Gratitude Interventions: Effective Self-help? A Meta-analysis of the Impact on Symptoms of Depression and Anxiety

Abstract

Research suggests gratitude interventions—designed to increase appreciation of positive qualities, situations, and people in one’s life—may improve psychological well-being (e.g., Seligman et al. in Am Psychol 60:410–421, 2005. https://doi.org/10.1037/0003-066X.60.5.410). Accordingly, mental health practitioners have promoted gratitude interventions as a means of self-help. However, results from previous reviews suggest that well-being improvements associated with gratitude interventions may be attributable to placebo effects (Davis et al. in J Couns Psychol 63:20–31, 2016. https://doi.org/10.1037/cou0000107; Wood et al. in Clin Psychol Rev 30:890–905, 2010, https://doi.org/10.1016/j.cpr.2010.03.005). With this meta-analysis, we examined the efficacy of gratitude interventions (k = 27, N = 3675) in reducing symptoms of depression and anxiety at post-test and follow-up periods. Gratitude interventions had a small effect on symptoms of depression and anxiety at both post-test (g = − 0.29, SE = 0.06, p < .01) and follow-up (g = − 0.23, SE = 0.06, p < .01). Correcting for attenuation from unreliability did not change results. Moderation analyses indicated effect sizes were larger for studies using waitlist, rather than active, control conditions at post-test and follow-up. We did not find consistent evidence for effects of other moderator variables (e.g., risk of bias, depressive symptom severity, or type of intervention used). Our results suggest the effects of gratitude interventions on symptoms of depression and anxiety are relatively modest. Therefore, we recommend individuals seeking to reduce symptoms of depression and anxiety engage in interventions with stronger evidence of efficacy for these symptoms.

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Notes

  1. 1.

    Additional outcomes reviewed included body dissatisfaction, changes in positive and negative affect, life satisfaction, sleep quality, and physical pain.

  2. 2.

    Following the recommendation of the Cochrane Collaboration (Higgins et al. 2017), we use the term “risk of bias” here rather than “study quality”, as a study may be of the highest possible quality, yet still contain important sources of bias.

  3. 3.

    If authors did not report sample sizes for individual groups, we assumed equal sample sizes by dividing the combined study sample by the number of groups in the study.

  4. 4.

    One study included follow-up data without reporting pre-test data (Ozimkowski 2007). Thus, we did not include follow-up data for this study.

  5. 5.

    We ran our analyses with and without these studies (k = 2). Results changed by only two-hundredths of a decimal point. Therefore, we retained the aggregated studies in all final analyses.

  6. 6.

    These studies did not include follow-up data.

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Acknowledgements

The authors would like to extend their sincerest thanks to Owen Morrish for his assistance with data extraction and the risk of bias assessment.

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Cregg, D.R., Cheavens, J.S. Gratitude Interventions: Effective Self-help? A Meta-analysis of the Impact on Symptoms of Depression and Anxiety. J Happiness Stud 22, 413–445 (2021). https://doi.org/10.1007/s10902-020-00236-6

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Keywords

  • Gratitude
  • Thanks
  • Intervention
  • Positive psychology
  • Depression
  • Anxiety