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. 2024 Nov 12:38:100787.
doi: 10.1016/j.invent.2024.100787. eCollection 2024 Dec.

Effectiveness of a guided multicomponent internet and mobile gratitude training program - A pragmatic randomized controlled trial

Dirk Lehr  1 , Henning Freund  2 , Bernhard Sieland  3 , Lina Kalon  1 , Matthias Berking  4 , Heleen Riper  5 , David Daniel Ebert  6
Affiliations

Effectiveness of a guided multicomponent internet and mobile gratitude training program - A pragmatic randomized controlled trial

Dirk Lehr et al. Internet Interv. .

Abstract

Objective: To investigate the effectiveness of a guided, internet- and smartphone-based gratitude intervention on the transdiagnostic risk-factor 'repetitive negative thinking'. The multicomponent intervention integrates a variety of gratitude exercises, targeting the cognitive, emotional and behavioural facets of gratitude.

Method: Two hundred adults with pronounced repetitive negative thinking were recruited from the general population. Participants were randomly assigned to either a four-session guided gratitude intervention (n = 100) or waiting list (n = 100). The primary outcome was repetitive negative thinking three months after randomization, with exploratory assessments at six weeks and six months, the latter just for participants in the intervention group.

Results: Following the intention-to-treat principle, by analyses of covariance (ANCOVA), the gratitude intervention group exhibited significantly lower levels of repetitive negative thinking than controls at three months, with d = 0.66, 95 % CI [0.37, 0.94] maintained at six-month follow-up. Significant and meaningful beneficial effects were observed in symptoms of depression (d = 0.42) and generalized anxiety (d = 0.38). These effects were notably stronger in intervention completers who finished at least three sessions.

Conclusions: Results suggest that a multicomponent gratitude intervention is effective at reducing repetitive negative thinking. Multicomponent interventions may be a next step needed to fully realize the potential of gratitude interventions. Such interventions could expand the repertoire of transdiagnostic interventions, especially for repetitive negative thinking. Furthermore, due to its positive connotations, gratitude is a candidate for an indirect intervention aimed at reducing the burden of depression in the general population.

Trial registration: The study is registered in the German Clinical Trial Register (approved primary register of the WHO) as DRKS00006825. The trial protocol can be assessed at: https://www.drks.de/.

Keywords: Gratitude; Internet and mobile intervention; Positive psychology; Repetitive negative thinking; Transdiagnostic.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dirk Lehr, Matthias Berking, David Daniel Ebert reports financial support was provided by European Union. Matthias Berking has served as a consultant on the scientific advisory boards of GET.ON institute and mentalis GmbH, used to be shareholder of GET.ON institute, and is currently shareholder of mentalis GmbH. David Daniel Ebert has served as a consultant to/on the scientific advisory boards of Sanofi, Novartis, Minddistrict, Lantern, Schoen Kliniken, Ideamed and German health insurance companies (BARMER, Techniker Krankenkasse) and a number of federal chambers for psychotherapy. He is also shareholder of "GET.ON Institut für Online Gesundheitstrainings GmbH für Gesundheitstrainings online GmbH" (HelloBetter), which aims to implement scientific findings related to digital health interventions into routine care. All other authors, declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flow of participants. Follow-up I: Six weeks after randomization; Follow-up II: Three months after randomization; Follow-up III: Six months after randomization. PTQ = Perseverative Thinking Questionnaire; IG = Intervention group; WLC = Waiting-list control group; ITT = Intention-to-treat analysis. a Participants who completed fewer than 3 out of 4 units. b Counts/Percentage of provided data for the primary outcome.
Fig. 2
Fig. 2
Development of repetitive negative thinking from baseline to six weeks to three-months and to six-months follow-up in the intervention group and waiting-list control group. Marginal means from the intention-to-treat sample. The scale ranges from 0 to 60. PTQ = Perseverative Thinking Questionnaire.
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