Elsevier

Clinical Psychology Review

Volume 30, Issue 7, November 2010, Pages 890-905
Clinical Psychology Review

Gratitude and well-being: A review and theoretical integration

https://doi.org/10.1016/j.cpr.2010.03.005Get rights and content

Abstract

This paper presents a new model of gratitude incorporating not only the gratitude that arises following help from others but also a habitual focusing on and appreciating the positive aspects of life", incorporating not only the gratitude that arises following help from others, but also a habitual focusing on and appreciating the positive aspects of life. Research into individual differences in gratitude and well-being is reviewed, including gratitude and psychopathology, personality, relationships, health, subjective and eudemonic well-being, and humanistically orientated functioning. Gratitude is strongly related to well-being, however defined, and this link may be unique and causal. Interventions to clinically increase gratitude are critically reviewed, and concluded to be promising, although the positive psychology literature may have neglected current limitations, and a distinct research strategy is suggested. Finally, mechanisms whereby gratitude may relate to well-being are discussed, including schematic biases, coping, positive affect, and broaden-and-build principles. Gratitude is relevant to clinical psychology due to (a) strong explanatory power in understanding well-being, and (b) the potential of improving well-being through fostering gratitude with simple exercises.

Introduction

Throughout this special issue, contributors have highlighted the clinical importance of various aspects of positive functioning, such as positive affect (Watson & Naragon-Gainey, this issue), positive emotions (Garland, Fredrickson, Kring, Johnson, Meyer, & Penn, 2010-this issue), psychological flexibility (Kashdan & Rottenberg, this issue), and optimism (Carver, Scheier, & Segerstrom, 2010-this issue), as well as the implications of these findings for conducting research in clinical psychology (Joseph & Wood, 2010-this issue). As these reviews show, at a broad level, positive functioning can explain unique variance in understanding disorder and clinically relevant characteristics. Constructs such as optimism have a long lineage of clinical and health research, and have already been integrated into established practice. This review considers the role of gratitude in well-being, and the potential of interventions that facilitate gratitude to contribute to the treating of disorder. Unlike constructs such as optimism, until very recently gratitude has been one of the most unstudied emotions (McCullough et al., 2002, Wood et al., 2007b), despite having been historically considered essential to normal functioning in philosophical and theological accounts (Emmons & Crumpler, 2000), and 67% of young people reporting expressing gratitude “all of the time” (Gallup, 1999). As with other understudied aspects of positive functioning (Linley, Joseph, Harrington, & Wood, 2006), the previous low knowledge base in gratitude provided the opportunity for rapid scientific progress (cf., Gable & Haidt, 2005).

In recent years a very large body of evidence has emerged suggesting that gratitude is strongly related to all aspects of well-being, on the basis of which promising clinical interventions have been developed (e.g., Bono et al., 2004, Emmons and McCullough, 2003), in fitting with calls to explore the potential for improving disorder through fostering positive functioning and psychological strengths (Duckworth et al., 2005, Linley et al., 2009, Seligman et al., 2006). This paper presents the first review of the burgeoning literature on gratitude and well-being, and reviews the potential of interventions to increase gratitude as a way of increasing well-being and improving disorder, as well as considering the necessary future research and developments for these interventions to become used in mainstream clinical practice. This review presents a new integrative framework for gratitude research, conceptualizing the trait as involving a life orientation towards noticing and appreciating the positive in life. Gratitude is shown to relate to various clinically relevant phenomena, including psychopathology, adaptive personality characteristics, health, positive relationships, subjective and eudemonic well-being, and humanistically orientated functioning. Four forms of interventions to increase gratitude are critically considered, along with methodological critiques, and a research agenda for the future study of these techniques. Finally, four mechanisms whereby gratitude may relate to well-being are evaluated, including characteristic schematic processing, coping, the general benefits of positive affect, and mechanisms suggested by broaden-and-build theory. The review argues that gratitude is a key underappreciated trait in clinical psychology, of relevance due to a strong, unique, and causal relationship with well-being, and due to the potential to use simple and easy techniques to increase gratitude alongside existing clinical interventions.

Section snippets

Defining trait gratitude

Within the field of gratitude research, there is a lack of agreement about the nature of the construct. In part, gratitude is an emotion which occurs after people receive aid which is perceived as costly, valuable, and altruistic (Wood, Maltby, Stewart, Linley, & Joseph, 2008). On this basis, several researchers have conceptualized gratitude as an emotion that is always directed towards appreciating the helpful actions of other people (c.f. McCullough, Kilpatrick, Emmons, & Larson, 2001). This

Research into gratitude and personality, well-being, relationships and health

If gratitude is a life orientation towards the positive, then it should have a wide range of adaptive correlates. Research into the individual differences in gratitude has largely focused on four areas, (a) relationships to other personality traits, (b) various indicators of well-being, (c) social relationships and socially facilitative behavior, and (d) physical health. Research in to these four areas has led to a consistent picture of gratitude being important for well-being, broadly defined.

Gratitude interventions

If gratitude is strongly related to well-being, and there is an indication that this relationship may be unique and causal, the question arises on how to increase gratitude therapeutically. Gratitude interventions have commonly been highlighted as a key success of the positive psychology movement (Bono et al., 2004, Seligman et al., 2005), and as an especially clinically relevant technique (Duckworth et al., 2005, Seligman et al., 2006). As shown in Table 5, there have now been 12 published

Mechanisms linking gratitude to well-being

Mechanisms linking gratitude and well-being may be different for gratitude interventions and for gratitude as a personality trait. Currently there is little evidence to show that gratitude interventions operate through the mechanisms of increased gratitude. Whilst it may seem intuitively obvious that this is the case, it is not logical to say (a) gratitude interventions increase well-being, and (b) gratitude interventions increase gratitude, therefore (c) gratitude interventions increase

Conclusion and future directions

The research reviewed suggests that gratitude is related to a variety of clinically relevant phenomena, including psychopathology (particularly depression), adaptive personality characteristics, positive social relationships, and physical health (particularly stress and sleep). Further many of these relationships may be unique, as gratitude can explain variance in the outcome after controlling for 50 of the most studied traits in psychology, suggesting that gratitude may be able to add a

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