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'The Three Good Things' – The effects of gratitude practice on wellbeing: A randomised controlled trial

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Background: There are mixed findings concerning the effectiveness of gratitude interventions. This study investigated a commonly used gratitude-based intervention (‘count-your-blessings’) in promoting physical and psychological wellbeing in a UK sample. Methods: A randomised controlled trial to examine the efficacy of a three-week gratitude intervention in promoting psychological and physical health. 108 healthy participants (aged 18–36) were randomly assigned to 1 of 2 conditions (gratitude or no-assigned 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 wellbeing. 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 including those who dropped out (Intention-to-treat analysis [ITT]). Findings: Completer analysis revealed that the gratitude condition resulted in heightened feelings of gratefulness. Those in the grateful condition showed greater increases in state gratitude and positive affect, relative to the control condition, who reported a reduction in wellbeing. Overall, the ITT analysis yielded essentially the same findings as the completer analysis. Discussion: Counting one’s blessings can improve wellbeing and could be incorporated in existing psychotherapies. This brief and simple intervention warrants further investigation.
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10 Health Psychology Update, Volume 26, Issue 1, Spring 2017
Research Paper
‘The Three Good Things’ – The effects of
gratitude practice on wellbeing:
A randomised controlled trial
Siew Tim Lai & Ronan E. O’Carroll
Background: There are mixed ndings concerning the effectiveness of gratitude interventions. This study
investigated a commonly used gratitude-based intervention (‘count-your-blessings’) in promoting physical
and psychological wellbeing in a UK sample.
Methods: A randomised controlled trial to examine the efcacy of a three-week gratitude intervention in
promoting psychological and physical health. 108 healthy participants (aged 18–36) were randomly assigned
to 1 of 2 conditions (gratitude or no-assigned 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 wellbeing. 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 including those who dropped out (Intention-to-treat analysis [ITT]).
Findings: Completer analysis revealed that the gratitude condition resulted in heightened feelings of
gratefulness. Those in the grateful condition showed greater increases in state gratitude and positive affect,
relative to the control condition, who reported a reduction in wellbeing. Overall, the ITT analysis yielded
essentially the same ndings as the completer analysis.
Discussion: Counting one’s blessings can improve wellbeing and could be incorporated in existing
psychotherapies. This brief and simple intervention warrants further investigation.
Keywords: Gratitude; positive affect; wellbeing; health; positive psychology interventions.
Introduction
Studies that aimed to promote wellbeing have
shown that individuals with positive mental
health hold numerous physical, social and intel-
lectual benets compared to their unhappy
counterparts (Fredrickson, 2001). This
increased emphasis on positive phenomena
has led the United Nation General Assembly
to review the approaches to systematic meas-
urements of happiness at the individual and
national level (Layard, 2013). Although there
are various ways to increase wellbeing, the culti-
vation of gratitude is thought to be the quin-
tessential positive personality trait, allowing
individuals to lead a ourishing life (Wood et
al., 2009).
Conceptualisation of gratitude
Gratitude is considered as both trait
and state. State gratitude is the feeling
of awe, gratefulness and appreciation for
outcomes received (McCullough et al.,
2002). Emmons (2007) characterizes these
experiences as acute, intense and co-occur-
ring with joyful feelings. Trait gratitude is
described as an individual’s predisposition
to experience this state in life (McCullough
et al., 2002).
Theoretically, being thankful in life is
expected to be strongly associated to well-
being. This is explained in the schematic
hypothesis (Wood et al., 2010), which claims
that grateful individuals are more likely to
Health Psychology Update, Volume 26, Issue 1, Spring 2017 11
‘The Three Good Things’ – The effects of gratitude practice on wellbeing: A randomised controlled trial
notice the positivity in life, and this inu-
ences how they interpret their life events
(Wood et al., 2010). Watkins (2004) elabo-
rated that in times of adversity, gratitude
shifts one’s mindset of deprivation to appre-
ciation; this particular interpretative lens
enhances subjective wellbeing. Drawn from
Fredrickson’s (2001) broaden-and-build theory,
positive emotions like gratitude broadens
through thought-action repertoires which
builds a person’s psychosocial and spiritual
resources. The broadening hypothesis is
compatible with aforementioned accounts
of the mechanisms linking gratitude to well-
being. As Fredrickson (2001) suggested, grat-
itude facilitates ‘meaning-nding’ in ordinary
events and within the adversity itself. This
may fuel psychological resilience, leading
to appreciable increases in emotional well-
being over time (Kashdan & Rottenberg,
2010). Although emerging perspectives
complementing this notion have highlighted
the inter-intrapersonal benets of gratitude
(McCullough et al., 2001), the effects of
gratitude on human health identied thus
far are likely just the tip of the proverbial
iceberg.
Empirical research on gratitude and
wellbeing
Emmons and McCullough (2003) employed
a self-guided journal method to determine
the effect of gratitude on wellbeing among
college students. Their ndings revealed
that those who recorded grateful thoughts
had positive results (i.e. increased in posi-
tive emotions, altruistic behaviour and fewer
physical complaints). Grateful contempla-
tion reduces excessive worrying and levels
of depression over time (Wood et al., 2007).
Whilst other research demonstrated grateful
individuals reported less post-traumatic
symptoms when compared to their less
grateful counterparts following a stressful
life-event (Wood et al., 2010).
A meta-analysis has shown that the impact
of gratitude practice on wellbeing and its
efcacy is moderated by various factors
(Wood et al., 2010). For instance, previous
control groups used in gratitude interven-
tion involved downward social comparison,
writing about earliest memories, and listing
hassles. The diverse control conditions may
not generate equal expectancy effects as the
gratitude condition. This makes it problem-
atic to infer the effectiveness of the interven-
tion. Moreover, some studies did not explore
whether gratitude was successfully cultivated
(Sin et al., 2009) leaving doubts to its posi-
tive changes.
To explore these issues, we replicated
Emmons and McCullough’s (2003) study.
We included validated scales (e.g. the Grati-
tude Adjectives Checklist [GAC] and Grati-
tude Dispositional Scales [GQ-6]) to track
the changes in gratitude. A control group
without any assigned activity was used to
minimise expectancy effects, allowing us to
gauge the true effect of the intervention.
We utilised both completer and intention-
to-treat analysis (ITT). Given that the inter-
vention will not be effective for everyone,
we also explored the relationship between
effort and time taken to perform the inter-
vention and outcome.
Predictions
We predict that a grateful contemplation
would result in higher levels of state and
trait gratitude, positive affect and wellbeing.
Participants in the gratitude condition would
score higher on the perception of inter-
personal quality and report fewer physical
complaints compared to participants in the
control condition.
Methods
Design
A three-week experimental randomised
controlled trial (RCT) was employed to
address the research aim. The independent
variable comprised of two experimental
conditions: (1) Gratitude (participants
assigned with gratitude-inducing activity)
and (2) Control (no assigned task). Both
groups were measured at two time points,
12 Health Psychology Update, Volume 26, Issue 1, Spring 2017
Siew Tim Lai & Ronan E. O’Carroll
three weeks apart: (a) Pre-test (prior to inter-
vention); (b) Post-test (immediately after
intervention).
Participants
Eligible participants were students from a
university in the UK, age range 18–21, able to
read and write English; recruited via online
advertisement and the face-to-face approach.
In an effort to minimise unintended vari-
ation in the procedure, both approaches
utilised standard instructions that partici-
pants read themselves.
The study was advertised as ‘A Study on
Human Emotions’ to mask the trial hypoth-
eses. The face-to-face method contains a
set of questionnaires and consent form in
a sealed envelope which were distributed
randomly in the campus. Those who agreed
to participate then signed the consent form
and returned the required documents to
the investigator. For the online recruitment,
interested candidates commenced the study
via a web-link, completion of baseline meas-
ures was considered as informed consent.
A total 108 participants (62 females, 46
males) were recruited and randomised into
either the gratitude (N=51) or the control
(N=57) condition. The average age was 22
years (SD=2.85), with over 65 per cent unem-
ployed university graduates. Almost half
of the sample was White (53.7 per cent),
and the rest was Asia/Pacic Islander (41.7
per cent). The nal analysis included 36
in the gratitude condition and 45 in the
control group, 27 participants (gratitude=15,
control=12) dropped out from the study.
Measures
At baseline participants were asked to provide
demographic information, including age,
sex, education, employment status, and
ethnicity. Participants completed additional
measures relating to gratitude, affect, well-
being, health complaints and perceived
quality of interpersonal relationship at base-
line and 21 days after intervention. All meas-
ures were administered online.
State and dispositional gratitude (GAC
and GQ-6) (McCullough et al., 2002). The
Grateful Adjectives Checklist consists of
three adjectives (appreciative, thankful, and
grateful) to examine participant’s feelings of
state gratefulness on a 5-point Likert scale
(1=not at all, 5=extremely). Scores range
from 3 to 15, higher scores indicates higher
levels of state gratitude.
The Gratitude Dispositional Scales
assesses an individual’s disposition to expe-
rience this state. It has six descriptive items
that is scored on a 7-point Likert scale
(1=strongly disagree, 5=strongly agree).
Scores range from 6 to 42.
Positive and negative affect scale
(PANAS) (Watson, Clark, & Tellegen, 1998).
The PANAS includes 20 affective states rated
on a 5-point Likert scale (1=very slightly,
5=extremely). Scores range from 10 to 50
and higher scores indicate higher levels of
positive or negative emotions experienced.
Warwick-Edinburgh mental wellbeing
scale (WEMWBS) (Tennant el al., 2007). The
WEMWBS is a 14-item questionnaire that
measures mental wellbeing on a 5-point
Likert scale (1=none of the time, 5=all of
the time). Scores vary from 14 to 70, higher
scores indicates higher levels of mental well-
being.
Physical symptoms checklist (Emmons &
McCullough, 2003). A list of 13 physical symp-
toms (e.g. runny/congested nose, headache
and etc.) requires participants to indicate
whether they had experienced these symp-
toms for the past two weeks. Participant’s
perceived health status was obtained by
summing up the symptoms experienced.
Quality of relationship with signicant
others (Martinez-Marti et al., 2010). Four
items rated on a 4-point Likert scale (1=not
at all, 4=a great deal) was used to assess
the participant’s quality of relationship with
close others.
An exploratory effort and motivation form
was given to participants at post-intervention.
The form included questions developed by
Odou et al. (2013) to assess participant’s
Health Psychology Update, Volume 26, Issue 1, Spring 2017 13
‘The Three Good Things’ – The effects of gratitude practice on wellbeing: A randomised controlled trial
effort (e.g. on average how many minutes
did it take you to complete your activity?)
and motivation (e.g. how motivated did you
feel about doing the activity?) on a 5-point
Likert scale (1=not at all, 5=extremely).
To measure adherence for the assigned
activity, participants were asked to answer a
question on a 7-point Likert scale (1=never,
7=daily). The question was ‘We understand
that at some point there are circumstances that
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.’
Procedure
Participants who provided consent and
completed baseline measures were assigned
an identication number that can only be
identied by the researcher. They were then
randomised to the experimental condi-
tions using a computer software package
(Urbaniak & Plous, 2013). After randomi-
sation, specic instructions were given to
participants according to their respective
groups. Participants in both conditions were
contacted by mail before, during and after
21 days of the intervention to complete their
online measures.
The gratitude condition received an
instruction to cultivate gratefulness for
21 days. The information to perform the
gratitude-inducing activity incorporated
instructions from both studies (Emmons
& McCullough, 2003; Martinez-Marti et al.,
2010). The instructions were:
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.’
They were required to record their
daily grateful thoughts in a journal that was
provided. To encourage adherence they
were invited to submit their journal on an
appointed date after post-test. Participants in
the control condition were not assigned any
activity, but to complete the same measures
given to the gratitude condition.
Analytic plan
Descriptive statistics were generated for
the total sample. Missing cases (<5%) were
addressed with means substitution. Two-way
mixed ANCOVA was used to test for change
over time among participants who completed
the intervention versus control. Effects were
calculated for time and time × group interac-
tions. Covariates were ethnicity and gender
because randomisation revealed unequal
distributions of these variables in the exper-
imental conditions. Pearson’s correlation was
used to explore the relationship between indi-
vidual’s engagement (e.g. effort and motiva-
tion) and the effects of gratitude practice.
Two analyses were conducted – Completer
analysis (participants who completed the
intervention) and Intention-to-treat (ITT)
analysis (included participants who dropped
out). The ITT was carried out using the
last observation carried forward (LOCF)
method. For all hypotheses testing, it is
expected that participants in the gratitude
condition would have better outcomes than
the control condition.
Results
We only present the main ndings for
completer analysis (Table 1) because all
measures yielded essentially the same results
as the ITT analysis.
Dispositional and state gratitude
The main effect of group on disposi-
tional gratitude scores was signicant [F(1,
77)=4.892, p=.030, partial η2=.060]. The
condition × time interaction for disposi-
tional gratitude was also signicant [F(1, 77)
=4.84, p=.044, partial η2 =.052]. Dispositional
gratitude decreased in the control condition
relative to the gratitude intervention (see
Table 1).
14 Health Psychology Update, Volume 26, Issue 1, Spring 2017
Siew Tim Lai & Ronan E. O’Carroll
The condition × time interaction for
state gratitude was signicant [F(1, 77)=8.48,
p=.005, partial η2=.099]. State gratitude
increased in the gratitude intervention (see
Figure 1). Thus, those who practiced grat-
itude had higher levels of state and trait
gratitude relative to the control condition.
Positive affect
The condition × time interaction for positive
affect was signicant [F(1, 77)=4.90, p=.030,
partial η2 =.060] – see gure 2.
Wellbeing
The completer analysis for the condition ×
time interaction for well-being measure was
of borderline signicance (p=.053); however,
the results for the ITT analysis was signicant
[F(1, 104)=4.73, p=.032, partial η2=.043].
There was greater drop in wellbeing in the
control condition (see Table 1).
Physical health
Table 1 showed no difference was observed
for reported physical illness (p=.055) in both
experimental conditions.
Perceived quality of interpersonal
relationships
For participants in the gratitude condition,
the perception of relationship quality with
others was not signicantly different (p=.871)
than the control condition (see table 1).
Individual differences in practicing
gratitude
Motivation and effort were positively corre-
lated with increase in state gratitude, moti-
vation (r=.333, p=.047) and effort (r=.414,
p=.012). 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 signicantly related
to dispositional gratitude and both the affec-
tivity scores.
Figure 1: Change in state gratitude from pre- to post-intervention for the gratitude
group condition versus the control group condition.
Pre- Post-
Estimated marginal means of state gratitude
Intervention periods
Means of gratitude at state levels
.00
2.50
5.00
7.50
10.00
12.50
15.00
Conditions
Control
Gratitude
Health Psychology Update, Volume 26, Issue 1, Spring 2017 15
‘The Three Good Things’ – The effects of gratitude practice on wellbeing: A randomised controlled trial
Table 1: Completer analysis on the effects of gratitude intervention in
the experimental and control group (
N
=81).
Figure 2: Change in positive affect from pre- to post-intervention for the gratitude
group condition versus the control group condition.
Measures Pre-test
mean (SD)
Post-test
mean (SD)
Time Group × time
interactions
GRAT CTRL GRAT CTRL F-ratio p F-ratio p
WEMWBS 46.17
(10.00)
45.69
(9.38)
45.50
(10.81)
39.47
(13.87)
5.110 .027* 3.87 .053
PANAS
PA
31.38
(8.31)
30.87
(7.13)
33.47
(8.23)
28.69
(8.22)
1.987 .163 4.895 .030*
NA 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
quality of
relationship
14.39
(4.44)
13.36
(3.15)
13.61
(2.50)
12.78
(3.40)
.496 .483 .871 .354
Physical
symptoms
4.46
(2.98)
5.07
(3.20)
3.77
(3.01)
4.34
(3.11)
5.563 .021* .055 .816
* p < .05;
** p < .01
Intervention periods
Pre- Post-
Conditions
Control
Gratitude
Estimated marginal means of positive affect
Means of positive affect
10.00
.00
20.00
30.00
40.00
50.00
16 Health Psychology Update, Volume 26, Issue 1, Spring 2017
Siew Tim Lai & Ronan E. O’Carroll
Discussion
One approach to boost an individual’s
contentment is the deliberate practice of
counting one’s blessings. To date, grateful
induction to alter one’s dispositional grati-
tude has not been investigated in a system-
atic manner (Emmons, 2007). Future work
can explore whether continuous practice
of gratitude-oriented activities increases a
person’s disposition toward gratitude.
Some may express gratefulness only
under certain circumstances (Watkins,
2004). Through journaling one’s grateful
thoughts, we can determine whether the
immediate feelings of gratefulness can be
cultivated. Our results suggest that keeping
a gratitude journal increases state gratitude;
this is congruent with ndings from previous
studies (Emmons & McCullough, 2003;
Martínez-Martí et al., 2010).
Another main nding emerged from
this study is that participants who practiced
gratitude had more positive affect (PA) and
less negative affect (NA) compared to the
control condition. Gratitude may operate
through savouring – a conscious focus on
one’s fortunate moments that could have
been otherwise (Bryant, 2003). Our gratitude
intervention may have successfully increased
PA through the accessibility and retrieva-
bility of pleasant memories (Watkins, 2004),
contributing to one’s subjective wellbeing.
Consistent with Emmons and McCullough’s
(2003) study, the gratitude intervention
did not lead to signicant reduction in NA.
Nevertheless, the mean scores for NA were
in the expected direction. The attrition rate
(over 30 per cent) may have led to insuf-
cient power to detect signicant differences.
We found that those who keep a grati-
tude journal had relatively stable wellbeing
scores. Fredrickson’s (2001) broaden-and-
build model suggests that gratitude harnesses
behavioural and cognitive repertoires by
undoing’ the adverse effects of negative
emotions. Grateful responses to life – as
Fredrickson (2001) claimed, build enduring
coping resources to stabilise mood when
stressful life-events arise. Several studies (e.g.
Tugade & Fredrickson, 2004) support this
interpretation.
Somewhat contrary to our expectations,
gratitude appeared to worsen the perception
of relationship quality. Gratitude prototypi-
cally, stems from the recognition of received
aid is evaluated as costly and altruistic (Wood
et al., 2007). It is possible that the expression
of gratitude causes momentary experiences of
indebtedness’ – an obligated feeling to return
the giver the valuable act (Emmons, 2007).
Indebtedness is associated with feelings of
shame and guilt (Emmons, 2007) which may
complicate or reduce the quality of interper-
sonal relationships. Both ‘thankfulness’ and
indebtedness’ are embedded in reciprocity,
but the subtle differences in appraising the
benefactor’s intentions (benevolent vs. ambig-
uous) determines the recipient’s emotional
responses (Tsang, 2006). This suggests that
received benets should be considered when
future research examines its interaction with
interpersonal consequences.
Regarding physical wellbeing, there were
no differences between conditions. Though
the main effect of time revealed signicant
changes across conditions, both groups
reported having experienced less physical
symptoms.
The current study sought to examine how
a person’s motivation and effort inuence
the success of the intervention. The ndings
showed participants who put greater motiva-
tion and effort into the gratitude-inducing
activity had increased feelings of grateful-
ness. This is consistent with previous studies
(Sheldon & Lyubomirsky, 2006), which
suggested that when the mood-enhancing
activity ‘ts’ the person’s interest and values
and is performed with appropriate effort,
the goal of developing a grateful thinking is
achievable.
Changes in wellbeing, however, were not
signicantly correlated with effort. Volitional
activities like the gratitude-inducing exercise
require commitment and a certain amount
of effort to initiate, engage, and maintain
Health Psychology Update, Volume 26, Issue 1, Spring 2017 17
‘The Three Good Things’ – The effects of gratitude practice on wellbeing: A randomised controlled trial
the activity (Sin et al., 2009). As Sheldon et
al. (2006) stated, if a person yearns for happi-
ness but does not exert any effort to practice
the mood-enhancing strategy, they may not
experience signicant increase in wellbeing.
While motivation and effort are important
variables for continued adherence to the
activity (Lyubomirsky et al., 2011), only moti-
vation was positively correlated with adher-
ence in this study.
Limitations
First, the randomisation was not entirely
successful as some differences between
groups were evident in pre-intervention.
This was dealt with by including these vari-
ables as covariates in the analyses. Second,
reduction in sample size due to attrition
resulted in reduced power to detect signi-
cant changes; however our ITT results were
very similar. Last but not least, the lack of
longer-term follow-up means that we cannot
comment on the sustainability of interven-
tion effects.
Future directions
Although the current ndings have advanced
our understanding of how gratitude affects
an individual’s wellbeing, many questions
remained unanswered. Pre-existing traits
(e.g. trait gratitude or affective traits) may
affect an individual’s ability to benet from
the gratitude intervention (Emmons, 2007).
Can we expect gratitude induction to work
better in improving health outcomes of
less or more grateful individuals? Further
research is required to explore the trait-
moderator link.
Conclusion
Our results suggest that the count-your-
blessings approach may be an effective tech-
nique to increase individuals’ predisposition
to experience gratitude. A mindfulness
appreciation helps individuals to focus on
benets (Emmons, 2007). Future studies are
required to test the effectiveness of gratitude
interventions against active control condi-
tions and other psychological interventions.
This study shows that a simple count-your-
blessings intervention can improve psycho-
logical wellbeing and could potentially be
included alongside existing psychological
interventions.
The Authors
Siew Tim Lai, and Ronan E. O’Carroll,
University of Stirling, Scotland, UK
Correspondence
Lai Siew Tim
Department of Psychology,
University of Stirling, Stirling,
Email: lai.siewtim@gmail.com
18 Health Psychology Update, Volume 26, Issue 1, Spring 2017
Siew Tim Lai & Ronan E. O’Carroll
References
Bryant, F.B. (2003). Savouring beliefs inventory (SBI):
A scale for measuring beliefs about savouring.
Journal of Mental Health, 12(2), 175–196.
doi: .1080/0963823031000103489
Emmons, R.A. (2007). Thanks! How the new science
of gratitude can make you happier. New York:
Houghton Mifin Company.
Emmons, R.A. & McCullough, M.E. (2003). Counting
blessings versus burdens: An experimental
investigation of gratitude and subjective well-
being in daily life. Journal of Personality and Social
Psychology, 84(2), 311–389. doi: 10.1037/0022-
3514.84.2.3.77
Fredrickson, B.L. (2001). The role of positive
emotions in positive psychology: The broaden-
and-build theory of positive emotions. American
Psychologist, 56, 218–226.
Layard, R. (2013). First world happiness report launched
at the United Nations. Retrieved from http://www.
earth.columbia.edu/articles/view/2960
Martínez-Martí, M.L., Avia, M.D. & Hernández-
Lloreda, M.J. (2010). The effects of counting
blessings on subjective well-being: A gratitude
intervention in a Spanish sample. The Spanish
Journal of Psychology, 13(2), 886–896.
McCullough, M.E., Emmons, R.A. & Tsang, J.A.
(2002). The grateful disposition: A conceptual
and empirical topography. Journal of Personality
and Social Psychology, 82, 112–127.
Odou, N. & Vella-Brodrick, D.A. (2013). The efcacy
of positive psychology interventions to increase
well-being and the role of mental imagery
ability. Social Indicators Research, 110, 111–129.
doi: 10.1007/s11205-011-9919-1
Sheldon, K.M. & Lyubomirsky, S. (2006). How to
increase and sustain positive emotion: The effects
of expressing gratitude and visualising best
possible selves. The Journal of Positive Psychology,
1(2), 73–82. doi: 10.1080/17439760500510676
Sin, N.L., Della Porta, M.D. & Lyubomirsky, S.
(2009). Tailoring positive psychology inter-
ventions to treat depressed individuals. In S.
I. Donaldson, M. Csikszentmihalyi, & J. Naka-
mura (Eds.), Applied positive psychology: Improving
everyday life, schools, work, health, and society. New
York: Routledge.
Tennant, R., Hiller, L., Fishwick, R., Platt, S.,
Joseph, S., Weich, S., et al. (2007). The
Warwick-Edinburgh mental well-being scale
(WEMWBS): Development and UK validation.
Health and Quality of Life Outcomes, 5(1), 63–75.
doi: 10.1186/1477-7525-5-63.
Tugade, M.M. & Fredrickson, B.L. (2004). Resillient
individuals use positive emotions to bounce back
from negative emotional experiences. Journal of
Personality and Social Psychology, 86, 320–333.
Urbaniak, G.C. & Plous, S. (2013). Research Rand-
omizer (Version 4.0) [Computer software].
Retrieved on June 22, 2013, from http://www.
randomizer.org/
Watkins, P.C. (2004). Gratitude and subjective well-
being. In R.A. Emmons & M.E. McCullough
(Eds.), The Psychology of Gratitude (pp.167–192).
New York: Oxford University Press.
Watson, D., Clark, L.A. & Tellegen, A. (1988). Devel-
opment and validation of brief measures of
positive and negative affect: The PANAS scales.
Journal of Personality and Social Psychology, 54,
1063–1070.
Wood, A.M., Froh, J.J. & Geraghty, A.W.A. (2010).
Gratitude and well-being: A review and theo-
retical integration. Clinical Psychology Review, 1-16.
doi: 10.1016/j.cpr.2010.03.005
Wood, A.M., Joseph, S. & Linley, P.A. (2007). Coping
style as a psychological resource of grateful
people. Journal of Social and Clinical Psychology,
26, 1108–1125.
... Interestingly, Watkins et al. (2021) highlighted gratitude to be the positive emotion that was most experienced during the pandemic, compared with happiness, hope, relief, and joy, highlighting a critical role for gratitude-and opportunities for promoting itduring a time of great suffering. Importantly, gratitude interventions, such as the three good things exercise (Lai, 2017), have been shown to increase levels of gratitude, providing opportunities to promote sustainable wellbeing (Bohlmeijer et al., 2021), and facilitate PTG during times of trauma. ...
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... For example, Fehr et al. (2017, p. 376) recommend "making gratitude a fundamental part of the employee experience, such that leaders and managers can leverage the benefits of gratitude for employees and the organization." This can be done by aligning human resource management practices and creating bundles of human resource management practices (e.g., performance management, onboarding, or human resource development) that support gratitude, providing gratitude training (Di Fabio et al., 2017), or stimulating exercises such as counting blessings or appreciative inquiry (Lai & O'Carroll, 2017). An example of an extensive intervention is the 4-week gratitude intervention by Jung and Han (2017), which covers four stages: introduction to gratitude, recognition of gratitude, expression of gratitude, and empathy of gratitude. ...
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Since workers are increasingly suffering from burnout, there is a need for insights into how burnout can be decreased to improve subjective well-being. The broaden-and-build theory proposes that gratitude increases well-being through an upward spiral. Few studies have examined whether gratitude decreases burnout and what mediating behaviors explain this relationship. Using an international sample of employees (N = 353), this study examines whether work-specific gratitude negatively relates to exhaustion and disengagement. Additionally, since gratitude stimulates helping through upstream reciprocity, this study investigates whether interpersonal helping behavior (IHB) mediates these relationships. Our study showed a negative effect of work-specific gratitude on disengagement and exhaustion and a negative relationship between work-specific gratitude and disengagement, mediated by IHB, suggesting that gratitude stimulates IHB, thereby alleviating disengagement.
... As such, it has been argued that tragic optimism and existential gratitude are needed during COVID-19 and post-pandemic world (Uppal, 2020;Wong, 2020a). We therefore advocate for the adoption of strategies to promote the experience of gratitude and tragic optimism, through, for example, the "three good things" activity (Lai, 2017) and finding meaning from adverse experiences in order to cultivate a tragically optimistic outlook (Leung, 2019). Gratitude and optimism can enhance connectedness to oneself, others and the natural environment (Brissette et al., 2002;Bono and Sender, 2018). ...
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The COVID-19 pandemic has presented a global threat to physical and mental health worldwide. Research has highlighted adverse impacts of COVID-19 on wellbeing but has yet to offer insights as to how wellbeing may be protected. Inspired by developments in wellbeing science and guided by our own theoretical framework (the GENIAL model), we examined the role of various potentially protective factors in a sample of 138 participants from the United Kingdom. Protective factors included physical activity (i.e., a health behaviour that helps to build psychological wellbeing), tragic optimism (optimism in the face of tragedy), gratitude (a prosocial emotion), social support (the perception or experience of being loved, cared for, and valued by others), and nature connectedness (physical and psychological connection to nature). Initial analysis involved the application of one-sample t-tests, which confirmed that wellbeing (measured by the Warwick-Edinburgh Mental Well-being scale) in the current sample (N = 138; M = 46.08, SD = 9.22) was significantly lower compared to previous samples (d = −0.36 and d = −0.41). Protective factors were observed to account for up to 50% of variance in wellbeing in a hierarchical linear regression that controlled for a range of sociostructural factors including age, gender, and subjective social status, which impact on wellbeing but lie beyond individual control. Gratitude and tragic optimism emerged as significant contributors to the model. Our results identify key psychological attributes that may be harnessed through various positive psychology strategies to mitigate the adverse impacts of hardship and suffering, consistent with an existential positive psychology of suffering.
... Gratitude is defned as both a positive afect ensuing from the perception of receiving a beneft from another individual (McCullough et al. 2002) and a trait, which comprises the ability to appreciate simple things in life, sense of abundance and experience and express gratitude towards others (Wood et al. 2009). When practiced, gratitude interventions have a positive effect on physical health and health behaviours (Boggins et al., 2020), enhancing sustainable mental health (Bohlmeijer et al., 2020) and wellbeing (Lai and O'Carroll, 2017). ...
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COVID-19 pandemic has shaken the roots of healthcare facilities worldwide, with the US being one of the most affected countries irrespective of being a superpower. Along with the current pandemic, COVID-19 can cause a secondary crisis of mental health pandemic if left unignored. Various studies from past epidemics, financial turmoil and pandemic, especially SARS and MERS, have shown a steep increase in mental and psychological issues like depression, low quality of life, self-harm and suicidal tendencies among general populations. The most venerable being the individuals infected and cured due to social discrimination. The government is taking steps to contain and prevent further infections of COVID-19. However, the mental and psychological wellbeing of people is still left ignored in developing countries like India. There is a significant gap in India concerning mental and psychological health still being stigmatized and considered 'non-existent'. This study's effort is to highlight the importance of mental and psychological health and to suggest interventions based on positive psychology literature. These interventions can support the wellbeing of people acting as a psychological first aid. Keywords: COVID-19, Coronavirus, Pandemic, Mental wellbeing, Psychological Wellbeing, Positive Psychology Interventions.
... Several previous studies have shown the relationship between gratitude and subjective well-being (Alkozei, Smith, & Killgore, 2018;Diebel, Woodcock, Cooper, & Brignell, 2016;Killen & Macaskill, 2015;Lai & O'Carroll, 2017;Waters, 2011). Gratitude is inextricably linked to individuals' mental health and life satisfaction. ...
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... This notoriety based type of summed up correspondence is driven without anyone else's input intrigue and key activity. (Lai & O'Carroll, 2017) Their outcomes recommend that the remember your good fortune approach might be a viable procedure to build people's inclination to encounter appreciation. A care gratefulness encourages people to concentrate on benefits.This study demonstrates that a basic remember your good fortune mediation can improve mental prosperity and could possibly be incorporated close by existing mental intercessions. ...
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In four studies, the authors examined the correlates of the disposition toward gratitude. Study 1 revealed that self-ratings and observer ratings of the grateful disposition are associated with positive affect and well-being prosocial behaviors and traits, and religiousness/spirituality. Study 2 replicated these findings in a large nonstudent sample. Study 3 yielded similar results to Studies 1 and 2 and provided evidence that gratitude is negatively associated with envy and materialistic attitudes. Study 4 yielded evidence that these associations persist after controlling for Extraversion/positive affectivity, Neuroticism/negative affectivity, and Agreeableness. The development of the Gratitude Questionnaire, a unidimensional measure with good psychometric properties, is also described.
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Article
Background To reduce the spread of antibiotic resistance, there is a pressing need for worldwide implementation of effective interventions to promote more prudent prescribing of antibiotics for acute LRTI. This study is a process analysis of the GRACE/INTRO trial of a multifactorial intervention that reduced antibiotic prescribing for acute LRTI in six European countries. The aim was to understand how the interventions were implemented and to examine effects of the interventions on general practitioners’ (GPs’) and patients’ attitudes. Methods GPs were cluster randomised to one of three intervention groups or a control group. The intervention groups received web-based training in either use of the C-reactive protein (CRP) test, communication skills and use of a patient booklet, or training in both. GP attitudes were measured before and after the intervention using constructs from the Theory of Planned Behaviour and a Website Satisfaction Questionnaire. Effects of the interventions on patients were assessed by a post-intervention questionnaire assessing patient enablement, satisfaction with the consultation, and beliefs about the risks and need for antibiotics. Results GPs in all countries and intervention groups had very positive perceptions of the intervention and the web-based training, and felt that taking part had helped them to reduce prescribing. All GPs perceived reducing prescribing as more important and less risky following the intervention, and GPs in the communication groups reported increased confidence to reduce prescribing. Patients in the communication groups who received the booklet reported the highest levels of enablement and satisfaction and had greater awareness that antibiotics could be unnecessary and harmful. Conclusions Our findings suggest that the interventions should be broadly acceptable to both GPs and patients, as well as feasible to roll out more widely across Europe. There are also some indications that they could help to engender changes in GP and patient attitudes that will be helpful in the longer-term, such as increased awareness of the potential disadvantages of antibiotics and increased confidence to manage LRTI without them. Given the positive effects of the booklet on patient beliefs and attitudes, it seems logical to extend the use of the patient booklet to all patients.