.......................................................05.2.Copinghypo - PDF document

.......................................................05.2.Copinghypothesis.........................................................05.3.Positiveaffecthypothesis.....................................................0ClinicalPsychologyReviewxxx(2010)xxxÐxxx!Correspondingauthor.E-mailaddress:Alex.wood@manchester.ac.uk(A.M.Wood).CPR-01050;NoofPages160272-7358/$Ðseefrontmatter©2010ElsevierLtd.Allrightsreserved.doi:10.1016/j.cpr.2010.03.005ContentslistsavailableatScienceDirectClinicalPsychologyReviewARTICLEINPRESSPleasecitethisarticleas:Wood,A.M.,etal.,Gratitudeandwell-being:Areviewandtheoreticalintegration,ClinicalPsychologyReview aspositiveaffect(Watson&Naragon-Gainey,thisissue),positiveemotions(Garland,Fredrickson,Kring,Johnson,Meyer,&Penn,thisissue),psychological"exibility(Kashdan&Rottenberg,thisissue),andoptimism(Carver,Scheier,&Segerstrom,thisissue),aswellastheimplicationsofthese!ndingsforconductingresearchinclinicalpsychology(Joseph&Wood,thisissue).Asthesereviewsshow,atabroadlevel,positivefunctioningcanexplainuniquevarianceinunderstandingdisorderandclinicallyrelevantcharacteristics.Constructssuchasoptimismhavealonglineageofclinicalandhealthresearch,andhavealreadybeenintegratedintoestablishedpractice.Thisreviewconsiderstheroleofgratitudeinwell-being,andthepotentialofinterventionsthatfacilitategratitudetocontributetothetreatingofdisorder.Unlikeconstructssuchasoptimism,untilveryrecentlygratitudehasbeenoneofthemostunstudiedemotions(McCullough,Emmons,&Tsang,2002;Wood,Joseph,&Linley,2007b),despitehavingbeenhistoricallyconsid-eredessentialtonormalfunctioninginphilosophicalandtheolog-icalaccounts(Emmons&Crumpler,2000),and67%ofyoungpeoplereportingexpressinggratitudeÒallofthetimeÓ(Gallup,1999).Aswithotherunderstudiedaspectsofpositivefunctioning(Linley,Joseph,Harrington,&Wood,2006),thepreviouslowknowledgebaseingratitudeprovidedtheopportunityforrapidscienti!cprogress(cf.,Gable&Haidt,2005).Inrecentyearsaverylargebodyofevidencehasemergedsuggestingthatgratitudeisstronglyrelatedtoallaspectsofwell-being,onthebasisofwhichpromisingclinicalinterventionshavebeendeveloped(e.g.,Bono,Emmons,&McCullough,2004;Emmons&McCullough,2003),in!ttingwithcallstoexplorethepotentialforimprovingdisorderthroughfosteringpositivefunctioningandpsychologicalstrengths(Duckworth,Steen,&Seligman,2005;Linley,Harrington,Joseph,Maltby,&Wood,2009;Seligman,Rashid,&Parks,2006).Thispaperpresentsthe!rstreviewoftheburgeoningliteratureongratitudeandwell-being,andreviewsthepotentialofinterventionstoincreasegratitudeasawayofincreasingwell-beingandimprovingdisorder,aswellasconsider-ingthenecessaryfutureresearchanddevelopmentsfortheseinterventionstobecomeusedinmainstreamclinicalpractice.Thisreviewpresentsanewintegrativeframeworkforgratituderesearch,conceptualizingthetraitasinvolvingalifeorientationtowardsnoticingandappreciatingthepositiveinlife.Gratitudeisshowntorelatetovariousclinicallyrelevantphenomena,includingpsychopathology,adaptivepersonalitycharacteristics,health,pos-itiverelationships,subjectiveandeudemonicwell-being,andhumanisticallyorientatedfunctioning.Fourformsofinterventionstoincreasegratitudearecriticallyconsidered,alongwithmethod-ologicalcritiques,andaresearchagendaforthefuturestudyofthesetechniques.Finally,fourmechanismswherebygratitudemayrelatetowell-beingareevaluated,includingcharacteristicsche-maticprocessing,coping,thegeneralbene!tsofpositiveaffect,andmechanismssuggestedbybroaden-and-buildtheory.Thereviewarguesthatgratitudeisakeyunderappreciatedtraitinclinicalpsychology,ofrelevanceduetoastrong,unique,andcausalrelationshipwithwell-being,andduetothepotentialtousesimpleandeasytechniquestoincreasegratitudealongsideexistingclinical multifactorialGratitude,Appreciation,andResentmentTest(GRAT:Watkins,Woodward,Stone,&Kolts,2003).Eachofthesescalesarosefromadifferentconceptualizationofwhatcomposesgratitude,andtogetherprovideawidede!nitionofgratitude,inkeepingwithalifeorientationapproach.AsshowninTable1,thesethreescalesprovide12sub-scalesassessingeightdiverseaspectsofgratitude:(1)individualdifferencesintheexperienceofgratefulaffect,(2)appreciationofotherpeople,(3)afocusonwhatthepersonhas,(4)feelingsofawewhenencounteringbeauty,(4)behaviorstoexpressgratitude,(5)focusingonthepositiveinthepresentmoment,(6)appreciationrisingfromunderstandinglifeisshort,(7)afocusonthepositiveinthepresentmoment,and(8)positivesocialcomparisons.2A.M.Woodetal./ClinicalPsychologyReviewxxx(2010)xxxÐxxxARTICLEINPRESSPleasecitethisarticleas:Wood,A.M.,etal.,Gratitudeandwell-being:Areviewandtheoreticalintegration,ClinicalPsychologyReview Maltby,Stewart,andJoseph,(2008)testedthisviewwithtwolargegroupsofparticipantswhocompletedeachofthe12sub-scales.Acrosstwostudies,exploratoryandcon dimension,andmayhavedistinctcauses,correlates,andprospectiveoutcomes.Similarly,thehierarchicalviewofgratitudedoesnotsuggestthatanytwoofthelowerorderfacetsofgratitude(e.g.,interpersonalgratitudeandappreciationofthepresentmoment)areidentical,butratherthatasinglehigherordergratefulpersonalityexistsaboveeachaspectofgratitude.Thehigherordergratitudefactorappearstocoverthefullbreathofthepeopleandeventswhichpeoplereportelicitinggratitude,explainingthestudies(outlinedabove)wherepeoplereportedgratitudetowardsnon-socialsources(e.g.,Weineretal.,1979;Emmons&McCullough,2003;Veisson,1999).Thefactoralsoseemstowidenthe )canalsobeexperiencedonastatelevel,andhowandwhytraitandstatelevelofgratitudeinteractisanimportantareaofstudy(withearlyworkconductedbyWoodandMaltbyetal.,2008).However,forapersontobesaidtohavealifeorientation,thesecomponentswouldhavetobeeasilyexperiencedinastrongandfrequentmanner.Therelationshipoftheemotionofgratitudetothelifeorientationneedsfurtherempiricalwork.Wesuggestthattheemotionoccurswhenoneormoreoftheothercomponentsofgratitudeareactive.Thusgratitudeservesasanindicatorofaspectsoflifeforwhichtobeappreciative.ThisisconsistentwithMcCullough'setal.(2001)reviewofgratitude,whichshowedthatemotionalgratitudecanacttodrawattentiontoaidreceivedandencouragethereciprocationofaid.Wewouldagreewiththisview,butsuggestthattheprocessappliesmorewidelythansimplythroughtherecognitionandreciprocationofinterpersonalaid;withgratitudedrawingattentiontotheperceptionofanythingtoappreciateintheworld,andthisappreciationmakingthepersonmorelikelytobehaveinpersonallyandsociallyproductivemannerasaresult.Theoretically,alifeorientationtowardsnoticingandappreciatingthepositiveinlifemaybeexpectedtobestronglyrelatedtowell-being,andmaybecontrastedwiththeBeckianviewofdepression,whichviewsthedisorderasinvolvingalifeorientationtowardsperceivingthenegativeintheself,world,andfuture(Beck,1976).Conceptualizinggratitudeasalifeorientationalsoresolvesalogicalinconsistencyintheliterature.Iftraitgratitudesimplyinvolvedthankfulnesstootherpeople,itisunclearthatitshouldbe thankyou ),GRAT=Gratitude,Appreciation,andResentmentTest(Watkinsetal.,2003).BasedinpartonWood,Maltby,Stewart,andJoseph(2008).3A.M.Woodetal./ClinicalPsychologyReviewxxx(2010)xxxÐxxxARTICLEINPRESSPleasecitethisarticleas:Wood,A.M.,etal.,Gratitudeandwell-being:Areviewandtheoreticalintegration,ClinicalPsychologyReview Table2 N5:Impulsiveness.11*.02N6:Vulnerability!.14**!.27***E1:Warmth.34***.44***E2:Gregariousness.26***.26***E3:Assertiveness.10.16*E4:Activity.12*.24***E5:Excitementseeking.11*.12E6:Positiveemotions.43***.51***O1:Fantasy.15**.13O2:Aesthetics.19**.01O3:Feelings.14**.33***O4:Actions.23***.03O5:Ideas.16**.15*O6:Values.13*.18*A1:Trust.31***.26***A2:Straightforwardness.09.17*A3:Altruism.26***.40***A4:Compliance.11*.06 Wood,Maltby,Gillettetal.(2008)156/87Depressionduringalifetransition5A.M.Woodetal./ClinicalPsychologyReviewxxx(2010)xxxÐxxxARTICLEINPRESSPleasecitethisarticleas:Wood,A.M.,etal.,Gratitudeandwell-being:Areviewandtheoreticalintegration,ClinicalPsychologyReview Emotionalfunctioningisconceptualizedwithintheconstructofsubjectivewell-being,whichcompriseshighpositiveaffect,lownegativeaffect,andhighsatisfactionwithlife(Joseph&Wood,this inconsistentbeliefs,andinaccuratesymbolizationofexperiences,(2)acceptingexternalin"uences,and(3)behavinginwaysconsistentwithpersonalbeliefsandvalues( 100Relationshipcloseness6BartlettandDesteno(2006)105Costlyhelpingbehavior7Baumgarten-Tramer(1938)2,000Typesofexpressivethanks8Bennett,Ross,andSunderland(1996)174Positiveorganizationalclimate9DeShea(2003)317Willingnesstoforgive10Deutsch,Roksa,andMeeske(2003)22Praise11DunnandSchweitzer(2005)161Trust12EmmonsandMcCullough(2003)65/157Connectionwithothersandemotionalsupporttoothers13FrohandSe!cketal.(2008)221Prosocialbehavior14FrohandYurkewiczetal.(2009)154Perceivedpeerandfamilysupport,prosocialbehavior,andsocialsupport15KashdanandMishraetal.(2009)288/190Expressiveness,andrelatedness(forwomen)16Michie(2009)298Pride,socialjustice,andaltruism17Naitoetal.(2005)284Prosocialmotivation18Tsang(2006)40Motivationtoactprosocially19Ventimiglia(1982)479Receiptofanaltruisticact20WeinerandGraham(1989)370Helping,sympathytothedistressofothers,andaltruism21WoodandJosephetal.(2008)389Positiverelationships22Wood,Joseph,andMaltby(2009)201Positiverelationships23Wood,Maltby,Gillettetal.(2008)156/87Perceivedsocialsupport6A.M.Woodetal./ClinicalPsychologyReviewxxx(2010)xxxÐxxxARTICLEINPRESSPleasecitethisarticleas:Wood,A.M.,etal.,Gratitudeandwell-being:Areviewandtheoreticalintegration, Deutsch(1984),andgratitudehasshowntoleadtodecreasinglevelsofstressovertime(Wood,Maltby,Gillettetal.,2008).Asstressisrelatedtoahostofphysicalwell-beingcomplaints,gratitudemayrelatemoregenerallytohealththroughthemechanismofstress.Second,thereisanindicationthatgratitudemaybeespeciallyimportantforsleep.Inaninterventiontoincreasegratitude(Emmons&McCullough,2003),discussedmorefullyinalatersection,improvementsinhoursofsleepandrefreshmentuponwakingemergedasakeyphysicalhealthimprovement.WoodandJosephetal.(2009)speci!callyexaminedthepossiblerelationshipsbetweengratitudeandsleepinacommunitysampleof401people,40%ofwhohadclinicallyimpairedsleep.Gratitudewasrelatedtototalsleepquality,sleepduration(includingbothinsuf!cientandexcessivesleep),sleeplatency(abnormallyhightimetakentofallasleep),subjectivesleepquality,anddaytimedysfunction(arisingfrominsuf!cientsleep).Ineachcase,gratitudewasrelatedtosleepthroughthemechanismofpre-sleepcognitions.Negativethoughtspriortosleeparerelatedtoimpairedsleep,whereaspositivepre-sleepcognitionsarerelatedto Wood,Maltby,Gillettetal.,2008),gratitudewasassessedin!rstyearundergraduatestudentsstartinguniversity,atthestartandendsoftheir!rstterm,approximately3monthsapart.Thisperiodisknowntobealifetransitionwithvaryingimplicationsforwell-being,withsomepeople!ndingtheexperienceexcellent,andothersstressfulanddepressing(e.g.,Brissette,Scheier,&Carver,2002).Usingstructuralequationmodeling,Woodetal.directlytestedseveralrivalmodels,suchas(a)gratitudeleadingtowell-being,(b)well-beingleadingtogratitude,(c)mediatedeffects,and(d)reciprocalmodelswherebothgratitudeledtowell-being,andwell-beingledtogratitude.Inbothstudies,onlythemodelwheregratitudeledtowell-beingwassupported,withpeoplehigheringratitude7A.M.Woodetal./ClinicalPsychologyReviewxxx(2010)xxxÐxxxARTICLEINPRESSPleasecitethisarticleas:Wood,A.M.,etal.,Gratitudeandwell-being:Areviewandtheoreticalintegration,ClinicalPsychologyReview However,asallparticipantsweregoingthroughthesamelifetransition,itcouldnotbetestedwhethergratitudeinteractedwithlifeexperiences,sothatmoregratefulpeoplefunctionedbetterinthefaceofadversity.Thistestwouldbeanecessaryconditionofshowingthatgratitudeisaresiliencyfactor(ÒbufferÓ),ratherthansimplyacausalprecursorofwell-being(cf.,Johnson,Gooding,Wood,&Tarrier,2010).Additionally,althoughgratitudedidnotchangeinthisshortperiodoftime,thisshouldnotbetakenasevidencethatgratitudecannotchange.Rather,itmaybethatindividualdifferencesingratituderepresentstablephenomena,likeschematicprocessing,orstablebeliefsabouttheword,whichleadtraitgratitudetowardstendingtoremainquitestable.ChanginglevelsofgratitudemayneedtoinvolveaÒkickstartÓintervention.4.Gratitudeinterventions self-referredtoaweb-siteanddownloadedworkbooks.Onceset-up,suchinterventionsarelowcost,andhavethepotentialtosubstan-tiallyincreaseaccesstopsychologicalservices(Bennett&Glasgow,2009),thusimprovingpopulationhealth.However,astheseinter-ventionsaregivenwithouthumancontact,attritioniscommonlyveryhigh( ,severalfurtherstudieshavealsoshownsupportforgratitudelists.Thetwobestconductedstudiesshowedthat(a)gratitudelistsweremoreeffectivethanwaitinglistsatimprovingfunctioninginpeoplewithneuromusculardiseases(Emmons&McCullough,2003 studiesmakeinterpretationdif!cult.Recently,theeffectofmakinggratitudelistshasbeeninvestigatedinschoolsettings.Ifgratitudedoesconferresilience(Wood,Maltby,Gillettetal.,2008),buildingthecharacteristicinyouthmaybean8A.M.Woodetal./ClinicalPsychologyReviewxxx(2010)xxxÐxxxARTICLEINPRESSPleasecitethisarticleas:Wood,A.M.,etal.,Gratitudeandwell-being:Areviewandtheoreticalintegration,ClinicalPsychologyReview beenwidelypromotedasbeingasbeingthemostsuccessfulpositivepsychologyintervention,andonethatshouldbeusedwidely,perhapsevenonanationalscale(Bonoetal.,2004;Duckworthetal.,2005;Seligman,2005;Seligmanetal.,2005,2006).Suchconclusions,however,seempremature.Althoughgratitudeinterventionsareeffective,thequestionremains:effectivecomparedtowhat?Withthenotableexceptionofthetworecentstudiescomparinggratitudetechniquestothosecommonlyusedintherapy(Geraghtyetal.,inpress,2010),moststudieshavenotshownthatgratitudeinterven-tionsareeffectiveagainstatruecontrolgroup(seeTable2).ManyofthepreviousstudieshaveclaimedtheyarecomparinggratitudetoaÒplacebocontrolÓgroup.AsKirsch(2005)convincinglyargues,thetermplaceboarisesfrommedicine,andreferstoatreatmentthatworksduetopsychologicaleffects,ratherthanthroughdirectbiologicalimpact.Bythisde!nition,allpsychologicaltherapiesareplacebos,giventheyworkthroughpsychologicalratherthandirectbiologicalpathways.ThusitisstillunclearwhatmanyofthepreviousgratitudetherapiesaretryingtoshowwiththeirÒplaceboÓcontrolgroups.Presumably,thetermisusedmetaphori-callytoclaimthatgratitudeconditionisbeingcomparedtoanalternateconditionwhichisÒpsychologicallyinertÓ,havingnoimpactinandofitself,andonlyimpactingonthedependantvariable(e.g.,Òwell-beingÓ)throughgenericmechanisms,suchaspsychologicalexpectancyofchange.Thisitselfisproblematic,asexpectancyofchangemaybeakeymechanismwherebypsychologicalchangeoccurs(seeHyland,Geraghty,Joy,&Turner,2006;Hyland,Whalley,&Geraghty,2007).Itisalsohighlyunlikelythatmostofthepreviouslyusedcontrolgroupwouldgeneratethesamedegreeofexpectancyasthegratitudecondition.Thebestcontrolgroupsarethosethatareidenticalinallaspectsapartfromtheaspectofinterest.Intheabsenceofsuchcontrolgroups,itisdif!culttoevaluatetheeffectivenessofthegratitudecomponentoftheinterventionÑcomparedtotheothermoregenericaspects.AsshowninTable5,previouscontrolgroupsusedhaveinvolvedlistingdailyhassles(versusthingsforwhichtobegrateful),listing!veeventsthathadanimpact,listingthingsparticipantswantedtodooverthesummerbutwereunabletodo(versusthingstheydidoverthesummerthattheyweregratefulfor),writingaboutthelayoutofthetheirlivingroom(versuswritinganddeliveringalettertoalivingpersontowhomtheyweregrateful),writingaboutthetypicalthingsthathappenduringaday(versusthingstobegratefulabout),writingaboutearliestmemories(versusgratitudelists).Fromthislist,itisunclearthatallofthecontrolgroupswereeffectiveinproducingequalexpectancyeffects,orfullycontrollingforothergenericexplanationsoftheresults.Indeed,wherestudiesusedmultiplecontrolgroups,comparinggratitudelistswithbothlistinghasslesandmoreneutralcontrols,gratitudewasonlyeffectiveforcertainaspectsofwell-beingwhencomparedwithlistinghassles,butnotversusothercontrols(e.g.,Emmons&McCullough,2003;Frohetal.,2008;Sheldon&Lyubomirsky,2006).Theinclusionofhasslesconditionsinthesestudiesisvaluable,asitallowsthisconclusiontobedrawn.Additionally,theseresultscannotbeusedtosuggestthatgratitudeonlyworksversushassles, A.M.Woodetal./ClinicalPsychologyReviewxxx(2010)xxxÐxxxARTICLEINPRESSPleasecitethisarticleas:Wood,A.M.,etal.,Gratitudeandwell-being:Areviewandtheoreticalintegration,ClinicalPsychologyReview (n Geraghtyetal.(inpress)Study112weekgratitudediary,communitysample,internetadministered.BodydissatisfactiontargetedListupto6thingstobegratefulfor(n=40)Completeautomaticthoughtrecords(ATR,n=22)Decreasesinbodydissatisfaction=.15Waitlistcontrol(n=120)Decreasesinbodydissatisfactiond=.96Geraghtyetal.(2010)Study122weekgratitudediary,communitysample,Internetadministered.WorrytargetedListupto6thingstobegratefulfor(n=52)Completeaworrydiary(self-monitoring/restructuring/planning,n=28)Decreasesinworryd=.11WaitlistControl(n=56)Decreasesinworryd=1.5*AscitedinLyubomirsky,Sheldon,andSchkade(2005).11A.M.Woodetal./ClinicalPsychologyReviewxxx(2010)xxxÐxxxARTICLEINPRESSPleasecitethisarticleas:Wood,A.M.,etal.,Gratitudeandwell-being:Areviewandtheoreticalintegration,ClinicalPsychologyReview ndingssuggestthatgratefulpeoplehavecharacteristicschemasthatin"uencehowtheyinterprethelpgivingsituations.Thisisconsistentwithevidenceshowingthatpeoplehavebiasestowardsinterpretingotherpeople'sintentionsandbehaviorsassimilartotheirown(e.g.,Markus,Smith,&Moreland,1985),andmoregenerallyevidenceofcharacteristicbiasesinprocessingandemotionaldisorders(e.g.,Beck,1976).Wood,Maltby,Stewart,Linley,andJoseph's(2008)modelsuggestthatgratefulpeoplegoaroundinlifewithaparticularinterpretivelens,seeinghelpasmorecostly,valuable,andaltruistic.Equally,ungratefulpeoplewillviewthehelptheyseeasloweronthesedimensions.Forexample,anungratefulpersoncouldreceivealifttoanairport,whichsavesthemvastamountsoftime(highvalue),takestheirbenefactorhourstocomplete(highcost),andwhichtheirbenefactorsimplydoestohelpthemout(highaltruism).Mostpeoplewouldperceivethis well-beingthroughschematicprocessing.5.2.CopinghypothesisThesecondspeci!cmechanismthatcouldpotentiallyexplainthelinkbetweengratitudeandwell-beingarepositivecopingstrategies.Onlyonestudyhasexaminedthelinebetweengratitudeandcoping(Woodetal.,2007a).Acrosstwosamples,gratitudewasshowntorelatetothreebroadcategoriesofcoping.First,gratefulpeopleweremorelikelytoseekoutandusebothinstrumentalandemotionalsocialsupport.Thisisconsistentwiththeschematichypothesis;ifgratefulpeoplewereprimedtorealizethesupportivenessoftheirsocialnetworks,thentheywouldbemorelikelytomakefulluseofthesocialresources'availabletothemwhentheneedarose.Second,gratefulpeopleusedcopingstrategiescharacterizedbyapproachinganddealingwiththeproblem,suchasthroughcopingactively,planning,andpositivereinterpretingthesituationandtryingto!ndthepotentialforgrowth.Third,gratefulpeoplewereconverselylesslikelytobehavior-allydisengage,denytheproblemexists,orescapethroughmaladaptivesubstanceanduse.Threeofthesecopingstrategies(lowerself-blameandbehavioraldisengagement,andmorepositivereinterpretationand loughetal.,2002;Wood,Joseph,Lloydetal.,2009;Wood,Maltby,Gillettetal.,2008;Wood,Maltby,Stewart,Linleyetal.,2008).Inthemostconclusivestudy,usingmeta-analyticmethods,McCulloughetal.,showedthatcontrollingforagreeablenessmadelittledifferencetotherelationshipbetweengratitudeandanyvariablestudied.Positiveaffectwasdirectlycontrolledasoneofthe50facetsoftheBigFive,inthetwostudiesdiscussedabove(Wood,Josephetal.,2008;Wood,Joseph,&Maltby,2009),suggestingthatpositiveaffectcannotexplainwhygratefulpeoplearemoresatis!edwithlife,orhavehighereudemonicwell-being.Notethatallofthesestudiesalsocontrolledfornegativeaffect(eitherdirectly,orthroughthehigherorderconstructofneuroticism),suggestingthatgratitudeisneitheronlyassociatedwithwell-beingduetomoregratefulpeopleexperiencing workisanexemplarofthis;demonstratingthatgratitudeisrelatedtohigherlevelsofdailysubjectiveandeudemonicwell-beinginpeoplewithPTSDaftercontrollingforsymptomatology,aswellasshowingmeanlevelofdifferenceingratitudebetweenveteranswithandwithoutthediagnosisofthedisorder.KendlersandLiuetal.'s(2003)studyfurthersuggeststhatgratitudemaybeimportanttoawidevarietyofdisorders.Similarly,itseemslikelythatgratitudeislinkedtopost-traumaticgrowth,moreresearchisneededintothispossibility.Inadditiontothegeneralrecommendationsfortestinggratitudeinterventionsgivenabove,newapproachesshouldbedevelopedthatmaybemoreeffectivethanthefourcurrentlyusedapproaches.Techniquessuchasmakinggratitudelistsseemtoworkbetterwhen cacyofthisapproach.Inrecentyears,alargebodyofliteraturehasdevelopedshowingthatgratitudeisrelatedtoawidevarietyofformsofwell-being.ThisliteraturestandsincontrasttoworkshowingthathugeincreasesinincomeÑanindicationofhowspendingpowerareneededforevenmodestgainsinwell-being(Boyce&Wood,inpress).Perhapsinsteadofspendinglivestryingtoamassevermorepossessions,peoplewouldbebetteradvisedtoappreciatemorewhattheyactuallyhave(c.f.,Lyubomirsky,Sheldon,&Schkade,2005).Simpleeasyinterventionshavebeendevelopedthatcanbeeasilyusedinclinicaltherapytoincreasegratitude,whichmayconsequentlyimprovewell-being.Moreresearchisnowneededintothemechanismswherebygratituderelatestowell-being,andintodevelopingoptimumtherapies.ReferencesAbramson,L.Y.,Seligman,M.E.P.,&Teasdale,J.D.(1978).Learnedhelplessnessin ,131,1338! !270.Fredrickson,B.L.(2001).TheroleofpositiveemotionsinpositivepsychologyÑThebroaden-and-buildtheoryofpositiveemotions.AmericanPsychologist,56, Psychology,46,213!233. 14.Greenberger,D.,&Padesky,C.A.(1995).Mindovermood:Acognitivetherapytreatmentmanualforclients.NewYork,NY,US:GuilfordPress.Higginson,S.,Mansell,W.,andWood,A.M.(inpress).Anintegrativemechanisticaccountofpsychologicaldistress,therapeuticchangeandrecovery:Theperceptualcontroltheoryapproach.ClinicalPsychologyReview.doi:10.1016/j.cpr.2010.01.005Hunsley,J.,&Meyer,G.J.(2003).Theincrementalvalidityofpsychologicaltestingandassessment:Conceptual,methodological,andstatisticalissues.PsychologicalAssessment,15,446!455. 16.Linley,P.A.,Maltby,J.,Wood,A.M.,Joseph,S.,Harrington,S.,Peterson,C.,etal.(2007).CharacterstrengthsintheUnitedKingdom:TheVIAinventoryofstrengths.PersonalityandIndividualDifferences,43,341!351.,47,878!884.,9,111!131. PsychiatryResearch.16A.M.Woodetal./ClinicalPsychologyReviewxxx(2010)xxxARTICLEINPRESSPleasecitethisarticleas:Wood,A.M.,etal.,Gratitudeandwell-being:Areviewandtheoreticalintegration,ClinicalPsychologyReview