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Gratitude - more than just a platitude? The science behind gratitude and health

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Gratitude - more than just a platitude? The science behind gratitude and health

British Journal of Health Psychology (2018)
©2018 The British Psychological Society
www.wileyonlinelibrary.com
Editorial
Gratitude more than just a platitude? The science
behind gratitude and health
It is well established that gratitude is associated with better psychological well-being. Less
well understood is whether or how gratitude is associated with physical health outcomes.
Below, we review the limited research examining links between gratitude and physical
health suggesting that, for gratitude research to progress, models that help to identify the
underlying mechanisms through which gratitude may influence outcomes are needed.
We argue that the available research on gratitude does not clarify the causal mechanisms,
making it difficult to empirically test possible pathways. Of particular note, work has not
systematically considered the two key pathways via health behaviours and biological
functioning that appear likely to underpin this link. We make the argument that although
gratitude and other positive psychology constructs may have distinct indirect effects on
health, the pathways are likely to be similar at the behavioural and biological levels.
Ultimately, we advocate for the use of a unifying model of positive psychological
well-being, such as that developed in the context of cardiovascular disease (Boehm &
Kubzansky, 2012). An organizing model could be tested across different positive
psychology constructs (including gratitude) and across illness groups and used to advance
and refine specific theories and models of gratitude.
In psychological research, gratitude is conceptualized as both a trait and a state
(Emmons, 2004; McCullough, Emmons, & Tsang, 2002). At a trait level, gratitude is
characterized by individual differences in the average occurrence of feeling grateful in day-
to-day life while gratitude as a state or an emotion involves feeling gratitude as a response
to a beneficial experience (Wood, Maltby, Stewart, Linley, & Joseph, 2008). Altho ugh state
and trait gratitude may differ, reviews have highlighted consistent associations between
both forms and greater psychological well-being in healthy adult populations (Emmons &
Mishra, 2011; Lomas, Froh, Emmons, Mishra, & Bono, 2014; Wood, Froh, & Geraghty,
2010). Similarly, observational studies in groups with chronic health conditions have
found associations between gratitude, quality of life, increased social support, and
improved health behaviours and self-reported adherence (Eaton, Bradley, & Morrissey,
2014; Legler et al., 2018; Ruini & Vescovelli, 2012; Sirois & Wood, 2017; Wood, Maltby,
Gillett, Linley, & Joseph, 2008).
Findings from gratitude interventions are more mixed and demonstrate the lack of
clarity surrounding how interventions work. Gratitude interventions often take the form
of compiling a list of things to be grateful for in a journal (gratitude journals/lists; Wood
et al., 2010), brief grateful contemplation (Watkins, Woodward, Stone, & Kolts, 2003), or
writing letters of gratitude (Seligman, Steen, Park, & Peterson, 2005). As is evidenced
below, general positive psychology interventions (PPIs) often include components of
gratitude, adding to the challenges of identifying behaviour change pathways and teasing
DOI:10.1111/bjhp.12348
1
apart causal mechanisms. Some gratitude interventions or PPIs with a gratitude
component have demonstrated improvements in psychological well-being (e.g.,
increases in positive affect, reductions in depression; Seligman et al., 2005; Watkins,
Uhder, & Pichinevskiy, 2014; Wood et al., 2010) and, more recently, in improved
biological functioning (e.g., blood pressure) in healthy populations (Jackowska, Brown,
Ronaldson, & Steptoe, 2016). Others, notably when contrasting gratitude with another
positive psychology intervention (e.g., writing about best possible selves), have found
little evidence that gratitude interventions were superior (Kerr, O’Donovan, & Pepping,
2015; Manthey, Vehreschild, & Renner, 2016), begging the question of whether gratitude
interventions are distinct from other positive psychology interventions (Dickens, 2017).
Gratitude-based intervention studies in patients with chronic disease remain rare, a
consideration that is evident in reviews and meta-analyses of gratitude interventions that
have found limited evidence for their effectiveness in improving physical health out comes
(Dickens, 2017; Wood et al., 2010). There are several reasons to study gratitude in patient
samples. First, patient samples may yield larger effect sizes and greater variance in
outcomes, helping to clarify the links between gratitude and physical health outcomes
more broadly. Patient-based studies may also reduce the likelihood of ceiling effects (e.g.,
for positive affect; Froh, Kashdan, Ozimkowski, & Miller, 2009), which would, in turn,
help clarify cause and effect relationships in intervention studies and may further clarify
how different PPI constructs impact health. Equally, attempting to improve health and
well-being among patients is morally warranted, especially as gratitude-based interven-
tions are easy to administer, acceptable, low risk, and can be feasibly employed in busy
clinical settings.
To date, there are a few scattered investigations of gratitude interventions among
patients. One early study conducted among 65 people with neuromuscular disorders
found that writing gratitude lists improved positive affect and self-reported sleep relative
to a non-active control condition, but found no differences in pain, exercise, or functional
status (Emmons & McCullough, 2003). More recently, a positive affect skills intervention
that included a gratitude component was trialled in comparison with an emotion-
reporting control group in type 2 diabetes (n=49), with improvements in depression but
not in self-care behaviours (Cohn, Pietrucha, Saslow, Hult, & Moskowitz, 2014). A similar
intervention in HIV patients showed improvements in some health indicators (e.g.,
antidepressant use) but not in health behaviours or viral load (Moskowitz et al., 2017).
Another PPI for 67 cancer patients (based on practising optimistic thinking and writing
gratitude letters) demonstrated improvements in psychological adaptation to cancer in
comparison to an active control condition (Otto, Szczesny, Soriano, Laurenceau, & Siegel,
2016). Finally, relative to treatment as usual, a gratitude journaling intervention in a
sample of 70 asymptomatic heart failure patients improved parasympathetic heart rate
variability and reduced inflammation (Redwine et al., 2016). Despite their ease of use and
acceptability, 15 years has seen fewer than 10 trials of gratitude-based interventions in
patients with chronic health conditions.
There are likely several reasons for this lack. One possible reason is that the benefits of
gratitude for physical health outcomes may be seen as inconclusive based on the present
literature (Dickens, 2017). Another reason may reflect the lack of a model describing the
underlying mechanisms through which gratitude influences outcomes. Although several
general theories regarding gratitude exist (Fredrickson, 2004b; Watkins, 2014; Watkins
et al., 2014), these have not been specified into models depicting the hypothesized causal
relationships. Clearly specified models would allow the associations between the
different components proposed in these theories (e.g., positive affect, gratitude, social
2Editorial
support) and outcomes to be empirically examined and would guide the development and
implementation of more informed and effective interventions. Perhaps, the most
influential theory germane to understanding the positive effects of gratitude is the
broaden and build theory of positive emotion s (Fredrickson, 2001, 2004a,b). This theory
hypothesizes that positive emotions such as gratitude broaden the repertoire of thoughts,
actions, and attention (Fredrickson & Branigan, 2005; Le Nguyen & Fredrickson, 2017),
contributing to the development of long-term physical, psychological, social, and
intellectual resources (Fredrickson, 1998, 2004a; Fredrickson & Branigan, 2005; see
Figure 1). Despite the far-reaching impact of this theory (Fredrickson & Joiner, 2018), it
has been labelled a descriptive rather than a ‘mechanistic’ framework and may be limited
in its ability to identify causal mechanisms (Alkozei, Smith, & Killgore, 2017; Wood et al.,
2010).
With respect to the specific emotion of gratitude, there are at least three potential
mechanisms that are not clearly delineated within the broaden and build theory. First,
the original theory does not include a role for health behaviours, although health-
promoting behaviours are positively associated with gratitude (Hill, Allemand, & Roberts,
2013). While more recent iterations of the theory have expanded on the possible role of
health behaviours (Fredrickson, 2013; Fredrickson & Joiner, 2018; Van Cappellen, Rice,
Catalino, & Fredrickson, 2018; see Figure 2), health behaviours are not directly linked to
health outcomes. Rather, this model suggests that health behaviours work via positive
affect to influence biological function. Secondly, biological functioning is not depicted as
a mechanism, although this possibility has been acknowledged (Fredrickson, 2004a;
Fredrickson, Tugade, Waugh, & Larkin, 2003). Finally, while increased social connections
and increased positive emotions may also build physiologic al resources (e.g., cardiac vagal
tone; Kok et al., 2013; Le Nguyen & Fredrickson, 2017), these pathways are not clearly
represented. Therefore, although the broaden and build theory aids our general
understanding of how gratitude may increase well-being and, to some extent physical
Intellectual resources
Develop problem-solving skills
Learn new information
Broaden and build theory of
positive emotions
Physical resources
Develop coordination
Develop strength and cardiovascular
health
Social resources
Solidify bonds
Make new bonds
Psychological resources
Develop resilience and optimism
Develop sense of identity and goal
orientation
Figure 1. Broaden and build theory of positive emotions. Fredrickson (2003). Sigma Xi, The
Scientific Research Honor Society. Reprinted with permission.
Editorial 3
health outcomes, a causal model is needed to understand and model specific pathways.
Only by testing causal pathways are we able to refine and develop theories and thus
improve the frameworks we use to guide the development and implementation of
interventions.
While writers in this tradition have been understandably cautious in positing causal
links, there are several reasons to suspect that incorporating more causal pathways into
models would be useful. First, many behavioural scientists argue that the links between
positive psychological constructs and health-related outcomes reflect the actions of two
pathways: health behaviours (e.g., increased physical activity) and/or more adaptive
biological functioning (e.g., neuroendocrine functioning; Boehm & Kubzansky, 2012;
Kok et al., 2013; Pressman & Cohen, 2005; Steptoe, Dockray, & Wardle, 2009). Increasing
evidence can be used and built upon to further clarify how positive psychological factors,
such as gratitude, influence health. A second argument for using a broader, unifying model
is that positive psychological functioning encompasses many different constructs (e.g.,
positive affect, optimism, happiness, gratitude). Not only do such constructs overlap in
measurement, but they may also have similar effects on outcomes (Kashdan, Biswas-
Diener, & King, 2008).
While there are some early suggestions regarding mechanism in gratitude research
(Alkozei et al., 2017), these frameworks do not include both health behaviours and
biological functioning as mechanisms. A more global and inclusive model is found in the
model of positive psychological well-being (Boehm & Kubzansky, 2012). Developed to
organize thinking regarding the association between positive psychological well-being
and cardiovascular health, this model (see Figure 3) proposes that the link is mediated by
restorative processes (which protect against ill health) as well as by the absence or
reduction in deteriorative processes. In this view, restorative and deteriorative processes
include health behaviours (e.g., exercise, diet) as well as biological functions (e.g.,
Non-conscious
motives for health
behaviours
Positive affect
during health
behaviours
Built resources:
Biological &
psychological
Engagement in
health behaviours
Figure 2. Upward spiral theory of lifestyle change. Fredrickson and Joiner (2018). SAGE. Reprinted
with permission.
4Editorial
inflammation, cholesterol). This model allows for a clear visualization of the pathways
through which positive emotions may be related to health outcomes. If the model were
adapted to include gratitude, we propose that increased gratitude and positive affect
would directly influence restorative biological functioning and health behaviours as well
as indirectly via social support and stress (see Figure 4). Clearly identifying possible causal
candidates facilitates both their measurement and their being targeted in observational
and experimental research (see Boehm & Kubzansky, 2012 for specific candidates
identified in CVD research, something not yet available in gratitude research). In turn,
clear, mechanism-oriented measurement will help test hypotheses and build on existing
theories.
As has been intimated above, in using the above adapted model as a starting point to
organize gratitude research into a more causally oriented footing, we are not suggesting
that all constructs or measures of positive psychological well-being are identical. Indeed,
constructs such as gratitude may have discrete effects on health. Equally, we are not
suggesting that prominent, valuable theories should be discarded. Rather, we are arguing
for the merits of supplementing their ideas by delineating the pathways underlying
positive emotions and health outcomes: the behavioural pathway and/or the biological
Positive psychological
well-being
Eudaimonic
well-being
Optimism and
other measures
of well-being
Hedonic
well-being
Stress
+
Health behaviours
Biological function
Restorative
process
Deteriorative
process
Cardiovascular disease
+
+
Figure 3. Model of positive psychological well-being. Boehm and Kubzansky (2012). APA.
Reprinted with permission.
Editorial 5
pathway, as well as acknowledging other positive psychological constructs and their
probable overlap in future models. By using a unified model of positive psychological
constructs, the field can move towards a more causally oriented and mechanistic
theoretical framework which can also guide the development and implementation of
gratitude and other positive psychology interventions.
Although we believe gratitude is more than just a platitude, there is still much research
to do, particularly in clinical populations. This includes conducting carefully designed
experimental studies in which specific mediators (e.g., specific health behaviours and
specific health- and disease-related biomarkers) are tested, as well as improving study
design in general (Wood et al., 2010), a consideration that is beyond the scope of this
editorial. With the increased interest in positive psychological constructs such as
gratitude, more theory and model development needs to be undertaken so that the
mechanisms underlying gratitudehealth links are identified and systematically investi-
gated. Adapted models based on the model of positive psychological well-being (Boehm
& Kubzansky, 2012) which depict many of the mechanisms which are likely to operate
across many different positive psychological constructs, including gratitude, may
represent a useful starting point.
Conflict of interest
The authors declare that they have no conflict of interests.
Positive affect
Positive psychological well-being
Gratitude
Health behaviours
Biological function
Restorative
process
Deteriorative
process
Illness
+
+
Social support
Stress
Figure 4. Adapted model of positive psychological well-being. Boehm and Kubzansky (2012)
reprinted [or adapted] with permission.
6Editorial
Kiralee Schache
1
, Nathan Consedine
1
, Paul Hofman
2
and Anna Serlachius
1
1
Department of Psychological Medicine, Faculty of Medical and Health Sciences,
University of Auckland, New Zealand
2
Liggins Institute, University of Auckland, New Zealand
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Editorial 9
... One such factor which has attracted a growing level of interest for physical health and biological processes is gratitude Park et al., 2014;Schache et al., 2019). Gratitude is conceptualized as a broad dispositional orientation towards perceiving and appreciating the positive in life (Wood et al., 2010). ...
... Moreover, reduced TPR and increased CO have been associated with emotional and social factors (Brown et al., 2019;Weisbuch et al., 2009) and so may be relevant to the present context. Thus, given the call for researchers to examine the pathways underling the gratitude-health link Schache et al., 2019) and the paucity of research in the area, further research into the influence of gratitude on CVR to acute stress is needed. ...
... Further, studies that also include assessment of related constructs such as trait personality, emotions, and depression, may help clarify associations between CVR and both gratitude, and perceived social support. Moreover, our gratitude and CVR findings provides evidence for an indirect pathway behind gratitudehealth links (Schache et al., 2019). Finally, given the health promoting effects of keeping gratitude diaries for health , this concept aligns well with a recent call by some cardiologists for harnessing low-cost mind-body medicine to improve cardiovascular health (Prasad, 2016). ...
Article
The pathways linking gratitude to cardiovascular reactivity (CVR) to acute stress are not fully understood. We examine whether this association is mediated by social support. Healthy adults (N = 178) completed measures of trait gratitude and perceived social support and participated in a standardised mental arithmetic and speech stress testing protocol. Their CVR (i.e., systolic and diastolic blood pressure [SBP, DBP], heart rate [HR], cardiac output [CO] and total peripheral resistance [TPR]) were monitored throughout. Gratitude was positively associated with SBP, DBP and TPR reactivity, with those reporting higher gratitude showing higher CVR. Social support was positively associated with TPR to the maths task. The association between gratitude and TPR was mediated by social support but this was only evident in response to the maths task and not the speech task. These novel findings suggest that CVR may be a potential mechanism underlying the gratitude-physical health link.
... Exactly why gratitude predicts better outcomes and the mechanisms explaining how it may influence physical health outcomes is less understood. Recently, an adaption of the model of positive psychological wellbeing (17) was proposed (18), providing a comprehensive overview of possible causal mechanisms. Although experimental studies have yet to begin testing pathways in this framework, increases in gratitude and positive affect are theorized to benefit physical health directly through improving biological processes (e.g., inflammation) and health behaviours (e.g., exercise and diet), and indirectly through increasing social support and decreasing stress. ...
... This may imply that gratitude has a more immediate effect on pre-sleep cognitions, influencing sleep quality, and providing a possible explanation for the promising results reported for sleep quality over other physical health outcomes reviewed. Importantly, sleep quality may also be a health behaviour mechanism underlying the association between gratitude and enhanced biological , these variables should be tested as causal health behaviour and biological process mechanisms in testing the adapted model of positive psychological wellbeing (18). Further, gratitude's impact on sleep quality may be especially relevant to study in patient populations. ...
... interventions. As patient populations may also yield larger effect sizes and reduce ceiling effects (18), patient populations may represent an important opportunity to clarify causal mechanisms. ...
Article
Objective Gratitude interventions are easy-to-deliver, offering promise for use in clinical-care. Although gratitude interventions have consistently shown benefits to psychological wellbeing, the effects on physical health outcomes are mixed. This systematic review aims to synthesize gratitude intervention studies which assessed physical health and health behavior outcomes, as well as evaluate study quality, comment on their efficacy, and provide directions for future research. Methods Relevant studies were identified through searches conducted in PsycINFO, MedLine, Embase and Cochrane Library databases, up until August 2019. Only studies that evaluated a gratitude intervention, randomly assigned participants to gratitude and control conditions, and assessed objective and subjective measures of physical health and health behaviors were included. The Revised Cochrane risk-of-bias (RoB2) tool was used to assess risk of bias. Results Of the 1433 articles found, 19 were included in the review. Subjective sleep quality was improved in 5/8 studies. Improvements in blood pressure, glycemic control, asthma control and eating behavior were understudied yet demonstrated improvements (all 1/1). Other outcome categories remain understudied and mixed, such as inflammation markers (1/2) and self-reported physical symptoms (2/8). The majority of studies showed some risk of bias concerns. Conclusions Although it was suggested gratitude interventions may improve subjective sleep quality, more research is still needed to make firm conclusions on the efficacy of gratitude interventions on improving health outcomes. Further research focusing on gratitude's link with sleep and causal mechanisms is needed, especially in patient populations where more ‘clinically-usable’ psychosocial interventions are urgently needed.
... Positive psychology studies have proven that appreciation and gratitude have a strong association with greater happiness because these feelings enhance dopamine production within the brain [27]. Dopamine is the same neurotransmitter that is released in the brain in reaction to when something good happens to us, i.e., having any reward or gift resulting in healthier sleep habits, boosting metabolism, and decrease stress levels [28,29]. This underlines the importance of recognition and rewards towards the physicians and caregivers during the COVID-19 pandemic. ...
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Background This study aims to explore the experiences, beliefs, feelings, and challenges faced by Pakistani migrant doctors working in the United Kingdom in times of the COVID-19 pandemic. The qualitative study aims to explore the lived experiences, beliefs, feelings, and challenges faced by Pakistani migrant physicians working in the United Kingdom during the COVID-19 pandemic. Methods An exploratory phenomenological approach was used to collate data on experiences expressed during the COVID-19 pandemic. Purposive and snowball sampling was used to target participants, which were doctors of Pakistani origin involved in the direct care and management of COVID-19 patients in different NHS hospitals of the United Kingdom. Semi-structured, in-depth telephonic interviews were conducted with study participants in May 2020. Data analysis was done parallel with data collection by using an inductive qualitative approach. Results We recruited ten frontline physicians. Four theme categories emerged from the data analysis: 1) Working across borders and cultures, 2) Role of beliefs for coping with stress and fear, 3) Passion and profession, and 4) Scaffolding the Pakistani health system. Overall, the results show that the participants received limited professional support, in terms of counseling and psychological rehabilitation. Instead, they had to use self-management strategies to cope with the situation. Conclusion The intensive work exhausted participants physically and emotionally. They were holding a lot of grief and hurt inside, but still, healthcare professionals showed the spirit of professional dedication to overcome difficulties. Although currently coping with their emotional problems, comprehensive professional support should be made available to cater to the wellbeing of frontline physicians.
... Positive psychology studies have proven that appreciation and gratitude have a strong association with greater happiness because these feelings enhance dopamine production within the brain [26]. Dopamine is the same neurotransmitter that is released in the brain in reaction to when something good happens to us, i.e. having any reward or gift resulting in healthier sleep habits, boosting metabolism and decrease stress levels [27,28]. This underlines the importance of recognition and reward towards the phsycians and caregivers during the COVID-19 pandemic. ...
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Background: This study aims to explore the experiences, beliefs, feelings and challenges faced by Pakistani migrant doctors working in the United Kingdom in times of the COVID-19 pandemic. This qualitative approach was chosen to document their lived experiences and to develop a post-COVID-19 response to help them recover from their shared and individual traumas. Methods: An empirical phenomenological approach was used to collate data on experiences made during the COVID-19 pandemic. Purposive and snowball sampling was used to target participants, which were doctors of Pakistani origin involved in the direct care and management of COVID-19 patients in different NHS hospitals of the United Kingdom. Semi-structured, in-depth telephonic interviews were conducted with study participants in May 2020. Data collection was done parallel with data analysis by using standard qualitative methods. Results: We recruited ten frontline physicians. Four theme categories emerged from the data analysis: 1) Working across borders and cultures, 2) Role of beliefs for coping stress and fear, 3) Passion and profession, and 4) Scaffolding the Pakistani health system. Overall, the results show that the participants received no professional support, in terms of counselling and psychological rehabilitation. Instead, they had to use self-management strategies to cope with the situation. Conclusion: The intensive work exhausted participants physically and emotionally. They were holding a lot of grief and hurt inside; but still healthcare professionals showed the spirit of professional dedication to overcome difficulties. Although currently coping with their emotional problems, comprehensive professional support should be made available to them in order to cater for the wellbeing of frontline physicians.
... Observational studies in healthy populations have found a consistent association between highgratitude and lower rates of depression and stress [6,7]. Gratitude interventions have demonstrated improvements in psychological well-being in healthy adolescent populations [8,9] and research is emerging on their efficacy for influencing physiological health outcomes [10]. Gratitude interventions come in different formats with the most common being a gratitude journal [8], where participants are asked to write a list of things for which they are thankful; the format also used in the current study. ...
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Aim Cost‐effective psychosocial interventions that can feasibly be implemented into busy clinical settings are needed to improve psychological and physical health outcomes in adolescents with Type 1 diabetes. We examined the efficacy of a gratitude journalling intervention to improve psychological well‐being and glycaemic control in adolescents aged 10–16 years with Type 1 diabetes. Methods Eighty adolescents were randomized to the 8‐week gratitude intervention (N = 40) or standard care (N = 40). Self‐reported measures of stress, quality of life, self‐care, depression and gratitude were assessed at baseline and 8 weeks after baseline. Glycaemic control (HbA1c) was assessed at baseline and 12 weeks after baseline. A per‐protocol analysis was conducted with the adolescents who completed all questionnaires (N = 60). Analysis of covariance (ANCOVA) was used to examine differences between treatment arms at follow‐up adjusting for baseline scores. Results There was no evidence of any between‐group differences in the psychological or behavioural measures at follow‐up (all P‐values > 0.05). Glycaemic control slightly increased in the control group while remaining stable in the gratitude group, with a between‐group difference of 6.1 mmol/mol [95% confidence interval (CI) −2.6 to 14.7; 0.6%, 95% CI −0.2 to 1.3] at 12 weeks after baseline. After adjusting for baseline HbA1c, this between‐group difference was significant (P = 0.048). Conclusions This is the first randomized trial of a gratitude journalling intervention for adolescents with Type 1 diabetes. Gratitude journalling interventions represent a clinically usable approach. If and how it helps to stabilise glycaemic control in adolescents with Type 1 diabetes remains to be confirmed in future research.
Article
Aims To investigate whether protective psychological factors in young adults with type 1 diabetes are associated with more optimal self-care behaviours and HbA1c, and to explore possible mediators between protective psychological factors and HbA1c. Methods This cross-sectional study examined the associations between protective psychological factors (optimism, positive efficacy expectancies, self-compassion), maladaptive psychological factors (depression, anxiety, stress), self-care behaviours and HbA1c in 113 young adults (17–25 years) with type 1 diabetes in Auckland, New Zealand. Pearson's correlations, multiple linear regression, and multiple mediation analyses were used to examine associations and mediators. Results Higher positive efficacy expectancies (beliefs about coping with difficulties) were associated with more optimal HbA1c (β = −0.26, 95% CI: −1.99 to −0.45) and more optimal self-care behaviours (β = 0.33, 95% CI: 0.28 to 0.92) in the adjusted models. Higher levels of self-compassion were associated with more optimal self-care behaviours (β = 0.27, 95% CI: 0.09 to 0.43). Depression was associated with less optimal self-care behaviours (β = −0.35, 95% CI: −1.33 to −0.43) and stress was associated with less optimal HbA1c (β = 0.26, 95% CI: 0.27 to 1.21). Mediation results suggested that self-care behaviours mediated the relationship between all three of the protective psychological factors and more optimal HbA1c, and that lower stress also mediated the relationship between higher self-compassion and more optimal HbA1c. Conclusions This study adds to the emerging literature that protective psychological factors may play an adaptive role in improving health outcomes in young adults with type 1 diabetes. Interventions targeting protective psychological factors present a promising approach to optimising wellbeing and self-care in youth with type 1 diabetes. This article is protected by copyright. All rights reserved.
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Positive health behaviours such as physical activity can prevent or reverse many chronic conditions, yet a majority of people fall short of leading a healthy lifestyle. Recent discoveries in affective science point to promising approaches to circumvent barriers to lifestyle change. Here, we present a new theoretical framework that integrates scientific knowledge about positive affect with that on implicit processes. The upward spiral theory of lifestyle change explains how positive affect can facilitate long-term adherence to positive health behaviours. The inner loop of this spiral model identifies nonconscious motives as a central mechanism of behavioural maintenance. Positive affect experienced during health behaviours increases incentive salience for cues associated with those behaviours, which in turn, implicitly guides attention and the everyday decisions to repeat those behaviours. The outer loop represents the evidence-backed claim, based on Fredrickson's broaden-and-build theory, that positive affect builds a suite of endogenous resources, which may in turn amplify the positive affect experienced during positive health behaviours and strengthen the nonconscious motives. We offer published and preliminary evidence in favour of the theory, contrast it to other dominant theories of health behaviour change, and highlight attendant implications for interventions that merit testing.
Chapter
The broaden-and-build theory hypothesizes that positive emotions broaden attention and thought-action urges and in doing so build durable biopsychosocial resources over time which supports an upward spiral toward well-being. Substantiating this framework, evidence shows that positive emotions grow psychological resources such as resilience, leading to enhanced subjective wellbeing over time. Positive emotions appear to also improve physical health through assisting health behavior maintenance and impacting the body’s biophysiological systems such as the cardiovascular system. However, the pursuit of positive emotions does not always have positive results. The relationship between the variety of positive emotions and well-being appears to be moderated by cultural contexts. Extreme, inappropriate positive emotions and an excessive desire to feel good may result in negative health and social outcomes. We recommend that to improve wellbeing, one may pursue culturally appropriate emotions through effective means such as prioritizing decisions and activities that generate positive emotions.
Article
Extrapolating from B. L. Fredrickson's (1998, 2001) broaden-and-build theory of positive emotions, the authors hypothesized that positive emotions are active ingredients within trait resilience. U.S. college students (18 men and 28 women) were tested in early 2001 and again in the weeks following the September 11th terrorist attacks. Mediational analyses showed that positive emotions experienced in the wake of the attacks - gratitude, interest, love, and so forth - fully accounted for the relations between (a) precrisis resilience and later development of depressive symptoms and (b) precrisis resilience and postcrisis growth in psychological resources. Findings suggest that positive emotions in the aftermath of crises buffer resilient people against depression and fuel thriving, consistent with the broaden-and-build theory. Discussion touches on implications for coping.
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The effect of a grateful outlook on psychological and physical well-being was examined. In Studies 1 and 2, participants were randomly assigned to 1 of 3 experimental conditions (hassles, gratitude listing, and either neutral life events or social comparison); they then kept weekly (Study 1) or daily (Study 2) records of their moods, coping behaviors, health behaviors, physical symptoms, and overall life appraisals. In a 3rd study, persons with neuromuscular disease were randomly assigned to either the gratitude condition or to a control condition. The gratitude-outlook groups exhibited heightened well-being across several, though not all, of the outcome measures across the 3 studies, relative to the comparison groups. The effect on positive affect appeared to be the most robust finding. Results suggest that a conscious focus on blessings may have emotional and interpersonal benefits.
Article
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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We reflect on our 2002 article and the impact this research report has had both within and beyond psychological science. This article was both one of the first publications to provide empirical support for hypotheses based on the broaden-and-build theory of positive emotions and a product of the genesis of positive psychology. We highlight empirical and theoretical advancements in the scientific understanding of upward spiral dynamics associated with positive emotions, with particular focus on the new upward spiral theory of lifestyle change. We conclude by encouraging deeper and more rigorous tests of the prospective and reciprocal relations associated with positive emotions. Such progress is needed to better inform translations and applications to improve people’s health and well-being.
Article
Gratitude may be associated with beneficial health outcomes, but studies of this association have been mixed, and in these studies gratitude has often been conceptualized as a stable, unidimensional trait. We used four specific items to examine the prospective association of state- and domain-specific gratitude with medical outcomes among 152 patients with a recent acute coronary syndrome. State gratitude for one’s health 2 weeks post-event was associated with increased physical activity (measured via accelerometer) 6 months later, controlling for relevant demographic, social, medical and psychological factors (β = 340.9; 95% confidence interval = 53.4–628.4; p = .020). Gratitude for one’s life was associated with increased self-reported medical adherence at 6 months on the maximally adjusted model (β = .60; 95% confidence interval = .16–1.04; p = .008); no gratitude items were associated with rehospitalizations. In contrast, dispositional gratitude, measured by the Gratitude Questionnaire-6, was less dynamic and responsive to change over the 6-month period and was not associated with physical activity.
Article
Gratitude interventions have been proposed as beneficial practices for improving myriad positive outcomes, and are promoted in self-help literature. The current work examined gratitude interventions’ effects with meta-analytic techniques to synthesize findings of thirty-eight studies, totaling 282 effect sizes. Fifty-six separate meta-analyses examined outcome effects for: gratitude versus neutral comparison at postintervention and delayed follow-up; gratitude versus negative comparison at post and follow-up; and gratitude versus positive comparison at post and follow-up. Results show that gratitude interventions can lead to improvements for numerous outcomes, including happiness, but do not influence others. Their unique benefits may be overemphasized in the literature.
Article
Objective: We conducted a randomized controlled trial to determine whether IRISS (Intervention for those Recently Informed of their Seropositive Status), a positive affect skills intervention, improved positive emotion, psychological health, physical health, and health behaviors in people newly diagnosed with HIV. Method: One-hundred and fifty-nine participants who had received an HIV diagnosis in the past 3 months were randomized to a 5-session, in-person, individually delivered positive affect skills intervention or an attention-matched control condition. Results: For the primary outcome of past-day positive affect, the group difference in change from baseline over time did not reach statistical significance (p = .12, d = .30). Planned secondary analyses within assessment point showed that the intervention led to higher levels of past-day positive affect at 5, 10, and 15 months postdiagnosis compared with an attention control. For antidepressant use, the between group difference in change from baseline was statistically significant (p = .006, d = -.78 baseline to 15 months) and the difference in change over time for intrusive and avoidant thoughts related to HIV was also statistically significant (p = .048, d = .29). Contrary to findings for most health behavior interventions in which effects wane over the follow up period, effect sizes in IRISS seemed to increase over time for most outcomes. Conclusions: This comparatively brief positive affect skills intervention achieved modest improvements in psychological health, and may have the potential to support adjustment to a new HIV diagnosis. (PsycINFO Database Record