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The Role of Gratitude in Breast Cancer: Its Relationships with Post-traumatic Growth, Psychological Well-Being and Distress

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Abstract

Despite the increasing number of studies documenting the positive effects of gratitude in coping with traumatic events and facilitating psychological well-being, none is addressed to patients with life-threatening illnesses such as cancer. The aims of this study are to examine the role of gratitude in a breast cancer sample and its correlations with post-traumatic growth, psychological well-being, and distress; and to compare patients reporting higher levels of gratitude (High Gratitude Individuals, HGI) versus those reporting lower levels (Low Gratitude Individuals, LGI). 67 breast cancer patients were assessed with: (1) Gratitude Questionnaire; (2) Post-traumatic Growth Inventory (PTGI); (3) Psychological Well-being Scales (PWBS) (4) Symptom Questionnaires (SQ); and were divided into: (1) High Gratitude Individuals—HGI (n = 27); (2) Low Gratitude Individuals—LGI (n = 40). Bivariate correlations between questionnaires and ANOVA between-group were calculated. Gratitude was significantly and positively correlated to all of PTGI scales, to PWBS positive relations, to SQ relaxation and contentment, and negatively related to anxiety, depression, and hostility-irritability. HGI and LGI reported significant differences on the PTGI and SQ dimensions, but not on PWB scales, with HGI displaying higher levels of PTGI, positive affect and lower symptomatology. Also in breast cancer patients gratitude is strongly associated to post-traumatic growth, reduced distress and increased positive emotions, but surprisingly not to psychological well-being. Since the majority of patients reported low gratitude levels, the results suggest the importance of developing interventions to clinically increase them also in oncology.

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References

  • Affleck, G., & Tennen, H. (1996). Construing benefits from adversity: Adaptational significance and dispositional underpinnings. Journal of Personality, 64(4), 899–922.

    Article  Google Scholar 

  • Antoni, M. H., Lehman, J., Kilbourn, K., Boyers, A., Culver, J., Alferi, S., et al. (2001). Cognitive–behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychology, 20(1), 20–32.

    Article  Google Scholar 

  • Belaise, C., Fava, G. A., & Marks, I. M. (2005). Alternatives to debriefing and modifications to cognitive behavior therapy for posttraumatic stress disorder. Psychotherapy and Psychosomatics, 74(4), 212–217.

    Article  Google Scholar 

  • Bellizzi, K. M., Smith, A. W., Reeve, B. B., Alfano, C. M., Bernstein, L., Meeske, K., et al. (2010). Posttraumatic growth and health-related quality of life in a racially diverse cohort of breast cancer survivors. Journal of Health Psychology, 15(4), 615–626.

    Article  Google Scholar 

  • Calhoun, L. G., & Tedeschi, R. G. (1989). Positive aspects of critical life problems: Recollections of grief. Journal of Death & Dying, 20(4), 265–272.

    Article  Google Scholar 

  • Cordova, M. J., Cunningham, L. L., Carlson, C. R., & Andrykowski, M. A. (2001). Posttraumatic growth following breast cancer: A controlled comparison study. Health Psychology, 20(3), 176–185.

    Article  Google Scholar 

  • Costanzo, E. S., Ryff, C. D., & Singer, B. H. (2009). Psychosocial adjustment among cancer survivors: Findings from a national survey. Health Psychology, 28(2), 147–156.

    Article  Google Scholar 

  • Davis, C. G., Nolen-Hoeksema, S., & Larson, J. (1998). Making sense of loss and benefiting from the experience: Two construals of meaning. Journal of Personality and Social Psychology, 75(2), 561–574.

    Article  Google Scholar 

  • Duckworth, A. L., Steen, T. A., & Seligman, M. E. P. (2005). Positive psychology in clinical practice. Annual Review of Clinical Psychology, 1(1), 629–651.

    Article  Google Scholar 

  • Emmons, R. A., & Crumpler, C. A. (2000). Gratitude as human strength: Appraising the evidence. Journal of Social and Clinical Psychology, 19(1), 56–69.

    Article  Google Scholar 

  • Emmons, R. A., & McCullough, M. E. (2003). Counting blessing versus burden: an experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377–389.

    Article  Google Scholar 

  • Emmons, R. A., & Shelton, C. S. (2002). Gratitude and the science of positive psychology. In C. R. Snyder & S. J. Lopez (Eds.), Handbook of positive psychology (pp. 459–471). New York: Oxford University Press.

    Google Scholar 

  • Fava, G. A., Kellner, R., Perini, G. I., Fava, M., Michelacci, L., Munari, F., et al. (1983). Italian validation of the Symptom Rating Test (SRT) and Symptom Questionnaire (SQ). Canadian Journal of Psychiatry, 28(2), 117–123.

    Google Scholar 

  • Fava, G. A., Rafanelli, C., Grandi, S., Conti, S., & Belluardo, P. (1998). Prevention of recurrent depression with cognitive behavioral therapy. Archives of General Psychiatry, 55(9), 816–820.

    Article  Google Scholar 

  • Fava, G. A., & Ruini, C. (2003). Development and characteristics of a well-being enhancing psychotherapeutic strategy: Well-being therapy. Journal of Behavior Therapy and Experimental Psychiatry, 34(1), 45–63.

    Article  Google Scholar 

  • Fava, G. A., Ruini, C., Rafanelli, C., Finos, L., Conti, S., & Grandi, S. (2004). Six year outcome of cognitive behavior therapy for prevention of recurrent depression. American Journal Psychiatry, 161(10), 1872–1876.

    Article  Google Scholar 

  • Fava, G. A., Ruini, C., Rafanelli, C., Finos, L., Salmaso, L., Mangelli, L., et al. (2005). Well-being therapy of generalized anxiety disorder. Psychotherapy and Psychosomatics, 74(1), 26–30.

    Article  Google Scholar 

  • Fava, G. A., & Sonino, N. (2009). Psychosomatic assessment. Psychotherapy and Psychosomatics, 78(6), 333–341.

    Article  Google Scholar 

  • Fredrickson, B. L. (1998). What good are positive emotions? Review of General Psychology, 2(3), 300–319.

    Article  Google Scholar 

  • Fredrickson, B. L., Tugade, M. M., Waugh, C. E., & Larkin, G. R. (2003). What good are positive emotions in crises? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001. Journal of Personality and Social Psychology, 84(2), 365–376.

    Article  Google Scholar 

  • Gallup, G. (1999). Survey results on “Gratitude”, adults and teenagers. Emerging Trends, 20(4–5), 9.

    Google Scholar 

  • Harrington, C. B., Hansen, J. A., Moskowitz, M., Todd, B. L., & Feuerstein, M. (2010). It’s not over when it’s over: Long-term symptoms in cancer survivors-a systematic review. Internal Journal of Psychiatry in Medicine, 40(2), 163–181.

    Article  Google Scholar 

  • Helgeson, V. S., Reynolds, K. A., & Tomich, P. L. (2006). A meta-analytic review of benefit finding and growth. Journal of Consulting and Clinical Psychology, 74(5), 797–816.

    Article  Google Scholar 

  • Henry, M., Cohen, S. R., Lee, V., Sauthier, P., Provencher, D., Drouin, P., et al. (2010). The Meaning-Making intervention (MMi) appears to increase meaning in life in advanced ovarian cancer: A randomized controlled pilot study. Psychooncology, 19(12), 1340–1347.

    Article  Google Scholar 

  • Horgan, O., Holcombe, C., & Salmon, P. (2011). Experiencing positive change after a diagnosis of breast cancer: A grounded theory analysis. Psychooncology, 20(10), 1116–1125.

    Google Scholar 

  • Joseph, S., & Wood, A. M. (2010). Assessment of positive functioning in clinical psychology: Theoretical and practical issues. Clinical Psychology Review, 30(7), 830–838.

    Article  Google Scholar 

  • Kashdan, T. B., Uswatte, G., & Julian, T. (2006). Gratitude and hedonic and eudaimonic well-being in Vietnam War veterans. Behaviour Research and Therapy, 44(2), 177–199.

    Article  Google Scholar 

  • Kellner, R. (1987). A symptom questionnaire. Journal of Clinical Psychiatry, 48(7), 269–274.

    Google Scholar 

  • Kendler, K. S., Liu, X., Gardner, C. O., McCullough, M. E., Larson, D., & Prescott, C. A. (2003). Dimensions of religiosity and their relationship to lifetime psychiatric and substance use disorders. American Journal of Psychiatry, 160(3), 496–503.

    Article  Google Scholar 

  • Lelorain, S., Bonnaud-Antignac, A., & Florin, A. (2010). Long term posttraumatic growth after breast cancer: Prevalence, predictors and relationships with psychological health. Journal of Clinical Psychology in Medical Settings, 17(1), 14–22.

    Article  Google Scholar 

  • McCullough, M. E., Emmons, R. A., & Tsang, J. (2002). The grateful disposition: A conceptual and empirical topography. Journal of Personality and Social Psychology, 82(1), 112–127.

    Article  Google Scholar 

  • McCullough, M. E., Kilpatrick, S. D., Emmons, R. A., & Larson, D. B. (2001). Is gratitude a moral affect? Psychological Bullettin, 127(2), 249–266.

    Article  Google Scholar 

  • McGregor, B. A., Antoni, M. H., Boyers, A., Alferi, S. M., Blomberg, B. B., & Carver, C. S. (2004). Cognitive–behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer. Journal of Psychosomatic Research, 56(1), 1–8.

    Article  Google Scholar 

  • Mehnert, A., & Koch, U. (2008). Psychological comorbidity and health-related quality of life and its association with awareness, utilization, and need for psychosocial support in a cancer register-based sample of long-term breast cancer survivors. Journal of Psychosomatic Research, 64(4), 383–391.

    Article  Google Scholar 

  • Mols, F., Vingerhoets, A. J., Coebergh, J. W., & Van de Poll-Franse, L. (2009). Well-being, posttraumatic growth and benefit finding in long-term breast cancer survivors. Psychology & Health, 24(5), 583–595.

    Article  Google Scholar 

  • Morris, B. A., & Shakespeare-Finch, J. (2011). Rumination, post-traumatic growth, and distress: Structural equation modelling with cancer survivors. Psychooncology, 20(11), 1176–1183.

    Google Scholar 

  • Peterson, C., Park, N., Pole, N., D’Andrea, W., & Seligman, M. E. P. (2008). Strengths of character and posttraumatic growth. Journal of Traumatic Stress, 21(2), 214–217.

    Article  Google Scholar 

  • Peterson, C., Park, N., & Seligman, M. E. P. (2005). Assessment of character strengths. In G. P. Koocher, J. C. Norcross & S. S. III Hill (Eds.), Psychologists’ desk reference (2nd ed., p. 93). New York: Oxford University Press.

  • Peterson, C., & Seligman, M. E. (2003). Character strengths before and after September 11. Psychological Science, 14(4), 381–384.

    Article  Google Scholar 

  • Pierce, C. A., Block, R. A., & Aguinis, H. (2004). Cautionary note on reporting eta-squared values from multifactor anova designs. Educational and Psychological Measurement, 64(6), 916–924.

    Article  Google Scholar 

  • Ruini, C., & Fava, G. A. (2009). Well-being therapy for generalized anxiety disorder. Journal of Clinical Psychology, 65(5), 510–519.

    Article  Google Scholar 

  • Ruini, C., Ottolini, F., Rafanelli, C., Ryff, C. D., & Fava, G. A. (2003). La validazione italiana delle Psychological Well-Being Scales (PWB). Rivista di Psichiatria, 38(3), 117–130.

    Google Scholar 

  • Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57(6), 1069–1081.

    Article  Google Scholar 

  • Ryff, C. D., & Singer, B. (1998). The contours of positive human health. Psychological Inquiry, 9(1), 1–28.

    Article  Google Scholar 

  • Seligman, M. E. P., Rashid, T., & Parks, A. C. (2006). Positive psychotherapy. American Psychologist, 61(8), 774–788.

    Article  Google Scholar 

  • Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9(3), 455–471.

    Article  Google Scholar 

  • Toepfer, S. M., Cichy, K., & Peters, P. (2012). Letters of gratitude: Further evidence for author benefits. Journal of Happiness Studies, 13(1), 187–201.

    Google Scholar 

  • Toussaint, L., & Friedman, P. (2009). Forgiveness, gratitude, and well-being: The mediating role of affect and beliefs. Journal of Happiness Studies, 10(6), 635–654.

    Article  Google Scholar 

  • Tugade, M. M., & Fredrickson, B. L. (2007). Regulation of positive emotions: Emotion regulation strategies that promote resilience. Journal of Happiness Studies, 8(3), 311–333.

    Article  Google Scholar 

  • Vernon, L. L., Dillon, J. M., & Steiner, A. R. W. (2009). Proactive coping, gratitude, and posttraumatic stress disorder in college women. Anxiety, Stress & Coping, 22(1), 117–127.

    Article  Google Scholar 

  • Wood, A. M., Froh, J. J., & Geraghty, A. W. A. (2010). Gratitude and well-being: A review and theoretical integration. Clinical Psychology Review, 30(7), 890–905.

    Article  Google Scholar 

  • Wood, A. M., Joseph, S., Lloyd, J., & Atkins, S. (2009a). Gratitude influences sleep through the mechanism of pre-sleep cognitions. Journal of Psychosomatic Research, 66(1), 43–48.

    Article  Google Scholar 

  • Wood, A. M., Joseph, S., & Maltby, J. (2008a). Gratitude uniquely predicts satisfaction with life: Incremental validity above the domains and facets of the five factor model. Personality and Individual Differences, 45(1), 49–54.

    Article  Google Scholar 

  • Wood, A. M., Joseph, S., & Maltby, J. (2009b). Gratitude predicts psychological well-being above the Big Five facets. Personality and Individual Differences, 46(4), 443–447.

    Article  Google Scholar 

  • Wood, A. M., Maltby, J., Gillett, R., Linley, P. A., & Joseph, S. (2008b). The role of gratitude in the development of social support, stress, and depression: Two longitudinal studies. Journal of Research in Personality, 42(4), 854–871.

    Article  Google Scholar 

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Acknowledgments

The Authors thank Dr Graziella Strappato and the Breast Cancer Centre medical team of S. Croce Hospital in Loreto (Italy) for their volunteer collaboration to this study.

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Authors and Affiliations

  1. Department of Psychology, University of Bologna, Viale Berti pichat, 5, 40127, Bologna, Italy

    Chiara Ruini & Francesca Vescovelli

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  1. Chiara Ruini
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  2. Francesca Vescovelli
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Correspondence to Chiara Ruini.

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Ruini, C., Vescovelli, F. The Role of Gratitude in Breast Cancer: Its Relationships with Post-traumatic Growth, Psychological Well-Being and Distress. J Happiness Stud 14, 263–274 (2013). https://doi.org/10.1007/s10902-012-9330-x

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