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Can Gratitude and Kindness Interventions Enhance Well-Being in a Clinical Sample?

Abstract

Grounded in Fredrickson’s (Rev Gen Psychol 2(3):300–319, 1998) broaden and build model of positive emotions, the current study examines the efficacy of 2-week self-administered gratitude and kindness interventions within a clinical sample on a waiting-list for outpatient psychological treatment. Results demonstrate that we can reliably cultivate the emotional experiences of gratitude but not kindness in this brief period. Further, both the gratitude and kindness interventions built a sense of connectedness, enhanced satisfaction with daily life, optimism, and reduced anxiety compared to a placebo condition. These brief interventions did not impact on more overarching constructs, including general psychological functioning and meaning in life. These findings demonstrate that gratitude and kindness have a place in clinical practice; not just as end states, but as emotional experiences that can stimulate constructive change. Further, these strategies can serve as useful pre-treatment interventions that may reduce the negative impact of long waiting times before psychological treatment.

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References

  1. Archer, J. (1984). Waiting list dropouts in a university counseling center. Professional Psychology: Research and Practice, 15(388–395), 192.

    Google Scholar 

  2. Bartlett, M. Y., & DeSteno, D. (2006). Gratitude and prosocial behavior: Helping when it costs you. Psychological Science, 17(4), 319–325. doi:10.1111/j.1467-9280.2006.01705.x.

    Article  Google Scholar 

  3. Boehm, J. K., Lyubomirsky, S., & Sheldon, K. M. (2011). A longitudinal experimental study comparing the effectiveness of happiness-enhancing strategies in Anglo Americans and Asian Americans. Cognition and Emotion, 25(7), 1152–1167. doi:10.1080/02699931.2010.541227.

    Google Scholar 

  4. Bolier, L., Haverman, M., Westerhof, G., Riper, H., Smit, F., & Bohlmeijer, E. (2013). Positive psychology interventions: A meta-analysis of randomized controlled trials. BMC Public Health, 13. Advance online publication. doi:10.1186/1471-2458-13-119.

  5. Bono, G., & McCullough, M. E. (2006). Positive responses to benefit and harm: Bringing forgiveness and gratitude into cognitive psychotherapy. Journal of Cognitive Psychotherapy: An International Quarterly, 20(2), 147–158. doi:10.1891/jcop.20.2.147.

    Article  Google Scholar 

  6. Carpenter, P. J., Morrow, G. R., Del Gaudio, A. C., & Ritzler, B. A. (1981). Who keeps the first outpatient appointment? American Journal of Psychiatry, 138(1), 102–105.

    Article  Google Scholar 

  7. Chan, D. W. (2010). Gratitude, gratitude intervention and subjective well-being among Chinese school teachers in Hong Kong. Educational Psychology, 30(2), 139–153. doi:10.1186/1471-2458-13-119.

    Article  Google Scholar 

  8. Christensen, K. C., Birk, J. B., & Sedlacek, W. E. (1975). Follow-up of clients placed on a counselling center waiting list: Where have they gone? In Counseling center research (Report No. 4-75). College Park: University of Maryland.

  9. Cohn, M. A., & Fredrickson, B. L. (2010). In search of durable positive psychology interventions: Predictors and consequences of long-term positive behavior change. Journal of Positive Psychology, 5(5), 355–366. doi:10.1080/17439760.2010.508883.

    Article  Google Scholar 

  10. Collins, A., Gelso, K., & Sedlacek, W. E. (1973). Evaluation of a counselling center innovation. Journal of College Student Personnel, 14, 144–148.

    Google Scholar 

  11. Crumbaugh, J. C. (1968). Cross-validation of purpose in life test based on Frankl’s concepts. Journal of Individual Psychology, 24, 74–81.

    Google Scholar 

  12. Crumbaugh, J. C., & Maholick, L. T. (1964). An experimental study in existentialism: The psychometric approach to Frankl’s concept of noogenic neurosis. Journal of Clinical Psychology, 20(2), 200–207. doi:10.1002/1097-4679.

    Article  Google Scholar 

  13. Diener, E., Larsen, R. J., Levine, S., & Emmons, R. A. (1985). Intensity and frequency: Dimensions underlying positive and negative affect’. Journal of Personality and Social Psychology, 48(5), 253–1265. doi:10.1037//0022-3514.48.5.1253.

    Article  Google Scholar 

  14. 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. doi:10.1146/annurev.clinpsy.1.102803.144154.

    Article  Google Scholar 

  15. Dunn, J. A., & Schweitzer, M. E. (2005). Feeling and believing: The influence of emotion on trust. Journal of Personality and Social Psychology, 88(5), 736–748. doi:10.1037/0022-3514.88.5.736.

    Article  Google Scholar 

  16. Emmons, R. A., & Crumpler, C. A. (2000). Gratitude as a human strength: Appraising the evidence. Journal of Social and Clinical Psychology, 19(1), 56–69. doi:10.1521/jscp.2000.19.1.56.

    Article  Google Scholar 

  17. Emmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377–389. doi:10.1037//0022-3514.84.2.377.

    Article  Google Scholar 

  18. Emmons, R. A., & Shelton, C. M. (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 

  19. Fagin-Jones, S., & Midlarsky, E. (2007). Courageous altruism: Personal and situational correlates of rescue during the Holocaust. The Journal of Positive Psychology, 2(2), 136–147. doi:10.1080/17439760701228979.

    Article  Google Scholar 

  20. Fredrickson, B. L. (1998). What good are positive emotions? Review of General Psychology, 2(3), 300–319. doi:10.1037//1089-2680.2.3.300.

    Article  Google Scholar 

  21. Fredrickson, B. L. (2000a). Cultivating research on positive emotions. Prevention and Treatment, 3. Retrieved October 26, 2004, from http://www.journals.apa.org/prevention/volume3/pre0030007r.html.

  22. Fredrickson. B. L. (2000b). Cultivating positive emotions to optimize health and well-being. Prevention and Treatment, 3. Retrieved October 26, 2004, from http://www.journals.apa.org/prevention/volume3/pre0030001a.html.

  23. Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broaden and build theory of positive emotions. American Psychologist, 56(3), 218–226. doi:10.1037//0003-066X.56.3.218.

    Article  Google Scholar 

  24. Fredrickson, B. L. (2004). Gratitude, like other positive emotions, broadens and builds. In R. A. Emmons & M. E. McCullough (Eds.), The psychology of gratitude (pp. 145–166). New York: Oxford University Press.

    Google Scholar 

  25. Fredrickson, B. L., & Branigan, C. (2005). Positive emotions broaden the scope of attention and thought-action repertoires. Cognition and Emotion, 19(3), 313–332. doi:10.1080/02699930441000238.

    Article  Google Scholar 

  26. Fredrickson, B. L., Cohn, M. A., Coffey, K. A., Pek, J., & Finkel, S. M. (2008). Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Journal of Personality and Social Psychology, 95(5), 1045–1062. doi:10.1037/a0013262.

    Article  Google Scholar 

  27. Fredrickson, B. L., & Joiner, T. (2002). Positive emotions trigger upward spirals toward emotional well-being. Psychological Science, 13(2), 172–175. doi:10.1111/1467-9280.00431.

    Article  Google Scholar 

  28. Fredrickson, B. L., & Levenson, R. W. (1998). Positive emotions speed recovery from the cardiovascular sequelae of negative emotions. Cognition and Emotion, 12(2), 191–220. doi:10.1080/026999398379718.

    Article  Google Scholar 

  29. Fredrickson, B. L., Mancuso, R. A., Branigan, C., & Tugade, M. M. (2000). The undoing effect of positive emotions. Motivation and Emotion, 24(4), 237–258. doi:10.1023/A:1010796329158.

    Article  Google Scholar 

  30. Froh, J. J., Sefick, W. J., & Emmons, R. A. (2008). Counting blessings in early adolescence: An experimental study of gratitude and subjective well-being. Journal of School Psychology, 46(2), 213–233. doi:10.1016/j.jsp.2007.03.005.

    Article  Google Scholar 

  31. Geraghty, A. W. A., Wood, A. M., & Hyland, M. E. (2010). Attrition from self-directed interventions: Investigating the relationship between psychological predictors, intervention content, and dropout from a body dissatisfaction intervention. Social Science and Medicine, 71(1), 30–37. doi:10.1016/j.socscimed.2010.03.007.

    Article  Google Scholar 

  32. Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large, non-clinical sample. The British Journal of Clinical Psychology, 44(2), 227–239. doi:10.1348/014466505X29657.

    Article  Google Scholar 

  33. Hoffman, S. G., Grossman, P., & Hinton, D. E. (2011). Loving-kindness and compassion meditation: Potential for psychological interventions. Clinical Psychology Review, 31(7), 1126–1132. doi:10.1016/j.cpr.2011.07.003.

    Article  Google Scholar 

  34. Howard, K. I., Kopta, S. M., Krause, M. S., & Orlinsky, D. E. (1986). The dose–effect relationship in psychotherapy. American Psychologist, 41(2), 159–164. doi:10.1037//0003-066X.41.2.159.

    Article  Google Scholar 

  35. Janoff-Bulman, R., & Berger, A. R. (2000). The other side of trauma: Towards a psychology of appreciation. In J. H. Harvey & E. D. Miller (Eds.), Loss and trauma: General and close relationship perspectives (pp. 29–44). Philadelphia: Brunner-Routledge.

    Google Scholar 

  36. Johnson, D. P., Penn, D. L., Fredrickson, B. L., Kring, A. M., Meyer, P. S., Catalino, L. I., et al. (2011). A pilot study of loving-kindness meditation for the negative symptoms of schizophrenia. Schizophrenia Research, 129(2–3), 137–140. doi:10.1016/j.schres.2011.02.015.

    Article  Google Scholar 

  37. 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. doi:10.1016/j.brat.2005.01.005.

    Article  Google Scholar 

  38. King, L. A. (2000). Why happiness is good for you: A commentary on Fredrickson. Prevention and Treatment, 3. Retrieved October 26, 2004, from http://journals.apa.org/prevention/volume3/pre0030004c.html.

  39. Kirk, J. (1989). Cognitive-behavioural assessment. In K. Hawton, P. Salkovskis, J. Kirk, & D. M. Clark (Eds.), Cognitive behaviour therapy for psychiatric problems: A practical guide (pp. 13–51). New York: Oxford University Press.

    Google Scholar 

  40. Kokotovic, A. M., & Tracey, T. J. (1987). Premature termination at a university counselling center. Journal of Counseling Psychology, 34(1), 80–82. doi:10.1037//0022-0167.34.1.80.

    Article  Google Scholar 

  41. Lambert, M. J., Hansen, N. B., Umpress, V., Lunnen, K., Okiishi, J., & Burlingame, G. M. (2002). Administration and scoring manual for the OQ-45.2 (Outcome Questionnaire). American Professional Credentialing Services LLC.

  42. Lambert, M. J., Okiishi, J. C., Finch, A. E., & Johnson, L. D. (1998). Outcome assessment: From conceptualization to implementation. Professional Psychology: Research and Practice, 29(1), 63–70. doi:10.1037//0735-7028.29.1.63.

    Article  Google Scholar 

  43. Langston, C. A. (1994). Capitalizing on and coping with daily-life events: Expressive responses to positive events. Journal of Personality and Social Psychology, 67(6), 1112–1125. doi:10.1037//0022-3514.67.6.1112.

    Article  Google Scholar 

  44. Lawe, C., Horne, A., & Taylor, S. (1983). Effects of pretraining procedures for clients in counseling. Psychological Reports, 50(1), 1151–1159. doi:10.2466/pr0.1983.53.1.327.

    Google Scholar 

  45. Layous, K., Nelson, S. K., & Lyubomirsky, S. (2012). What is the optimal way to deliver a positive activity intervention? The case of writing about one’s best possible selves. Journal of Happiness Studies. Advance online publication. doi:10.1007/s10902-012-9346-2.

  46. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney: Psychology Foundation.

    Google Scholar 

  47. Lyubomirsky, S., Dickerhoof, R., Boehm, J. K., & Sheldon, K. M. (2011). Becoming happier takes both a will and a proper way: An experimental longitudinal intervention to boost well-being. Emotion, 11(2), 391–402. doi:10.1037/a0022575.

    Article  Google Scholar 

  48. Lyubomirsky, S., King, L., & Diener, E. (2005a). The benefits of frequent positive affect: Does happiness lead to success? Psychological Bulletin, 131(6), 803–855. doi:10.1037/0033-2909.131.6.803.

    Article  Google Scholar 

  49. Lyubomirsky, S., & Layous, K. (2013). How do simple positive activities increase well-being? Current Directions in Psychological Science, 22(1), 57–62. doi:10.1177/0963721412469809.

    Article  Google Scholar 

  50. Lyubomirsky, S., Sheldon, K. M., & Schkade, D. (2005b). Pursuing happiness: The architecture of sustainable change. Review of General Psychology, 9(2), 111–131. doi:10.1037/1089-2680.9.2.111.

    Article  Google Scholar 

  51. May, R. J. (1990). Are waiting lists really a problem? A follow-up survey of wait list dropouts. Journal of College Student Development, 31, 564–566.

    Google Scholar 

  52. May, R. J. (1991). Effects of waiting for clinical services on attrition, problem resolution, satisfaction, attitudes towards psychotherapy, and treatment outcome: A review of the literature. Professional Psychology: Research and Practice, 22(3), 209–214. doi:10.1037//0735-7028.22.3.209.

    Article  Google Scholar 

  53. 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. doi:10.1037//0022-3514.82.1.112.

    Article  Google Scholar 

  54. McCullough, M. E., Emmons, R. A., & Tsang, J. (2004). Gratitude in intermediate affective terrain: Links of grateful moods to individual differences and daily emotional experience. Journal of Personality and Social Psychology, 86(2), 295–309. doi:10.1037/0022-3514.86.2.295.

    Article  Google Scholar 

  55. McCullough, M. E., Kilpatrick, S. D., Emmons, R. A., & Larson, D. B. (2001). Is gratitude a moral affect? Psychological Bulletin, 127(2), 249–266. doi:10.1037//0033-2909.127.2.249.

    Article  Google Scholar 

  56. Midlarsky, E. (1991). Helping as coping. In M. Clark (Ed.), Prosocial behaviour (pp. 238–264). Newbury Park, CA: Sage.

    Google Scholar 

  57. Miley, W. M., & Spinella, M. (2006). Correlations among measures of executive function and positive psychological attributes in college students. The Journal of General Psychology, 133(2), 175–182. doi:10.3200/GENP.133.2.175-182.

    Article  Google Scholar 

  58. Mitchell, J., Vella-Brodrick, D., & Klein, B. (2010). Positive psychology and the internet: A mental health opportunity. Electronic Journal of Applied Psychology, 6(2), 30–41.

    Google Scholar 

  59. Musick, M. A., & Wilson, J. (2003). Volunteering and depression: The role of psychological and social resources in different age groups. Social Science and Medicine, 56(2), 259–269. doi:10.1016/S0277-9536(02)00025-4.

    Article  Google Scholar 

  60. Ng, F., Trauer, F., Dodd, S., Callaly, T., Campbell, S., & Berk, M. (2007). The validity of the 21-item version of the Depression Anxiety Stress Scales as a routine clinical outcome measure. Acta Neuropsychiatrica, 19(5), 304–310. doi:10.1111/j.1601-5215.2007.00217.x.

    Article  Google Scholar 

  61. Oliner, S., & Oliner, P. (1988). The altruistic personality. New York: Free Press.

    Google Scholar 

  62. Orme, D. R., & Boswell, D. (1991). The pre-intake drop-out at a community mental health center. Community Mental Health Journal, 27(5), 375–379. doi:10.1007/BF00752387.

    Article  Google Scholar 

  63. Otake, K., Shimai, S., Tanaka-Matsumi, J., Otsui, K., & Fredrickson, B. L. (2006). Happy people become happier through kindness: A counting kindnesses intervention. Journal of Happiness Studies, 7(3), 361–375. doi:10.1007/s10902-005-3650-z.

    Article  Google Scholar 

  64. Paige, L. & Mansell, W. (2013). To attend or not to attend? A critical review of the factors impacting on initial appointment attendance from an approach-avoidance perspective. Journal of Mental Health, 22(1), doi:10.3109/09638237.2012.705924.

  65. Parker, J. D., Turk, C. L., & Busby, L. D. (2002). A brief telephone intervention targeting treatment engagement from a substance abuse program wait list. The Journal of Behavioural Health Services and Research, 29(3), 288–303. doi:10.1097/00075484-200208000-00004.

    Article  Google Scholar 

  66. Peeters, F. P. M. L., & Bayer, H. (1999). ‘No-show’ for initial screening at community mental health centre: Rate, reasons, and further help seeking. Social Psychiatry and Psychiatric Epidemiology, 34(6), 323–327. doi:10.1007/s001270050151.

    Article  Google Scholar 

  67. Peterson, C., & Seligman, M. E. P. (2004). Character strengths and virtues: A handbook and classification. New York: Oxford University Press.

    Google Scholar 

  68. Reker, G. T. (1977). The purpose-in-life test in an inmate population: An empirical investigation. Journal of Clinical Psychology, 33(3), 688–693. doi:10.1002/1097-4679(197707.

    Article  Google Scholar 

  69. Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60(5), 410–421. doi:10.1037/0003-066X.60.5.410.

    Article  Google Scholar 

  70. Sheldon, K. M., & Lyubomirsky, S. (2006). How to increase and sustain positive emotion: The effects of expressing gratitude and visualizing best possible selves. The Journal of Positive Psychology, 1(2), 73–82. doi:10.1080/17439760500510676.

    Article  Google Scholar 

  71. Shueman, S. A., Gelso, C. J., Mindus, L., Hunt, B., & Stevenson, J. (1980). Client satisfaction with intake: Is the waiting list all that matters? Journal of College Student Personnel, 21, 114–121.

    Google Scholar 

  72. Sparr, L. F., Moffitt, M. C., & Ward, M. F. (1993). Missed psychiatric appointments: Who returns and who stays away. The American Journal of Psychiatry, 150, 801–805.

    Article  Google Scholar 

  73. Stone, W. N., & Klein, E. B. (1999). The waiting-list group. International Journal of Group Psychotherapy, 49(4), 417–428.

    Google Scholar 

  74. Strauss, G. P., & Allen, D. N. (2006). The experience of positive emotion is associated with the automatic processing of positive emotional words. The Journal of Positive Psychology, 1(3), 150–159. doi:10.1080/17439760600566016.

    Article  Google Scholar 

  75. Tsang, J. A. (2006). Gratitude and prosocial behaviour: An experimental test of gratitude. Cognition and Emotion, 20(1), 138–148. doi:10.1080/02699930500172341.

    Article  Google Scholar 

  76. Tugade, T. T., & Fredrickson, B. L. (2004). Resilient individuals use positive emotions to bounce back from negative emotional experiences. Journal of Personality and Social Psychology, 86(2), 320–333. doi:10.1037/0022-3514.86.2.320.

    Article  Google Scholar 

  77. Ventura, J. N., & Boss, P. G. (1983). The family coping inventory applied to parents with new babies. Journal of Marriage and the Family, 45(4), 867–875. doi:10.2307/351799.

    Article  Google Scholar 

  78. Watkins, P. C., Woodward, K., Stone, T., & Kolts, R. L. (2003). Gratitude and happiness: Development of a measure of gratitude, and relationships with subjective well-being. Social Behavior & Personality, 31(5), 431–452. doi:10.2224/sbp.2003.31.5.431.

    Article  Google Scholar 

  79. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1070. doi:10.1037//0022-3514.54.6.1063.

    Article  Google Scholar 

  80. Wills, T. A. (1991). Social support and interpersonal relationships. In M. S. Clark (Ed.), Prosocial behavior (pp. 265–289). Thousand Oaks, CA: Sage Publications Inc.

    Google Scholar 

  81. 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. doi:10.1016/j.cpr.2010.03.005.

    Article  Google Scholar 

  82. Wood, A. M., & Tarrier, N. (2010). Positive clinical psychology: A new vision and strategy for integrated research and practice. Clinical Psychology Review, 30(7), 819–829. doi:10.1016/j.cpr.2010.06.003.

    Article  Google Scholar 

  83. Worthington, E. L, Jr, O’Connor, L. E., Berry, J. W., Sharp, C., Murray, R., & Yi, E. (2005). Compassion and forgiveness Implications for psychotherapy. In P. Gilbert (Ed.), Compassion: Conceptualisations, research, and use in psychotherapy (pp. 168–192). East Sussex: Routledge.

    Google Scholar 

  84. Zahn-Waxler, C., Iannotti, R., & Chapman, M. (1983). Peers and social development. In K. Rubin & H. Ross (Eds.), Peer relationships and social skills in childhood (pp. 133–162). New York: Springer.

    Google Scholar 

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Acknowledgments

We gratefully thank Jennifer Wilson for her helpful statistical advice.

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Correspondence to Analise O’Donovan.

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Kerr, S.L., O’Donovan, A. & Pepping, C.A. Can Gratitude and Kindness Interventions Enhance Well-Being in a Clinical Sample?. J Happiness Stud 16, 17–36 (2015). https://doi.org/10.1007/s10902-013-9492-1

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Keywords

  • Gratitude
  • Kindness
  • Interventions
  • Treatment
  • Clinical sample
  • Broaden and build