching. Certainly, not all aspects of a person’s life are good. However, even if there are certain things that are not good at the end of life, there may well be others that are. In a recent paper in Theoretical Medicine and Bioethics, we argue that a person can in fact flourish in certain unique ways, even at the end of life. Unique Features of Flourishing at the End of Life Unlike a tree or a flower, a person also has mental capacities, is involved in human relationships, and finds meaning within the narrative of his or her life. These are important aspects of the human person and of human flourishing. These are aspects of human life that can perhaps find some degree of fulfillment even when health is in decline. As health declines and as death approaches, one will certainly not be flourishing in a perfect sense, but one can arguably flourish in a qualified or conditional sense, conditional on that end-of-life context. We should perhaps pay more attention to these other aspects of flourishing in end-of-life settings. Flourishing is multi-dimensional, and we will be neglecting opportunities to flourish if we consider only health as the end of life approaches. In fact, we would argue that in certain respects flourishing can be realized in unique ways at the end of life. The meaning of one’s life gradually unfolds over time; events take place that can alter not only one’s future trajectory but also one’s understanding of the past. At the end of life, it is perhaps more possible to make sense of the entire trajectory of one’s life, to find meaning in it, and to try to make sense of it as a coherent whole, with all its twists and turns. The end of life can also be an important time for relationships. It can be a time when relationships are themselves brought to a satisfactory conclusion; or where there may be unique opportunities for reconciliation or forgiveness in instances in which relationships have been broken. One’s marital vows are, in some sense, brought to their fulfillment at the time of death. No doubt, with death approaching, there can also be pain, loneliness, and fear in the context of relationships as well, but also opportunities for growth and fulfillment. Given the struggles, fear, pain, and suffering that may be present as death approaches, such settings can again perhaps paradoxically also be opportunities for growth and for the strengthening of character. Working through the challenges one confronts can help bring about greater fortitude. Trying to make sense of suffering and struggles can perhaps help deepen one’s spirituality. Working through pain and suffering may increase one’s compassion and love for others. There can be unique opportunities for growth at the end of life as well. None of this should be glamorized, and the struggles at the end of life can often be excruciating. We should certainly seek to alleviate pain and suffering, and the causes of that suffering, but when we cannot fully address these matters, we should arguably also seek opportunities for growth within suffering. Indeed, our work in the Global Flourishing Study sometimes suggests some surprising relationships between adversity and subsequent growth or resilience. This is not an excuse to not address suffering, but rather an invitation to try sometimes to find meaning and growth in the midst of it. End-of-Life Flourishing Assessments and Future Directions To facilitate reflection on these matters, and also to advance research on flourishing at the end of life, we have introduced a modification of our flourishing assessment, adapted to end-of-life contexts. This new end-of-life flourishing assessment takes our prior flourishing measure but alters a number of the questions to be more appropriate for the end of life: from health to questions of pain; from purposes to meaning; from delayed gratification to growth; from satisfaction in relationships to their conclusion. We also propose that in the context of the end of life, particular priority be given to the flourishing domains of meaning, character, and relationships over those of health, happiness, and financial security. While all of these are important in life as a whole, when death is approaching, meaning, character, and relationships are arguably especially salient. We are currently piloting the use of this measure in a number of settings. The assessment is not intended to be a replacement for more traditional quality-of-life assessments, more tailored to symptoms of specific conditions, but rather a supplement. We think both assessments, and others, can and should be used to help try to understand patient experience, and to provide appropriate care. The flourishing assessment helps address broader questions of meaning, relationships, and growth, even at the end of life. We hope that these assessments, as tools for understanding and reflection, might in some sense assist with the “art of dying” (Ars moriendi), bringing about a good death in the midst of real challenges. We hope that this work might also help us reevaluate how we think about human experience at the end of life as well, perhaps even influencing discussions of physician aid in dying. When our entire focus is placed on the domains of health, happiness, and financial considerations, an early termination of life may seem, to some, like the best option. But this is to miss the broader context of flourishing, and a flourishing life. It is to neglect those aspects of flourishing that arguably matter most at the end of life. When we think also about meaning, relationships, and character, the considerations change. Some degree of flourishing can be attained—and even attained in unique ways—even at the end of life. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. References Symons, X. Rhee, J.Y., Tanous, A., Balboni, T. and VanderWeele, T.J. (2024). Flourishing at the end of life. Theoretical Medicine and Bioethics, 45:401-425.

Forgiveness contributes to flourishing. By Tyler J. VanderWeele Ph.D., Kate Jackson-Meyer, and Richard Cowden Key points Levels of forgiveness vary across the globe. Childhood experiences shape subsequent adult forgiveness. A new Global Flourishing Movement has the potential to promote forgiveness worldwide. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. Forgiveness is needed globally, and it is critical to flourishing. As social beings, we are all hurt, wronged, or offended by others at some point in life. One might contemplate numerous options for how to approach such wounds, from suppression of the hurt that leaves it unresolved and likely to re-emerge, to rumination, anger, and revenge-seeking that do not necessarily address root causes of the wounds. More constructively, one might seek justice, accountability, and forgiveness. The benefits of forgiveness and its relation to flourishing make forgiveness a powerful pathway toward both individual and community healing. This is why the Human Flourishing Program continues to research and prioritize the promotion of forgiveness. When the potential benefits of forgiveness are considered alongside how common it is to be hurt or wronged by others, forgiveness is an important public health issue worthy of greater attention. Forgiveness and the Global Flourishing Study With nationally representative data from roughly 200,000 adult participants across more than 20 countries, the Global Flourishing Study (GFS) has taken a key step in advancing our understanding of forgiveness as a public health issue by providing a novel opportunity to explore the distribution, determinants, and outcomes of forgiveness in a culturally and geographically diverse set of countries. Using data from Wave 1 of the GFS, researchers at the Human Flourishing Program conducted two studies that examined (1) the distribution of forgiveness within and across the countries and sociodemographic correlates of forgiveness and (2) retrospectively recalled childhood predictors of subsequent forgiveness in adulthood. In the first study, approximately 75 percent of people across the countries reported "often/always" forgiving those who had hurt them (the remaining 25 percent reported "rarely/never" forgiving others). National estimates of forgiveness ranged from 41 percent (Turkey) to 92 percent (Nigeria). In the 22 countries, the subgroups that reported the highest forgiveness across the most countries included the 80 years or older age group (13 countries), females (12 countries), those who are widowed (16 countries), those who are retired (11 countries), those who attend religious services more than once a week (18 countries), and those with 16 or more years of education (15 countries). The subgroups that reported the lowest forgiveness in the most countries were those in the 18–24 years age group (7 countries), those who are single and have never been married (10 countries), those who are unemployed and looking for a job (8 countries), those who never attend religious services (19 countries), and those with 8 or fewer years of education (11 countries). In the second study, pooled regression estimates from the 22 countries suggested that early life conditions or experiences (e.g., more frequent religious service attendance, better health, more secure family financial status), and social circumstances or influences when growing up (e.g., higher quality maternal and paternal relationships) are associated with a higher likelihood of forgiveness in adulthood. Although there was some variation in the pattern of associations across the countries, the findings suggest there may be value in implementing multipronged interventions and policy initiatives targeting different aspects of a child’s environment during the early years of life to support the development of forgiveness. Together, these two studies provide nationally representative benchmarks of forgivingness in 22 countries, point to possible differences in forgiveness among sociodemographic subgroups, and identify potential childhood factors that may contribute to the development of forgiveness in adulthood. The findings offer important insights that policymakers and public health experts might draw on in their efforts to promote forgiveness, while also laying the foundation for future population-level forgiveness research in the GFS. As future waves of GFS data are collected and analyzed, we hope to gain additional insights into the role of forgiveness in flourishing, especially its effects on well-being. Promoting Forgiveness: Human Flourishing Program’s Global Forgiveness Movement Because forgiveness can make individuals and communities stronger and healthier, the Human Flourishing Program has launched the Global Forgiveness Movement. This initiative, funded by generous support from Bancel Philanthropies and the Kern Family Foundation, aims to use our research and evidence-based interventions to support flourishing by making the world a more loving and forgiving place. The cornerstone of the Global Forgiveness Movement is the promotion of Everett Worthington’s evidence-based brief REACH Do-It-Yourself Forgiveness Workbook, which can be completed in a few hours. Worthington’s REACH model, one of the most widely tested models of forgiveness, encourages emotional forgiveness through the following steps: (R) Recall the interpersonal hurt one experienced and the emotions associated with it. (E) Try to empathize with the offender. (A) Explore the idea that forgiveness can be seen as an altruistic gift to the offender. (C) Make a voluntary commitment to forgive. (H) Seek to hold onto or maintain forgiveness through difficult times. As we have noted previously, the workbook was tested by the Human Flourishing Program and others in a randomized controlled trial. The trial, with more than 4,500 participants across five countries with a history of relatively high conflict (Colombia, South Africa, Ukraine, Indonesia, and Hong Kong), indicates that the workbook is effective in increasing individual forgiveness, reducing anxiety, reducing depression, increasing hope, and increasing flourishing. The Human Flourishing Program has enhanced the workbook design to make it more user-friendly. In response to interest from churches, we have also made a version of the workbook adapted for use in churches. We hope to continue to make future adaptations to the REACH workbook to meet the needs of various communities as our initiative continues. Kate Jackson-Meyer is research associate, Human Flourishing Program, Harvard University Richard Cowden is psychology research scientist, Human Flourishing Program, Harvard University Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. References Cowden, R.G., Worthington, E.L., Jr., Chung, C.A. et al. (2025). Sociodemographic variation in dispositional forgivingness: a cross-national analysis with 22 countries. Scientific Reports, 15, 12144. Cowden, R.G., Worthington E.L., Jr., Weziak-Bialowolska, D. et al. (2025). Childhood predictors of dispositional forgivingness in adulthood: A cross-national analysis with 22 countries. Applied Research Quality Life.

Different countries are flourishing in different ways. By Tyler J. VanderWeele Ph.D. Key points Wealthier countries have fallen behind on meaning, character, and relationships. Young people in many countries are struggling. Religious communities powerfully shape flourishing across the globe. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. The Quest for Global Flourishing We all desire to flourish. The flourishing of all people should be made a national and international priority across the globe. To promote flourishing, we need to understand its determinants and its distribution: Who is flourishing and who is not? Who needs help, and in what ways? How are things changing over time? What works to promote flourishing? What is nearly universal… and what is culturally specific? It was precisely these questions that motivated the development of the Global Flourishing Study (GFS). The Global Flourishing Study, with principal investigators Byron Johnson (Baylor) and myself (Harvard) and data collection by Gallup, is a longitudinal panel study of more than 200,000 participants in 22 geographically and culturally diverse countries, spanning all six populated continents, with nationally representative sampling, and intended five years of annual data collection to assess numerous aspects of flourishing and their possible determinants. The first wave of data was released in February 2024 and the second wave in April 2025. From its release last year, the data have been open-access and freely available to all through the Center for Open Science after submitting a pre-registration. We’ve also been hard at work for more than a year analyzing the data and are happy to report a special collection, published April 30th by Nature-Springer-BMC with numerous papers reporting on the study’s initial results concerning a host of topics ranging from balance in life and inner peace to forgiveness, relationships, smoking, character, educational attainment, optimism, trust, physical health, spiritual practice, and many others. The special collection also includes our Global Flourishing Study flagship paper in Nature Mental Health, summarizing much of what we have learned, which we also reported at our launch event, now available also on video. Global Variation in Flourishing Perhaps one of the most striking results of the study is how different countries are flourishing in different ways. While richer developed countries tend to report higher overall life evaluation and subjective financial security, the same is not true for other aspects of flourishing. GDP per capita, for instance, appears to be negatively correlated with meaning and purpose in life. If one aggregates across numerous domains of flourishing, including happiness, health, meaning, character, relationships, and financial security (as with our flourishing measure), the ordering of the self-report mean scores looks somewhat different than one might expect… Much of what we see here is because many middle-income countries report higher levels of meaning in life, of pro-social character, and of relationship quality than those high-income countries. We’ve noted, as a particularly dramatic example, that of the 22 GFS countries, Sweden reports the second-highest life evaluation, but is 19th for meaning. Much of the well-being literature including, for example, the important World Happiness Report, has focused on a single life evaluation question. However, it seems much is missed when this is the sole focus. As we’ve argued in a commentary in Nature Human Behavior, if we are going to have more adequate efforts to promote flourishing, we need to take into account its multidimensional nature. Indeed, other recent work has indicated that when people respond to the ladder-based life evaluation question, they often think about money and status, rather than other aspects of well-being, such as relationships. While economic development is critical, such development needs to be carried out in ways that do not compromise relationships, meaning, and character. It may be the case that in the West we have sacrificed too much in pursuit of maximal economic gain… and this may not be the right path toward sustainable flourishing. Distributions and Determinants of Flourishing With regard to the demographic distribution of flourishing, many of the initial results from the Global Flourishing Study confirm what has emerged from prior work on well-being, but with interesting variations, and also extend this to a more global context, and not just the West. For example, confirming prior work, married respondents in many countries tend to report higher flourishing than those who are single, but in India and Tanzania, it was the reverse. Likewise, those with higher education tend to report higher flourishing than those with lower levels, but in Hong Kong, the gradient is the opposite. When aggregated over the 22 countries, men and women tend to report relatively similar flourishing, but there are exceptions: In Japan, women report notably higher than men, and in Brazil, men report notably higher than women. One important and very consistent result across countries was that those who attend religious services regularly report considerably higher flourishing. While such demographic analyses are purely descriptive, not causal, other analyses of GFS data, and also other data, do suggest a causal link. For example, it was the case that when assessing childhood religious service attendance retrospectively, and controlling for a host of other retrospective childhood exposures, childhood attendance was likewise a strong predictor of subsequent adult flourishing. Such analyses again replicate what we and others have reported in the past, but now extend this to a more global context. Religious community may be an important pathway to flourishing. While these countries are only particular examples, it is striking that Israel (with relatively high rates of religious service attendance) is one of the few high-income countries also reporting among the highest levels of flourishing, and Japan (with the lowest levels of attendance of the 22 GFS countries) reports the lowest levels of flourishing. While there may be many possible pathways to jointly pursuing economic development along with meaning and relationships, the sustaining of religious community may prove to be a particularly important approach. One especially unsettling aspect of the results was that, in many countries, though certainly not all, flourishing was steadily increasing with age, with the youngest group (age 18-24 years) often being the worst off. We had reported this previously in the United States but have now found closely related patterns, for example, in Argentina, Australia, Brazil, Germany, Mexico, Spain, Sweden, and the United Kingdom, with several other countries also suggesting struggles among young adults. As we note, this is in striking contrast to earlier work—focused mostly on life evaluation/satisfaction—which suggested more U-shaped patterns, with younger people and older people doing better and those in mid-life (perhaps struggling with young children, aging parents, and career challenges) reporting lowest. While the pattern is not universal (in Poland and Tanzania, flourishing decreases with age), it seems that in many places, young people are not doing well. The reasons for this may be numerous, but more needs to be done at a societal and policy level to care for the well-being of youth and of generations ahead. While we have learned a great deal, much still needs to be done. Many of the results and patterns that we have documented, we also now need to better understand and explain, and then use to better foster flourishing. We discuss in a commentary in Nature how countries around the world need to start their own efforts at flourishing data collection and tracking, focused upon each specific culture and context, and their own priorities. Further reflection is also needed on the limitations of the data, as one must always treat these self-report responses with a grain of salt, since questions and response scales can be interpreted in different ways in different languages and contexts. Integrating the results of the GFS with more objective and societal level measures will be an important step forward. But the results also raise numerous issues and questions of critical importance, with discussion of these matters now already covered in The New York Times (here and here), The Atlantic, National Geographic, CNN, The Harvard Gazette, and Christianity Today. We need to think about priorities and about translating those priorities into policy and practice. Wealthier nations seem not to be doing as well on relationships, meaning, and character. These are important aspects of flourishing. Flourishing is not just reducible to health, life satisfaction, and financial security. The other, more humanistic aspects of flourishing are important individually… and they are also important for societal flourishing. We have seen, for example, increasing political polarization in the United States. Might our relative failure to prioritize relationships, meaning, and character have, in part, contributed to this? Will we be able to find a way out without committing to relationships, to a prosocial orientation to all, to a love of neighbor, or perhaps even a love of enemy? If we are to take flourishing seriously—if we are to become truly capable of promoting it—we must acknowledge its multi-faceted nature and we must pursue together those things that lie at the deepest core of our human nature. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. References VanderWeele, T. J., Johnson, B. R., Bialowolski, P. T., Bonhag, R., Bradshaw, M., Breedlove, T., Case, B., Chen, Y., Chen, Z. J., Counted, V., Cowden, R. G., de la Rosa, P. A., Felton, C., Fogleman, A., Gibson, C., Grigoropoulou, N., Gundersen, C., Jang, S. J., Johnson, K. A., Kent, B. V., Kim, E. S., Kim, Y. I., Koga, H. K., Lee, M. T., Le Pertel, N., Lomas, T., Long, K. N. G., Macchia, L., Makridis, C. A., Markham, L., Nakamura, J. S., Norman-Krause, N., Okafor, E. E., Okuzono, S. S., Ouyang, S., Padgett, R. N., Paltzer, J., Ritchie-Dunham, J. L., Ritter, Z., Shiba, K., Srinivasan, R., Ssozi, J., Weziak-Bialowolska, D., Wilkinson, R., Woodberry, R. D., Wortham, J., and Yancey, G. The Global Flourishing Study: study profile and initial results on flourishing. Nature Mental Health (2025). VanderWeele, T. J., and Johnson, B.R. Why we need to measure wellbeing—lessons from a global survey. Nature (2025). VanderWeele, T. J., and Johnson, B.R. Multidimensional versus unidimensional approaches to well-being. Nature Human Behavior (2025). Bialowolski, P., Makridis, C., Bradshaw, M., Weziak-Bialowolska, D., Gundersen, C., Le Pertel, N., Gibson, C., Jang, S.J., Padgett, R.N., Johnson, B.R., and VanderWeele, T.J. Analysis of demographic variation and childhood correlates of financial well-being across 22 countries. Nature Human Behavior (2025). Padgett, R.N., Cowden, R.G., Chattopadhyay, M., Han, Y., Honohan, J., Ritter, Z., Srinivasan, R., Johnson, B.R., and VanderWeele, T.J. Survey sampling design in wave 1 of the Global Flourishing Study. European Journal of Epidemiology (2025).

Measuring what matters in the classroom. By Tyler J. VanderWeele Ph.D. Key points Education has tremendous potential to enable students to flourish. Flourishing is of course enabled through learning and cognitive development. Education can also help student flourish through formation and character development. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. There has been increasing interest in flourishing as an aim of education. Some of this likely arises from the experiences that many students have of a teacher or mentor who profoundly shapes their lives. Some of the interest in education for flourishing may also have to do with a dissatisfaction with prior models of education, such as human capital models, focused principally on equipping students to produce goods and services to support themselves and society. This is doubtless important, but education can arguably accomplish more. Such earlier models seem to miss the transformative potential of education, and the opportunities it affords to enable students to flourish. The Scope of Education for Flourishing While education can help students flourish, there is also a danger of potentially construing the scope of formal educational institutions too broadly. Schools and universities cannot be held accountable for all aspects of student flourishing, and student lives are shaped and flourishing enabled by numerous other non-academic institutions, including, for example, families, neighborhoods, religious and other communities, subsequent workplace experiences, and governments. If flourishing is to be taken seriously as an aim of education, it is important to more clearly specify what is, and what is not, within the purview of a formal educational institution. In a recent paper in the Journal of Philosophy of Education, we have proposed an understanding of the scope of education for flourishing to attempt to find a middle way between an overly broad understanding that is impossible to achieve, and an overly narrow understanding that does not acknowledge the real potential for student formation. We believe that the scope of the contribution of a formal educational institution to student life might be specified as: The proper scope of education for flourishing concerns the developing of students’ knowledge, understanding, and the cognitive skills and epistemic virtues that facilitate knowledge and understanding along with the promotion of those aspects of student flourishing around which broad consensus can be attained, and which teachers and educational leaders are prepared to address. This is a broader set of aims than mere cognitive or professional formation, but narrower than all of flourishing. In particular, not all aspects of flourishing are included because of two restrictions: first, a restriction to those aspects of flourishing around which broad consensus can be attained and, second, a restriction to those aspects of flourishing which teachers and educational leaders are prepared to address. The extent of the first restriction may vary depending on the nature of the school or educational system and consensus may be narrower for a large public school system, say, than a small independent religious school. However, as we’ve argued elsewhere, even within a pluralistic society, we believe there is broad consensus across much of the world that flourishing includes at least happiness, health, meaning, character, relationships, and financial security. The second restriction is to those aspects of flourishing that teachers and educational leaders are prepared to address. Preparedness includes psychological readiness but also having the time, resources, and skills needed to promote flourishing. Such efforts could, in principle, range from nutrition and home finance classes to character development programs to opportunities for aesthetic appreciation. Of course, there can be trade-offs in terms of time and resources allocated between fostering well-being and developing students’ knowledge, but research shows that, in general, they are mutually reinforcing. This second restriction is, moreover, not static. It can be altered over time. Teachers and educational leaders can become better equipped to help foster flourishing. Greater resources can be made available to do so. This second restriction is thus not definitively limiting and in some sense is aspirational as it points towards what might be possible with further time, training, and resources. This is especially important if well-being promotion is not to increasing existing inequalities. More disadvantaged schools and systems will, in many cases, need further resources. In any case, we do think that specifying the scope of education for flourishing in this manner can help address some of the objections to flourishing as an aim of education, as indeed we describe in our paper. Metrics for Education for Flourishing Based on this understanding of the scope of education for flourishing, members of the Human Flourishing Program at Harvard were commissioned by the Organisation for Economic Cooperation and Development (OECD) to develop a framework for metrics to assess the contributions of a school or educational system to students’ future flourishing. The full report was recently published in the International Journal of Wellbeing, and a slightly shortened version is available on the OECD website. The report details a number of important methodological considerations, but the basic framework is reasonably simple and resolves around three pillars at both the individual and the school or system level. These three pillars are: Current flourishing Academic attainment Social, emotional, and character-based capacities A large body of evidence indicates that current flourishing is strongly causally related to subsequent flourishing. Academic attainment itself, of course, enables employment and income but also a host of other outcomes such as social connectedness, happiness, mental health, and the likelihood of marriage. Social, emotional, and character-based capacities likewise have effects on happiness, health, relationships, and other aspects of well-being. And all of these are within the purview of an educational system to influence, and all can readily be measured. But that measurement should extend beyond the individual, and also look at whether schools are flourishing as a community; and whether there are adequate academic curricula and teaching staff in place; and whether there are programs to enhance social, emotional, and character-based capacities, and these matters constitute the institutional pillars of the framework and of measurement. We are now in the process of operationalizing this framework. We have previously introduced school community well-being and individual flourishing measures, including an adolescent version and most recently a 9-11 year-old version (see below). Existing assessment infrastructure can often be used for the second pillar of academic attainment. For the third pillar in our work with schools, we’ll be employing the VIA Inventory of Strengths for Youth and also assessing quantitatively and qualitatively students’ perceptions of the school’s contributions to their own personal and character development. We are currently in the process of piloting this measurement approach and plan to extend it to many networks of schools globally in the years ahead. We believe this work also has implications, albeit in a modified form, for higher education as well, and that will be the topic of a future posting… Such metrics for education for flourishing can help us understand what is going well and what is not, who needs help and in what ways, and how things are changing over time. Such measures also help us to assess the effects of educational interventions, initiatives, and policies to determine which are most effective in what contexts, so that we can implement evidence-based practices that promote flourishing for all. Moreover, measurement itself is not a neutral act. What we measure shapes what we discuss, what we know, what we aim for, and the policies put in place to achieve this. For a school even to take a serious look at how well it is promoting flourishing is arguably a significant intervention in its own right and may provide reorientation towards student flourishing. Flourishing and Formation Education is ultimately about formation: formation of the mind, but also of the person and, ultimately, of our societies as well. This is not the work of a single institution, and we must respect the important work of families, workplaces, religious institutions, neighborhood communities, governments, and others in bringing about personal formation and societal flourishing. However, education has an important role to play and we believe that education for flourishing metrics can better enable educational institutions to promote flourishing for all. Flourishing measure for children ages 9-11 Please answer the questions below on a scale from 0 to 10: Overall, I am happy with life. 0 = Strongly Disagree, 10 = Strongly Agree I’m a happy person. 0 = Strongly Disagree, 10 = Strongly Agree How healthy are you? 0 = Not healthy, 10 = Completely healthy My mind is at peace. 0 = Strongly Disagree, 10 = Strongly Agree Do you feel the things you do in your life matter? 0 = Not at all, 10 = Completely I am doing things now that will help me in my life when I grow up. 0 = Strongly Disagree, 10 = Strongly Agree I always try to do the right thing, even when it is hard. 0 = Strongly Disagree, 10 = Strongly Agree I am always able to do something hard now that I know will make me happy later. 0 = Strongly Disagree, 10 = Strongly Agree I am happy with my friendships and relationships. 0 = Strongly Disagree, 10 = Strongly Agree I have people in my life I can talk to about things that really matter. 0 = Strongly Disagree, 10 = Strongly Agree My family has enough money to live a good life. 0 = Strongly Disagree, 10 = Strongly Agree How often do you worry about being safe, having food to eat, or having a place to live? 0 = Worry All of the Time, 10 = Do Not Ever Worry Copyright Tyler VanderWeele and Christina Hinton Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. References VanderWeele, T.J. and Hinton, C. (2024). Metrics for education for flourishing: A framework. International Journal of Wellbeing, 14, Article 3197: 1–35. Kristjánsson, K. and VanderWeele, T.J. (2024). The proper scope of education for flourishing. Journal of Philosophy of Education, in press.

Distinguishing meaning, purpose, and their varieties. By Tyler J. VanderWeele Ph.D. Key points Meaning and purpose are important aspects of flourishing, distinct from happiness. Having a sense of purpose affects many other aspects of flourishing, including longevity. Meaning includes cognitive coherence, affective significance, and motivational direction. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. There is a growing consensus among social scientists and philosophers alike that a sense of life’s meaning and purpose is a key aspect of flourishing, and one that is not reducible either to happiness (in the sense of positive emotion) or to goodness (in the sense of personal virtue). There are also nuances and subtleties worth paying attention to here. While “meaning” and “purpose” are sometimes used interchangeably, there are important distinctions that can be drawn. Meaning tends to concern an understanding of the relation of things to one another, whereas purpose is more end-directed and concerns trying to accomplish a certain goal or life aim. And, as we’ll see below, there are additional important distinctions that can be drawn further still. The importance of having meaning is also reflected in surveys of the general public. For example, a survey of 2,285 American professionals found that the average respondent “would be willing to forego 23% of their entire future lifetime earnings in order to have a job that was always meaningful.” Meaning can also affect other aspects of flourishing. For example, a group of researchers at the University of Michigan published a paper in 2019 that found considerable longevity benefits to having a sense of purpose in life for adults above age 50. Effects of Purpose and Meaning on Health In 2020, our team at the Human Flourishing Program examined the role that having a sense of mission in life played among 6,000 young adults in the Growing Up Today Study (GUTS). The participants’ sense of mission was assessed in adolescence, and they were followed up for six years into early adulthood. We explored whether and how having such a sense of mission would affect other aspects of health and well-being. As described previously, we made extensive control for potential confounding variables to try to provide evidence for causality. Even after these controls, however, there was evidence that, over time, a sense of mission subsequently improved flourishing in numerous domains, including life satisfaction, positive affect, self-esteem, emotional processing, emotional expression, possibly fewer depressive symptoms, and more subsequent volunteering. Although we did not find associations of a sense of mission with specific physical health outcomes, it must be remembered that this sample was a relatively young group of participants (essentially in their 20s during the study follow-up), and major health problems usually begin later in life. By contrast, a subsequent study by our team examined the relationship between purpose in life and subsequent flourishing among about 13,000 older adults in the Health and Retirement Study (HRS) and found substantial associations of purpose with both physical and mental health. Over the four-year follow-up period, people with the highest sense of purpose had a 13 percent reduced risk of sleep problems, a 43 percent reduced risk of depression, a 35 percent reduced risk of loneliness, and a remarkable 46 percent lower risk of dying in those four years. Purpose in life is clearly not only a key constituent of flourishing but also a powerful determinant of other aspects of flourishing in many areas of life. A Comprehensive Measure of Meaning To facilitate a more careful study of meaning and purpose, in 2021, we put forward a new Comprehensive Measure of Meaning and recently published a paper describing its psychometric properties and reliability and validity as a measurement tool. In developing this measure, our team took an approach that is unusual within psychology: Rather than beginning first with focus-group interviews or reviews of existing items, we took as our starting point a series of recent debates in philosophy and psychology about the nature of meaning, which had converged on the view that meaning is experienced in at least three dimensions of life—namely, cognitive coherence (having a sense of the “meaning of life” as a whole), affective significance (having a sense of “meaning in life,” or the meaningfulness of one’s regular activities), and motivational direction or purpose (having important goals and pursuits). We further proposed, drawing again on the philosophical literature on the topic, that the above dimensions might be further subdivided into global and individual coherence (meaning of life as a whole vs. meaning of my life), into subjective and objective significance, and, for direction, into goals, purposes, and mission (with purposes being larger-life aims that generate more specific goals; and a more unified sense of mission or calling yet broader still, generating our various purposes and life aims). Each of these is arguably independently valuable, and each can be possessed apart from the others. With these distinctions in hand, our team then undertook a thorough review of existing scales designed to measure meaning and purpose and extracted more than 700 items from these, classifying them into the various subcategories above, and eventually selecting three items in each of the seven domains to form a Comprehensive Measure of Meaning. The Comprehensive Measure of Meaning makes use of a variety of items from those previous scales, but it categorizes these in ways that are consistent with that threefold philosophical-psychological typology and its seven sub-domains. Our evaluation of the resulting scale’s properties is based on data from a longitudinal sample of 4,000 college students and a single survey of about 8,800 employees at a Latin American financial institution. Happily, the initial data collected using the Comprehensive Measure of Meaning provides relatively strong support for the threefold conceptual grouping of the items into measures of coherence, significance, and direction (as has other work in psychology), and also even of our further subdivision into each of the seven aforementioned subdomains: global and individual coherence, subjective and objective significance, and goals, purposes, and mission. These results also provide some initial empirical confirmation of the proposal we outlined in an earlier piece that the humanities can provide important conceptual clarity, and further insights, for constructs—such as meaning—that the social sciences seek to study. We hope that the Comprehensive Measure of Meaning will prove a valuable resource in ongoing efforts to understand the distribution, effects, and causes of meaning—including the coherence, significance, and direction of human life. We have begun to embed the measure in longitudinal studies (and we invite others to do the same), and we look forward to discovering what we will learn. Meaning and Flourishing If, as Viktor Frankl proposed, “self-transcendence is the essence of human existence”—if our ultimate happiness consists at least in part in the search to devote ourselves to and fit ourselves within a larger story than our own private pleasure, in losing our lives in order to find them—then cultivating and sustaining meaning is at the very heart of the promotion of human flourishing. We’ve been examining meaning and purpose worldwide in our Global Flourishing Study, and we look forward to sharing with you the results of that research later this year. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. References Padgett, R., Hanson, J.A., Nakamura, J.S., Ritchie-Dunham, J.L., Kim, E.S., and VanderWeele, T.J. (2024). Measuring meaning in life by combining philosophical and psychological distinctions: psychometric properties of the Comprehensive Measure of Meaning. Journal of Positive Psychology, doi: 10.1080/17439760.2024.2403367. Hanson, J.A. and VanderWeele, T.J. (2021). The Comprehensive Measure of Meaning: psychological and philosophical foundations. In: M. Lee, L.D. Kubzansky, and T.J. VanderWeele (Eds.). Measuring Well-Being: Interdisciplinary Perspectives from the Social Sciences and the Humanities. Oxford University Press, Chapter 12: 339–376. Kim, E.S., Nakamura, J.S., Chen, Y., Ryff, C.D., and VanderWeele, T.J. (2022). Sense of purpose in life and subsequent health and well-being in older adults: an outcome-wide analysis. American Journal of Health Promotion, 36:137–147.

Why knowledge should be viewed as an integrated whole. By Tyler J. VanderWeele Ph.D. Key points The humanities can inform the social and biomedical sciences by clarifying concepts, motivating hypotheses, and enriching the interpretation of empirical results. The sciences can contribute to the humanities by testing claims, supplying new data for reflection, and evaluating the effects of traditional practices. Genuine integration allows each discipline to retain its own integrity of method and subject while enriching the others. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. The two-fold aim of the Human Flourishing Program at Harvard University is (i) to study and promote human flourishing, and (ii) to develop and implement systematic approaches to the synthesis of knowledge across disciplines. Our second aim of synthesizing knowledge across disciplines has been important to our work. However, working out how knowledge and methodologies in each of these disciplines are related to each other is not straightforward. Developing systematic approaches to synthesizing such knowledge is challenging. Earlier this year, we published a paper summarizing some of our reflections that have emerged from our work together on how the humanities can inform and enrich the social and biomedical sciences, and likewise on how the sciences can inform and enrich the humanities. Humanities Contributing to the Social and Biomedical Sciences Our paper is shaped around six “modes,” which have emerged from our work, as to how these various disciplines can contribute to each other. There is no claim in the paper that these six modes are exhaustive. The paper is thus principally a documentation of the contributions of one set of disciplines to the other that we’ve seen over and over again. Each of the modes themselves could benefit from further development and systematization. However, it seemed good also to summarize, and illustrate, our current thinking on this task of integration. One clear contribution that the humanities can make to the social sciences is bringing conceptual clarity and drawing of relevant distinctions. Indeed, some take drawing of distinctions to be one of, if not the, central task of philosophy. This can be relevant both in ensuring that there are precise definitions being used in the social sciences, but also in clarifying distinctions between concepts and constructs. This is important in general but also arguably crucial in work on measure development, including drawing relevant distinctions between hope and optimism, developing more grounded measures of suffering, and in more comprehensively measuring meaning. A second potential contribution of the humanities to the social sciences is to motivate research and formulate hypotheses that arise from various philosophical and theological traditions. Work on love and human flourishing can be motivated by the insistence of so many of the world’s religions on the centrality of love to human life, human society, spirituality, and human well-being. Likewise the central role of character in philosophical understanding of well-being provides motivation for empirical work on this topic, and the same is arguably true for empirical research on suffering as well. A third potential contribution of the humanities to the social sciences is enriching, and refining, the interpretation of empirical results. Deeper philosophical or theological interpretation of empirical results can be carried on a number of topics ranging from social connectedness, to deaths of despair, to health itself, and its relation to religion. The Sciences’ Contribution to the Humanities While empirical research can benefit from making use of philosophy and theology, the social and biomedical sciences can also regularly contribute to humanistic scholarship in a number of ways. First, empirical research can sometimes help confirm or refute claims made in philosophical or theological literatures. Empirical work, for example, has confirmed theological claims that spiritual practice is generally conducive to well-being. Conversely, philosophical claims have sometimes been made that pondering the vastness of the universe or the unlikelihood of one’s own birth may lead to feelings of meaningless, whereas empirical work on this topic may suggest the opposite. Second, empirical research can sometimes supply new data for philosophical and theological reflection. There are long-standing philosophical and theological traditions that suffering can sometimes be a pathway for growth, development, character transformation, and future flourishing. While this growth may take place for some, empirical research has suggested that this is certainly not the average experience. This can in turn prompt both further philosophical and theological reflection on the kinds of responses to suffering that in fact do enable growth and future flourishing (and this can then motivate yet further empirical research as well). Third, the empirical sciences can sometimes help develop and evaluate the effects of practices which philosophical or theological traditions suggest may be conducive to well-being. Indeed, this is essentially the work we carried out in the randomized trial of a forgiveness workbook intervention which showed effects also on decreasing depression and anxiety, and increasing hope and flourishing. Clearly, the sciences can build upon, develop further, and implement the rich insights of the humanities. As noted above, these various modes concerning how the sciences and humanities can inform and enrich one another are in no way intended to be exhaustive, but these are modes we’ve seen arise, again and again, in our and others’ work, and further illustrations are given in our paper. Integration and Incarnation The relation of the disciplines to one another is an important topic. As noted above, one of the humanistic disciplines that can arguably enrich interpretation of empirical results is theology. Our work has often drawn upon ideas across the world religious traditions, but a number, though certainly not all, of our staff approach this from a Christian perspective, reflecting on the nature of and the relation between God and creation, and also on what this means for flourishing here on earth, as illustrated also in my own recent book on a Theology of Health. One of the deepest mysteries pondered in the Christian faith and in Christian theology is what Christians all over the world remember and celebrate at Christmas - the incarnation: the joining of God’s nature with human nature in the person of Jesus Christ. Many Christian confessions affirm that Christ’s divine and human natures are united “without division or confusion.” We seek a similar union of apparent opposites in our work of integrating the humanities and social sciences, allowing each to inform and enrich the other, while retaining its own integrity of method and subject. Christmas celebrates Jesus’ birth as a sign and act of God’s love, and one that allows us to better understand the nature of love, and the nature of God, and which provides the potential for a fuller restoration of human nature, and further, in the life of Jesus, provides an example of love for us to follow. As we continue to ponder insights arising from a range of disciplines and our knowledge of flourishing, let us also, in this season, seek that knowledge, and that flourishing, that comes from seeking to love one another, and seeking together the source of that love. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. References Case, W.B. and VanderWeele, T.J. (2024). Integrating the humanities and social sciences: six approaches and case studies. Humanities and Social Sciences Communications, 11, 231.

Optimism is more complicated than you think. Here's what the research reveals. By Tyler J. VanderWeele Ph.D. Key points Hope can be present even when people are not optimistic. There are various forms of optimism, some of which are rational. Optimism itself may sometimes be grounded in personal agency or other resources. People need hope and rational optimism to move forward as individuals and as a society. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. Facing Our Difficulties Sometimes, the struggles we face, both as individuals and as a society, seem insurmountable. While there is much around us that is good, some problems and conflicts—personal, relational, political—can appear intractable. It may not always be reasonable to be optimistic, but that does not mean we need to be paralyzed. Even if there are no reasons to be optimistic, there may nevertheless be grounds for hope. Hope Versus Optimism The terms “hope” and “optimism” are sometimes used interchangeably. While there are various resemblances between these two states, there are also differences. Optimism tends to concern expectations that the future will be positive. Hope may not. Hope may be present even if we think a positive outcome is not especially likely. Even in such cases, there may still be reasons for action and reasons to hope. Aquinas understood hope as a desire arising from the perception of “a future good [that is] difficult but possible to obtain.” Likewise, Milona and Stockdale argue that hope entails a desire for something good in the future and a belief that this is possible, but it extends beyond belief and desire to include a reason for action to try to obtain the future good. Even when circumstances are difficult, and we cannot necessarily expect a good outcome, there may be reasons to hope for it and to work for it. Rational Optimism But what of optimism? Psychologists often consider optimism a psychological asset, and there is empirical research to support its beneficial effects on health. Philosophers, however, tend to be more skeptical of optimism. Many philosophers consider optimism to be an “epistemic deficiency.” If we tend to think a positive outcome is more likely than it is, then we do not have a rational view of the situation. While there is undoubtedly something correct in this philosophical perspective, the picture is arguably somewhat more complicated. There are varieties of optimism, and some of them are, in fact, rational. Such forms of rational optimism were the topic of one of our recent papers at the Human Flourishing Program at Harvard. One intriguing fact about optimism is that, in the West, at least, it tends to increase (not decrease) with education. This might seem unusual if optimism were always irrational. While there are undoubtedly cases in which we simply misjudge probabilities (e.g., “when 70 percent of the population take themselves to be less likely to be divorced than the average person, they cannot all be correct”), there are other instances in which our optimism may be grounded in reasons. We might be optimistic about a positive outcome because we have the resources to bring about a good outcome (“resourced optimism”), or we might be optimistic about a good outcome because we are willing to work hard towards it (“agentive optimism”). Sometimes, optimism might also not concern expectations about the future at all but really be more about a way of looking at the world: seeing the glass half full rather than half empty (“perspectival optimism”). Thus, in addition to the “groundless optimism” rightly criticized by philosophers, there are also other forms of optimism that, at least at times, can be rational. Our paper describes the conditions for such optimism to be rational and considers other issues of the scope of optimism, its moral and practical implications, and its relation to hope. We’ve also provided a brief summary elsewhere for those who do not want to read the whole paper. Empirical Research on Hope and Optimism Given the challenges we face and the importance of hope and “rational” optimism in confronting our challenges, it also makes sense to try to study such dispositions empirically—to learn about their causes and effects. Some of our prior research on hope has indicated the important effects of hope on various other aspects of health and well-being, both for adults and for adolescents. A lot of empirical research has been carried out on optimism as well, again indicating effects on health. While this is of interest in its own right, the existing research does not adequately distinguish between the grounds of optimism and whether it is rational or irrational. This might also explain why, while the associations between health and optimism are seen in the U.S., they are not seen in Japan. Irrational forms of optimism may perhaps not function as well there. To understand these nuances better so as to promote rational forms of optimism, along with health and well-being globally, we need more nuanced measures, and over the past years, we have been working to produce these and have recently introduced an assessment of optimism that distinguishes the different forms of optimism: groundless, resourced, agentive, and perspectival. We’ve also introduced a new, and arguably conceptually more adequate, measure of hope since the measure most frequently used at present (that of Charles Snyder) does not adequately capture the notion of difficulty that plays such an important role in the philosophical discussions of hope and in our own daily experience, when we are sometimes not optimistic about the future, but can nevertheless hope and work towards a good outcome. We’ve collected quite a bit of data on these new measures of hope and optimism (and you are welcome to use them as well) and are in the process of reporting on their psychometric properties. We hope that in doing so, these measures might empower new research in this field so that we can promote hope, rational optimism, and human well-being. Facing the Weeks, Months, and Years Ahead We need hope, and we need rational—agentive, resourced, perspectival—optimism to confront the many challenges of society today. In many ways, we are a divided, polarized society, and it can be difficult to have hope. Next week, our country will have an election, and regardless of what happens, roughly half of the country will be disappointed with the outcome—many bitterly so. Some may be disappointed with both possible outcomes. Regardless of what happens, however, we will need to continue to work together. We will need to continue to have hope. Those on the “winning” side need to reach across the divide and discern how we can work together. Those whose preferred candidate does not triumph, rather than resisting, can likewise ponder how, or in what ways, we might together seek the common good. Our attitudes towards others, and towards our country, will shape what we can hope for together. There is much that we share, and we all want to flourish. While we may understand the precise meaning of flourishing differently and propose different means to attain it, there is a lot that we nearly all desire for our lives, including, as we’ve argued elsewhere, happiness, health, meaning, being good, having good relationships, and material security. Seeking these things together requires hope. Seeking these things together and also recognizing the good that we have already accomplished together in this country and around the world requires a perspectival optimism: seeing the glass half full rather than half empty. Seeking the good together requires making use of our resources, and our agency, to try to realize our hopes—our individual hopes and our hopes for life together. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. References Wilson, M. and VanderWeele, T.J. (2024). Rational optimism. Philosophia, 52(3):757-778.

How to broaden our perspectives on health. By Tyler J. VanderWeele Ph.D. Key points The health of the person, and human flourishing, extends beyond the health of the body. A theology of health helps us better see the value of community, faith, and love in flourishing. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. We all desire to be healthy. The practice of medicine seeks to restore health. Our institutions of public health aim to preserve and promote health. But what is health? The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Some people have criticized this definition as too broad. Is it reasonable or realistic for medicine to aim at something so expansive? We do spend a great deal of time pursuing health, but rather less time trying to understand what health really is. Perspectives on the matter may of course vary. What one considers health or healthy may differ by culture, context, or tradition. Etymologically, the word “health” is related to “wholeness.” But to consider what “wholeness” is, we need to understand the human body and human person, which will also vary by culture and tradition. A well-developed understanding of the human person and wholeness thus requires some sort of normative framework. A new book I have authored, A Theology of Health, attempts to advance the discussion by providing an account of health or wholeness specifically from the Christian tradition. A lot has previously been written on the theology of healthcare: for example, what it means to be a good clinician from a theological perspective. However, much less has been written from a theological perspective on the concept of health itself. This book attempts to fill this gap and some of that content is described below. Health of the Body Versus Health of the Person An important distinction is that we have two concepts of health: the health of the body and the health of the person. Our narrower concept of the “health of the body” concerns the body’s parts and systems being and functioning as normal to allow for the full range of characteristically human activities. The broader concept of the “health of the person” is essentially synonymous with “flourishing” or “complete human well-being.” Both the narrower and the broader concepts of health arise in our ordinary language concerning health. Both can even be manifest in the same sentence, such as “Every day he just sits in his room; he is physically healthy, but he is not a healthy person.” Arguably some of the conceptual confusions and puzzles around health arise from failure to recognize these two distinct concepts of health and to clarify which is in view in any particular context. A Theology of Health In terms of our understanding of health, one might consider the nature of health, the nature of ill health, and the nature of healing, or the restoration to health. While the new book explores these from a theological perspective, there are connections to empirical data as well. We can, for example, empirically examine what people mean by "health" and "well-being" and what aspects of this they think are important. With regard to the causes of ill-health, there is empirical evidence that injustice and unkind acts not only detract from well-being but also propagate. Finally, many "spiritual" paths to health and well-being such as hope, or community, or religious participation, or gratitude, or forgiveness can be examined empirically. I do think that laying out an explicit understanding of health can also help others to consider what they mean by “health.” Having an understanding of health explicitly laid out can also help promote dialogue around this question of what it is that we are pursuing when we pursue health. It can, for example, help those who are not Christians develop a greater understanding of how many Christians and Christian organizations around the world, perhaps somewhat implicitly, approach the topic of health. Likewise, when others from different cultures, traditions, and religions clarify perspectives on health I believe this too facilitates greater understanding and dialogue, and greater opportunities for partnership and collaboration. Additionally, some of the insights arising from a theological perspective on health may be of interest, value, and relevance even to those who do not embrace the same faith. Some of the implications concerning community, forgiveness, and love as pathways to healing, for example, do not necessarily require a distinctively theological perspective. Non-Theological Implications We have, as a society, done a remarkable job of discerning how public health efforts can preserve health and prevent disease and how medicine can bring healing in the context of illness. However, our success in these regards has arguably led us to neglect other pathways to health and healing—psychological, relational, and spiritual pathways, for instance. Extensive research has documented the powerful effects of purpose and hope and psychological well-being on health. Extensive research has likewise documented the power of relationships, of community, and love on health. Similarly, extensive research has documented the effects of religious and spiritual community participation on health—both the health of the body and the health of the person. While not neglecting more traditional efforts at health and healing, we should also pursue, embrace, support, and make better use of these psychological, relational, and spiritual pathways as well. The power of love and forgiveness have likewise arguably been neglected within our efforts at health promotion. Love—whether from family, friends, colleagues, or God—seems to powerfully alter well-being. Love is something that we all desire to receive, and to give, and greater effort could be made to think about how to promote love within society. The WHO’s proposed right to the “highest attainable standard of health” is arguably not attainable if we neglect to love and care for one another. To promote love we also need to address issues of wrongdoing, suffering, and hurt. While a variety of approaches are necessary, including the pursuit of justice, to restore love, we also need forgiveness. All of these various, and often neglected, pathways can help expand our vision of health and our pursuit of health. Such considerations can prompt further reflection on the nature of health, and hopefully allow us to better pursue health and human flourishing together: the health of the body and the health of the person. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. References VanderWeele, T.J. (2024). A Theology of Health: Wholeness and Human Flourishing. University of Notre Dame Press: Notre Dame, IN. (A free PDF is on Project MUSE.) VanderWeele, T.J. (2017). On the promotion of human flourishing. Proceedings of the National Academy of Sciences of the United States of America, 31:8148-8156. VanderWeele, T.J. (2024). Flourishing and the scope of medicine and public health. Journal of Epidemiology and Community Health, 78:466-470.

Our most recent work shows that gratitude extends life expectancy. By Tyler J. VanderWeele Ph.D. Key points The practice of gratitude involves seeing the good in things around us. Gratitude has been shown to improve well-being. Anyone can practice gratitude, and, so, it should be widely practiced and promoted. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. In spite of much around us that is difficult, undesirable, or challenging, there is also a great deal in our lives that is good that we can appreciate and celebrate. The practice of gratitude involves seeing the good in things around us. When we fix our attention on these positive aspects of life, acknowledge that they are good, and realize that, in many cases, we are not their source, we can experience gratitude. We may be grateful to someone who has helped us, who has given us something, or who has somehow brought about what is good. We may be grateful for the opportunities we have been given that allow us to act to bring about something good. We may be grateful for the intrinsic goodness of nature or of what surrounds us. We may be grateful to God for the goodness of creation. All of these various forms of gratitude involve a recognition of what is good. Gratitude and Well-Being Past research has indicated important effects of gratitude on enhancing well-being. And simple easy-to-use interventions have been developed to increase gratitude in life and, thereby, well-being. One might, for instance, try writing down three things one is grateful for three times a week over the course of a month or two, or even longer. Evidence from numerous randomized trials (summarized in this meta-analysis) suggests that such simple activities of focusing the mind on what is good in one’s past or present can help increase happiness, relieve symptoms of depression, and perhaps even improve sleep. There are, of course, numerous other variations on this exercise of expressing gratitude, but study after study has suggested positive effects of gratitude on enhancing well-being, and it is for this reason that we’ve promoted such gratitude exercises previously among helpful activities for flourishing. While studies have indicated beneficial effects of gratitude on numerous outcomes, no one has previously examined the effects of gratitude on longevity. But that is effectively what we did in our most recent study. Gratitude and Mortality In a paper recently published in JAMA Psychiatry, we used data on more than 49,000 women in the Nurses’ Health Study and followed them up over four years after the initial gratitude assessment to examine the mortality risk of those with high versus low levels of gratitude. Certainly, objective circumstances, like baseline health, might affect both gratitude and subsequent mortality risk, and, so, we controlled for a host of baseline health measures. We also controlled for numerous other social, demographic, economic, health behavior, and psychological variables, including other aspects of psychological well-being such as depressive symptoms and optimism. Such rigorous control, with longitudinal data over time, is needed if we want to have any hope of making causal inferences. In spite of such rigorous control, we found that those with high levels of gratitude were 9 percent less likely to die over the four years of follow-up than those with low levels of gratitude. More specifically, the high-gratitude group was 15 percent less likely to die from cardiovascular disease. While the mortality reduction is not huge, it is meaningful; and while the effect of gratitude may be somewhat smaller than what one finds with optimism, say, these effects of gratitude are present above and beyond the potential protective effects of optimism (for which control was made). Implications The effects on mortality risk, and also on well-being, are also important because anyone can practice gratitude. It can be hard to change optimism in any straightforward manner, and, indeed, some of the interventions that have tried to bring about such changes have failed. However, once again, anyone can practice gratitude. Anyone can recognize what is good around them. And, as noted above, there are interventions that we know work to increase gratitude and to increase well-being, and our study suggests that such practices could help reduce mortality risk as well. Given the effects of gratitude interventions on well-being and health, this information and these gratitude exercises could be widely disseminated in schools, workplaces, neighborhoods, and communities. In each of these settings, it may be possible to run mini-gratitude campaigns, discussing the results of such research, providing examples of gratitude exercises, and perhaps even taking some time out of the day—in a school or at a workplace—to practice gratitude together. In my family, we take time during family dinners to express what we are grateful for, and we find it very helpful. In day-to-day life, such gratitude practices recognize the good around us, help us to be grateful for one another, contribute to our well-being, and bring life. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. References Chen, Y., Okereke, O. I., Kim, E. S., Tiemeier, H., Kubzansky, L. D., & VanderWeele, T. J. (2024). Gratitude and Mortality Among Older US Female Nurses. JAMA Psychiatry, July 3, 2024. doi:10.1001/jamapsychiatry.2024.1687.

We need to bring forgiveness to our world. Here's one way to do it. By Tyler J. VanderWeele Ph.D. Key points Human beings urgently need greater forgiveness in the world. In a randomized trial, forgiveness workbooks improved depression and anxiety and promoted flourishing. Forgiveness workbooks could be distributed in local, national, and international contexts. Forgiveness campaigns could promote mental health and human flourishing. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. The Need for Forgiveness These past months, our country and our world have witnessed numerous forms of conflict and tension, disagreement and violence. It is easy to become angry, and often, there is just cause to do so. Anger itself can be channeled towards justice, but ultimately, seeking justice should involve restoring and promoting the good. To do that effectively, we also need to re-orient our own motivations and actions to seek the good of others, even those who have hurt us. Forgiveness is a practice that brings this about. Forgiveness involves replacing ill will towards an offender with goodwill. Because of the wrongs we have experienced, our thoughts and feelings about others may be bitter, angry, or even hateful, but with forgiveness—without forgetting or discounting the past offense—we come to want good things for the offenders, to hope that they will flourish. This doesn’t necessarily mean foregoing just punishment for their wrongdoing; after all, justice and redress might be the very thing needed in order to change, or it might be necessary to keep others safe from harm. Nonetheless, forgiving the wrongdoer does mean that you won’t seek such punishment out of a desire for vengeance and that your pursuit of it will be tempered by a sense of mercy flowing from your desire for his or her good. Bringing About Forgiveness For many of us, however, forgiveness is a tall order. Resentment, rumination, and a desire for vengeance often return. Recognizing this, clinical psychologists have in recent decades drawn upon both psychological research and also deep religious and cultural traditions concerning forgiveness to better understand how forgiveness can be brought about. One such approach is Everett Worthington’s REACH model: Recall the hurt, empathize with the offender, realize forgiveness is an altruistic gift, commit to forgive, and hold on to forgiveness during the return of anger. The effectiveness of this forgiveness model has been studied in dozens of randomized trials in clinical settings. However, truly promoting global forgiveness requires approaches that are more easily disseminated. To try to bring this about, over the past years, we have worked with Dr. Worthington and others to evaluate the effectiveness of a self-directed workbook version of the REACH forgiveness approach. Our Forgiveness Randomized Trial Our forgiveness workbook randomized trial was carried about with about 4,500 participants in five relatively high-conflict countries: Colombia, South Africa, Ukraine, Indonesia, and Hong Kong. We’ve given further details of the trial design and the REACH forgiveness model in an earlier post. However, we are happy to now report that the results of that trial were just recently published in BMJ Public Health. The self-directed forgiveness workbook, which takes about 2-3 hours to complete, did effectively promote forgiveness. But it also effectively reduced depression and anxiety and improved flourishing. Given the important effects of the forgiveness workbook, and its easy, costless dissemination, we believe the workbook could be used as a cornerstone of local, national, and even international campaigns to promote forgiveness. The workbook is now available in translation into the primary languages of more than two-thirds of the world’s population. Forgiveness Campaigns We need forgiveness. Right now, much of the news and social media we consume add fuel to the fires of tension and hatred. Some of this reporting is important. But if we are going to bring about greater societal flourishing, we need to re-orient ourselves to seek the good of others, of those with whom we disagree, or by whom we are offended. Bringing about more global forgiveness could be greatly facilitated by campaigns designed to promote forgiveness. To better understand how to most effectively carry out such campaigns, we have worked with researchers at Universidad del Sinú in Colombia to examine changes in forgiveness, anxiety, depression, and flourishing both before and after a 4-week forgiveness campaign and how such changes potentially varied by campaign activity. While such pre- and post-designs do not have the same level of rigor as randomized trials, they can be helpful in assessing how activities and campaigns might be effective in practice, and the results of this campaign study were just recently published in the International Journal of Public Health. The forgiveness campaign included 16 different campus-wide activities ranging from the dissemination of the REACH forgiveness workbook to forgiveness movies, webinars, journals, and social media marathons to forgiveness walls and trees and group activities. Participants were free to engage in as many of these as desired, and data was collected on about 2,800 participants. Overall forgiveness, depression, anxiety, and flourishing all improved during the course of the campaign, though there was considerable variability in improvements and in participation by activity. In general, the greater the number of activities, the greater the improvement. Amongst the various activities, the REACH workbook and the forgiveness animated videos had both high participation rates and strong associations with improvements in forgiveness. More details are available in the paper, but we hope that the study will help inform future forgiveness campaign efforts. And we are continuing our partnership with Andrea Bechara and Maria Fatima Bechara at Universidad del Sinú and their new Flow Center to better understand promoting campus-wide flourishing. Potential for Future Forgiveness Given the effectiveness of the REACH workbook intervention and its free accessibility in so many different languages, efforts can, and arguably should, be made to disseminate it. This could be done in the context of psychiatric care and clinical counseling for those struggling with anger who want to forgive but are having trouble doing so. The workbooks could be disseminated at the community level as an important preventive mental health resource. The workbooks could be disseminated within religious communities to help facilitate the forgiveness that such groups already value. The workbooks could be disseminated in schools, universities, and workplaces, possibly accompanied by videos, lectures, and group activities to promote forgiveness. If we truly desire to be oriented towards seeking the good of others, even amidst conflict, we need such efforts to promote forgiveness and thereby bring healing and better flourishing for all. Receive Tyler's monthly insight and research updates from the Human Flourishing Program team. References Ho, M. Y., Worthington, E., Cowden, R., Bechara, A. O., Chen, Z. J., Gunatirin, E. Y., Joynt, S., Khalanskyi, V.V., Korzhov, H., Kurniati, N.M.T., Rodriguez, N., Salnykova, A., Shtanko, L., Tymchenko, S., Voytenko, V.L., Zulkaida, A., Mathur, M. and VanderWeele, T.J. (2024). International REACH Forgiveness Intervention: A multi-site randomised controlled trial. BMJ Public Health, 2:e000072. Bechara, A.O., Chen, Z.J., Cowden, R.G., Worthington, E.L., Toussaint, L., Rodriguez, N., Murillo, H.G., Ho, M.Y., Mathur, M.B., and VanderWeele, T.J. (2024). Do forgiveness campaign activities improve forgiveness, mental health, and flourishing? International Journal of Public Health, 69:1605341.