The Effects of Manipulating Expectations in a Gratitude Intervention

Cultivating Gratitude: Does Manipulating Expectations Improve the Efficacy of a Gratitude Intervention?

Gratitude - an emotion felt when an individual receives something beneficial from other people or entities - has been shown to positively affect well-being. Beginning in 2003, "count your blessings" interventions - in which participants list items they are grateful for, and gratitude letter writing interventions were designed to cultivate gratitude. Gratitude interventions have many positive outcomes; they can increase well-being and life satisfaction (Froh, Sefick, & Emmons, 2008) and increase self-esteem (Rash, Matsuba, & Prkachin, 2011) to name a few.

Knowing the benefits of gratitude prior to an intervention could affect participant behavior and health outcomes. Past studies have illustrated that sharing information about treatments changes expectations and improves outcomes (Zion & Crum, 2018). For instance, overt medical treatments are more effective than hidden ones (Colloca, Lopiano, Lanotte, & Benedetti, 2004).

The proposed study is designed to evaluate whether expectations about intervention efficacy can enhance the benefits of a brief gratitude intervention. Specifically, the investigators will test if providing information on the benefits of gratitude will enhance intervention outcomes. This 3-armed randomized controlled trial will have the following conditions: gratitude + expectation, gratitude, and events control. Participants will be undergraduate college students and the online intervention will last two weeks.

Participants in the two gratitude conditions will login to an online form three times a week for two weeks and make entries of up to five things they are grateful for. The form for participants in the gratitude + expectation condition will also provide information about benefits of gratitude. An everyday events control will be used to provide a neutral comparison condition. This group will be instructed to type up to five things or events of note from their day on their form.

Outcome measures will be collected via an online survey before and immediately after the intervention. The primary outcome is well-being and the secondary outcomes are sleep quality and quantity, state gratitude, positive affect, healthcare self-efficacy, stress, and depressive symptoms. The investigators predict that participants in the gratitude + expectation condition will have enhanced intervention outcomes compared to participants in comparison conditions.

Study Overview

• Status: Completed
• Conditions: Gratitude + No Expectations; Gratitude + Expectations; Events Control
• Intervention / Treatment: Behavioral: Gratitude + No Expectations Intervention; Behavioral: Gratitude + Expectations Intervention; Behavioral: Events Control Intervention

Detailed Description

Overview: Potential participants will be recruited from an undergraduate psychology class. Participants will have one week after initial study advertisement to read the consent form and decide if they wish to participate. When participants turn in a signed consent form, they will be officially enrolled in the study and issued a personal identification (PI) number to use throughout the study.

Participants will be randomly assigned to one of three conditions: gratitude + expectations, gratitude, or an everyday events control condition. Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type either a short gratitude list (for gratitude + expectations and gratitude conditions) or an events list (for everyday events control), and will have a section for participants to enter their personal identification numbers. Additionally, the first form will include a demographics questionnaire and the first and sixth forms will include questionnaires assessing all outcomes of interest.The primary outcome of interest is well-being. The secondary outcomes of interest are sleep, state gratitude, healthcare self-efficacy, stress, and depressive symptoms.

Participants in the gratitude + expectations condition will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: "Practicing gratitude may increase social connectedness" and "Cultivating gratitude was shown to improve school satisfaction in a sample of students". By the end of the study, participants will have completed six gratitude or everyday events lists and two questionnaires.

Interventions:

1. Gratitude + No Expectations: Participants in the gratitude condition will practice a counting your blessings intervention for two weeks. Participants will be instructed to list up to five things they are grateful for every two days for the two weeks of the intervention (six times total).
2. Gratitude + expectations: Participants in this condition will be given the same instructions as the gratitude condition and will also be given the regular reminders of the benefits of gratitude.
3. Everyday events: Participants will be instructed to list up to five details about their day, such as activities they engaged in, or conversations they had. Participants will make these lists every two days for two weeks (six times total).

Questionnaires:

Self-report questionnaires with high test-retest reliability and internal validity will be administered at baseline and post intervention to access changes in outcomes of interest, such as well-being, depressive symptoms, and anxiety.

Questionnaires administered only at baseline: Communication and Attitudinal Self-Efficacy Scale (CASE) and demographic questionnaire

Questionnaires administered pre- and post-intervention: Mental Health Continuum-Short Form, Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Scale, Pittsburg Sleep Quality Index (PSQI) duration items, Modified Differential Emotions Scale, Center for Epidemiologic Studies Depression Scale (CES-D), Perceived Stress Scale 4

• Study Type: Interventional
• Enrollment (Actual): 125
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Los Angeles, California, United States, 90024
      • UCLA

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Undergraduate Student
• Proficient in English
• 18 years of age or older
• Has a valid email address
• Access to the internet

Exclusion Criteria:

-No other exclusion criteria (aside from meeting the inclusion criteria above)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Gratitude + No Expectations; Participants will type online lists of up to five items they are grateful for, every two days for two weeks.	Behavioral: Gratitude + No Expectations Intervention; Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Additionally, the first form will include a demographics questionnaire and the first and sixth forms will include questionnaires assessing all outcomes of interest
Experimental: Gratitude + Expectations; Participants will type online lists of up to five items they are grateful for, every two days for two weeks. They will also be told a benefit of gratitude each time they write an online gratitude list.	Behavioral: Gratitude + Expectations Intervention; Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Participants will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: "Practicing gratitude may increase social connectedness" and "Cultivating gratitude was shown to improve school satisfaction in a UK sample of students". Additionally, the first form will include a demographics questionnaire and the first and sixth forms will include questionnaires assessing all outcomes of interest
Active Comparator: Events Control; Participants will type online lists of up to five events from their day, every two day for two weeks.	Behavioral: Events Control Intervention; Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a list of up to five items about events from their day. Additionally, the first form will include a demographics questionnaire and the first and sixth forms will include questionnaires assessing all outcomes of interest.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mental Health Continuum-Short Form (MHC-SF)	Hedonic well-being, eudaimonic well-being, and overall well-being were assessed at baseline and post-intervention. Well-being was measured with the Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). Participants rated how often they felt 14 different emotions or statements, such as "happy" and "satisfied with life". Items are rated on a 6-point likert scale (0 = never, 5 = everyday). This measure assesses both hedonic and eudaimonic well-being. The MHC-SF is both reliable and valid for use with young adults (Robitschek & Keyes, 2009). Total scores are created by the sum of scores for all 14 items, with a range of 0-70. Higher scores indicate greater overall well-being.	Assessed at Pre- and Post- Intervention (2 weeks apart)
Mental Health Continuum-Short Form (MHC-SF): Hedonic Well-Being SubScale	Well-being was measured with the Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). Participants rated how often they felt 14 different emotions or statements, such as "happy" and "satisfied with life". Items are rated on a 6-point likert scale (0 = never, 5 = everyday), with higher numbers indicating greater well-being. This measure assesses both hedonic and eudaimonic well-being. The MHC-SF is both reliable and valid for use with young adults (Robitschek & Keyes, 2009). The Hedonic Well-Being Subscale is the sum of items 1-3 on the Mental Health Continuum Short-Form. Total scores range from 0-15, with higher scores indicating greater hedonic well-being. Scoring a 4 or 5 on at least one of the 3 items on the Hedonic Well-Being Subscale indicates a diagnosis of flourishing mental health.	Assessed at Pre- and Post- Intervention (2 weeks apart)
Mental Health Continuum-Short Form (MHC-SF): Eudaimonic Well-Being SubScale	Well-being was measured with the Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). Participants rated how often they felt 14 different emotions or statements, such as "happy" and "satisfied with life". Items are rated on a 6-point likert scale (0 = never, 5 = everyday), with higher numbers indicating greater well-being. This measure assesses both hedonic and eudaimonic well-being. The MHC-SF is both reliable and valid for use with young adults (Robitschek & Keyes, 2009). The score of the Eudaimonic Subscale is the sum of items 4-14 on the MHC-SF. Scores range from 0-55. Higher scores indicate greater eudaimonic well-being (i.e., greater social and psychological well-being).	Assessed at Pre- and Post- Intervention (2 weeks apart)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Scale	Sleep quality was measured with the 8-item PROMIS sleep disturbance short form (Yu et al., 2012). Participants rated their level of agreement with eight different statements about their sleep in the past seven days such as "My sleep was restless" and "I had difficulty falling asleep". Participants rated each item on a 5 point scale (1 = not at all, 5 = very much). Items 2, 3, 7, and 8 were reverse scored. The total score of the PROMIS Sleep Disturbance Scale is the sum of the scores for all 8 items. Total scores range from 8-40, with higher scores indicating more severe sleep disturbance.	Assessed at Pre- and Post- Intervention (2 weeks apart)
Pittsburg Sleep Quality Index (PSQI) Duration Items	Sleep quantity was measured with the Pittsburgh Sleep Quality Index Duration Items (PSQI-4), which asks participants questions such as when they went to bed and when they woke up in the morning (Buysse et al., 1989). PSQI duration items are questions 1-4 on the PSQI, which measure how much sleep respondents have been getting. Higher hours of sleep is a better outcome.	Assessed at Pre- and Post- Intervention (2 weeks apart)
Modified Differential Emotions Scale (MDES): Positive Emotions Subscale	Positive affect was measured with the ten-item Positive Emotions (PE) subscale of the Modified Differential Emotions Scale (mDES) (Fredrickson, Tugade, Waugh, and Larkin, 2003). Participants rated how often they felt ten different groups of positive emotions such as "amused, fun-loving, silly" on a 5-point scale (0 = not at all, 4 = most of the time). The average of the items was calculated to measure positive affect, with higher numbers indicating greater positive affect.	Assessed at Pre- and Post- Intervention (2 weeks apart)
Perceived Stress Scale - 4 (PSS-4)	Stress was measured with the 4-item Perceived Stress Scale (PSS-4; Cohen, Kamarack, and Mermelstein, 1983). Participants rated how often they felt a certain way in the last week on four different items such as "How often have you felt confident about your ability to handle your personal problems?" and "How often have you felt that things were going your way?" on a 5- point scale (0 = never, 4 = very often). The total score of the PSS-4 is the sum of all 4 items. Total scores range from 0-16, and higher scores indicate greater perceived stress.	Assessed at Pre- and Post- Intervention (2 weeks apart)
Center for Epidemiologic Studies Depression Scale (CES-D)	Depressive symptoms were measured by the Center for Epidemiological Studies - Depression Scale (CES-D, Radloff, 1977). Participants rated how often they experienced 20 different statements such as "I was bothered by things that usually don't bother me" and "I felt like everything I did was an effort" in the past week. Participants scored each item on a 4-point scale (0 = rarely or none of the time 3 = all of the time). The total score for the CES-D is the sum of all 20 items, with a range of 0-60, with higher scores indicating greater depressive symptoms.	Assessed at Pre- and Post- Intervention (2 weeks apart)
Modified Differential Emotions Scale (MDES): State Gratitude	State gratitude was measured with item one of the mDES (Fredrickson, Tugade, Waugh, and Larkin, 2003), which asks participants how often they felt "grateful, appreciative, or thankful" in the past two weeks. Participants rated this item on a 5-point scale (0 = not at all, 4 = most of the time), with a higher number indicating higher feelings of gratitude.	Assessed at Pre- and Post- Intervention (2 weeks apart)

Collaborators and Investigators

• Sponsor: University of California, Los Angeles
• Investigators: Principal Investigator: Tanera van Diggelen, University of California, Los Angeles

Publications and helpful links

General Publications

• Emmons RA, McCullough ME. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol. 2003 Feb;84(2):377-89. doi: 10.1037//0022-3514.84.2.377.
• Froh JJ, Sefick WJ, Emmons RA. Counting blessings in early adolescents: an experimental study of gratitude and subjective well-being. J Sch Psychol. 2008 Apr;46(2):213-33. doi: 10.1016/j.jsp.2007.03.005. Epub 2007 May 4.
• Bartlett MY, DeSteno D. Gratitude and prosocial behavior: helping when it costs you. Psychol Sci. 2006 Apr;17(4):319-25. doi: 10.1111/j.1467-9280.2006.01705.x.
• Watkins, P., Woodward, K., Stone, T., & Kolts, R. (2003). Gratitude and happiness: Development of a measure of gratitude and relationships with subjective well-being. Social Behavior and Personality: An international journal, 31, 431-452. doi: 10.2224/sbp.2003.31.5.431
• Kruse, E., Chancellor, J., Ruberton, P.M., & Lyubomirsky, S. (2014). An upward spiral between gratitude and humility. Social Psychological and Personality Science. 5(7), 805-814. doi: 10.1177/1948550614534700
• Rash, J. A., Matsuba, M. K., & Prkachin, K. M. (2011). Gratitude and well-being: who benefits the most from a gratitude intervention? Applied Psychology: Health and Well-Being, 3(3), 350-369. doi: 10.1111/j.1758-0854.2011.01058.x
• Zion SR, Crum AJ. Mindsets Matter: A New Framework for Harnessing the Placebo Effect in Modern Medicine. Int Rev Neurobiol. 2018;138:137-160. doi: 10.1016/bs.irn.2018.02.002. Epub 2018 Mar 20.
• Colloca L, Lopiano L, Lanotte M, Benedetti F. Overt versus covert treatment for pain, anxiety, and Parkinson's disease. Lancet Neurol. 2004 Nov;3(11):679-84. doi: 10.1016/S1474-4422(04)00908-1.
• Sheldon, K.M. & Lyubomirsky, S. 2006. How to increase and sustain positive emotion: The effects of expressing gratitude and visualizing best possible selves. The Journal of Positive Psychology. 1(2). 73-82. doi:10.1080/17439760500510676
• Jackowska M, Brown J, Ronaldson A, Steptoe A. The impact of a brief gratitude intervention on subjective well-being, biology and sleep. J Health Psychol. 2016 Oct;21(10):2207-17. doi: 10.1177/1359105315572455. Epub 2015 Mar 2.

Study record dates

Study Major Dates

• Study Start (Actual): February 5, 2019
• Primary Completion (Actual): February 28, 2019
• Study Completion (Actual): February 28, 2019

Study Registration Dates

• First Submitted: December 19, 2018
• First Submitted That Met QC Criteria: December 20, 2018
• First Posted (Actual): December 21, 2018

Study Record Updates

• Last Update Posted (Actual): June 9, 2020
• Last Update Submitted That Met QC Criteria: May 24, 2020
• Last Verified: May 1, 2020

More Information

Terms related to this study

• Keywords: Gratitude, Expectations, Well-being
• Other Study ID Numbers: 1997

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No