Abstract
Research suggests gratitude interventions—designed to increase appreciation of positive qualities, situations, and people in one’s life—may improve psychological well-being (e.g., Seligman et al. in Am Psychol 60:410–421, 2005. https://doi.org/10.1037/0003-066X.60.5.410). Accordingly, mental health practitioners have promoted gratitude interventions as a means of self-help. However, results from previous reviews suggest that well-being improvements associated with gratitude interventions may be attributable to placebo effects (Davis et al. in J Couns Psychol 63:20–31, 2016. https://doi.org/10.1037/cou0000107; Wood et al. in Clin Psychol Rev 30:890–905, 2010, https://doi.org/10.1016/j.cpr.2010.03.005). With this meta-analysis, we examined the efficacy of gratitude interventions (k = 27, N = 3675) in reducing symptoms of depression and anxiety at post-test and follow-up periods. Gratitude interventions had a small effect on symptoms of depression and anxiety at both post-test (g = − 0.29, SE = 0.06, p < .01) and follow-up (g = − 0.23, SE = 0.06, p < .01). Correcting for attenuation from unreliability did not change results. Moderation analyses indicated effect sizes were larger for studies using waitlist, rather than active, control conditions at post-test and follow-up. We did not find consistent evidence for effects of other moderator variables (e.g., risk of bias, depressive symptom severity, or type of intervention used). Our results suggest the effects of gratitude interventions on symptoms of depression and anxiety are relatively modest. Therefore, we recommend individuals seeking to reduce symptoms of depression and anxiety engage in interventions with stronger evidence of efficacy for these symptoms.
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Notes
Additional outcomes reviewed included body dissatisfaction, changes in positive and negative affect, life satisfaction, sleep quality, and physical pain.
Following the recommendation of the Cochrane Collaboration (Higgins et al. 2017), we use the term “risk of bias” here rather than “study quality”, as a study may be of the highest possible quality, yet still contain important sources of bias.
If authors did not report sample sizes for individual groups, we assumed equal sample sizes by dividing the combined study sample by the number of groups in the study.
One study included follow-up data without reporting pre-test data (Ozimkowski 2007). Thus, we did not include follow-up data for this study.
We ran our analyses with and without these studies (k = 2). Results changed by only two-hundredths of a decimal point. Therefore, we retained the aggregated studies in all final analyses.
These studies did not include follow-up data.
References
References marked with an asterisk indicate studies included in the meta-analysis
Algoe, S. B., Gable, S. L., & Maisel, N. C. (2010). It’s the little things: Everyday gratitude as a booster shot for romantic relationships. Personal Relationships, 17, 217–233. https://doi.org/10.1111/j.1475-6811.2010.01273.x.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Andrews, G., Cuijpers, P., Craske, M. G., McEvoy, P., & Titov, N. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: A meta-analysis. PLoS ONE, 5, e13196.
Becker, B. J. (1988). Synthesizing standardized mean-change measures. British Journal of Mathematical and Statistical Psychology, 41, 257–278. https://doi.org/10.1111/j.2044-8317.1988.tb00901.x.
Bolier, L., Haverman, M., Westerhof, G. J., Riper, H., Smit, F., & Bohlmeijer, E. (2013). Positive psychology interventions: A meta-analysis of randomized controlled studies. BMC Public Health, 13, 119. https://doi.org/10.1186/1471-2458-13-119.
*Booker, J. A., & Dunsmore, J. C. (2017). Expressive writing and well-being during the transition to college: Comparison of emotion-disclosing and gratitude-focused writing. Journal of Social and Clinical Psychology, 36, 580–606. https://doi.org/10.1521/jscp.2017.36.7.580.
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009). Introduction to meta-analysis. West Sussex: Wiley. https://doi.org/10.1002/9780470743386.
Carl, J. R., Soskin, D. P., Kerns, C., & Barlow, D. H. (2013). Positive emotion regulation in emotional disorders: A theoretical review. Clinical Psychology Review, 33, 343–360.
Carleton, R. N., Mulvogue, M. K., Thibodeau, M. A., McCabe, R. E., Antony, M. M., & Asmundson, G. J. (2012). Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression. Journal of Anxiety Disorders, 26, 468–479. https://doi.org/10.1016/j.janxdis.2012.01.011.
Celano, C. M., Beale, E. E., Mastromauro, C. A., Stewart, J. G., Millstein, R. A., Auerbach, R. P., et al. (2017). Psychological interventions to reduce suicidality in high-risk patients with major depression: A randomized controlled trial. Psychological Medicine, 47, 810–821. https://doi.org/10.1017/S0033291716002798.
Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7–18. https://doi.org/10.1037/0022-006X.66.1.7.
*Cheng, S. T., Tsui, P. K., & Lam, J. H. (2015). Improving mental health in health care practitioners: Randomized controlled trial of a gratitude intervention. Journal of Consulting and Clinical Psychology, 83, 177–186. https://doi.org/10.1037/a0037895.
Cheung, Y. L., Molassiotis, A., & Chang, A. M. (2003). The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. Psycho-Oncology, 12, 254. https://doi.org/10.1002/pon.638.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. New York: Routledge Academic.
Davis, D. E., Choe, E., Meyers, J., Wade, N., Varjas, K., Gifford, A., et al. (2016). Thankful for the little things: A meta-analysis of gratitude interventions. Journal of Counseling Psychology, 63, 20–31. https://doi.org/10.1037/cou0000107.
DerSimonian, R., & Laird, N. (1986). Meta-analysis in clinical trials. Controlled Clinical Trials, 7, 177–178.
Dietz, G., Dahabreh, I. J., Gurevitch, J., Lajeunesse, M. J., Schmid, C. H., Trikalinos, T. A. et al. (2015). OpenMEE: Software for ecological and evolutionary meta-analysis.
Dobson, K. S. (1985). An analysis of anxiety and depression scales. Journal of Personality Assessment, 49, 522–527.
Duckworth, A. L., Steen, T. A., & Seligman, M. E. P. (2005). Positive psychology in clinical practice. Annual Review of Clinical Psychology, 1, 629–651. https://doi.org/10.1146/annurev.clinpsy.1.102803.144154.
Dickens, L. R. (2017). Using gratitude to promote positive change: A series of meta-analyses investigating the effectiveness of gratitude interventions. Basic and Applied Social Psychology, 39, 193–208. https://doi.org/10.1080/01973533.2017.1323638.
Emmons, R. A. (2013). Gratitude practice explained. Retrieved November 9, 2016, from http://ei.yale.edu/what-is-gratitude/.
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, 377–389.
Emmons, R. A., & Stern, R. (2013). Gratitude as a psychotherapeutic intervention. Journal of Clinical Psychology, 69, 846–855. https://doi.org/10.1002/jclp.22020.
*Gander, F., Proyer, R. T., Ruch, W., & Wyss, T. (2013). Strength-based positive interventions: Further evidence for their potential in enhancing well-being and alleviating depression. Journal of Happiness Studies, 14, 1241–1259. https://doi.org/10.1007/s10902-012-9380-0.
*Gavian, M. E. (2011). The effects of relaxation and gratitude interventions on stress outcomes. Dissertation Abstracts International: Section b: The Sciences and Engineering, 73, 1248.
*Geraghty, A. W. A. (2010). From placebo to self-help: Investigating retention, outcome and mechanisms in self-directed gratitude interventions (Unpublished doctoral dissertation). University of Plymouth, Plymouth, Devon, United Kingdom.
*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, 30–37. https://doi.org/10.1016/j.socscimed.2010.03.007.
Graff, M. (2016). The letter (pp. 82–91). Southwest: The Magazine.
Happify. (2016). Happify, Inc. (Version 1.4.0R5433.bbbfa2d) [Mobile application software]. Retrieved September 3, 2016, from http://my.happify.com/.
*Harbaugh, C. N., & Vasey, M. W. (2014). When do people benefit from gratitude practice? Journal of Positive Psychology, 9, 535–546. https://doi.org/10.1080/17439760.2014.927905.
Heart Centered Practices. Retrieved November 9, 2016, from https://wexnermedical.osu.edu/integrative-complementary-medicine/heart-centered-practices.
Hedges, L. V., & Olkin, L. (1985). Statistical methods for meta-analysis. New York: Academic Press.
Higgins, J., Altman, D., & Sterne, J. (2017). Chapter 8: Assessing risk-of-bias in included studies. In J. Higgins, R. Churchill, J. Chandler, & M. Cumpston (Eds.), Cochrane handbook for systematic reviews of interventions (version 5.2.0). London: Cochrane.
*Jackowska, M., Brown, J., Ronaldson, A., & Steptoe, A. (2016). The impact of a brief gratitude intervention on subjective well-being, biology and sleep. Journal of Health Psychology, 21, 2207–2217. https://doi.org/10.1177/1359105315572455.
Kaplan, J. (2015). The gratitude diaries: How a year looking on the bright side can transform your life. New York: Penguin Publishing Group.
Kashdan, T., Mishra, A., Breen, A., & Froh, J. (2009). Gender differences in gratitude: Examining appraisals, narratives, the willingness to express emotions, and changes in psychological needs. Journal of Personality, 77, 691–730. https://doi.org/10.1111/j.1467-6494.2009.00562.x.
Kendler, K. S., Liu, X. Q., 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. The American Journal of Psychiatry, 160, 496–503. https://doi.org/10.1176/appi.ajp.160.3.496.
Kendrick, T., & Pilling, S. (2012). Common mental health disorders—identification and pathways to care: NICE clinical guideline. British Journal of General Practice, 62, 47–49. https://doi.org/10.3399/bjgp12X616481.
*Kerr, S. L., O’Donovan, A., & Pepping, C. A. (2015). Can gratitude and kindness interventions enhance well-being in a clinical sample? Journal of Happiness Studies, 16, 17–36. https://doi.org/10.1007/s10902-013-9492-1.
*Ki, T. P. (2009). Gratitude and stress of health care professionals in hong kong (Unpublished doctoral dissertation). City University of Hong Kong, Kowloon, Hong Kong, China.
Krumrei, E. J., & Pargament, K. I. (2008). Are gratitude and spirituality protective factors against psychopathology? Poster session presented at the 5th Biennial international conference on personal meaning.
*Lambert, N. M., Fincham, F. D., & Stillman, T. F. (2012). Gratitude and depressive symptoms: The role of positive reframing and positive emotion. Cognition and Emotion, 26, 615–633. https://doi.org/10.1080/02699931.2011.595393.
Lau, J., Ioannidis, J. P. A., Terrin, N., Schmid, C. H., & Olkin, I. (2006). The case of the misleading funnel plot. BMJ: British Medical Journal, 333, 597–600.
Lewinsohn, P. M., Seeley, J. R., Roberts, R. E., & Allen, N. B. (1997). Center for epidemiological studies-depression scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychology and Aging, 12, 277–287.
*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, 391–402. https://doi.org/10.1037/a0022575.
*Manthey, L., Vehreschild, V., & Renner, K. (2016). Effectiveness of two cognitive interventions promoting happiness with video-based online instructions. Journal of Happiness Studies, 17, 319–339. https://doi.org/10.1007/s10902-014-9596-2.
McKenzie, J. E., Herbison, G. P., & Deeks, J. J. (2016). Impact of analysing continuous outcomes using final values, change scores and analysis of covariance on the performance of meta-analytic methods: A simulation study. Research Synthesis Methods, 7, 371–386. https://doi.org/10.1002/jrsm.1196.
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the penn state worry questionnaire. Behaviour Research and Therapy, 28, 487–495. https://doi.org/10.1016/0005-7967(90)90135-6.
Mogg, K., & Bradley, B. P. (2005). Attentional bias in generalized anxiety disorder versus depressive disorder. Cognitive Therapy and Research, 29, 29–45. https://doi.org/10.1007/s10608-005-1646-y.
*Mongrain, M., & Anselmo-Matthews, T. (2012). Do positive psychology exercises work? A replication of seligman et al. Journal of Clinical Psychology, 68, 382–389. https://doi.org/10.1002/jclp.21839.
*O’Leary, K., & Dockray, S. (2015). The effects of two novel gratitude and mindfulness interventions on well-being. The Journal of Alternative and Complementary Medicine, 21, 243–245. https://doi.org/10.1089/acm.2014.0119.
*Ozimkowski, K. M. (2007). The gratitude visit in children and adolescents: An investigation of gratitude and subjective well-being (Unpublished doctoral dissertation). Hofstra University, New York, New York.
Peckham, A. D., McHugh, R. K., & Otto, M. W. (2010). A meta-analysis of the magnitude of biased attention in depression. Depression and Anxiety, 27, 1135–1142. https://doi.org/10.1002/da.20755.
Persons, J. B., & Burns, D. D. (1985). Mechanisms of action of cognitive therapy: The relative contributions of technical and interpersonal interventions. Cognitive Therapy and Research, 9, 539–551. https://doi.org/10.1007/BF01173007.
Petrocchi, N., & Couyoumdjian, A. (2016). The impact of gratitude on depression and anxiety: The mediating role of criticizing, attacking, and reassuring the self. Self and Identity, 15, 191–205. https://doi.org/10.1080/15298868.2015.1095794.
*Proyer, R. T., Gander, F., Wellenzohn, S., & Ruch, W. (2014). Positive psychology interventions in people aged 50-79 years: Long-term effects of placebo-controlled online interventions on well-being and depression. Aging & Mental Health, 18, 997–1005. https://doi.org/10.1080/13607863.2014.899978.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401. https://doi.org/10.1177/014662167700100306.
Rosenthal, R. (1979). The file drawer problem and tolerance for null results. Psychological Bulletin, 86, 638–641. https://doi.org/10.1037/0033-2909.86.3.638.
Schmidt, F. L., & Hunter, J. E. (2015). Methods of meta-analysis: Correcting error and bias in research findings (3rd ed.). London: SAGE. https://doi.org/10.4135/9781483398105.
Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. The American Psychologist, 60, 410–421. https://doi.org/10.1037/0003-066X.60.5.410.
Seligman, M. E. P., Rashid, T., & Parks, A. C. (2006). Positive psychotherapy. American Psychologist, 61, 774–788. https://doi.org/10.1037/0003-066X.61.8.774.
*Senf, K., & Liau, A. K. (2012). The effects of positive interventions on happiness and depressive symptoms, with an examination of personality as a moderator. Journal of Happiness Studies, 14, 591–612. https://doi.org/10.1007/s10902-012-9344-4.
Seppala, E., Rossomando, T., & Doty, J. R. (2013). Social connection and compassion: Important predictors of health and well-being. Social Research, 80, 411–430.
*Sergeant, S., & Mongrain, M. (2011). Are positive psychology exercises helpful for people with depressive personality styles? Journal of Positive Psychology, 6(4), 260–272. https://doi.org/10.1080/17439760.2011.577089.
Sheldon, K. M., Boehm, J. K., & Lyubomirsky, S. (2012). Variety is the spice of happiness: The hedonic adaptation prevention (HAP) model. In I. Boniwell & S. David (Eds.), Oxford handbook of happiness (pp. 901–914). Oxford: Oxford University Press.
Sin, N. L., & Lyubomirsky, S. (2009). Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: A practice-friendly meta-analysis. Journal of Clinical Psychology, 65, 467–487. https://doi.org/10.1002/jclp.20593.
*Smullen, A. M. (2012). A gratitude intervention with older adults (Unpublished master’s thesis). Kean University, Union, New Jersey.
Snyder, D. (1998). Marital satisfaction inventory—revised. Los Angeles, CA: Western Psychological Services.
*Southwell, S., & Gould, E. (2017). A randomised wait list-controlled pre-post-follow-up trial of a gratitude diary with a distressed sample. The Journal of Positive Psychology, 12, 579–593. https://doi.org/10.1080/17439760.2016.1221127.
Sterne, J., Egger, M., Moher, D., & Boutron, I. (2017). Chapter 10: Addressing reporting biases. In J. Higgins, R. Churchill, J. Chandler, & M. Cumpston (Eds.), Cochrane handbook for systematic reviews of interventions (version 5.2.0). London: Cochrane.
Stoeckel, M., Weissbrod, C., & Ahrens, A. (2014). The adolescent response to parental illness: The influence of dispositional gratitude. Journal of Child and Family Studies, 24, 1501–1509. https://doi.org/10.1007/s10826-014-9955-y.
Taylor, C., Lyubomirsky, S., & Stein, M. (2017). Upregulating the positive affect system in anxiety and depression: Outcomes of a positive activity intervention. Depression and Anxiety, 34, 267–280. https://doi.org/10.1002/da.22593.
*Timmons, L., & Ekas, N. V. (2018). Giving thanks: Findings from a gratitude intervention with mothers of children with autism spectrum disorder. Research in Autism Spectrum Disorders, 49, 13–24. https://doi.org/10.1016/j.rasd.2018.01.008.
*Toepfer, S., Cichy, K., & Peters, P. (2012). Letters of gratitude: Further evidence for author benefits. Journal of Happiness Studies, 13, 187–201. https://doi.org/10.1007/s10902-011-9257-7.
Viechtbauer, W. (2010). Conducting meta-analyses in R with the metafor package. Journal of Statistical Software, 36, 1–48.
Watkins, P. C. (2014). Gratitude and the good life. Dordrecht: Springer. https://doi.org/10.1007/978-94-007-7253-3.
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 and Personality, 31, 431–452.
*Watkins, P. C., Cruz, L., Holben, H., & Kolts, R. L. (2008). Taking care of business? Grateful processing of unpleasant memories. The Journal of Positive Psychology, 3, 87–99. https://doi.org/10.1080/17439760701760567.
*Watkins, P. C., Uhder, J., & Pichinevskiy, S. (2015). Grateful recounting enhances subjective well-being: The importance of grateful processing. Journal of Positive Psychology, 10, 91–98. https://doi.org/10.1080/17439760.2014.927909.
*Wolfe, W. L., & Patterson, K. (2017). Comparison of a gratitude-based and cognitive restructuring intervention for body dissatisfaction and dysfunctional eating behavior in college women. Eating Disorders, 25, 330–344. https://doi.org/10.1080/10640266.2017.1279908.
Wood, A. M., Froh, J. J., & Geraghty, A. W. (2010). Gratitude and well-being: A review and theoretical integration. Clinical Psychology Review, 30, 890–905. https://doi.org/10.1016/j.cpr.2010.03.005.
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The authors would like to extend their sincerest thanks to Owen Morrish for his assistance with data extraction and the risk of bias assessment.
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Cregg, D.R., Cheavens, J.S. Gratitude Interventions: Effective Self-help? A Meta-analysis of the Impact on Symptoms of Depression and Anxiety. J Happiness Stud 22, 413–445 (2021). https://doi.org/10.1007/s10902-020-00236-6
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DOI: https://doi.org/10.1007/s10902-020-00236-6