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Gratitude interventions: A review and future agenda

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Abstract

Gratitude is highly prized. A small sampling of quotes reveals the power and potential of this virtue. “Whatever you are in search of – peace of mind, prosperity, health, love – it is waiting for you if only you are willing to receive it with an open and grateful heart,” writes Sarah Breathnach in the Simple abundance journal of gratitude. Elsewhere she refers to gratitude as “the most passionate transformative force in the cosmos.” Another popular treatment of the topic refers to it as “one of the most empowering, healing, dynamic instruments of consciousness vital to demonstrating the life experiences one desires” (Richelieu, 1996). Lock and key metaphors are especially common; gratitude has been referred to as “the key that opens all doors,” that which “unlocks the fullness of life,” and the “key to abundance, prosperity, and fulfillment” (Emmons & Hill, 2001; Hay, 1996). How do these extraordinary claims regarding the power and promise of gratitude fare when scientific lights are shone on them? Can gratitude live up to its billing? In this chapter we review the growing body of work on gratitude and wellbeing, explore mechanisms by which gratitude interventions elevate well-being, and close by presenting what we consider important issues for the next generation of gratitude intervention studies to address.
Part I
Established Areas of
Intervention
The Wiley Blackwell Handbook of Positive Psychological Interventions, First Edition.
Edited by Acacia C. Parks and Stephen M. Schueller.
© 2014 John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd.
1
Gratitude Interventions
A Review and Future Agenda
Tara Lomas, Jeffrey J. Froh, Robert A. Emmons,
Anjali Mishra, and Giacomo Bono
Gratitude is highly prized. A small sampling of quotes reveals the power and poten-
tial of this virtue. “Whatever you are in search of – peace of mind, prosperity,
health, love – it is waiting for you if only you are willing to receive it with an
open and grateful heart,” writes Sarah Breathnach in the Simple abundance jour-
nal of gratitude. Elsewhere she refers to gratitude as “the most passionate trans-
formative force in the cosmos.” Another popular treatment of the topic refers to
it as “one of the most empowering, healing, dynamic instruments of conscious-
ness vital to demonstrating the life experiences one desires” (Richelieu, 1996).
Lock and key metaphors are especially common; gratitude has been referred
to as “the key that opens all doors,” that which “unlocks the fullness of life,”
and the “key to abundance, prosperity, and fulllment” (Emmons & Hill, 2001;
Hay, 1996).
How do these extraordinary claims regarding the power and promise of grat-
itude fare when scientic lights are shone on them? Can gratitude live up to its
billing? In this chapter we review the growing body of work on gratitude and well-
being, explore mechanisms by which gratitude interventions elevate well-being,
and close by presenting what we consider important issues for the next generation
of gratitude intervention studies to address.
What Is Gratitude and How Is It Measured?
Gratitude is a feeling that occurs in exchange-based relationships when one per-
son acknowledges receiving a valuable benet from another. Much of human life
is about giving, receiving, and repayment. In this sense, gratitude, like other social
emotions, functions to help regulate relationships, solidifying and strengthening
The Wiley Blackwell Handbook of Positive Psychological Interventions, First Edition.
Edited by Acacia C. Parks and Stephen M. Schueller.
© 2014 John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd.
4Lomas, Froh, Emmons, Mishra, and Bono
them (Algoe & Stanton, 2011). Feelings of gratitude stem from two stages of
information processing: (i) an afrmation of goodness or “good things” in one’s
life, and (ii) the recognition that the sources of this goodness lie at least partially
outside the self. This cognitive process, furthermore, gives rise to behavioral con-
sequences, specically the “passing on of the gift” through positive action. As
such, gratitude serves as a key link in the dynamic between receiving and giv-
ing. It is not only a response to kindnesses received, but it is also a motivator
of future benevolent actions on the part of the recipient (see Emmons, 2007 for
a review).
Since the emergence of gratitude research in the past 20 years, the two main
questionnaires that have been widely administered to measure gratitude are
the six-item Gratitude Questionnaire (GQ-6; McCullough, Emmons, & Tsang,
2002) and the 44-item Gratitude, Resentment and Appreciation Test or the
GRAT (Watkins, Grimm, & Hailu, 1998). Both measures conceptualize grat-
itude as a trait, or disposition – in other words, a generalized tendency to
rst recognize and then emotionally respond with thankfulness, after attribut-
ing benets received through benevolence to an external moral agent (Emmons,
McCullough, & Tsang, 2003). When measuring dispositional gratitude,
researchers examine gratitude as an “affective trait,” or an individual’s innate ten-
dency toward grateful experience (Watkins, Woodward, Stone, & Kolts, 2003).
State gratitude, rather, is experienced after a positive event has occurred and as
a result usually promotes further reciprocal, prosocial behavior (Wood, Maltby,
Stewart, Linley, & Joseph, 2008). Individuals who reported greater dispositional
gratitude also reported experiencing greater state gratitude daily (McCullough,
Tsang, & Emmons, 2004); this is largely due to grateful people processing pos-
itive events differently than those less grateful. Specically, people with greater
trait gratitude perceived a benefactor’s actions toward them more positively (more
costly, valuable, and genuine) than their less grateful counterparts, thus demon-
strating greater increases in state gratitude (Wood et al., 2008).
The 44-item GRAT includes the three dimensions of trait gratitude: resent-
ment, simple appreciation, and social appreciation (Watkins et al., 1998). Partici-
pants complete the GRAT by answering questions such as, “I believe that I am a
very fortunate person” and “I’m really thankful for friends and family” using a ve-
point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree with the
statement) (Watkins et al., 2003). Retrospective self-report is the primary method
used when measuring gratitude (Emmons, Froh, & Mishra, in press). Further,
the self-report scales noted above such as the GRAT (Watkins et al., 1998) and
the GQ-6 (McCullough et al., 2002) are measuring dispositional gratitude. State
gratitude on the other hand is measured through gratitude interventions where
participants are partaking in positive psychology exercises such as, keeping a grat-
itude journal, writing a gratitude letter, and then delivering the letter (Emmons
et al., in press). The benets derived from participating in these gratitude-
inducing exercises are examined by measuring positive outcome variables such as
Gratitude Interventions 5
happiness, life satisfaction, and overall well-being at post-intervention follow-
up (Bono, Emmons, & McCullough, 2004; McCullough et al., 2004; Selig-
man, Steen, Park, & Peterson, 2005). Other means for assessing trait gratitude
are through attributional measures and free response. With attributional mea-
sures, gratitude is measured indirectly through participants’ analysis of help-
ing scenarios and their attribution of the help as being either autonomous
or controlled (Emmons et al., in press). For example, grateful individuals are
more likely to perceive the help as autonomously motivated versus controlled
(Emmons et al., in press). Free response measures ask participants to sponta-
neously answer questions revolving around the subject of gratitude (Emmons
et al., in press). For example, participants may be asked about a time when they
felt grateful or about a person for whom they were grateful (Emmons et al.,
in press).
Findings from the Science of Gratitude
Gratitude is foundational to well-being and mental health throughout the life
span. From childhood to old age, accumulating evidence documents the wide
array of psychological, physical, and relational benets associated with gratitude
(Emmons & McCullough, 2003; McCullough, Kilpatrick, Emmons, & Larson,
2001). In particular, dispositional gratitude has been shown to uniquely and incre-
mentally contribute to subjective well-being (McCullough et al., 2004; Watkins
et al., 2003, Wood, Joseph, & Maltby, 2008), and to result in benets above and
beyond those conferred by general positive affect (Bartlett & DeSteno, 2006;
Froh, Yurkewicz, & Kashdan, 2009). For example, dispositional gratitude encour-
ages more positive social interactions, in turn making people better adjusted
and accepted by people around them, and nally leading to well-being (McCul-
lough et al., 2001). Dispositional gratitude has also been found to be positively
associated with prosocial traits such as empathy, forgiveness, and willingness to
help others. People who rate themselves as having a grateful disposition perceive
themselves as having more prosocial characteristics, expressed by their empathetic
behavior and emotional support for friends within the last month (McCullough
et al., 2002). Other benets have extended to the physical realm including longer
sleep and improved sleep quality and more time spent exercising (Emmons &
McCullough, 2003).
Interventions to Increase Gratitude in Adults
Numerous research ndings, briey reviewed above, have highlighted gratitude’s
positive relationship to subjective well-being and psychological functioning. We
6Lomas, Froh, Emmons, Mishra, and Bono
will now describe and discuss the empirical evidence behind some widely used
gratitude interventions for adults.
Counting blessings
In the seminal gratitude interventions study (Emmons & McCullough, 2003),
participants were randomly assigned to one of three conditions: counting bless-
ings, listing hassles, or a no-treatment control (Study 1). People who were ran-
domly assigned to keep gratitude journals on a weekly basis exercised more regu-
larly, reported fewer physical symptoms, felt better about their lives as a whole, and
were more optimistic about the upcoming week compared to those who recorded
hassles or neutral life events (Emmons & McCullough, 2003, Study 1). Study 2
was an extension of the rst study in that a fourth condition was added: down-
ward social comparison. Participants completed weekly reports which asked ques-
tions pertaining to physical health and psychological well-being, and were also
provided instructions for the condition to which they were assigned (counting
blessings, listing hassles, downward social comparison). In each condition, partic-
ipants listed weekly up to ve things they were grateful for, listed ve hassles they
encountered, or made downward social comparisons indicating ways in which they
were better off than others. The daily gratitude journal-keeping exercise resulted
in higher reported levels of the positive states of alertness, enthusiasm, determi-
nation, attentiveness, and energy compared to a focus on hassles or a downward
social comparison (Emmons & McCullough, 2003, Study 2). Participants only in
the gratitude condition responded to the following instruction, “There are many
things in our lives to be grateful about. Think back over the past week and write
down on the lines below up to ve things in your life that you are grateful or
thankful for” (Emmons & McCullough, 2003, p. 379). Results from both Study
1 and Study 2 showed that individuals in the gratitude condition (counting bless-
ings) reported higher instances of prosocial behavior – they were more likely to
report having helped someone with a personal problem or having offered emo-
tional support to another, relative to the hassles or social comparison condition.
This indicates that, relative to a focus on complaints, an effective strategy for pro-
ducing reliably higher levels of pleasant affect is to lead people to reect, on a
daily basis, on those aspects of their lives for which they are grateful (Emmons &
McCullough, 2003).
In Study 3, participants with neuromuscular disease were assigned to either the
gratitude condition (i.e., counting blessings) or a no-treatment control condi-
tion. Participants in both conditions completed 21 “daily experience rating forms”
that asked questions about their daily affect, subjective well-being, and health
behaviors. Results indicated that individuals in the gratitude condition experi-
enced greater positive affect, were more optimistic, and felt more connected to
others than those in the control condition. Spouses of individuals in the gratitude
condition also conrm the results of this intervention, indicating increases in their
partners’ positive affect and life satisfaction (Emmons & McCullough, 2003).
Gratitude Interventions 7
Three Good Things
The benets of gratitude were further conrmed in another study that com-
pared the efcacy of ve different interventions that were hypothesized to increase
personal happiness and decrease personal depression (Seligman et al., 2005).
Participants randomly assigned to the “Three Good Things” intervention were
instructed to write down each day three good things that had happened to them
over the course of one week and attribute causes to these positive events (Selig-
man et al., 2005). Although this intervention did not procure immediate benets,
individuals in the Three Good Things condition experienced lasting effects, with
an increase in happiness and decrease in depressive symptoms seen three and six
months later (Seligman et al., 2005).
Grateful self-reection
In a cross-cultural intervention study (Chan, 2010) Chinese teachers voluntarily
participated in an eight-week-long “self-improvement project” aimed at increas-
ing individual self-awareness through the process of self-reection. Participants’
gratitude, subjective well-being, happiness, meaning derived from life, and teacher
burnout were assessed. Participants were asked weekly to record three good things
that had occurred, for eight weeks. Teachers then reected on these positive occur-
rences using Naikan meditation-inspired questions. The Naikan meditation rep-
resents a form of reection that not only focuses on the self but also on others.
Participants were asked to meditate on the following questions: What did I receive?
What did I give? What more could I do? These questions appeared to orient the
individual not only to think gratefully but also to be more prosocial (e.g., What
more could I do?) (Chan, 2010). Teachers who were more grateful (indicated
at pre-test) reported more gratitude, less teacher burnout (emotionally drained,
depersonalized), and considered meaning in life of greater importance at post-test.
In another cross-cultural study (Boehm, Lyubomirsky, & Sheldon 2011),
foreign-born Asian Americans and Anglo Americans participated in an online
intervention study to assess cultural differences in reported life satisfaction after a
gratitude intervention. A factorial design was utilized where Anglo Americans and
Asian Americans were randomly assigned to one of three conditions: practicing
optimism, expressing gratitude, and listing the past week’s experiences (control).
In the optimism condition, participants wrote about “their best possible life in the
future,” and in the gratitude condition participants wrote letters of appreciation
to those for whom they were grateful.
Cultural differences were noted in both the optimism condition and gratitude
condition. Overall, Anglo Americans beneted most from the interventions, expe-
riencing the greatest changes in life satisfaction from baseline across all activities
(Boehm et al., 2011). Among Asian American participants, the gratitude inter-
vention was most effective, with modest increases in life satisfaction over time;
however, Asian Americans in the optimism condition reported very little change
8Lomas, Froh, Emmons, Mishra, and Bono
in life satisfaction after participating in the intervention (Boehm et al., 2011).
This nding suggests that gratitude interventions with a collectivist orientation
(i.e., focus on family and others) may be more benecial in non-American cul-
tures than are activities with an individualistic orientation (i.e., focus on self and
personal accomplishments) (Boehm et al., 2011).
The “Gratitude Visit”
Grateful reection and acknowledgment in the form of gratitude letters helps fos-
ter an appreciation of others and encourages a grateful orientation (i.e., appreci-
ating the benets – big and small – in one’s life) (Emmons & McCullough, 2003;
Seligman et al., 2005). In a study comparing several positive psychology inter-
ventions, individuals were asked to write a letter to someone to whom they were
grateful and then to deliver their letter in person. Individuals who completed this
activity reported large gains in happiness and reductions in depression up to one
month later (Seligman et al., 2005). Although the gains only lasted one month
(compared to six months for some of the other interventions), the magnitude
of change was the greatest for this gratitude intervention when compared to the
other interventions tested. To date, the Gratitude Visit remains the most powerful
positive psychology intervention in terms of degree of change. It can be specu-
lated that the hyperemotional nature and behavioral follow-through involved in
this intervention are two characteristics which foster the powerful effects.
In another study, Lyubomirsky, Dickerhoof, Boehm and Sheldon (2011)
assessed the role of self-selection and effort in fostering the positive benets
(positive affect, life satisfaction, happiness) of grateful intervention. Participants
unknowingly self-selected the condition they were a part of by choosing to partic-
ipate in either a “happiness intervention” (high motivation) or a “study involving
cognitive exercises” (low motivation) (Lyubomirsky et al., 2011, p. 394). Based
on their selection, participants were then randomly assigned to one of three con-
ditions: a gratitude condition, optimism condition, or control group. The vari-
ables examined (positive and negative affect, life satisfaction, happiness, and effort)
were combined to represent an overall factor: well-being (Lyubomirsky et al.,
2011). Within this study, participants in the gratitude condition were asked to
write “gratitude letters” but not send them, while participants in the optimism
condition envisioned and wrote about their “best possible selves” (Lyubomirsky
et al., 2011).
Positive benets were immediately observed, with “high motivation” partic-
ipants reporting greater well-being compared to the “low motivation” partici-
pants at post-intervention follow-up (Lyubomirsky et al., 2011). Unfortunately,
the intervention did not have a lasting effect, even for the “high motivation”
group, at the six-month follow-up (Lyubomirsky et al., 2011). These ndings
suggest that other factors, such as motivation, effort, and willingness, may also
contribute to the benets that derive from gratitude interventions (Lyubomirsky
et al., 2011). Further, in this study participants in the “high motivation” gratitude
Gratitude Interventions 9
condition who wrote a letter of appreciation but did not send it failed to experience
the lasting effects of the intervention at the six-month follow-up compared with
the low motivation condition (Lyubomirsky et al., 2011). This suggests that the
Gratitude Visit may only have lasting positive effects when both the psychological
(writing letter) and social (delivering letter) mechanisms of the intervention are
at work.
Summary of gratitude interventions
Gratitude interventions in adults consistently produce positive benets, many of
which appear to endure over reasonably lengthy periods of time. Gratitude inter-
ventions lead to greater gratitude, life satisfaction, optimism, prosocial behavior
(Emmons & McCullough, 2003), positive affect (PA) (Emmons & McCullough,
2003; Watkins et al., 2003, Study 4), and well-being (Lyubomirsky, Sheldon,
& Schkade, 2005; Seligman et al., 2005), as well as decreased negative affect
(NA) (Emmons & McCullough, 2003; Seligman et al., 2005; Watkins et al.,
2003, Study 3), compared with controls, for up to six months. Similar nd-
ings, over shorter follow-up periods, have been documented in youth (Froh,
Seck, & Emmons, 2008). Despite these encouraging results, much remains
unknown, including if children and adults can reap similar benets from gratitude
interventions.
Interventions to Increase Gratitude in Children
and Adolescents
Given the benets of the above-described interventions for adults, some
researchers have suggested that gratitude interventions should be applied to many
settings and populations so as to spread health, functionality, and happiness to
more and more people and to society at large (Bono et al., 2004). Although
gratitude interventions for youth surfaced only four years ago, initial ndings are
promising.
Counting blessings
The best evidence that gratitude can improve youths’ well-being comes from three
gratitude intervention studies. In one study, Froh, Seck, and Emmons (2008)
randomly assigned 11 classrooms of 6th and 7th graders (ages 11–14) to one
of three conditions – gratitude, hassles, or a no-treatment control – to partially
replicate Emmons and McCullough’s (2003) “counting blessings” intervention.
Participants completed the intervention activity daily for two weeks and measures
of psychological, physical, and social well-being at pre-test, immediate post-test,
and a three-week follow-up. Those in the gratitude condition were instructed to
count up to ve things they were grateful for, and those in the hassles condition
10 Lomas, Froh, Emmons, Mishra, and Bono
were asked to focus on irritants. Gratitude journal entries included benets such
as: “My coach helped me out at baseball practice,” “My grandma is in good health,
my family is still together, my family still loves each other, my brothers are healthy,
and we have fun everyday,” and “I am grateful that my mom didn’t go crazy when
I accidentally broke a patio table.”
Counting blessings, compared with hassles, was related to more gratitude, opti-
mism, life satisfaction, and less negative affect. Students who claimed feeling grate-
ful for receiving help from others reported more positive affect. In fact, the rela-
tion between feeling grateful for help from others and positive affect became
stronger during the two-week intervention and was strongest three weeks after
the intervention ended. Gratitude in response to aid also explained why students
instructed to count blessings reported more general gratitude. Recognizing the
gift of aid – yet another blessing to be counted – seemed to engender more
gratitude.
Most signicantly, students instructed to count blessings, compared with those
in the hassles or control conditions, reported more satisfaction with their school
experience (i.e., nd school interesting, feel good at school, think they are learning
a lot, and are eager to go to school; Huebner, Drane, & Valois, 2000) immediately
after the two-week intervention and three weeks after completing it. Expressions
of school satisfaction included: “I am thankful for school,” “I am thankful for my
education,” and “I am thankful that my school has a track team and that I got
accepted into honor society.” School satisfaction is positively related to academic
and social success (Verkuyten & Thijs, 2002), and many early and late adoles-
cents indicate signicant amounts of dissatisfaction with their school experience
(Huebner, Valois, Paxton, & Drane, 2005). Therefore, inducing gratitude in stu-
dents via counting blessings may be a viable intervention for mitigating negative
academic appraisals while promoting a positive attitude about school. Holding
such a view predisposes students to improving both their academic and social
competence and may help motivate them to get the most out of school.
The “Gratitude Visit”
In another intervention study, children and adolescents from a parochial school
were randomly assigned to a gratitude intervention or a control condition (Froh,
Kashdan, Ozimkowski, & Miller, 2009). This study partially replicated Seligman
et al.’s (2005) “Gratitude Visit” study using a youth population. Participants in
the gratitude condition were asked to write a letter to a benefactor whom they had
never properly thanked, to read the letter to him/her in person, and to then share
their experience with others in the same condition. To illustrate, one 17-year-old
female wrote and read the following letter to her mother:
I would like to take this time to thank you for all that you do on a daily basis and have
been doing my whole life I am so thankful that I get to drive in with you [to school]
everyday and for all the work you do for our church I thank you for being there
Gratitude Interventions 11
whenever I need you. I thank you that when the world is against me that you stand up
for me and you are my voice when I can’t speak for myself. I thank you for caring about
my life and wanting to be involved for the words of encouragement and hugs of love
that get me through every storm. I thank you for sitting through countless games in the
cold and rain and still having the energy to make dinner and all the things you do. I thank
you for raising me in a Christian home where I have learned who God was and how to
serve him I am so blessed to have you as my mommy and I have no idea what I would
have done without you.
Participants in the control condition were asked to record and think about daily
events. Findings indicated that youth low in positive affect in the gratitude con-
dition reported greater gratitude and positive affect at post-treatment and greater
positive affect at the two-month follow-up than youth in the control condition.
Thus, although 44% of the gratitude studies published to date found support
for gratitude interventions compared against conditions inducing negative affect
(e.g., recording hassles) (Froh, Kashdan, et al., 2009), this study suggests that
there may be specic individuals – namely, those low in positive affect – who may
benet more.
Learning schematic help appraisals
The most promising intervention study, as we hinted earlier, seems to be one
conducted by Froh et al. (in press) that increased gratitude by training individu-
als’ benet appraisals. Using the youngest children targeted by interventions to
date, this study employed a novel technique of strengthening children’s schematic
help appraisals. Classrooms of children (8–11 years) were randomly assigned to
a school-based gratitude curriculum or an attention-control curriculum. School
psychology interns taught participants in the gratitude condition about the social-
cognitive determinants of gratitude via structured lesson plans. Lessons adhered
to the following outline: the introduction (session 1), understanding benefactors’
intentions when being a beneciary (session 2), understanding the cost experi-
enced by benefactors when giving a benet (session 3), understanding the benets
of receiving a gift bestowed by a benefactor (session 4), and the review/summary,
which incorporates all components of the previous sessions (session 5). Using
the methods of classroom discussions, acting out different role plays, and writing
down personal stories in a “gratitude journal,” the intern emphasized the connec-
tion between positive things happening to them and the actions of a benefactor.
Across ve sessions the intern explained that whenever others are nice to us, they
may be doing so on purpose (illustrating intention), using their resources (illus-
trating cost), and helping us (illustrating benet).1
Students in the attention-control condition were also provided with structured
lesson plans that followed an outline but they focused on neutral topics, such
as events of the day. Similar to the gratitude condition, the attention-control
12 Lomas, Froh, Emmons, Mishra, and Bono
condition lessons included classroom discussions, writing assignments, and role-
playing activities. Importantly, the general structure of the attention-control ses-
sions closely mirrored that of the gratitude condition lessons in terms of task
assignment but not in terms of content.
Across two different studies, the authors found that children can be taught to
become more aware of the social-cognitive appraisals involved in circumstances of
receiving help from another, and that this schematic change makes children more
grateful and benets their well-being. A weekly intervention obtained such effects
in the long term (up to ve months later). A daily intervention produced these
effects immediately (two days later) and showed further that children behaviorally
expressed gratitude more (i.e., wrote 80% more thank you cards to their Parent
Teacher Association) and that their teachers even observed them to be happier,
compared to those in the control condition. Evidence thus supported the effec-
tiveness of this intervention.
Next Steps for Gratitude Interventions
Use of gratitude in clinical therapy
Many of the gratitude interventions conducted up until now have found gratitude
inductions to be effective in improving mental health and well-being in compar-
ison to control groups that induce people to think about hassles or complaints.
Many of the studies we have discussed in this chapter examine various outcomes
that are clinically relevant. Researchers have also indicated ways to use gratitude
interventions in therapeutic contexts and reasons why this would be benecial
(Bono & McCullough, 2006; Duckworth, Steen, & Seligman, 2005; Seligman,
Rashid, & Parks, 2006). Further research, however, is needed before this can
occur. Wood, Froh, and Geraghty (2010) lay out an agenda for the kinds of grati-
tude intervention studies that are needed if gratitude interventions are to be used
for clinical therapy. First, they argue that more rigorous experimental studies are
needed that compare gratitude inductions against true neutral control conditions
(using either a no-treatment control or wait-list method) so that we can know the
extent to which gratitude inductions actually produce improvements in individu-
als’ health and well-being over doing nothing at all. Wood et al.’s argument for a
stronger, more neutral control group is noteworthy as this will allow researchers
to more accurately assess and understand the effects of the intervention. However,
using an active control group is a wiser alternative to using a no-treatment control
group when a tting, neutral control is unavailable.
Wood et al. (2010) also argue that experiments using clinical samples are needed
to examine whether gratitude interventions would be better than other com-
mon therapies known to be effective (i.e., “gold standards”) for the treatment
of mental disorder. Counseling psychologists are increasingly considering the use
Gratitude Interventions 13
of gratitude strategies in developing more sustained programs of intervention for
a range of client groups, such as those experiencing depression, substance abuse,
or bereavement (Nelson, 2009). Two recent studies have directly examined grat-
itude’s potential for treating mental disorder. One study found that over a two-
week period daily listing of up to six things for which one was grateful was as effec-
tive as daily automatic thought records in helping a community sample of people
with severe body image dissatisfaction, compared to a wait-list control (Geraghty,
Wood, & Hyland, 2010a); and another made this same nding with a commu-
nity sample of people with excessive worrying, or generalized anxiety (Geraghty,
Wood, & Hyland, 2010b). Notably, in both studies individuals who did the grat-
itude listing were twice as likely to stay in the treatment, compared to individu-
als who received the automatic thought record treatment. These studies provide
examples of the kind of evidence that is needed for gratitude interventions to be
employed for therapeutic purposes.
Other recent research indicates several fruitful avenues for the therapeutic use
of gratitude in populations free of mental disorder, but experiencing other dis-
tress. For instance, one recent study found that the experience and expression
of gratitude may help patients with metastatic breast cancer tap sources of social
support and nd improved quality of life (Algoe & Stanton, 2011). These nd-
ings suggest that gratitude may help people cope with the stress of lifelong or
deadly diseases, issues that are becoming more pressing due to the growth of the
elderly population in society. Gratitude may also be helpful in counseling mar-
ried couples toward more fullling and satised relationships (Gordon, Arnette,
& Smith, 2011). This is consistent with Algoe and colleagues’ ndings that grati-
tude can help boost sense of connection and satisfaction in romantic relationships
(Algoe, Gable, & Maisel, 2010). Therefore, gratitude will likely play a valuable
role in bringing comfort to more and more people in our world as such therapeu-
tic applications are developed.
While gratitude is helpful in many populations, recent research has revealed that
gratitude interventions can be detrimental to certain personality types. Sergeant
and Mongrain (2011) examined the use of gratitude exercises with two vulnerable
depressive personality types: self-critical individuals and needy individuals. Partic-
ipants participated in the intervention for one week and follow-up assessment
was conducted one, three, and six months later (Sergeant & Mongrain, 2011).
Individuals were randomly assigned to participate in one of three conditions:
a gratitude condition (listing daily ve things to be grateful for), music condi-
tion (listening to uplifting music), or control condition (writing about childhood
memories) (Sergeant & Mongrain, 2011). Interestingly, the gratitude exercise and
music exercise only procured positive benets for the self-critical individuals, with
reported increases in self-esteem and decreases in physical symptoms. The needy
individuals experienced negative effects as a result of participating in the music
and gratitude exercises, reporting decreases in happiness and increases in physical
symptomology (Sergeant & Mongrain, 2011).
14 Lomas, Froh, Emmons, Mishra, and Bono
Use of booster sessions to strengthen interventions
Are there ways to strengthen gratitude interventions so that they produce more
long-term effects on well-being? Lyubomirsky and her colleagues make the case
that gratitude interventions are most effective when they are distributed regularly
over time, rather than all in one day, and when individuals intentionally and will-
fully engage in activities that match their lifestyle and interests (Lyubomirsky et al.,
2005). These researchers have found that people are more likely to experience
sustained levels of happiness if they endorse and personally commit themselves to
positive exercises like optimistic thinking about their future and writing letters of
gratitude to others. These ndings suggest that including booster sessions would
be a powerful method for strengthening gratitude interventions. To extend on
Emmons and McCullough’s (2003) intervention as an example, participants who
previously kept a gratitude journal (see Emmons & McCullough, 2003) might
want to do more entries a month or two later to refresh and “boost” the effects
of partaking in this gratitude-inducing exercise.
There are at least two good reasons why booster sessions would help. First, they
would remind individuals to continue to put gratitude exercises in practice in their
daily lives. Second, they would also help refresh individuals’ knowledge about how
to do this. Because gratitude requires people to focus their attention on experi-
ences of interpersonal benets and to remember to express thanks, reminders and
refreshers would help encourage both the experience and expression of gratitude.
As we intimated earlier, combining cognitive and behavioral strategies may be a
powerful method for strengthening gratitude interventions. Thus, boosters may
encourage individuals to personally apply the intervention exercises to new sit-
uations and people in their lives so that the practices are more likely to instill
in them an attitude of gratitude and grateful habits. The more gratitude takes
root and has time to inuence and become a part of people’s relationships and
life narratives, the more positive an impact it will have on their lives. We could
expect more research in the future examining the generative function of gratitude
and ways that gratitude interventions could be used to improve the functioning
of relationships, groups, organizations, and communities. Undoubtedly, booster
sessions will be involved in implementing such interventions so that impacts could
permeate and transform such systems.
Consideration of moderators in interventions
There is evidence that gratitude benets boys more than it does girls (Froh,
Kashdan, et al., 2009). So research examining different mechanisms through
which gratitude benets males and females differently will help to produce better
interventions. With the use of exercises that are better tailored to the sexes, indi-
viduals are more likely to personally “own” and commit to the interventions. The
same could be said of other potential moderators, such as positive affect (Froh,
Kashdan, et al., 2009), cultural factors, or attitudinal factors. Recent work by
Gratitude Interventions 15
Wood, Brown, and Maltby (2011) suggests that different people will experience
different amounts of gratitude for help or gifts they are given, depending on the
amount of help or size of gifts they are accustomed to receiving. A better under-
standing of how gratitude is experienced and expressed in different cultures and in
different groups, then, may help improve our ability to use gratitude to promote
well-being or peace for instance.
Yet another important moderator variable to consider is personal responsibil-
ity. Chow and Lowery (2010) found that in achievement contexts individuals do
not experience gratitude without the belief that they are responsible for their suc-
cess, even when they acknowledge the help they have received. This is a critically
overlooked dimension of gratitude, which for the most part has been regarded
as a phenomenon that depends on external attributions of responsibility for pos-
itive outcomes that one experiences in life. This research suggests that gratitude
may serve a social capital function, enabling individuals to better achieve goals
when they themselves, and other people, are more invested in the pursuit of those
goals. Again, such knowledge can be used to improve upon gratitude interven-
tions, especially those targeting younger populations. As noted above in relation
to the Sergeant and Mongrain (2011) study, personality orientation must be con-
sidered when treating clinical populations in order to procure efcacious results
when using positive psychology exercises for intervention.
Infusing gratitude into existing school curricula
Our intervention research with children aged 8–11 (Froh et al., in press) shows
that gratitude could be easily infused into reading and writing programs in schools,
something that is in line with the rise of social-emotional learning programs
(CASEL, 2003). To positively transform school and community programs for
youth, better understanding is needed of how to improve social settings to bet-
ter promote positive youth development (Shinn & Yoshikawa, 2008). Social-
emotional learning programs are one example of such efforts, and there is evidence
that they are helping to improve both the academic and social development of stu-
dents (Jones, Brown, & Aber, 2008). We believe gratitude can enhance literacy
programs and complement social-emotional learning programs.
Modern forms of communication and interaction
Last but not least, yet another direction for gratitude interventions in the future
will be techniques that use forms of communication that increasingly character-
ize our interactions in today’s world – the use of digital and electronic modes of
communication. We live in a wired culture where teenagers and adults are using
social networking websites and cell-phones to chat, text, and convey informa-
tion to each other. Therefore, future research will undoubtedly explore how these
modes of communication and interaction can be used to promote the experience
16 Lomas, Froh, Emmons, Mishra, and Bono
and expression of gratitude. There is a book already exploring this very topic,
entitled I am gr8ful for you (Serani, 2011).
Conclusion
The research reviewed highlights the success and lasting effects of gratitude inter-
ventions on people’s physical and psychological well-being. Taken together, these
effects indicate improvements in both personal and relational functioning. The
evidence, we think, provides implications for the well-being of people, groups,
organizations, and society, and personal and global well-being. Specic to the
latter, making nations more grateful may be best accomplished by rst incorpo-
rating gratitude curricula into schools, for children and adolescents. How might
the world be if we fostered a grateful generation? In our opinion, we think soci-
eties would improve in many ways. Families would enjoy stronger bonds; neigh-
borhoods would become more supportive; schools would better invest in the
strengths and possibilities of youth; and quite possibly, societies would become
more cohesive, where people will continue to “pass on the gift” of gratitude.
Note
1 The manual is available on the second author’s website.
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