The Effect of Forgiveness-based Motivational Interviewing

The Effect of Forgiveness-based Motivational Interviewing on Death Anxiety, Life Satisfaction, and Forgiveness Disposition in Patients With COPD: A Randomized Controlled Trial

This study aimed to examine the effect of forgiveness-based motivational interviewing on death anxiety, life satisfaction, and forgiveness disposition in patients with COPD. A randomized controlled experimental design with pretest, posttest, and one-month follow-up measurements was employed. The study sample consisted of 30 patients (experimental group: 15; control group: 15). The experimental group received forgiveness-based motivational interviewing, whereas no intervention was provided to the control group. Data were collected using a personal information form, the Death Anxiety Scale, the Life Satisfaction Scale, and the Forgiveness Scale. The findings revealed that, in the posttest and follow-up measurements, the experimental group had significantly lower mean scores on the Death Anxiety Scale compared to the control group (p<0.05). Furthermore, the experimental group demonstrated significantly higher mean scores on the Life Satisfaction Scale and the Forgiveness Scale in the posttest and follow-up measurements than the control group (p<0.05). This study concluded that forgiveness-based motivational interviewing effectively reduces death anxiety while enhancing life satisfaction and forgiveness disposition in patients with COPD. Therefore, implementing motivational interviewing for patients is recommended.

Study Overview

• Status: Completed
• Conditions: Psychoeducation; Psychiatric Nursing; COPD (Chronic Obstructive Pulmonary Disease); Forgiveness
• Intervention / Treatment: Other: Control; Other: forgiveness-based motivational interviewing

Detailed Description

Chronic obstructive pulmonary disease (COPD) is a global chronic respiratory disease that arises from a combination of genetic and environmental factors, predominantly due to smoking and air pollution.As the disease progresses, symptoms such as dyspnoea, cough, and sputum production emerge, leading to several complications, including fatigue, insomnia, social withdrawal, and anxiety. The persistent presence of these symptoms can result in intense death anxiety among COPD patients. Studies on COPD patients in the literature suggest that the prolonged duration of the disease, continuous medication use, and the burden of disease-related symptoms negatively impact their quality of life, ultimately reducing their life satisfaction. This decline in life satisfaction can, in turn, give rise to a diminished sense of hope for the future and an escalation in death anxiety. Moreover, COPD patients frequently encounter emotional distress during treatment and care, undergo a critical reassessment of their past lives, and grapple with feelings of guilt and regret. The management of these emotions can be arduous. In this context, the concept of forgiveness emerges as a potential mitigating factor for the adverse emotional effects of the disease. Forgiveness is not about denying the pain and consequences of a distressing experience but rather an effort to replace feelings of anger, resentment, and bitterness with compassion, empathy, and kindness. To date, no studies have specifically examined forgiveness training for COPD patients; however, previous research indicates that motivational interviewing has positive effects on various patient populations. Motivation can be defined as an internal state influenced by external factors. Motivational interviewing is a client-centred and encouraging approach that helps individuals explore and resolve ambivalence to facilitate behaviour change. Motivational interviewing not only supports behavioural and lifestyle changes in patients but also enhances their adherence to treatment. Beyond the necessity of treating physical symptoms in individuals with chronic diseases like COPD, the need for psychological support underscores the importance of consultation-liaison psychiatry. Consultation-liaison psychiatry (CLP) nurses do not merely provide care services; they also assume advisory and educational roles by conducting individual or group psychoeducation sessions. CLP nurses should support patients in expressing emotions such as anger, guilt, sadness, and regret, strengthen their coping mechanisms, mobilise effective support systems, and increase awareness of the impact of these emotions on their lives. In consideration of the role of CLP nurses, it can be posited that forgiveness-based motivational interviewing for COPD patients may prove efficacious in reducing death anxiety, increasing life satisfaction, and enhancing forgiveness tendencies, while concomitantly addressing their need for care, education, and counselling.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Bergama
    • Izmir, Bergama, Turkey (Türkiye), 35700
      • Bergama Necla Mithat Öztüre State Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• They must be 18 years of age or older,
• Possess sufficient mental capacity and communication skills to follow the study guidelines, be literate,
• Have a diagnosis of COPD,
• Have been hospitalized in the pulmonary diseases unit between June and September 2024.

Exclusion Criteria:

• Determined having communication barriers due to disease symptoms,
• Experiencing dyspnea at a level that prevents cooperation
• Having a chronic psychiatric disorder that would interfere with participation in the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: forgiveness-based motivational interviewing; Participants will receive an 6-session forgiveness-based motivational interviewing	Other: Control; no intervention was performed in the control group; Other: forgiveness-based motivational interviewing; The forgiveness-based motivational interviewing was administered face-to-face, with each session lasting 40-60 minutes, scheduled twice a week over a three-week period (a total of six sessions).
No Intervention: Control; Throughout the study, the forgiveness-based motivational interviewing was applied only to the experimental group, and no intervention was performed in the control group

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Death Anxiety Scale	The scale is a unidimensional, dichotomous Likert-type instrument consisting of 15 items that assess an individual's anxiety related to their own death and the risk of dying. Each item is answered as "yes" or "no," where a "yes" response for the first nine items and a "no" response for the remaining six items receive one point. The total score ranges from 0 to 15, with higher scores indicating greater death anxiety.	Baseline (pretest), 3 weeks (posttest) and one month after the posttest

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Forgiveness scale	Forgiveness Scale, developed by Ersanlı and Batık, designed to measure individuals' levels of self-forgiveness and forgiveness of others. The scale is scored from "strongly disagree" to "strongly agree," with higher scores indicating higher levels of forgiveness.	Baseline (pretest), 3 weeks (posttest) and one month after the posttest

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Life satisfaction scale	The scale consists of a single dimension with five items, rated on a five-point Likert scale ranging from 1 ("Strongly Disagree") to 5 ("Strongly Agree"). The total score ranges from 5 to 25, with higher scores indicating higher life satisfaction.	Baseline (pretest), 3 weeks (posttest) and one month after the posttest

Collaborators and Investigators

• Sponsor: Ömer USLU
• Investigators: Principal Investigator: Merve Şahin, PhD, RN, Bergama Necla Mithat Öztüre State Hospital

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2024
• Primary Completion (Actual): September 27, 2024
• Study Completion (Actual): September 30, 2024

Study Registration Dates

• First Submitted: January 17, 2026
• First Submitted That Met QC Criteria: January 23, 2026
• First Posted (Actual): January 26, 2026

Study Record Updates

• Last Update Posted (Actual): January 26, 2026
• Last Update Submitted That Met QC Criteria: January 23, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: COPD; motivational interviewing; Death anxiety; life satisfaction; forgiveness
• Additional Relevant MeSH Terms: Pathologic Processes; Chronic Disease; Disease Attributes; Respiratory Tract Diseases; Lung Diseases; Lung Diseases, Obstructive; Pathological Conditions, Signs and Symptoms; Behavior; Pulmonary Disease, Chronic Obstructive; Personal Satisfaction; Necrophobia
• Other Study ID Numbers: MERVE-RCT-2025-COPD

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) from this study will not be shared due to ethical and institutional restrictions. The dataset includes sensitive health information from postpartum women, and the informed consent process did not include permission for public data sharing. Therefore, in accordance with privacy regulations and ethical committee requirements, IPD will not be made available to other researchers

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No