Gratitude and hedonic and eudaimonic well-being in Vietnam war veterans

Abstract

Little information exists on the contribution of psychological strengths to well-being in persons with post-traumatic stress disorder (PTSD). Data from other populations suggest that gratitude, defined as the positive experience of thankfulness for being the recipient of personal benefits, may have salutary effects on everyday functioning. We investigated whether dispositional gratitude predicted daily hedonic and eudaimonic well-being in combat veterans with and without PTSD. We also examined associations between daily gratitude and daily well-being across time. Veterans with PTSD, compared to those without PTSD, exhibited significantly lower dispositional gratitude; no differences were found on daily gratitude. Dispositional gratitude predicted greater daily positive affect, percentage of pleasant days over the assessment period, daily intrinsically motivating activity, and daily self-esteem over and above effects attributable to PTSD severity and dispositional negative and positive affect in the PTSD group but not the non-PTSD group. Daily gratitude was uniquely associated with each dimension of daily well-being in both groups. Although preliminary, these results provide support for the further investigation of gratitude in trauma survivors.

Introduction

A large literature exists on the contribution of pathological characteristics to impaired functioning and diminished quality of life in persons with post-traumatic stress disorder (PTSD; e.g., Zatick et al., 1997; van der Kolk, 2001). Recently, researchers are increasing attention to protective factors that decrease the likelihood of distress and pathological outcomes in trauma survivors (e.g., hardiness, social support: King, King, Fairbank, Keane, & Adams, 1998; sense of coherence: Frommberger et al., 1999; hope: Crowson, Frueh, & Snyder, 2001; Irving, Telfer, & Blake, 1997). These studies have almost exclusively relied on global self-report measures to assess protective factors. In this paper, we sought to extend this line of research by examining relationships between the interpersonal strength of gratitude (Emmons & Shelton, 2002) with day-to-day hedonic and eudaimonic well-being in veterans with and without PTSD.

A small body of literature has found that some trauma survivors, in addition to negative outcomes, report positive outcomes following trauma such as enhanced social relationships and a renewed sense of meaning in life (see Tedeschi, Park, & Calhoun, 1998 for review). We believe a neglected area of resilience following traumatic events is the experience of gratitude, which involves active, mindful attention to the positive benefits, values, and experiences in daily life (see McCullough, Kilpatrick, Emmons, & Larson, 2001 for review). Appreciation and thankfulness for being the recipient of personal benefits from others (e.g., people, spiritual sources, luck) may serve as a channel to living a more satisfying and meaningful life. Gratitude emerges from two information-processing stages: (1) recognizing positive personal experiences, and (2) attributing these positive experiences to an external source¹ (McCullough et al., 2001). Gratitude is a moderately pleasant and activating emotion (Emmons & McCullough, 2003) that, following a trait-state model, can be operationalized as an enduring disposition (individual differences in gratitude experiences: McCullough, Emmons, & Tsang, 2002) or a momentary emotional experience.

Initial studies with non-psychiatric samples indicate that being grateful is positively associated with well-being and adaptive behavior (Emmons & Shelton, 2002; McCullough, Emmons, & Tsang (2002), McCullough, Kilpatrick, Emmons, & Larson (2001)). Replications of these results in experiments that randomly assigned participants to keep daily self-reports of either gratitude, hassles, impactful events, or downward social comparisons suggest that it is unlikely that gratitude is simply an epiphenomenon associated with high life satisfaction (Emmons & McCullough, 2003). In two independent studies, as an example, the gratitude intervention enhanced positive affect and gratitude. To test whether increases in gratitude were merely a function of changes in positive affect, positive affect was examined as a mediator of the interventions’ effect on gratitude. Both studies found that the effects of the intervention on gratitude were not simply a function of the intervention's impact on global, daily positive emotions (see Emmons & McCullough, 2003 for details on analyses). Rather, reports of gratitude fully accounted for the intervention's effect on positive affect.

Fredrickson's (2000) “broaden and build” model of positive emotions provides a framework for understanding how gratitude might have salutary effects on well-being. This model hypothesizes that positive emotions broaden repertoires of cognition and behavior (Folkman & Moskowitz, 2000; Fredrickson & Branigan, in press), build personal resources (Fredrickson, Tugade, Waugh, & Larkin, 2003), and “undo” the adverse physiological effects of negative emotions (Fredrickson & Levenson, 1998; Tugade & Fredrickson, 2004). The potential broadening and building effects of gratitude are partially supported by recent studies. Data suggest that the daily practice of being grateful increases the likelihood that an individual will help someone with a personal problem (i.e., prosocial behavior), and improves sleep and exercise habits (Emmons & McCullough, 2003; McCullough et al., 2001). A study of 2616 twins in the general population found that stronger feelings of thankfulness reduced the risk of meeting diagnostic criteria for various internalizing and externalizing psychiatric disorders (Kendler et al., 2003). Similarly, gratitude was shown to be a common emotion following the terrorist attacks on September 11, 2001, and stronger feelings of gratitude were related to less psychological distress (Fredrickson et al., 2003). Thus, there is some evidence showing that gratitude should be considered an element of resilience.

Theories of PTSD-related cognitive and emotional processing (Ehlers & Clark, 2000; Litz, 1992) provide a rationale for investigating the contribution of gratitude to psychological well-being in trauma survivors. PTSD symptoms are maintained, according to these models, by overt and covert experiential avoidance behavior, such as the evasion of situations that trigger intrusive cognitions, dissociation, rumination, and emotional numbing (Ehlers & Clark, 2000; Litz, 1992). These avoidance behaviors reduce opportunities for survivors to process and integrate trauma experiences with other autobiographical memories, which maintain the persistence of fears. Experiential avoidance behaviors such as ruminating about the trauma experience and being “frozen” in the trauma time frame (Ehlers & Clark, 2000) can also be expected to directly diminish well-being. Because attention is a limited resource (during any given period), an excessive focus on past negative events precludes attending to present positive stimuli (e.g., savoring of positive events, experiential acceptance). Furthermore, these models (Ehlers & Clark, 2000; Litz, 1992) posit that the frequent triggering of trauma-related memories, sensations, and emotions disrupt self-regulatory abilities. Purportedly the triggering of trauma-related sensations also increases the frequency of mood-congruent aversive experiences such as intense negative emotions and self-appraisals. These downward emotional spirals are proposed to interfere with the accessibility of positive experiences and the mobilization of behaviors toward personally meaningful goals.² As noted, gratitude is generated by being mindful of positive experiences and attributing them to external sources, and appears to broaden an individual's cognitive and behavioral repertoire. The experience of greater gratitude might limit access to the trauma network by inducing a more present, positive time perspective (e.g., Foa, Steketee, & Rothbaum, 1989). Greater gratitude may also counter the adverse effects of trauma triggers and associated avoidance behaviors by facilitating the experience of positive affect, and engagement in social and other adaptive activities.

A complementary or alternate way to conceptualize mechanisms by which gratitude might improve well-being in persons with PTSD is that it operates on well-being in the same manner as with non-psychiatric populations by harnessing physiological, cognitive, and behavioral aspects of trauma survivors that are not compromised by PTSD. As described, Fredrickson's broaden and build model (2000) suggests that the experience of positive emotions, such as gratitude, undoes the adverse physiological effects of negative emotions and increases the flexibility of individual's cognitive and behavioral coping strategies.

The examination of both day-to-day hedonic and eudaimonic well-being in this paper is based on a view that wellness is more than the absence of distress. Such a perspective demands that well-being be measured in a broader way than simply documenting absence of disorder or distress as in many previous studies. Individuals can be without disorder and, at the same time, experience less than satisfactory personal relationships, self-determination in activities and choices, and feelings of self-regard. Hedonic well-being is conceptualized as the experience of pleasant emotions in one's life. Hedonic well-being is more commonly referred to as happiness or life satisfaction in psychological literature, and is defined in the now large body of work on subjective well-being (see Diener, Suh, Lucas, & Smith, 1999 for overview) as the presence of life satisfaction, frequent positive emotions, and infrequent negative emotions. Assessments of these three components typically involve soliciting individuals’ affective and cognitive appraisals of their overall life and current experiences. Eudaimonic well-being is conceptualized as the experience of enriching activities and personal growth. Despite the tendency for happiness to be equated with hedonic well-being, particularly in modern Western societies, social thinkers as early as Aristotle suggest that well-being is more than the experience of pleasant feelings and physical pleasures (e.g., sex, drugs, rock n’ roll, chocolate). In Aristotelian philosophy, the two essentials of being happy (i.e., experiencing the “good” life or eudaimonia) are thought to be engaging in activities that (1) are freely chosen and desired for their own sake (i.e., intrinsically motivating activity) and (2) provide opportunities to maximize one's potential and foster genuine positive relations with others. The satisfaction of the need to belong is thought of as a necessary (but not sufficient) condition for human flourishing (Aristotle, 1962). (In other philosophical and religious traditions, such as Buddhism, attachment to pleasure is even conceived of as a hindrance to achieving happiness; Rahula, 1996.) In the more recent psychological literature on eudaimonic well-being (Ryff & Singer (1998), Ryff & Singer (2000)), eudaimonia is defined as engagement in purposeful and meaningful activities that provide opportunities for personal growth, positive relations with others, feelings of mastery, and positive self-regard. Although several components of eudaimonic well-being are strongly associated with pleasant emotions (e.g., Kashdan, Rose, & Fincham, 2004; Watson, Clark, McIntyre, & Hamaker, 1992), hedonic and eudaimonic well-being are distinguishable but related dimensions (Keyes, Shmotkin, & Ryff, 2002) with diverse correlates, predictors, and trajectories (see Ryan & Deci, 2001 for review). Measuring day-to-day well-being is thought to provide a richer and more accurate picture of actual, ecological functioning than global self-reports (Stone et al., 1999).

We evaluated the degree to which dispositional and daily gratitude were associated with daily hedonic and eudaimonic well-being in Vietnam War veterans with and without PTSD. Dispositional or trait gratitude was assessed with a psychometrically sound, self-report questionnaire (McCullough et al., 2002). Daily gratitude was assessed using an experience sampling approach. Subsequent to completing trait measures, participants were asked to complete daily self-reports for 2 weeks in which they rated how grateful and appreciative they felt over the course of the day. Well-being was assessed using a similar approach. Participants, in their daily reports, rated the extent to which they experienced hedonic well-being (i.e., positive versus negative affect; e.g., Diener et al., 1999; Kashdan, 2004), and eudaimonic well-being (i.e., positive self-regard, rewarding social activity, and opportunity for personal growth; Seligman & Csiksentmihalyi, 2000; Ryff & Singer, 1998). Rewarding social activity was defined as social participation and social connectedness (e.g., feeling cared for and understood by others), both of which have been found to be associated with psychological and physical health (e.g., Watson, 1988; Watson et al., 1992; Uchino, Cacioppo, & Kiecolt-Glaser, 1996). Opportunity for personal growth was defined as engagement in intrinsically motivating activity, for arguably, “no single phenomenon reflects the positive potential of human nature as much as intrinsic motivation, the inherent tendency to seek out novelty and challenges, to extend and exercise one's capacities, to explore, and to learn” (Ryan & Deci, 2000, p. 70). To our knowledge, this is the first empirical study of gratitude (as well as the first to examine everyday well-being) in trauma survivors.

We hypothesized that gratitude and well-being would be lower in the PTSD than the non-PTSD group and that greater trait gratitude would predict greater daily well-being in each of the groups. In addition, we hypothesized that daily gratitude would covary with daily well-being across time. Daily gratitude was expected to be more strongly related to daily well-being than trait gratitude. This is because of the temporal proximity between daily gratitude experiences and daily well-being. Furthermore, both of these states are based on the retrieval of specific memories (episodic knowledge), as opposed to trait gratitude, which is based on generalized beliefs and biased memories of oneself (semantic knowledge) (Robinson & Clore, 2002). Gratitude was expected to be related to both hedonic and eudaimonic well-being because of the studies discussed above that have found positive associations between gratitude and (a) positive affect and (b) rewarding social activity (Emmons & Shelton, 2002; McCullough, Emmons, & Tsang (2002), McCullough, Kilpatrick, Emmons, & Larson (2001)). To address the alternative hypothesis that any gratitude effects were artifacts of the distress experienced by war veterans, we tested whether gratitude contributed to well-being independently of PTSD severity and trait negative affect. Disconfirmation of this alternate hypothesis would provide some evidence for the view that well-being is more complex than low psychological distress. Moreover, as a test of incremental validity, analyses were conducted to determine whether relations between gratitude and well-being were a spurious function of positive affect rather than the unique facets of gratitude. We posit that studying the role of gratitude in daily living may advance our understanding of individual and interpersonal functioning following traumatic and stressful events, offering insights into resilience and novel interventions.