Gratitude Interventions Insufficient to Reduce Anxiety and Depression

Reframing one’s perspective alone is not enough to relieve distress.

Sadie Cathcart
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Over the past several years, research in the field of positive psychology has examined practices that can enhance well-being and reduce depression and anxiety. One such practice, known as gratitude interventions, encourages people to reflect on experiences they are grateful for in their life. New research, however, published in the Journal of Happiness Studies, suggests that gratitude interventions have a negligible impact on the symptoms associated with depression and anxiety.

The researchers, David Cregg and Jennifer Cheavens from Ohio State University, conducted a meta-analysis of twenty-seven studies looking at the effects of gratitude-based interventions on depression and anxiety symptoms. While they found slightly higher effects of gratitude interventions compared to waitlist conditions, the overall effects were modest and may be “attributable to placebo effects.”

“Gratitude is a state of affirming the goodness or good things in one’s life, accompanied by a recognition that the sources of this goodness lie at least partially outside the self, such as with the good intentions of another person. Gratitude may be elicited by another person when he or she provides some aid or benefit, but it may also stem from noninterpersonal sources, such as a feeling of thanks for waking up in the morning.”
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According to the authors, research has indicated significant associations between gratitude and wellbeing, as well as correlations between wellbeing and a variety of attributes widely considered desirable (e.g., life-satisfaction and forgiveness). However, although gratitude may be associated with other positive qualities, this does not, in and of itself, imply that gratitude facilitates reduced distress.

Common gratitude-orientated interventions include constructing routine gratitude lists, gratitude journals, and gratitude letters aimed at people in one’s life who’ve made an impact. Gratitude-based interventions, typically aimed at increasing gratitude, have been examined in relation to a variety of facets of wellbeing and distress including worry, positive affect, life satisfaction, symptoms of anxiety, symptoms of depression, and more.

In the context of challenging circumstances, particularly those outside of one’s control, searching for areas gratitude may be discouraging and can frame distress as a function of a person’s attitude as opposed to an adaptive response to oppressive structural determinants.

In an anecdotal account of the potential consequences of a gratitude intervention promoting “positive thinking”, one woman disclosed, “[g]ratitude lists didn’t help me one bit. Writing them was a practice that drove me deeper into shame and self-loathing when I was already in a very dark place.”

Of course, gratitude is not a construct mutually exclusive with anxiety or depression. One can be anxious and grateful, or satisfied with one’s life and not at all grateful. In moments of acute distress, in particular, mustering pockets of gratitude may be comforting for some. Concerted efforts to systematically integrate gratitude into one’s routine may reduce stress.

Cregg and Cheavens conducted a meta-analysis to capture recent literature not accounted in past gratitude-oriented meta-analyses, and to look at implications for anxiety and depression in particular. They integrated a risk-of-bias assessment to reduce the influence of factors that may compromise the validity of results reflected in effect sizes including “participants’ awareness of the condition, dropout, and baseline differences,” and a correction for lack of reliability potentially reflected in study effect sizes.

The researchers screened a total of 1,277 abstracts, identifying 27 articles that ultimately satisfied inclusion criteria. Across all studies included, a total of 3,675 participants completed depression and/or anxiety screeners immediately post-intervention, and 2,318 participants completed follow up screeners approximately one-month post-intervention.

All but two studies comprised non-clinical samples of participants spanning multiple generations (mean age ranging from 19 to 69). Most interventions examined had an intrapersonal orientation (evoking facets of gratitude not necessarily related to others), but some had an interpersonal focus (directed at gratitude towards others), and some were intrapersonal with interpersonal elements.

In addition to limited evidence for gratitude-focused interventions, and contrary to what authors anticipated, intervention effects weren’t found to be any larger among participants with higher clinically depressive symptoms, among older adults, nor across a variety of intervention characteristics. The effects were consistently small or modest.

“Based on the currently available data, we find limited evidence for the efficacy of gratitude interventions in reducing symptoms of depression and anxiety. They have a medium-sized effect when compared to no intervention at all, but a small effect when compared with any active control task.”

While Cregg and Cheavens’ findings indicated insufficient evidence for implementation of gratitude-based interventions to reduce symptoms of anxiety and depression, this doesn’t mean practicing gratitude can’t be useful, soothing, or effective in other ways. If it appeals to you as a regular practice to pursue, there’s unlikely any harm in trying. However, in the context of anxiety and depression, interventions in which gratitude is central may be misguided.

 

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Cregg, D. R. & Cheavens. J. S. (2020). Gratitude interventions: Effective self-help? A meta-analysis of the impact on Symptoms of depression and anxiety. Journal of Happiness Studies. (Link)

20 COMMENTS

  1. Sounds about right to me. I would imagine that for some people the relationship runs in exactly the opposite direction, where depression leads to a lack of gratitude, especially if you consider polyvagal theory and the state of the vagal system as a determinant of emotional state. People in a “frozen” dorsal vagal state simply are not able to feel things like compassion and gratitude as much as those in a ventral vagal state. There’s a teriffic talk on youtube by Stephen Porges on polyvagal theory and compassion that explains this.

    At the same time, I would also think that meditation practices like meta and tonglen, geared to generate compassion, may go deeper than the trendy making of gratitude lists, and so have the potential to be more helpful. But still, even there the nervous system has to reach a certain level of safety and relaxation for such practices to get traction. So it’s complicated.

      • Yes. I think they are tightly interconnected, and as I write now I’m uncertain exactly where the line between the two is, or if there is a clear line. I think the bigger thing, which has been really helpful to me, is that the old idea that ideas influence or even determine neuropsychological state (including emotional state) is to some degree exactly backwards. Deb Dana, who’s interpreted Porges’s work for practitioners says it’s not “state follows story” (i.e., ideas and narratives determine how we feel) but rather “story follows state.” At the same time, clearly there are things going in both directions and in complex ways. It’s just that the old idea that if we get our thinking right (e.g., make gratitude lists) then we’ll feel better doesn’t work so well. Make sense?

        Here’s the Porges talk on compassion. I’d love to get others’ thoughts on the whole thing. https://www.youtube.com/watch?v=MYXa_BX2cE8

  2. Good article. In the 5th paragraph, should it read “areas OF gratitude”? And to the point of emphasis on gratitude awareness possibly masking oppressive structural determinants, I found value in a new book, “McMindfullness” by Ronald Purser. Cheers.

      • LoL Boans and Steve.

        Personally, when I was looking a LOT online, the plethora of information about “mental health” was quite depressing.
        When someone poses a question to me, such as, “Do you feel joy”, “what are you thankful for”, it makes me feel nothing but distaste for the questions.
        I consider them not all that intelligent, psychology 101.
        It makes me realize that the person asking it, might be a very miserable person, and yet I fail my test if I say the wrong thing.
        So I can’t play that kind of kindergarten game.

        It’s fine to inquire, in a more mature manner and it might even help to get a conversation started around “gratitude”, by someone perhaps saying something simple like, “there are times when it is difficult to feel thankful” etc.
        Because if you live life, there will be those times and most people would be embarrassed to admit how often.
        It is difficult for the mind to be absorbed with two opposing thoughts, feelings at once. To be absolutely miserable and to feel “gratitude”.
        We can see it logically of course. What we have to be thankful for. But we don’t need to turn everything into a course for therapy, or therapists.

        As I said, it might be okay to mention it, the words, but often these guided tours are not what we booked up for.
        It should not be work, and if one pays attention to these guided tours, one can start questioning oneself about whether one has gratitude. And people should not beat themselves up for not feeling “gratitude”. I know I am often thankful, just not conscious of it if that makes sense.

        All my life I have always been thankful for my food, and remember where it comes from, and the people involved.
        I am thankful for art, natural art of nature, and all the beautiful things people can create. The sweater you wear, someone made.
        And you can be royally pissed off at psychiatry.
        Within that, I am full of gratitude that there are others speaking out about it

        • Just a comment about gratitude and a comment you made in another article Sam (cost of being psychotic)

          I watched half of a documentary last night regarding the group of child raping priests that formed in the Maitland – Newcastle area here in Australia. Nasty bunch of people who were enabled for a fairly long time (claim being that it started back in the late 1950s). There was a moment that sent shivers down my spine when a young boy (12 i think) had hung himself on his bedroom door and his mother had found him. Within an hour there were three (abusing) priests including his personal abuser at the home asking if the boy had left a note. Once it had been established that he had not made any allegations that could be proven, they left. It reminded me so much of the police chasing me to retrieve the documents I have in an attempt to ensure that the initial abuse was concealed, and as a secondary consequence that their enabling of that abuse was also concealed. What concerns me more is that the rather bad cover up resulted in a further cover up. Retrieve the documented proof of torture and kidnapping before we gaslight him to suicide. Sounds like an illness till you examine the proof, though that’s difficult now the State has threatened the witnesses.

          The good news for us in this is that it seems important that we document and leave a paper trail back to these enablers. Yes the priests who anally raped large numbers of boys for many years are now in prison. But what I noted about this program last night was that the journalist (Sarah Ferguson) was prepared to openly state that the people who obviously knew, and found ways of neglecting their duty were exposed. “Here’s a picture of these enablers shaking hands with the Pontiff only last year”.

          Better late than never I say. And I would add, ensure you document and leave a paper trail to the highest authorities possible regarding this vile abuse that is being mislabeled ‘medicine’. Because like the Catholic Church, psychiatry (and psychiatrists) will find themselves in a position where exposure will damage both their “moral and political power”. It can’t come too soon for my liking, though I feel sure tha large number of deaths in the meantime with make Corona Virus seem insignificant.

          https://iview.abc.net.au/show/revelation

          My gratitude that someone is prepared to attempt to expose the enablers of these criminals.

          I am certain that anyone looking back at this letter I have from the Chief Psychiatrist will recognise an enabler when they see one in black and white. His rewriting of the law and denial of access to a legal representative a telling tale for those who are yet to come with some courage and compassion, rather than the profit seeking sycophants I have met to this point.

          I have no doubt that his move from being the principle of the Royal College of Psychiatrists where he represented the interests of psychiatrists, to the Chief Psychiatrist where his negligence would achieve a much better result for psychiatrists was no accident (the duty is to consumers, carers and the community under s.4). The failure to even recognise the most basic legal protection in the Mental Health Act provides the ability to arbitrarily detain and force drug any citizen a doctor would like, and call it medicine. Not that the Minister or anyone else seems in the slightest concerned about, do what you want and we will cover for you is the model being employed here.

          And let me openly state here that the words “formal investigation” from the authorities is code for “show us what evidence you have so we can do a cover up”. Record everything in detail. They will not accept it at a police station because they tell me “we don’t have a copy of the criminal code at this station” and from another officer “it might be best I don’t know about that”, but it has been recorded. In my Book it states that the ‘frauds’ are subjected to a process of ‘crushing’. It takes time but God moves in mysterious ways 🙂

          • They are all in this together boans, and is why I was waiting for a UN move.
            Other therapists and counselors, many who could speak up, but won’t for fear of losing their jobs.

            We have Mr. Breggin, Paula, and Tina and more. It’s shocking how such brilliant people devote their time when they could ignore and do something that pays more.
            We have brilliant bloggers, who put psychiatry to shame in more ways than one.
            And we have MIA, Robert who rationally has looked at all there is to see.

            There is a reason these people speak, and it is NOT because they are somehow radical, or even anti “psychiatry”. They are anti bullshit. Anti-dehumanizing, anti oppression.

            But we see that the only way it would or could EVER get better is by them taking the high road and walking out, or by driven out.
            I would never expect a religion to die out overnight, but I DO know, that nothing ever remains the same.

          • I recently watched a documentary about Dr Charles Norris and Alexander Gettler, and the development of the use of science (toxicology) in the courts.

            These people stand out because despite the pressures to go with the flow, they stood up for what was right. Mayor Jimmy Walker remembered for his corruption, Norris and Gettler for their contribution to a just and fair society.

            I look at these old black and white pictures and think , you know what there are people just like that nowadays. I believe Mr Whitaker to be one of them. I believe his work will go down as the early warning that these drugs are doing more damage than smoking, and I get the feeling he isn’t going to point fingers and say “I told you so”. But he did tell us so.

            Unfortunately the train must be turned slowly, and a lot of people are going to be harmed and die as a result. Corona Virus doesn’t discriminate and requires urgent attention. Mental health is based on discrimination and the negative outcomes are seen as being like weeding to a gardener, poison them, rip them out of their environment and throw them into the compost etc. The Ghosts of the Civil Dead.

            Me personally I have a constant in my life. And it will remain the same, not just for me but for future generations. And despite the slander that this was from a “man possessed” it seems to have lasted. Their lack of insight is no reason to use force and have them believe, though as many a psychiatrist would know torture will get you the answers you want to hear.
            The people you mention are driven by something other than the trappings of this world I believe. Something that lasts and results in further good deeds. Perhaps its a ‘chemical balance’ that needs to be investigated further? Nooooo, enough lol

    • But we need the patience of Job with the “mental health” researchers, boans, since they never want to stop researching into their BS DSM disorders.

      https://www.wired.com/2010/12/ff_dsmv/

      “Gratitude is a state of affirming the goodness or good things in one’s life, accompanied by a recognition that the sources of this goodness lie at least partially outside the self, such as with the good intentions of another person.”

      Notice, no mention of offering gratitude to God, by the “mental health” researchers? God forbid someone believe in being grateful to God. The “mental health” workers like to drug up those of us who believe in God!

      “In the context of challenging circumstances, particularly those outside of one’s control, searching for areas gratitude may be discouraging…” But praying to God is beneficial in such times.

      Of course, “practicing gratitude [can] be useful, soothing, or effective,” if the gratitude is directed at the correct source. A source that died for my sins, and saved me from 14 different egregious, anticholinergic toxidrome poisoning attempted murders by insane, child abuse covering up, criminal “mental health” workers. Don’t say miracles don’t happen.

      • “Notice, no mention of offering gratitude to God, by the “mental health” researchers?”

        I sure did SomeoneElse. And I realised that, like the psychiatrists who are having their “patients” leave the hospital in a state much worse than they came in, it would be a bit rich to ask that people have gratitude towards doctor/MH workers who see themselves AS god.

        I know the doctor who ‘interupted’ the group of people who were arranging my ‘unintended negative outcome’ tried to make it appear as if it fitted with Biblical prophesy (as one would expect from a professor). But what it really came down to was one gang picking up resources from another gang in our medical fraternity. Fight fire with fire? No, this was about taking the fire and burning down other peoples houses for profit. Though I must say I admire the way the situation was manipulated to achieve this end. The look on that doctors face when he was interrupted right in the middle of murdering someone :). And the look on the faces of police who know there’s not a damn thing they can do about him as a result of protection provided by the law. They step up and their families will suffer as a consequence. They are corrupted with their need to provide support to known criminals. The proverbial blind eye ordered by their masters in Parliament.

        I watch them during this time of crisis associating themselves with ‘good news’ and hiding when the tough decisions need to be taken. Image before truth, ego before community.

        I finished watching the first episode of Revelation, the Children have been used by the Devil. And the explanation that the Catholic Church sees the child victims of rape as being capable of understanding that they were doing wrong by participating in sexual acts with priests at the age of 7. Why are they not requesting that our legislators change the laws and age of consent given their position? These evil children tempting these good men.

        I think back to the threat issued by the Operations Manager who investigated my claim of torture and kidnapping. I’m sure the authorities would now claim they were not in support of her commission of criminal acts, but they find it easier to ignore the truth despite knowing that she was responsible for the distribution of the fraudulent documents to the Law Centre.

        I also feel sure that the threats issued by the Church (not just the rapists) to the families of victims have been systematically ignored. My government and this organisation still seem to have much in common. They use the exact same methods to conceal their misconduct. Negligence, fraud, slander and threats and intimidation of witnesses. And a Minister (and Chief Psychiatrist) who ignore the very laws they are writing that supposedly provide legal protections to the carers, consumers and community. And a community that is prepared to allow them to do whatever they want and are too afraid to question the Emperors choice of fashion. (a Police State where complaints regarding torture are dealt with via an overdose in an Emergency Dept)

        For that I give thanks to God. Because He has also warned them of what will result from their concealment of the truth with falsehoods.

  3. I would feel rather pompous to suggest “gratitude”.
    How often are people handed sheets of paper and pencil to write down their thanks, when what they need is food?
    It’s guilt tripping.
    A long time ago, I told someone I was down in the dumps. Their reply was, “what do you have to be down about”.
    30 years later, I remember that comment, and I see the wisdom in it now, (that it could make someone think, but they would have to be cognizant at that time) but I also see the stupidity…. the overwriting of my narrative… of that comment.

    That “positive thinking” gig was not useless, but certainly highly overrated, because the deliverers of these messages, these programs and “interventions”, are often in their Lalaland and don’t know a heck of a lot about out of the box thinking.
    The weirdest thing to me, that people go learn to become “therapists”, and deliver their messages from that platform.

  4. I agree, Sam. Many “positive thinking” interventions, especially the quickie, workbook-based or online varieties, do little more than tell us what we SHOULD think. I was struck by the woman who reported that being made to write gratitude lists only “pushed her deeper into shame and self-loathing.” She’s not alone. I have found that lots of cookbook cognitive-behavioral therapy tips functioned the same way — giving me sophisticated new ways to despise myself for my “irrational, self-defeating” thought patterns.

    Right now, during this time of social lockdown and massive economic insecurity, do you know what I hear most often from the most anxious and unhappy people around me? “I *should* be grateful. I’ve got a place to live, I’m not sick, I’ve got plenty to eat, etc. etc.” It clearly does not make them feel better. It may help more to hear from others that they are frightened, angry, nervous too, and it’s OK to feel that way. Even realistic.

    • Accepting and normalizing one’s own feelings is an essential step. Looking at “positive thinking” may work for some people and be disastrous for others. The first mistake is telling the other person how to feel or what will “work.” The only one who knows what works is the person who is trying to make the changes.

      • I agree Steve.
        A lot of the “solutions”, that experts suggest are about “changing thoughts” and the very attempt will often lead to a feeling of “failure”, which just reinforces the first issue, the issue that someone might think there is “something” to “fix”.
        People can get very entangled in the “chase”.

        But a lot of it depends on the messages psychiatry has given us. The big trap message is “mental health”, so we imagine what that is, this linear path of life and no eruptions.
        And the reason every joe is an expert at “mental health” is because they know about the normal chaos that is part of life, they have experienced it or saw it. And we could sure benefit by having people be more open and honest with others, about their own difficulties. You’re so right about an essential step is to normalize feelings.

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