Comparing daily physiological and psychological benefits of gratitude and optimism using a digital platform

Spirituality-Based Intervention in Hypertension: EFfects on Blood PrEssure and EndotheliaL Function-FEEL Trial Results

Background

Emerging evidence suggests that spirituality improves patient outcomes, however, this has undergone only limited evaluation in randomized trials. Hypertension is a major cause of cardiovascular morbidity and mortality worldwide.

Objectives

To evaluate whether a spirituality-based intervention, compared to a control group, can reduce blood pressure (BP) and improve endothelial function after 12 weeks in patients with mild or moderate hypertension (HTN).

Methods

Open randomized controlled trial of adults with stage I or II hypertension. Following baseline evaluation, including lifestyle questionnaires, and measurements of office and central blood pressure (BP), home blood pressure monitoring (HBPM) and flow mediated dilation (FMD), patients were randomized to a spirituality-based intervention, which included training for forgiveness, gratitude, optimism, and life purpose delivered by daily WhatsApp communications, or to the control group (CG). Main outcomes were between group difference in change from baseline to 12 weeks in office and central BP, HBPM and FMD, using t-tests, analyses of covariance (ANCOVA) adjusting for baseline differences, and, in addition, missing data imputation as a sensitivity analysis.

Results

Fifty-one patients were randomized to spirituality-based intervention and 49 to control group. Baseline characteristics were well balanced between groups. Spirituality training, compared with control, improved 7.6 mmHg office systolic blood pressure (SBP), 4.1 mmHg central SBP and 4.1 percentage points FMD. Compared to control group, t-test demonstrated statistical significance for office SBP (-7.04 mmHg, p = 0.047) and FMD (7.46 percentage points, p < 0.001), and ANCOVA adjustment for baseline differences showed statistical significance for central SBP (-6.99 mmHg, p = 0.038) and FFMD (7.95 percentage points, p < 0.001) There was no significant effect on HBPM.

Conclusion

A spirituality-based intervention was associated with improved control of office SBP and FMD. These findings will be prospectively evaluated in a nationwide larger and well-powered RCT.

Feelings of gratitude to Allah and people and their associations with affect in daily life

Gratitude has been studied in the context of human social relationships primarily, but relatively less is known about gratitude in relation to a deity. We extended this research by studying gratitude among Muslim American adolescents, an understudied population, by comparing feelings of gratitude to Allah with feelings of gratitude to people in their associations with affect in daily life. Muslim adolescents (N = 202) participated in an Ecological Momentary Assessment study by completing up to three momentary reports each day during three separate weeks. Within-person results showed that both forms of gratitude were positively associated with concurrent happiness and calmness and were negatively associated with concurrent anxiety and sadness, though gratitude to people was a stronger predictor of happiness than gratitude to Allah. Most of the associations between gratitude to people and affect were stronger when youth felt less grateful to Allah, thus supporting a compensation model in which one form of gratitude offsets lower levels in the other. Lagged associations indicated that gratitude to people more consistently predicted greater subsequent feelings of happiness and calmness, whereas happiness and calmness consistently predicted greater subsequent feelings of gratitude to Allah. Results have implications for how distinct forms of gratitude may differentially influence affect.

Gratitude and Mortality Among Older US Female Nurses

Importance

Supporting healthy aging is a US public health priority, and gratitude is a potentially modifiable psychological factor that may enhance health and well-being in older adults. However, the association between gratitude and mortality has not been studied.

Objective

To examine the association of gratitude with all-cause and cause-specific mortality in later life.

Design, Setting, and Participants

This population-based prospective cohort study used data from self-reported questionnaires and medical records of 49 275 US older female registered nurses who participated in the Nurses' Health Study (2016 questionnaire wave to December 2019). Cox proportional hazards regression models estimated the hazard ratio (HR) of deaths by self-reported levels of gratitude at baseline. These models adjusted for baseline sociodemographic characteristics, social participation, physical health, lifestyle factors, cognitive function, and mental health. Data analysis was conducted from December 2022 to April 2024.

Exposure

Gratitude was assessed with the 6-item Gratitude Questionnaire, a validated and widely used measure of one's tendency to experience grateful affect.

Main Outcomes and Measures

Deaths were identified from the National Death Index, state statistics records, reports by next of kin, and the postal system. Causes of death were ascertained by physicians through reviewing death certificates and medical records.

Results

Among the 49 275 participants (all female; mean [SD] age at baseline, 79 [6.16] years), 4608 incident deaths were identified over 151 496 person-years of follow-up. Greater gratitude at baseline was associated with a lower hazard of mortality in a monotonic fashion. For instance, the highest tertile of gratitude, compared with the lowest tertile, was associated with a lower hazard of all-cause deaths (HR, 0.91; 95% CI, 0.84-0.99) after adjusting for baseline sociodemographic characteristics, social participation, religious involvement, physical health, lifestyle factors, cognitive function, and mental health. When considering cause-specific deaths, death from cardiovascular disease was inversely associated with gratitude (HR, 0.85; 95% CI, 0.73-0.995).

Conclusions and Relevance

This study provides the first empirical evidence suggesting that experiencing grateful affect is associated with increased longevity among older adults. The findings will need to be replicated in future studies with more representative samples.

The effectiveness of positive psychological interventions for patients with cancer: A systematic review and meta-analysis

AIMS AND OBJECTIVES

To evaluate the effectiveness of positive psychological interventions on quality of life, positive psychological outcomes and negative psychological outcomes in patients with cancer.

BACKGROUND

Patients with cancer often suffer from various psychological problems and have a poor quality of life. Positive psychological interventions have been increasingly applied to patients with cancer, but the results of these studies have not been synthesized.

DESIGN

A systematic review and meta-analysis of randomized controlled trials according to PRISMA.

METHODS

Six English databases and four Chinese databases were searched from the inception to December 2022. Two reviewers independently assessed the risk of bias using the Cochrane Risk of Bias tool. RevMan was used for meta-analysis.

RESULTS

Twenty-nine randomized controlled trials examined the effects of positive psychological interventions including meaning therapy, dignity therapy, positive psychotherapy, mindfulness- based intervention, life review, expressive writing intervention, acceptance and commitment psychotherapy, attention and interpretation therapy, compassion training and spiritual therapy on patients with cancer. Positive psychological interventions significantly improved the quality of life, enhanced positive psychological outcomes including well-being, meaning of life, self-esteem, optimism, resilience and self-efficacy and alleviated negative psychological outcomes including depression, anxiety and hopelessness. However, the heterogeneity of some outcomes was rather high, due to the wide diversity of the interventions included.

CONCLUSION

Positive psychological interventions have potentially positive effects on improving quality of life, enhancing positive psychological outcomes and alleviating negative psychological outcomes in patients with cancer. However, due to the heterogeneity and the lack of follow-up studies, more high-quality studies are needed to confirm the results of our review and to clarify the long-term effects of positive psychological interventions.

RELEVANCE TO CLINICAL PRACTICE

As feasible psychological interventions, healthcare professionals can consider applying appropriate positive psychological interventions according to the condition of cancer patients.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Stress reduction experiments in daily life: Scaling from the lab to the world

Paced breathing-longer exhalation than inhalation-can show short-term improvement of physiologic responses and affective well-being, though most studies have relied on narrow sample demographics, small samples, and control conditions that fail to address expectancy effects. We addressed these limitations through an app-based experiment where participants were randomly assigned to paced breathing or sham control (hand closure) conditions. We first validated the conditions in an online sample (N = 201; Study 1) and in a lab environment (N = 72; Study 2). In the primary app-based experiment, participants (N = 3,277; Study 3) completed 3 days of baseline assessments that included three check-ins each day in which we obtained heart rate and blood pressure responses using an optic sensor and assessed current stress and emotions. Participants were then randomly assigned to either the paced breathing or hand closure condition for the next 6 days. Relative to baseline days, both conditions were associated with increased positive emotions and perceived coping, and reduced blood pressure. Moreover, the increase in positive emotions and perceived coping was not evident among a comparison sample (N = 2,600) who completed check-ins but did not participate in either of the paced breathing or sham-control conditions. However, their blood pressure declined over time, suggesting that the continual monitoring of one's blood pressure may result in detectable decreases. Our results highlight the importance of designing experiments with appropriately matched control conditions and suggest that changes associated with techniques like paced breathing, in part, may stem from positive incidental features of the technique. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The effect of gratitude on death anxiety is fully mediated by optimism in Lebanese adults following the 2023 earthquake

BACKGROUND

Exploring the levels of death anxiety and factors that can undermine its impact are crucial for the Lebanese nationals. Even though studies have shown various relationships between death anxiety and several factors, very few to no research has been done to show the relationship of death anxiety, gratitude and optimism. Therefore, the objectives of our study were to assess the mediating role of optimism in the association between gratitude and death anxiety, along with investigating the validity and reliability of the Arabic version of the Death Anxiety Scale.

METHODS

A one-time-point online survey was conducted among Arabic-speaking community adults from the general population of Lebanon (N = 601; mean age 29.91 ± 12.61; 62.7% females). The following scales were used: Scale of Death Anxiety, Optimism-Pessimism Short Scale-2, and Gratitude Questionnaire-Six-Item Form.

RESULTS

The results of the mediation analysis showed that optimism fully mediated the association between gratitude and death anxiety. Higher gratitude was significantly associated with more optimism; higher optimism was significantly associated with less death anxiety. Finally, higher gratitude was not directly associated with death anxiety.

CONCLUSION

Our study reveals the relationship between gratitude and death anxiety and the mediating role of optimism. Our results need to be confirmed in a longitudinal study, but point to the importance of assessing optimism in prevention and management of persons with death anxiety.

Examining Daily Associations Among Sleep, Stress, and Blood Pressure Across Adulthood

BACKGROUND

Sleep can have consequential effects on people's health and well-being, and these effects may vary among younger and older adults.

PURPOSE

The goal of the present study was to investigate how sleep relates to physiologic and stress responses in daily life across adulthood.

METHODS

We used an Ecological Momentary Assessment method in a large sample of participants (N = 4,359; Mage = 46.75, SD = 12.39; 69.30% male, 29.85% female) who completed morning sleep diaries, reported subjective stress, and recorded their heart rate and blood pressure for 21 days. Sleep was assessed with self-reports of duration, efficiency, and quality.

RESULTS

Using multilevel modeling, between-person analyses showed that sleep duration, efficiency, and quality were negatively related to morning heart rate and stress, such that people who slept longer, more efficiently, or better experienced lower heart rate and stress compared to those who slept shorter, less efficiently, or worse. Within-person analyses showed that sleep duration, efficiency, and quality predicted morning heart rate, blood pressure (though less consistently), and stress. That is, people experienced lower heart, blood pressure, and stress following nights when they slept longer, more efficiently, or better than they typically did. These within-person relationships were moderated by age, such that the effects of better and longer sleep on lower morning heart rate, blood pressure, and stress were stronger among younger than older adults.

CONCLUSION

These findings suggest that daily variations in sleep show immediate associations with stress and physiologic responses, but these daily variations have a stronger relationship among younger compared to older adults.

General Gratitude and Gratitude to God: Associations with Personality and Well-Being

A growing body of research has focused on distinguishing general forms of gratitude from gratitude to God. We contributed to this area of research by examining correlates of personality traits and meaning in life in a cross-sectional study (N = 1,398). General gratitude was more strongly positively related to honesty-humility, extraversion, conscientiousness, agreeableness, openness, and meaning in life than gratitude to God. Moreover, gratitude to God moderated the positive relationship between general gratitude and meaning in life such that the relationship was stronger at lower than higher levels of gratitude to God. The results suggest that general forms of gratitude may be more important for well-being and positive traits than gratitude to God. General forms of gratitude may be particularly beneficial among less religious people, while gratitude to God may be particularly beneficial for people's well-being among those who are less grateful in general.