Using Gratitude to Promote Positive Change: A Series of Meta-Analyses Investigating the Effectiveness of Gratitude Interventions

The Even Shorter Almost Perfect Scale: Psychometric Evaluation and Cross-National Implications for Psychological Outcomes

Short empirically-supported scales or individual items are preferred in comprehensive surveys, brief screeners, and experience sampling studies. To that end, we examined the Short Almost Perfect Scale (SAPS) to evaluate empirical support for the interchangeability of items to measure perfectionistic strivings (Standards) and perfectionistic concerns (Discrepancy). Based on a large and diverse sample (N = 1,103) and tests of tau-equivalence (equal factor loadings) for each respective set of items, Study 1 advanced a subset of SAPS items to measure Standards (2 items) and Discrepancy (3 items). Cross-sectional gender and race/ethnicity invariance were supported, and in structural equations analyses, the SAPS5 factors were significantly associated with depression, state anxiety, life satisfaction, and gratitude. Study 2 cross-validated Study 1 measurement and structural findings with a new U.S. sample (N = 803). The three items representing the Discrepancy (perfectionistic concerns) factor also were supported in a cross-national comparison between the U.S. sample and a scale development sample in New Zealand (N = 3,921). For the most part, across both studies and all analyses, the three Discrepancy items were empirically interchangeable indicators of perfectionistic concerns and comparably strong predictors of psychological outcomes, supporting their use in studies or other contexts with space or time restrictions for measurement.

A randomized feasibility study of a positive psychology journaling intervention to support recovery from substance-use disorders

BACKGROUND

Individuals in early recovery face significant biopsychosocial stressors causing a preponderance of negative affect. Novel interventions are needed to improve mood and well-being to support recovery. Positive Recovery Journaling (PRJ) combines elements of positive psychology, behavioral activation, and journaling to emphasize what is going right and to encourage small, positive steps that align with an individual's values to make life in recovery more rewarding and therefore more reinforcing. Our objective was to determine PRJ's feasibility, acceptability, and impact on a set of strengths-based, multidimensional aspects of recovery, including satisfaction with life, happiness with recovery, and commitment to sobriety.

METHODS

The study randomized adults in substance-use disorder treatment (N = 81) to PRJ or control. Those in PRJ were asked to practice PRJ daily and complete online surveys for four weeks; those in the control group completed online surveys for four weeks. We used multi-level modelling to determine intercept and slope for feasibility and acceptability outcomes as well as to compare differences in recovery indicators between treatment and control at baseline and Weeks 2, 4, and 8. We conducted intention-to-treat and per-protocol analyses for each recovery indicator.

RESULTS

Participants were 53 % female, and 26 % Black, Indigenous, People of Color (BIPOC) and mean age of 39 years. PRJ participants attended 71 % of groups and completed 56 % of the daily PRJ entries. Treatment and control groups rated their study tasks (PRJ for the treatment group, surveys for the control group) as equally easy; however, the PRJ group rated PRJ as significantly more satisfying, helpful, and pleasant. Treatment and control were not significantly different on any recovery indicator. In post hoc analyses, we found that for those with <90 days sobriety at baseline (51 %), PRJ had a statistically significant beneficial effect for satisfaction with life, happiness with recovery, and numerous secondary recovery indicators.

DISCUSSION

Results suggest a positive impact of PRJ on numerous recovery indices for those in earliest recovery. Integrating PRJ into support services among those with <90 days sobriety could reinforce what is going well in recovery to encourage its continued maintenance and thereby improve treatment outcomes.

Trait emotional intelligence mediates the dispositional gratitude and subjective well-being in young adults

Gratitude has proved to be an enhancer of subjective well-being in previous studies. However, studies that linked the relation between emotional intelligence and its facets when interacting with gratitude, are still limited. In this sense, this study examined the mediating roles of emotional intelligence between gratitude and subjective well-being indicators, by introducing the general factor of emotional intelligence. The first approach to data analysis was to examine the descriptive statistics; the second approach consisted of an Exploratory Structural Equation Modelling, applying also a bifactor analysis. Data was collected from 406 Spanish students, through an online survey that includes the gratitude, trait meta mood scale, satisfaction with life and subjective happiness scale. The mean age of participants was 20.27 years (SD = 4.68), whereas 79.5% were females. The results provided preliminary evidence of the mediation role of the general factor of emotional intelligence between gratitude and subjective well-being, which provided a meaningful insight about the role of trait emotional intelligence. These findings suggested that gratitude promotes emotional intelligence, allowing to an increase in subjective well-being. Nonetheless, there is a need for further research to achieve a better understanding of the role of the emotional intelligence facets between gratitude and subjective well-being.

A pilot study examining whether restricting and resuming specific actions systematically changes symptoms of depression and anxiety. A series of N-of-1 trials

Anxiety and depressive disorders are highly prevalent and a leading cause of disability. Understanding how symptoms develop could lead to new preventive and clinical interventions. This pilot study examined whether systematically restricting specific behaviours (target actions) associated with good psychological health would increase psychological symptoms in healthy participants, and whether resuming those actions would reduce symptoms to baseline levels. Twelve adults participated in a series of N-of-1 trials comprising baseline (A), restriction (B) and recovery (C) phases. Outcomes were assessed weekly using measures of depression (PHQ-9), anxiety (GAD-7), and a validated 15-item measure of target actions (Big 5). Symptoms of depression and anxiety increased significantly from Phase A to Phase B and returned to baseline by the end of Phase C. Increased symptoms during Phase B were only observed in participants who restricted actions by more than 25%. Symptom increases were evident within 2 weeks of restriction, but most participants appeared to take longer to recover to baseline levels. This study demonstrates that reducing the frequency of specific actions may increase symptoms of anxiety and depression, which is reversed when those actions are resumed. This contributes to our understanding of the aetiology, maintenance, and recovery from depression, anxiety, and possibly other disorders.

Contextual AI Journaling: Integrating LLM and Time Series Behavioral Sensing Technology to Promote Self-Reflection and Well-being using the MindScape App

MindScape aims to study the benefits of integrating time series behavioral patterns (e.g., conversational engagement, sleep, location) with Large Language Models (LLMs) to create a new form of contextual AI journaling, promoting self-reflection and well-being. We argue that integrating behavioral sensing in LLMs will likely lead to a new frontier in AI. In this Late-Breaking Work paper, we discuss the MindScape contextual journal App design that uses LLMs and behavioral sensing to generate contextual and personalized journaling prompts crafted to encourage self-reflection and emotional development. We also discuss the MindScape study of college students based on a preliminary user study and our upcoming study to assess the effectiveness of contextual AI journaling in promoting better well-being on college campuses. MindScape represents a new application class that embeds behavioral intelligence in AI.

Distinct associations between gratitude, self-esteem, and optimism with subjective and psychological well-being among Japanese individuals

BACKGROUND

Mounting evidence suggests that the effectiveness of positive psychology interventions is influenced by a variety of factors, including cultural context. Identifying intervention targets that can effectively contribute to improving individual well-being under these boundary conditions is a crucial step when developing viable interventions. To this end, we examined how gratitude disposition, self-esteem, and optimism relate to the subjective well-being (SWB) and psychological well-being (PWB) of Japanese individuals.

METHODS

Multivariate regression analysis was employed to quantify the unique relationships between the three potential intervention targets and both SWB and PWB, while accounting for the influence of other variables. Participants (N = 71) also engaged in a 4-week experience sampling study to explore how gratitude, self-esteem and optimism shape the link between momentary affective states in everyday life and evaluations of day satisfaction.

RESULTS

Multivariate regression analysis revealed that self-esteem was predominantly more strongly associated with SWB compared to gratitude disposition, whereas gratitude disposition was more strongly associated with the PWB dimensions, particularly personal growth, positive relations with others and purpose in life. Experience sampling data indicated that while both gratitude disposition and self-esteem moderated the association between momentary positive affect and day satisfaction evaluations, they did so in opposite ways; greater gratitude disposition strengthened the association, while greater self-esteem weakened it.

CONCLUSIONS

Overall, the current results suggest that while gratitude, self-esteem, and optimism influence individual well-being as a whole, they likely play distinct roles in facilitating SWB and PWB in the studied cohort.

Trajectories of Perceived Gratitude and Change Following Relationship Interventions: A Randomized Controlled Trial With Lower-Income, Help-Seeking Couples

The current study was designed to advance basic and applied research on perceived gratitude from one's partner in established couple relationships. From a three-arm randomized controlled trial involving 615 lower-income, help-seeking couples (N = 1,224 individuals), study analyses examined (a) the trajectory of perceived gratitude from one's partner among couples assigned to the wait-list condition (i.e., absent of any intervention), and (b) changes in perceived gratitude for individuals assigned to either the OurRelationship (OR) or ePREP relationship intervention condition. With respect to the first aim, levels of perceived gratitude among wait-listed couples demonstrated no significant mean increase over the 6-month period; this rate of change was significantly different from rates of change observed in other relationship constructs (e.g., satisfaction, communication, support) during the wait-list period. Being married, female, and having more children were all associated with lower initial levels of perceived gratitude. For the second aim, individuals assigned to either the OR or ePREP treatment condition demonstrated significant improvements in levels of perceived partner gratitude compared to wait-listed couples. The magnitude of program effect sizes for gratitude (d = 0.33), however, was 3%-48% smaller compared to the magnitude of program effects of other relationship constructs (0.34 < d < 0.64). Results indicated that perceived gratitude is a distinct component of couple relationships, generally lower in more established relationships, and can be improved by participating in OR or ePREP relationship interventions. Implications for research and practice related to gratitude in couple relationships are discussed.

Effectiveness of subjective support-focused cognitive behavioral therapy on depressive symptoms among (pre)frail community-dwelling older adults: A randomized controlled trial

BACKGROUND

Subjective support could ameliorate the adverse effect of (pre)frailty on depressive symptoms. However, there is scarce evidence regarding subjective support-focused intervention in preventing depression among (pre)frail community-dwelling older adults. This study aims to explore the effectiveness of subjective support-focused cognitive behavioral therapy (SS-CBT) in preventing depression among this group of population.

METHODS

A total of 100 community-dwelling (pre)frail older adults were recruited from six communities in a Chinese city and were randomized to an 8-week SS-CBT group or a wait-list control group. Depressive symptoms and subjective support were assessed at baseline (T0), and at 8 week (T1), 12 week (T2), 16 week (T3) after randomization. Generalized estimating equation was used to examine the effectiveness of SS-CBT on depressive symptoms and subjective support. Hierarchical linear regression models and Bootstrapping method were used to examine whether subjective support mediated the effectiveness of SS-CBT on depressive symptoms.

RESULTS

Participants in SS-CBT group reported significant reduction in depressive symptoms (Wald χ2 = 20.800, p < 0.001) and improvement in subjective support (Wald χ2 = 92.855, p < 0.001) compared to those in wait-list control group. Changes in subjective support mediated the effectiveness of SS-CBT on changes in depressive symptoms.

LIMITATIONS

Restricted regions to recruit participants, inclusion of the most motivated participants, lack of diagnosis of depression, potential experimenter bias and contamination, short follow-up period, and lack of an active control group.

CONCLUSIONS

The findings support the benefits of SS-CBT in preventing depression among (pre)frail community-dwelling older adults, and provide insight into possible mechanisms.

Mindfulness and loneliness in retired older adults in China: mediation effects of positive and negative affect

Objectives: Drawing from the mindfulness framework and the broaden-and-build theory, this study investigates the extent to which mindfulness influences loneliness and whether the relation is mediated by positive and negative affect.Method: Data were collected from 748 retired older adults aged 60 and above in Chengdu, China in 2022. Loneliness and mindfulness were measured by the UCLA loneliness scale and by the short-form version of the Five Facet Mindfulness Questionnaire, while the positive and negative affect was assessed by the International Positive and Negative Affect Schedule.Results: The results of this study show that mindfulness was positively associated with positive affect (β = 0.37, p<.001), negatively related to negative affect (β=-0.21, p<.001) and loneliness (β=-0.13, p<.001), and had an indirect effect on loneliness via positive and negative affect (β=-0.20, p<.001).Conclusion: The findings suggest that mindfulness could be a positive resource for improving mental health and reducing loneliness among retired older adults in China.

Being Thankful for What You Have: A Systematic Review of Evidence for the Effect of Gratitude on Life Satisfaction

Background

Many studies suggest a link between gratitude and life satisfaction, including experimental tests of gratitude interventions. This paper presents a systematic review of recent literature on the influence of gratitude on life satisfaction. The aim of this research is to better understand the nature of the relationship between gratitude and life satisfaction and to evaluate the state of literature.

Methodology

A systematic search was conducted using four databases (APA PsycInfo, Scopus, Web of Science, and EBSCO), targeting articles published since 2010. Correlational studies were included if they used the GQ6 measure of gratitude and the Satisfaction With Life Scale (SWLS). Intervention studies were included if they reported effects of a gratitude manipulation on SWLS scores. Forty-four articles (N = 16,529) focusing on gratitude and life satisfaction were ultimately selected. Among the selected studies, 18 employed experimental designs and 26 were cross-sectional studies. Five studies also presented cross-lagged analyses from two or more timepoints.

Results

The review indicated a substantial positive correlation between gratitude and life satisfaction. Various potential mediators were also identified, including meaning in life, social support, and self-esteem. Some experimental research suggested that gratitude interventions may increase life satisfaction compared to neutral control conditions, although evidence was mixed. There was stronger evidence for these effects in people from Western countries. However, there is no strong evidence that gratitude interventions outperform positively valenced control conditions. Thus, it is possible that the effects of intervention could be caused by demand- or placebo effects.

Conclusion and Recommendation

While it is clear that there is a link between gratitude and life satisfaction, the extent to which gratitude causes life satisfaction and the mechanism underlying that link require further exploration. We suggest that experimental work test effects of changes in gratitude that cannot be explained by placebo- or demand effects. We also encourage more interactive interventions as well as research that investigates third variables that could underlie both gratitude and life satisfaction.

World beliefs, character strengths, and hope for the future

Research in recent years has revealed the rate of premature and avoidable deaths from suicide and drug/‌alcohol misuse is rising in the United States. These are sometimes referred to as deaths of despair based on evidence that they are concentrated in relatively poor communities with less access to social resources and low labor force participation. The pattern was first noted in middle-aged White men but seems to be gradually spreading to other ethnic groups. As a first step in establishing a psychological response to this public health issue, the present article summarizes two studies that compared psychological variables to demographics as predictors of hopefulness. A number of intriguing findings emerged. Despite concerns about American despair and conflict, U.S. residents proved the most hopeful among residents of eight countries. Low-income Americans are particularly hopeful except for low-income Whites. Positive character traits and primal beliefs about the world generally proved to be better predictors of hope than ethnicity, financial status, or their interaction. A number of relationships were found between psychological variables and community demographics. The findings as a group suggest hopefulness is driven more by psychological variables than by life circumstances. It is suggested that psychologists could play an important role in the study of this topic by implementing programs intended to enhance hopefulness in impoverished populations, and by encouraging an intentional communal focus on the importance of enhancing well-being.

The Role of Gratitude in a Positive Psychology Group Intervention Program Implemented for Undergraduate Engineering Students

Over the past decades, research on positive psychology for building strengths has proliferated. The present study aimed to explore the effect of gratitude in a 5-week positive psychology group program for undergraduate engineering students which included an intermediary 2-week gratitude intervention. In a mixed-design, 69 students from three engineering departments of the School of Pedagogical and Technological Education (ASPETE), assigned to the intervention (N = 34) and the control group (N = 35), with an average age of 21.52 years (SD = 4.63), were administered the Gratitude Questionnaire-six item form (GQ-6), the Modified Differential Emotions Scale (mDES), the Connor-Davidson Resilience Scale (CD-RISC), the Subjective Happiness Scale (SHS), and the Life Orientation Test-Revised (LOT-R). The condition experimental vs. control group was designated as the between-subjects factor, and time, that is, baseline vs. post intervention, was set as the within-subjects factor. Students who received the intervention reported significantly higher levels of gratitude. The increase in gratitude was due to the positive psychology group program. In addition, gratitude showed a significant effect on happiness and optimism, but failed to attain a significant impact on positive and negative emotions and resilience. Further research is needed to elucidate the effectiveness of positive psychology programs for undergraduate engineering students and the intervening cognitive processes.

Qualitative evaluation of a brief positive psychological online intervention for nursing staff

AIM

The aim of this study is to evaluate a brief positive psychological intervention with regard to the mental health of nursing staff in German hospitals. It addresses the question of how positive-psychological online exercises should be designed.

BACKGROUND

Nurses in hospitals are known to suffer from mental strain and risk depressive as well as anxiety disorders. The covid-19-pandemic leads to a further aggravation of the situation. Opposed to that, positive psychological interventions can increase resilience by promoting self-management competences and mental strength.

RESEARCH METHODS

A 90 min positive-psychological workshop was conducted with six nurses who worked in German hospitals. It consisted of imparting knowledge on positive psychology and learning different positive psychological practices. Afterwards, guideline-based interviews were conducted with six nurses. The outcomes of interest were how the intervention was evaluated, to what extent the intervention led to a reflection and a promotion of self-management competences and whether it allowed the participants to transfer the learnings into everyday life.

RESULTS

The intervention led to a reflection of the application competence of positive-psychological techniques by the participating nurses. A promotion of the competences could not be reached. Especially the reflection and promotion of humour competence manifested itself as difficult.

CONCLUSION

Despite its short-term nature, the online intervention resulted in a reflection of the nurses' application competence of positive psychology indicating its resource-promoting potential. Follow-up exercises or peer groups should be used for further development, while a training of humour competence might be part of a separate intervention.

Giving and receiving thanks: a mixed methods pilot study of a gratitude intervention for palliative patients and their carers

BACKGROUND

Psychological research examining the nature and workings of gratitude has burgeoned over the past two decades. However, few studies have considered gratitude in the palliative care context. Based on an exploratory study which found that gratitude was correlated with better quality of life and less psychological distress in palliative patients, we designed and piloted a gratitude intervention where palliative patients and a carer of their choice wrote and shared a gratitude letter with each other. The aims of this study are to establish the feasibility and acceptability of our gratitude intervention and provide a preliminary assessment of its effects.

METHODS

This pilot intervention study adopted a mixed-methods, concurrent nested, pre-post evaluation design. To assess the intervention's effects, we employed quantitative questionnaires on quality of life, quality of relationship, psychological distress, and subjective burden, as well as semi-structured interviews. To assess feasibility, we considered patients and carers' eligibility, participation and attrition rates, reasons for refusal to participate, appropriateness of intervention timeframe, modalities of participation, and barriers and facilitators. Acceptability was assessed through post-intervention satisfaction questionnaires.

RESULTS

Thirty-nine participants completed the intervention and twenty-nine participated in interviews. We did not find any statistically significant pre/post intervention changes for patients, but found significant decrease in psychological distress for carers in terms of depression (median = 3 at T0, 1.5 at T1, p = .034) and total score (median = 13 at T0, 7.5 at T1, p = .041). Thematic analysis of interviews indicates that overall, the intervention had: (1) multiple positive outcomes for over a third of interviewees, in the form of positive emotional, cognitive, and relational effects; (2) single positive outcomes for nearly half of interviewees, who experienced emotional or cognitive effects; (3) no effect on two patients; and (4) negative emotional effects on two patients. Feasibility and acceptability indicators suggest that the intervention was well received by participants, and that it should adopt flexible modalities (e.g. writing or dictating a gratitude message) to ensure that it is feasible and adapted to individual needs and preferences.

CONCLUSIONS

Larger scale deployment and evaluation of the gratitude intervention, including a control group, is warranted in order to have a more reliable evaluation of its effectiveness in palliative care.

Pilot Study on the Impact of Gratitude Journaling or Cognitive Strategies on Health Care Workers

INTRODUCTION

The COVID-19 pandemic has significantly impacted the mental well-being of health care workers (HCWs). This study assessed the feasibility, acceptability, and preliminary efficacy of two psychological interventions, gratitude journaling or cognitive strategies, on pediatric HCWs.

METHOD

A pilot randomized parallel repeated measures design was used, with a convenience sample of 59 HCWs. Data were collected before and after the intervention period, 2 weeks after, and again 6 months later. Outcomes included depression, anxiety, meaning and purpose, feasibility, and acceptability.

RESULTS

Thirty-seven participants completed the study. The majority were nurses (registered nurses and advanced practice registered nurses) and physicians. In both groups, depression and anxiety scores diminished, but changes were not statistically significant. The study was feasible to conduct, and subjects reported high acceptability.

DISCUSSION

Gratitude journaling and cognitive strategies may help mental well-being in HCWs; however, future studies with larger samples are needed.

The Catalyst Model of Change: Gratitude Interventions with Positive Long-Term Effects

How can gratitude interventions be designed to produce meaningful and enduring effects on people's well-being? To address this question, the author proposes the Catalyst Model of Change-this novel, practical, and empirically testable model posits five socially oriented behavioral pathways that channel the long-term effects of gratitude interventions as well as how to augment gratitude experiences in interventions to boost treatment effects and catalyze these behavioral pathways. Specifically, interventions that enhance the frequency, skills, intensity, temporal span, and variety of gratitude experiences are likely to catalyze the following post-intervention socially oriented behaviors: (a) social support-seeking behaviors, (b) prosocial behaviors, (c) relationship initiation and enhancement behaviors, (d) participation in mastery-oriented social activities, and (e) reduced maladaptive interpersonal behaviors, which, in turn, produce long-term psychological well-being. A unique feature of the Catalyst Model of Change is that gratitude experiences are broadly conceptualized to include not just gratitude emotions, cognitions, and disclosures, but also expressing, receiving, witnessing, and responding to interpersonal gratitude. To this end, gratitude interventions that provide multiple opportunities for social experiences of gratitude (e.g., members expressing gratitude to each other in a group) might offer the greatest promise for fostering durable, positive effects on people's psychological well-being.

Positive Psychological Intervention Effects on Depression: Positive Emotion Does Not Mediate Intervention Impact in a Sample with Elevated Depressive Symptoms

Positive psychological interventions (PPIs), programs that specifically target positive emotions, cognitions, and behaviors, have been shown to reduce depression and improve other aspects of psychological well-being. However, potential pathways linking PPIs to better outcomes have been under-explored. In this paper, we report the results of a randomized trial of a self-guided online delivered PPI called MARIGOLD (Mobile Affect Regulation Intervention with the Goal of Lowering Depression). Participants with elevated depression were randomized to receive MARIGOLD (n = 539) or an emotion reporting control condition (n = 63). In addition to testing direct effects of the intervention on depressive symptoms, we explored whether positive or negative emotion-operationalized as past day, past week, reactivity, or flexibility-mediated the intervention impact on depression. Results demonstrated that participants in the MARIGOLD condition had reduced depressive symptoms compared to controls and, although the effect did not reach statistical significance, reductions in past day negative emotion appeared to mediate this effect. Contrary to hypotheses, the intervention did not increase positive emotion compared to the control condition. Discussion focuses on the need for future studies to continue investigating the mechanisms of action for PPIs with emphasis on theoretically-based measurement and operationalization of emotion and other potential mediators to maximize the ultimate impact of PPIs on psychological well-being. Clinical Trials registration #NCT02861755.

Can Good Memories of the Past Instill Happiness? Nostalgia Improves Subjective Well-Being by Increasing Gratitude

The positive effect of nostalgia provides an effective way to improve subjective well-being. However, there is little research on the relationship between nostalgia and subjective well-being, especially the mechanism of this link. This study tested the positive effects of nostalgia on emotional well-being (positive affect and negative affect) and cognitive well-being (satisfaction with life) via gratitude. Two experiments were conducted in samples of young adults who were randomized to experimental or control conditions. The analyses involved group comparisons as well as regression-based analyses of mediation. In Experiment 1 (N = 196), we induced nostalgia using a guided autobiographical recall procedure. The nostalgia group had higher positive affect and gratitude, and gratitude partially mediated the association between nostalgia and positive affect. In Experiment 2 (N = 102), we induced nostalgia by showing a nostalgic video from the period when the participants were children. The nostalgia group had higher positive affect and lower negative affect, and gratitude partially mediated these associations. The findings suggest that nostalgia could improve emotional well-being by increasing gratitude, but may not alter cognitive well-being.

Are Some Ways of Expressing Gratitude More Beneficial Than Others? Results From a Randomized Controlled Experiment

Gratitude activities have been shown to increase well-being and other positive outcomes in numerous experiments to date. The current study tested whether self-directed gratitude interventions that vary by type (i.e., social vs. nonsocial) and format (i.e., long-form letters vs. shorter lists) produce differential benefits. To that end, 958 Australian adults were assigned to one of six activities to complete each day for 1 week, including five gratitude activities that varied by type and format and an active control condition (i.e., keeping track of daily activities). Regressed change analyses revealed that, overall, long-form writing exercises (i.e., essays and letters) resulted in greater subjective well-being and other positive outcomes than lists. Indeed, those who were instructed to write social and nonsocial gratitude lists did not differ from controls on any outcomes. However, participants who wrote unconstrained gratitude lists—that is, those who wrote about any topics they wanted—reported greater feelings of gratitude and positive affect than did controls. Finally, relative to the other gratitude conditions, participants who wrote gratitude letters to particular individuals in their lives not only showed stronger feelings of gratitude, elevation, and other positive emotions but also reported feeling more indebted. This study demonstrates that not only does gratitude “work” to boost well-being relative to an active neutral activity, but that some forms of gratitude may be more effective than others. We hope these findings help scholars and practitioners to develop, tailor, implement, and scale future gratitude-based interventions.

New horizons in group psychotherapy research and practice from third wave positive psychology: a practice-friendly review

Group psychotherapy has been shown to be equivalent to individual therapy for many disorders, including anxiety, depression, grief, eating disorders, and schizophrenia (Burlingame & Strauss, 2021). In addition to effectiveness in reducing symptoms, group offers members a sense of belonging, purpose, hope, altruism, and meaning throughout treatment (Yalom & Leszcz, 2020). These additional outcomes are especially important considering the COVID-19 pandemic and national/international conflicts, given the trauma, disruptions, and losses people have experienced. Applying recent developments in positive psychology to group therapy can enhance treatment. A practice-friendly review examined recent advances in the positive psychology literature, demonstrating how group therapy offers members unique growth opportunities in addition to reducing symptoms. Key findings from studies applying positive psychological constructs to group therapy outcomes are synthesized. Our review sheds light on the relevance of third wave positive psychology to enrich group therapy (Lomas et al., 2021). Specifically, group therapy can facilitate the development of vitalizing psychological virtues, and these can be used to assess treatment outcome: humanity, wisdom, transcendence, courage, temperance, and justice. Interrelatedly, we present support for including attachment theory and mentalization within a positive psychological group framework. Implications are explored for group therapy research, clinical work, and training.

Identifying factors associated with elevated suicidal intent among U.S. military veterans

OBJECTIVE

Suicidal intent is a risk factor for engagement in suicidal behavior, use of violent means, and suicide mortality. Yet, scarce research has examined factors associated with suicidal intent among U.S. military veterans, a population at high risk for suicide. This study examined vulnerability factors associated with suicidal intent in a population-based sample of U.S. veterans.

METHODS

Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a representative sample of 4069 U.S. veterans. Analyses estimated the prevalence of current suicidal intent (i.e., veterans' report that they would likely attempt suicide in the future) and examined factors most strongly associated with suicidal intent.

RESULTS

Forty-nine veterans (1.4%; 95% confidence interval = 1.0-1.8%) reported suicidal intent. Recurrent past-year suicidal ideation (≥2 times), low dispositional gratitude, current depression, current insomnia, childhood sexual abuse, and a prior suicide attempt were most strongly associated with suicidal intent (7.1-50.1% of the total explained variance). Veterans with several of these co-occurring factors were at highest risk for suicidal intent; of veterans with 0, ≥1, ≥2, ≥3, and ≥4 of these factors, 0.1%, 4.4%, 10.8%, 19.5%, and 28.1% reported suicidal intent, respectively.

DISCUSSION

Specific vulnerability factors, particularly when co-occurring, may increase veterans' intention of attempting suicide. Findings underscore the importance for clinicians to continuously assess suicidal intent when working with this population, particularly as veterans' reports of suicidal thinking increases.

Appreciating the Good Things in Life During the Covid-19 Pandemic: A Randomized Controlled Trial and Evaluation of a Gratitude App

The Covid-19 pandemic has had many negative consequences on the general public mental health. The aim of this study was to test the effectiveness of and satisfaction with an app with gratitude exercises to improve the mental health of people with reduced mental well-being due to the Covid-19 pandemic, as well as potential mechanisms of well-being change and dose-response relationships. A two-armed randomized controlled trial design was used, with two groups receiving the 6-week gratitude intervention app either immediately (intervention group, n = 424) or after 6 weeks (waiting list control group, n = 425). Assessments took place online at baseline (T0), six weeks later (T1) and at 12 weeks (T2), measuring outcomes (i.e., mental well-being, anxiety, depression, stress), and potential explanatory variables (i.e., gratitude, positive reframing, rumination). Linear mixed models analyses showed that when controlled for baseline measures, the intervention group scored better on all outcome measures compared to the control group at T1 (d = .24-.49). These effects were maintained at T2. The control group scored equally well on all outcome measures at T2 after following the intervention. Effects of the intervention on well-being were partially explained by gratitude, positive reframing, and rumination, and finishing a greater number of modules was weakly related to better outcomes. The intervention was generally appealing, with some room for improvement. The results suggest that a mobile gratitude intervention app is a satisfactory and effective way to improve the mental health of the general population during the difficult times of a pandemic.

Context matters: Sociocultural considerations in the design and implementation of community-based positive psychology interventions in sub-Saharan Africa

Scholars conducting cross-cultural research in mental health often import intervention programs found to be efficacious in one social context (e.g., Western) and directly implement them in other contexts (e.g., African and Asian) without recourse to the sociocultural disparities between the target populations and the theoretical foundations of the constructs and principles underpinning the intervention programs. Such efforts mistakenly assume that positive psychology interventions (PPIs), most of which were developed from Western perspectives and assumed individualistic cultural orientation and value systems, operate equally across all contexts. Drawing on the extant literature and on insights from designing, implementing, and evaluating group-based (mental) health behavior change intervention programs across several communities in Ghana, we discuss some sociocultural, theoretical, and methodological issues that can significantly constrain the design, uptake, and effectiveness of PPIs in the rural, low literate, socioeconomically disadvantaged, highly collectivistic context of Ghana, and sub-Saharan Africa more generally. In all illustrations, we offer suggestions to guide the design and implementation processes to ensure culturally appropriate, highly acceptable, and potentially effective intervention programs. We argue that PPIs can be potentially fructuous in the sub-region when adapted to, or embedded in, the cultural values of the target population and tailored to the needs, capacities, and circumstances of participants.

More than Merely Positive: The Immediate Affective and Motivational Consequences of Gratitude

Although gratitude is typically conceptualized as a positive emotion, it may also induce socially oriented negative feelings, such as indebtedness and guilt. Given its mixed emotional experience, we argue that gratitude motivates people to improve themselves in important life domains. Two single-timepoint studies tested the immediate emotional and motivational effects of expressing gratitude. We recruited employees (n = 224) from French companies in Study 1 and students (n = 1026) from U.S. high schools in Study 2. Participants in both studies were randomly assigned to either write gratitude letters to benefactors or outline their weekly activities (control condition). Expressing gratitude led to mixed emotional experiences (e.g., greater elevation and indebtedness) for employees and students as compared with the control group. Students also felt more motivated and capable of improving themselves, as well as conveyed stronger intentions to muster effort towards self-improvement endeavors.

Does the Weekly Practice of Recalling and Elaborating Episodes Raise Well-Being in University Students?

Increasing well-being is a prominent worldwide goal that can be achieved primarily through social support and environmental factors. However, in times of social distancing or isolation, it is important to also rely on self-managed activities. This study aimed to (a) test the effectiveness of a seven-week well-being intervention, in increasing need satisfaction, self-compassion, emotion regulation, and grateful disposition by curbing need frustration, self-derogation, and emotional suppression, and (b) examine the maintenance and long-term effects of the practices based on recall, elaboration, and writing. One hundred and twenty university students weekly recalled and elaborated for seven consecutive weeks on three recent episodes of gratitude, self-affirmation, goal setting, or meaningful things, according to the group to which they were assigned. Before the intervention, immediately after and one month later, they filled in questionnaires to assess need satisfaction/frustration, self-compassion/derogation, emotion regulation and grateful disposition. The results confirmed an increase in well-being and a decrease in ill-being for all groups (Cohen d for the significant differences ranging from 0.18 to 0.53). The effects were maintained one month later and even increased for self-compassion, self-derogation, need frustration, and emotional reappraisal. A follow-up assessment revealed that a third of the participants continued with the well-being practices. Implications and suggestions for future well-being interventions are discussed.

Measures of Daily Activities Associated With Mental Health (Things You Do Questionnaire): Development of a Preliminary Psychometric Study and Replication Study

Background

A large body of research has identified modifiable cognitions and behaviors (actions) associated with psychological health. However, little is known regarding the actions that are most strongly associated with psychological health or the frequency with which they should be performed.

Objective

This paper described 2 studies that used survey methodology to create the Things You Do Questionnaire (TYDQ), which aims to identify and rank actions (items) and domains of actions (factors) most strongly associated with psychological health.

Methods

We used digital marketing strategies to recruit Australian adult participants, who were asked to complete 2 web-based surveys comprising versions of the TYDQ; validated measures of depression, anxiety, and satisfaction with life; and demographic questions. In study 1, a total of 3040 participants rated how often they performed each of the 96 items comprising the TYDQ. This design was replicated in study 2, in which a 59-item version of the TYDQ was completed by 3160 participants. In both studies, the factor structure and validity were examined, as were the associations between individual TYDQ items and 3 mental health outcomes: depression, anxiety, and satisfaction with life.

Results

In study 1, factor analyses revealed that a 5-factor model comprising 27 items achieved an optimum balance between brevity and variance and accounted for 38.1%, 31.4%, and 33.2% of the variance in scores on measures of depression, anxiety, and satisfaction with life, respectively. The factors were interpreted as realistic thinking, meaningful activities, goals and plans, healthy habits, and social connections. These 5 factors were more strongly associated with psychological health than those such as practicing kindness, exercising gratitude, and practicing spirituality. This pattern of results was replicated across gender, age groups, and depression severity. The 5-factor solution found in study 1 was replicated in study 2. Analyses revealed that a 21-item version accounted for 46.8%, 38.2%, and 38.1% of the variance in scores on measures of depression, anxiety, and satisfaction with life, respectively.

Conclusions

These findings indicate that some actions are more strongly associated with psychological health than others and that these activities fall within 5 broad domains, which represent skills often taught in psychological treatments. Subsequent studies are planned to explore the reliability of these items and results in other samples and to examine patterns of change in scores during treatment for anxiety and depression. If replicated, these efforts will assist in the development of new psychological interventions and provide an evidence base for public mental health campaigns designed to promote good mental health and prevent the emergence of common mental disorders.

Tiny Habits® for Gratitude-Implications for Healthcare Education Stakeholders

The COVID-19 pandemic has led to diminished sleep and increased stress, anxiety, and burnout for many health professionals and health professions students. One simple approach that may be effective for bolstering personal well-being is consciously cultivating gratitude. Gratitude is positively associated with physical health, psychological health, hope, sleep, and health behavior engagement; and randomized studies indicate that gratitude interventions can improve psychological well-being and sleep. The primary aim of this study was to assess the impact of practicing Tiny Habits^® on self-reported gratitude, as measured by the 6-Item Gratitude Questionnaire (GQ-6). In January 2021, 154 adult participants with GQ-6 <35/42 were randomized to one of 3 groups: Tiny Habits for Gratitude (n = 50), Tiny Habits Control (n = 52), and Inactive Control (n = 52). Both Tiny Habits groups chose 3 Tiny Habits Recipes to practice daily and participated in the free, email-based 5-Day Program with automated daily check-in emails and personalized feedback from a Certified Tiny Habits Coach. The Recipes for the Tiny Habits for Gratitude group focused on cultivating gratitude, while those for the Tiny Habits Control group did not. Post-intervention, the mean change in GQ-6 scores in the Tiny Habits for Gratitude (Δ = ↑6.9 ± 5.6; n = 37/50, 74%; p< 0.001, Cohen's d = 0.85) and Tiny Habits Control (Δ = ↑5.6 ± 4.1; n = 31/52, 60%; p = 0.009, Cohen's d = 0.71) groups were greater than that of the Inactive Control group (Δ = ↑2.5 ± 4.4; N = 42/52, 81%). At 1 month, the mean change in GQ-6 scores in the Tiny Habits for Gratitude group (Δ = ↑7.0 ± 5.3; N = 28/50, 56%) was greater than that of the Inactive Control group (Δ = ↑2.9 ± 5.4; N = 39/52, 72%; p = 0.002, Cohen's d = 0.78). These findings suggest that practicing Tiny Habits Recipes and participating in the 5-Day Program can significantly increase gratitude in the short term and focusing specifically on gratitude during this process can sustain the increase in gratitude for up to 1 month. Implementation is quick, simple, and free. This has significant implications for healthcare education stakeholders.

Factors associated with remission of suicidal thoughts and behaviors in U.S. military veterans with a history of suicide attempt

Suicide is a major public health problem in U.S. military veterans, but little is known about factors associated with remission from suicide attempts in this population. We aimed to identify risk and protective correlates of remission from suicidal thoughts and behavior (STB) in U.S. veterans with a prior suicide attempt. Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study survey. A broad range of sociodemographic, military, physical and mental health, and psychosocial variable were assessed. Purpose in life, dispositional gratitude, and conscientiousness emerged as independent correlates of STB remission (24.3%-40.3% of explained variance), even after accounting for other relevant risk and protective factors. While the cross-sectional nature of the study precludes the ability to determine whether the identified protective factors are causally related to STB remission, results suggest three potentially modifiable targets for suicide prevention efforts in veterans. Longitudinal studies are needed to better understand the role of purpose in life, dispositional gratitude, and conscientiousness in promoting remission from STBs in veterans and other populations at risk for suicide.

The impact of a gratitude intervention on mental well-being during COVID-19: A quasi-experimental study of university students

Previous research suggest that gratitude interventions are effective in improving mental well‐being, which might be beneficial to university students during the COVID‐19 pandemic. This quasi‐experimental study sought to investigate if a gratitude intervention will lead to higher mental well‐being of university students during the COVID‐19 pandemic. Participants (N = 47) mental well‐being was assessed before and after 10 weekly gratitude reflection journals and statistically compared with a control group (N = 40). An analysis of covariance (ANCOVA) was used to analyze the data. The treatment group showed significantly higher well‐being after the gratitude intervention compared with the control group (Cohen's d = 0.74). The treatment group significantly increased (Cohen's d = 0.35) and the control group significantly decreased (Cohen's d = −0.41). Gratitude interventions may be effective in improving the mental well‐being of university students even during a crisis such as the COVID‐19 pandemic. Gratitude interventions seem suitable for improving mental well‐being for temporary mental challenges of university students such as a pandemic or other forms of crisis.

Nostalgia, Gratitude, or Optimism: The Impact of a Two-Week Intervention on Well-Being During COVID-19

Research indicates that brief 2-min positive psychology interventions (PPIs) increase well-being during COVID-19 lockdowns. The present study extended this to assess the effectiveness over two-weeks. Participants (n = 150) were randomly allocated to one of three PPIs; nostalgia, gratitude, best possible self (BPS), or control. The interventions were slightly adapted for the lockdown and were completed three times, every seven days over two-weeks. Well-being measures were completed immediately after the first intervention (T1), after the next two interventions (T2-T3) and at one-week follow-up (T4) (but no baseline measure of well-being was taken). At T1, participants in the nostalgia, gratitude, and BPS intervention had higher self-esteem than those in the control intervention. At T1 and T2, participants in the gratitude and BPS intervention reported higher social connectedness than participants in the nostalgia and control intervention. Then at follow-up (T4), participants in the nostalgia, gratitude, and BPS intervention had lower fear of COVID-19 than those in the control intervention. Overall, the results show the benefits of nostalgia, gratitude and optimism, compared to the control, during lockdown.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10902-022-00513-6.

Experimental Phenomenology as an Approach to the Study of Contemplative Practices

During history humans have developed a large variety of contemplative practices, in many different areas of life, and as part of many different traditions and contexts. Although some contemplative practices are very old, the research field of Contemplation Studies is young, and there are no agreed-upon definitions of central concepts such as contemplative practices and contemplative experiences. The present paper focuses on contemplative practices, defined as practices that are engaged in for the sake of the contemplative experiences they afford (e.g., the contemplation of nature, or the contemplation of various aspects of being-in-the world). The purpose of the present paper is to discuss the potential of experimental phenomenology to contribute to the development of the research field of Contemplation Studies. Experimental phenomenology is defined as the investigation of phenomenological practices and their effects on experience. Phenomenological practices involve intentional variations of experiencing by means of changes in the direction of attention and the choice of attitude, typically as guided by verbal instructions or self-instructions. It is suggested that contemplative practices represent a subcategory of phenomenological practices. Two different varieties of experimental phenomenology are described and illustrated in the present paper: (1) an informal variety which involves the development of new phenomenological practices by creative variation of procedures and observation of effects; and (2) a more rigorously scientific variety, which involves the systematic variation of phenomenological practices in accordance with experimental designs to study their experiential effects. It is suggested that the development of contemplative practices during the ages is the result of an informal experimenting of the first kind; this variety of experimental phenomenology can also be used to develop personalized health interventions in a clinical setting. As to the more rigorously scientific experimental phenomenology, it is possible that it may lead not only to an improved understanding of general principles underlying contemplative practices, but also to a more systematic development of new contemplative practices. The experimental-phenomenological approach to contemplative practices is illustrated by various examples involving mindfulness, gratitude, receiving and giving.

Gratitude as Mood Mediates the Effects of a 6-Weeks Gratitude Intervention on Mental Well-Being: Post hoc Analysis of a Randomized Controlled Trial

There is a gap of knowledge about the extent to which gratitude is indeed the working mechanism of change in gratitude interventions aiming to promote mental well-being. This study explores the mediational role of gratitude as mood in the context of a recently conducted randomized controlled trial on the effects of a 6-week gratitude intervention on mental well-being in comparison with a waitlist control group. Gratitude as mood was measured at 2, 4, and 6 weeks. Both simple and multiple mediation models were conducted as well as various sensitivity analyses. Results showed a gradual increase of gratitude as mood during the intervention. The effects of the 6-week gratitude intervention on mental well-being were mediated by increases of gratitude as mood at 4 weeks but not at 2 weeks. These findings suggest a dose-response relationship for gratitude interventions, but more research is warranted.

Feeling grateful to be optimistic: The influence of recalling special moments on feelings of gratitude and optimism during the COVID-19 pandemic

In one experiment, we tested the influence of bringing to mind the memory of a special moment versus an ordinary moment from high school on gratitude and the relationship between gratitude and optimism. Participants were first asked to report how the current pandemic has affected their lives. After, participants were randomly assigned to either recalling a special moment from their high school years or recalling an ordinary event from the same life period. Participants then completed a battery of questionnaires assessing gratitude, optimism and some demographics. Results showed a positive influence of bringing to mind the memory of a special moment on gratitude. Gratitude was then positively related to optimism. Hence, the positive relationship between recalling a special event and optimism was mediated by gratitude. Our results showed that brief interventions might help individuals see a brighter future under the current difficult conditions of prolonged lockdowns.

The Work Gratitude Scale: Development and Evaluation of a Multidimensional Measure

This study explores gratitude as a multidimensional and work-specific construct. Utilizing a sample of 625 employees from a variety of positions in a medium-sized school district in the United States, we developed and evaluated a new measure, namely the Work Gratitude Scale (WGS), which encompasses recognized conative (intentional), cognitive, affective, and social aspects of gratitude. A systematic, six-phased approach through structural equation modeling (SEM) was used to explore and confirm the factorial structure, internal consistency, measurement invariance, concurrent, convergent, and discriminant validity of the WGS. The results supported a 10-item measure with three dimensions: "grateful appraisals" (three items), "gratitude toward others" (four items), and "intentional attitude of gratitude" (three items). Thereafter, first-order, second-order, and bifactor confirmatory models were estimated and compared. Work gratitude was found to be best described by a second-order construct with three underlying first-order dimensions. Measurement invariance was supported in relation to gender. Concurrent validity was supported in relation to two existing dispositional gratitude scales, namely the Gratitude Questionnaire and the Gratitude, Resentment, and Appreciation Scale (GRAT). Convergent validity was supported in relation to the Core Self-Evaluations Scale (CSES) and the Psychological Capital Questionnaire. Discriminant validity was supported in relation to various demographic factors such as age, gender, occupation, and tenure. The findings support the WGS as a multidimensional measure that can be used in practice to measure overall work-related gratitude and to track the effectiveness of gratitude-related workplace interventions.

A Brief Gratitude Writing Intervention Decreased Stress and Negative Affect During the COVID-19 Pandemic

Exploring ways to mitigate the stress of the COVID-19 pandemic is important for long-term health. Expressive and gratitude-focused writing are effective methods to help individuals process traumatic or stressful events. Gratitude-focused writing may yield additional benefits because it helps individuals appraise events positively. We hypothesized that an online gratitude writing intervention would yield greater benefits than an expressive writing intervention or control group. Participants were randomized to one of three groups and completed assessments one-week and one-month post-intervention. The gratitude writing group maintained gratitude levels and decreased stress and negative affect at one-month post-intervention. The expressive writing group decreased in gratitude and showed no changes in stress or negative affect at one-month post-intervention. The control group decreased in gratitude and negative affect and showed no changes in stress at one-month post-intervention. Gratitude writing may be a better resource for dealing with stress and negative affect than traditional expressive writing methods under extremely stressful situations with uncertain trajectories.

Gratitude Moderates the Relation between Daily Hassles and Satisfaction with Life in University Students

Satisfaction with life as a judgmental cognitive process can be negatively influenced by appraisals of daily events such as hassles. Trait-gratitude-a tendency to appraise, recognize and respond to life events through being grateful-is a determinant of mental health and well-being, and has been shown to be related to the positive appraisal of life. The aim of the current study was to investigate the moderating role of trait-gratitude in the relationship between daily hassles and satisfaction with life. In the process of carrying out this study, the French version of the Gratitude Questionnaire (GQ-6) was validated. A total of 328 French undergraduates completed questionnaires measuring gratitude, satisfaction with life, and daily hassles to test the main hypothesis. They also completed optimism, coping strategies, depression, and anxiety questionnaires in order to assess the convergent validity of the French version of the GQ-6. First, the results showed satisfactory psychometric properties of the Gratitude Questionnaire. Second, the results indicated the moderating role of trait-gratitude in the relationship between daily hassles disturbance and satisfaction with life. This study further documents the role of gratitude as a determinant of well-being and provides French-speaking clinicians and researchers with a useful tool to measure grateful disposition.

A Co-Created Methodological Approach to Address the Relational Dimension of Environmental Challenges: When Critical Legal Analysis Meets Illustrated Storytelling

Environmental education research needs to take into account the relational dimension of the ecological challenges of our time. It requires the development of methodological techniques that prioritize community concerns, and generally foster positive relational dynamics of the research and study group. This leads to the construction of a research and educational approach around the collective and cocreated interpretation of stories related to ecological bonds and knowledge, and the adoption of illustrations enabling participation, inclusion, and interaction among the parties. Through the lens of critical legal analysis and participatory research, we explore the beneficial effects of cocreating knowledge with the help of a specific learning toolkit (LT), built around storytelling and designed to stimulate respectful relationships between participants. The LT addresses a wide audience of indigenous and local communities, students, and researchers. Founded on participated storytelling, collective interpretation, and illustration, the toolkit includes (1) the project cover, (2) an illustrated handbook based on an indigenous story, and (3) the illustration and conceptualization of a silent book. Through the interpretation of stories on the ecological bonds between humans and nonhumans, we analyze how the process of looking for common solutions to environmental threats makes participants reflect on their relational connection to the theme and each other. We also observe how the discussion generates a sense of responsibility that comes with bringing a new idea into being. The result is that both education and research become part of the solution to the challenge itself in the shape of a harmonious relational and transformative experience. The solution lies in the recognition of the individual and collective capacity to change systems by changing relationships. Only through a collective effort towards a common sense of relational accountability and trust we can heal the wounds of our planet, and our individual and collective wounds.

Creating joy in the workplace

Creating a joyful workplace is not the same as dealing with issues of stress, fatigue, burn-out, and resilience. It requires a proactive approach to augment feelings of worth, appreciation, and well-being in the members of the team. The sense that one is pursuing worthwhile, valuable activities requires a wholesale commitment to the mission, vision and values of the organization. These tenets are often created through an organic consensus of collegial workmates and then put to action by a leadership team. Reassessing the goals and virtues of the organization at appropriate intervals leads to ongoing loyalty and commitment to the team and a positive attitude. Well-being is addressed through the creation of a bright and cheerful physical and psychosocial workplace that offers programs that encourage mindfulness, humor, playfulness, and fitful lifestyle choices. The sense that one's work is appreciated and valued stems from an attitude of gratitude on behalf of all levels of the organization including management and peers where such encouragement flourishes. Those expressions of appreciation may be in the form of celebrations in the workplace and/or compensation and benefits that appropriately value the contributions of the employee. The organization's executive team should be dedicated to crafting an environment that leads to delighted, healthy employees.

The Model for Sustainable Mental Health: Future Directions for Integrating Positive Psychology Into Mental Health Care

This position paper proposes a model for systematic integration of positive psychology interventions (PPIs) in mental healthcare. On the one hand, PPIs can contribute to the decrease of dysfunctional processes underlying mental illness. This evidence is at the core of the new domains of positive clinical psychology and positive psychiatry. On the other hand, a growing number of studies demonstrate that mental health is not merely the absence of mental illness. Mental wellbeing represents a related but separate dimension of mental health. Mental wellbeing reduces the risk of future incidence of mental illness and is highly valued by people receiving psychological treatment as an important aspect of personal and complete recovery and personal growth. This makes mental wellbeing a vital outcome of mental healthcare. PPIs can directly increase mental wellbeing. The model of sustainable mental health is presented integrating the science of positive psychology and mental wellbeing into mental healthcare. This heuristic model can guide both practitioners and researchers in developing, implementing, and evaluating a more balanced, both complaint- and strength-oriented, treatment approach. The role of gratitude interventions is discussed as an example of applying the model. Also, three potential modalities for implementing PPIs as positive psychotherapy in treatment are as: positive psychotherapy as primary treatment, as combinatorial treatment, and as intervention for personal recovery of people with severe or persistent mental disorder. Finally, we argue that longitudinal studies are needed to substantiate the model and the processes involved.

Practicing Other-Focused Kindness and Self-Focused Kindness Among Those at Risk for Mental Illness: Results of a Randomized Controlled Trial

People with reduced levels of mental well-being might be at risk for developing future mental illness. Although several positive psychology interventions successfully improve mental well-being and psychological distress, less is known about their efficacy in a sample at risk for mental disorders. A Dutch sample of 289 participants with low or moderate levels of well-being were randomly assigned to other-focused kindness with reflection, other-focused kindness without reflection, self-focused kindness, or waitlist control (Trial register: NTR6786). Results of multilevel growth curve analyses revealed that other-focused kindness, but not self-focused kindness, led to improvements in the primary outcome mental well-being relative to waitlist control up to 6-week follow-up. By contrast, only other-focused kindness without reflection led to improvements in psychological distress. The three kindness conditions mainly did not differ from one another, and mainly no differences were found up to 6-months follow-up. An exception was that perceived stress was significantly more reduced up to 6-week and 6-months follow-up when people practiced other-focused kindness without reflection then when participants had practiced self-focused kindness. These findings point to the benefits of practicing kindness for others when people might be at risk for future mental illness. The study also indicates that reflecting about practicing kindness does not seem to have added value.

Do Social Ties Moderate the Association between Childhood Maltreatment and Gratitude in Older Adults? Results from the NEIGE Study

Background: Childhood maltreatment can impede gratitude, yet little is known about the older population and its moderators. The aim of this study is to clarify the association between childhood maltreatment and levels of gratitude of the older population, and the moderating effect of social ties on the association. Methods: We analyzed the data of 524 community-dwelling older adults aged 65–84 years without functional disabilities in Tokamachi City, Niigata, Japan, collected for the Neuron to Environmental Impact across Generations (NEIGE) study in 2017. Using a questionnaire, the participants rated three types of childhood maltreatment before the age of 18 (physical abuse, emotional neglect, and psychological abuse), level of gratitude, and social ties. Results: We found an inverse association between emotional neglect and gratitude. Furthermore, emotional neglect was inversely associated with gratitude only for those with lower levels of social ties. Conclusions: Promoting social ties may mitigate the adverse impact of emotional neglect on the level of gratitude.

The Influence of Human Support on the Effectiveness of Digital Mental Health Promotion Interventions for the General Population

Mental wellbeing amongst the general population is languishing—exacerbated by the Coronavirus Disease 2019 (COVID-19) pandemic. Digital mental health promotion interventions, that improve mental health literacy and encourage adoption of evidence-informed practical strategies are essential. However, attrition and non-adherence are problematic in digital interventions. Human support is often applied as an antidote; yet, there is a paucity of randomized trials that compare different human support conditions amongst general population cohorts. Limited trials generally indicate that human support has little influence on adherence or outcomes in DMHPIs. However, providing participants autonomy to self-select automated support options may enhance motivation and adherence.