The Efficacy of Gratitude Practice on Well-Being: A Randomized

The Efficacy of Gratitude Practice on Well-Being: A Randomized Controlled Trial

By Siew Tim Lai

MSc in Health Psychology, 2014

Psychology, School of Natural Sciences, University of Stirling

Winner of The British Psychological Society Division of Health Psychology award for ‘Outstanding MSc Thesis’ 2014/15

Running head: EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 1

The Efficacy of Gratitude Practice on Well-Being: A Randomized Controlled Trial

Psychology, School of Natural Sciences

MSc in Health Psychology

University of Stirling

Professor Ronan O’Carroll

Supervisor

2229633

Student Number

28th

August 2014

Submission Date

12, 498

Word Count

EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 2

Abstract

Objectives: Despite the benefits accrued from the practice of gratitude, there are mixed

findings concerning the effectiveness of gratitude interventions. Thus, the study examined

a commonly used gratitude-based intervention (‘count-your-blessings’) in promoting

physical and psychological well-being in a UK sample.

Methods: Participants were randomly assigned to 1 of 2 conditions (gratitude and 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 well-being. These measures were collected at two

time-points (pre-and-post intervention), three weeks apart. Two separate analyses were

conducted for participants who completed the intervention (Completer analysis) and for

those who dropped out (Intention-to-treat analysis [ITT]).

Results: Completer analysis revealed that the gratitude condition resulted in heightened

feelings of gratefulness. The most robust finding was positive affect. Though not all

findings were replicated, those with a “grateful-outlook” exhibited fewer negative affect

and physical symptoms. Apart from well-being scores, the ITT analysis yields essentially

the same findings as the completer analysis. While completer analysis showed marginally

insignificant well-being scores, the ITT revealed significant findings.

Conclusion: Findings suggest counting one’s blessings can augment well-being and may

be incorporated in existing psychotherapies to enhance momentary happiness. Regardless,

such simple technique warrants further investigation.

Keywords: Gratitude; Positive affect; Well-being; Health; Positive psychology

interventions

Word Count: 205


Acknowledgement

First and foremost, I offer my deepest gratitude to my supervisor, Professor Ronan

O’Carroll, for his sage advice and mastery guidance from the very initial stage to the

completion of this research. It was also his selfless time and care that kept me going

during tough times. His knowledge in his expertise and professional way of carrying out a

task in a systematic manner has triggered and nourished my intellectual maturity that I will

benefit from, for a long time to come.

It gives me great pleasure in acknowledging all the lecturers in the Department of

Psychology for offering valuable insight and remarks in thesis discussion. Their different

perspectives allowed me to consider and take up a better approach to conduct the research

study. Most importantly, I could never have embarked and started all of this without their

prior teachings in psychology which opened up unknown areas to me. Thank you.

I owe many thanks to Dr Reiko Yeap and Ms Zuhrah Beevi for their continued

encouragement and support. Even though they are miles away, they never cease to devote

their time to provide constructive comments in my data-analysis and research write-up.

I am indebted to Ng Ka Ting and Zenny Lyn for their precious time to help out throughout

the process of data-collection. Without their assistance, I can never successfully

implement this research project in an efficient manner. To Devin Johnson, thank you for

your brilliant input in my statistical analysis. Special thanks to Alicia Wong Sue Yee and

Chang Wei Lun for their willingness to proof read countless pages of texts and

meaningless mathematics.


Completing this work would have been all the more difficult were it not for the emotional

support and patience of my family and my partner, who knowingly and unknowingly – led

me to an understanding of some of the more subtle challenges to our ability to thrive.

Loving thanks go to my friends, Sowbahgya, Rachel Westmore, Chloe Peng and Rebecca

Chen, for their wicked sense of humour when I had lost mine.

I would like to gratefully acknowledge everybody who was important to the successful

realization of thesis, as well as expressing my apology that I could not mention personally

one by one. Thank you.

This thesis is written in honour to be dedicated to my grandmother, in memoriam. For the

myriad of ways in which, she has been the source of inspiration throughout my life.

Last but not least, all praises and thanks to God the Divine, for His showers of blessings

and unfailing grace that carry me through in times of hardship.


TABLE OF CONTENTS

ABSTRACT ................................................................................................................... 2

ACKNOWLEDGEMENT .................................................................................................. 3

CHAPTER ONE: INTRODUCTION ..................................................................... 10

SECTION I: BRIEF OVERVIEW OF POSITIVE PSYCHOLOGY ....................................... 12

Origins of positive psychology .................................................................................... 12

Positive psychology and the calculus of well-being .................................................... 13

Enhancing well-being via positive psychology interventions (PPIs) ........................... 15

Influential factors in the facets of positive psychology interventions .......................... 16

SECTION II: REVIEW OF THE SCIENCE OF GRATITUDE ............................................. 19

Conceptualization of gratitude ..................................................................................... 19

Mechanisms linking gratitude to well-being ................................................................ 22

Effectiveness of gratitude-based interventions ............................................................ 23

Evaluation of gratitude interventions ........................................................................... 26

CONCLUDING SUMMARY ........................................................................................... 28

PRESENT STUDY ........................................................................................................ 29

HYPOTHESES ............................................................................................................. 30

CHAPTER TWO: METHODS................................................................................ 31

Design .............................................................................................................................. 31

Participants ....................................................................................................................... 31

Procedure ......................................................................................................................... 34

Blinding ........................................................................................................................... 36

Measures .......................................................................................................................... 37

Ethical considerations ...................................................................................................... 40

Statistical power ............................................................................................................... 40

Data analysis .................................................................................................................... 40


CHAPTER THREE: RESULTS.............................................................................. 42

PART I: MAIN FINDINGS FOR COMPLETER ANALYSIS ............................................... 42

Gratitude ....................................................................................................................... 42

Affect ............................................................................................................................ 44

Well-being .................................................................................................................... 46

Social relationship ........................................................................................................ 46

Physical symptoms ....................................................................................................... 46

Individual differences in the efficacy of gratitude intervention ................................... 48

PART II: INTENTION-TO-TREAT ANALYSIS ................................................................ 49

CHAPTER FOUR: DISCUSSION .......................................................................... 51

Cultivating gratitude ..................................................................................................... 51

The benefits of practicing gratitude ............................................................................. 52

Factors influencing the efficacy of the intervention ..................................................... 56

LIMITATIONS AND SUGGESTED IMPROVEMENTS ....................................................... 57

FUTURE DIRECTIONS ................................................................................................. 58

PRACTICAL IMPLICATIONS AND CONCLUSION .......................................................... 59

REFERENCES ......................................................................................................... 62

APPENDICES .......................................................................................................... 73


APPENDICES

Appendix A. Participant Information Sheet 73

Appendix B. Consent Form 75

Appendix C. Post-Intervention Information Sheet 76

Appendix D. Basic Demographic Information 77

Appendix E. Emotion Study Questionnaire 78

I. Warwick-Edinburgh Mental Well-being Scale

[WEMWBS]

78

II. Positive Affect and Negative Affect Schedule

[PANAS]

79

III. Gratitude Adjectives Checklist

[GAC]

79

IV. The Grateful Disposition Measure

[GQ-6]

80

V. Perceived Quality of Relationship with a Close

Others

81

VI. Physical Symptoms Checklist 82

VII. Exploratory Data Form 83

Appendix F. Brief-Diary Type Task 84

Appendix G. Instructions for Standard Scripts 88

Appendix H. Instructions for Randomization 92

Appendix I. Table 1. VIA Classification of Strengths 93

Table 2. Types of Positive Psychology Interventions (PPI) 94

Table 3. Conception of Trait Gratitude 95

Table 5. Independent t-test for completer analysis on the

comparison of group differences in relation to the

effects of gratitude intervention

96


INDEX OF TABLES

TABLE 1. VIA Classification of Strengths 93

TABLE 2. Types of positive psychology interventions (PPI) 94

TABLE 3. Conception of trait gratitude 95

TABLE 4. Socio-demographic characteristics of participants 33

TABLE 5. Independent t-test for completer analysis on the comparison of

group differences in relation to the effects of gratitude intervention

96

TABLE 6. Completer analysis on the effects of gratitude intervention in the

experimental and control group

47

TABLE 7.

Correlations of motivation and effort required to engage in the

gratitude-inducing activity with well-being, affect, and gratitude

change scores

48

TABLE 8. Intention-to-treat analysis on the effects of gratitude intervention

in both conditions

50


LIST OF FIGURES

FIGURE 1. CONSORT Diagram 32

FIGURE 2. Procedural flowchart 37

FIGURE 3.

Change in dispositional gratitude from pre- to post-

intervention for the gratitude group condition versus the

control condition

43

FIGURE 4. Change in state gratitude from pre- to post-intervention for

the gratitude group condition versus the control condition 44

FIGURE 5. Change in positive affect from pre- to post-intervention for

the gratitude group condition versus the control condition 45

FIGURE 6.

Intention-to-treat analysis for the change in well-being from

pre- to post-intervention for the gratitude group condition

versus the control condition

49


CHAPTER ONE: INTRODUCTION

The World Health Organisation (WHO) declared mental health as a state of well-

being in which the individual recognises his or her own strengths, can deal with daily

stressors, able to work efficiently, and is capable to contribute to his or her community

(WHO, 2004). Following a laudable effort by the Scottish government to incorporate

positive psychology into their prevention and intervention health plans, mental health was

characterised as having socio-emotional and psychological resilience to experience the

abundance in life and to cope with adversity and toxic emotions (Myers, McCollam, &

Woodhouse, 2005). Evidently, understanding what well-being constitutes and its

beneficial correlates have become the central focus of current research.

Beyond the illness ideology, positive psychology emphasize on the understanding

of human behaviour to enhance individual’s quality of life. Various modes of positive

psychology interventions were developed to build character strengths that contain

desirable traits (e.g. gratitude, hope, self-control and etc.). These traits were derived from

virtues extolled by ancient scholars and has been associated with increased well-being

(Peterson & Seligman, 2004).

From prehistoric religious scriptures to contemporary scientific evidence-based

research, gratitude is recognised as a desirable virtue that can enhance a person’s well-

being (Watkins, Woodward, Stone, & Kolts, 2003). Evidence showed that the effects of

gratitude practice can be classified as the following categories: Increase in happiness and

life satisfaction; effective coping with adversity; strengthen social bonds; benefits health;

and broaden the civic, moral, and spiritual dimensions (Worthen & Isakson, 2007).

However, gratitude is not an automatic response to life situations and it needs to be

deliberately cultivated via gratitude-inducing activities. Most gratitude-based

interventions adopt tactics and strategies suggested by the general design of positive


psychology interventions to investigate its links to well-being; nonetheless, the

effectiveness of these interventions requires careful examinations.

This chapter consist of two sections. The first section of this chapter aims to

provide an overview of positive psychology including the origins, definition, links to the

calculus of well-being, and factors that may hinder or maximise the utility of positive

psychology interventions. The second section provides a description of how the practice

of gratitude promotes human flourishing.


SECTION I: BRIEF OVERVIEW OF POSITIVE PSYCHOLOGY

Origins of positive psychology

Historically, psychologists focused on ameliorating human sufferings such as

depression, suicidal ideation, and schizophrenia (Seligman, 2010). Until the 20th

century,

there is a shift in mental health practice and research that emphasizes on positive human

functioning and psychological well-being (Seligman, Steen, Park, & Peterson, 2005). The

advent of positive psychology can be mapped from Martin Seligman’s 1998 presidential

speech to the American Psychological Association urging psychologists to not only repair

pathologies but also help individuals to build a meaningful life (Seligman &

Csikszentmihalyi, 2000). Positive psychology, as implied by Seligman et al. (2005) is not

a panacea for modern ills, rather is a supplement to the existing knowledge about

psychological distress. By understanding and synthesizing the positive and negative

aspects of human experience, interventions can be developed to decrease misery and build

the enabling conditions of life (Linley, Joseph, Harrington, & Wood, 2006).

Peterson and Seligman (2004) developed a handbook on the classification of

“Character Strengths and Virtues” (CSV) which shed light on what makes life worth

living. They proposed that the 24 character strengths and six virtues as means to complete

the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association

(APA, 1987). The virtues identified (i.e. wisdom, courage, love, justice, temperance, and

transcendence) are valued by moral philosophers and religious thinkers, and character

strengths (e.g. gratitude, creativity, and forgiveness) are routes or mechanisms that

describe the virtues (Peterson et al., 2004) (Table 1; Appendix I).

Positive psychology highlighted that the cultivation of character strengths are

robustly linked to important aspects of individuals and social well-being (Park & Peterson,

2006). The beneficial correlates include academic achievement, altruism, and valuing


diversity (Park, 2004). Findings demonstrated that different strengths predict different

outcomes. For example, strengths of “character” (e.g. gratitude, zest, and curiosity) are

highly correlated with life satisfaction (Park, Peterson, & Seligman, 2004). Strengths of

“heart”, those that allows formation of social bonds (e.g. gratitude and love) are strongly

associated with well-being when compared to strengths of “head” (e.g. creativity and awe

appreciating excellence) that are essential in human nature (Park et al., 2004). Moreover,

strengths like appreciation of beauty and bravery facilitate illness recovery, whereas

religiosity is related with meaning and purpose in life (Park & Peterson, 2009).

These aforementioned studies illuminate the connection between character

strengths and desirable outcomes; the question is how to enhance the strengths for

individuals who already possess them or instil it to those who lack them. Thomas

Jefferson (1819) once said “happiness is the aim of life, but virtue is the foundation of

happiness”. Although everyone yearns for a happy and fulfilled life, would it be possible

to build the positive side of life?

Positive psychology and the calculus of well-being

Positive psychology, succinctly, is about the concept of well-being which entails

the five components (PERMA) – positive emotion, engagement, relationships, meaning

and accomplishment (Seligman, 2011). As defined by Seligman’s (2002) Authentic

Happiness theory, emotion is regarded as positive feelings and engagement as being

absorbed. Seligman (2011) viewed humans are driven to seek and preserve positive

relationships, and also find meanings in life (i.e. serving something bigger than oneself).

Accomplishment – the last element described as the pursuit of achievement, mastery, and

competence (Seligman, 2011). Taken together, these components are essential to lead a

“good” life – a life worth living for (King, Eells, & Burton, 2004).


To date, blossoming interest revolves around the topic of well-being (also

classified as subjective well-being (SWB) and psychological well-being (PWB) (Odou &

Vella-Brodrick, 2013). Subjective well-being includes the cognitive and affective

components (Diener & Lucas, 1999), whereas psychological well-being refers to the extent

of meaning and purpose in life assigned by individuals (Ryff & Keyes, 1995). Scholars

found that a boost in overall well-being resulted in increases in work productivity, social

engagement, and fewer healthcare visits (Keyes & Grzywacz, 2005). Additionally, well-

being is positively correlated with physical health (Diener & Chan, 2011). Pressman and

Cohen (2005) suggested that the relationship is mediated by a healthy lifestyle and an

improved immune system, which cushions against the impact of stress. Growing evidence

showed that well-being decreases the chances of developing mental illnesses and also

reduces mortality risks in people with physical disease (Wood & Joseph, 2010; Lamers,

Bolier, Westerhof, Smit, & Bohlmeijer, 2012).

Therein lies the question of whether well-being can be increased and maintained

over time. According to Lyubomirsky, Sheldon and Schkade’s (2005) Architecture of

Sustainable Change, there are three major factors that contribute to well-being – (i) genetic

set point, (ii) life-circumstances, and (iii) intentional activities. Research underlying this

model indicated that genes made up 50% (Lykken & Tellegen, 1996), and life-

circumstances (e.g. income, marital status, and religiosity) explain roughly 10% (Diener,

Lucas, & Scollon, 2006) of variance in well-being. Intentional activities (i.e. positive

cognitive-, behavioural-, and goal-based activities) accounted up to 40% of the residual

variance (Lyubomirsky, Dickerhoof, Boehm, & Sheldon, 2011). As it is relatively difficult

to alter the expression of genes or one’s life circumstances, the last factor – intentional

activities, serves as the target to bolster people’s well-being (Lyubomirsky, 2008).


Enhancing well-being via positive psychology interventions (PPIs)

The designs of PPIs are mostly structured forms of volitional activities centralized

around the themes of increment of positive feelings, cognitions, and behaviours (Sin &

Lyubomirsky, 2009). Although scepticism views interventions that increase well-being as

an epiphenomenon, studies showed that well-being can be enhanced by engaging in

intentional, effortful activities such as expressing gratitude (Emmons & McCullough,

2003; Toepfer, 2009), having optimistic outlook (Sheldon & Lyubomirsky, 2006),

practicing kindness (Otake, Shimai, Tanaka-Matsumi, Otsui, & Fredrickson, 2006), and

using signature strengths in daily lives (Seligman et al., 2005) (Table 2; Appendix I).

A meta-analysis of 51 studies on the efficacy of PPIs revealed that PPIs are

effective at both boosting well-being and ameliorating depressive symptoms (Sin &

Lyubomirsky, 2009). The effect sizes for well-being (mean r = .29) and depression (mean

r = .31) were medium, which is notable, considering these interventions are self-

administered designs compared to the conventional face-to-face administered

interventions. Another similar meta-analysis of 39 randomised, controlled PPIs studies on

clinical and nonclinical populations, although standardized effect sizes were small for

SWB, PWB, and depression (mean rs= .34, .20, and .23, respectively), a three- to six-

month follow-up indicated that effects were fairly sustainable (Bolier, Haverman,

Westerhof, Riper, Smit, & Bohlmeijer, 2013).

Findings of the effectiveness of PPIs studies are inconsistent. A study by Sin,

Della Porta, and Lyubomirsky (2009) showed that the practice of writing gratitude letters

was ineffective in enhancing well-being among dysphoric individuals. In comparison, the

control group who performed a neutral activity (i.e. listening and writing about classical

music) experienced an immediate boost in well-being. Likewise, Sin et al. (2009) reported

no significant changes in participants’ well-being after eight consecutive weeks of writing


gratitude letters. They attributed this finding to those who demonstrated increased in SWB

were due to individual intrinsic motivation to become happier.

Another study by Kashdan, Uswatte, and Julian (2006) found that dispositional

gratitude significantly influenced well-being of veterans with PTSD compared to non-

traumatized veterans. However, the veterans with PTSD in this study have been exposed

to actual combat; hence, group differences between gratitude and well-being may be

attributed to the contact of war-zone stressors as opposed to the presence of PTSD.

Somewhat similar to Kashdan et al.’s (2006) findings, Sin and Lyumbomirsky

(2009) found no significant differences in well-being among non-depressed individuals,

whereas individuals with depression experienced reduction in depressive symptoms and

enhanced well-being. This suggests that an individual’s psychopathology condition (e.g.

depression or anxiety) may play a role in the effectiveness of PPIs.

Though the therapeutic efficacy of these positive activities is not fully understood,

a majority who participated in the happiness-inducing activities benefitted from it to some

degree. These findings point towards there are factors or conditions that temper the

relationship between gratitude and well-being.

Influential factors in the facets of positive psychology interventions

If PPIs are to be taken seriously to be implemented in clinical settings and utilised

amongst general population, it is essential to identify the factors that could either dampen

or enhance the effectiveness of PPIs.

Timeframe of intervention. Studies found that interventions with longer duration

(measured in hours or weeks) were more effective than short-term interventions in treating

psychological disorders and boosting happiness (Sin et al., 2009). Studies that adopted

techniques such as counting one’s blessings (Emmons & McCullough, 2003), performing

acts of kindness (Otake et al., 2006), utilising signature strengths in daily lives (Seligman


et al., 2005), and visualising best possible selves are what Sheldon and Lyubomirksy

(2006) termed as – habitual activities. Lyubomirsky et al. (2011) suggested that longer

interventions pave the way for more practice, in return transforms activities into long-

lasting habits. Likewise, individuals who continued to practice positive exercises after the

intervention has ended experienced greater boost in happiness (Lyubomirsky et al., 2011).

Recruitment and randomization of subjects. A meta-analysis conducted by

Bolier et al. (2013) revealed that participants who were recruited via referral from

healthcare professionals or hospitals showed larger effect sizes in efficacy of PPIs.

Contrariwise to Bolier et al.’s (2013) findings, Sin et al. (2009) found that volunteers or

self-select individuals who choose to be involved in the PPIs demonstrated greater success

in eliciting happiness and coping with depressive symptoms compared to those who were

randomly assigned to interventions. Interventions that permit the choice to participate

presumably instil more motivation and awareness of the aim of the PPIs (Lyumbomirsky

et al., 2011). Perhaps, participants who are motivated to be happier appear to be more

diligent and enthusiastic in following the guidelines.

Person-activity fit. Sheldon and Lyubomirsky (2006) described the notion of fit

as the match between individual’s motives, strengths, personality, or needs with the

particular happiness-inducing activity. This, in turn, would determine the success rate of

an intervention. Instead of writing about one’s positive traits – a form of solitary activity,

being kind to others is rewarding to a sociable person as it serves to strengthen social

bonds (Lyubomirsky, 2008). When the positive activity is executed for an appropriate

duration, intensity, combined with the proper person-activity fit, the person’s well-being is

maximized (Sheldon & Lyubomirsky, 2006).


One essential standard for living is the ability to be happy (Eid & Larsen, 2008).

Buoyed by research findings from positive psychology scholars, a mentally healthy

individual holds numerous physical, social, and intellectual benefits compared to their

unhappy counterparts (Fredrickson, 2001; Lyubomirsky, King, & Diener, 2005). This

increased emphasis on positive phenomena has generated an interest in the United Nation

General Assembly to review the approaches to systematic measurements of one’s

happiness as well as a whole nation (Layard, 2013). Undoubtedly, there is value in

understanding people’s sense of well-being. Although there are various ways to increase

well-being, the cultivation of gratitude is said to be the quintessential positive personality

trait, serving as a channel to allow individuals to lead a flourishing life. Thus, the next

section attempts to demonstrate how gratitude increases one’s well-being.


SECTION II: REVIEW OF THE SCIENCE OF GRATITUDE

The section aims to critically analyse the literature regarding the effects of

gratitude practice on well-being. Firstly, the conceptualization of gratitude will be

provided, followed by the mechanisms linking gratitude and human flourishing. Next, the

techniques and the effectiveness of gratitude interventions will be examined. Upon

reviewing these interventions, knowledge gaps will be addressed and appropriate

suggestions will be provided.

Conceptualization of gratitude

Gratitude has a long lineage of acknowledgment from historically, religious, and

philosophical standpoints, in which it underlined the importance of having a grateful-

outlook in life (Emmons & Crumpler, 2000). A virtue that is deemed integral to well-

being, however, is understudied in the social sciences. This abandonment might be

attributed to a more general negligence of research into positive emotions (Linley et al.,

2006). Regardless, the previously disregarded construct has received calls to explore its

potential to improve well-being (Gable & Haidt, 2005). Burgeoning evidence on gratitude

and human flourishing suggested there is a need to understand how and in what ways it

brings advantages into the life of the practitioner (Emmons & McCullough, 2003;

Emmons, 2012).

There are various interpretations of the construct within the field of gratitude

research. Some claimed that gratitude manifests from two information-processing stages,

which firstly requires the individual to have an awareness of positive experiences, and

subsequently attributing these positive experiences to an external source (McCullough,

Kilpatrick, Emmons, & Larson, 2001). However, if gratitude is only directed outwards,

this conceptualization neglects other grateful sources that people attribute to in their daily

lives. For instance, participants in Emmons and McCullough’s (2003) study listed grateful


events such as “woke up early today” which indicates that gratitude is not always directed

towards the particular benefactor. Another example, demonstrated by Graham and Barker

(1990), was asking young children to identify circumstances a person would feel most

grateful. They presented participants with videos observing another child successfully

completing a task under two conditions – either being assisted by an adult, or working

independently. Participants were hypothesized to identify more gratitude for the subject

who was offered help. Interestingly, their findings showed that participants reported the

subject who worked independently feel most grateful compared to those who received

assistance. This suggests that gratitude may emerge from sources like appreciation of

one’s capabilities, or of circumstances that allow successful culmination of work. Similar

work has been demonstrated among adult populations (Veission, 1999), which propose

that gratitude encompasses beyond an interpersonal appreciation of another person’s help.

These data point out that a standard definition is needed to resolve this inconsistency.

Gratitude as a life orientation. Gratitude represents a broader attitude towards

noticing and appreciating the positivity in life (Wood, Froh, & Geraghty, 2010). This

grateful-outlook was tested by Wood, Maltby, Stewart, and Joseph (2008) using various

scales that assess gratitude. The three developed scales that measure gratitude were – (i)

GQ-6 (McCullough, Emmons, & Tsang, 2002), (ii) Appreciation Scale (Adler & Fagley,

2005), and the (iii) Gratitude, Appreciation, and Resentment Test (GRAT) (Watkins,

Woodward, Stone, & Kolts, 2003). These scales capture distinct features of what gratitude

comprises in order to provide a broad definition that is aligned with the life-orientation

perspective (Wood et al., 2010). As cited by Wood et al. (2010), the three scales provide

eight conceptions of gratitude (see Table 3; Appendix I) to indicate how a grateful person

views and interacts with the world.


Trait and state gratitude. People who are more oriented towards noticing the

positive in life encounter the eight aspects of gratitude more frequently, intensely, and

through a range of eliciting stimuli (McCullough et al., 2002). This put forth the notion

that an interaction might exist between trait1 and state

2 gratitude in determining a person’s

life-orientation (Emmons, McCullough, & Tsang, 2003; Watkins, Woodward, Stone, &

Kolts, 2003). Levels of trait gratitude can be measured using GQ-6 or the GRAT;

nonetheless, the GQ-6 is a more common tool in assessing individual’s dispositional

gratitude (Watkins, 2004). Gratitude Adjectives Checklist (GAC), on the other hand is

used to evaluate levels of state gratitude (McCullough et al., 2002). It contains three

adjectives – ‘appreciative’, ‘grateful’, and ‘thankful’, which investigates the time spent

reflecting upon the feeling of gratefulness.

Theoretically, viewing life as something to be thankful for is anticipated to be

strongly associated to well-being. Wood et al. (2010) demonstrated that individuals with

low well-being attribute their successes to factors that are uncontrollable, brief, and due to

the course of others’ actions, which in turn generate depression, anxiety, and negative

emotions. This finding is supported by the reformulated learned helplessness theory and

attribution theory that postulate well-being (and psychopathology) arises from how

individuals interpret their life happenings. Gratitude is said to be the antithesis of Beck’s

(1976) negative cognitive triad (i.e. negative in self, world, and future). Consequently,

assessing gratitude at both trait and state levels can be an important determinant to

understand its interaction with well-being.

1 Trait (dispositional) gratitude is described as individual predisposition to experience the

state of gratitude in life 2 State gratitude is defined as the feeling of awe, gratefulness, and appreciation for

outcomes received


Mechanisms linking gratitude to well-being

Scholars have noted that gratitude has happiness-bestowing properties (Emmons &

McCullough, 2003). This can be explained using Fredrickson’s (2001) broaden-and-build

theory, which states that positive emotions broaden thinking and attention. According to

Fredrickson (2004), gratitude broadens through innovative reciprocity which builds

enduring personal resources (e.g. psychosocial, spiritual, and physical skills), and

consequently enhances individual well-being.

Another mechanism is the coping hypothesis, suggested by Wood, Joseph, and

Linley (2007), that grateful individuals often utilised three broad coping strategies: (i)

actively seeking both instrumental and emotional social support, (ii) approaching and

dealing with the problem via active coping, managing, and benefit-finding, and (iii)

engaging in adaptive behaviour. These coping strategies were reported to mediate the

relationship between gratitude and stress (Wood et al., 2007). Stress arises when events

are perceived as threatening and exceeding personal coping resources; hence, grateful

individuals who engage in positive coping appraisals are less likely to experience stress

(Wood et al., 2007). This mechanism provides a perspective on how gratitude facilitates

mood stabilization to counteract stressful life events.

Watkins (2004) provided a detailed account on how gratitude influences well-

being. He proposed that viewing positive happenings as “blessings” enhances well-being

and may counteract the normal hedonic set-point. Similar to the coping hypothesis,

gratitude serves as a coping mechanism that when one encounters adversity, they recollect

pleasant memories which allow them to shift their attention from a mindset of deprivation

to appreciation (Watkins, 2004). Gratitude is an interpersonal emotion resulting from

receiving help that is perceived as valuable, costly, and an altruistic act (McCullough et al.,

2001); this suggested that grateful individuals have specific characteristic schemas that


may be associated with well-being (Wood et al., 2008). Equally, this benefits the

individual in a social context by cultivating interconnectedness and strengthens

relationship with others (Emmons, 2012).

Effectiveness of gratitude-based interventions

To cultivate gratitude therapeutically, several interventions have been developed to

prove that physical and psychological benefits can accrue from a grateful-outlook. These

interventions are categorised into behavioural expressions of gratitude, grateful

contemplation, and gratitude listings (Wood, Froh, & Geraghty, 2010).

Behavioural expressions of gratitude. Also referred as the “gratitude visit”, this

strategy requires an individual to write a letter to a benefactor to show appreciation for

their kindness. The underlying assumption of this exercise is that people may often say

“thank-you” but fail to demonstrate the actual depth of their gratefulness to the benefactor

(Rashid, 2009). Hence, this exercise aims to encourage expression of thankfulness for the

received goods. In Seligman et al.’s (2005) findings, participants who composed and later

delivered the gratitude letter had a boost in happiness compared to the placebo condition

that was instructed to write about their early childhood memories. Though the gratitude

visit yielded the largest effect sizes, the effects faded substantially over a month. It is

plausible that writing just one gratitude letter was insufficient for sustained happiness.

Toepfer (2009) extended the design to writing three gratitude letters; his findings revealed

that participants who completed wrote multiple letters demonstrated higher cumulative

effect for both gratitude and happiness index scores compared to non-writers. Contrary to

these studies, Lyubomirsky et al. (2011) removed the psychological realism of the exercise

(i.e. removal of letter delivery) yet, results indicated that individuals experienced an

improvement in well-being. Mailing out a ‘thank you’ letter may appear effective for the

first few occasions; one can imagine repetitive action could become stale. Future


investigation should compare the impact of “delivery versus non-delivery” of the gratitude

letter and assess the level of impact based on to whom one writes.

Grateful contemplation. This involves participants to either think or write about

what one is grateful for in a more casual manner. In Watkins et al.’s (2003) study, one

group of participants were instructed to list several summer activities that they were

thankful for, whereas another group were told to list things they wanted to do but were not

given the opportunity. In this seemingly five minutes intervention, those who were

thankful for the activities over the summer reported less negative affect compared to their

counterpart. Coherent with other similar findings (Henrie, 2007; Koo, Algoe, Wilson, &

Gilbert, 2008), this simple technique has important clinical implications for therapists to

induce immediate positive mood among dysphoric individuals.

Gratitude lists. Among all gratitude interventions, this approach is widely used

and examined (Wood, Froh, & Geraghty, 2010). More specific than the grateful

contemplation method, it requires participants to record grateful thoughts in a daily or

weekly journal. Emmons and McCullough (2003) carried out three experimental studies

which assigned participants to keep a gratitude journal. The first study randomly assigned

students to three conditions – (i) gratitude condition (i.e. listing five things they were

grateful for), (ii) hassles condition (i.e. listing five hassles), and (iii) life events condition

(i.e. listing five events that has affected them) for the past one week. Students in these

three conditions were required to complete the task along with other measures that

assessed coping behaviour, mood, physical distress and global appraisals for 10-week.

Findings revealed that those assigned in the gratitude condition reported being more

grateful, optimistic, and had fewer physical complaints compared to the hassles and life

events condition. The second study adopted a two weeks daily gratitude journal-keeping

exercise, and the hassles condition was replaced with a social-downward comparison


group (i.e. participants were encouraged to think about how they were better off than

others). Participants in the gratitude condition exhibited increased positive affect and

altruistic behaviour compared to other conditions. However, the second study failed to

replicate the findings for health benefits. Extending the study to three weeks (i.e. third

study), which focused on adults with neuromuscular disease, these participants were

randomly assigned to either the gratitude condition or control group. Those in the

gratitude condition demonstrated marked enhancement in positive affect and life

satisfaction. Other benefits include improved sleep quality, more time spent on exercising,

and greater bond with others.

The lack of follow-up in Emmons and McCulloughs’ (2003) study makes it

impossible to determine how long the effects lasted for the gratitude condition compared to

other conditions. The study was revised by Froh, Sefick and Emmons (2008) which

included a three weeks follow-up. In the post-test and follow-up, participants in the

gratitude condition were found to experience greater gratitude, higher satisfaction with

school experience, and reduction in negative affect compared to the hassles and control

group. Physical benefits and perceived quality of interpersonal relationship remained

insignificant.

A similar replication by Seligman et al. (2005) which required participants to keep

a daily journal to reflect and write on the positive events that happened during the day

showed a boost in happiness and alleviated depressive symptoms over a six-month follow

up. Another study conducted by Lyubomirsky, Sheldon, and Schkade (2005) found

evidence that the frequency of the happiness-enhancing intervention plays a role in

therapeutic outcome. However, Lyubomirsky et al.’s (2005) study showed that

participants who kept a once-per-week gratitude journal received greater benefits than

those who kept frequent gratitude journal (i.e. three times per week). Perhaps a systematic


comparison of the “dosage” for these interventions would allow future recommendations

to be made with confidence.

Evaluation of gratitude interventions

Previous work revealed that gratitude has the ability to enhance well-being through

simple techniques. However, it is important to highlight the caveats and concerns about

the effectiveness of these interventions. First, several studies that aim to enhance well-

being via gratitude practice did not evaluate whether the intervention successfully foster

gratitude (Sheldon & Lyubomirsky, 2006; Sin, Della Porta, & Lyubomirsky, 2009). The

intensity, span, frequency, and density of experienced gratitude among participants were

not assessed, leaving doubts to question the objective findings of the gratitude

interventions.

Though interventions based on the principle of gratitude listing has demonstrated

its usefulness in inducing grateful experiences among individuals when compared to the

letter-writing approach (Wood, Froh, & Geraghty, 2010), the effectiveness of this

technique was supported by comparing with diverse control conditions (e.g. listing hassles

and downward social comparison) that induces negative emotions. This makes it

problematic to infer the effectiveness of the gratitude component of the intervention when

compared to more common aspects.

These aforementioned studies showed beneficial correlates associated with the

practice of gratitude. This includes improvement in well-being (i.e. increased in positive

affect, life satisfaction, and reduced in negative affect), altruistic behaviour (i.e. frequency

of giving and receiving aid), and spirituality and religiosity (Bono, Emmons, &

McCullough, 2004). However, the duration of the effects remains a question unanswered.

Evidence from Seligman et al.’s (2005) study highlighted the need to follow-up on those


who practice PPIs because some positive changes may not be present at the initial post-

intervention assessment.

The generalizability of the effects of gratitude interventions needs to be explored as

most studies were conducted on US participants. As North Americans celebrate

Thanksgiving, they may view gratitude as a central cultural value as opposed to other

cultures (Martínez-Martí, Avia, & Hernández-Lloreda, 2010). Whether these interventions

would have the same effects on other populations is unknown due to scarcity of research in

this area.

In implementing gratitude interventions, researchers should consider the type of

positive exercises and time commitment required from the participants (Bono et al., 2004).

The question on how and who should be the recipient of gratitude activities is only tackled

by few studies (Sheldon & Lyubomirsky, 2006; Sin, Della-Porta, & Lyubomirsky, 2009;

Odou et al., 2013). Perceived activity-fit is an important predictor of outcome, in which

those who perceived practicing gratitude as beneficial will experience greater results (Sin

et al., 2009). An overlook of this factor may have contributed to the mixed findings thus

far.


Concluding Summary

Contemporary social science researchers have identified gratitude as a

psychological strength which promotes human flourishing. A thorough inspection of a

grateful person has been associated with numerous beneficial outcomes, including

increased interpersonal connectedness, and improvement in psychological and physical

health. The positive outcomes generated by a grateful-outlook are supported by various

cognitive mechanisms, all of which revolves around the reinterpretation of events to draw

upon positive memories to buffer and protect against debilitating emotions and psychiatric

disorders.

Social scientists have developed gratitude-based interventions in an attempt to

maximise humans’ positive experiences in life. Research has verified that experiencing

and expressing gratitude provide a peaceful mind, satisfying relationship with others, and

happiness in general (Watkins et al., 2003). However, because of the dearth of evidence

on psychological techniques for improving well-being, the encouraging findings reported

in gratitude studies to promote overall positive human functioning remains speculative

without rigorous experimental validation (Slade, 2010).

Evidence mounting that positive mental health plays a substantial role in the onset

of illness and recovery rate, the WHO urges health services to incorporate elements of

positive health into operation at several dimensions (e.g. individual-community; physical-

mental, etc.), in particular to any health prevention and intervention programs (Vázquez,

Hervás, Rahona, & Gómez, 2009). Beyond the realm of illness or disorder, the ability to

enjoy life and handle adversities is equally important. Therefore, the importance of this

study is to examine the impact of grateful thinking on psychological well-being, thereby

instilling awareness among social science research about the benefits and practical

implications of gratitude.


Present Study

Previous research has suggested that gratitude produces multiple positive outcomes

ranging from health benefits, positive emotions, and social reciprocity. However, the

effects of gratitude interventions may not extrapolate to other populations (e.g. the UK), as

being grateful may yield different results in cross-cultural samples.

Some of the aforementioned studies did not assess whether the proposed gratitude

interventions actually fostered gratitude among participants. Owing to that reason, results

from previous studies can be questioned: What were the levels of gratitude before and after

intervention? Further examination of these studies revealed that the gratitude condition

was compared with diverse “placebo” control group, in which the activities assigned to the

control group may induce expectancy effects (Wood et al., 2010). Wood et al. (2010)

suggested that a control group without any assigned activity would serve as a better

comparison to examine the true effect of the intervention.

To answer these queries, the present study replicated Emmons and McCullough

(2003) study to explore whether the effects of gratitude practice can be generated in a non-

American population. In addition, validated scales (i.e. GQ-6 and GAC) were included to

track the changes in levels of gratitude. In an effort to minimise expectancy effects,

participants were blinded to the trial hypotheses. Enhancement of methodological features

such as homogeneity check of samples and Intention-to-treat analysis (ITT) were included.

Noting that the intervention may not be effective for everyone, the current study

investigated whether a relationship exists between effort and time committed to perform a

prescribed positive activity.


Hypotheses

The research hypotheses formulated were that:

H1: Individuals in the gratitude condition would exhibit an increase in state and trait

gratitude compared to individuals in the control group.

H2 Participants in the gratitude condition would demonstrate an increase in positive

affectivity and a decrease in negative affectivity when compared to participants in

the control group.

H3: Participants in the gratitude condition would report an increase in well-being when

compared to those in the control group.

H4: Participants in the gratitude condition would report an increase in quality of

relationship with a close other when compared to participants in the control group.

H5: Participants in the gratitude condition would report a decrease in physical symptoms

compared to those in the control group.

H6: There would be positive correlations between a person-activity fit (i.e. individual’s

motivation and effort in engaging in the gratitude-inducing activity) and the effects

of gratitude practice.


CHAPTER TWO: METHODS

Design

This study utilized a 3-week experimental randomized controlled trial to address

the research aims. Two experimental conditions served as the independent variables: (1)

Gratitude (individuals assigned with daily gratitude-inducing activity) and (2) Control (no-

assigned activity). Both groups were measured at two time points, three weeks apart: (a)

Pre-test (prior to the intervention); (b) Post-test (immediately after intervention).

Participants

Eligible participants were university students enrolled in a local university in

Stirling, aged 18 and above, able to read and write English. Participants were 108

students, comprising 62 females and 46 males with an age range of 18 – 36 years (M = 22,

S = 2.85). Majority were university graduates (67.6%) and not employed (61.1%).

Almost half the sample was White (53.7%), and the other half was Asian/Pacific Islander

(41.7%). As shown in Figure 1, 108 participants were randomised to the gratitude (n = 51)

and control condition (n = 57).

Socio-demographic differences were examined with chi-square. Demographic

characteristics were equally distributed in both groups, with the exception of gender [(χ²

(1, n = 108) = 6.39, p = .011)] and ethnicity [(χ² (5, n = 108) = 16.14, p = .006)]. The

gratitude condition had more females (71%) and Asians (59%), whereas the control

condition had more males (54%) and Whites (68%). The final analysis included 45 in the

control group and 36 in the gratitude condition, with 15 participants dropped out from the

intervention group and 12 dropped out from the control group (see Table 4).


Figure 1. CONSORT Diagram


Table 4

Socio-demographic characteristics of participants

Baseline Completed Intervention Dropouts

GRAT CTRL GRAT CTRL GRAT CTRL

N (%) N (%) N (%) N (%) N (%) N (%)

Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD)

Participants, N (%) a 51 (100) 57 (100) 36 (100) 45 (100) 15 (100) 12 (100)

Demographic characteristics

Age, mean (SD) 22.27 (2.18) 21.29 (3.28) 22.28 (2.29) 21.29 (3.28) 22.25 (1.68) 20.92 (4.30)

Sex, N (%) *

Male 15 (29) 31 (54) 10 (28) 26 (58) 5 (32) 5 (58)

Female 36 (71) 26 (46) 26 (72) 19 (42) 10 (68) 7 (42)

Ethnicity, N (%) *

White 19 (37) 39 (68) 12 (33) 28 (62) 7 (47) 11 (92)

Black or African American - 2 (4) - 2 (5) - -

Hispanic or Latino 1 (2) - 1 (3) - - -

Native American or American Indian - 1 (2) - 1 (2) - -

Asian or Pacific Islander 30 (59) 15 (26) 22 (61) 14 (31) 8 (53) 1(8)

Others 1 (2) - 1 (3) - - -

Education, N (%) b

Foundation 7 (14) 13 (23) 7 (19) 13 (23) - -

Bachelor Degree 33 (65) 40 (70) 22 (61) 28 (70) 11 (73) 12 (100)

Postgraduate 11 (21) 4 (7) 7 (20) 4 (7) 4 (27) -

Employment, N (%)

Yes 17 (33) 25 (44) 10 (28) 18 (40) 7 (47) 7 (58)

No 34 (67) 32 (56) 26 (72) 27 (60) 8(53) 5 (42)

a Total participants at baseline prior randomization (n = 108); completed the intervention (n = 81); dropped out (n = 27)

b Categories collapsed.

Significance levels tested with independent samples chi-square tests after randomization has been carried out. Statistical significant differences

are highlighted in bold

* p < .05


Procedure

Eligible individuals were recruited via an internet-based medium and a face-to-face

method. For the web-based approach, the study was advertised through the university’s main

portal and on social media (i.e. Facebook). Interested candidates were instructed to go online

to read the participant information statement (Appendix A) and commence the study via

PSYCHWEB. The completion of the initial questionnaire was considered as informed

consent. As for the face-to-face approach, in addition to the set of instructions and

questionnaires used for the online recruitment, a consent form was included (Appendix B).

The following documents were pre-packed in a sealed envelope and were randomly

distributed to different departments within the university. Individuals who agreed to

participate would sign the consent form and complete the baseline measures (Appendix E).

They were instructed to submit the following documents in a packet provided in the library.

In an attempt to maximise response rate, participants were told that upon completion

of the study, they would be entered into a lottery. The lottery prize included one £50

Amazon gift certificate. Data were collected at – (i) baseline and (ii) post-intervention (three-

weeks after baseline measures) (Figure 2). Participants who consented and completed the

questionnaires were assigned a unique identification number in which it can only be

identified by the researcher. Participants were then randomized to the intervention –

gratitude condition (n = 51) or control group (n = 57).

Randomisation was conducted using a computer software developed by Urbaniak and

Plous (2013). The software provides a form that allows the researcher to specify the choices

to create random numbers. After the form was completed (Appendix H), a set of numbers

that ranged from 1 to 2 was generated. The allocation of groups was determined using the

coin-tossing method by the study supervisor.


After randomization, participants were given specific instructions tailored according

to their respective groups (Appendix G) via email. During the study, participants would

receive a reminder email early in the week to remind them of their assigned task. A second

reminder email was sent after the intervention has ended to remind them to complete the

same measures administered at pre-test via an assigned web-link.

Participants who were allocated to the gratitude condition received an instruction to

cultivate a sense of gratitude for 21 days. The instruction given to participants for the

gratitude-inducing activity was based on the original study conducted by Emmon and

McCullough (2003). It also incorporated the instructions given in Martínez-Martí et al.’s

(2010) study to enhance the expected effects for the perceived quality of relationships. The

instructions for the gratitude condition were as follows:

“There are many things in our lives, both large and small, that we might consider as a

form of blessing. It could even be those who help us to reach our goals, or just make our

lives easier with small details. If we try to put ourselves in their shoes, appreciate their

efforts, and notice the voluntary nature of their acts, we have a good reason to feel grateful.

Please think of today and write down three things in your life that you are grateful for”.

Those in the gratitude condition were instructed to write their daily grateful thoughts

on a separate sheet of paper using the template provided (Appendix F). Participants in the

control group were not assigned to any activity; they were only required to complete the same

measures given to the gratitude condition. Participants in both conditions were contacted by

mail to complete their online measures for the post-test (i.e. after 21 days of the intervention).

To encourage adherence to the intervention, participants in the gratitude condition were

invited to submit their daily gratitude journal to the researcher by turning in on an appointed

date after the intervention was completed.


Blinding

The trial hypotheses were masked by naming the study “A Study on Human

Emotion”. Moreover, participants were told that they were randomized to one of the two

groups and that the tasks assigned to the other participants would not be revealed. At the end

of the intervention, participants in the control condition received a Post-Intervention

Information Sheet (Appendix C) which contained brief descriptions of the study and also the

gratitude-inducing instructions to give them equal opportunity to practice the intervention.


Figure 2. Procedural flowchart

Measures

Well-being. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) tap into

the domains of an individual’s psychological functioning, affective-emotional, and cognitive-

evaluative components. Fourteen items (e.g. “I’ve been feeling useful”, “I’ve been feeling


loved” and etc.) were measured on a five-point Likert scale from 1 (none of the time) to 5 (all

of the time). Scores vary from 14 to 70, with higher scores indicating higher levels of mental

well-being. The WEMWBS has been reported to have higher correlations with positive

affect (r = .71) and the Scale of Psychological Well-Being (r = .74), signifying good criterion

validity (Tennant et al., 2007).

Affect. To gauge participant’s feelings and emotions, the Positive and Negative

Affect Schedule (PANAS) was used (Watson, Clark, & Tellegen, 1988). The PANAS has

two scales – (i) positive affect (PA) and (ii) negative affect (NA) that assess 20 emotion

adjectives (e.g. inspired, distressed, and jittery). Using a five-point Likert scale from 1 (very

slightly or not at all) to 5 (extremely), scores for PA and NA can be obtained, and ranges

from 10 to 50 for both scales respectively. Individuals with higher scores on PA indicate

higher positive emotions; similar scoring applies to the NA scale. High internal consistency

(Cronbach’s α = .85) has been reported for the two scales (Watson et al., 1988).

Gratitude at the state and dispositional levels. At the state level, the GAC scale

developed by McCullough et al. (2002), which consists of three adjectives (appreciative,

grateful, and thankful), was used to examine participants’ feeling of gratefulness. These

adjectives were rated on a five-point Likert scale from 1 (not at all) to 5 (extremely) based on

the intensity of experiencing each emotion at that given moment. Scores range from 3 to 15,

with higher scores indicating higher levels of state gratitude. The GAC has been reported

across studies for having strong internal consistency (Cronbach’s α = .87) (McCullough et al.,

2002).

The grateful disposition was assessed using the GQ-6 (McCullough et al., 2002). It

consists of six items that include the four domains – (1) intensity, (2) frequency, (3) life-span,

and (4) density of an individual to elicit the feeling of gratefulness. Item responses that are in

descriptive statements (e.g. I have so much in life to be thankful for) is scored on a seven-


point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree) except for items 3

and 6 which are reverse-scored. Scores range from 6 to 42, individual’s dispositional levels

of gratitude can be determined via median split (McCullough et al. 2002). The GQ-6 is

widely used to examine individual’s dispositional gratitude (Watkins, 2004) due to its

excellent psychometric properties and strong internal consistency (Cronbach’s α = .82)

(McCullough et al., 2002).

Physical Symptoms. Adapted from the study conducted by Emmons and

McCullough (2003), a list of 13 physical symptoms (e.g. acne/skin irritation, runny/congested

nose, and etc.) requires participants to indicate whether they experienced any of these for the

past two weeks. This method was proven to be reliable and valid in assessing self-perceived

health status (Pennebaker, 1982; Emmons, 1992; Elliot & Sheldon, 1998).

Quality of relationship with significant others. Adapted from Martínez-Martí,

Avia, and Hernández-Lloreda’s (2010) study, this domain assessed participant’s quality of

relationship with close others. A total of four items (e.g. “to what extent can you contribute

to the well-being of that person?”) were scored on a four-point Likert scale from 1 (not at all)

to 4 (a great deal).

Socio-demographic information and exploratory data. Demographic information

included age, sex, contact details, education, employment status, and nationality (Appendix

D). Exploratory data form was given to participants after the intervention. The form

included several questions developed by (Odou et al., 2013) to assess participant’s motivation

(e.g. How motivated did you feel about doing the activity?) on a five-point Likert scale from 1

(not at all) to 5 (extremely), and another question to explore participant’s effort (e.g. on

average how many minutes did it take you to complete your activity?). An additional

question was added to the exploratory data form to measure adherence for the assigned

activity. The question was “We understand that at some point there are circumstances that


cause you to be unable to carry out the assigned activity as intended. We appreciate your

honesty to indicate throughout these 21 days, how often you think you actually did the

assigned activity”. They were asked to indicate from a seven-point Likert scale ranging from

1 (never) to 7 (daily).

Ethical considerations

Participants consented acknowledging they understood the aim of the study,

involvement required, and that they have the right to withdraw from the study at any time

without any imposed penalties. Before the study was carried out, approval was obtained

within the institution – the university with which the primary researcher was associated.

Statistical power

The study was designed to recruit 100 eligible participants using a medium effect size

(.50) suggested by Emmons & McCullough (2003). This would provide 90% power using an

ANOVA within-between interactions with alpha at .05. A possible 20% of attrition rate

between baseline and post-intervention was estimated.

Data analysis

Preliminary analysis. Overall missing cases for each of the variables were less than

5%; hence missing values were addressed with means substitution before total variable scores

were computed. The randomization was evaluated by comparing demographic characteristics

of the two groups with chi-square. The Kolmogorov-Smirnov test was conducted to examine

the distribution of the scores, and results revealed that each of the variable scores was

normally distributed.

Statistical analysis. Two-way mixed analyses of variance (ANOVA) were used to

test for important differences among participants who completed the intervention. Effects

were calculated for time and time × group interactions. Pearson’s correlation was used to


determine the degree of linear association between individual differences (e.g. motivation and

effort) and the effectiveness of gratitude intervention.

Two analyses were conducted using the above mentioned statistical methods – (i)

‘Completer analysis’ – for participants who provided data for both baseline and post-

intervention measures; (ii) ‘Intention-to-treat (ITT) analysis’ – included all participants who

completed baseline measures and also those who did not provide the follow-up data.

The ITT was carried out by replacing the missing follow up data with the participants’

baseline data (last observation carried forward (LOCF). The purpose of performing the ITT

was to avoid overoptimistic estimates of the effectiveness of the intervention (Heritier,

Gebski, & Keech, 2003). In other words, the completer analyses may provide a falsely

positive picture, indicating that participants who adhere to the intervention might find the

gratitude-inducing activity enjoyable, whereas those who dropout or were noncompliant

actually feels no benefit from the intervention. Therefore, the LOCF principle allows a

conservative estimate by accepting that protocol deviations and noncompliance are likely to

occur in actual settings (Heritier et al., 2003).


CHAPTER THREE: RESULTS

Taking ethnicity and gender as covariates3, a two-way mixed ANOVA was carried

out for all dependent variables. To determine whether the gratitude and control groups

differed at pre-test and post-test, an unrelated t-test was used to evaluate the two test periods

separately (Table 5, Appendix I). Pearson’s correlation was used to explore the relationship

between individual’s engagement (e.g. effort and motivation) and the effects of gratitude

practice.

The first part of the results section aimed to present the findings for the completer

analysis. The second part of the results was findings obtained from the ITT analysis. The

ITT analysis included all participants who completed baseline measures and were analysed

according to the randomization scheme. For all hypotheses testing, it is expected that

participants in the gratitude condition would have better outcome than the control condition.

PART I: MAIN FINDINGS FOR COMPLETER ANALYSIS

Gratitude

Hypothesis 1: The effect of gratitude practice on disposition and state gratitude

Disposition. The dispositional gratitude scores differed at the end of the intervention,

[F(1, 77) = 7.884, p = .006, partial 2 = .093]. The main effect of group on dispositional

gratitude scores was significant [F(1, 77) = 4.892, p = .030, partial 2 = .060]. The

conditions × time interaction for dispositional gratitude was also significant [F(1, 77) = 4.84,

p = .044, partial 2 = .052]. The gratitude (M = 33.43, SD = 5.99) and the control condition

(M = 31.82, SD = 6.18) were not significantly different prior intervention [t(79) = -1.92, p =

.058], the post-intervention showed statistical significance [t(79) = -3.04, p = .003]. There

was a slight decrease in the gratitude condition from pre-test (M = 33.43, SD = 5.99) to post-

3 In this context covariates is defined as covary out the effects of a categorical variable

(Grace-Martin, 2008).


test (M = 33.36, SD = 5.80), yet it was not as much as the control condition which

experienced a decrease from pre-intervention (M = 31.82, SD = 6.18) to post-intervention (M

= 28.16, SD = 8.86).

State. The overall effect of time [F(1, 77) = .416, p = .521, partial 2 = .005], and

effect for state gratitude scores between both conditions, [F(1, 77) = 3.870, p = .053, partial

η2 = .048] was not significant. However, the conditions × time interaction for state gratitude

was significant [F(1, 77) = 8.48, p = .005, partial 2 = .099]. Because variances for the two

groups were significantly unequal at the pre-test (F = 5.35, p < .05) and post-test (F = 5.65, p

< .05), a t-test for unequal variances was used. Though the pre-test means for both groups

were not significant [t(60.96) = -.196, p = .851], the post-test means were significant

[t(78.81) = -3.85, p = .001]. There was an increase of state gratitude for the gratitude


condition from pre-intervention (M = 9.83, SD = 3.87) to post-intervention (M = 11.67, SD =

2.55), but not for the control condition that experienced a decrease from pre-intervention (M

= 9.69, SD = 2.75) to post-intervention (M = 9.13, SD = 3.62). Overall, the first hypothesis is

accepted.

Affect

Hypothesis 2: The effect of gratitude practice on subjective well-being

Positive Affect. The overall effect of time for positive affectivity scores was not

significant [F(1, 77) = 1.99, p = .163, η2 = .025] and there was no significant effect for

positive affectivity scores between both conditions [F(1, 77) = .629, p = .430, η2 = .008].

Nevertheless, the conditions × time interaction for positive affect was significant [F(1, 77) =

4.90, p = .030, 2 = .060] (Figure 4). Although the pre-intervention means did not differ


significantly [t(79) = -.304, p = .762] in both gratitude (M = 31.38, SD = 8.31) and control

condition (M = 30.87, SD = 7.13), the post-intervention mean for the gratitude condition (M =

33.47, SD = 8.23) was significantly higher than [t(79) = -2.60, p = .011] the control condition

(M = 28.69, SD = 8.22).

Negative Affect. Negative affectivity scores revealed no significant differences in

pre-intervention and post-intervention [F(1, 77) = .147, p = .703, partial η2 = .002]. The main

effect for negative affectivity scores in both conditions was not significant [F(1, 77) = .824, p

= .367, partial η2 = .011]. The conditions × time interaction for negative affect also revealed

no significant findings [F(1, 77) = 1.753, p = .189, partial η2 = 022]. These results suggest

that the second hypothesis is not accepted.


Well-being

Hypothesis 3: The effect of gratitude practice on well-being

The overall effect of time was significant, [F(1, 77) = 5.11, p = .027, partial 2 =

.062]. However, no significant effect existed for well-being scores between both conditions,

[F(1, 77) = 2.031, p = .153, partial 2 = .026]. Critically, the conditions × time interaction for

well-being was also not significant [F(1, 77) = 3.87, p = .053, partial 2 = .048]. To

conclude, the third hypothesis is rejected.

Social relationship

Hypothesis 4: The effect of gratitude practice on perceived quality of relationship

with a close other

The results revealed that the overall effect of time for the perceived quality of a

relationship with a close other was not significant [F(1, 77) = .483, p = .483, partial 2 =

.006]. Furthermore, no significant effect existed for the perceived interpersonal relationship

scores between both conditions [F(1, 77) = .123, p = .726, partial 2 = .002]. Similarly, there

was no significant conditions × time interaction for perceived quality of social relationship

[F(1, 77) = .871, p = .354, partial 2 = .011]. Hypothesis 4 is therefore rejected.

Physical symptoms

Hypothesis 5: The effect of gratitude practice on health

The reported physical symptoms were significantly different after the intervention

was implemented [F(1, 77) = 5.56, p = .021, partial 2 = .069], but the main effect of group

on reported physical symptoms was non-significant [F(1, 77) = .877, p = .352, partial 2 =

.012]. The conditions × time interaction for experienced health symptoms was also non-

significant [F(1, 77) = .055, p = .816, partial 2 = .001]. As both groups experienced a

reduction in physical symptoms experienced, hypothesis 5 is rejected.


Table 6

Completer analysis on the effects of gratitude intervention in the experimental and control

group (n = 81)

Measuresa

Pre-test

Mean (SD)

Post-test

Mean (SD) Time

b

Group × Time

Interactionsb

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

GRAT, gratitude condition; CTRL, control condition aMeasures used were used to test the dependent variables and were denoted as follow:

WEMWBS, Warwick-Edinburgh Mental Well-being Scale (WEMWBS); PANAS, (Positive

Affect [PA] and Negative Affect [NA] Schedule); GAC, (Gratitude Adjectives Checklist);

GQ-6, (Gratitude Dispositional Scale) bSignificance levels tested with two-way mixed ANOVA, holding sex and ethnicity as

covariates. Statistical significant differences are highlighted in bold

* p < .05;

** p < .01


Individual differences in the efficacy of gratitude intervention

Hypothesis 6: The relationship between the person-activity fit factor and the

effects of gratitude practice

Findings showed the more motivated (r = .333, p = .047) and effort (r = .414, p =

.012) put into doing the gratitude-inducing activity, the greater the increase in state gratitude.

Participants with greater motivation were more likely to adhere to the activity (r = .321, p =

.046) and have higher well-being scores (r = .331, p = .049). Motivation and effort, however,

was not significantly related to dispositional gratitude and both the affectivity scores (Table

7). Though the findings did not support the sixth hypothesis, the strengths of correlations

which range from .32 to .41 indicate a moderate relationship.

Table 7

Correlations of motivation and effort required to engage in the gratitude-inducing activity

with well-being, affect, and gratitude change scores

WEMWBS PA NA GAC GQ-6 Adherence

Motivation a .331* .079 -.284 .333* .082 .321*

Effort b

.291 .165 -.267 .414* -.125 .143



GQ-6, (Gratitude Dispositional Scale) aMotivation was measured in terms of how motivated the participants felt when they did the

gratitude-inducing activity. bEffort was measured in terms of average time taken to complete the prescribed activity.

*Significance at p < .05


PART II: INTENTION-TO-TREAT ANALYSIS

Apart from the well-being measure, all measures revealed essentially the same results

as the findings for the completer analysis (Table 8). The completer analysis for the

conditions × time interaction for well-being measure was non-significant; however, the

results for the ITT analysis was significant [F(1, 104) = 4.73, p = .032, partial 2 = .043]

(Figure 6). Specifically, there was significant drop in well-being scores [t(106) = -2.16, p =

.033] in the control condition (M = 40.93, SD = 13.31), but a much lower drop in the

gratitude condition (M = 46.19, SD = 8.78). This suggests that the gratitude condition has

benefitted from the intervention, whereas the control condition experienced slight decrease on

well-being.


Table 8

Intention-to-treat analysis on the effects of gratitude intervention in both conditions (n = 108)

Pre-test

Mean (SD)

Post-test

Mean (SD) Time

b

Group × Time

Interactionsb

Measuresa GRAT CTRL GRAT CTRL F-ratio P F-ratio P

WEMWBS 46.35

(9.52)

46.19

(8.78)

45.88

(10.13)

40.93

(13.31) 4.820 .030* 4.725 .032*

PANAS

PA 31.23

(7.83)

29.99

(7.97)

35.57

(7.83)

28.28

(8.63)

1.772 .186 4.053 .047*

NA 21.14

(8.21)

20.97

(7.58)

20.31

(6.30)

22.11

(8.75)

.098 .754 1.754 .188

GAC 10.06

(3.61)

9.11

(3.10)

11.35

(2.69)

8.67

(3.47)

.384 .537 7.544 .007**

GQ-6 34.00

(5.71)

31.86

(5.87)

33.94

(5.58)

28.97

(8.29)

6.174 .015* 4.161 .044*

Perceived

quality of

relationship

14.51

(4.20)

13.58

(3.01)

13.96

(2.92)

13.11

(3.25)

.032 .858 1.432 .234

Physical

symptoms

4.84

(3.15)

4.80

(2.95)

4.43

(3.27)

4.35

(3.06)

2.915 .091 .129 .720

GRAT, gratitude condition; CTRL, control condition aMeasures used were used to test the dependent variables and were denoted as:



GQ-6, (Gratitude Dispositional Scale) bSignificance levels tested with two-way mixed ANOVA, holding sex and ethnicity as

covariates. Statistical significant differences are highlighted in bold

* p < .05;

** p < .01


CHAPTER FOUR: DISCUSSION

This paper discusses whether gratitude can be taught in a sample of UK individuals.

The second aim was to examine whether the gratitude intervention successfully delivers its

promising benefits to those who practice it. In addition, the study aimed to scrutinize the

relative influence of individual differences on the efficacy of the gratitude-inducing

intervention.

Cultivating gratitude

One of the most credible approaches to boost an individual’s contentment is the

deliberate practice of counting one’s blessings (Emmons & McCullough, 2003; Howell,

2012). The present study inspected this acclamation by assessing the levels of disposition

and state gratitude exhibited by participants who completed the count-your-blessings

intervention. Findings revealed that participants who engaged in the gratitude-inducing

activity experienced higher levels of dispositional and state gratitude.

With respect to the levels of dispositional gratitude, it was observed that there was a

slight decrease in grateful disposition among those who practiced gratitude. However, the

decrement was marginal when compared to participants in the control condition. To the best

of our knowledge, altering a person’s grateful disposition has not been studied in a systematic

manner (Emmons, 2012). Future research should consider whether it is possible to gradually

increase a person’s disposition toward gratitude by encouraging the continuous practice of

gratitude-oriented activities.

Scholars cautioned that not all dispositionally grateful people experience gratitude at

any given moment; rather, some are more likely to express gratefulness under certain

situations (Watkins et al., 2003). Owing to that reason, this study examined whether the

immediate feeling of gratefulness can be elicited or intensified through a self-directed

exercise of journaling one’s grateful thoughts. Results showed that participants who list their


blessings experienced increased levels of state gratitude, whereas their counterparts

experienced a marked decline of state gratitude. Taken together, this finding is congruent

with existing literature stating that gratitude can be experimentally cultivated (Emmons &

McCullough, 2003; Froh et al., 2008). As gratitude is viewed as the potential agent for

human flourishing (Polak & McCullough, 2006; Wood et al., 2010), this implies that

therapists can intervene to help clients cultivate grateful habits that may led to increased

disposition of thankfulness.

The benefits of practicing gratitude

Affect. The second hypothesis was that participants in the gratitude condition would

have greater increase of positive affect (PA) and reduction in negative affect (NA) compared

to participants in the control condition. This hypothesis was only supported for PA but not

for NA; nevertheless the means changed in the predicted direction. The increase in PA was

consistent with Martínez-Martí et al.’s (2010) finding and Wood et al.’s (2010) meta-

analysis. A qualitative study conducted by Akhtar and Boniwell (2010) revealed that feeling

grateful, encapsulated by the distinct theme of “appreciating the good things in life” has

helped a group of alcohol-misuse adolescents to manage their emotions and feel better about

their lives. As mentioned, gratitude counteracts against the mindset of deprivation through

savouring – a shift in attention by focusing on one’s fortunate moments that could have been

otherwise (Watkins, 2004; Emmons, 2007). Savouring also prolongs the enjoyment of a

pleasant experience (Bryant, 2003). This explains how a grateful schema serves as an

adaptive psychological mechanism to appraise life experiences in a positive manner,

affirming that gratitude has the happiness-bestowing properties.

The results for NA were non-significant. This corroborates Emmons and

McCullough’s (2003) second study, in which there were no significant differences for NA

between participants who kept a two-week gratitude journal with those who wrote about


neutral or downward social comparison stimuli. Despite non-significance, the mean scores

for NA were in the expected direction. This suggests that the attrition rate (over 30%) might

contribute to inadequate group sizes that led to insufficient power to detect significant

differences.

Well-being. Contrary to the third hypothesised outcome, the group who wrote the

three daily blessings did not have statistically significant benefit from the gratitude

intervention. When additional analysis (ITT) was used, the results revealed a significant

difference in well-being scores between the two conditions, but the mean scores were not in

the trended direction. This finding contrasted with most of the earlier studies which stated

that the practice of gratitude would elevate one’s well-being (Dickerhoof, 2007; Froh et al,

2008; Wood et al., 2008). However, there are several studies that lend support to the current

finding (Kashdan et al., 2006; Guren, 2008; Mallen, 2008; Sin et al., 2009) suggesting that

there are situations or conditions that temper the link between gratitude and well-being.

Irrespectively, the count-your-blessing intervention does contribute a fair amount to a

person’s well-being – in this context, mean well-being scores was relatively stable among

those who keep a gratitude journal. Using Fredrickson’s (2001) broaden-and-build model,

gratitude was postulated to harness behavioural and cognitive repertoires by “undoing” the

adverse effects of negative emotions. It should, then, build enduring personal coping

resources to stabilize mood when stressful life-events arise (Wood et al., 2007). Up to date,

there are several studies that partially support the broadening-and-build effects of gratitude

(Folkman & Moskowit, 2000; Fredrickson, Tugade, Waugh, & Larkin, 2003; Tugade &

Fredrickson, 2004). This provides insight to approach gratitude as a resilient factor in times

of adversity.

Social-connection. Existing claims (McCullough et al., 2002; Emmons &

McCullough, 2003; Algoe, Haidt, & Gable, 2008) that gratitude strengthens and improves


social relationship did not apply in this study as the investigated variables yielded results

without statistical significance. The current findings were rather unexpected, in that the

gratitude practice actually worsened the perception of quality relationship with a close other.

Gratitude is notably centralised around the thankful feeling that arises when people recognize

received aid as costly and altruistic (Wood, Maltby, Gillett, Linley, & Joseph, 2008). Taking

a middle-ground position, Wood et al. (2010) proposed that gratitude involves more than

appreciating the altruistic acts of others. This is because studies have demonstrated that

gratitude emerges from various sources such as appreciating one’s abilities (Graham &

Barker, 1990), being thankful for neutral events like “waking up early” (Emmons &

McCullough, 2003) and giving thanks to non-human agent (i.e. God) (Worthen & Isakson,

2007). Thus, this null finding offers additional interpretation that – gratitude, in this study

may have emerged from such sources and that it is not restricted to the realm of interpersonal

appreciation.

Alternative speculation is that the expression of gratitude causes momentary

experiences of “indebtedness” – an obligated feeling to return the giver the valuable act

(Watkins, Scheer, Ovnicek, & Kolts, 2006). The two emotions are embedded in reciprocity;

however, the appraisal of benefactor’s intentions determines the emotional responses of

feeling grateful or indebted (Tsang, 2006). Feeling thankful occurs when the individual

perceives the received aid as benevolent, whereas indebtedness is felt when the benefactor’s

intentions are ambiguous (Algoe, Gable, & Maisel, 2010). Indebtedness generates a slight

negative feeling because the recipient would feel compelled to return the favour in near future

(Watkins et al., 2006). Studies found that indebtedness is associated with feelings of shame

and guilt (Natio, Wangwan, & Tani, 2005), and thus, may complicate or even reduce the

quality of interpersonal relationships (Tracy & Robins, 2006). Therefore, it is important to

take into account the recipient’s perception and emotional responses to benefits received.


This suggests that received benefits should be considered when future research examines its

interaction with interpersonal consequences.

Physical health. Regarding physical well-being, there were no differences between

conditions. Though the main effect of time revealed significant changes across conditions,

both groups reported having experienced less physical symptoms. This phenomenon could

be attributed as spontaneous health recovery or regression to the mean. Along the same vein,

Martínez-Martí et al. (2010) found no differences in illness-reporting between those who

practiced gratitude and those who were listing hassles or neutral events.

Currently, there is insufficient research on the gratitude-to-health link to draw any

firm conclusions about how grateful individuals tend to have better health outcome. A recent

study established a bidirectional relationship suggesting that healthier individuals, in part, are

thankful for their good health, which in turn generates a drive to take up healthy behaviours

(Hills, Allemand, & Roberts, 2013). That being said, the main effect of group on the grateful

disposition scores indicated that on average the gratitude condition scored higher than their

counterparts. It is may be difficult to increase the feeling of thankfulness among highly

grateful individuals to further notice and appreciate their health as a “gift” to be thankful

about. Thus far, research has been focusing on the traditional direction of trait predicting

health behaviours. The current non-significant finding offers different perspectives for future

work to explore and expand the mechanism of trait gratitude and health.

Only several studies illustrated a relationship between gratitude and physical health

(Emmons & McCullough, 2003), but their results were not solid. The effect of gratitude on

health may be made more apparent through more objective measures of bodily symptoms

(Gillani & Smith, 2001; McCraty & Childre, 2004), or increased intervention duration with

follow-up.


Factors influencing the efficacy of the intervention

Notwithstanding the fact that the count-your-blessings intervention promotes positive

mood and mental well-being through induction of habitual practice (Sheldon & Lyubomirsky,

2006), equal engagement and benefit from the happiness-bestowing activity across

individuals is improbable. To this end, the current experiment sought to examine a person’s

motivation and effort influence over the success of the intervention. The findings showed

participants who put greater motivation and effort into the gratitude-inducing activity had

increased feelings of gratefulness. Supported by previous studies (Seligman et al., 2005;

Worthen &Isakson, 2007), which suggested that when the mood-enhancing activity “fits” the

person’s interest and values and is performed with appropriate effort, the goal of developing a

grateful thinking is achievable (Brunstein, 1993; Sheldon & Kasser, 1998). Such work

demonstrated the person-activity fit, indicating a proper match between an individual and

prescribed happiness-inducing activity can impact the efficacy of the intervention.

Taking well-being into account, the present study found that effort was not

significantly correlated. This finding contrast Odou et al.’s (2013) result that both effort and

motivation contribute to a person’s well-being. The explanation for the current result can be

explained using the “Model of Sustainable Well-being”. Teasing apart the components (i.e.

happiness set-point and life circumstances) that made up this model, positive goal-based

activities serve as the linchpin to enhance well-being (Lyubomirsky et al., 2005b). Ample

evidence proposed that volitional activities involve commitment and certain amount of effort

to initiate, engage, and maintain the activity (Sheldon et al., 2010). Obviously, if a person

yearns for happiness, but does not exert any effort to practice the mood-enhancing strategy,

he will see few or no results (Sheldon & Lyubomirsky, 2006). This probably explains the

bigger picture of why participants in the gratitude condition did not experienced significant

increase of well-being in post-intervention. Consistent with this idea, effortful practice of the


activity along with the desire to be happy is necessary for participants to experience the

benefits of the intervention (Seligman et al., 2005; Lyubomirsky et al., 2011). These studies

specifically examine its relationship with adherence to the happiness-promoting activities

(Seligman et al., 2005). While motivation and effort are important variables for continued

adherence to the activity (Lyubomirsky et al., 2011), only motivation was positively

correlated with adherence in this study. If greater motivation was instilled, those who

practice the gratitude-oriented activity may bear effort and persistence, and thus allow the

effects of the gratitude practice to be more noticeable.

Limitations and Suggested Improvements

A relatively easy technique to bolster one’s happiness is not without limitations.

Firstly, the randomization was not entirely successful as some differences between groups

were evident in pre-intervention. This was largely dealt with by including the variables as

covariates4 in the analyses, restricting the external validity of the findings.

Secondly, the shrinkage of sample size due to attrition might have influenced the

significance of the results. This means that some of the statistically significant variables

might be due to the unwarranted scorings of few other members. Although the ITT analysis

was conducted to address this issue, it cannot guarantee lowered likelihood of a false positive.

While the small sample itself is a limitation, these findings might not represent the actual

population of UK individuals, thus have to be interpreted with caution.

Thirdly, self-report measures may be subjected to bias. For instance, questions

related to interpersonal benefits which assess individual’s perceived quality of relationship

with a close other might have been overestimated. Furthermore, there is no absolute

confirmation that those in the gratitude condition actually perform the prescribed activity. It

could be possible that participants’ reports of engagement in the activity were due to demand

4 The covariates are gender and ethnicity.


characteristics. Last but not least, the lack in follow-up could not answer for the

sustainability of intervention effects.

Future studies should consider larger sample sizes to ensure generalizability of the

research findings. As the study aimed to examine the effects of practicing gratitude on

individual’s well-being, a longer duration with inclusion of follow-up sessions would

establish more solid foundation on the lasting impact of the gratitude practice toward the

enhancement of well-being. To supplement self-report measures, the gratitude intervention

would benefit from adopting a triangulation approach. Specifically in assessing prosociality

(i.e. how much they help others and others help them), triangulation could account for more

accurate reports from multiple perspectives. As the findings for health outcome is congruent

with the inconsistencies found in the gratitude literature, aggregating mean levels of physical

symptoms in a short period of time may have restricted the range and attenuated the effects of

the experimental study. Future research should either extend the duration to collect health

reports or employ objective measure of health behaviours (i.e. doctor’s report of healthcare

visit) to enable more reliable effects.

Future Directions

Although the current findings have advanced the understanding of how gratitude

affects an individual’s well-being, many questions remained unanswered. First and foremost,

it is postulated that pre-existing traits (e.g. trait gratitude or affective traits) might affect

individual’s ability to benefit from the gratitude intervention (Emmons & Mishra, 2011).

Drawing attention to the explanation on the findings for reported symptomology, can we

expect gratitude induction to work better in improving health outcomes of less grateful

individuals or grateful individuals? Alternatively, can people with high positive affect (PA)

experience additional gains in well-being? Until more research is conducted to explore the


trait moderator link, informed recommendation regarding how the gratitude-inducing

exercises might be used can be provided.

In addition, it might be valuable to examine the contents written in the gratitude diary.

This provides insight into the benefactor-recipient relationship and further investigation into

the level of impact based on ‘what’ and ‘who’ one writes. Such discovery might help identify

circumstances under which the count-your-blessings intervention can be fully optimized.

While this was not the aim of the current investigation, it is an option for future study.

Another issue to consider is retention enhancement in self-directed exercises.

Especially when intervention is delivered online, the anonymity and distance between the

participants and the researcher may induce participants’ reluctant to oblige to instructions for

the assigned task. The challenge for future research is to design a study that can be integrated

into individual’s daily routine, and in a way that it is self-reinforcing and self-maintaining.

It is beyond the scope of the present study to uncover how gender and different

ethnicity experience and express gratitude. These are avenues that future research should

explore because it may discover barriers on the generality of gratitude interventions.

Practical Implications and Conclusion

The present findings suggest that the gratitude intervention can be applied in a UK

cultural setting. Evidence showed that the count-your-blessings approach is an effective

technique to increase individuals’ predisposition to experience gratitude. Tapping into this

asset, a mindfulness appreciation helps individuals to come into terms with the absence of

benefits (Koo et al., 2008) and learn to recognize the benefits received in the past and also in

present (Emmons & Mishra, 2011). This type of positive attributional style magnifies

individuals’ ability to retrieve and experience positive emotions with ease (Watkins, Grimm,

& Kolts, 2004). Thus, habitual accessibility to positive memories can trigger an upward

spiral in well-being by buffering against negative emotions (Aspinwall & Tedeschi, 2010).


This suggests that the conscious practice of gratitude can function as a happiness barometer,

increasing the chances to live “the good life”.

The current study points out that gratitude may serves as a “therapeutic ingredient” in

finding benefits in adversity. If psychopathology arises from how people appraise the events

of their lives, it may be useful to implement gratitude interventions to counteract the

“negative triads” of beliefs pertaining to the self, world, and future (Wood et al., 2010). To

promote gratitude-based interventions in clinical settings, future study would need to

compare its effectiveness with existing “gold standards” (e.g. CBT).

Of great importance, the null findings for perceived interpersonal benefits propel

future work to explore and include additional variables into the causal model of gratitude-

induction. Whether gratitude stems from thanking other’s altruistic acts (interpersonal

appreciation) or from acknowledging one’s ability (interpersonal appreciation), regardless of

it sources, the cultivation of gratitude has proven to privilege the individual to achieve an

optimal human functioning.

Despite the insignificant findings for physical well-being, participants who practiced

gratitude reported less symptomology. Bearing in mind that the cost of direct (e.g. diseases

and death) and indirect illnesses (e.g. absenteeism, lack of productivity) is high and hard to

estimate, on the basis of these preliminary findings, the gratitude intervention could be useful

from both humane and economic perspective (DeVol & Bedroussian, 2007).

Considering both the individuals and the wider community is to envisage a flourishing

nation and a decrease in psychological suffering (Ustun et al., 2004), health authorities and

public institutions should pay attention to the mind and body connection – specifically how

well-being impacts illness recovery and prevention. The current results demonstrated that

altering cognitive habits and augmenting well-being is possible, but it takes both the ‘drive’

and ‘will’ to initiate and maintain the happiness-bestowing activity. Perhaps a more far-


reaching methodology would discover the means to meet such goals, generating greater

accessibility to develop mental strength as well as alleviate suffering.

To sum it all up, the essential message of this study shows that the count-your-

blessings approach – a relatively easy technique has its strength to improve well-being and it

can be included alongside existing clinical therapies. Looking further afield, instead of

seeking therapists to talk about weaknesses and troubles, the future of psychology would be a

place to build character strengths – and gratitude can catalyse this vision into a reality.


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APPENDICES

Appendix A

PARTICIPANT INFORMATION SHEET

A STUDY ON HUMAN EMOTION

INVITATION

We are interested to explore how human emotions fluctuate on a daily basis. We need to

collect data on how mood interacts with physical and mental health in general. Your

participation is highly appreciated.

WHAT WILL PARTICIPATION INVOLVE

In this study, you are required to complete a survey which consists of three brief

questionnaires with different parts. The first part of the questionnaire consists of collecting

your basic demographic information. The second part includes questions related to your

feelings, emotions, physical health and your opinions on human interaction. The last part of

the questionnaire is about your general opinion about this study.

Depending on random allocation, you might or might not need to complete an assigned brief

dairy-type task. The brief dairy-type task you will receive is simple and straightforward. It

will take maximum 5 minutes to complete.

TIME COMMITMENT

This study requires approximately 5 – at most 10 minutes (per day) for 4 weeks.

Week 1:

(Day 1 – present moment) You will be asked to complete a set of questionnaires (5mins)

Week 1 – Week 3:

(Day 2 to Day 22)

Depending on random allocation, you might or might

not be assigned to carry out a brief diary-type task. (5 min)

Week 4

(Day 23) You will be asked to complete a set of questionnaires (10mins)

BENEFITS AND RISKS

There are no risk involve.


COST, REIMBURSEMENT AND COMPENSATION

Your participation is voluntary. However, as part of your successful completion of this

study, if you are a

1. An undergraduate psychology student, you will receive a total of 2 tokens on the

PSYCHWEB system for participating.

2. Non-psychology undergraduate student, you will be entered into a lottery. The

lottery prize is one £50 amazon gift certificate.

Confidentiality / Anonymity

All data provided will be used as part of an MSc health psychology research project.

However, we ensure all your personal details (e.g. name and contact details) will not be

disclosed to anyone else except to the researcher.

Take note that you will be given a unique code number in this study. You will (i) not be

identified by anyone else and (ii) your personal details will not be linked to your responses

in any completed set of questionnaires or performance on the brief diary-type task.

As an Informed Participant of This Study, I understand that:

1. My participation is voluntary and I have the right to withdraw from this study at any

time.

If I wish to withdraw from this study, I will send the following email to the

researcher: “I WISH TO WITHDRAW FROM THIS STUDY”.

2. I am aware of what my involvement are in this study.

3. There are no risks involved in this study.

If you have read and understood the above, you could continue this study by giving consent

to participate.

If you want to clarify any doubts in this information sheet before participation or have any

questions during your course of participation, you can contact the researcher.

FURTHER INFORMATION

Any enquiries should be addressed to the researcher (LAI SIEW TIM) by email at

[email protected]

Thank You for Your Time

mailto:[email protected]


Appendix B

INFORMED CONSENT SHEET

CONSENT FORM

Title of Project: A Study on Human Emotion

Name of Researcher: LAI SIEW TIM

Please initial all boxes

1. I confirm that I have read and understand the information sheet. I have had the

opportunity to consider the information, ask questions and have had these

answered satisfactorily.

2. I understand that my participation is voluntary and that I am free to withdraw at

any time. If I wish to withdraw from this study, I will send the following email

to the researcher: “I WISH TO WITHDRAW FROM THIS STUDY” at

[email protected]

3. I understand that all data provided will be used as part of an MSc health

psychology research project, and my personal details (e.g. name and contact

details) will not be disclosed to anyone else except to the researcher.

4. I am aware of of what my involvement are in this study, and there are no risks

involved in this study

5. I agree to take part in the above study.

Name of Participant Date Signature


Appendix C

POST-INTERVENTION INFORMATION SHEET

Dear Participant,

Thank you for your commitment in this research project. Your participation is highly

appreciated.

The main goal of this study was to investigate the effect of gratitude practice on well-being.

You were randomly assigned to either one of the conditions – (i) gratitude condition or a (ii)

control condition. Specifically, this research project sought to examine whether the

cultivation of gratitude by focusing on the good things that has happened to you can increase

your levels of positive emotions and overall quality of life.

I would like to offer the participants who were in the control condition (i.e. those who were

not assigned any brief diary-type task) the equal opportunity to obtain the guidelines for the

gratitude condition. If you wish to practice the gratitude intervention, please read the

following guidelines:

The Instructions for Gratitude Intervention

“There are many things in our lives, both large and small, that we might consider as a form

of blessing. It could be even be those who help us to reach our goals, or just make our lives

easier with small details. If we try to put ourselves in their shoes, appreciate their efforts,

and notice the voluntary nature of their acts, we have a good reason to feel grateful. Please

think of today and write down three things in your life that you are grateful for”.

FURTHER INFORMATION

If you want to clarify any doubts or have any questions, please address it to the researcher

(LAI SIEW TIM) by email at [email protected]

Thank you,

Lai Siew Tim



Appendix D

BASIC DEMOGRAPHIC INFORMATION

1. Name :

2. What is your age :

3. Sex (please tick): Female Male

4. Please specify your ethnicity (please tick):

a) White

b) Hispanic or Latino

c) Black or African American

d) Native American or American Indian

e) Asian/Pacific Islander

f) Others (please specify) ( )

5. What is the highest degree or level of school you have completed/

currently pursuing?

a) Primary school

b) High school

c) Diploma or pre-university (e.g. A’levels)

d) Bachelor’s degree

e) Master’s degree

f) Professional degree

6. Are you currently employed? Yes No

7. Are you a undergraduate psychology student Yes No

If you are a non-psychology student, please specify

what course are you currently studying or have studied.

( )

8. Personal contact details

E-mail address:

Mobile number (optional):

Thank You.


Appendix E

EMOTION STUDY QUESTIONNAIRE

I. Warwick-Edinburgh Mental Well-being Scale (WEMWBS)

This survey is on the topic of human emotions. Please answer as honestly as possible. All

responses will be kept confidential.

Below are some statements about feelings and thoughts. Please circle the box that best

describes your experience of each over the last 2 weeks

None of the time Rarely Some of the time Often All of the time

1 2 3 4 5

Statements None of

the time Rarely

Some of

the time Often

All of the

time

1. I’ve been feeling optimistic about

the future

1 2 3 4 5

2. I’ve been feeling useful 1 2 3 4 5

3. I’ve been feeling relaxed 1 2 3 4 5

4. I’ve been feeling interested in other

people

1 2 3 4 5

5. I’ve had energy to spare 1 2 3 4 5

6. I’ve been dealing with problems

well

1 2 3 4 5

7. I’ve been thinking clearly 1 2 3 4 5

8. I’ve been feeling good about

myself

1 2 3 4 5

9. I’ve been feeling close to other

people

1 2 3 4 5

10. I’ve been feeling confident 1 2 3 4 5

11. I’ve been able to make up my own

mind about things

1 2 3 4 5

12. I’ve been feeling loved 1 2 3 4 5

13. I’ve been interested in new things 1 2 3 4 5

14. I’ve been feeling cheerful 1 2 3 4 5


II. Positive Affect and Negative Affect Schedule (PANAS) &

III. Gratitude Adjectives Checklist (GAC)

This scale consists of a number of words that describe different feelings and emotions. Read

each item and then list the number from the scale below (i.e. using 1 – 5) next to each word.

Indicate to what extent you feel this way right now, that is, at the present moment.

Very Slightly or Not at All A Little Moderately Quite a Bit Extremely

1 2 3 4 5

Very

Slightly/

Not at All

A Little Moderately Quite a Bit Extremely

1. Interested 1 2 3 4 5

2. Appreciative 1 2 3 4 5

3. Distressed 1 2 3 4 5

4. Excited 1 2 3 4 5

5. Upset 1 2 3 4 5

6. Thankful 1 2 3 4 5

7. Guilty 1 2 3 4 5

8. Scared 1 2 3 4 5

9. Hostile 1 2 3 4 5

10. Enthusiastic 1 2 3 4 5

11. Proud 1 2 3 4 5

12. Irritable 1 2 3 4 5

13. Alert 1 2 3 4 5

14. Ashamed 1 2 3 4 5

15. Inspired 1 2 3 4 5

16. Nervous 1 2 3 4 5

17. Determined 1 2 3 4 5

18. Attentive 1 2 3 4 5

19. Grateful 1 2 3 4 5

20. Jittery 1 2 3 4 5

21. Active 1 2 3 4 5

22. Afraid 1 2 3 4 5

23. Strong 1 2 3 4 5

Note. Positive Affect (PA) adjectives are – interested, determined, attentive, proud, alert,

inspired, excited, strong, enthusiastic, and active. The Negative Affect (NA) adjectives are –

upset, distressed, guilty, nervous, jittery, hostile, irritable, scared, afraid, and ashamed. The

Gratitude Adjectives Checklist (GAC) contains – grateful, appreciative, and thankful.


IV. The Grateful Disposition – (GQ-6)

Read each of these statements carefully, then using the scale 1 – 7, select the response that

indicates how much you agree or disagree with each statement.

Strongly

Disagree Disagree

Slightly

Disagree Neutral

Slightly

Agree

Agree Strongly

Agree

1 2 3 4 5 6 7

Statements 1 2 3 4 5 6 7

1. I have so much in life to be thankful for 1 2 3 4 5 6 7

2. If I had to list everything that I felt grateful for, it would be a

very long list

1 2 3 4 5 6 7

3. When I look at the world, I don’t see much to be grateful for 1 2 3 4 5 6 7

4. I am grateful to a wide variety of people 1 2 3 4 5 6 7

5. As I get older I find myself more able to appreciate the

people, events, and situations that have been part of my life

history

1 2 3 4 5 6 7

6. Long amounts of time can go by before I feel grateful to

something or someone

1 2 3 4 5 6 7

Note. Items 3 and 6 are reverse-scored


V. Perceived Quality of Relationship with Close Others

This section involves your opinions on your interpersonal relationship with significant others,

and your thoughts about this study.

Read each of these statements carefully, then using the scale 1 – 4, select the response that

best describe your quality of relationship with a significant person. The significant person can

be anyone whom you have a close relationship with (e.g. family member or a close friend)

Not At All A Little Quite A Bit A Great Deal

1 2 3 4

Statements Not At All A

Little

Quite

A Bit

A Great

Deal

1. To what extent can you contribute to the

well-being of the person

1 2 3 4

2. To what extent does the person contribute to

your well-being

1 2 3 4

3. To what extent do you think you can count

on this person to help you with the problems

you have

1 2 3 4

4. To what extent can this person count of you

to help him/her with the problems that

she/he has?

1 2 3 4


VI. Physical Symptoms Checklist

In this section, you will be asked about your health in general. Would you please, for all

symptoms mentioned, please tick (√) which symptoms you have been bothered by it for the

past 2 weeks.

Have you, during the 2 past week, been bothered by

Physical Symptom Yes No

1. Headaches

2. Faintness/dizziness

3. Stomachache/pain

4. Shortness of breath

5. Chest pain

6. Acne/skin irritation

7. Runny/congested nose

8. Stiff or sore muscles

9. Stomach upset/nausea

10. Irritable bowels

11. Hot or cold spells

12. Poor appetite

13. Coughing/sore throat

14. Other

Please indicate in the space provided if the experienced symptoms were not mentioned

above:

_________________________________________________________________________


VII. Exploratory Data Form

This is the exploratory data form that is designed to ask your opinions and thoughts about this

study.

1) How motivated did you feel about doing this activity?

Very Slightly or Not at All A Little Moderately Quite a Bit Extremely

1 2 3 4 5

2) On average how many minutes did it take you to complete your activity?

** If you are assigned the brief diary-type task, please answer this question:

“We understand that at some point there are circumstances that cause you to unable to carry

out the assigned activity as intended. We appreciate your honesty to indicate throughout

these 21 days, how often you think you actually did the assigned activity.”

Please indicate by circling which statement best describe you

Never A few times in

three weeks

Once in two

weeks

A few times in

two weeks

Once a

week

A few times

a week

Daily

1 2 3 4 5 6 7

Thank you.


Appendix F

BRIEF-DIARY TYPE TASK

Instructions:

You have been randomly assigned to perform a brief diary-type task.

The instruction is as below:

“There are many things in our lives, both large and small, that we might consider as a form of

blessing. It could be even be those who help us to reach our goals, or just make our lives easier

with small details. If we try to put ourselves in their shoes, appreciate their efforts, and notice the

voluntary nature of their acts, we have a good reason to feel grateful. Please think of today and

write down three things in your life that you are grateful for”.

Please continue this for 21 days. I would be very grateful if you could return this journal to me upon

completion. However, there is no penalty involved if you do not wish to do so.


Researcher: Lai Siew Tim

Contact: [email protected] [or]

[email protected]




MY DAILY JOURNAL –

Counting My Blessings Days Date List three things you are grateful for today… Time taken (mins)

E.G.

EXAMPLE

21/04/2014

1. MY SISTER JUST GAVE BIRTH TO A HEALTHY

BABY BOY

2. MY HUSBAND PICKED UP MY FAVOURITE ICE

CREAM FOR DESSERT ON THE WAY HOME FROM

WORK TODAY

3. I FOUND PARKING NEAR MY OFFICE

5

1 1.

2.

3.

2 1.

2.

3.

3 1.

2.

3.

4 1.

2.

3.

5 1.

2.

3.

6 1.

2.

3.

7

1.

2.

3.



Counting My Blessings

Days Date List three things you are grateful for today… Time taken (mins)

8 1.

2.

3.

9 1.

2.

3.

10 1.

2.

3.

11 1.

2.

3.

12 1.

2.

3.

13 1.

2.

3.

14 1.

2.

3.



Counting My Blessings

Days Date List three things you are grateful for today… Time taken (mins)

15 1.

2.

3.

16 1.

2.

3.

17 1.

2.

3.

18 1.

2.

3.

19 1.

2.

3.

20 1.

2.

3.

21 1.

2.

3.


Appendix G

INSTRUCTIONS

I. Standard script for pre-intervention

Control Group Gratitude Condition

Hi,

A few weeks ago, you took part in a survey

entitled "A Study on Human Emotion". I very

much appreciate you taking the time to

complete that survey. At that time you gave

permission for me to now contact you.

Based on random allocation for the research

project, you do not need to keep a diary of

your thoughts. Please continue carrying out

your normal daily activities.

Between (Date) to (Date/Month/Year), I will

send you another link to complete a brief

questionnaire which takes no longer than 5

minutes to complete.

Please keep this for reference: Your unique

participant ID is XXX. (This is required to

complete the later part of the questionnaire).

If you have any questions about the study or

how your information will be used please

contact me.

Thank you very much once again for your

participation, it is very much appreciated.

Kind Regards,

Lai Siew Tim

Department of Psychology



Stirling FK9 4LA

email: [email protected] [or]

[email protected]

Hi,

A few weeks ago, you took part in a survey

entitled "A Study on Human Emotion". I very

much appreciate you taking the time to complete

that survey. At that time you gave permission for

me to now contact you.

Based on random allocation for the research

project, you are assigned to a group which

requires you to complete a brief-diary type task

(Please refer to the attached document for

instructions). You are invited to carry out this

task for 21 days. The task should take less than 5

minutes each day.

You should begin your task on

(Date/Month/Year) and it ends on

(Date/Month/Year)

When you have finished, please return the

completed diary back to me either in docx. or pdf

format via email. None of your responses will be

linked to your personal identification data.

Between (Date) to (Date/Month/Year), I will send

you another link to complete a brief questionnaire

which takes no longer than 5 minutes to complete.

Please keep this for reference: Your unique

participant ID is XXX. (This is required to


If you have any questions about the study or how

your information will be used please contact me.



Kind Regards,

Lai Siew Tim




Stirling FK9 4LA


[email protected]

mailto:[email protected]/t_blank





II. Standard script for participants in the gratitude condition – Beginning of the

Count-Your-Blessings Intervention (Time-point 1)

Hi,

Thank you for participating in a survey entitled “A Study on Human Emotion”.

This email is to remind you that you should begin the count-your-blessings journal

today (Date/ Month/ Year).

Around (Date) to (Date/ Month/ Year), I will then send you another link to complete a

brief questionnaire which takes no longer than 5 minutes to complete.

Please keep this for reference: Your unique participant ID is XXX. (This is required to


If you have any questions about the study or how your information will be used please

contact me.

Thank you very much once again for your participation, it is very much appreciated.

Kind Regards,

Lai Siew Tim




Stirling FK9 4LA

email: [email protected] [or] [email protected]

Note. There was no email required for the control group condition.




III. Standard script for participants in the gratitude condition – A week after the

start of the Count-Your-Blessings Intervention (Mid time-point)

Hi,

Thank you for agreeing to take part in my research project. By now you should have

completed the first 7 days of the study. Please continue to keep a diary of your thoughts

for another 14 days.

If you have not started the brief-diary type task, could you please begin today and refer

to the attached document for instructions?

For further information or any questions regarding this study, do not hesitate to drop me

an email.

Thank you once again for agreeing to take part in my research project.

Kind Regards,

Lai Siew Tim




Stirling FK9 4LA

email: [email protected] [or] [email protected]

Note. There was no email required for the control group condition.


IV. Standard script for post-intervention

(Time Point 2; 3-weeks apart; 21 days after the intervention)

Control Group Gratitude Condition

Hi,

Thank you for agreeing to participate in my

survey entitled "A Study on Human

Emotion". You gave the permission for me to

now contact you.

Could you please now use your unique

participant ID (XXX) to complete a brief



The link is: (INSERT LINK)

Please keep your unique participant ID for

reference, your name will be entered in a

lottery system.



contact me.



Kind Regards,

Lai Siew Tim




Stirling FK9 4LA


[email protected]

Hi,

Thank you for agreeing to participate in my

survey entitled "A Study on Human

Emotion". You gave the permission for me to

now contact you.

Please return the completed diary back to me either in docx. or pdf format via email.. None

of your responses will be linked to your

personal identification data.

Could you now please use your unique

participant ID (XXX) to complete a brief



The link is: (INSERT LINK)

Do keep your unique participant ID for

reference, your name will be entered in a

lottery system.



contact me.



Kind Regards,

Lai Siew Tim




Stirling FK9 4LA


[email protected]





Appendix H

INSTRUCTIONS FOR RANDOMIZATION PROCEDURE

Adapted from: Urbaniak, G. C., & Plous, S. (2013). Research Randomizer (Version 4.0)

[Computer software]. Retrieved on June 22, 2013, from http://www.randomizer.org/

The number “108”

is the amount of

participants who

completed the

baseline measures

prior to the

intervention

The number range

from 1 to 2 to

further determine

the allocation of

group via the coin-

tossing method.


Appendix I

Table 1

VIA Classification of Strengths

Wisdom and Knowledge

Creativity Thinking of novel and productive ways to do things

Curiosity Taking an interest in all of on-going experience

Open-mindedness Thinking things through and examining them from all sides

Love of learning Mastering new skills, topics, and bodies of knowledge

Perspective Being able to provide wise counsel to others

Courage

Honesty Speaking the truth and presenting oneself in a genuine way

Bravery Not shrinking from threat, challenge, difficulty, or pain

Persistence Finishing what one starts

Zest Approaching life with excitement and energy

Humanity

Kindness Doing favours and good deeds for others

Love Valuing close relationship with others

Being aware of the motives and feelings of self and others

Justice

Fairness Treating all people the same according to the notions of

fairness and justice

Leadership Organizing group activities and seeing that they happen

Teamwork Working well as member of a group or team

Temperance

Forgiveness Forgiving those who have done wrong

Modesty Letting one’s accomplishments speak for themselves

Prudence Being careful about one’s choices; not saying or doing

things that might later be regretted

Self-regulation Regulating what one feels and does

Transcendence

Appreciation of beauty

and excellence

Noticing and appreciating beauty, excellence, and/ or

skilled performance in all domains of life

Gratitude Being aware of and thankful for the good things that happen

Hope Expecting the best and working to achieve it

Humour Liking to laugh and joke; bringing smiles to other people

Religiousness Having coherent beliefs about the higher purpose and

meaning of life

Note. Descriptions of character strengths organized under the six broad virtues - Wisdom and

Knowledge, Courage, Humanity, Justice, Temperance and Transcendence.

Adapted from Peterson, C., & Seligman, M. E. P. (2004). Character strengths and virtues:

A handbook for classification. Washington, DC: American Psychological Association.


Table 2

Types of positive psychology interventions (PPI)

Components Techniques Brief descriptions Remarks

Gratitude

Three good

things

List down three things that

happened in your day and

provide a causal explanation Practical and simple

Gratitude visit

With a given a time frame, write

a letter of gratitude to someone

who had been especially kind to

you but had never been properly

thanked

Mixed findings revealed

potential confounds

whether to mail letter or

not

Optimism You at your

best

Visualise and write about a time

when you were at your best and

reflect on the personal strengths

displayed in the story

Envisioning future or

best possible selves is

self-relevant and

motivating

Best possible

selves

Imagine and write about the

realisation of your dreams and

fulfilment of life goals

Kindness Counting

kindness

With a given time frame, you

are to keep track of your own

kind behaviours towards others

Dependent on the

quantity of kind acts

Dependent on the

magnitude of the acts

(i.e. big or small)

Character

strengths

Identify and

Use signature

strengths

Complete and receive

individualized feedback about

your top five strengths via the

online inventory of character

strengths. Use one of the top

strengths in a new and different

way for

Provide insight to both

clients and therapists to

build or cultivate

particular strengths

Though inventory is

fairly reliable, it has not

been used extensively

on clinical populations


Table 3

Conception of trait gratitude

Conception Scale (or sub-scale)

assessing conception Brief descriptions Characteristic item

Individual

differences

in grateful

affect

GQ-6

Assess gratitude as a

single factor, based on the

frequency, intensity, and

density of grateful affect.

I have so much in life to be

thankful for

Appreciation

of other

people

GRAT:

appreciating others Gratitude towards other

people

I am really thankful for

friends and family

AS:

interpersonal

I reflect on how important

my friends are to me

Focus on

what the

person has

AS:

have focus

A focus on the positive

tangible and intangible

assets that a person

possesses.

I reflect on how fortunate I

am to have basic things in

life like food, clothing, and

shelter

GRAT:

sense of abundance

The absence of feeling

deprivation

I think life has handed me as

a short stick (reverse coded)

Awe AS:

awe Frequency of feeling awe

When I see natural beauty

like Niagara Falls, I feel like

a child who is awestruck

Behaviour

AS:

ritual

Performing regular

behaviours to express

gratitude

I use personal or religious

rituals to remind myself to

be thankful to things

AS:

gratitude

Behaviours designed to

express gratitude

I say “please” and “thank

you” to indicate my

appreciation

Present

moment

AS:

present moment

Regularly focusing

positive aspects in a given

moment

I stop and enjoy my life as it

is

GRAT:

simple appreciation

Gratitude towards non-

social sources

I think it is really important

to “stop and smell the roses”

Life is short AS:

loss/ adversity

Appreciation arising from

the understanding nothing

is permanent

Thinking about dying

reminds me to live every

day to the fullest

Positive

social

comparisons

AS:

self/social

comparison

Positive feelings arising

for appreciation of how

life could be worse

When I see someone less

fortunate than myself, I

realize how lucky I am

Note. GQ-6 (McCullough et al., 2002); AS = Appreciation Scale (Adler & Fagley, 2005);

GRAT = Gratitude, Appreciation, and Resentment Test (Watkins et al., 2003).

Based in part on Wood, Maltby, Stewart, & Joseph (2008).

Adapted from:

Wood, A. M., Froh, J. J., & Geraghty, A. W. A. (2010). Gratitude and well-being: A review

and theoretical integration. Clinical Psychology Review, 1-16. doi:

10.1016/j.cpr.2010.03.005 [Original Source].


Table 5

Independent t-test for completer analysis on the comparison of group differences in

relation to the effects of gratitude intervention (n = 81)

GRAT CTRL

Measuresa Time

b M SD M SD t Df p 95% CI

WEMWBS T1 46.17 10.00 45.69 9.38 -.221 79 .826 [-4.779, 3.823]

T2 45.50 10.81 39.47 13.87 -2.14 79 .036* [-11.64, -.419]

PANAS

PA T1 31.38 8.31 30.87 7.13 -.304 79 .762 [-3.940, 2.895]

T2 33.47 8.23 28.69 8.22 -2.60 79 .011* [-8.443, -1.124]

NA T1 22.00 9.05 21.93 7.65 -.036 79 .971 [-3.761, 3.628]

T2 20.83 6.62 23.38 8.93 1.43 79 .158 [-1.010, 6.099]

Gratitude

GAC T1 9.83 3.87 9.69 2.75 -.196 60.96 0.851 [-1.673, 1.384]

T2 11.67 2.55 9.13 3.62 -3.85 78.81 .001** [-3.842, -1.225]

GQ-6 T1 33.43 5.99 31.82 6.18 -1.92 79 .058 [-4.355, .074]

T2 33.36 5.80 28.16 8.86 -3.04 79 .003** [-8.618, -1.793]

Social

relationship T1 14.39 4.44 13.36 3.15 -1.23 79 .224 [-2.713, .646]

T2 13.61 2.50 12.78 3.40 -1.23 79 .223 [-2.183, .516]

Physical

symptoms T1 4.46 4.44 5.07 3.20 -.055 79 .956 [-1.232, 1.167]

T2 3.77 3.01 4.34 3.11 .878 79 .383 [-.795, 2.051]

GRAT, gratitude condition; CTRL, control condition aMeasures were denoted as:

WEMWBS, Warwick-Edinburgh Mental Well-being Scale (WEMWBS); PANAS,

(Positive Affect [PA] and Negative Affect [NA] Schedule); GAC, (Gratitude Adjectives

Checklist); GQ-6, (Gratitude Dispositional Scale) bTime represented the intervention periods – pre-intervention (T1); post-intervention (T2)

Significance levels tested with unrelated t-test. Statistical significant differences are

highlighted in bold

* p < .05;

** p < .01

Documents

The Efficacy of Gratitude Practice on Well-Being: A Randomized