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The effects of gratitude expression on neural activity

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The effects of gratitude expression on neural activity
Prathik Kini, Joel Wong, Sydney McInnis, Nicole Gabana, Joshua W. Brown
Indiana University, Bloomington, United States
abstractarticle info
Article history:
Received 23 July 2015
Accepted 23 December 2015
Available online 30 December 2015
Gratitude is a common aspect of social interaction, yet relatively little is known about the neural bases of grati-
tude expression, nor how gratitude expression may lead to longer-term effects on brain activity. To address
these twin issues, we recruited subjects who coincidentally were entering psychotherapy for depression and/
or anxiety. One group participated in a gratitude writing intervention, which required them to write letters ex-
pressing gratitude. The therapy-as-usual control group did not perform a writing intervention. After three
months, subjects performed a Pay It Forwardtask in the fMRI scanner. In the task, subjects were repeatedly
endowed with a monetary gift and then asked to pass it on to a charitable cause to the extent they felt grateful
for the gift. Operationalizing gratitude as monetary gifts allowed us to engage the subjects and quantify the grat-
itude expression for subsequent analyses. We measured brain activity and found regionswhere activity correlat-
ed with self-reported gratitude experience during the task, even including related constructs such as guilt
motivation and desire to help as statistical controls. These were mostly distinct from brain regions activated by
empathy or theory of mind. Also, ourbetween groups cross-sectional study found that a simplegratitude writing
intervention was associated with signicantly greater and lasting neural sensitivity to gratitude subjects who
participated in gratitude letter writing showed both behavioral increases in gratitude and signicantly greater
neural modulation by gratitude in the medial prefrontal cortex three months later.
© 2015 Elsevier Inc. All rights reserved.
Keywords:
Gratitude
fmri
Plasticity
Counseling
Empathy
Introduction
Gratitude is an essential part of human prosocial behavior. A number
of recent studies have shown the benets of gratitude interventions on
well being, mainly using gratitude letter writing or keeping a gratitude
diary, both of which can be effective (Kaczmarek et al., 2015). Gratitude
interventions have recently been shown as effective at increasing well
being in students (Flinchbaugh et al., 2012), those with chronic pain
(Baxter et al., 2012), depression (Cheng et al., 2015), and older adults
(Killen and Macaskill, 2015). Gratitude interventions have similar effec-
tiveness compared with mindfulness interventions (OLeary and
Dockray, 2015) and practicing kindness (Kerr et al., 2015).
Despite the recent ndings regarding gratitude intervention effec-
tiveness, the basic neural mechanisms involved in gratitude are rela-
tively unknown, as are the neurological mechanisms mediating the
effects of gratitude interventions (Layous et al., 2011). On the one
hand, gratitude may involve affective processes. Gratitude has been
characterized as a positive moral affect alongside other moral affects
such as empathy, sympathy, guilt, and shame, and as a force that helps
people maintain positive social reciprocity (McCullough et al., 2001).
On the other hand, other work has cast gratitude as related to a more
cognitive process of benetappraisal(Wood et al., 2008).
Gratitude may also be delineated in terms of experience vs. expres-
sion. The recipients (or observers) of a generous or prosocial act may
experience emotions related to gratitude, such as positive affect,
empathy, and increased inclination toward prosocial behavior
(Emmons and Stern, 2013). The experience of gratitude may natural-
ly lead to an expression of gratitude, which typically takes the form
of a verbal recognition (thank you)orareciprocalgift(suchas
generous restaurant tipping). In this paper we address both experience
and expression of gratitude in three inter-related ways. First, subjects in
an experimental group express gratitude in the form of a written letter
three months prior to fMRI scanning. Second, during scanning, we
model gratitude as an expression, with monetary gifting as a quanti-
able operationalization of gratitude expression. Third, during scanning,
we also ask subjects to evaluate their experience of gratitude on each
trial, with self-reports on a Likert scale.
Gratitude has been studied with neuroimaging as part of more gen-
eral investigationsof human social value (Zahnet al., 2009), but the spe-
cic neural correlates of gratitude have only recently been explored
(Fox et al., 2015). A number of similar social cognitive and affective con-
structs have been studied, including trust and reciprocity (King-Casas
et al., 2005), fairness (De Quervain et al., 2004; Sanfey et al., 2003),
and empathy (Singer et al., 2004, 2006). Collectively these studies high-
light a number of brain regions as central to social interaction, including
prominently the anterior cingulate cortex (ACC), anterior insula (AI),
ventromedial prefrontal cortex (vmPFC), and striatum, which are gen-
erally limbic regions associated with affect and valuation. The anterior
NeuroImage 128 (2016) 110
Corresponding author at: Dept. of Psychological and Brain Sciences, 1101 E Tenth St.,
Bloomington, IN 47405-7007, United States.
E-mail address: jwmbrown@indiana.edu (J.W. Brown).
http://dx.doi.org/10.1016/j.neuroimage.2015.12.040
1053-8119/© 2015 Elsevier Inc. All rights reserved.
Contents lists available at ScienceDirect
NeuroImage
journal homepage: www.elsevier.com/locate/ynimg
cingulate cortex in particular may play a key role in predicting and eval-
uating the outcomes of actions (Alexander and Brown, 2010, 2011), in-
cluding in social contexts (Chiu et al., 2008; King-Casas et al., 2005;
Tomlin et al., 2006). ACC activity reects and drives avoidance behavior,
especially of potential losses (Brown and Braver, 2007; Fukunaga et al.,
2012) as well as potential regret (Coricelli et al., 2005) and social affect
(Harris et al., 2007), and has been shown to correlate with empathy
(Rameson et al., 2012), especially for pain (Singer et al., 2006). If grati-
tude involves primarily an affective process, then gratitude expression
should correlate with activity in the limbic regions.
Gratitude may also involve cognitive processes, including computa-
tions and appraisals of appropriate reciprocity (Wood et al., 2008).
Mental calculations generally involve more dorsolateral prefrontal and
parietal brain regions (Dehaene et al., 2004). Thus, if gratitude involves
more cognitive than affective processes, then gratitude expression
should correlate with activity in the parietal and dorsolateral prefrontal
regions.
In addition to questions about the basic neural mechanisms of grat-
itude, there is potential clinical relevance. Growing evidence supports
the mental health benets of gratitude interventions (e.g.Boehm et al.,
2011; Emmons and McCullough, 2003; Froh et al., 2008; Lyubomirsky
et al., 2011; Seligman et al., 2005; Sheldon and Lyubomirsky, 2006;
Watkins et al., 2003). Research on such interventions has focused main-
ly on non-clinical populations (e.g., college and high school students).
Still, the basic neural mechanisms through which gratitude interven-
tions might positively inuence mental health are not well understood.
Several mechanisms have been proposed (Emmons and Mishra, 2012;
Geraghty et al., 2010) but only one peer-reviewed study so far has
identied a mediator (i.e., feelings of gratitude) of the positive effects
of a gratitude intervention (Emmons and McCullough, 2003).
Here our aim is to elucidate specically the basic neural correlates of
gratitude expression, and we do not investigate or report clinical effects.
Our study focuses on four related questions: rst, what are the immedi-
ate neural activity correlates associated with acts of expressing
gratitude (operationalized as monetary gifts)? Second, is the neural ac-
tivity more consistent with gratitude as a cognitive process or as an
emotional process? Third, to what extent does gratitude expression in-
volve the brain regions associated with empathy and theory of mind
processes? Fourth, what are the long-term effects of written gratitude
expression (as distinct from grateful monetary gifting) on neural sensi-
tivity to gratitude?
To addressthese questions, we developed a variant of the trust game
(Berg et al., 1995), called the Pay It Forwardtask, in which subjects ex-
press gratitude as monetary gifts while undergoing fMRI. We adminis-
tered a short gratitude writing intervention to half of the subjects and
explored the effect of that intervention on brain activity during the grat-
itude task several months later. This approach allows us to measure
both the immediate neural activity associated with gratitude and the
lasting effects of gratitude expression on brain activity. Here we show
two main results: rst, that gratitude correlates with activity in specic
set of brain regions; and second, that a simple gratitude writing inter-
vention is associated with signicant increases in both gratefulness
and neural sensitivity to gratitude over the course of weeks to months.
Methods
Subject recruitment
Subjects were recruited from a population of psychotherapy cli-
ents seeking clinical counseling. All subjects provided written in-
formed consent, and all procedures were approved by the Indiana
University IRB. Subjects were randomized to one of three conditions:
a gratitude writing intervention, an expressive writing intervention,
or a psychotherapy-only condition. The randomization was per-
formed with successive subjects to keep the running group sizes as
equal as possible, without regard for particular demographic factors.
Subjects initially completed the six-item Gratitude Questionnaire
(GQ) (Mccullough et al., 2002), the three-item gratitude adjectives
scale (GAC3) (Mccullough et al., 2002), which assess self-reports of
how grateful one feels in daily life, and the BHM-20 scale, which
briey assesses mental health, including anxiety and depression
(Kopta and Lowry, 2002). Higher BHM-20 scores reect better men-
tal health. For the gratitude writing intervention, subjects were
asked to spend 20 min writing a letter to someone expressing grati-
tude. They did this during three consecutive sessions on the rst, sec-
ond, and third week of counseling. They were instructed that they
could choose whether or not to actually send the letters to the recip-
ient. Subjects in the expressive writing condition were asked to write
about their most stressful episodes in life. Three months after
counseling, the gratitude writing and psychotherapy-only subjects
were recruited to participate in the fMRI task.
A total of 43 clients (22 in the gratitude intervention condition and
21 in the psychotherapy only condition, age range 18 to 34, mean
22.98, 32 females, all right handed) were recruited for the fMRI study.
We did not scan the expressive writing subjects for cost reasons, al-
though future studies might consider doing so as an additional control.
The subject demographics are summarized in Table 1. There was no dif-
ference between the fMRI gratitude writing vs. psychotherapy-only
groups with respect to their age (p=0.50), gender (p = 0.73) initial
GQ (trait gratitude) scores (p=0.41), or symptoms of anxiety/depres-
sion as measured on the BHM-20 symptom subscale (p=0.55). The av-
erage BHM-20 score at intake was 2.39 for the gratitude group and 2.50
for the therapy-as-usual group (Table 1), which is consistent with aver-
age scores of 2.33 for psychotherapy outpatients and 2.68 for college
counseling clients, as reported by the BHM-20 developer (Kopta and
Lowry, 2002), who also reported for comparison that the average
healthy college student BHM-20 score was 3.13 (SD=0.51). Lower
BHM-20 scores indicate more symptoms of anxiety and/or depression.
fMRI task
In order to perform the study in a controlled setting, the expression
of gratitude was operationalized as money, with a function similar to
tipping a restaurant server. To partly dissociate gratitude from guilt
aversion, we modied the trust game (Berg et al., 1995) to make it a
Pay It Forward(PIF) task (Fig. 1). In the PIF task, subjects acted as a
Trustee,who received a sum of money between $1 and $20 from a ben-
efactor, whose picture wasshown on the screen. Subjects were told that
the benefactor was a real person, not a computer, although the endow-
ments were in fact determined by a computer. The subjects were then
shown a potential third party beneciary, with whom the trustee
could share any portion of the endowment given by the benefactor.
They were told that the benefactor did not want the money back, but
that the benefactor wanted them to pass on what they had received if
they felt that they wanted to express gratitude for the endowment.
The beneciary was said to not have immediate need of the money,
but would nevertheless appreciate it. We could have quantied grati-
tude simply as a Likert rating, but we chose not to. Instead, we chose
to operationalize gratitude here as money given, for several reasons.
First, it renders gratitude quantiable in terms of monetary value,
which is necessary for the quantitative analyses we perform. Second,
Table 1
Demographics. Subjects showed no signicant differences between groups regardingage,
gender, initial gratitude (GQ), or initial anxiety/depression symptoms (BHM-20).
Variable Gratitude Control P
Gender F= 17, M=5 F= 15, M=6 0.73 (Fisher exact 2 sided)
Age (range 1834) 23.41 22.52 0.50 (2 tailed)
GQ 5.38 5.67 0.41 (2 tailed)
Symptoms
(initial BHM-20)
2.39 2.50 0.55 (2 tailed)
2P. Kini et al. / NeuroImage 128 (2016) 110
we reasoned that a costly expression of gratitude was more likely to en-
gage the subjects than a cost-free expression, such as a Likert rating of
experienced gratitude. Third, monetary gifts as expressions of gratitude
are ecologically valid as for example in tipping restaurant servers, with
the caveat that our task here involves payment to a third party rather
than reciprocity to the benefactor. Of note, we still measured the self-
reported experience of gratitude separately on each trial as described
below.
Subjects were placed in the fMRI scanner and performed repeated it-
erations of the PIF task. They performed ve runs of 7.5-minute fMRI
blocks. Each trial began with one of ten possible benefactor faces and
names, 5 male and 5 female with neutrallevels of emotional expression
(Fig. 1). The ctitious benefactors name appeared above the face, and
the amount of the endowment for the trial was displayed below the
benefactors face. The endowment range was between $1 and $20 for
each trial. The endowment value was visible for 3 seconds followed by
a blank screen for a jittered interval with a minimum of 1 second dura-
tion, followed by a potential beneciary, with the ctitious name of the
beneciary above. The beneciary was one of eight possibilities, either a
ctitious person, (neutral emotional expression, p= 0.5 female, p=0.5
Caucasian), or a politically neutral charity (Aid for Africa, Indiana Wild-
life Federation, Mother Hubbards Kitchen, or the Rainforest Founda-
tion). The beneciary was visible for 3 seconds followed by a jittered
interval of a minimum one second duration, followed by a cue to select
a donation amount. Once subjects selected a donation amount via but-
ton presses, they were asked to rate on 5-point Likert scale their
a) gratitude motivation, (b) their desire to help the particularbenecia-
ry, (c) their guilt motivation. The order of these three questions was
consistent across trials, i.e. not counterbalanced, for two reasons. First,
we wanted to ensure that gratitude self-report was always rst and
thus not contaminated by order effects from subsequent questions. Sec-
ond, the consistent order of the remaining two questions made them
more predictable, which we expected would reduce confusion about
the questions and lower reaction times. This mattered because the
responses were self-paced in order to ensure that subjects provided a
response to all self-report questions on all trials. The tradeoff with our
design choice is that we cannot rule out order effects of the self-report
question responses. Still, the self-paced design maximizes trial yield
while ensuring that subjects answer every question. For validity, sub-
jects were informed that one of their interactions would be chosen at
random and actually paid out according to their choices, with the desig-
nated gift going to the charity and the remaining portion being paid to
the subject. We did in fact choose one of each subjects choices and
pay it to the designated charity, except that when the beneciary was
an individual, then themoney wentto a charitable organization instead
for purposes of accountability. After the self report phase of each trial
there was a jittered interval with a minimum one second duration
until the start of the following trial. Each run began with and ended
with 15 seconds of blank screen to establish a baseline of neuralactivity.
There were 27 trials per block, which led to 135 trials per subject.
We counterbalanced the order of button presses across subjects, so
that for half of the subjects, the left hand pressed buttons1 (little nger)
through 5 (thumb), and for the other half of subjects, the left hand
pressed buttons 0 (little nger), 9 (ring nger), 8 (middle nger), 7
(index nger), and 6 (thumb). The nger-to-button mapping was pre-
sented visually to the subjects during the experiment. This motor
counterbalancing avoids potential confounds between motor-related
activation and higher-level factors such as gratitude, guilt, and desire
to help, allowing the motor activation to load instead on motor regres-
sors at the time of button press. Subjects indicated the amount of money
they wished to give by pressing two buttons in succession, correspond-
ing to the tens and ones places of the number of dollars they wished to
give.
fMRI methods and analysis
Images were acquired on a 3T Siemens TIM Trio scanner using a 32-
channel head coil. Functional BOLD data were collected at a 30° angle
Fig. 1. The Pay It Forwardtask. Each trial of the task began with a benefactor, who endowed the subject with a dollar value between $1 and $20. After a variable delay, the subject was
shown a charitable cause (person or organization) to which they could donate. They were told that the benefactor requested them to donate to the charity to the extent that they
appreciated the benefactors gift. Subjects were then given an opportunity to type in a donation amount. Then they were asked to rate on a Likert scale how much the factors of
gratitude, desire to help the cause, and guilt inuenced their decision ab out how much to give. All jittered delays lasted between 1 and 7 seconds, with an aver age of 2.14 s,
exponentially distributed. A wide range of charities and benefactor ethnicities were used in the experiment in order to maximize the variance in the responses. One response from
each subject was chosen to be actually paid the subject was given the amount of money they chose to keep, and the donation amount was given to the charity.
3P. Kini et al. / NeuroImage 128 (2016) 110
from the anterior commissureposterior commissure line in order to
maximize signal-to-noise ratio in the orbital and ventral regions of the
brain (Deichmann et al. 2003). FunctionalT2-weighted images were
acquired using a gradient echo planar imaging sequence with 35 axial
slices and 3.44 × 3.44 × 3.8 mm voxels; TR= 2000 ms; TE = 25 ms;
64 × 64 voxel matrix; ip angle = 70; eld of view =
220mm × 220mm. High resolution T1-weighted MPRAGE images
were collected for spatial normalization excitation consisting of
160 sagittal slices (256 × 256 × 160 voxel matrix of 1 × 1 × 1 mm
voxels, TR = 1800 ms; TE = 2.67 ms; ip angle = 9) at the end of
each session.
Functional data were spike-corrected on a voxel-by-voxel basis to
reduce the impact of artifacts using AFNI's 3dDespike (http://afni.
nimh.nih.gov/afni). Subsequent preprocessing was done using SPM5
(Wellcome Department of Imaging Neuroscience London, UK; www.
l.ion.ucl.ac.uk/spm/). Functional images were corrected for differences
in slice timing using sinc-interpolation (Oppenheim et al., 1999) and
head movement using a least-squares approach and a 6 parameter
rigid body spatial transformation. Once the resulting images were
coregistered to the structural image and normalized to the SPM stan-
dard 152T1 atlas template Montreal Neurological Institute (MNI)
space usingthe standard SPM5 normalization functions withboth afne
and nonlinear warping, the resulting functional images were then spa-
tially smoothed with an 8-mm3 full-width-at-half-maximum isotropic
Gaussian kernel. Functional neuroimaging data were statistically ana-
lyzed based on a general linear model (GLM) with random effects im-
plemented in SPM5. Each individual subjectsGLMwasestimatedwith
a canonical hemodynamic response function with no derivatives, a
microtime resolution of 16 time bins per scan, a high-pass lter cutoff
of 128 seconds using a residual forming matrix, autoregressive
AR(1) to account for serial correlations, and restricted maximum likeli-
hood (ReML) for model estimation.
For each subject, we constructed GLMs with the aim of measuring
the processes involved in the decision to express a level of gratitude
with a monetary gift. We included one regressor for each of the follow-
ing event types, each with events modeled as having zero duration: the
onset of the endowment event, the onset of the beneciary information,
the onset of the decision time (i. e. the prompt to enter a donation
amount), the onset of the rst button press (when subjects indicated
how much they wanted to pay forward), the onset of the second
button press (again for how much to pay forward), the onset of the
gratitude rating button press (a single digit on a Likert scale), the
onset of the desire to help rating button press (also on a Likert scale),
and the onset of the guilt motivation rating button press (also on a
Likert scale). Although the information about which button was pressed
provided valuable information (and that information was recorded),
the motor-related activity of the button press itself was unimportant,
so the button press regressors were largely nuisance regressors to ac-
count for motor-related activation that was not of interest. In addition,
we added four parametrically modulated (PM) regressors, with zero-
duration events modeled at the onset of the decision time. The height
of each modeled event was determined by the corresponding PM,
which was mean-centered for each subject. These PM regressors were
independent of the button press response regressors, because the PM
regressors were mean-centered and parametrically modulated, and
they occurred at somewhat different times. The varying parametric
modulation across events decorrelates the PM regressors from regres-
sors that model the main effect of an event. The rst PM was the grati-
tude rating; the second was the guilt rating; the third was the desire
to help rating, and the fourth was the percent of the initial endowment
actually given. These PM regressors afforded an estimate of how much
each self-reported emotion correlated with activity at the time of deci-
sion. We were primarily interested in the gratitude PM regressor,
while the others served as statistical controls. It is important to note
that the order matters when entering the PM, because successive PMs
are orthogonalized with respect to the preceding ones. This means
that the rst PM regressor entered has priority in accounting for any
variance shared with subsequent regressors. We also included motion
regressors for those subjects (eight in total) who had more than 3 mm
total movement across a session or 0.5 mm from one image acquisition
to another. In that case, we included 24 motion regressors, using a
Volterra expansion (Friston et al., 1996): the six degrees of freedom in-
cluding three for translation and three for rotation, the squaredvalues of
the six degrees of freedom, the scan-to-scan difference (i.e. time deriv-
ative) of the six motion regressors, and the squared values of the six
time derivative regressors. Selectively including motion regressors for
subjects with substantial movement maximizes the sensitivity to real
effects while minimizing the spurious effects of motion (Johnstone
et al., 2006). GLM regressor contrasts were computed for each subject
and then evaluated with random effects tests at the population level.
Unless otherwise noted, we analyzed each regressor across the popula-
tion by looking at the whole brain, with an initial threshold of p b0.001,
and we report as signicant those regions which further passed a
cluster-correction for multiple comparisons with p b0.05, using SPM5
standard cluster correction based on random eld theory.
Results
The gratitude writing intervention led to better clinical outcomes in
a larger cohort of subjects than we analyze here, but there were no sig-
nicant differences in clinical outcomes between the therapy-as-usual
control group and the gratitude group fMRI subjects here, as we elabo-
rate below. We treat the clinical questions and results more fully in a
separate paper (Wong et al., in preparation). Briey, in a larger cohort
of several hundred subjects, those in the gratitude writing condition (in-
cluding all subjects, both those that were fMRI participants and those
that were not) reported signicantly better mental health than those
in the expressive writing and therapy-as-usual control conditions
about 4 weeks and 12 weeks after the conclusion of the writing
interventions. Additionally, when the gratitude writing condition was
compared to the expressive writing condition, a lower proportion of
negative emotion words in subjectswriting mediated the effect of
condition on mental health. That is, subjects in the gratitude writing
condition used a lower percentage of negative words than those in the
expressive writing condition, which was in turn associated with better
mental health. Detailed information about these ndings are described
in a separate manuscript (Wong et al., in preparation).
With regard to only the subjects who participated in the present
fMRI study, we found no signicant differences in the clinical outcomes
of those in the gratitude group vs. those in the therapy-as-usual control
group. We compared the difference in BHM-20 scores one week after
the writing sessions relative to intake (two weeks before completion
of all the writing sessions). The gratitude subjects showed a trend of
greater improvement relative to therapy-as-usual controls, but this
was not signicant (Gratitude group increase = 0.36, Control group
increase= 0.17, t(39)=1.44,p =0.08, one-tail). However, thegratitude
subjects did show a greater increase in gratitude (GAC) scores rela-
tive to therapy-as-usual controls at one week after the writing ses-
sions relative to intake (Gratitude = 1.27, Control = 0.06, t(40)=
2.25, p = 0.015, one-tail). This suggests that our gratitude writing in-
tervention was effective at increasing gratitude in the fMRI subjects
and provides a behavioral basis for the between groups fMRI effects
shown below.
For the Pay It Forward task, subjects gave an average of 60.5%
(range 18.4% to 91.5%) of their endowment on each trial to the ben-
eciaries, indicating that the task was effective in eliciting altruistic
donations, and subjects neither gave all the money away nor kept
it all for themselves. Also, the average gratitude rating across sub-
jects was 2.71 (range 1 to 4.66), which was signicantly greater
than the minimum possible gratitude rating (p b0.001). The average
guilt rating was 2.41 (range 1 to 4.3), which was signicantly greater
than the minimum possible (p b0.001). The average desire to help
4P. Kini et al. / NeuroImage 128 (2016) 110
rating was 2.97 (range 1.41 to 4.26), which likewise was signicantly
greater than the minimum possible (p b0.001). All of these suggest
that the subjects experienced gratitude, guilt, and desire to help as
signicant factors in their decisions.
Parametric modulators
We rst collapsed across both intervention groups to explore
whether the self-reported gratitude, guilt, and desire-to-help ratings
were correlated within subjects. We found that the self-reported desire
to help and guilt regressors were not correlated within a given subject
(average r= 0.01, t(42)=0.14, p = 0.89, Fishers r-to-Z transformed).
The gratitude and desire-to-help ratings were positively correlated
(average r = 0.36, t(42)=7.04, p b10
7
, Fishers r-to-Z transformed).
The gratitude and guilt ratings were positively correlated as well
(average r = 0.10, t(42)=2.3, p = 0.026, Fishers r-to-Z transformed).
The gratitude ratings and percent of endowment given were positively
correlated (average r = 0.21, t(42)=4.53, p b0.00005, Fishers r-to-Z
transformed). This suggests that gratitude was most closely associated
with a desire to Pay It Forwardto help the designated cause, and
while guilt may have played some role, that role was less signicant.
These ndings also suggest that brain activity correlating with a de-
sire to help may share some variance with brain activity correlating
with gratitude in this study, and vice versa.Furthermore,although
the percent given was unsurprisingly correlated positively with the
total amount given (average r = 0.37, t(42)=9.01, p b10
10
,Fishers
r-to-Z transformed), there was apparently a ceiling effect alarger
initial endowment correlated negatively with the percent given (av-
erage r=-.23, t(42)=6.50, pb10
7
,Fishers r-to-Z transformed),
indicating that subjects were reluctant to give large absolute dollar
amounts.
Neuroimaging
Across the population, the gratitude PM regressor loaded signi-
cantly positively on four regions (Fig. 2A): in the left superior parie-
tal lobule, left superior frontal gyrus, left inferior frontal gyrus, and
right middle occipital gyrus (Table 2), using an initial uncorrected
threshold of pb0.001 to identify regions and then a cluster-correced
threshold of p b0.05 to determine which clusters were signicant
after correcting for multiple comparisons. We also explored whether
any regions loaded negatively on the parametrically modulated
gratitude rating regressor. With a slightly more liberal threshold of p b
0.005 for determining candidate clusters, we found several additional
regions that passed cluster correction (Table 2), in the medial frontal
gyrus, parietal lobe, and visual cortex. We further interrogated the lim-
bic regions including the amygdala, ventral striatum, ventromedial pre-
frontal cortex, and insula, but we found no other signicant loading on
the gratitude rating regressor, either positively or negatively, even at an
uncorrected threshold of pb0.001.
For the Guilt PM regressor, there were no brain regions that passed
correction. For the Desire to help PM regressor, there were four brain
regions that reached signicance, in the left mid-occipital region, left
precental gyrus (BA6), left superior parietal lobule (BA7), and left
cerebellar declive (Fig. 2B, Table 3).
Since the gratitude rating regressor was entered rst, it had priority
for accounting for the variance in the BOLD signal at the time of deci-
sions. We tested how robust the gratitude effect was by constructing
two additional GLMs: the guilt-then-gratitudeGLM was identical to
the original GLM, except that we entered the guilt regressor rst, and
then gratitude (followed by desire to help, then percent given). This af-
fords a test of the gratitude effect while partialing outthe effects of
guilt. The gratitude effect cluster remained signicant in the left superi-
or parietal lobule (MNI 22, 58, 54; p b0.001, cluster-corrected). The
Regressor loading
Gratitude (positive)
Gratitude (negative)
Desire-to-help (positive)
Z=56 Z=28
Z=16
Z=3.09 Z=4
B
Gratitude
A
Desire-to-help
Fig. 2. Neural correlates of motivations during decision-making. (A) Gratitude related neural activity. A regressor at the time of decision-making is parametrically modulated by self-
reported gratitude for each trial. The regressor is mean-centered. Regions in red represent areas that showed a signicant positive loading on the gratitude rating regressor across the
population of all subjects. Regions in green show negative loading. Shown at an uncorrected threshold of p b0.001 for visualization purposes. Signicant clusters are shown in Table 2.
(B) Desire-to-help related neural activity. As in Fig. 2A, except that the parametrically-modulated regressors track the self-reported desire to help the beneciary on each trial.
5P. Kini et al. / NeuroImage 128 (2016) 110
peak voxels in BA6 and BA9 listed in Table 2 remained signicant (p b
0.001, uncorrected), and the region in BA18 was not signicant.
In the help-then-gratitudeGLM, we entered the desire-to-help re-
gressor rst, and then gratitude (followed byguilt, then percent given).
In this GLM, the gratitude effect remained signicant in a cluster of 60
voxels in the superior parietal lobule region identied earlier (peak
MNI 26, 58, 56, p b0.001, uncorrected), however the cluster as a
whole did not pass cluster correction. No other regions showed a signif-
icant effect. This conrms that gratitude-related activation shares vari-
ance with a desire to help, but neither desire to help nor guilt can
completely account for neural activity that correlates with gratitude.
We hypothesized that neural activity related to gratitude in the grat-
itude task would correlate positively with trait measures of gratitude, in
particular the GQ and the GAC3 (Mccullough et al., 2002). To test this,
we collapsed across both intervention groups and tested for a correla-
tion between the GQ and GAC3 self-report measures and each of the
four PM regressors of gratitude, guilt, desire to help, and percent of
endowment given. We found no correlations between self-reported
gratitude and the parametrically modulated regressors for gratitude or
guilt. We did nd positive correlations between the GQ and the
desire-to-help regressor in the bilateral supplementary motor area
(MNI 6, 12, 62; p b0.001, cluster corrected), which is activated with
willful actions (Debaere et al., 2003). A scatter plot of this region
showed that the result was strongly driven by an outlier (Fig. 3). To
investigate this further, we recomputed the correlation without the
outlier and found that the correlation was still signicant and positive
(r-squared = 0.154, t(40)=2.70, p= 0.01). We also found positive cor-
relations between the GAC3 and the percent given parametric modula-
tor in the medial prefrontal cortex (MNI 6, 42, 30, p b0.001, cluster
corrected), as shown in Fig. 3. No other regions correlated with the
trait gratitude measures.
Effect of gratitude intervention
We hypothesized that the gratitude writing intervention would lead
to measurable changes in brain activity, and specically in greater
neural activity related to the expression of gratitude. We thus explored
the GLM beta weights for the gratitude PM regressor at the time of
decision making. We compared these beta weights voxel-by-voxel in
those that received the gratitude writing intervention relative to those
that received only psychotherapy. Using a between-groups random
effects t-test, we found that relative to the therapy-as-usual control
group, the gratitude-writing group showed greater loading on the
gratitude PM regressor in a single region, the perigenual anterior cingu-
late cortex (p b0.05, cluster corrected, MNI 10, 38, 2), as shown in
Fig. 4. This dovetails with our nding above that the gratitude writing
intervention led to signicantly greater self-reported gratefulness in
the two weeks following the intervention relative to the therapy-as-
usual control group. Also, there was signicantly greater loading on
the percent-given PM regressor in the gratitude intervention group rel-
ative to the therapy-as-usual control group, in the right thalamus at MNI
10, 28, 0 (p b0.05, cluster corrected). There was no between-group
effect of the intervention on the guilt PM regressor, nor on the desire-
to-help PM regressor. These results are consistent with an effect of neu-
ral plasticity, but given that we did not collect baseline functional scans
on subjects prior to the gratitude writing intervention, we cannot den-
itively rule out a pre-existing group difference. This is less likely though
given that our subjects were randomized to the three intervention
groups, and there were no age, gender, or initial symptom differences
between the groups.
Discussion
Until now, very few studies have attempted to determinethe neural
correlates of gratitude. Structural imaging studies have shown relation-
ships between cortical volume, especially larger right inferior temporal
cortical volume, and gratitude traits (Zahn et al., 2014). An earlier study
showed that individuals who identify gratitude in a social narrative
more often showed greater hypothalamic activity while reading
sentences that describe a social interaction (Zahn et al., 2009). This
may reect signicant physiological effects of recognizing gratitude.
Our ndings (Fig. 2) show that greater gratitude expression generally
correlated more with activity in parietal and lateral prefrontal cortex
rather than with activity in the limbic regions. We found activity corre-
lating with gratitude specically extending across the intraparietal sul-
cus and inferior frontal gyrus, both of which have previously been
implicated in mental arithmetic specically (Dehaene et al., 2004;
Simon et al., 2002). This is consistent with the nature of our task,
which required subjects to operationalize and quantify their gratitude
as a payment amount. A very recent paper also shows a correlation be-
tween self-reported gratitude experience and pre-genual medial pre-
frontal cortex activity (Fox et al., 2015), in a region that appears to
overlap with the region showing between-groups effect of the gratitude
intervention in our study (Fig. 4). This provides converging evidence for
this regions role in gratitude-related cognitive processes.
Gratitude consists of both experience and expression, and our task
also required a reective self-report of gratitude experience after each
gratitude expression. For our GLM analysis, we chose to model the
gratitude-related neural activity at the time when gratitude was
expressed, i.e. when they chose how much money to pay forward. An
alternative possibility would be to model gratitude earlier, at the time
when the initial endowment was received and gratitude may have
been experienced, or later when subjects self-report their degree of
gratitude motivation. Our analysis reects a construction of gratitude
as an expression rather than an experience per se. Put another way,
gratitude has prosocial effects by virtue of its expression if one
experiences positive affect as a consequence of receiving benet, the
Table 2
Gratitude-related activation. Regions that load on the gratitude parametric modulator at the time of decision making. Clusters dened at an uncorrected threshold of p b0.001 (positive
modulation) or p b0.005 (negative modulation). The Cluster Pshows the cluster-corrected probability of the cluster.
Positive modulation Cluster P Cluster size MNI (x, y ,z) Area
0.001 596 26, 58, 54 BA7, left superior parietal lobule
0.002 332 24, 6, 60 BA6, left superior frontal gyrus
0.003 307 52, 8, 26 BA9, left inferior frontal gyrus
0.023 196 38, 82, 14 BA18, right middle occipital gyrus
Negative modulation 0.013 513 6, 52, 16 BA10, right medial frontal gyrus
0.048 390 60, 48, 32 BA40, right supramarginal gyrus
b0.001 1032 10, 84, 28 BA19, left visual cortex
Table 3
Desire to helpeffects. Regions thatload on the desire-to-helpparametric modulator at the
time of decision making. Clusters dened at an initial uncorrected threshold of p b0.001,
and the Cluster Pshows the cluster-corrected probability of the cluster.
Cluster P Cluster size MNI (x, y ,z) Area
0.001 404 30, 80, 36 Left mid-occipital
0.004 232 30, 12, 58 BA6, left precentral gyrus
0.001 279 30, 56, 58 BA7, left superior parietal lobule
0.025 157 20, 74, 18 Left cerebellar declive
6P. Kini et al. / NeuroImage 128 (2016) 110
experience has no direct prosocial value unless it is converted into an
expression of gratitude. It is the activity during the expression of grati-
tude that we measure here. Of note, subjects also evaluated and self-
reported their experience of gratitude in deciding how much money
to give, butthat self-report happened later in each trial. Our neuroimag-
ing analyses thus modeled neural activity at the time when subjects de-
cided how much to give, and the regressors were parametrically
modulated by the subsequently self-reported gratitude, desire-to-help,
and guilt motivation values in each trial.
It is also noteworthy that our Pay It Forwardtask involves grati-
tude expressed as monetary gifting to a third party. This differs some-
what from a more typical expression of gratitude as reciprocal, in that
gratitude is expressed to the person one is grateful to. We believe this
approach is justied on the basis that the benefactor specically re-
quests that gratitude be expressed this way, and also many subjects
did report experiencing substantial gratitude as a motivating factor in
their task decisions, as measured by the self-report during the task.
Still, our analysis subtly assumes that subjects modulated their donation
amount in proportion to how grateful they felt, per the instructions,
such that the donation amount was directly driven by the felt gratitude.
This assumption would be violated to the extent that subjects were not
intrinsically motivated to donate more out of gratitude, but instead
were simply attempting to comply with the experimenter instructions.
Nevertheless, in either case, the regions where activity correlates with
self-reported gratitude ratings may reect an operationalized expres-
sion of gratitude.
Besides gratitude experience vs. expression vs. evaluation, the motor
effects of button pressing present a potential confound, so we carefully
counterbalanced the subjects to control motor confounds and included
separate motor regressors as nuisance covariates. We counterbalanced
across subjects the motor (button press) mappings to different levels
of gratitude expression (operationalized as monetary gifts), so neural
activity related to gratitude expression is not confounded with simple
motor activity here.
-3
-2
-1
0
1
2
0510
GQ vs. HelpRating
-3
-2
-1
0
1
2
0510
GAC3 vs. Pct. Given
X=4
Z=3.09
Z=4
Z=3.09
Z=4
Y=48Y=-12
Fig. 3. Neural correlates of trait gratitude measures. The region in orange shows a signicant correlationacross all subjects between the GQ self-report measure (Mccullough et al., 2002)
and the GLM regressor that is parametrically modulated by the desire to help (peak MNI= 6,-12,62. p b0.001 cluster corrected, 399 voxels. Peak voxel Z = 4.40). The corresponding
scatterplot is shown in orange. The correlation in this region remains signicant even when excluding the outlier (r-squared = 0.154, p= 0.01). The medial prefrontal region in violet
shows a signicant correlation across all subjects between the GAC3 self report measure (Mccullough et al., 2002) and the GLM regressor that is parametrically modulated by the
percent of the initial endowment given (peak MNI = 6, 42, 30. pb0.001, cluster corrected, 622 voxels. Peak voxel Z=4.38). The corresponding scatterplot is shown in violet. All
contrasts are visualized at p b0.001 uncorrected.
Z=3.09 Z=4
-0.3
-0.15
0
0.15
Y=36X=-10 Z=4
Fig. 4. Effects of prior gratitude intervention on brain activity three months post-treatment. The contrast shows the greater loading of the gratitude rating parametrically modulated
regressor on the gratitude intervention group relative to the control group. The pregenual anterior cingulate cluster shown (Peak MNI = 10, 38, 2) is signicant at the level of the
cluster, p b0.05. Inset: The gratitude PM regressor loads positively on the region in the gratitude group (arbitrary units), but it loads negatively in the therapy-as-usual control group.
7P. Kini et al. / NeuroImage 128 (2016) 110
Tables 2 and 3 summarize the brain regions that are modulated by
self-reported gratitude and desire to help. It is essential to recall that
the activities are measured at the time when a decision is made regard-
ing how much to give, and not at the time later when motivations are
reported. We nd that a number of regions in the frontal, parietal, and
occipital lobes show greater activity when gratitude motivations is
greater. Some regions notably show activity that is decreased when
gratitude motivation is greater.
We also explored whether gratitude involves brain regions related
to social and affective processes, and we found some evidence in sup-
port of this hypothesis. Gratitude may involve positive affect and a
focus on other people rather than self. In that sense, it is perhaps most
related to empathy, which may be either positively or negatively
valenced, and that is other-oriented as well (Tangney et al., 2007). The
neurobiology of empathy has been studied thoroughly and generally in-
volves the anterior cingulate cortex and anterior insula (Singer et al.,
2004, 2009), as well as the amygdala and pars opercularis in the inferior
frontal gyrus (IFG) (Bzdok et al., 2012; Carr et al., 2003; Moll et al., 2002;
Shamay-Tsoory et al., 2009). The region we found that loaded on the
gratitude parametric modulated regressor (Fig. 2A) was found in BA9,
which was distinct from earlier reports of empathy effects in the pars
opercularis BA44. Nevertheless, our between-groups nding of greater
activity in the pregenual anterior cingulate cortex are consistent with
recent reports (Fox et al., 2015), which may be consistent with empa-
thy, theory of mind, and moral cognition-related activation.
The constructs of cognitive mentalizing and theory of mind (ToM)
are closely related and have been found to involve overlapping brain re-
gions (Bzdok et al., 2012), though they were found to be distinct in that
they are connected with different networks (Vollm et al., 2006). Cogni-
tive mentalizing and ToM operations involve overlapping activations in
the medial prefrontal cortex, superior temporoparietal junction (TPJ),
and temporal poles, however the ToM also includes activations in
the frontal gyrus, cuneus, and superior temporal gyrus (Vollm et al.,
2006). Notably, there are no common regions of brain activation
involved in cognitive mentalizing that overlap with regions found to
be activated in the present study. Other than the activation in the IFG,
signicant activations were found in the left superior parietal lobule,
left superior frontal gyrus, and the right middle occipital gyrus, all of
which are not within the same regions as common literature observing
the cognitive mentalizing system. Still, our results show activation relat-
ed to gratitude and the desire to help (Fig. 2B) in the left superior pari-
etal lobule (BA7). This region is at least adjacent to the TPJ, which is
involved in ToM (Saxe and Kanwisher, 2003), among other functions
(Mitchell, 2008). Overall, a recent meta-analysis has identied regions
associated with ToM, empathy, and moral cognition (Bzdok et al.,
2012), but we nd little if any overlap between the regions identied
by the meta-analysis and the regions showing signicant effects of
gratitude here.
It was particularly noteworthy that the gratitude intervention was
associated with such a lasting increase in pregenual anterior cingulate
responsiveness to gratitude, even three months later (Fig. 4). The inter-
vention lasted around an hour in all, which is relatively short given the
lasting nature of the effects. This nding may reect a neural plasticity
effect, but it must also be treated with caution. This was a cross-
sectional study. The subjects were randomized into groups, and there
were no signicant differences in the age, gender, trait gratitude (GQ)
or clinical symptom scores between groups. A signicant constraint on
interpreting our results stems from the fact that we did not perform
initial fMRI scans pre-intervention due to budget constraints. Thus, we
cannot denitively rule out a possible pre-existing between-group
difference in neural sensitivity to gratitude, despite the absence of
pre-existing differences in trait gratitude. The pre-intervention scans
would be necessary to conclude that there is a neural plasticity effect,
and a follow-up study would be warranted by these results. Also, the
therapy-as-usual control group can be considered a passive control, as
we simply omitted the gratitude writing intervention. This means that
part of the group differences could be due to the writing itself, apart
from the specic content of the writing. We considered using the
expressive writing condition as an active control group, but given the
absence of similar previous studies, we elected to cast a wide net and
leave the further dissection of gratitude writing effects to future studies.
The particular region showing between-groups effects in Fig. 4 over-
laps with another regionvery recently reported as correlating with grat-
itude (Fox et al., 2015). It also overlaps with a similar region found to be
altered by mindfulness interventions (Allen et al., 2012), which have
also been shown to increase gratitude (Shapiro et al., 2002). Functional-
ly, the pregenual anterior cingulate has been shown to be involved in
predicting the outcomes of actions (Alexander and Brown, 2011; Jahn
et al., 2014) and in dual task performance (Dreher, 2003). This suggests
a possible mechanistic account of the gratitude intervention: specical-
ly, it may increase the neural activity related to predicting the effects of
ones actions on another person. To the extent one predicts and evalu-
ates the likely effects of ones actions on others, one might be more will-
ing to direct those actions towards having a positive impact on others.
For example, individuals who role-play typically report greater empa-
thy for the subjects whose roles they are playing (Poorman, 2002).
The measures of trait gratitude (especially the GQ) showed a corre-
lation between gratitude and the activity related to desire to help in the
supplementary motor area (SMA), as shown in Fig. 3. The desire to help
is conceptually related to altruism, which may also be driven by empa-
thy (De Waal, 2008). In any case, the SMAis generally involved in motor
functions and may reect a greater neural preparation to act as an ex-
pression of gratitude. Studies of altruism have generally shown activity
in the posterior superior temporal cortex, which has been suggested to
be related to prediction of the beliefs of others or their actions in an en-
vironment (Saxe and Kanwisher, 2003; Singer et al., 2004; Tankersley
et al., 2007; Vollm et al., 2006). Thus, our results suggest that gratitude
and the neural underpinnings of a desire to help in the SMA may be
distinct from effects related to altruism.
Similarly, trait gratitude (especially the GAC3) showed a correlation
with neural activity in the medial prefrontal cortex related to the per-
cent of the endowment given. This region is adjacent to the region
that showed lasting effects of the gratitude intervention and may reect
a cognitive process related to predicting the results of onesactions
(Jahn et al., 2014).
Our studyhas a few limitations. First, because the gratitude rating re-
gressor and the desire to help regressor were partially correlated in the
GLM, we cannot be sure that the regions showing a correlation with
gratitude would not also show some correlation with the desire to
help, and vice versa. We partially addressed this by entering the guilt
and desire to help regressors before gratitude in a follow-up GLM anal-
ysis. This essentially partialed out the guilt and desire to help signals in
the neural activity, and we found that the gratitude rating regressor
loadings remained signicant in several of the regions. Still, future stud-
ies may be able to decorrelate these factors in the experimental design,
but that was not possible with our self-report approach. Second, it is
possible that the scanner environment and static pictures of benefactors
and beneciaries may not fully recreate the social experience of
interacting with people in a prosocial manner. This is a limitation that
confronts all such studies of social interactions to varying degrees. This
may partly account for the relative lack of affective brain region activity
observed here. Nevertheless, the task was valid in that participants
knew that they would get to keep the part of an endowment they
chose to keep and that the remaining part would in fact be given to a
charitable cause. All subjects did in fact choose to donate part of their
endowments and reported experiencing gratitude, which suggests
that the task was successful in evoking prosocial experiences and
actions.
Another potential limitation of our study is that we recruited from a
population seeking counseling for anxiety and/or depression. There was
no signicant difference between the two groups in terms of the mental
health scores either before or after the interventions, but the average
8P. Kini et al. / NeuroImage 128 (2016) 110
mental health score at intake reected more anxiety and/or depression
than the normal healthy population. For this reason, we cannot rule out
the possibility that the effects we observed may differ in a normal
healthy population.
Overall, our results suggest a nuanced view of the neural mecha-
nisms of gratitude. It is somewhat distinct at the neural level from em-
pathy, theory of mind, and altruism, despite some modest overlap. It
involves neural mechanisms associated with predicting the effects of
ones actions, mental arithmetic and calculations, and carrying out mul-
tiple tasks at once. We show here that even brief expressions of grati-
tude may have profound and lasting effects on neural activity and
sensitivity, perhaps related to monitoring of self and others, which
may have implications for practices and interventions involving grati-
tude expression.
Acknowledgments
This work was supported in part by the Expanding the Science and
Practice of Gratitude Project run by UC Berkeley's Greater Good Science
Center in partnership with UC Davis with funding from the John
Templeton Foundation. We thank K. McKinney and S. Berry for help
with MR scanning.
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... Physically, gratitude is related to improved inflammatory markers linked to cardiovascular disease, as well as improved sleep (17,18). Mentally, gratitude is also linked to decreased levels of stress and improved mental health (19). College students who sought mental health treatment and spent three weeks writing letters of gratitude reported significantly fewer anxiety and depression symptoms and better overall function than those who did not (20). ...
... Neurologically, gratitude has very specific links to stress. Gratitude involves the medial prefrontal cortex of the brain where the two hemispheres align and is involved in prosocial behavior which helps build meaningful connections and relationships among humans and primates (16,19). It also regulates emotions and supports the stress relief process, which may explain why individuals with high levels of gratitude tend to experience lower stress and greater life satisfaction (19,37). ...
... Gratitude involves the medial prefrontal cortex of the brain where the two hemispheres align and is involved in prosocial behavior which helps build meaningful connections and relationships among humans and primates (16,19). It also regulates emotions and supports the stress relief process, which may explain why individuals with high levels of gratitude tend to experience lower stress and greater life satisfaction (19,37). In one study, practicing gratitude led to structural changes in the frontal lobe itself (19). ...
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Elite private universities have high stress levels, particularly for underrepresented populations. While physical activity and gratitude can both reduce stress, independent effects from gratitude and interaction effects between physical activity and gratitude on stress are insufficiently explored. Our study investigated these effects among undergraduates at elite private universities. Undergraduates (n = 145) completed an online survey in Fall 2022. Moderate-high physical activity levels were reported by 96.19% of the sample. No significant interaction effect between physical activity and gratitude was seen nor a significant main effect of physical activity on perceived stress. A significant main effect of gratitude on perceived stress [F (2, 99) = 16.732, p < .001, ω2 = .253] was found with higher perceived stress among participants with low compared to moderate (p = .001) or high gratitude (p < .001). Gratitude exerted an independent, significant effect on perceived stress among elite university undergraduates and could be used as an additional healthy coping mechanism along with physical activity to combat stress.
... Interventional studies (Table 1) identified a range of interventions and designs, with variable timing of the interventions, some being once per week for 2 to 4 weeks (Ahmed and Masoom, 2021;Berger et al., 2019), others on a weekly basis of up to 10 weeks (for example, Taylor et al., 2017), and others less intensive but delivered over a year (for example, Stegen and Wankier 2018). Interventions were broadly-collated across different approaches as: diarising/journalling elements (Berger et al., 2019;Chan, 2010;Cheng et al., 2015;Ducasse et al., 2019;Jackowska et al., 2016;Kerr et al., 2015;Killen and Macaskill, 2015;Kini et al., 2016;Krejtz et al., 2016;Mȃirean et al., 2019;Martin et al., 2019;O'Connell et al., 2017;Wolfe and Patterson, 2017); facilitated face-to-face or workshop style interventions delivered as individual or group sessions (Gabana et al., 2019;Martin et al., 2019;Ramírez et al., 2014;Salces-Cubero et al., 2019;Taylor et al., 2017;Yang et al., 2018); gratitude exercises, such as blessings counting, gratitude letters, gratitude lists, and gratitude sharing or expression (Berger et al., 2019;Chan, 2010;Deng et al., 2019;Jackowska et al., 2016;Killen and Macaskill, 2015;Kini et al., 2016;Krejtz et al., 2016;Mȃirean et al., 2019;Otto et al., 2016;Rash et al., 2011;Stegen and Wankier, 2018;Taylor et al., 2017;Wolfe and Patterson, 2017;Yang et al., 2018); a gratitude meditation or contemplation programme (Ahmed and Masoom, 2021); and finally, a number of combined or complex interventions (Berger et al., 2019;Martin et al., 2019;Osborn et al., 2020;Ramírez et al., 2014;Stegen and Wankier, 2018). ...
... Interventional studies (Table 1) identified a range of interventions and designs, with variable timing of the interventions, some being once per week for 2 to 4 weeks (Ahmed and Masoom, 2021;Berger et al., 2019), others on a weekly basis of up to 10 weeks (for example, Taylor et al., 2017), and others less intensive but delivered over a year (for example, Stegen and Wankier 2018). Interventions were broadly-collated across different approaches as: diarising/journalling elements (Berger et al., 2019;Chan, 2010;Cheng et al., 2015;Ducasse et al., 2019;Jackowska et al., 2016;Kerr et al., 2015;Killen and Macaskill, 2015;Kini et al., 2016;Krejtz et al., 2016;Mȃirean et al., 2019;Martin et al., 2019;O'Connell et al., 2017;Wolfe and Patterson, 2017); facilitated face-to-face or workshop style interventions delivered as individual or group sessions (Gabana et al., 2019;Martin et al., 2019;Ramírez et al., 2014;Salces-Cubero et al., 2019;Taylor et al., 2017;Yang et al., 2018); gratitude exercises, such as blessings counting, gratitude letters, gratitude lists, and gratitude sharing or expression (Berger et al., 2019;Chan, 2010;Deng et al., 2019;Jackowska et al., 2016;Killen and Macaskill, 2015;Kini et al., 2016;Krejtz et al., 2016;Mȃirean et al., 2019;Otto et al., 2016;Rash et al., 2011;Stegen and Wankier, 2018;Taylor et al., 2017;Wolfe and Patterson, 2017;Yang et al., 2018); a gratitude meditation or contemplation programme (Ahmed and Masoom, 2021); and finally, a number of combined or complex interventions (Berger et al., 2019;Martin et al., 2019;Osborn et al., 2020;Ramírez et al., 2014;Stegen and Wankier, 2018). ...
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Background New graduate nurses are the nursing cohort at greatest risk for turnover and attrition in every context internationally. This has possibly been heightened during the COVID-19 pandemic. Workplace conditions significantly impact nursing turnover; however, interventions under the positive psychology umbrella may have a mediating impact on the intention to leave. New graduate nurses are generally challenged most in their first three years of clinical practice, and the need for support to transition is widely accepted. Gratitude practice has been reported to improve individual control and resilient response to setbacks and, therefore, is of interest in testing if this intervention can impact turnover intention in the workforce. Objective To report on a scoping review undertaken to identify whether ‘gratitude practice’ as an intervention had the potential to improve new graduate nurses’ wellbeing and resilience. Methods Arksey and O'Malley's scoping review approach. Primary research papers of any methodology, published in English between January 2010 and July 2022 were included. Literature was sourced from seven databases, including CINAHL PLUS, ERIC, MEDLINE, Professional Development Collection, APA PsychInfo, APA PsychArticles, and Psychological and Behavioural Sciences Collection. Results We identified 130 records, of which we selected 35 for inclusion. A large range of interventions were identified; most had some form of writing, journaling, or diarising. The next most common intervention was teaching gratitude strategies via workshops, and many interventions had some form of list or activity trigger for participants to complete. Five studies had complex combined interventions, while the rest were simple, easily reproducible interventions. Interventions were delivered both face-to-face or asynchronously, with some being online only and others sent out as a ‘kit’ for participants to work through. Conclusion Our review of existing literature shows a significant gap in research on gratitude practice and its impact on nursing populations. To ensure robust future studies, we suggest defining concepts clearly and selecting outcome measures and tools that are not closely related. Intervention design may not be as important as the choice of measures and tools to measure outcomes.
... The model could explain why people may become ungrateful toward former helpful benefactors. Moreover, neuroimaging studies of gratitude have consistently found the involvement of the brain's reward system (e.g., ventral striatum, ventromedial prefrontal cortex) when people experience gratitude feelings (Fox et al., 2015;Karns et al., 2017;Kini et al., 2016;G. Liu et al., 2020;Xiong et al., 2020;Yu et al., 2017Yu et al., , 2018. ...
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The fluctuations in emotions during constant help are unexplained by traditional emotion theories but may align with the predictive coding theory. This theory suggests that individuals tend to form expectations of others’ help during social interactions. When outcomes exceed expectations, positive prediction errors are generated, potentially increasing gratitude. Conversely, constant help may build up expectations that surpass outcomes, resulting in negative prediction errors and reduced gratitude. Nevertheless, there is a lack of studies to examine the relationship between prediction errors and gratitude and its underlying mechanism. Here, we conducted two studies. Study 1 consistently found that higher expectations were associated with lower gratitude, when benefactors refused to help, in both reward-gaining and punishment-avoiding tasks. Moreover, prediction errors were positively and reliably linked to gratitude. Study 2 further identified that gratitude dynamically changed through an expectation-updating mechanism. A computational model incorporating predictive coding outperformed traditional theories in predicting the dynamics of gratitude. The findings support predictive coding theory, providing a temporal perspective and a mechanistic understanding of the fluctuations in gratitude, thus having implications for new interventions to improve mental health and well-being.
... Furthermore, neuroscienti c studies have provided insights into the underlying mechanisms of gratitude and its effects on the brain. Neuroimaging studies have shown that experiencing gratitude activates brain regions associated with reward processing, empathy, and social cognition, indicating its profound impact on neural processes underlying social interactions and emotional regulation [32,33]. This growing body of research underscores the importance of gratitude in fostering psychological well-being among students [34,35]. ...
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This study investigated the relationships between gratitude, positive reappraisal, peace of mind, and psychological well-being among Chinese college students using a cross-sectional design. Participants included 336 undergraduate students from various disciplines, recruited from four universities in mainland China. Self-reported measures assessed gratitude, positive reappraisal, peace of mind, and psychological well-being. Preliminary analyses ensured data quality and addressed potential common method bias. Confirmatory factor analysis supported the hypothesized measurement model, and structural equation modeling revealed significant direct effects of gratitude, positive reappraisal, and peace of mind on well-being. Additionally, gratitude and positive reappraisal demonstrated significant indirect effects on well-being mediated by peace of mind. Measurement invariance testing confirmed that the model operated equivalently across gender groups, supporting the robustness and generalizability of the findings. These results highlight the importance of gratitude, positive reappraisal, and peace of mind in promoting psychological well-being among college students, particularly in high-pressure academic environments.
... Neuroscientific studies reveal that engaging in gratitude activates brain regions such as parietal and lateral prefrontal cortex associated with reward, empathy, and emotional processing [11]. The release of neurotransmitters such as dopamine and serotonin, commonly linked to pleasure and mood regulation, is heightened during expressions of gratitude [12,13]. ...
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Happiness is a subjective feeling that comprises a sense of contentment, joy, and overall well-being. Amidst our regular, routine, and often complex daily life, the importance of happiness cannot be overstated. It serves as a guiding force, influencing our thoughts, actions, and interactions with the world around us. In the context of daily life, happiness acts as a powerful catalyst, shaping our attitudes and responses to the challenges we encounter. It serves as a motivational force, propelling us forward in the pursuit of our goals and aspirations. When individuals experience a genuine sense of happiness, they often find themselves more resilient in the face of adversity, better equipped to cope with stress, and more inclined to engage in positive behaviors. Moreover, happiness is intricately connected to our physical and mental well-being. Even though it seems obvious that positive emotions have a profound impact on our well-being as well as physical health, it is consistently demonstrated in scientific literature too [1-3]. A joyful disposition can contribute to lower stress levels, enhanced immune function, and even increased longevity.
... Second, by showing how journaling can engage youth and foster coping and resilience, the contributions point toward a possible source of durable solutions to the mental health challenges youth currently face. A growing body of evidence has demonstrated that journaling, broadly defined, can provide therapeutic benefits for individuals contending with mental health challenges (Bandini et al., 2021;Choi et al., 2018;Dwyer et al., 2013;Emmons & McCullough, 2003;Kini et al., 2016;Pennebaker, 1997), including people from racially-and ethnically-minoritized populations (De Los Ríos, 2020; Khatib & Potash, 2021;Smith et al., 2022;Williams, 2019). To date, however, research on journaling among youth and young adults has yielded mixed results, making it difficult to evaluate its overall effectiveness (Travagin et al., 2015). ...
Article
The COVID-19 crisis has taken a significant toll on the mental health of many students around the globe. In addition to the traumatic effects of loss of life and livelihood within students’ families, students have faced other challenges, including disruptions to learning and work; decreased access to health care services; emotional struggles associated with loneliness and social isolation; and difficulties exercising essential rights, such as rights to civic engagement, housing, and protection from violence. Such disruptions negatively impact students’ developmental, emotional, and behavioral health and wellbeing and also become overlaid upon existing inequities to generate intersectional effects. With these findings in mind, this special issue investigates how COVID-19 has affected the mental health and wellbeing of high school and college students in diverse locations around the world, including the United States, Mexico, Brazil, China, and South Africa. The contributions collected here analyze data collected through the Pandemic Journaling Project, a combined research study and online journaling platform that ran on a weekly basis from May 2020 through May 2022, along with complementary projects and using additional research methods, such as semi-structured interviews and autobiographical writing by students. The collection offers a nuanced, comparative window onto the diverse struggles that students and educators experienced at the height of the pandemic and considers potential solutions for addressing the long-term impacts of COVID-19. It also suggests a potential role for journaling in promoting mental wellbeing among youth, particularly in the Global South.
... Awareness of the aspects of daily life that one can be grateful for can foster resilience and positive well-being in an individual. Researchers have developed and tested many ways we can increase our state levels of gratitude, such as a daily gratitude diary (Emmons & McCullough, 2003), writing a gratitude letter (Adair et al., 2020b;Kini et al., 2016;Seligman et al., 2005;Sheldon & Lyubomirsky, 2006), and listing grateful events (Emmons & McCullough, 2003;Froh et al., 2008;Watkins et al., 2003), including the 'Three Good Things' exercise (Guo et al., 2020;Laguna et al., 2021;Lai, 2017;Lai & O'Carroll, 2017;Rippstein-Leuenberger et al., 2017;Seligman et al., 2005;Sexton & Adair, 2019). The Three Good things exercise is a classic gratitude intervention where participants are asked to write down three things that they are grateful for in their lives daily, either for a week, or up to eight weeks. ...
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The COVID-19 pandemic has significantly disrupted the daily lives of college students, resulting in elevated levels of stress, anxiety, and isolation. Research suggests positive psychology interventions aimed at practicing gratitude, offer potential benefits in reducing these common mental health problems. However, there is a limited understanding of how or why these interventions work nor what function gratitude plays in the lives of young adults during the COVID-19 pandemic. As such, the purpose of the paper was to explore the sources and targets of gratitude of college students during the COVID-10 lockdown in Ireland. This study aimed analyse the content of the ‘Three Good Things’ intervention as reported by young adults during the COVID-19 lockdowns in Ireland. A total of 109 college students participated in a 7-day online ‘Three Good Things’ intervention, where they were prompted to reflect on and document three positive experiences each day. Participants were asked to elaborate on how these experiences made them feel and to highlight their role in facilitating these positive experiences. Thematic analysis was used to analyze the 2,200 submitted responses. The findings revealed three overarching themes relating to participants’ expressions of gratitude during the COVID-19 lockdown: (1) cultivating positive social interactions, (2) prioritizing meaningful self-care, and (3) fostering hope for a more normal life post-pandemic. By delving into the lived experiences of college students, this study sheds light on the elements central to their expressions of gratitude during the COVID-19 pandemic. The findings underscore the importance of social connections, self-care practices, and hopeful prospects as sources of gratitude among students.
... Um estudo realizado por pesquisadores da Universidade de Indiana, nos Estados Unidos, publicado na revista Neurolmage, em 2016, sobre os efeitos da gratidão na atividade neural, revelou que uma simples escrita reflexiva sobre a gratidão provocou uma sensibilidade neural, significativamente maior e duradoura à gratidão, no córtex pré-frontal medial do cérebro dos participantes da pesquisa, após três meses da atividade (Kini et al., 2016). Essa prática foi muito significativa para os participantes do PEE baseado em Mindfulness. ...
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Objetivo: este estudo analisa as implicações de um programa de educação emocional (PEE) baseado em Mindfulness no bem-estar e no desenvolvimento de competências socioemocionais de estudantes. Design / metodologia / abordagem: o programa foi implementado no ano de 2021, no contexto da pandemia do Covid-19, e utilizou Mindfulness como base para sua estruturação. A sua operacionalizado ocorreu em oito semanas. Participaram de um estudo quase-experimental 55 estudantes de graduação e pós-graduação. Antes de iniciar o programa e ao final de sua realização, foi aplicado um instrumento de avaliação com escalas envolvendo a saúde mental, as competências socioemocionais e a contribuição do programa no autoconhecimento e bem-estar. Resultados: os resultados apontaram redução significativa nos níveis de ansiedade, depressão e estresse, melhoria na percepção da satisfação com a saúde e qualidade de vida e aumento nos níveis de desenvolvimento de cinco competências socioemocionais. Também foi possível identificar implicações do programa no bem-estar psicológico dos participantes. Implicações práticas: a disseminação de programas de educação emocional baseados em Mindfulness pode ser uma alternativa para melhorar o bem-estar dos estudantes em ambientes acadêmicos.
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Anhedonia and, particularly, social anhedonia is an important psychiatric symptom playing a crucial role in the development of depression and schizophrenia. Social anhedonia in healthy people is related to changes in structure, activation, and connectivity of different regions in the prefrontal, temporal, parieto-temporal, and basal areas. In patients with schizophrenia the core fMRI correlates of social anhedonia are located in the temporal lobe. Studies in social anhedonia in depressions and other mental disorders are insufficient for drawing conclusions on this topic. Unlike physical anhedonia, social anhedonia demonstrates no specific link with the Nucleus accumbens volume or activation.
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Although the past decade has witnessed growing research interest in positive psychological interventions (PPIs), their potential as adjunctive interventions for psychotherapy remains relatively unexplored. Therefore, this article expands the frontiers of PPI research by reporting the first randomized controlled trial to test a gratitude writing adjunctive intervention for psychotherapy clients. Participants were 293 adults seeking university-based psychotherapy services. Participants were randomly assigned to one of three conditions: (a) control (psychotherapy only), (b) a psychotherapy plus expressive writing, and (c) a psychotherapy plus gratitude writing. Participants in the gratitude condition wrote letters expressing gratitude to others, whereas those in the expressive writing condition wrote about their deepest thoughts and feelings about stressful experiences. About 4 weeks as well as 12 weeks after the conclusion of the writing intervention, participants in the gratitude condition reported significantly better mental health than those in the expressive and control conditions, whereas those in the expressive and control conditions did not differ significantly. Moreover, lower proportions of negative emotion words in participants’ writing mediated the positive effect of condition (gratitude versus expressive writing) on mental health. These findings are discussed in light of the use of gratitude interventions as adjunctive interventions for psychotherapy clients.
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Gratitude is an important aspect of human sociality, and is valued by religions and moral philosophies. It has been established that gratitude leads to benefits for both mental health and interpersonal relationships. It is thus important to elucidate the neurobiological correlates of gratitude, which are only now beginning to be investigated. To this end, we conducted an experiment during which we induced gratitude in participants while they underwent functional magnetic resonance imaging. We hypothesized that gratitude ratings would correlate with activity in brain regions associated with moral cognition, value judgment and theory of mind. The stimuli used to elicit gratitude were drawn from stories of survivors of the Holocaust, as many survivors report being sheltered by strangers or receiving lifesaving food and clothing, and having strong feelings of gratitude for such gifts. The participants were asked to place themselves in the context of the Holocaust and imagine what their own experience would feel like if they received such gifts. For each gift, they rated how grateful they felt. The results revealed that ratings of gratitude correlated with brain activity in the anterior cingulate cortex and medial prefrontal cortex, in support of our hypotheses. The results provide a window into the brain circuitry for moral cognition and positive emotion that accompanies the experience of benefitting from the goodwill of others.
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To examine the efficacy of two dual-component interventions, one based on mindfulness and one based on gratitude, to reduce depression and stress and increase happiness levels. Randomized, controlled study with data collected at baseline, 3 weeks, and 5 weeks. Participants completed an online gratitude or mindfulness intervention at home. Self-report questionnaires were completed at home or at work. Sixty-five women aged 18-46 years (mean age±standard deviation, 28.35±6.65 years). Participants were randomly assigned to a wait-list control condition or to either a gratitude or a mindfulness intervention condition. The interventions were used four times a week for 3 weeks. The gratitude intervention involved a gratitude diary and grateful reflection. The mindfulness intervention involved a mindfulness diary and mindfulness meditation, the Body Scan. The outcome variables were depression, stress, and happiness measured by using the Edinburgh Depression Scale, the Perceived Stress Scale, and the Subjective Happiness Scale, respectively. All outcome variables improved over time in both interventions group but not in the wait-list control group. Efficacy of the interventions differed between the interventions. These short novel interventions seem to provide a useful way to enhance well-being. Further research in the area is warranted.
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