Journal of Happiness Studies

, Volume 14, Issue 1, pp 263–274 | Cite as

The Role of Gratitude in Breast Cancer: Its Relationships with Post-traumatic Growth, Psychological Well-Being and Distress

Research Paper

Abstract

Despite the increasing number of studies documenting the positive effects of gratitude in coping with traumatic events and facilitating psychological well-being, none is addressed to patients with life-threatening illnesses such as cancer. The aims of this study are to examine the role of gratitude in a breast cancer sample and its correlations with post-traumatic growth, psychological well-being, and distress; and to compare patients reporting higher levels of gratitude (High Gratitude Individuals, HGI) versus those reporting lower levels (Low Gratitude Individuals, LGI). 67 breast cancer patients were assessed with: (1) Gratitude Questionnaire; (2) Post-traumatic Growth Inventory (PTGI); (3) Psychological Well-being Scales (PWBS) (4) Symptom Questionnaires (SQ); and were divided into: (1) High Gratitude Individuals—HGI (n = 27); (2) Low Gratitude Individuals—LGI (n = 40). Bivariate correlations between questionnaires and ANOVA between-group were calculated. Gratitude was significantly and positively correlated to all of PTGI scales, to PWBS positive relations, to SQ relaxation and contentment, and negatively related to anxiety, depression, and hostility-irritability. HGI and LGI reported significant differences on the PTGI and SQ dimensions, but not on PWB scales, with HGI displaying higher levels of PTGI, positive affect and lower symptomatology. Also in breast cancer patients gratitude is strongly associated to post-traumatic growth, reduced distress and increased positive emotions, but surprisingly not to psychological well-being. Since the majority of patients reported low gratitude levels, the results suggest the importance of developing interventions to clinically increase them also in oncology.

Keywords

Breast cancer Depression Gratitude Post-traumatic growth Psychological well-being 

References

  1. Affleck, G., & Tennen, H. (1996). Construing benefits from adversity: Adaptational significance and dispositional underpinnings. Journal of Personality, 64(4), 899–922.CrossRefGoogle Scholar
  2. Antoni, M. H., Lehman, J., Kilbourn, K., Boyers, A., Culver, J., Alferi, S., et al. (2001). Cognitive–behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychology, 20(1), 20–32.CrossRefGoogle Scholar
  3. Belaise, C., Fava, G. A., & Marks, I. M. (2005). Alternatives to debriefing and modifications to cognitive behavior therapy for posttraumatic stress disorder. Psychotherapy and Psychosomatics, 74(4), 212–217.CrossRefGoogle Scholar
  4. Bellizzi, K. M., Smith, A. W., Reeve, B. B., Alfano, C. M., Bernstein, L., Meeske, K., et al. (2010). Posttraumatic growth and health-related quality of life in a racially diverse cohort of breast cancer survivors. Journal of Health Psychology, 15(4), 615–626.CrossRefGoogle Scholar
  5. Calhoun, L. G., & Tedeschi, R. G. (1989). Positive aspects of critical life problems: Recollections of grief. Journal of Death & Dying, 20(4), 265–272.CrossRefGoogle Scholar
  6. Cordova, M. J., Cunningham, L. L., Carlson, C. R., & Andrykowski, M. A. (2001). Posttraumatic growth following breast cancer: A controlled comparison study. Health Psychology, 20(3), 176–185.CrossRefGoogle Scholar
  7. Costanzo, E. S., Ryff, C. D., & Singer, B. H. (2009). Psychosocial adjustment among cancer survivors: Findings from a national survey. Health Psychology, 28(2), 147–156.CrossRefGoogle Scholar
  8. Davis, C. G., Nolen-Hoeksema, S., & Larson, J. (1998). Making sense of loss and benefiting from the experience: Two construals of meaning. Journal of Personality and Social Psychology, 75(2), 561–574.CrossRefGoogle Scholar
  9. Duckworth, A. L., Steen, T. A., & Seligman, M. E. P. (2005). Positive psychology in clinical practice. Annual Review of Clinical Psychology, 1(1), 629–651.CrossRefGoogle Scholar
  10. Emmons, R. A., & Crumpler, C. A. (2000). Gratitude as human strength: Appraising the evidence. Journal of Social and Clinical Psychology, 19(1), 56–69.CrossRefGoogle Scholar
  11. Emmons, R. A., & McCullough, M. E. (2003). Counting blessing versus burden: an experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377–389.CrossRefGoogle Scholar
  12. Emmons, R. A., & Shelton, C. S. (2002). Gratitude and the science of positive psychology. In C. R. Snyder & S. J. Lopez (Eds.), Handbook of positive psychology (pp. 459–471). New York: Oxford University Press.Google Scholar
  13. Fava, G. A., Kellner, R., Perini, G. I., Fava, M., Michelacci, L., Munari, F., et al. (1983). Italian validation of the Symptom Rating Test (SRT) and Symptom Questionnaire (SQ). Canadian Journal of Psychiatry, 28(2), 117–123.Google Scholar
  14. Fava, G. A., Rafanelli, C., Grandi, S., Conti, S., & Belluardo, P. (1998). Prevention of recurrent depression with cognitive behavioral therapy. Archives of General Psychiatry, 55(9), 816–820.CrossRefGoogle Scholar
  15. Fava, G. A., & Ruini, C. (2003). Development and characteristics of a well-being enhancing psychotherapeutic strategy: Well-being therapy. Journal of Behavior Therapy and Experimental Psychiatry, 34(1), 45–63.CrossRefGoogle Scholar
  16. Fava, G. A., Ruini, C., Rafanelli, C., Finos, L., Conti, S., & Grandi, S. (2004). Six year outcome of cognitive behavior therapy for prevention of recurrent depression. American Journal Psychiatry, 161(10), 1872–1876.CrossRefGoogle Scholar
  17. Fava, G. A., Ruini, C., Rafanelli, C., Finos, L., Salmaso, L., Mangelli, L., et al. (2005). Well-being therapy of generalized anxiety disorder. Psychotherapy and Psychosomatics, 74(1), 26–30.CrossRefGoogle Scholar
  18. Fava, G. A., & Sonino, N. (2009). Psychosomatic assessment. Psychotherapy and Psychosomatics, 78(6), 333–341.CrossRefGoogle Scholar
  19. Fredrickson, B. L. (1998). What good are positive emotions? Review of General Psychology, 2(3), 300–319.CrossRefGoogle Scholar
  20. Fredrickson, B. L., Tugade, M. M., Waugh, C. E., & Larkin, G. R. (2003). What good are positive emotions in crises? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001. Journal of Personality and Social Psychology, 84(2), 365–376.CrossRefGoogle Scholar
  21. Gallup, G. (1999). Survey results on “Gratitude”, adults and teenagers. Emerging Trends, 20(4–5), 9.Google Scholar
  22. Harrington, C. B., Hansen, J. A., Moskowitz, M., Todd, B. L., & Feuerstein, M. (2010). It’s not over when it’s over: Long-term symptoms in cancer survivors-a systematic review. Internal Journal of Psychiatry in Medicine, 40(2), 163–181.CrossRefGoogle Scholar
  23. Helgeson, V. S., Reynolds, K. A., & Tomich, P. L. (2006). A meta-analytic review of benefit finding and growth. Journal of Consulting and Clinical Psychology, 74(5), 797–816.CrossRefGoogle Scholar
  24. Henry, M., Cohen, S. R., Lee, V., Sauthier, P., Provencher, D., Drouin, P., et al. (2010). The Meaning-Making intervention (MMi) appears to increase meaning in life in advanced ovarian cancer: A randomized controlled pilot study. Psychooncology, 19(12), 1340–1347.CrossRefGoogle Scholar
  25. Horgan, O., Holcombe, C., & Salmon, P. (2011). Experiencing positive change after a diagnosis of breast cancer: A grounded theory analysis. Psychooncology, 20(10), 1116–1125.Google Scholar
  26. Joseph, S., & Wood, A. M. (2010). Assessment of positive functioning in clinical psychology: Theoretical and practical issues. Clinical Psychology Review, 30(7), 830–838.CrossRefGoogle Scholar
  27. Kashdan, T. B., Uswatte, G., & Julian, T. (2006). Gratitude and hedonic and eudaimonic well-being in Vietnam War veterans. Behaviour Research and Therapy, 44(2), 177–199.CrossRefGoogle Scholar
  28. Kellner, R. (1987). A symptom questionnaire. Journal of Clinical Psychiatry, 48(7), 269–274.Google Scholar
  29. Kendler, K. S., Liu, X., Gardner, C. O., McCullough, M. E., Larson, D., & Prescott, C. A. (2003). Dimensions of religiosity and their relationship to lifetime psychiatric and substance use disorders. American Journal of Psychiatry, 160(3), 496–503.CrossRefGoogle Scholar
  30. Lelorain, S., Bonnaud-Antignac, A., & Florin, A. (2010). Long term posttraumatic growth after breast cancer: Prevalence, predictors and relationships with psychological health. Journal of Clinical Psychology in Medical Settings, 17(1), 14–22.CrossRefGoogle Scholar
  31. McCullough, M. E., Emmons, R. A., & Tsang, J. (2002). The grateful disposition: A conceptual and empirical topography. Journal of Personality and Social Psychology, 82(1), 112–127.CrossRefGoogle Scholar
  32. McCullough, M. E., Kilpatrick, S. D., Emmons, R. A., & Larson, D. B. (2001). Is gratitude a moral affect? Psychological Bullettin, 127(2), 249–266.CrossRefGoogle Scholar
  33. McGregor, B. A., Antoni, M. H., Boyers, A., Alferi, S. M., Blomberg, B. B., & Carver, C. S. (2004). Cognitive–behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer. Journal of Psychosomatic Research, 56(1), 1–8.CrossRefGoogle Scholar
  34. Mehnert, A., & Koch, U. (2008). Psychological comorbidity and health-related quality of life and its association with awareness, utilization, and need for psychosocial support in a cancer register-based sample of long-term breast cancer survivors. Journal of Psychosomatic Research, 64(4), 383–391.CrossRefGoogle Scholar
  35. Mols, F., Vingerhoets, A. J., Coebergh, J. W., & Van de Poll-Franse, L. (2009). Well-being, posttraumatic growth and benefit finding in long-term breast cancer survivors. Psychology & Health, 24(5), 583–595.CrossRefGoogle Scholar
  36. Morris, B. A., & Shakespeare-Finch, J. (2011). Rumination, post-traumatic growth, and distress: Structural equation modelling with cancer survivors. Psychooncology, 20(11), 1176–1183.Google Scholar
  37. Peterson, C., Park, N., Pole, N., D’Andrea, W., & Seligman, M. E. P. (2008). Strengths of character and posttraumatic growth. Journal of Traumatic Stress, 21(2), 214–217.CrossRefGoogle Scholar
  38. Peterson, C., Park, N., & Seligman, M. E. P. (2005). Assessment of character strengths. In G. P. Koocher, J. C. Norcross & S. S. III Hill (Eds.), Psychologists’ desk reference (2nd ed., p. 93). New York: Oxford University Press.Google Scholar
  39. Peterson, C., & Seligman, M. E. (2003). Character strengths before and after September 11. Psychological Science, 14(4), 381–384.CrossRefGoogle Scholar
  40. Pierce, C. A., Block, R. A., & Aguinis, H. (2004). Cautionary note on reporting eta-squared values from multifactor anova designs. Educational and Psychological Measurement, 64(6), 916–924.CrossRefGoogle Scholar
  41. Ruini, C., & Fava, G. A. (2009). Well-being therapy for generalized anxiety disorder. Journal of Clinical Psychology, 65(5), 510–519.CrossRefGoogle Scholar
  42. Ruini, C., Ottolini, F., Rafanelli, C., Ryff, C. D., & Fava, G. A. (2003). La validazione italiana delle Psychological Well-Being Scales (PWB). Rivista di Psichiatria, 38(3), 117–130.Google Scholar
  43. Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57(6), 1069–1081.CrossRefGoogle Scholar
  44. Ryff, C. D., & Singer, B. (1998). The contours of positive human health. Psychological Inquiry, 9(1), 1–28.CrossRefGoogle Scholar
  45. Seligman, M. E. P., Rashid, T., & Parks, A. C. (2006). Positive psychotherapy. American Psychologist, 61(8), 774–788.CrossRefGoogle Scholar
  46. Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9(3), 455–471.CrossRefGoogle Scholar
  47. Toepfer, S. M., Cichy, K., & Peters, P. (2012). Letters of gratitude: Further evidence for author benefits. Journal of Happiness Studies, 13(1), 187–201.Google Scholar
  48. Toussaint, L., & Friedman, P. (2009). Forgiveness, gratitude, and well-being: The mediating role of affect and beliefs. Journal of Happiness Studies, 10(6), 635–654.CrossRefGoogle Scholar
  49. Tugade, M. M., & Fredrickson, B. L. (2007). Regulation of positive emotions: Emotion regulation strategies that promote resilience. Journal of Happiness Studies, 8(3), 311–333.CrossRefGoogle Scholar
  50. Vernon, L. L., Dillon, J. M., & Steiner, A. R. W. (2009). Proactive coping, gratitude, and posttraumatic stress disorder in college women. Anxiety, Stress & Coping, 22(1), 117–127.CrossRefGoogle Scholar
  51. Wood, A. M., Froh, J. J., & Geraghty, A. W. A. (2010). Gratitude and well-being: A review and theoretical integration. Clinical Psychology Review, 30(7), 890–905.CrossRefGoogle Scholar
  52. Wood, A. M., Joseph, S., Lloyd, J., & Atkins, S. (2009a). Gratitude influences sleep through the mechanism of pre-sleep cognitions. Journal of Psychosomatic Research, 66(1), 43–48.CrossRefGoogle Scholar
  53. Wood, A. M., Joseph, S., & Maltby, J. (2008a). Gratitude uniquely predicts satisfaction with life: Incremental validity above the domains and facets of the five factor model. Personality and Individual Differences, 45(1), 49–54.CrossRefGoogle Scholar
  54. Wood, A. M., Joseph, S., & Maltby, J. (2009b). Gratitude predicts psychological well-being above the Big Five facets. Personality and Individual Differences, 46(4), 443–447.CrossRefGoogle Scholar
  55. Wood, A. M., Maltby, J., Gillett, R., Linley, P. A., & Joseph, S. (2008b). The role of gratitude in the development of social support, stress, and depression: Two longitudinal studies. Journal of Research in Personality, 42(4), 854–871.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of BolognaBolognaItaly

Personalised recommendations