1. This randomized control trial found that gratitude-focused writing improved levels of stress as compared to expressive writing and controls.
2. Participants in the gratitude-focused writing group also showed decreases in negative affect but no improvements in positive affect.
Evidence Rating Level: 2 (Good)
The coronavirus disease 2019 (COVID-19) pandemic has created a global state of chronic stress. Consequently, it is critical that coping methods are identified that decrease anxiety and improve mood in the general population. Creative expression techniques can be implemented independently and may be modified by users to address their personal sources of distress. Particularly, creative expression focusing on gratitude may help highlight and amplify positive emotions and perspectives of difficult situations.
This randomized control trial evaluated mental wellbeing following one month of either gratitude-focused writing, expressive writing, or no intervention. Participants were included who were >18 years old, could communicate in English, and were able to complete an online survey. Participants were excluded if they did not have access to email. Gratitude was assessed with the Gratitude Adjective Checklist (GAC), and emotional wellbeing was measured with the Depression, Anxiety, and Stress Scale (DASS-21), Positive and Negative Affect Schedule (PANAS), and Cohen-Hoberman Inventory of Physical Symptoms (CHIPS).
A total of 79 participants were included (35 control group; 25 expressive writing group; 19 gratitude-focused writing group). GAC score was sustained in the intervention group as compared to baseline but significantly decreased in both the expressive writing and control groups. Compared to the expressive writing and control groups, the gratitude-focused writing group had significant improved stress and negative affect scores. Interestingly, negative affect improved in the control and gratitude-focused writing groups at follow-up. Depression, anxiety, positive affect, and CHIPS scores did not differ between groups or within groups at one month follow-up. This study was limited due to the small sample size and substantial loss of follow-up, which may impair generalizability of the results. Nonetheless, this study was significant in suggesting gratitude-focused writing may improve mood during times of sustained stress.
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