The Effects of Manipulating Expectations in a Gratitude Intervention

Gratitude - an emotion felt when an individual receives something beneficial from other people or entities - has been shown to positively affect well-being. Beginning in 2003, "count your blessings" interventions - in which participants list items they are grateful for, and gratitude letter writing interventions were designed to cultivate gratitude. Gratitude interventions have many positive outcomes; they can increase well-being and life satisfaction (Froh, Sefick, \& Emmons, 2008) and increase self-esteem (Rash, Matsuba, \& Prkachin, 2011) to name a few. Knowing the benefits of gratitude prior to an intervention could affect participant behavior and health outcomes. Past studies have illustrated that sharing information about treatments changes expectations and improves outcomes (Zion \& Crum, 2018). For instance, overt medical treatments are more effective than hidden ones (Colloca, Lopiano, Lanotte, \& Benedetti, 2004). The proposed study is designed to evaluate whether expectations about intervention efficacy can enhance the benefits of a brief gratitude intervention. Specifically, the investigators will test if providing information on the benefits of gratitude will enhance intervention outcomes. This 3-armed randomized controlled trial will have the following conditions: gratitude + expectation, gratitude, and events control. Participants will be undergraduate college students and the online intervention will last two weeks. Participants in the two gratitude conditions will login to an online form three times a week for two weeks and make entries of up to five things they are grateful for. The form for participants in the gratitude + expectation condition will also provide information about benefits of gratitude. An everyday events control will be used to provide a neutral comparison condition. This group will be instructed to type up to five things or events of note from their day on their form. Outcome measures will be collected via an online survey before and immediately after the intervention. The primary outcome is well-being and the secondary outcomes are sleep quality and quantity, state gratitude, positive affect, healthcare self-efficacy, stress, and depressive symptoms. The investigators predict that participants in the gratitude + expectation condition will have enhanced intervention outcomes compared to participants in comparison conditions.

Overview: Potential participants will be recruited from an undergraduate psychology class. Participants will have one week after initial study advertisement to read the consent form and decide if they wish to participate. When participants turn in a signed consent form, they will be officially enrolled in the study and issued a personal identification (PI) number to use throughout the study. Participants will be randomly assigned to one of three conditions: gratitude + expectations, gratitude, or an everyday events control condition. Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type either a short gratitude list (for gratitude + expectations and gratitude conditions) or an events list (for everyday events control), and will have a section for participants to enter their personal identification numbers. Additionally, the first form will include a demographics questionnaire and the first and sixth forms will include questionnaires assessing all outcomes of interest.The primary outcome of interest is well-being. The secondary outcomes of interest are sleep, state gratitude, healthcare self-efficacy, stress, and depressive symptoms. Participants in the gratitude + expectations condition will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: "Practicing gratitude may increase social connectedness" and "Cultivating gratitude was shown to improve school satisfaction in a sample of students". By the end of the study, participants will have completed six gratitude or everyday events lists and two questionnaires. Interventions: 1. Gratitude + No Expectations: Participants in the gratitude condition will practice a counting your blessings intervention for two weeks. Participants will be instructed to list up to five things they are grateful for every two days for the two weeks of the intervention (six times total). 2. Gratitude + expectations: Participants in this condition will be given the same instructions as the gratitude condition and will also be given the regular reminders of the benefits of gratitude. 3. Everyday events: Participants will be instructed to list up to five details about their day, such as activities they engaged in, or conversations they had. Participants will make these lists every two days for two weeks (six times total). Questionnaires: Self-report questionnaires with high test-retest reliability and internal validity will be administered at baseline and post intervention to access changes in outcomes of interest, such as well-being, depressive symptoms, and anxiety. Questionnaires administered only at baseline: Communication and Attitudinal Self-Efficacy Scale (CASE) and demographic questionnaire Questionnaires administered pre- and post-intervention: Mental Health Continuum-Short Form, Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Scale, Pittsburg Sleep Quality Index (PSQI) duration items, Modified Differential Emotions Scale, Center for Epidemiologic Studies Depression Scale (CES-D), Perceived Stress Scale 4