How can the practice of gratitude boost well-being?

Themes and codes are displayed in Table 3.

TABLE 3. How can the practice of gratitude boost well-being?

Theme Codes

Positive Emotion Gratitude, positivity, specialness

Engagement Not mentioned

Positive Relationships Appreciation of other

Meaning Perspective, planning for future

Accomplishment Not mentioned

Positive Emotion

Most of the participants reported feeling gratitude and positivity with this exercise. One participant, who was managing to spend time almost every night before sleep thinking about why the day was “really good" for her (a positive framing), said it was making the day more special for her.

One participant found it easier than the mindfulness,

because it’s just clear that you have three different things to, to say, and it can be like small things, so it doesn’t need to be big things, so I feel very comfortable with this, and after I do this I feel like, yes, I became more positive.

However, one participant did not gain any benefit from the practice,

I don’t know if it’s so much my thing, because, mm, I was thinking...because it’s not really working for me, I was thinking why, because it’s really logical that it should work, but even tho’ I tell myself oh this went well today, it’s - while I’m telling myself like, yes, I know, so what, what about it? [laughs] I don’t know, I don’t really get the boost from that, I don’t know why.

I wondered was it perhaps that she was already focused on the positive so it did not do anything for her, and she said “Yeah, could be”. She also mentioned expecting a benefit from it and being

disappointed, so I will have to be careful to set expectations in future. My own experience is the same as hers as I generally feel appreciative in. I also tried posting the three things on social media during our project as a way to illustrate what we were doing in the group, but I quickly felt guilty, because even though I was thanking particular people in the post, the constant stream of gratitude looked very privileged. I stopped after a few days.

Engagement

Analysis did not turn up any reference to engagement in terms of gratitude. In hindsight, this could perhaps be a strategy for increasing engagement in a task, i.e., expressing gratitude about the opportunity to carry out the task, or for what it will result in.

Positive Relationships

The married couple of the three had found guidance about the gratitude exercise confusing, thinking they had to find three significant things to be grateful for each day, specifically things that each had done for each other. This came to light in the post-project interview with the wife, when she said,

I did try to do like daily appreciation things, but I found it’s not easy because we really can not get used to saying directly like thank-you for doing this or that, in certain time, and…face to face, it’s a little like unnatural for us. Because for us, like, especially I’m only talking about relationship between both of us - so we appreciate each others, like, we do not say it, but we do it...so normally I just like to support or to like kind of do some other things for him as well. I took that as a kind of gratefulness. It’s not really like I put it by the verbal, I just, uh, did it by action.

Clearly, there was gratitude being expressed between them (she provided me with specific examples), so this was a communication failure due to the language issues, and could have been prevented with short written instruction. When I clarified how gratitude could be expressed for very simple and basic things, she said “I think perhaps I just give a try for that. It’s a good way to force yourself to think and, like, stay positive. It’s a kind of like an instant exercise”. As this conversation took place at the end of the project, I do not know whether she tried that and what the outcome was. Again, similar errors could be prevented with a simple app (which could be in participants' own language) or some kind of written material.

Meaning

Some participants talked about using the gratitude exercise to keep perspective. The one who found nightly practice helped her feel the day was special added,

it really helps me, at least, to summarise somehow what is happening in my life and to see that I am moving somewhere, so that it’s not, you know, just sitting and living my life through, but I’m thinking what I want to do and what goals do I have, so I feel that I have some aim in the end and i’m doing something useful.

She told me at five-year follow-up that she now does that monthly, as it helps her to summarise good things over the month. Another participant was also continuing to use it at a much-reduced rate, telling me at follow-up that she now uses it three or four times a year “just as a quick grounding and perspective exercise”.

Accomplishment

Analysis did not turn up any reference to accomplishment in terms of gratitude practice.

Participants who had successfully formed a habit of it may have felt a sense of accomplishment for having done so.