Research

Attitude of Gratitude: Pilot Study of the ‘Three Good Things’ Exercise

Recovery scholars and enthusiasts, including but not limited to those in 12-step groups such as Alcoholics Anonymous, highlight the importance of gratitude – that is, the degree to which we are thankful or appreciative – in initiating and sustaining recovery.

Writing a gratitude list or keeping a gratitude is a common recommendation from 12-step sponsors and self-help experts alike.

However, the extent to which gratitude can be systematically manipulated and whether it is associated with remission and recovery more formally is poorly understood.

Krentzman and colleagues conducted a mixed methods (qualitative and quantitative) pilot study among 23 individuals with current or remitted alcohol use disorder in outpatient treatment to examine the feasibility, acceptability, and preliminary effects of the “Three Good Things” exercise (TGT; n = 12) relative to a control intervention asking patients to describe and report on sleep, exercise, and caffeine consumption (n = 11).

As the name suggests, the “Three Good Things” exercise (TGT) asks participants to describe and report the cause/context of three ‘good’ things that happened to him/her in the past 24 hours.

Patients engaged with the exercise through a Web-based platform for 14 days and received reminder emails to prime activity completion. The sample was 46 years old on average; about half were female and 80% were Caucasian. Importantly, the sample’s time in recovery was variable, spanning 15 days to over 5 years.

Gratitude was measured with the Gratitude questionnaire (see below) while the Positive and Negative Affective Schedule (PANAS) was used to assess positive affect, negative affect, and unactivated positive affect with the serenity scale (see below) during the active intervention phase and at 8 week follow-up. The authors also interviewed participants via telephone 14 weeks after study initiation to qualitatively examine the impact of the intervention and to assess participants’ overall subjective experience.

The Gratitude Questionnaire 6-Item Scale (GQ-6)
Source: (McCullough et al., 2002)


Positive and Negative Affective Schedule and Serenity Scale
Source: (Watson & Clark, 1994)

The authors found that both the “Three Good Things” (TGT) and control participants were generally satisfied with their daily activity (acceptance). Qualitative interviews demonstrated TGT participants found the exercise somewhat difficult to complete with respect to the added burden on their schedule (e.g., seeming “like a chore”) and at times on their emotional experience (e.g., if going through difficult life experience).

They found it became easier over time as it became part of their routine.

The “Three Good Things” (TGT) participants also reported greater difficulty with the task quantitatively compared to control participants. TGT participants showed greater reductions than control participants in negative affect and greater improvements in unactivated positive affect (serenity).

Individuals in the "Three Good Things" gratitude group experienced significant reduction in Negative Affect & significant increases in Unactivated Positive Affect.
Source: (Krentzman et al. 2015)

While qualitative interviews revealed  increased awareness of day-to-day gratitude, the “Three Good Things” (TGT) participants did not demonstrate increased gratitude when measured by questionnaire.

IN CONTEXT

 

This pilot study showed that a simple, daily positive psychology exercise can decrease negative affect and increase perceived serenity (feeling calm, at ease, etc.) in the short term among individuals in recovery from alcohol use disorder.

However, based on qualitative interviews, many found the task difficult to complete, particularly outside of describing gratitude for their recovery. Individuals may require a more directive exercise for optimal response (e.g., list 5 interpersonal relationships for which you are grateful).

It is unclear why the exercise did not lead to increased gratitude as the authors hypothesized. Nevertheless, it positively impacted participants’ emotional experience.

The study is an excellent example of how researchers can use recovery science to test experiential and anecdotal evidence.

NEXT STEPS

It is possible the “Three Good Things” (TGT) exercise affects emotional experience through a separate mechanism or that a larger, more representative sample may be needed to appropriately test these questions.

BOTTOM LINE

  • For individuals & families seeking recovery: Describing and reflecting on three good things that happen each day is a simple way to feel calmer and less stressed.
  • For scientists: As the authors point out, it is important to reiterate the preliminary nature of pilot results; the overall feasibility of the the “Three Good Things” (TGT) exercise in an online format appears to be key. The logical next step is to test the intervention in a larger sample across multiple settings and to assess substance use outcomes (misuse and cravings/urges) in addition to emotional functioning.
  • For policy makers: The relevance of positive psychological constructs in the addiction recovery field is emerging and warrants further investigation through appropriation of research funding.
  • For treatment professionals and treatment systems: Although further research is needed on the “Three Good Things” (TGT) and positive psychology more generally in recovery, encouraging your patients to engage in this daily exercise could help improve their subjective emotional experience.

CITATIONS

Krentzman, A. R., Mannella, K. A., Hassett, A. L., Barnett, N. P., Cranford, J. A., Brower, K. J., … & Meyer, P. S. (2015). Feasibility, acceptability, and impact of a web-based gratitude exercise among individuals in outpatient treatment for alcohol use disorder. The Journal of Positive Psychology.

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