The Efficacy of Gratitude Practice on Well-Being

Transcription

The Efficacy of Gratitude Practice on Well-Being: A Randomized
Controlled Trial
By Siew Tim Lai
MSc in Health Psychology, 2014
Psychology, School of Natural Sciences, University of Stirling
Winner of The British Psychological Society Division of Health
Psychology award for ‘Outstanding MSc Thesis’ 2014/15
Running head: EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING
The Efficacy of Gratitude Practice on Well-Being: A Randomized Controlled Trial
Psychology, School of Natural Sciences
MSc in Health Psychology
University of Stirling
Professor Ronan O’Carroll
Supervisor
2229633
Student Number
28th August 2014
Submission Date
12, 498
Word Count
1
EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING
Abstract
Objectives: Despite the benefits accrued from the practice of gratitude, there are mixed
findings concerning the effectiveness of gratitude interventions. Thus, the study examined
a commonly used gratitude-based intervention (‘count-your-blessings’) in promoting
physical and psychological well-being in a UK sample.
Methods: Participants were randomly assigned to 1 of 2 conditions (gratitude and noassigned activity). Those in the gratitude condition kept daily gratitude journals for 21
days.
Participants completed self-report measures related to gratefulness, affect,
prosociality, physical and subjective well-being. These measures were collected at two
time-points (pre-and-post intervention), three weeks apart. Two separate analyses were
conducted for participants who completed the intervention (Completer analysis) and for
those who dropped out (Intention-to-treat analysis [ITT]).
Results: Completer analysis revealed that the gratitude condition resulted in heightened
feelings of gratefulness. The most robust finding was positive affect. Though not all
findings were replicated, those with a “grateful-outlook” exhibited fewer negative affect
and physical symptoms. Apart from well-being scores, the ITT analysis yields essentially
the same findings as the completer analysis. While completer analysis showed marginally
insignificant well-being scores, the ITT revealed significant findings.
Conclusion: Findings suggest counting one’s blessings can augment well-being and may
be incorporated in existing psychotherapies to enhance momentary happiness. Regardless,
such simple technique warrants further investigation.
Keywords: Gratitude; Positive affect; Well-being; Health; Positive psychology
interventions
Word Count: 205
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Acknowledgement
First and foremost, I offer my deepest gratitude to my supervisor, Professor Ronan
O’Carroll, for his sage advice and mastery guidance from the very initial stage to the
completion of this research. It was also his selfless time and care that kept me going
during tough times. His knowledge in his expertise and professional way of carrying out a
task in a systematic manner has triggered and nourished my intellectual maturity that I will
benefit from, for a long time to come.
It gives me great pleasure in acknowledging all the lecturers in the Department of
Psychology for offering valuable insight and remarks in thesis discussion. Their different
perspectives allowed me to consider and take up a better approach to conduct the research
study. Most importantly, I could never have embarked and started all of this without their
prior teachings in psychology which opened up unknown areas to me. Thank you.
I owe many thanks to Dr Reiko Yeap and Ms Zuhrah Beevi for their continued
encouragement and support. Even though they are miles away, they never cease to devote
their time to provide constructive comments in my data-analysis and research write-up.
I am indebted to Ng Ka Ting and Zenny Lyn for their precious time to help out throughout
the process of data-collection.
Without their assistance, I can never successfully
implement this research project in an efficient manner. To Devin Johnson, thank you for
your brilliant input in my statistical analysis. Special thanks to Alicia Wong Sue Yee and
Chang Wei Lun for their willingness to proof read countless pages of texts and
meaningless mathematics.
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Completing this work would have been all the more difficult were it not for the emotional
support and patience of my family and my partner, who knowingly and unknowingly – led
me to an understanding of some of the more subtle challenges to our ability to thrive.
Loving thanks go to my friends, Sowbahgya, Rachel Westmore, Chloe Peng and Rebecca
Chen, for their wicked sense of humour when I had lost mine.
I would like to gratefully acknowledge everybody who was important to the successful
realization of thesis, as well as expressing my apology that I could not mention personally
one by one. Thank you.
This thesis is written in honour to be dedicated to my grandmother, in memoriam. For the
myriad of ways in which, she has been the source of inspiration throughout my life.
Last but not least, all praises and thanks to God the Divine, for His showers of blessings
and unfailing grace that carry me through in times of hardship.
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TABLE OF CONTENTS
ABSTRACT ................................................................................................................... 2
ACKNOWLEDGEMENT .................................................................................................. 3
CHAPTER ONE: INTRODUCTION ..................................................................... 10
SECTION I: BRIEF OVERVIEW OF POSITIVE PSYCHOLOGY ....................................... 12
Origins of positive psychology .................................................................................... 12
Positive psychology and the calculus of well-being .................................................... 13
Enhancing well-being via positive psychology interventions (PPIs) ........................... 15
Influential factors in the facets of positive psychology interventions .......................... 16
SECTION II: REVIEW OF THE SCIENCE OF GRATITUDE ............................................. 19
Conceptualization of gratitude ..................................................................................... 19
Mechanisms linking gratitude to well-being ................................................................ 22
Effectiveness of gratitude-based interventions ............................................................ 23
Evaluation of gratitude interventions ........................................................................... 26
CONCLUDING SUMMARY ........................................................................................... 28
PRESENT STUDY ........................................................................................................ 29
HYPOTHESES ............................................................................................................. 30
CHAPTER TWO: METHODS................................................................................ 31
Design .............................................................................................................................. 31
Participants....................................................................................................................... 31
Procedure ......................................................................................................................... 34
Blinding ........................................................................................................................... 36
Measures .......................................................................................................................... 37
Ethical considerations ...................................................................................................... 40
Statistical power ............................................................................................................... 40
Data analysis .................................................................................................................... 40
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CHAPTER THREE: RESULTS.............................................................................. 42
PART I: MAIN FINDINGS FOR COMPLETER ANALYSIS ............................................... 42
Gratitude ....................................................................................................................... 42
Affect ............................................................................................................................ 44
Well-being .................................................................................................................... 46
Social relationship ........................................................................................................ 46
Physical symptoms ....................................................................................................... 46
Individual differences in the efficacy of gratitude intervention ................................... 48
PART II: INTENTION-T O-TREAT ANALYSIS ................................................................ 49
CHAPTER FOUR: DISCUSSION .......................................................................... 51
Cultivating gratitude ..................................................................................................... 51
The benefits of practicing gratitude ............................................................................. 52
Factors influencing the efficacy of the intervention..................................................... 56
LIMITATIONS AND SUGGESTED IMPROVEMENTS ....................................................... 57
FUTURE DIRECTIONS ................................................................................................. 58
PRACTICAL IMPLICATIONS AND CONCLUSION .......................................................... 59
REFERENCES ......................................................................................................... 62
APPENDICES .......................................................................................................... 73
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APPENDICES
Appendix A.
Participant Information Sheet
73
Appendix B.
Consent Form
75
Appendix C.
Post-Intervention Information Sheet
76
Appendix D.
Basic Demographic Information
77
Appendix E.
Emotion Study Questionnaire
78
I.
II.
III.
IV.
V.
VI.
VII.
Warwick-Edinburgh Mental Well-being Scale
[WEMWBS]
Positive Affect and Negative Affect Schedule
[PANAS]
Gratitude Adjectives Checklist
[GAC]
The Grateful Disposition Measure
[GQ-6]
Perceived Quality of Relationship with a Close
Others
Physical Symptoms Checklist
Exploratory Data Form
78
79
79
80
81
82
83
Appendix F.
Brief-Diary Type Task
84
Appendix G.
Instructions for Standard Scripts
88
Appendix H.
Instructions for Randomization
92
Appendix I.
Table 1. VIA Classification of Strengths
93
Table 2. Types of Positive Psychology Interventions (PPI)
94
Table 3. Conception of Trait Gratitude
Table 5. Independent t-test for completer analysis on the
comparison of group differences in relation to the
effects of gratitude intervention
95
96
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INDEX OF TABLES
TABLE 1. VIA Classification of Strengths
93
TABLE 2. Types of positive psychology interventions (PPI)
94
TABLE 3. Conception of trait gratitude
95
TABLE 4. Socio-demographic characteristics of participants
33
TABLE 5.
TABLE 6.
Independent t-test for completer analysis on the comparison of
96
group differences in relation to the effects of gratitude intervention
Completer analysis on the effects of gratitude intervention in the
47
experimental and control group
Correlations of motivation and effort required to engage in the
48
TABLE 7. gratitude-inducing activity with well-being, affect, and gratitude
change scores
TABLE 8.
Intention-to-treat analysis on the effects of gratitude intervention
in both conditions
50
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LIST OF FIGURES
FIGURE 1.
CONSORT Diagram
32
FIGURE 2.
Procedural flowchart
37
Change in dispositional gratitude from pre- to postFIGURE 3.
intervention for the gratitude group condition versus the
43
control condition
FIGURE 4.
FIGURE 5.
Change in state gratitude from pre- to post-intervention for
the gratitude group condition versus the control condition
Change in positive affect from pre- to post-intervention for
the gratitude group condition versus the control condition
44
45
Intention-to-treat analysis for the change in well-being from
FIGURE 6.
pre- to post-intervention for the gratitude group condition
versus the control condition
49
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CHAPTER ONE: INTRODUCTION
The World Health Organisation (WHO) declared mental health as a state of wellbeing in which the individual recognises his or her own strengths, can deal with daily
stressors, able to work efficiently, and is capable to contribute to his or her community
(WHO, 2004). Following a laudable effort by the Scottish government to incorporate
positive psychology into their prevention and intervention health plans, mental health was
characterised as having socio-emotional and psychological resilience to experience the
abundance in life and to cope with adversity and toxic emotions (Myers, McCollam, &
Woodhouse, 2005).
Evidently, understanding what well-being constitutes and its
beneficial correlates have become the central focus of current research.
Beyond the illness ideology, positive psychology emphasize on the understanding
of human behaviour to enhance individual’s quality of life. Various modes of positive
psychology interventions were developed to build character strengths that contain
desirable traits (e.g. gratitude, hope, self-control and etc.). These traits were derived from
virtues extolled by ancient scholars and has been associated with increased well-being
(Peterson & Seligman, 2004).
From prehistoric religious scriptures to contemporary scientific evidence-based
research, gratitude is recognised as a desirable virtue that can enhance a person’s wellbeing (Watkins, Woodward, Stone, & Kolts, 2003). Evidence showed that the effects of
gratitude practice can be classified as the following categories: Increase in happiness and
life satisfaction; effective coping with adversity; strengthen social bonds; benefits health;
and broaden the civic, moral, and spiritual dimensions (Worthen & Isakson, 2007).
However, gratitude is not an automatic response to life situations and it needs to be
deliberately
cultivated
via
gratitude-inducing
activities.
Most
gratitude-based
interventions adopt tactics and strategies suggested by the general design of positive
psychology interventions to investigate its links to well-being; nonetheless, the
effectiveness of these interventions requires careful examinations.
This chapter consist of two sections. The first section of this chapter aims to
provide an overview of positive psychology including the origins, definition, links to the
calculus of well-being, and factors that may hinder or maximise the utility of positive
psychology interventions. The second section provides a description of how the practice
of gratitude promotes human flourishing.
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SECTION I: BRIEF OVERVIEW OF POSITIVE PSYCHOLOGY
Origins of positive psychology
Historically, psychologists focused on ameliorating human sufferings such as
depression, suicidal ideation, and schizophrenia (Seligman, 2010). Until the 20th century,
there is a shift in mental health practice and research that emphasizes on positive human
functioning and psychological well-being (Seligman, Steen, Park, & Peterson, 2005). The
advent of positive psychology can be mapped from Martin Seligman’s 1998 presidential
speech to the American Psychological Association urging psychologists to not only repair
pathologies but also help individuals to build a meaningful life (Seligman &
Csikszentmihalyi, 2000). Positive psychology, as implied by Seligman et al. (2005) is not
a panacea for modern ills, rather is a supplement to the existing knowledge about
psychological distress.
By understanding and synthesizing the positive and negative
aspects of human experience, interventions can be developed to decrease misery and build
the enabling conditions of life (Linley, Joseph, Harrington, & Wood, 2006).
Peterson and Seligman (2004) developed a handbook on the classification of
“Character Strengths and Virtues” (CSV) which shed light on what makes life worth
living. They proposed that the 24 character strengths and six virtues as means to complete
the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association
(APA, 1987). The virtues identified (i.e. wisdom, courage, love, justice, temperance, and
transcendence) are valued by moral philosophers and religious thinkers, and character
strengths (e.g. gratitude, creativity, and forgiveness) are routes or mechanisms that
describe the virtues (Peterson et al., 2004) (Table 1; Appendix I).
Positive psychology highlighted that the cultivation of character strengths are
robustly linked to important aspects of individuals and social well-being (Park & Peterson,
2006). The beneficial correlates include academic achievement, altruism, and valuing
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diversity (Park, 2004). Findings demonstrated that different strengths predict different
outcomes. For example, strengths of “character” (e.g. gratitude, zest, and curiosity) are
highly correlated with life satisfaction (Park, Peterson, & Seligman, 2004). Strengths of
“heart”, those that allows formation of social bonds (e.g. gratitude and love) are strongly
associated with well-being when compared to strengths of “head” (e.g. creativity and awe
appreciating excellence) that are essential in human nature (Park et al., 2004). Moreover,
strengths like appreciation of beauty and bravery facilitate illness recovery, whereas
religiosity is related with meaning and purpose in life (Park & Peterson, 2009).
These aforementioned studies illuminate the connection between character
strengths and desirable outcomes; the question is how to enhance the strengths for
individuals who already possess them or instil it to those who lack them.
Thomas
Jefferson (1819) once said “happiness is the aim of life, but virtue is the foundation of
happiness”. Although everyone yearns for a happy and fulfilled life, would it be possible
to build the positive side of life?
Positive psychology and the calculus of well-being
Positive psychology, succinctly, is about the concept of well-being which entails
the five components (PERMA) – positive emotion, engagement, relationships, meaning
and accomplishment (Seligman, 2011).
As defined by Seligman’s (2002) Authentic
Happiness theory, emotion is regarded as positive feelings and engagement as being
absorbed.
Seligman (2011) viewed humans are driven to seek and preserve positive
relationships, and also find meanings in life (i.e. serving something bigger than oneself).
Accomplishment – the last element described as the pursuit of achievement, mastery, and
competence (Seligman, 2011). Taken together, these components are essential to lead a
“good” life – a life worth living for (King, Eells, & Burton, 2004).
To date, blossoming interest revolves around the topic of well-being (also
classified as subjective well-being (SWB) and psychological well-being (PWB) (Odou &
Vella-Brodrick, 2013).
Subjective well-being includes the cognitive and affective
components (Diener & Lucas, 1999), whereas psychological well-being refers to the extent
of meaning and purpose in life assigned by individuals (Ryff & Keyes, 1995). Scholars
found that a boost in overall well-being resulted in increases in work productivity, social
engagement, and fewer healthcare visits (Keyes & Grzywacz, 2005). Additionally, wellbeing is positively correlated with physical health (Diener & Chan, 2011). Pressman and
Cohen (2005) suggested that the relationship is mediated by a healthy lifestyle and an
improved immune system, which cushions against the impact of stress. Growing evidence
showed that well-being decreases the chances of developing mental illnesses and also
reduces mortality risks in people with physical disease (Wood & Joseph, 2010; Lamers,
Bolier, Westerhof, Smit, & Bohlmeijer, 2012).
Therein lies the question of whether well-being can be increased and maintained
over time. According to Lyubomirsky, Sheldon and Schkade’s (2005) Architecture of
Sustainable Change, there are three major factors that contribute to well-being – (i) genetic
set point, (ii) life-circumstances, and (iii) intentional activities. Research underlying this
model indicated that genes made up 50% (Lykken & Tellegen, 1996), and lifecircumstances (e.g. income, marital status, and religiosity) explain roughly 10% (Diener,
Lucas, & Scollon, 2006) of variance in well-being. Intentional activities (i.e. positive
cognitive-, behavioural-, and goal-based activities) accounted up to 40% of the residual
variance (Lyubomirsky, Dickerhoof, Boehm, & Sheldon, 2011). As it is relatively difficult
to alter the expression of genes or one’s life circumstances, the last factor – intentional
activities, serves as the target to bolster people’s well-being (Lyubomirsky, 2008).
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Enhancing well-being via positive psychology interventions (PPIs)
The designs of PPIs are mostly structured forms of volitional activities centralized
around the themes of increment of positive feelings, cognitions, and behaviours (Sin &
Lyubomirsky, 2009). Although scepticism views interventions that increase well-being as
an epiphenomenon, studies showed that well-being can be enhanced by engaging in
intentional, effortful activities such as expressing gratitude (Emmons & McCullough,
2003; Toepfer, 2009), having optimistic outlook (Sheldon & Lyubomirsky, 2006),
practicing kindness (Otake, Shimai, Tanaka-Matsumi, Otsui, & Fredrickson, 2006), and
using signature strengths in daily lives (Seligman et al., 2005) (Table 2; Appendix I).
A meta-analysis of 51 studies on the efficacy of PPIs revealed that PPIs are
effective at both boosting well-being and ameliorating depressive symptoms (Sin &
Lyubomirsky, 2009). The effect sizes for well-being (mean r = .29) and depression (mean
r = .31) were medium, which is notable, considering these interventions are selfadministered
designs
compared
to
the
conventional
face-to-face
administered
interventions. Another similar meta-analysis of 39 randomised, controlled PPIs studies on
clinical and nonclinical populations, although standardized effect sizes were small for
SWB, PWB, and depression (mean rs= .34, .20, and .23, respectively), a three- to sixmonth follow-up indicated that effects were fairly sustainable (Bolier, Haverman,
Westerhof, Riper, Smit, & Bohlmeijer, 2013).
Findings of the effectiveness of PPIs studies are inconsistent. A study by Sin,
Della Porta, and Lyubomirsky (2009) showed that the practice of writing gratitude letters
was ineffective in enhancing well-being among dysphoric individuals. In comparison, the
control group who performed a neutral activity (i.e. listening and writing about classical
music) experienced an immediate boost in well-being. Likewise, Sin et al. (2009) reported
no significant changes in participants’ well-being after eight consecutive weeks of writing
gratitude letters. They attributed this finding to those who demonstrated increased in SWB
were due to individual intrinsic motivation to become happier.
Another study by Kashdan, Uswatte, and Julian (2006) found that dispositional
gratitude significantly influenced well-being of veterans with PTSD compared to nontraumatized veterans. However, the veterans with PTSD in this study have been exposed
to actual combat; hence, group differences between gratitude and well-being may be
attributed to the contact of war-zone stressors as opposed to the presence of PTSD.
Somewhat similar to Kashdan et al.’s (2006) findings, Sin and Lyumbomirsky
(2009) found no significant differences in well-being among non-depressed individuals,
whereas individuals with depression experienced reduction in depressive symptoms and
enhanced well-being. This suggests that an individual’s psychopathology condition (e.g.
depression or anxiety) may play a role in the effectiveness of PPIs.
Though the therapeutic efficacy of these positive activities is not fully understood,
a majority who participated in the happiness-inducing activities benefitted from it to some
degree. These findings point towards there are factors or conditions that temper the
relationship between gratitude and well-being.
Influential factors in the facets of positive psychology interventions
If PPIs are to be taken seriously to be implemented in clinical settings and utilised
amongst general population, it is essential to identify the factors that could either dampen
or enhance the effectiveness of PPIs.
Timeframe of intervention. Studies found that interventions with longer duration
(measured in hours or weeks) were more effective than short-term interventions in treating
psychological disorders and boosting happiness (Sin et al., 2009). Studies that adopted
techniques such as counting one’s blessings (Emmons & McCullough, 2003), performing
acts of kindness (Otake et al., 2006), utilising signature strengths in daily lives (Seligman
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et al., 2005), and visualising best possible selves are what Sheldon and Lyubomirksy
(2006) termed as – habitual activities. Lyubomirsky et al. (2011) suggested that longer
interventions pave the way for more practice, in return transforms activities into longlasting habits. Likewise, individuals who continued to practice positive exercises after the
intervention has ended experienced greater boost in happiness (Lyubomirsky et al., 2011).
Recruitment and randomization of subjects. A meta-analysis conducted by
Bolier et al. (2013) revealed that participants who were recruited via referral from
healthcare professionals or hospitals showed larger effect sizes in efficacy of PPIs.
Contrariwise to Bolier et al.’s (2013) findings, Sin et al. (2009) found that volunteers or
self-select individuals who choose to be involved in the PPIs demonstrated greater success
in eliciting happiness and coping with depressive symptoms compared to those who were
randomly assigned to interventions. Interventions that permit the choice to participate
presumably instil more motivation and awareness of the aim of the PPIs (Lyumbomirsky
et al., 2011). Perhaps, participants who are motivated to be happier appear to be more
diligent and enthusiastic in following the guidelines.
Person-activity fit. Sheldon and Lyubomirsky (2006) described the notion of fit
as the match between individual’s motives, strengths, personality, or needs with the
particular happiness-inducing activity. This, in turn, would determine the success rate of
an intervention. Instead of writing about one’s positive traits – a form of solitary activity,
being kind to others is rewarding to a sociable person as it serves to strengthen social
bonds (Lyubomirsky, 2008). When the positive activity is executed for an appropriate
duration, intensity, combined with the proper person-activity fit, the person’s well-being is
maximized (Sheldon & Lyubomirsky, 2006).
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One essential standard for living is the ability to be happy (Eid & Larsen, 2008).
Buoyed by research findings from positive psychology scholars, a mentally healthy
individual holds numerous physical, social, and intellectual benefits compared to their
unhappy counterparts (Fredrickson, 2001; Lyubomirsky, King, & Diener, 2005). This
increased emphasis on positive phenomena has generated an interest in the United Nation
General Assembly to review the approaches to systematic measurements of one’s
happiness as well as a whole nation (Layard, 2013). Undoubtedly, there is value in
understanding people’s sense of well-being. Although there are various ways to increase
well-being, the cultivation of gratitude is said to be the quintessential positive personality
trait, serving as a channel to allow individuals to lead a flourishing life. Thus, the next
section attempts to demonstrate how gratitude increases one’s well-being.
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SECTION II: REVIEW OF THE SCIENCE OF GRATITUDE
The section aims to critically analyse the literature regarding the effects of
gratitude practice on well-being. Firstly, the conceptualization of gratitude will be
provided, followed by the mechanisms linking gratitude and human flourishing. Next, the
techniques and the effectiveness of gratitude interventions will be examined.
Upon
reviewing these interventions, knowledge gaps will be addressed and appropriate
suggestions will be provided.
Conceptualization of gratitude
Gratitude has a long lineage of acknowledgment from historically, religious, and
philosophical standpoints, in which it underlined the importance of having a gratefuloutlook in life (Emmons & Crumpler, 2000). A virtue that is deemed integral to wellbeing, however, is understudied in the social sciences.
This abandonment might be
attributed to a more general negligence of research into positive emotions (Linley et al.,
2006). Regardless, the previously disregarded construct has received calls to explore its
potential to improve well-being (Gable & Haidt, 2005). Burgeoning evidence on gratitude
and human flourishing suggested there is a need to understand how and in what ways it
brings advantages into the life of the practitioner (Emmons & McCullough, 2003;
Emmons, 2012).
There are various interpretations of the construct within the field of gratitude
research. Some claimed that gratitude manifests from two information-processing stages,
which firstly requires the individual to have an awareness of positive experiences, and
subsequently attributing these positive experiences to an external source (McCullough,
Kilpatrick, Emmons, & Larson, 2001). However, if gratitude is only directed outwards,
this conceptualization neglects other grateful sources that people attribute to in their daily
lives. For instance, participants in Emmons and McCullough’s (2003) study listed grateful
events such as “woke up early today” which indicates that gratitude is not always directed
towards the particular benefactor. Another example, demonstrated by Graham and Barker
(1990), was asking young children to identify circumstances a person would feel most
grateful. They presented participants with videos observing another child successfully
completing a task under two conditions – either being assisted by an adult, or working
independently. Participants were hypothesized to identify more gratitude for the subject
who was offered help. Interestingly, their findings showed that participants reported the
subject who worked independently feel most grateful compared to those who received
assistance. This suggests that gratitude may emerge from sources like appreciation of
one’s capabilities, or of circumstances that allow successful culmination of work. Similar
work has been demonstrated among adult populations (Veission, 1999), which propose
that gratitude encompasses beyond an interpersonal appreciation of another person’s help.
These data point out that a standard definition is needed to resolve this inconsistency.
Gratitude as a life orientation. Gratitude represents a broader attitude towards
noticing and appreciating the positivity in life (Wood, Froh, & Geraghty, 2010). This
grateful-outlook was tested by Wood, Maltby, Stewart, and Joseph (2008) using various
scales that assess gratitude. The three developed scales that measure gratitude were – (i)
GQ-6 (McCullough, Emmons, & Tsang, 2002), (ii) Appreciation Scale (Adler & Fagley,
2005), and the (iii) Gratitude, Appreciation, and Resentment Test (GRAT) (Watkins,
Woodward, Stone, & Kolts, 2003). These scales capture distinct features of what gratitude
comprises in order to provide a broad definition that is aligned with the life-orientation
perspective (Wood et al., 2010). As cited by Wood et al. (2010), the three scales provide
eight conceptions of gratitude (see Table 3; Appendix I) to indicate how a grateful person
views and interacts with the world.
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Trait and state gratitude. People who are more oriented towards noticing the
positive in life encounter the eight aspects of gratitude more frequently, intensely, and
through a range of eliciting stimuli (McCullough et al., 2002). This put forth the notion
that an interaction might exist between trait1 and state2 gratitude in determining a person’s
life-orientation (Emmons, McCullough, & Tsang, 2003; Watkins, Woodward, Stone, &
Kolts, 2003).
Levels of trait gratitude can be measured using GQ-6 or the GRAT;
nonetheless, the GQ-6 is a more common tool in assessing individual’s dispositional
gratitude (Watkins, 2004). Gratitude Adjectives Checklist (GAC), on the other hand is
used to evaluate levels of state gratitude (McCullough et al., 2002). It contains three
adjectives – ‘appreciative’, ‘grateful’, and ‘thankful’, which investigates the time spent
reflecting upon the feeling of gratefulness.
Theoretically, viewing life as something to be thankful for is anticipated to be
strongly associated to well-being. Wood et al. (2010) demonstrated that individuals with
low well-being attribute their successes to factors that are uncontrollable, brief, and due to
the course of others’ actions, which in turn generate depression, anxiety, and negative
emotions. This finding is supported by the reformulated learned helplessness theory and
attribution theory that postulate well-being (and psychopathology) arises from how
individuals interpret their life happenings. Gratitude is said to be the antithesis of Beck’s
(1976) negative cognitive triad (i.e. negative in self, world, and future). Consequently,
assessing gratitude at both trait and state levels can be an important determinant to
understand its interaction with well-being.
1
Trait (dispositional) gratitude is described as individual predisposition to experience the
state of gratitude in life
2
State gratitude is defined as the feeling of awe, gratefulness, and appreciation for
outcomes received
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Mechanisms linking gratitude to well-being
Scholars have noted that gratitude has happiness-bestowing properties (Emmons &
McCullough, 2003). This can be explained using Fredrickson’s (2001) broaden-and-build
theory, which states that positive emotions broaden thinking and attention. According to
Fredrickson (2004), gratitude broadens through innovative reciprocity which builds
enduring personal resources (e.g. psychosocial, spiritual, and physical skills), and
consequently enhances individual well-being.
Another mechanism is the coping hypothesis, suggested by Wood, Joseph, and
Linley (2007), that grateful individuals often utilised three broad coping strategies: (i)
actively seeking both instrumental and emotional social support, (ii) approaching and
dealing with the problem via active coping, managing, and benefit-finding, and (iii)
engaging in adaptive behaviour. These coping strategies were reported to mediate the
relationship between gratitude and stress (Wood et al., 2007). Stress arises when events
are perceived as threatening and exceeding personal coping resources; hence, grateful
individuals who engage in positive coping appraisals are less likely to experience stress
(Wood et al., 2007). This mechanism provides a perspective on how gratitude facilitates
mood stabilization to counteract stressful life events.
Watkins (2004) provided a detailed account on how gratitude influences wellbeing. He proposed that viewing positive happenings as “blessings” enhances well-being
and may counteract the normal hedonic set-point.
Similar to the coping hypothesis,
gratitude serves as a coping mechanism that when one encounters adversity, they recollect
pleasant memories which allow them to shift their attention from a mindset of deprivation
to appreciation (Watkins, 2004). Gratitude is an interpersonal emotion resulting from
receiving help that is perceived as valuable, costly, and an altruistic act (McCullough et al.,
2001); this suggested that grateful individuals have specific characteristic schemas that
22
may be associated with well-being (Wood et al., 2008).
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Equally, this benefits the
individual in a social context by cultivating interconnectedness and strengthens
relationship with others (Emmons, 2012).
Effectiveness of gratitude-based interventions
To cultivate gratitude therapeutically, several interventions have been developed to
prove that physical and psychological benefits can accrue from a grateful-outlook. These
interventions are categorised into behavioural expressions of gratitude, grateful
contemplation, and gratitude listings (Wood, Froh, & Geraghty, 2010).
Behavioural expressions of gratitude. Also referred as the “gratitude visit”, this
strategy requires an individual to write a letter to a benefactor to show appreciation for
their kindness. The underlying assumption of this exercise is that people may often say
“thank-you” but fail to demonstrate the actual depth of their gratefulness to the benefactor
(Rashid, 2009). Hence, this exercise aims to encourage expression of thankfulness for the
received goods. In Seligman et al.’s (2005) findings, participants who composed and later
delivered the gratitude letter had a boost in happiness compared to the placebo condition
that was instructed to write about their early childhood memories. Though the gratitude
visit yielded the largest effect sizes, the effects faded substantially over a month. It is
plausible that writing just one gratitude letter was insufficient for sustained happiness.
Toepfer (2009) extended the design to writing three gratitude letters; his findings revealed
that participants who completed wrote multiple letters demonstrated higher cumulative
effect for both gratitude and happiness index scores compared to non-writers. Contrary to
these studies, Lyubomirsky et al. (2011) removed the psychological realism of the exercise
(i.e. removal of letter delivery) yet, results indicated that individuals experienced an
improvement in well-being. Mailing out a ‘thank you’ letter may appear effective for the
first few occasions; one can imagine repetitive action could become stale.
Future
investigation should compare the impact of “delivery versus non-delivery” of the gratitude
letter and assess the level of impact based on to whom one writes.
Grateful contemplation. This involves participants to either think or write about
what one is grateful for in a more casual manner. In Watkins et al.’s (2003) study, one
group of participants were instructed to list several summer activities that they were
thankful for, whereas another group were told to list things they wanted to do but were not
given the opportunity.
In this seemingly five minutes intervention, those who were
thankful for the activities over the summer reported less negative affect compared to their
counterpart. Coherent with other similar findings (Henrie, 2007; Koo, Algoe, Wilson, &
Gilbert, 2008), this simple technique has important clinical implications for therapists to
induce immediate positive mood among dysphoric individuals.
Gratitude lists. Among all gratitude interventions, this approach is widely used
and examined (Wood, Froh, & Geraghty, 2010).
More specific than the grateful
contemplation method, it requires participants to record grateful thoughts in a daily or
weekly journal. Emmons and McCullough (2003) carried out three experimental studies
which assigned participants to keep a gratitude journal. The first study randomly assigned
students to three conditions – (i) gratitude condition (i.e. listing five things they were
grateful for), (ii) hassles condition (i.e. listing five hassles), and (iii) life events condition
(i.e. listing five events that has affected them) for the past one week. Students in these
three conditions were required to complete the task along with other measures that
assessed coping behaviour, mood, physical distress and global appraisals for 10-week.
Findings revealed that those assigned in the gratitude condition reported being more
grateful, optimistic, and had fewer physical complaints compared to the hassles and life
events condition. The second study adopted a two weeks daily gratitude journal-keeping
exercise, and the hassles condition was replaced with a social-downward comparison
24
25
group (i.e. participants were encouraged to think about how they were better off than
others). Participants in the gratitude condition exhibited increased positive affect and
altruistic behaviour compared to other conditions. However, the second study failed to
replicate the findings for health benefits. Extending the study to three weeks (i.e. third
study), which focused on adults with neuromuscular disease, these participants were
randomly assigned to either the gratitude condition or control group.
Those in the
gratitude condition demonstrated marked enhancement in positive affect and life
satisfaction. Other benefits include improved sleep quality, more time spent on exercising,
and greater bond with others.
The lack of follow-up in Emmons and McCulloughs’ (2003) study makes it
impossible to determine how long the effects lasted for the gratitude condition compared to
other conditions. The study was revised by Froh, Sefick and Emmons (2008) which
included a three weeks follow-up. In the post-test and follow-up, participants in the
gratitude condition were found to experience greater gratitude, higher satisfaction with
school experience, and reduction in negative affect compared to the hassles and control
group. Physical benefits and perceived quality of interpersonal relationship remained
insignificant.
A similar replication by Seligman et al. (2005) which required participants to keep
a daily journal to reflect and write on the positive events that happened during the day
showed a boost in happiness and alleviated depressive symptoms over a six-month follow
up.
Another study conducted by Lyubomirsky, Sheldon, and Schkade (2005) found
evidence that the frequency of the happiness-enhancing intervention plays a role in
therapeutic outcome.
However, Lyubomirsky et al.’s (2005) study showed that
participants who kept a once-per-week gratitude journal received greater benefits than
those who kept frequent gratitude journal (i.e. three times per week). Perhaps a systematic
26
comparison of the “dosage” for these interventions would allow future recommendations
to be made with confidence.
Evaluation of gratitude interventions
Previous work revealed that gratitude has the ability to enhance well-being through
simple techniques. However, it is important to highlight the caveats and concerns about
the effectiveness of these interventions. First, several studies that aim to enhance wellbeing via gratitude practice did not evaluate whether the intervention successfully foster
gratitude (Sheldon & Lyubomirsky, 2006; Sin, Della Porta, & Lyubomirsky, 2009). The
intensity, span, frequency, and density of experienced gratitude among participants were
not assessed, leaving doubts to question the objective findings of the gratitude
interventions.
Though interventions based on the principle of gratitude listing has demonstrated
its usefulness in inducing grateful experiences among individuals when compared to the
letter-writing approach (Wood, Froh, & Geraghty, 2010), the effectiveness of this
technique was supported by comparing with diverse control conditions (e.g. listing hassles
and downward social comparison) that induces negative emotions.
This makes it
problematic to infer the effectiveness of the gratitude component of the intervention when
compared to more common aspects.
These aforementioned studies showed beneficial correlates associated with the
practice of gratitude. This includes improvement in well-being (i.e. increased in positive
affect, life satisfaction, and reduced in negative affect), altruistic behaviour (i.e. frequency
of giving and receiving aid), and spirituality and religiosity (Bono, Emmons, &
McCullough, 2004). However, the duration of the effects remains a question unanswered.
Evidence from Seligman et al.’s (2005) study highlighted the need to follow-up on those
who practice PPIs because some positive changes may not be present at the initial postintervention assessment.
The generalizability of the effects of gratitude interventions needs to be explored as
most studies were conducted on US participants.
As North Americans celebrate
Thanksgiving, they may view gratitude as a central cultural value as opposed to other
cultures (Martínez-Martí, Avia, & Hernández-Lloreda, 2010). Whether these interventions
would have the same effects on other populations is unknown due to scarcity of research in
this area.
In implementing gratitude interventions, researchers should consider the type of
positive exercises and time commitment required from the participants (Bono et al., 2004).
The question on how and who should be the recipient of gratitude activities is only tackled
by few studies (Sheldon & Lyubomirsky, 2006; Sin, Della-Porta, & Lyubomirsky, 2009;
Odou et al., 2013). Perceived activity-fit is an important predictor of outcome, in which
those who perceived practicing gratitude as beneficial will experience greater results (Sin
et al., 2009). An overlook of this factor may have contributed to the mixed findings thus
far.
27
Concluding Summary
Contemporary social science researchers have identified gratitude as a
psychological strength which promotes human flourishing. A thorough inspection of a
grateful person has been associated with numerous beneficial outcomes, including
increased interpersonal connectedness, and improvement in psychological and physical
health. The positive outcomes generated by a grateful-outlook are supported by various
cognitive mechanisms, all of which revolves around the reinterpretation of events to draw
upon positive memories to buffer and protect against debilitating emotions and psychiatric
disorders.
Social scientists have developed gratitude-based interventions in an attempt to
maximise humans’ positive experiences in life. Research has verified that experiencing
and expressing gratitude provide a peaceful mind, satisfying relationship with others, and
happiness in general (Watkins et al., 2003). However, because of the dearth of evidence
on psychological techniques for improving well-being, the encouraging findings reported
in gratitude studies to promote overall positive human functioning remains speculative
without rigorous experimental validation (Slade, 2010).
Evidence mounting that positive mental health plays a substantial role in the onset
of illness and recovery rate, the WHO urges health services to incorporate elements of
positive health into operation at several dimensions (e.g. individual-community; physicalmental, etc.), in particular to any health prevention and intervention programs (Vázquez,
Hervás, Rahona, & Gómez, 2009). Beyond the realm of illness or disorder, the ability to
enjoy life and handle adversities is equally important. Therefore, the importance of this
study is to examine the impact of grateful thinking on psychological well-being, thereby
instilling awareness among social science research about the benefits and practical
implications of gratitude.
28
Present Study
Previous research has suggested that gratitude produces multiple positive outcomes
ranging from health benefits, positive emotions, and social reciprocity. However, the
effects of gratitude interventions may not extrapolate to other populations (e.g. the UK), as
being grateful may yield different results in cross-cultural samples.
Some of the aforementioned studies did not assess whether the proposed gratitude
interventions actually fostered gratitude among participants. Owing to that reason, results
from previous studies can be questioned: What were the levels of gratitude before and after
intervention? Further examination of these studies revealed that the gratitude condition
was compared with diverse “placebo” control group, in which the activities assigned to the
control group may induce expectancy effects (Wood et al., 2010). Wood et al. (2010)
suggested that a control group without any assigned activity would serve as a better
comparison to examine the true effect of the intervention.
To answer these queries, the present study replicated Emmons and McCullough
(2003) study to explore whether the effects of gratitude practice can be generated in a nonAmerican population. In addition, validated scales (i.e. GQ-6 and GAC) were included to
track the changes in levels of gratitude. In an effort to minimise expectancy effects,
participants were blinded to the trial hypotheses. Enhancement of methodological features
such as homogeneity check of samples and Intention-to-treat analysis (ITT) were included.
Noting that the intervention may not be effective for everyone, the current study
investigated whether a relationship exists between effort and time committed to perform a
prescribed positive activity.
29
Hypotheses
The research hypotheses formulated were that:
H1: Individuals in the gratitude condition would exhibit an increase in state and trait
gratitude compared to individuals in the control group.
H2
Participants in the gratitude condition would demonstrate an increase in positive
affectivity and a decrease in negative affectivity when compared to participants in
the control group.
H3: Participants in the gratitude condition would report an increase in well-being when
compared to those in the control group.
H4: Participants in the gratitude condition would report an increase in quality of
relationship with a close other when compared to participants in the control group.
H5: Participants in the gratitude condition would report a decrease in physical symptoms
compared to those in the control group.
H6: There would be positive correlations between a person-activity fit (i.e. individual’s
motivation and effort in engaging in the gratitude-inducing activity) and the effects
of gratitude practice.
30
31
CHAPTER TWO: METHODS
Design
This study utilized a 3-week experimental randomized controlled trial to address
the research aims. Two experimental conditions served as the independent variables: (1)
Gratitude (individuals assigned with daily gratitude-inducing activity) and (2) Control (noassigned activity). Both groups were measured at two time points, three weeks apart: (a)
Pre-test (prior to the intervention); (b) Post-test (immediately after intervention).
Participants
Eligible participants were university students enrolled in a local university in
Stirling, aged 18 and above, able to read and write English.
Participants were 108
students, comprising 62 females and 46 males with an age range of 18 – 36 years (M = 22,
S = 2.85).
Majority were university graduates (67.6%) and not employed (61.1%).
Almost half the sample was White (53.7%), and the other half was Asian/Pacific Islander
(41.7%). As shown in Figure 1, 108 participants were randomised to the gratitude (n = 51)
and control condition (n = 57).
Socio-demographic differences were examined with chi-square.
Demographic
characteristics were equally distributed in both groups, with the exception of gender [(χ²
(1, n = 108) = 6.39, p = .011)] and ethnicity [(χ² (5, n = 108) = 16.14, p = .006)]. The
gratitude condition had more females (71%) and Asians (59%), whereas the control
condition had more males (54%) and Whites (68%). The final analysis included 45 in the
control group and 36 in the gratitude condition, with 15 participants dropped out from the
intervention group and 12 dropped out from the control group (see Table 4).
Figure 1. CONSORT Diagram
32
33
Table 4
Socio-demographic characteristics of participants
Participants, N (%) a
Demographic characteristics
Age, mean (SD)
Sex, N (%) *
Male
Female
Ethnicity, N (%) *
White
Black or African American
Hispanic or Latino
Native American or American Indian
Asian or Pacific Islander
Others
Education, N (%) b
Foundation
Bachelor Degree
Postgraduate
Employment, N (%)
Yes
No
a
Baseline
GRAT
N (%)
Mean (SD)
51 (100)
CTRL
N (%)
Mean (SD)
57 (100)
Completed Intervention
GRAT
CTRL
N (%)
N (%)
Mean (SD)
Mean (SD)
36 (100)
45 (100)
Dropouts
GRAT
N (%)
Mean (SD)
15 (100)
22.27 (2.18)
21.29 (3.28)
22.28 (2.29)
21.29 (3.28) 22.25 (1.68) 20.92 (4.30)
15 (29)
36 (71)
31 (54)
26 (46)
10 (28)
26 (72)
26 (58)
19 (42)
5 (32)
10 (68)
5 (58)
7 (42)
19 (37)
1 (2)
30 (59)
1 (2)
39 (68)
2 (4)
1 (2)
15 (26)
-
12 (33)
1 (3)
22 (61)
1 (3)
28 (62)
2 (5)
1 (2)
14 (31)
-
7 (47)
8 (53)
-
11 (92)
1(8)
-
7 (14)
33 (65)
11 (21)
13 (23)
40 (70)
4 (7)
7 (19)
22 (61)
7 (20)
13 (23)
28 (70)
4 (7)
11 (73)
4 (27)
12 (100)
-
17 (33)
34 (67)
25 (44)
32 (56)
10 (28)
26 (72)
18 (40)
27 (60)
7 (47)
8(53)
7 (58)
5 (42)
CTRL
N (%)
Mean (SD)
12 (100)
Total participants at baseline prior randomization (n = 108); completed the intervention (n = 81); dropped out (n = 27)
Categories collapsed.
Significance levels tested with independent samples chi-square tests after randomization has been carried out. Statistical significant differences
are highlighted in bold
* p < .05
b
34
Procedure
Eligible individuals were recruited via an internet-based medium and a face-to-face
method. For the web-based approach, the study was advertised through the university’s main
portal and on social media (i.e. Facebook). Interested candidates were instructed to go online
to read the participant information statement (Appendix A) and commence the study via
PSYCHWEB.
consent.
The completion of the initial questionnaire was considered as informed
As for the face-to-face approach, in addition to the set of instructions and
questionnaires used for the online recruitment, a consent form was included (Appendix B).
The following documents were pre-packed in a sealed envelope and were randomly
distributed to different departments within the university.
Individuals who agreed to
participate would sign the consent form and complete the baseline measures (Appendix E).
They were instructed to submit the following documents in a packet provided in the library.
In an attempt to maximise response rate, participants were told that upon completion
of the study, they would be entered into a lottery. The lottery prize included one £50
Amazon gift certificate. Data were collected at – (i) baseline and (ii) post-intervention (threeweeks after baseline measures) (Figure 2). Participants who consented and completed the
questionnaires were assigned a unique identification number in which it can only be
identified by the researcher.
Participants were then randomized to the intervention –
gratitude condition (n = 51) or control group (n = 57).
Randomisation was conducted using a computer software developed by Urbaniak and
Plous (2013). The software provides a form that allows the researcher to specify the choices
to create random numbers. After the form was completed (Appendix H), a set of numbers
that ranged from 1 to 2 was generated. The allocation of groups was determined using the
coin-tossing method by the study supervisor.
35
After randomization, participants were given specific instructions tailored according
to their respective groups (Appendix G) via email. During the study, participants would
receive a reminder email early in the week to remind them of their assigned task. A second
reminder email was sent after the intervention has ended to remind them to complete the
same measures administered at pre-test via an assigned web-link.
Participants who were allocated to the gratitude condition received an instruction to
cultivate a sense of gratitude for 21 days. The instruction given to participants for the
gratitude-inducing activity was based on the original study conducted by Emmon and
McCullough (2003). It also incorporated the instructions given in Martínez-Martí et al.’s
(2010) study to enhance the expected effects for the perceived quality of relationships. The
instructions for the gratitude condition were as follows:
“There are many things in our lives, both large and small, that we might consider as a
form of blessing. It could even be those who help us to reach our goals, or just make our
lives easier with small details. If we try to put ourselves in their shoes, appreciate their
efforts, and notice the voluntary nature of their acts, we have a good reason to feel grateful.
Please think of today and write down three things in your life that you are grateful for”.
Those in the gratitude condition were instructed to write their daily grateful thoughts
on a separate sheet of paper using the template provided (Appendix F). Participants in the
control group were not assigned to any activity; they were only required to complete the same
measures given to the gratitude condition. Participants in both conditions were contacted by
mail to complete their online measures for the post-test (i.e. after 21 days of the intervention).
To encourage adherence to the intervention, participants in the gratitude condition were
invited to submit their daily gratitude journal to the researcher by turning in on an appointed
date after the intervention was completed.
36
Blinding
The trial hypotheses were masked by naming the study “A Study on Human
Emotion”. Moreover, participants were told that they were randomized to one of the two
groups and that the tasks assigned to the other participants would not be revealed. At the end
of the intervention, participants in the control condition received a Post-Intervention
Information Sheet (Appendix C) which contained brief descriptions of the study and also the
gratitude-inducing instructions to give them equal opportunity to practice the intervention.
37
Figure 2. Procedural flowchart
Measures
Well-being. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) tap into
the domains of an individual’s psychological functioning, affective-emotional, and cognitiveevaluative components. Fourteen items (e.g. “I’ve been feeling useful”, “I’ve been feeling
38
loved” and etc.) were measured on a five-point Likert scale from 1 (none of the time) to 5 (all
of the time). Scores vary from 14 to 70, with higher scores indicating higher levels of mental
well-being. The WEMWBS has been reported to have higher correlations with positive
affect (r = .71) and the Scale of Psychological Well-Being (r = .74), signifying good criterion
validity (Tennant et al., 2007).
Affect. To gauge participant’s feelings and emotions, the Positive and Negative
Affect Schedule (PANAS) was used (Watson, Clark, & Tellegen, 1988). The PANAS has
two scales – (i) positive affect (PA) and (ii) negative affect (NA) that assess 20 emotion
adjectives (e.g. inspired, distressed, and jittery). Using a five-point Likert scale from 1 (very
slightly or not at all) to 5 (extremely), scores for PA and NA can be obtained, and ranges
from 10 to 50 for both scales respectively. Individuals with higher scores on PA indicate
higher positive emotions; similar scoring applies to the NA scale. High internal consistency
(Cronbach’s α = .85) has been reported for the two scales (Watson et al., 1988).
Gratitude at the state and dispositional levels. At the state level, the GAC scale
developed by McCullough et al. (2002), which consists of three adjectives (appreciative,
grateful, and thankful), was used to examine participants’ feeling of gratefulness. These
adjectives were rated on a five-point Likert scale from 1 (not at all) to 5 (extremely) based on
the intensity of experiencing each emotion at that given moment. Scores range from 3 to 15,
with higher scores indicating higher levels of state gratitude. The GAC has been reported
across studies for having strong internal consistency (Cronbach’s α = .87) (McCullough et al.,
2002).
The grateful disposition was assessed using the GQ-6 (McCullough et al., 2002). It
consists of six items that include the four domains – (1) intensity, (2) frequency, (3) life-span,
and (4) density of an individual to elicit the feeling of gratefulness. Item responses that are in
descriptive statements (e.g. I have so much in life to be thankful for) is scored on a seven-
39
point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree) except for items 3
and 6 which are reverse-scored. Scores range from 6 to 42, individual’s dispositional levels
of gratitude can be determined via median split (McCullough et al. 2002). The GQ-6 is
widely used to examine individual’s dispositional gratitude (Watkins, 2004) due to its
excellent psychometric properties and strong internal consistency (Cronbach’s α = .82)
(McCullough et al., 2002).
Physical Symptoms.
Adapted from the study conducted by Emmons and
McCullough (2003), a list of 13 physical symptoms (e.g. acne/skin irritation, runny/congested
nose, and etc.) requires participants to indicate whether they experienced any of these for the
past two weeks. This method was proven to be reliable and valid in assessing self-perceived
health status (Pennebaker, 1982; Emmons, 1992; Elliot & Sheldon, 1998).
Quality of relationship with significant others. Adapted from Martínez-Martí,
Avia, and Hernández-Lloreda’s (2010) study, this domain assessed participant’s quality of
relationship with close others. A total of four items (e.g. “to what extent can you contribute
to the well-being of that person?”) were scored on a four-point Likert scale from 1 (not at all)
to 4 (a great deal).
Socio-demographic information and exploratory data. Demographic information
included age, sex, contact details, education, employment status, and nationality (Appendix
D).
Exploratory data form was given to participants after the intervention. The form
included several questions developed by (Odou et al., 2013) to assess participant’s motivation
(e.g. How motivated did you feel about doing the activity?) on a five-point Likert scale from 1
(not at all) to 5 (extremely), and another question to explore participant’s effort (e.g. on
average how many minutes did it take you to complete your activity?). An additional
question was added to the exploratory data form to measure adherence for the assigned
activity. The question was “We understand that at some point there are circumstances that
40
cause you to be unable to carry out the assigned activity as intended. We appreciate your
honesty to indicate throughout these 21 days, how often you think you actually did the
assigned activity”. They were asked to indicate from a seven-point Likert scale ranging from
1 (never) to 7 (daily).
Ethical considerations
Participants consented acknowledging they understood the aim of the study,
involvement required, and that they have the right to withdraw from the study at any time
without any imposed penalties. Before the study was carried out, approval was obtained
within the institution – the university with which the primary researcher was associated.
Statistical power
The study was designed to recruit 100 eligible participants using a medium effect size
(.50) suggested by Emmons & McCullough (2003). This would provide 90% power using an
ANOVA within-between interactions with alpha at .05. A possible 20% of attrition rate
between baseline and post-intervention was estimated.
Data analysis
Preliminary analysis. Overall missing cases for each of the variables were less than
5%; hence missing values were addressed with means substitution before total variable scores
were computed. The randomization was evaluated by comparing demographic characteristics
of the two groups with chi-square. The Kolmogorov-Smirnov test was conducted to examine
the distribution of the scores, and results revealed that each of the variable scores was
normally distributed.
Statistical analysis. Two-way mixed analyses of variance (ANOVA) were used to
test for important differences among participants who completed the intervention. Effects
were calculated for time and time × group interactions. Pearson’s correlation was used to
41
determine the degree of linear association between individual differences (e.g. motivation and
effort) and the effectiveness of gratitude intervention.
Two analyses were conducted using the above mentioned statistical methods – (i)
‘Completer analysis’ – for participants who provided data for both baseline and postintervention measures; (ii) ‘Intention-to-treat (ITT) analysis’ – included all participants who
completed baseline measures and also those who did not provide the follow-up data.
The ITT was carried out by replacing the missing follow up data with the participants’
baseline data (last observation carried forward (LOCF). The purpose of performing the ITT
was to avoid overoptimistic estimates of the effectiveness of the intervention (Heritier,
Gebski, & Keech, 2003). In other words, the completer analyses may provide a falsely
positive picture, indicating that participants who adhere to the intervention might find the
gratitude-inducing activity enjoyable, whereas those who dropout or were noncompliant
actually feels no benefit from the intervention. Therefore, the LOCF principle allows a
conservative estimate by accepting that protocol deviations and noncompliance are likely to
occur in actual settings (Heritier et al., 2003).
42
CHAPTER THREE: RESULTS
Taking ethnicity and gender as covariates3, a two-way mixed ANOVA was carried
out for all dependent variables. To determine whether the gratitude and control groups
differed at pre-test and post-test, an unrelated t-test was used to evaluate the two test periods
separately (Table 5, Appendix I). Pearson’s correlation was used to explore the relationship
between individual’s engagement (e.g. effort and motivation) and the effects of gratitude
practice.
The first part of the results section aimed to present the findings for the completer
analysis. The second part of the results was findings obtained from the ITT analysis. The
ITT analysis included all participants who completed baseline measures and were analysed
according to the randomization scheme.
For all hypotheses testing, it is expected that
participants in the gratitude condition would have better outcome than the control condition.
PART I: MAIN FINDINGS FOR COMPLETER ANALYSIS
Gratitude
Hypothesis 1: The effect of gratitude practice on disposition and state gratitude
Disposition. The dispositional gratitude scores differed at the end of the intervention,
[F(1, 77) = 7.884, p = .006, partial
2
= .093]. The main effect of group on dispositional
gratitude scores was significant [F(1, 77) = 4.892, p = .030, partial
2
= .060].
The
conditions × time interaction for dispositional gratitude was also significant [F(1, 77) = 4.84,
p = .044, partial
2
= .052]. The gratitude (M = 33.43, SD = 5.99) and the control condition
(M = 31.82, SD = 6.18) were not significantly different prior intervention [t(79) = -1.92, p =
.058], the post-intervention showed statistical significance [t(79) = -3.04, p = .003]. There
was a slight decrease in the gratitude condition from pre-test (M = 33.43, SD = 5.99) to post3
In this context covariates is defined as covary out the effects of a categorical variable
(Grace-Martin, 2008).
43
test (M = 33.36, SD = 5.80), yet it was not as much as the control condition which
experienced a decrease from pre-intervention (M = 31.82, SD = 6.18) to post-intervention (M
= 28.16, SD = 8.86).
State. The overall effect of time [F(1, 77) = .416, p = .521, partial
2
= .005], and
effect for state gratitude scores between both conditions, [F(1, 77) = 3.870, p = .053, partial
η2 = .048] was not significant. However, the conditions × time interaction for state gratitude
was significant [F(1, 77) = 8.48, p = .005, partial
2
= .099]. Because variances for the two
groups were significantly unequal at the pre-test (F = 5.35, p < .05) and post-test (F = 5.65, p
< .05), a t-test for unequal variances was used. Though the pre-test means for both groups
were not significant [t(60.96) = -.196, p = .851], the post-test means were significant
[t(78.81) = -3.85, p = .001]. There was an increase of state gratitude for the gratitude
44
condition from pre-intervention (M = 9.83, SD = 3.87) to post-intervention (M = 11.67, SD =
2.55), but not for the control condition that experienced a decrease from pre-intervention (M
= 9.69, SD = 2.75) to post-intervention (M = 9.13, SD = 3.62). Overall, the first hypothesis is
accepted.
Affect
Hypothesis 2: The effect of gratitude practice on subjective well-being
Positive Affect. The overall effect of time for positive affectivity scores was not
significant [F(1, 77) = 1.99, p = .163, η2 = .025] and there was no significant effect for
positive affectivity scores between both conditions [F(1, 77) = .629, p = .430, η2 = .008].
Nevertheless, the conditions × time interaction for positive affect was significant [F(1, 77) =
4.90, p = .030,
2
= .060] (Figure 4). Although the pre-intervention means did not differ
45
significantly [t(79) = -.304, p = .762] in both gratitude (M = 31.38, SD = 8.31) and control
condition (M = 30.87, SD = 7.13), the post-intervention mean for the gratitude condition (M =
33.47, SD = 8.23) was significantly higher than [t(79) = -2.60, p = .011] the control condition
(M = 28.69, SD = 8.22).
Negative Affect. Negative affectivity scores revealed no significant differences in
pre-intervention and post-intervention [F(1, 77) = .147, p = .703, partial η2 = .002]. The main
effect for negative affectivity scores in both conditions was not significant [F(1, 77) = .824, p
= .367, partial η2 = .011]. The conditions × time interaction for negative affect also revealed
no significant findings [F(1, 77) = 1.753, p = .189, partial η2 = 022]. These results suggest
that the second hypothesis is not accepted.
46
Well-being
Hypothesis 3: The effect of gratitude practice on well-being
The overall effect of time was significant, [F(1, 77) = 5.11, p = .027, partial
2
=
.062]. However, no significant effect existed for well-being scores between both conditions,
2
[F(1, 77) = 2.031, p = .153, partial
= .026]. Critically, the conditions × time interaction for
well-being was also not significant [F(1, 77) = 3.87, p = .053, partial
2
= .048]. To
conclude, the third hypothesis is rejected.
Social relationship
Hypothesis 4: The effect of gratitude practice on perceived quality of relationship
with a close other
The results revealed that the overall effect of time for the perceived quality of a
relationship with a close other was not significant [F(1, 77) = .483, p = .483, partial
2
=
.006]. Furthermore, no significant effect existed for the perceived interpersonal relationship
scores between both conditions [F(1, 77) = .123, p = .726, partial
2
= .002]. Similarly, there
was no significant conditions × time interaction for perceived quality of social relationship
[F(1, 77) = .871, p = .354, partial
2
= .011]. Hypothesis 4 is therefore rejected.
Physical symptoms
Hypothesis 5: The effect of gratitude practice on health
The reported physical symptoms were significantly different after the intervention
was implemented [F(1, 77) = 5.56, p = .021, partial
2
= .069], but the main effect of group
on reported physical symptoms was non-significant [F(1, 77) = .877, p = .352, partial
2
=
.012]. The conditions × time interaction for experienced health symptoms was also nonsignificant [F(1, 77) = .055, p = .816, partial
2
= .001]. As both groups experienced a
reduction in physical symptoms experienced, hypothesis 5 is rejected.
47
Table 6
Completer analysis on the effects of gratitude intervention in the experimental and control
group (n = 81)
Pre-test
Mean (SD)
GRAT
CTRL
46.17
45.69
(10.00) (9.38)
Post-test
Mean (SD)
GRAT
CTRL
45.50
39.47
(10.81)
(13.87)
Timeb
F-ratio
p
Group × Time
Interactionsb
F-ratio p
5.110
.027*
3.87
.053
31.38
(8.31)
30.87
(7.13)
33.47
(8.23)
28.69
(8.22)
1.987
.163
4.895
.030*
22.00
(9.05)
21.93
(7.65)
20.83
(6.62)
23.38
(8.93)
.147
.703
1.753
.189
GAC
9.83
(3.87)
9.69
(2.75)
11.67
(2.55)
9.13
(3.62)
.416
.521
8.476
.005**
GQ-6
33.44
(5.99)
31.82
(6.18)
33.36
(5.80)
28.16
(8.86)
7.884
.006**
4.184
.044*
Perceived
14.39
quality of (4.44)
relationship
13.36
(3.15)
13.61
(2.50)
12.78
(3.40)
.496
.483
.871
.354
Physical
symptoms
5.07
(3.20)
3.77
(3.01)
4.34
(3.11)
5.563
.021*
.055
.816
Measuresa
WEMWBS
PANAS
PA
NA
4.46
(2.98)
GRAT, gratitude condition; CTRL, control condition
a
Measures used were used to test the dependent variables and were denoted as follow:
WEMWBS, Warwick-Edinburgh Mental Well-being Scale (WEMWBS); PANAS, (Positive
Affect [PA] and Negative Affect [NA] Schedule); GAC, (Gratitude Adjectives Checklist);
GQ-6, (Gratitude Dispositional Scale)
b
Significance levels tested with two-way mixed ANOVA, holding sex and ethnicity as
covariates. Statistical significant differences are highlighted in bold
* p < .05;
** p < .01
48
Individual differences in the efficacy of gratitude intervention
Hypothesis 6: The relationship between the person-activity fit factor and the
effects of gratitude practice
Findings showed the more motivated (r = .333, p = .047) and effort (r = .414, p =
.012) put into doing the gratitude-inducing activity, the greater the increase in state gratitude.
Participants with greater motivation were more likely to adhere to the activity (r = .321, p =
.046) and have higher well-being scores (r = .331, p = .049). Motivation and effort, however,
was not significantly related to dispositional gratitude and both the affectivity scores (Table
7). Though the findings did not support the sixth hypothesis, the strengths of correlations
which range from .32 to .41 indicate a moderate relationship.
Table 7
Correlations of motivation and effort required to engage in the gratitude-inducing activity
with well-being, affect, and gratitude change scores
Motivation
Effort b
a
WEMWBS
.331*
.291
PA
.079
.165
NA
-.284
-.267
GAC
.333*
.414*
GQ-6
.082
-.125
Adherence
.321*
.143
a
Motivation was measured in terms of how motivated the participants felt when they did the
gratitude-inducing activity.
b
Effort was measured in terms of average time taken to complete the prescribed activity.
*
Significance at p < .05
49
PART II: INTENTION-TO-TREAT ANALYSIS
Apart from the well-being measure, all measures revealed essentially the same results
as the findings for the completer analysis (Table 8).
The completer analysis for the
conditions × time interaction for well-being measure was non-significant; however, the
results for the ITT analysis was significant [F(1, 104) = 4.73, p = .032, partial
2
= .043]
(Figure 6). Specifically, there was significant drop in well-being scores [t(106) = -2.16, p =
.033] in the control condition (M = 40.93, SD = 13.31), but a much lower drop in the
gratitude condition (M = 46.19, SD = 8.78). This suggests that the gratitude condition has
benefitted from the intervention, whereas the control condition experienced slight decrease on
well-being.
50
Table 8
Intention-to-treat analysis on the effects of gratitude intervention in both conditions (n = 108)
Measuresa
WEMWBS
PANAS
PA
Pre-test
Mean (SD)
GRAT
CTRL
46.35
46.19
(9.52)
(8.78)
31.23
(7.83)
NA
21.14
(8.21)
GAC
10.06
(3.61)
GQ-6
34.00
(5.71)
Perceived
14.51
quality of (4.20)
relationship
Physical
4.84
symptoms
(3.15)
Post-test
Mean (SD)
GRAT
CTRL
45.88
40.93
(10.13)
(13.31)
Timeb
F-ratio
P
Group × Time
Interactionsb
F-ratio P
4.820
.030*
4.725
.032*
29.99
(7.97)
20.97
(7.58)
9.11
(3.10)
31.86
(5.87)
13.58
(3.01)
35.57
(7.83)
20.31
(6.30)
11.35
(2.69)
33.94
(5.58)
13.96
(2.92)
28.28
(8.63)
22.11
(8.75)
8.67
(3.47)
28.97
(8.29)
13.11
(3.25)
1.772
.186
4.053
.047*
.098
.754
1.754
.188
.384
.537
7.544
.007**
6.174
.015*
4.161
.044*
.032
.858
1.432
.234
4.80
(2.95)
4.43
(3.27)
4.35
(3.06)
2.915
.091
.129
.720
a
Measures used were used to test the dependent variables and were denoted as:
b
Significance levels tested with two-way mixed ANOVA, holding sex and ethnicity as
covariates. Statistical significant differences are highlighted in bold
* p < .05;
** p < .01
51
CHAPTER FOUR: DISCUSSION
This paper discusses whether gratitude can be taught in a sample of UK individuals.
The second aim was to examine whether the gratitude intervention successfully delivers its
promising benefits to those who practice it. In addition, the study aimed to scrutinize the
relative influence of individual differences on the efficacy of the gratitude-inducing
intervention.
Cultivating gratitude
One of the most credible approaches to boost an individual’s contentment is the
deliberate practice of counting one’s blessings (Emmons & McCullough, 2003; Howell,
2012). The present study inspected this acclamation by assessing the levels of disposition
and state gratitude exhibited by participants who completed the count-your-blessings
intervention.
Findings revealed that participants who engaged in the gratitude-inducing
activity experienced higher levels of dispositional and state gratitude.
With respect to the levels of dispositional gratitude, it was observed that there was a
slight decrease in grateful disposition among those who practiced gratitude. However, the
decrement was marginal when compared to participants in the control condition. To the best
of our knowledge, altering a person’s grateful disposition has not been studied in a systematic
manner (Emmons, 2012). Future research should consider whether it is possible to gradually
increase a person’s disposition toward gratitude by encouraging the continuous practice of
gratitude-oriented activities.
Scholars cautioned that not all dispositionally grateful people experience gratitude at
any given moment; rather, some are more likely to express gratefulness under certain
situations (Watkins et al., 2003). Owing to that reason, this study examined whether the
immediate feeling of gratefulness can be elicited or intensified through a self-directed
exercise of journaling one’s grateful thoughts. Results showed that participants who list their
52
blessings experienced increased levels of state gratitude, whereas their counterparts
experienced a marked decline of state gratitude. Taken together, this finding is congruent
with existing literature stating that gratitude can be experimentally cultivated (Emmons &
McCullough, 2003; Froh et al., 2008). As gratitude is viewed as the potential agent for
human flourishing (Polak & McCullough, 2006; Wood et al., 2010), this implies that
therapists can intervene to help clients cultivate grateful habits that may led to increased
disposition of thankfulness.
The benefits of practicing gratitude
Affect. The second hypothesis was that participants in the gratitude condition would
have greater increase of positive affect (PA) and reduction in negative affect (NA) compared
to participants in the control condition. This hypothesis was only supported for PA but not
for NA; nevertheless the means changed in the predicted direction. The increase in PA was
consistent with Martínez-Martí et al.’s (2010) finding and Wood et al.’s (2010) metaanalysis. A qualitative study conducted by Akhtar and Boniwell (2010) revealed that feeling
grateful, encapsulated by the distinct theme of “appreciating the good things in life” has
helped a group of alcohol-misuse adolescents to manage their emotions and feel better about
their lives. As mentioned, gratitude counteracts against the mindset of deprivation through
savouring – a shift in attention by focusing on one’s fortunate moments that could have been
otherwise (Watkins, 2004; Emmons, 2007). Savouring also prolongs the enjoyment of a
pleasant experience (Bryant, 2003). This explains how a grateful schema serves as an
adaptive psychological mechanism to appraise life experiences in a positive manner,
affirming that gratitude has the happiness-bestowing properties.
The results for NA were non-significant.
This corroborates Emmons and
McCullough’s (2003) second study, in which there were no significant differences for NA
between participants who kept a two-week gratitude journal with those who wrote about
53
neutral or downward social comparison stimuli. Despite non-significance, the mean scores
for NA were in the expected direction. This suggests that the attrition rate (over 30%) might
contribute to inadequate group sizes that led to insufficient power to detect significant
differences.
Well-being. Contrary to the third hypothesised outcome, the group who wrote the
three daily blessings did not have statistically significant benefit from the gratitude
intervention. When additional analysis (ITT) was used, the results revealed a significant
difference in well-being scores between the two conditions, but the mean scores were not in
the trended direction. This finding contrasted with most of the earlier studies which stated
that the practice of gratitude would elevate one’s well-being (Dickerhoof, 2007; Froh et al,
2008; Wood et al., 2008). However, there are several studies that lend support to the current
finding (Kashdan et al., 2006; Guren, 2008; Mallen, 2008; Sin et al., 2009) suggesting that
there are situations or conditions that temper the link between gratitude and well-being.
Irrespectively, the count-your-blessing intervention does contribute a fair amount to a
person’s well-being – in this context, mean well-being scores was relatively stable among
those who keep a gratitude journal. Using Fredrickson’s (2001) broaden-and-build model,
gratitude was postulated to harness behavioural and cognitive repertoires by “undoing” the
adverse effects of negative emotions.
It should, then, build enduring personal coping
resources to stabilize mood when stressful life-events arise (Wood et al., 2007). Up to date,
there are several studies that partially support the broadening-and-build effects of gratitude
(Folkman & Moskowit, 2000; Fredrickson, Tugade, Waugh, & Larkin, 2003; Tugade &
Fredrickson, 2004). This provides insight to approach gratitude as a resilient factor in times
of adversity.
Social-connection.
Existing claims (McCullough et al., 2002; Emmons &
McCullough, 2003; Algoe, Haidt, & Gable, 2008) that gratitude strengthens and improves
54
social relationship did not apply in this study as the investigated variables yielded results
without statistical significance. The current findings were rather unexpected, in that the
gratitude practice actually worsened the perception of quality relationship with a close other.
Gratitude is notably centralised around the thankful feeling that arises when people recognize
received aid as costly and altruistic (Wood, Maltby, Gillett, Linley, & Joseph, 2008). Taking
a middle-ground position, Wood et al. (2010) proposed that gratitude involves more than
appreciating the altruistic acts of others. This is because studies have demonstrated that
gratitude emerges from various sources such as appreciating one’s abilities (Graham &
Barker, 1990), being thankful for neutral events like “waking up early” (Emmons &
McCullough, 2003) and giving thanks to non-human agent (i.e. God) (Worthen & Isakson,
2007). Thus, this null finding offers additional interpretation that – gratitude, in this study
may have emerged from such sources and that it is not restricted to the realm of interpersonal
appreciation.
Alternative speculation is that the expression of gratitude causes momentary
experiences of “indebtedness” – an obligated feeling to return the giver the valuable act
(Watkins, Scheer, Ovnicek, & Kolts, 2006). The two emotions are embedded in reciprocity;
however, the appraisal of benefactor’s intentions determines the emotional responses of
feeling grateful or indebted (Tsang, 2006). Feeling thankful occurs when the individual
perceives the received aid as benevolent, whereas indebtedness is felt when the benefactor’s
intentions are ambiguous (Algoe, Gable, & Maisel, 2010). Indebtedness generates a slight
negative feeling because the recipient would feel compelled to return the favour in near future
(Watkins et al., 2006). Studies found that indebtedness is associated with feelings of shame
and guilt (Natio, Wangwan, & Tani, 2005), and thus, may complicate or even reduce the
quality of interpersonal relationships (Tracy & Robins, 2006). Therefore, it is important to
take into account the recipient’s perception and emotional responses to benefits received.
55
This suggests that received benefits should be considered when future research examines its
interaction with interpersonal consequences.
Physical health. Regarding physical well-being, there were no differences between
conditions. Though the main effect of time revealed significant changes across conditions,
both groups reported having experienced less physical symptoms. This phenomenon could
be attributed as spontaneous health recovery or regression to the mean. Along the same vein,
Martínez-Martí et al. (2010) found no differences in illness-reporting between those who
practiced gratitude and those who were listing hassles or neutral events.
Currently, there is insufficient research on the gratitude-to-health link to draw any
firm conclusions about how grateful individuals tend to have better health outcome. A recent
study established a bidirectional relationship suggesting that healthier individuals, in part, are
thankful for their good health, which in turn generates a drive to take up healthy behaviours
(Hills, Allemand, & Roberts, 2013). That being said, the main effect of group on the grateful
disposition scores indicated that on average the gratitude condition scored higher than their
counterparts. It is may be difficult to increase the feeling of thankfulness among highly
grateful individuals to further notice and appreciate their health as a “gift” to be thankful
about. Thus far, research has been focusing on the traditional direction of trait predicting
health behaviours. The current non-significant finding offers different perspectives for future
work to explore and expand the mechanism of trait gratitude and health.
Only several studies illustrated a relationship between gratitude and physical health
(Emmons & McCullough, 2003), but their results were not solid. The effect of gratitude on
health may be made more apparent through more objective measures of bodily symptoms
(Gillani & Smith, 2001; McCraty & Childre, 2004), or increased intervention duration with
follow-up.
56
Factors influencing the efficacy of the intervention
Notwithstanding the fact that the count-your-blessings intervention promotes positive
mood and mental well-being through induction of habitual practice (Sheldon & Lyubomirsky,
2006), equal engagement and benefit from the happiness-bestowing activity across
individuals is improbable. To this end, the current experiment sought to examine a person’s
motivation and effort influence over the success of the intervention. The findings showed
participants who put greater motivation and effort into the gratitude-inducing activity had
increased feelings of gratefulness. Supported by previous studies (Seligman et al., 2005;
Worthen &Isakson, 2007), which suggested that when the mood-enhancing activity “fits” the
person’s interest and values and is performed with appropriate effort, the goal of developing a
grateful thinking is achievable (Brunstein, 1993; Sheldon & Kasser, 1998). Such work
demonstrated the person-activity fit, indicating a proper match between an individual and
prescribed happiness-inducing activity can impact the efficacy of the intervention.
Taking well-being into account, the present study found that effort was not
significantly correlated. This finding contrast Odou et al.’s (2013) result that both effort and
motivation contribute to a person’s well-being. The explanation for the current result can be
explained using the “Model of Sustainable Well-being”. Teasing apart the components (i.e.
happiness set-point and life circumstances) that made up this model, positive goal-based
activities serve as the linchpin to enhance well-being (Lyubomirsky et al., 2005b). Ample
evidence proposed that volitional activities involve commitment and certain amount of effort
to initiate, engage, and maintain the activity (Sheldon et al., 2010). Obviously, if a person
yearns for happiness, but does not exert any effort to practice the mood-enhancing strategy,
he will see few or no results (Sheldon & Lyubomirsky, 2006). This probably explains the
bigger picture of why participants in the gratitude condition did not experienced significant
increase of well-being in post-intervention. Consistent with this idea, effortful practice of the
57
activity along with the desire to be happy is necessary for participants to experience the
benefits of the intervention (Seligman et al., 2005; Lyubomirsky et al., 2011). These studies
specifically examine its relationship with adherence to the happiness-promoting activities
(Seligman et al., 2005). While motivation and effort are important variables for continued
adherence to the activity (Lyubomirsky et al., 2011), only motivation was positively
correlated with adherence in this study.
If greater motivation was instilled, those who
practice the gratitude-oriented activity may bear effort and persistence, and thus allow the
effects of the gratitude practice to be more noticeable.
Limitations and Suggested Improvements
A relatively easy technique to bolster one’s happiness is not without limitations.
Firstly, the randomization was not entirely successful as some differences between groups
were evident in pre-intervention. This was largely dealt with by including the variables as
covariates4 in the analyses, restricting the external validity of the findings.
Secondly, the shrinkage of sample size due to attrition might have influenced the
significance of the results. This means that some of the statistically significant variables
might be due to the unwarranted scorings of few other members. Although the ITT analysis
was conducted to address this issue, it cannot guarantee lowered likelihood of a false positive.
While the small sample itself is a limitation, these findings might not represent the actual
population of UK individuals, thus have to be interpreted with caution.
Thirdly, self-report measures may be subjected to bias.
For instance, questions
related to interpersonal benefits which assess individual’s perceived quality of relationship
with a close other might have been overestimated.
Furthermore, there is no absolute
confirmation that those in the gratitude condition actually perform the prescribed activity. It
could be possible that participants’ reports of engagement in the activity were due to demand
4
The covariates are gender and ethnicity.
characteristics.
58
Last but not least, the lack in follow-up could not answer for the
sustainability of intervention effects.
Future studies should consider larger sample sizes to ensure generalizability of the
research findings. As the study aimed to examine the effects of practicing gratitude on
individual’s well-being, a longer duration with inclusion of follow-up sessions would
establish more solid foundation on the lasting impact of the gratitude practice toward the
enhancement of well-being. To supplement self-report measures, the gratitude intervention
would benefit from adopting a triangulation approach. Specifically in assessing prosociality
(i.e. how much they help others and others help them), triangulation could account for more
accurate reports from multiple perspectives. As the findings for health outcome is congruent
with the inconsistencies found in the gratitude literature, aggregating mean levels of physical
symptoms in a short period of time may have restricted the range and attenuated the effects of
the experimental study. Future research should either extend the duration to collect health
reports or employ objective measure of health behaviours (i.e. doctor’s report of healthcare
visit) to enable more reliable effects.
Future Directions
Although the current findings have advanced the understanding of how gratitude
affects an individual’s well-being, many questions remained unanswered. First and foremost,
it is postulated that pre-existing traits (e.g. trait gratitude or affective traits) might affect
individual’s ability to benefit from the gratitude intervention (Emmons & Mishra, 2011).
Drawing attention to the explanation on the findings for reported symptomology, can we
expect gratitude induction to work better in improving health outcomes of less grateful
individuals or grateful individuals? Alternatively, can people with high positive affect (PA)
experience additional gains in well-being? Until more research is conducted to explore the
59
trait moderator link, informed recommendation regarding how the gratitude-inducing
exercises might be used can be provided.
In addition, it might be valuable to examine the contents written in the gratitude diary.
This provides insight into the benefactor-recipient relationship and further investigation into
the level of impact based on ‘what’ and ‘who’ one writes. Such discovery might help identify
circumstances under which the count-your-blessings intervention can be fully optimized.
While this was not the aim of the current investigation, it is an option for future study.
Another issue to consider is retention enhancement in self-directed exercises.
Especially when intervention is delivered online, the anonymity and distance between the
participants and the researcher may induce participants’ reluctant to oblige to instructions for
the assigned task. The challenge for future research is to design a study that can be integrated
into individual’s daily routine, and in a way that it is self-reinforcing and self-maintaining.
It is beyond the scope of the present study to uncover how gender and different
ethnicity experience and express gratitude. These are avenues that future research should
explore because it may discover barriers on the generality of gratitude interventions.
Practical Implications and Conclusion
The present findings suggest that the gratitude intervention can be applied in a UK
cultural setting. Evidence showed that the count-your-blessings approach is an effective
technique to increase individuals’ predisposition to experience gratitude. Tapping into this
asset, a mindfulness appreciation helps individuals to come into terms with the absence of
benefits (Koo et al., 2008) and learn to recognize the benefits received in the past and also in
present (Emmons & Mishra, 2011).
This type of positive attributional style magnifies
individuals’ ability to retrieve and experience positive emotions with ease (Watkins, Grimm,
& Kolts, 2004). Thus, habitual accessibility to positive memories can trigger an upward
spiral in well-being by buffering against negative emotions (Aspinwall & Tedeschi, 2010).
60
This suggests that the conscious practice of gratitude can function as a happiness barometer,
increasing the chances to live “the good life”.
The current study points out that gratitude may serves as a “therapeutic ingredient” in
finding benefits in adversity. If psychopathology arises from how people appraise the events
of their lives, it may be useful to implement gratitude interventions to counteract the
“negative triads” of beliefs pertaining to the self, world, and future (Wood et al., 2010). To
promote gratitude-based interventions in clinical settings, future study would need to
compare its effectiveness with existing “gold standards” (e.g. CBT).
Of great importance, the null findings for perceived interpersonal benefits propel
future work to explore and include additional variables into the causal model of gratitudeinduction.
Whether gratitude stems from thanking other’s altruistic acts (interpersonal
appreciation) or from acknowledging one’s ability (interpersonal appreciation), regardless of
it sources, the cultivation of gratitude has proven to privilege the individual to achieve an
optimal human functioning.
Despite the insignificant findings for physical well-being, participants who practiced
gratitude reported less symptomology. Bearing in mind that the cost of direct (e.g. diseases
and death) and indirect illnesses (e.g. absenteeism, lack of productivity) is high and hard to
estimate, on the basis of these preliminary findings, the gratitude intervention could be useful
from both humane and economic perspective (DeVol & Bedroussian, 2007).
Considering both the individuals and the wider community is to envisage a flourishing
nation and a decrease in psychological suffering (Ustun et al., 2004), health authorities and
public institutions should pay attention to the mind and body connection – specifically how
well-being impacts illness recovery and prevention. The current results demonstrated that
altering cognitive habits and augmenting well-being is possible, but it takes both the ‘drive’
and ‘will’ to initiate and maintain the happiness-bestowing activity. Perhaps a more far-
61
reaching methodology would discover the means to meet such goals, generating greater
accessibility to develop mental strength as well as alleviate suffering.
To sum it all up, the essential message of this study shows that the count-yourblessings approach – a relatively easy technique has its strength to improve well-being and it
can be included alongside existing clinical therapies. Looking further afield, instead of
seeking therapists to talk about weaknesses and troubles, the future of psychology would be a
place to build character strengths – and gratitude can catalyse this vision into a reality.
62
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APPENDICES
Appendix A
PARTICIPANT INFORMATION SHEET
A STUDY ON HUMAN EMOTION
INVITATION
We are interested to explore how human emotions fluctuate on a daily basis. We need to
collect data on how mood interacts with physical and mental health in general. Your
participation is highly appreciated.
WHAT WILL PARTICIPATION INVOLVE
In this study, you are required to complete a survey which consists of three brief
questionnaires with different parts. The first part of the questionnaire consists of collecting
your basic demographic information. The second part includes questions related to your
feelings, emotions, physical health and your opinions on human interaction. The last part of
the questionnaire is about your general opinion about this study.
Depending on random allocation, you might or might not need to complete an assigned brief
dairy-type task. The brief dairy-type task you will receive is simple and straightforward. It
will take maximum 5 minutes to complete.
TIME COMMITMENT
This study requires approximately 5 – at most 10 minutes (per day) for 4 weeks.
Week 1:
(Day 1 – present moment)
Week 1 – Week 3:
(Day 2 to Day 22)
You will be asked to complete a set of questionnaires
(5mins)
Depending on random allocation, you might or might
not be assigned to carry out a brief diary-type task.
(5 min)
You will be asked to complete a set of questionnaires
(10mins)
Week 4
(Day 23)
BENEFITS AND RISKS
There are no risk involve.
74
COST, REIMBURSEMENT AND COMPENSATION
Your participation is voluntary. However, as part of your successful completion of this
study, if you are a
1. An undergraduate psychology student, you will receive a total of 2 tokens on the
PSYCHWEB system for participating.
2. Non-psychology undergraduate student, you will be entered into a lottery. The
lottery prize is one £50 amazon gift certificate.
Confidentiality / Anonymity
All data provided will be used as part of an MSc health psychology research project.
However, we ensure all your personal details (e.g. name and contact details) will not be
disclosed to anyone else except to the researcher.
Take note that you will be given a unique code number in this study. You will (i) not be
identified by anyone else and (ii) your personal details will not be linked to your responses
in any completed set of questionnaires or performance on the brief diary-type task.
As an Informed Participant of This Study, I understand that:
1. My participation is voluntary and I have the right to withdraw from this study at any
time.
If I wish to withdraw from this study, I will send the following email to the
researcher: “I WISH TO WITHDRAW FROM THIS STUDY”.
2. I am aware of what my involvement are in this study.
3. There are no risks involved in this study.
If you have read and understood the above, you could continue this study by giving consent
to participate.
If you want to clarify any doubts in this information sheet before participation or have any
questions during your course of participation, you can contact the researcher.
FURTHER INFORMATION
Any enquiries should be addressed to the researcher (LAI SIEW TIM) by email at
[email protected]
Thank You for Your Time
75
Appendix B
INFORMED CONSENT SHEET
CONSENT FORM
Title of Project: A Study on Human Emotion
Name of Researcher: LAI SIEW TIM
Please initial all boxes
1. I confirm that I have read and understand the information sheet. I have had the
opportunity to consider the information, ask questions and have had these
answered satisfactorily.
2.
I understand that my participation is voluntary and that I am free to withdraw at
any time. If I wish to withdraw from this study, I will send the following email
to the researcher: “I WISH TO WITHDRAW FROM THIS STUDY” at
[email protected]
3.
I understand that all data provided will be used as part of an MSc health
psychology research project, and my personal details (e.g. name and contact
details) will not be disclosed to anyone else except to the researcher.
4.
I am aware of of what my involvement are in this study, and there are no risks
involved in this study
5. I agree to take part in the above study.
Name of Participant
Date
Signature
76
Appendix C
POST-INTERVENTION INFORMATION SHEET
Dear Participant,
Thank you for your commitment in this research project. Your participation is highly
appreciated.
The main goal of this study was to investigate the effect of gratitude practice on well-being.
You were randomly assigned to either one of the conditions – (i) gratitude condition or a (ii)
control condition. Specifically, this research project sought to examine whether the
cultivation of gratitude by focusing on the good things that has happened to you can increase
your levels of positive emotions and overall quality of life.
I would like to offer the participants who were in the control condition (i.e. those who were
not assigned any brief diary-type task) the equal opportunity to obtain the guidelines for the
gratitude condition. If you wish to practice the gratitude intervention, please read the
following guidelines:
The Instructions for Gratitude Intervention
“There are many things in our lives, both large and small, that we might consider as a form
of blessing. It could be even be those who help us to reach our goals, or just make our lives
easier with small details. If we try to put ourselves in their shoes, appreciate their efforts,
and notice the voluntary nature of their acts, we have a good reason to feel grateful. Please
think of today and write down three things in your life that you are grateful for”.
FURTHER INFORMATION
If you want to clarify any doubts or have any questions, please address it to the researcher
(LAI SIEW TIM) by email at [email protected]
Thank you,
Lai Siew Tim
77
Appendix D
BASIC DEMOGRAPHIC INFORMATION
1. Name :
2. What is your age :
3. Sex (please tick):
Female
4. Please specify your ethnicity (please tick):
a) White
b) Hispanic or Latino
c) Black or African American
d) Native American or American Indian
e) Asian/Pacific Islander
f) Others (please specify)
Male
(
)
5. What is the highest degree or level of school you have completed/
currently pursuing?
a) Primary school
b) High school
c) Diploma or pre-university (e.g. A’levels)
d) Bachelor’s degree
e) Master’s degree
f) Professional degree
6. Are you currently employed?
Yes
No
7. Are you a undergraduate psychology student
Yes
No
(
)
If you are a non-psychology student, please specify
what course are you currently studying or have studied.
8. Personal contact details
E-mail address:
Mobile number (optional):
Thank You.
78
Appendix E
EMOTION STUDY QUESTIONNAIRE
I.
Warwick-Edinburgh Mental Well-being Scale (WEMWBS)
This survey is on the topic of human emotions. Please answer as honestly as possible. All
responses will be kept confidential.
Below are some statements about feelings and thoughts. Please circle the box that best
describes your experience of each over the last 2 weeks
None of the time
1
Rarely
2
Statements
1.
I’ve been feeling optimistic about
Some of the time
3
None of
the time
Rarely
Often
4
Some of
the time
All of the time
5
Often
All of the
time
1
2
3
4
5
the future
2.
I’ve been feeling useful
1
2
3
4
5
3.
I’ve been feeling relaxed
1
2
3
4
5
4.
I’ve been feeling interested in other
1
2
3
4
5
people
5.
I’ve had energy to spare
1
2
3
4
5
6.
I’ve been dealing with problems
1
2
3
4
5
well
7.
I’ve been thinking clearly
1
2
3
4
5
8.
I’ve been feeling good about
1
2
3
4
5
1
2
3
4
5
myself
9.
I’ve been feeling close to other
people
10.
I’ve been feeling confident
1
2
3
4
5
11.
I’ve been able to make up my own
1
2
3
4
5
mind about things
12.
I’ve been feeling loved
1
2
3
4
5
13.
I’ve been interested in new things
1
2
3
4
5
14.
I’ve been feeling cheerful
1
2
3
4
5
II.
III.
79
Positive Affect and Negative Affect Schedule (PANAS) &
Gratitude Adjectives Checklist (GAC)
This scale consists of a number of words that describe different feelings and emotions. Read
each item and then list the number from the scale below (i.e. using 1 – 5) next to each word.
Indicate to what extent you feel this way right now, that is, at the present moment.
Very Slightly or Not at All
1
1. Interested
2. Appreciative
3. Distressed
4. Excited
5. Upset
6. Thankful
7. Guilty
8. Scared
9. Hostile
10. Enthusiastic
11. Proud
12. Irritable
13. Alert
14. Ashamed
15. Inspired
16. Nervous
17. Determined
18. Attentive
19. Grateful
20. Jittery
21. Active
22. Afraid
23. Strong
A Little
2
Very
Slightly/
Not at All
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Moderately
3
Quite a Bit
4
Extremely
5
A Little
Moderately
Quite a Bit
Extremely
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
Note. Positive Affect (PA) adjectives are – interested, determined, attentive, proud, alert,
inspired, excited, strong, enthusiastic, and active. The Negative Affect (NA) adjectives are –
upset, distressed, guilty, nervous, jittery, hostile, irritable, scared, afraid, and ashamed. The
Gratitude Adjectives Checklist (GAC) contains – grateful, appreciative, and thankful.
IV.
80
The Grateful Disposition – (GQ-6)
Read each of these statements carefully, then using the scale 1 – 7, select the response that
indicates how much you agree or disagree with each statement.
Strongly
Disagree
1
Disagree
2
Slightly
Disagree
3
4
Statements
Agree
Slightly
Agree
5
Neutral
6
Strongly
Agree
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
3. When I look at the world, I don’t see much to be grateful for
1
2
3
4
5
6
7
4. I am grateful to a wide variety of people
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1. I have so much in life to be thankful for
2. If I had to list everything that I felt grateful for, it would be a
very long list
5. As I get older I find myself more able to appreciate the
people, events, and situations that have been part of my life
history
6. Long amounts of time can go by before I feel grateful to
something or someone
Note. Items 3 and 6 are reverse-scored
V.
81
Perceived Quality of Relationship with Close Others
This section involves your opinions on your interpersonal relationship with significant others,
and your thoughts about this study.
Read each of these statements carefully, then using the scale 1 – 4, select the response that
best describe your quality of relationship with a significant person. The significant person can
be anyone whom you have a close relationship with (e.g. family member or a close friend)
Not At All
1
A Little
2
Statements
1. To what extent can you contribute to the
well-being of the person
2. To what extent does the person contribute to
your well-being
Quite A Bit
3
A Great Deal
4
A
Quite
A Great
Little
A Bit
Deal
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Not At All
3. To what extent do you think you can count
on this person to help you with the problems
you have
4. To what extent can this person count of you
to help him/her with the problems that
she/he has?
VI.
82
Physical Symptoms Checklist
In this section, you will be asked about your health in general. Would you please, for all
symptoms mentioned, please tick (√) which symptoms you have been bothered by it for the
past 2 weeks.
Have you, during the 2 past week, been bothered by
Physical Symptom
Yes
No
1. Headaches
2. Faintness/dizziness
3. Stomachache/pain
4. Shortness of breath
5. Chest pain
6. Acne/skin irritation
7. Runny/congested nose
8. Stiff or sore muscles
9. Stomach upset/nausea
10. Irritable bowels
11. Hot or cold spells
12. Poor appetite
13. Coughing/sore throat
14. Other
Please indicate in the space provided if the experienced symptoms were not mentioned
above:
_________________________________________________________________________
VII.
83
Exploratory Data Form
This is the exploratory data form that is designed to ask your opinions and thoughts about this
study.
1) How motivated did you feel about doing this activity?
Very Slightly or Not at All
1
A Little
2
Moderately
3
Quite a Bit
4
Extremely
5
2) On average how many minutes did it take you to complete your activity?
** If you are assigned the brief diary-type task, please answer this question:
“We understand that at some point there are circumstances that cause you to unable to carry
out the assigned activity as intended. We appreciate your honesty to indicate throughout
these 21 days, how often you think you actually did the assigned activity.”
Please indicate by circling which statement best describe you
Never
1
A few times in
three weeks
2
Once in two
weeks
3
A few times in
two weeks
4
Once a
week
5
A few times
a week
6
Daily
7
Thank you.
84
Appendix F
BRIEF-DIARY TYPE TASK
Instructions:
You have been randomly assigned to perform a brief diary-type task.
The instruction is as below:
“There are many things in our lives, both large and small, that we might consider as a form of
blessing. It could be even be those who help us to reach our goals, or just make our lives easier
with small details. If we try to put ourselves in their shoes, appreciate their efforts, and notice the
voluntary nature of their acts, we have a good reason to feel grateful. Please think of today and
”
write down three things in your life that you are grateful for .
Please continue this for 21 days. I would be very grateful if you could return this journal to me upon
completion. However, there is no penalty involved if you do not wish to do so.
Researcher: Lai Siew Tim
Contact: [email protected] [or]
[email protected]
85
MY DAILY JOURNAL –
Counting My Blessings
Days
List three things you are grateful for today…
1. MY SISTER JUST GAVE BIRTH TO A HEALTHY
Date
Time taken (mins)
BABY BOY
EXAMPLE
2. MY
E.G.
HUSBAND PICKED UP MY FAVOURITE ICE
CREAM FOR DESSERT ON THE WAY HOME FROM
21/04/2014
WORK TODAY
3. I
1
1.
2.
3.
2
1.
2.
3.
3
1.
2.
3.
4
1.
2.
3.
5
1.
2.
3.
6
1.
2.
3.
7
1.
2.
3.
FOUND PARKING NEAR MY OFFICE
5
86
Days
8
Date
1.
2.
3.
9
1.
2.
3.
10
1.
2.
3.
11
1.
2.
3.
12
1.
2.
3.
13
1.
2.
3.
14
1.
2.
3.
Time taken (mins)
87
Days
15
Date
1.
2.
3.
16
1.
2.
3.
17
1.
2.
3.
18
1.
2.
3.
19
1.
2.
3.
20
1.
2.
3.
21
1.
2.
3.
Time taken (mins)
88
Appendix G
INSTRUCTIONS
I.
Standard script for pre-intervention
Control Group
Gratitude Condition
Hi,
Hi,
A few weeks ago, you took part in a survey
entitled "A Study on Human Emotion". I very
much appreciate you taking the time to
complete that survey. At that time you gave
permission for me to now contact you.
A few weeks ago, you took part in a survey
entitled "A Study on Human Emotion". I very
much appreciate you taking the time to complete
that survey. At that time you gave permission for
me to now contact you.
Based on random allocation for the research
project, you do not need to keep a diary of
your thoughts. Please continue carrying out
your normal daily activities.
Between (Date) to (Date/Month/Year), I will
send you another link to complete a brief
questionnaire which takes no longer than 5
minutes to complete.
Please keep this for reference: Your unique
participant ID is XXX. (This is required to
complete the later part of the questionnaire).
If you have any questions about the study or
how your information will be used please
contact me.
Thank you very much once again for your
participation, it is very much appreciated.
Kind Regards,
Lai Siew Tim
Department of Psychology
Stirling FK9 4LA
email: [email protected] [or]
[email protected]
Based on random allocation for the research
project, you are assigned to a group which
requires you to complete a brief-diary type task
(Please refer to the attached document for
instructions). You are invited to carry out this
task for 21 days. The task should take less than 5
minutes each day.
You should begin your task on
(Date/Month/Year) and it ends on
(Date/Month/Year)
When you have finished, please return the
completed diary back to me either in docx. or pdf
format via email. None of your responses will be
linked to your personal identification data.
Between (Date) to (Date/Month/Year), I will send
you another link to complete a brief questionnaire
which takes no longer than 5 minutes to complete.
Please keep this for reference: Your unique
participant ID is XXX. (This is required to
If you have any questions about the study or how
your information will be used please contact me.
Kind Regards,
Lai Siew Tim
Stirling FK9 4LA
[email protected]
89
Standard script for participants in the gratitude condition – Beginning of the
Count-Your-Blessings Intervention (Time-point 1)
II.
Hi,
Thank you for participating in a survey entitled “A Study on Human Emotion”.
This email is to remind you that you should begin the count-your-blessings journal
today (Date/ Month/ Year).
Around (Date) to (Date/ Month/ Year), I will then send you another link to complete a
brief questionnaire which takes no longer than 5 minutes to complete.
Please keep this for reference: Your unique participant ID is XXX. (This is required to
If you have any questions about the study or how your information will be used please
contact me.
Thank you very much once again for your participation, it is very much appreciated.
Kind Regards,
Lai Siew Tim
Stirling FK9 4LA
email: [email protected] [or] [email protected]
Note. There was no email required for the control group condition.
90
Standard script for participants in the gratitude condition – A week after the
start of the Count-Your-Blessings Intervention (Mid time-point)
III.
Hi,
Thank you for agreeing to take part in my research project. By now you should have
completed the first 7 days of the study. Please continue to keep a diary of your thoughts
for another 14 days.
If you have not started the brief-diary type task, could you please begin today and refer
to the attached document for instructions?
For further information or any questions regarding this study, do not hesitate to drop me
an email.
Thank you once again for agreeing to take part in my research project.
Kind Regards,
Lai Siew Tim
Stirling FK9 4LA
email: [email protected] [or] [email protected]
Note. There was no email required for the control group condition.
IV.
91
Standard script for post-intervention
(Time Point 2; 3-weeks apart; 21 days after the intervention)
Control Group
Gratitude Condition
Hi,
Hi,
Thank you for agreeing to participate in my
survey entitled "A Study on Human
Emotion". You gave the permission for me to
now contact you.
Thank you for agreeing to participate in my
survey entitled "A Study on Human
Emotion". You gave the permission for me to
now contact you.
Could you please now use your unique
participant ID (XXX) to complete a brief
Please return the completed diary back to me
either in docx. or pdf format via email.. None
of your responses will be linked to your
personal identification data.
The link is: (INSERT LINK)
Please keep your unique participant ID for
reference, your name will be entered in a
lottery system.
contact me.
Kind Regards,
Lai Siew Tim
Stirling FK9 4LA
[email protected]
Could you now please use your unique
participant ID (XXX) to complete a brief
The link is: (INSERT LINK)
Do keep your unique participant ID for
reference, your name will be entered in a
lottery system.
contact me.
Kind Regards,
Lai Siew Tim
Stirling FK9 4LA
[email protected]
92
Appendix H
INSTRUCTIONS FOR RANDOMIZATION PROCEDURE
The number “108”
is the amount of
participants who
completed the
baseline measures
prior to the
intervention
The number range
from 1 to 2 to
further determine
the allocation of
group via the cointossing method.
Adapted from: Urbaniak, G. C., & Plous, S. (2013). Research Randomizer (Version 4.0)
[Computer software]. Retrieved on June 22, 2013, from http://www.randomizer.org/
93
Appendix I
Table 1
VIA Classification of Strengths
Wisdom and Knowledge
Creativity
Curiosity
Open-mindedness
Love of learning
Perspective
Thinking of novel and productive ways to do things
Taking an interest in all of on-going experience
Thinking things through and examining them from all sides
Mastering new skills, topics, and bodies of knowledge
Being able to provide wise counsel to others
Courage
Honesty
Bravery
Persistence
Zest
Speaking the truth and presenting oneself in a genuine way
Not shrinking from threat, challenge, difficulty, or pain
Finishing what one starts
Approaching life with excitement and energy
Humanity
Kindness
Love
Justice
Fairness
Leadership
Teamwork
Temperance
Forgiveness
Modesty
Prudence
Self-regulation
Transcendence
Appreciation of beauty
and excellence
Gratitude
Hope
Humour
Religiousness
Doing favours and good deeds for others
Valuing close relationship with others
Being aware of the motives and feelings of self and others
Treating all people the same according to the notions of
fairness and justice
Organizing group activities and seeing that they happen
Working well as member of a group or team
Forgiving those who have done wrong
Letting one’s accomplishments speak for themselves
Being careful about one’s choices; not saying or doing
things that might later be regretted
Regulating what one feels and does
Noticing and appreciating beauty, excellence, and/ or
skilled performance in all domains of life
Being aware of and thankful for the good things that happen
Expecting the best and working to achieve it
Liking to laugh and joke; bringing smiles to other people
Having coherent beliefs about the higher purpose and
meaning of life
Note. Descriptions of character strengths organized under the six broad virtues - Wisdom and
Knowledge, Courage, Humanity, Justice, Temperance and Transcendence.
Adapted from Peterson, C., & Seligman, M. E. P. (2004). Character strengths and virtues:
A handbook for classification. Washington, DC: American Psychological Association.
94
Table 2
Types of positive psychology interventions (PPI)
Components
Gratitude
Techniques
Three good
things
Gratitude visit
Optimism
You at your
best
Best possible
selves
Kindness
Character
strengths
Brief descriptions
List down three things that
happened in your day and
provide a causal explanation
Remarks
 Practical and simple
With a given a time frame, write
 Mixed findings revealed
a letter of gratitude to someone
potential confounds
who had been especially kind to
whether to mail letter or
you but had never been properly
not
thanked
Visualise and write about a time
when you were at your best and
reflect on the personal strengths
displayed in the story
Imagine and write about the
realisation of your dreams and
fulfilment of life goals
 Envisioning future or
best possible selves is
self-relevant and
motivating
Counting
kindness
With a given time frame, you
are to keep track of your own
kind behaviours towards others
 Dependent on the
quantity of kind acts
 Dependent on the
magnitude of the acts
(i.e. big or small)
Identify and
Use signature
strengths
Complete and receive
individualized feedback about
your top five strengths via the
online inventory of character
strengths. Use one of the top
strengths in a new and different
way for
 Provide insight to both
clients and therapists to
build or cultivate
particular strengths
 Though inventory is
fairly reliable, it has not
been used extensively
on clinical populations
95
Table 3
Conception of trait gratitude
Conception
Scale (or sub-scale)
assessing conception
Brief descriptions
Characteristic item
Assess gratitude as a
single factor, based on the
frequency, intensity, and
density of grateful affect.
I have so much in life to be
thankful for
Gratitude towards other
people
I am really thankful for
friends and family
I reflect on how important
my friends are to me
A focus on the positive
tangible and intangible
assets that a person
possesses.
The absence of feeling
deprivation
I reflect on how fortunate I
am to have basic things in
life like food, clothing, and
shelter
I think life has handed me as
a short stick (reverse coded)
AS:
awe
Frequency of feeling awe
When I see natural beauty
like Niagara Falls, I feel like
a child who is awestruck
AS:
ritual
Performing regular
behaviours to express
gratitude
AS:
gratitude
Behaviours designed to
express gratitude
Individual
differences
in grateful
affect
GQ-6
Appreciation
of other
people
GRAT:
appreciating others
AS:
interpersonal
Focus on
what the
person has
Awe
AS:
have focus
GRAT:
sense of abundance
Behaviour
Present
moment
AS:
present moment
GRAT:
simple appreciation
Life is short
AS:
loss/ adversity
Positive
social
comparisons
AS:
self/social
comparison
Regularly focusing
positive aspects in a given
moment
Gratitude towards nonsocial sources
Appreciation arising from
the understanding nothing
is permanent
Positive feelings arising
for appreciation of how
life could be worse
I use personal or religious
rituals to remind myself to
be thankful to things
I say “please” and “thank
you” to indicate my
appreciation
I stop and enjoy my life as it
is
I think it is really important
to “stop and smell the roses”
Thinking about dying
reminds me to live every
day to the fullest
When I see someone less
fortunate than myself, I
realize how lucky I am
Note. GQ-6 (McCullough et al., 2002); AS = Appreciation Scale (Adler & Fagley, 2005);
GRAT = Gratitude, Appreciation, and Resentment Test (Watkins et al., 2003).
Based in part on Wood, Maltby, Stewart, & Joseph (2008).
Adapted from:
Wood, A. M., Froh, J. J., & Geraghty, A. W. A. (2010). Gratitude and well-being: A review
and theoretical integration. Clinical Psychology Review, 1-16. doi:
10.1016/j.cpr.2010.03.005 [Original Source].
Table 5
Independent t-test for completer analysis on the comparison of group differences in
relation to the effects of gratitude intervention (n = 81)
Measuresa
WEMWBS
Timeb
T1
T2
GRAT
M
SD
46.17 10.00
45.50 10.81
CTRL
M
SD
45.69
9.38
39.47 13.87
t
-.221
-2.14
Df
79
79
p
.826
.036*
95% CI
[-4.779, 3.823]
[-11.64, -.419]
PANAS
PA
T1
T2
31.38
33.47
8.31
8.23
30.87
28.69
7.13
8.22
-.304
-2.60
79
79
.762
.011*
[-3.940, 2.895]
[-8.443, -1.124]
NA
T1
T2
22.00
20.83
9.05
6.62
21.93
23.38
7.65
8.93
-.036
1.43
79
79
.971
.158
[-3.761, 3.628]
[-1.010, 6.099]
GAC
T1
T2
9.83
11.67
3.87
2.55
9.69
9.13
2.75
3.62
-.196
-3.85
60.96
78.81
0.851
.001**
[-1.673, 1.384]
[-3.842, -1.225]
GQ-6
T1
T2
33.43
33.36
5.99
5.80
31.82
28.16
6.18
8.86
-1.92
-3.04
79
79
.058
.003**
[-4.355, .074]
[-8.618, -1.793]
Social
relationship
T1
T2
14.39
13.61
4.44
2.50
13.36
12.78
3.15
3.40
-1.23
-1.23
79
79
.224
.223
[-2.713, .646]
[-2.183, .516]
Physical
symptoms
T1
T2
4.46
3.77
4.44
3.01
5.07
4.34
3.20
3.11
-.055
.878
79
79
.956
.383
[-1.232, 1.167]
[-.795, 2.051]
Gratitude
a
Measures were denoted as:
WEMWBS, Warwick-Edinburgh Mental Well-being Scale (WEMWBS); PANAS,
(Positive Affect [PA] and Negative Affect [NA] Schedule); GAC, (Gratitude Adjectives
Checklist); GQ-6, (Gratitude Dispositional Scale)
b
Time represented the intervention periods – pre-intervention (T1); post-intervention (T2)
Significance levels tested with unrelated t-test. Statistical significant differences are
highlighted in bold
* p < .05;
** p < .01

The Efficacy of Gratitude Practice on Well-Being

Transcription

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