The Efficacy of Gratitude Practice on Well-Being: A Randomized Controlled Trial. Psychology, School of Natural Sciences, University of Stirling

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1 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

2 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 Student Number 28 th August 2014 Submission Date 12, 498 Word Count

3 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 noassigned 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

4 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 3 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.

5 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 4 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.

6 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 5 TABLE OF CONTENTS ABSTRACT... 2 ACKNOWLEDGEMENT... 3 CHAPTER ONE: INTRODUCTION SECTION I: BRIEF OVERVIEW OF POSITIVE PSYCHOLOGY Origins of positive psychology Positive psychology and the calculus of well-being Enhancing well-being via positive psychology interventions (PPIs) Influential factors in the facets of positive psychology interventions SECTION II: REVIEW OF THE SCIENCE OF GRATITUDE Conceptualization of gratitude Mechanisms linking gratitude to well-being Effectiveness of gratitude-based interventions Evaluation of gratitude interventions CONCLUDING SUMMARY PRESENT STUDY HYPOTHESES CHAPTER TWO: METHODS Design Participants Procedure Blinding Measures Ethical considerations Statistical power Data analysis... 40

7 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 6 CHAPTER THREE: RESULTS PART I: MAIN FINDINGS FOR COMPLETER ANALYSIS Gratitude Affect Well-being Social relationship Physical symptoms Individual differences in the efficacy of gratitude intervention PART II: INTENTION-TO-TREAT ANALYSIS CHAPTER FOUR: DISCUSSION Cultivating gratitude The benefits of practicing gratitude Factors influencing the efficacy of the intervention LIMITATIONS AND SUGGESTED IMPROVEMENTS FUTURE DIRECTIONS PRACTICAL IMPLICATIONS AND CONCLUSION REFERENCES APPENDICES... 73

8 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 7 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 78 [WEMWBS] II. Positive Affect and Negative Affect Schedule 79 [PANAS] III. Gratitude Adjectives Checklist 79 [GAC] IV. The Grateful Disposition Measure 80 [GQ-6] V. Perceived Quality of Relationship with a Close 81 Others 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

9 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 8 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

10 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 9 LIST OF FIGURES FIGURE 1. CONSORT Diagram 32 FIGURE 2. Procedural flowchart 37 FIGURE 3. Change in dispositional gratitude from pre- to postintervention 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

11 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 10 CHAPTER ONE: INTRODUCTION The World Health Organisation (WHO) declared mental health as a state of wellbeing 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 wellbeing (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

12 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 11 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.

13 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 12 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 20 th 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

14 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 13 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).

15 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 14 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, wellbeing 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 lifecircumstances (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).

16 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 15 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 selfadministered 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 sixmonth 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

17 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 16 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 nontraumatized 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

18 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 17 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 longlasting 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).

19 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 18 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.

20 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 19 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 gratefuloutlook in life (Emmons & Crumpler, 2000). A virtue that is deemed integral to wellbeing, 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

21 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 20 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.

22 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 21 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 trait 1 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

23 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 22 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 wellbeing. 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

24 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 23 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

25 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 24 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

26 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 25 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

27 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 26 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 wellbeing 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

28 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 27 who practice PPIs because some positive changes may not be present at the initial postintervention 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.

29 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 28 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; physicalmental, 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.

30 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 29 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.

31 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 30 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.

32 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 31 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 (noassigned 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 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).

33 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 32 Figure 1. CONSORT Diagram

34 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 33 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) (2.18) (3.28) (2.29) (3.28) (1.68) (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

35 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 34 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 (threeweeks 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.

36 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 35 After randomization, participants were given specific instructions tailored according to their respective groups (Appendix G) via . During the study, participants would receive a reminder early in the week to remind them of their assigned task. A second reminder 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.

37 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 36 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.

38 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 37 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 cognitiveevaluative components. Fourteen items (e.g. I ve been feeling useful, I ve been feeling

39 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 38 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-

40 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 39 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

41 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 40 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

42 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 41 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 postintervention 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).

43 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 42 CHAPTER THREE: RESULTS Taking ethnicity and gender as covariates 3, 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).

44 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 43 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 η 2 =.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

45 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 44 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, η 2 =.025] and there was no significant effect for positive affectivity scores between both conditions [F(1, 77) =.629, p =.430, η 2 =.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

46 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 45 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 η 2 =.002]. The main effect for negative affectivity scores in both conditions was not significant [F(1, 77) =.824, p =.367, partial η 2 =.011]. The conditions time interaction for negative affect also revealed no significant findings [F(1, 77) = 1.753, p =.189, partial η 2 = 022]. These results suggest that the second hypothesis is not accepted.

47 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 46 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 nonsignificant [F(1, 77) =.055, p =.816, partial 2 =.001]. As both groups experienced a reduction in physical symptoms experienced, hypothesis 5 is rejected.

48 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 47 Table 6 Completer analysis on the effects of gratitude intervention in the experimental and control group (n = 81) Measures a Pre-test Post-test Time b Group Time Mean (SD) Mean (SD) Interactions b GRAT CTRL GRAT CTRL F-ratio p F-ratio p WEMWBS * (10.00) (9.38) (10.81) (13.87) PANAS PA (8.31) (7.13) (8.23) (8.22) * NA (9.05) (7.65) (6.62) (8.93) GAC 9.83 (3.87) 9.69 (2.75) (2.55) 9.13 (3.62) ** GQ (5.99) (6.18) (5.80) (8.86) ** * Perceived quality of relationship (4.44) (3.15) (2.50) (3.40) Physical symptoms 4.46 (2.98) 5.07 (3.20) 3.77 (3.01) 4.34 (3.11) * GRAT, gratitude condition; CTRL, control condition a Measures 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) b Significance levels tested with two-way mixed ANOVA, holding sex and ethnicity as covariates. Statistical significant differences are highlighted in bold * p <.05; ** p <.01

49 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 48 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* * * Effort b * 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) a Motivation was measured in terms of how motivated the participants felt when they did the gratitude-inducing activity. b Effort was measured in terms of average time taken to complete the prescribed activity. * Significance at p <.05

50 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 49 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.

51 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 50 Table 8 Intention-to-treat analysis on the effects of gratitude intervention in both conditions (n = 108) Pre-test Post-test Time b Group Time Mean (SD) Mean (SD) Interactions b Measures a GRAT CTRL GRAT CTRL F-ratio P F-ratio P WEMWBS (9.52) (8.78) (10.13) (13.31) * * PANAS PA * (7.83) (7.97) (7.83) (8.63) NA (8.21) (7.58) (6.30) (8.75) GAC ** (3.61) (3.10) (2.69) (3.47) GQ * * (5.71) (5.87) (5.58) (8.29) Perceived quality of (4.20) (3.01) (2.92) (3.25) relationship Physical symptoms 4.84 (3.15) 4.80 (2.95) 4.43 (3.27) 4.35 (3.06) GRAT, gratitude condition; CTRL, control condition a Measures used were used to test the dependent variables and 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) b Significance levels tested with two-way mixed ANOVA, holding sex and ethnicity as covariates. Statistical significant differences are highlighted in bold * p <.05; ** p <.01

52 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 51 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

53 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 52 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) metaanalysis. 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

54 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 53 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

55 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 54 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.

56 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 55 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.

57 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 56 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

58 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 57 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 covariates 4 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.

59 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 58 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

60 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 59 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).

61 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 60 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 gratitudeinduction. 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-

62 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 61 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-yourblessings 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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70 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 69 Ryff, C. D., & Keyes, C. L. M. (1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69(4), doi: / Seligman, M. E. P. (2002). Authentic happiness: Using the new positive psychology to realize your potential for lasting fulfilment. New York, NY: Free Press. Seligman, M. E. P. (2010, October 7). Flourish: Positive psychology and interventions [PDF], The University of Michigan. Retrieved from Seligman, M. E. P. (2011). Flourish. New York, NY: Free Press. Seligman, M. E. P., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 55, Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60, Sheldon, K. M., Abad, N., Ferguson, Y., Gunz, A., Houser-Marko, L., Nicolas, C. P., et al. (2010). Persistent pursuit of need-satisfying goals leads to increased happiness: A 6- month experimental longitudinal study. Motivation and Emotion, 34(1), doi: /s Sheldon, K. M., & Kasser, T. (1998). Pursuing personal goals: Skills enable progress but not all progress is beneficial. Personality and Social Psychology Bulletin, 24, Sheldon, K. M. & Lyubomirsky, S. (2006). How to increase and sustain positive emotion: The effects of expressing gratitude and visualising best possible selves. The Journal of Positive Psychology, 1(2), doi: / Sin, N. L., Della Porta, M. D., & Lyubomirsky, S. (2009). Tailoring positive psychology interventions to treat depressed individuals. In S. I. Donaldson, M. Csikszentmihalyi, &

71 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 70 J. Nakamura (Eds.), Applied positive psychology: Improving everyday life, schools, work, health, and society. New York: Routledge. 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(5), doi: /jclp Slade, M. (2010). Mental illness and well-being: The central importance of positive psychology and recovery approaches. BMC Health Services Research, 10(26), Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, S., et al. (2007). The Warwick-Edinburgh mental well-being scale (WEMWBS): Development and UK validation. Health and Quality of Life Outcomes, 5(1), doi: / Toepfer, S. M. (2009). Letters of gratitude: Improving well-being through expressive writing. Journal of Writing Research, 1(3), Tsang, J. (2006). The effects of helper intention on gratitude and indebtedness. Motivation and Emotion, 30, Tugade, M. M., & Fredrickson, B. L. (2004). Resillient individuals use positive emotions to bounce back from negative emotional experiences. Journal of Personality and Social Psychology, 86, Urbaniak, G. C., & Plous, S. (2013). Research Randomizer (Version 4.0) [Computer software]. Retrieved on June 22, 2013, from Ustun, T., Ayuso-Mateos, J., Chatterji, S., Mathers, C., & Murray, C. (2004). Global burden of depressive disorders in the year of British Journal of Psychiatry, 184(5), doi: /bjp

72 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 71 Watkins, P. C. (2004). Gratitude and subjective well-being. In R. A. Emmons & M. E. McCullough (Eds.), The Psychology of Gratitude (pp ). New York: Oxford University Press. Watkins, P. C., Grimm, D. L., & Kolts, R. (2004). Counting your blessings: Positive memories among grateful persons. Current Psychology, 23, Watkins, P., Scheer, J., Ovnicek, M., & Kolts, R. (2006). The debt of gratitude: Dissociating gratitude and indebtedness. Cognition and Emotion, 20, 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 Behaviour and Personality, 31, 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, Wood, A. M., & Joseph, S. (2010). The absence of positive psychological (eudemonic) well-being as a risk factor for depression: A ten year cohort study. Journal of Affective Disorders, 122, Wood, A. M., Froh, J. J., & Geraghty, A. W. A. (2010). Gratitude and well-being: A review and theoretical integration. Clinical Psychology Review, doi: /j.cpr Wood, A. M., Joseph, S., & Linley, P. A. (2007). Coping style as a psychological resource of grateful people. Journal of Social and Clinical Psychology, 26, Wood, A. M., Maltby, J., Gillett, R., Linley, P. A., & Joseph, S. (2008). The role of gratitude in the development of social support, stress, and depression: Two longitudinal studies. Journal of Research in Personality, 42, doi: /j.jrp

73 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 72 Wood, A. M., Maltby, J., Stewart, N., & Joseph, S. (2008). Conceptualizing gratitude and appreciation as a unitary personality trait. Personality and Individual Differences, 44, World Health Organization (WHO). (2004). Promoting mental health: Concepts, emerging evidence and practice. Geneva: World Health Organization. Worthen, V. E., & Isakson, R. L. (2007). Therapeutic value of experiencing and expressing gratitude. Issues in Religion and Psychotherapy, 31,

74 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 73 INVITATION APPENDICES Appendix A PARTICIPANT INFORMATION SHEET A STUDY ON HUMAN EMOTION 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) Week 1 Week 3: (Day 2 to Day 22) Week 4 (Day 23) You will be asked to complete a set of questionnaires Depending on random allocation, you might or might not be assigned to carry out a brief diary-type task. You will be asked to complete a set of questionnaires (5mins) (5 min) (10mins) BENEFITS AND RISKS There are no risk involve.

75 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 74 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 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 at sil00014@students.stir.ac.uk Thank You for Your Time

76 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 75 Appendix B INFORMED CONSENT SHEET Title of Project: A Study on Human Emotion Name of Researcher: LAI SIEW TIM CONSENT FORM 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. Please initial all boxes 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 to the researcher: I WISH TO WITHDRAW FROM THIS STUDY at sil00014@students.stir.ac.uk 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

77 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 76 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 at sil00014@students.stir.ac.uk Thank you, Lai Siew Tim

78 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING Name : 2. What is your age : Appendix D BASIC DEMOGRAPHIC INFORMATION 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 address: Mobile number (optional): Thank You.

79 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 78 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 Statements 1. I ve been feeling optimistic about the future None of the time Rarely Some of the time Often All of the time I ve been feeling useful I ve been feeling relaxed I ve been feeling interested in other people I ve had energy to spare I ve been dealing with problems well I ve been thinking clearly I ve been feeling good about myself 9. I ve been feeling close to other people I ve been feeling confident I ve been able to make up my own mind about things I ve been feeling loved I ve been interested in new things I ve been feeling cheerful

80 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 79 II. III. Positive Affect and Negative Affect Schedule (PANAS) & 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 Very Slightly/ A Little Moderately Quite a Bit Extremely Not at All 1. Interested Appreciative Distressed Excited Upset Thankful Guilty Scared Hostile Enthusiastic Proud Irritable Alert Ashamed Inspired Nervous Determined Attentive Grateful Jittery Active Afraid Strong 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.

81 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 80 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 Slightly Slightly Agree Strongly Disagree Neutral Disagree Disagree Agree Agree Statements I have so much in life to be thankful for If I had to list everything that I felt grateful for, it would be a very long list When I look at the world, I don t see much to be grateful for I am grateful to a wide variety of people As I get older I find myself more able to appreciate the people, events, and situations that have been part of my life history 6. Long amounts of time can go by before I feel grateful to something or someone Note. Items 3 and 6 are reverse-scored

82 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 81 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 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 To what extent does the person contribute to your well-being To what extent do you think you can count on this person to help you with the problems you have To what extent can this person count of you to help him/her with the problems that she/he has?

83 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 82 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:

84 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 83 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 ) 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 A few times in Once in two A few times in Once a A few times Daily Never three weeks weeks two weeks week a week Thank you.

85 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 84 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. University of Stirling Researcher: Lai Siew Tim Contact: sil00014@students.stir.ac.uk [or] lai.siewtim@gmail.com

86 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 85 MY DAILY JOURNAL Counting My Blessings Days Date List three things you are grateful for today Time taken (mins) E.G. EXAMPLE 21/04/ 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

87 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 86 MY DAILY JOURNAL Counting My Blessings Days Date List three things you are grateful for today Time taken (mins)

88 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 87 MY DAILY JOURNAL Counting My Blessings Days Date List three things you are grateful for today Time taken (mins)

89 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 88 Appendix G INSTRUCTIONS I. Standard script for pre-intervention Hi, Control Group Hi, Gratitude Condition 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 Psychology, School of Natural Sciences University of Stirling Stirling FK9 4LA lai.siewtim@gmail.com [or] sil00014@students.stir.ac.uk 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 . 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 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 Psychology, School of Natural Sciences University of Stirling Stirling FK9 4LA lai.siewtim@gmail.com [or] sil00014@students.stir.ac.uk

90 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 89 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 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 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 Psychology, School of Natural Sciences University of Stirling Stirling FK9 4LA lai.siewtim@gmail.com [or] sil00014@students.stir.ac.uk Note. There was no required for the control group condition.

91 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 90 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 . Thank you once again for agreeing to take part in my research project. Kind Regards, Lai Siew Tim Department of Psychology Psychology, School of Natural Sciences University of Stirling Stirling FK9 4LA lai.siewtim@gmail.com [or] sil00014@students.stir.ac.uk Note. There was no required for the control group condition.

92 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 91 IV. Standard script for post-intervention (Time Point 2; 3-weeks apart; 21 days after the intervention) Hi, Control Group Hi, Gratitude Condition 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 questionnaire which takes no longer than 5 minutes to complete. The link is: (INSERT LINK) Please keep your unique participant ID for reference, your name will be entered in a lottery system. 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 Psychology, School of Natural Sciences University of Stirling Stirling FK9 4LA lai.siewtim@gmail.com [or] sil00014@students.stir.ac.uk 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 .. 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 questionnaire which takes no longer than 5 minutes to complete. The link is: (INSERT LINK) Do keep your unique participant ID for reference, your name will be entered in a lottery system. 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 Psychology, School of Natural Sciences University of Stirling Stirling FK9 4LA lai.siewtim@gmail.com [or] sil00014@students.stir.ac.uk

93 EFFECTS OF GRATITUDE PRACTICE ON WELL-BEING 92 Appendix H INSTRUCTIONS FOR RANDOMIZATION PROCEDURE 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 cointossing method. Adapted from: Urbaniak, G. C., & Plous, S. (2013). Research Randomizer (Version 4.0) [Computer software]. Retrieved on June 22, 2013, from