Gratitude Journaling

Objective: Chronic occupational stress is common among health care practitioners, with potential impacts on personal mental health and staff turnover. This study investigated whether directing practitioners' attention to thankful events in work could reduce stress and depressive symptoms.

Method: A double-blind randomized controlled trial was conducted in 5 public hospitals with follow-up to 3 months posttreatment. One hundred two practitioners were randomly assigned into 3 conditions: gratitude, hassle, and nil-treatment. Those with scheduled long leaves were excluded. Participants in the gratitude and hassle group wrote work-related gratitude and hassle diaries respectively twice a week for 4 consecutive weeks. A no-diary group served as control. Depressive symptoms (primary outcome) and perceived stress (secondary outcome) were collected at baseline, posttreatment, and 3-month follow-up. Intent-to-treat analyses were performed with mixed-effects regression.

Results: Significant Treatment × Time interaction effects were found for the gratitude intervention, whether it was compared with control or hassle; the general pattern was a decline in stress and depressive symptoms over time, but the rate of decline became less pronounced as time progressed. Hassle and control were basically indistinct from each other. Relative to control, the gratitude group reported lower depressive symptoms (-1.50 points; 95% CI [-2.98, -0.01]; d = -0.49) and perceived stress (-2.65 points; 95% CI [-4.00, -1.30]; d = -0.95) at follow-up. RESULTS for the comparison between gratitude and hassle were similar.

Conclusion: Taking stock of thankful events is an effective approach to reduce stress and depressive symptoms among health care practitioners.

Rank: 1

First Author: Cheng

Outcome: Stress,Depression

Outcome p-value: Stress:⭑⭑⭑, Depression:⭑

Intervention Category: Reflection and Relaxation

Time per Employee (hours): No time specified.

D&B Study Quality Rating: 22

Reviewer Confidence: 4

Country: China

Study Design Type: RCT

Materials Available to Implement: Participants were asked to write diary entries expressing gratitude in terms of satisfaction or appreciation. Participant instructions are in the methods description; time required to write the entries not mentioned in the article. Corresponding author: takcheng@ied.edu.hk.

Materials Available: yes

Organiz./Individ. Focus: Individual

Prevention Category: Primary,Secondary

Effect Size: Medium,Large

Effect size Small:

Effect size Medium: Depression

Effect size Large: Stress

Reference: Cheng, Sheung-Tak, Pui Ki Tsui, and John H. M. Lam. “Improving Mental Health in Health Care Practitioners: Randomized Controlled Trial of a Gratitude Intervention.” Journal of Consulting and Clinical Psychology 83, no. 1 (February 2015): 177–86. https://doi.org/10.1037/a0037895.