<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03784001</url>
  </required_header>
  <id_info>
    <org_study_id>1997</org_study_id>
    <nct_id>NCT03784001</nct_id>
  </id_info>
  <brief_title>The Effects of Manipulating Expectations in a Gratitude Intervention</brief_title>
  <official_title>Cultivating Gratitude: Does Manipulating Expectations Improve the Efficacy of a Gratitude Intervention?</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>University of California, Los Angeles</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>University of California, Los Angeles</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Gratitude - an emotion felt when an individual receives something beneficial from other&#xD;
      people or entities - has been shown to positively affect well-being. Beginning in 2003,&#xD;
      &quot;count your blessings&quot; interventions - in which participants list items they are grateful&#xD;
      for, and gratitude letter writing interventions were designed to cultivate gratitude.&#xD;
      Gratitude interventions have many positive outcomes; they can increase well-being and life&#xD;
      satisfaction (Froh, Sefick, &amp; Emmons, 2008) and increase self-esteem (Rash, Matsuba, &amp;&#xD;
      Prkachin, 2011) to name a few.&#xD;
&#xD;
      Knowing the benefits of gratitude prior to an intervention could affect participant behavior&#xD;
      and health outcomes. Past studies have illustrated that sharing information about treatments&#xD;
      changes expectations and improves outcomes (Zion &amp; Crum, 2018). For instance, overt medical&#xD;
      treatments are more effective than hidden ones (Colloca, Lopiano, Lanotte, &amp; Benedetti,&#xD;
      2004).&#xD;
&#xD;
      The proposed study is designed to evaluate whether expectations about intervention efficacy&#xD;
      can enhance the benefits of a brief gratitude intervention. Specifically, the investigators&#xD;
      will test if providing information on the benefits of gratitude will enhance intervention&#xD;
      outcomes. This 3-armed randomized controlled trial will have the following conditions:&#xD;
      gratitude + expectation, gratitude, and events control. Participants will be undergraduate&#xD;
      college students and the online intervention will last two weeks.&#xD;
&#xD;
      Participants in the two gratitude conditions will login to an online form three times a week&#xD;
      for two weeks and make entries of up to five things they are grateful for. The form for&#xD;
      participants in the gratitude + expectation condition will also provide information about&#xD;
      benefits of gratitude. An everyday events control will be used to provide a neutral&#xD;
      comparison condition. This group will be instructed to type up to five things or events of&#xD;
      note from their day on their form.&#xD;
&#xD;
      Outcome measures will be collected via an online survey before and immediately after the&#xD;
      intervention. The primary outcome is well-being and the secondary outcomes are sleep quality&#xD;
      and quantity, state gratitude, positive affect, healthcare self-efficacy, stress, and&#xD;
      depressive symptoms. The investigators predict that participants in the gratitude +&#xD;
      expectation condition will have enhanced intervention outcomes compared to participants in&#xD;
      comparison conditions.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Overview: Potential participants will be recruited from an undergraduate psychology class.&#xD;
      Participants will have one week after initial study advertisement to read the consent form&#xD;
      and decide if they wish to participate. When participants turn in a signed consent form, they&#xD;
      will be officially enrolled in the study and issued a personal identification (PI) number to&#xD;
      use throughout the study.&#xD;
&#xD;
      Participants will be randomly assigned to one of three conditions: gratitude + expectations,&#xD;
      gratitude, or an everyday events control condition. Participants will be emailed six&#xD;
      different times, once every two days, with a link to an anonymous Google form. Each Google&#xD;
      form will instruct participants to type either a short gratitude list (for gratitude +&#xD;
      expectations and gratitude conditions) or an events list (for everyday events control), and&#xD;
      will have a section for participants to enter their personal identification numbers.&#xD;
      Additionally, the first form will include a demographics questionnaire and the first and&#xD;
      sixth forms will include questionnaires assessing all outcomes of interest.The primary&#xD;
      outcome of interest is well-being. The secondary outcomes of interest are sleep, state&#xD;
      gratitude, healthcare self-efficacy, stress, and depressive symptoms.&#xD;
&#xD;
      Participants in the gratitude + expectations condition will have a statement at the top of&#xD;
      their Google form about the benefits of gratitude. Examples of these statements are:&#xD;
      &quot;Practicing gratitude may increase social connectedness&quot; and &quot;Cultivating gratitude was shown&#xD;
      to improve school satisfaction in a sample of students&quot;. By the end of the study,&#xD;
      participants will have completed six gratitude or everyday events lists and two&#xD;
      questionnaires.&#xD;
&#xD;
      Interventions:&#xD;
&#xD;
        1. Gratitude + No Expectations: Participants in the gratitude condition will practice a&#xD;
           counting your blessings intervention for two weeks. Participants will be instructed to&#xD;
           list up to five things they are grateful for every two days for the two weeks of the&#xD;
           intervention (six times total).&#xD;
&#xD;
        2. Gratitude + expectations: Participants in this condition will be given the same&#xD;
           instructions as the gratitude condition and will also be given the regular reminders of&#xD;
           the benefits of gratitude.&#xD;
&#xD;
        3. Everyday events: Participants will be instructed to list up to five details about their&#xD;
           day, such as activities they engaged in, or conversations they had. Participants will&#xD;
           make these lists every two days for two weeks (six times total).&#xD;
&#xD;
      Questionnaires:&#xD;
&#xD;
      Self-report questionnaires with high test-retest reliability and internal validity will be&#xD;
      administered at baseline and post intervention to access changes in outcomes of interest,&#xD;
      such as well-being, depressive symptoms, and anxiety.&#xD;
&#xD;
      Questionnaires administered only at baseline: Communication and Attitudinal Self-Efficacy&#xD;
      Scale (CASE) and demographic questionnaire&#xD;
&#xD;
      Questionnaires administered pre- and post-intervention: Mental Health Continuum-Short Form,&#xD;
      Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Scale,&#xD;
      Pittsburg Sleep Quality Index (PSQI) duration items, Modified Differential Emotions Scale,&#xD;
      Center for Epidemiologic Studies Depression Scale (CES-D), Perceived Stress Scale 4&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">February 5, 2019</start_date>
  <completion_date type="Actual">February 28, 2019</completion_date>
  <primary_completion_date type="Actual">February 28, 2019</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <intervention_model_description>Participants will be randomly assigned to one of three conditions: Gratitude, Gratitude + Expectations, or Events Control Participants in the two gratitude conditions will login to an online Google form three times a week for two weeks and make entries of up to five things they are grateful for. The form for participants in the gratitude + expectation condition will also provide information about benefits of gratitude. An everyday events control will be used to provide a neutral comparison condition. This group will be instructed to type up to five things or events of note from their day on their form.</intervention_model_description>
    <primary_purpose>Other</primary_purpose>
    <masking>Single (Participant)</masking>
    <masking_description>Participants will only know they are taking part in a &quot;Mood and Writing Study&quot; and will not know which condition they are in.</masking_description>
  </study_design_info>
  <primary_outcome>
    <measure>Mental Health Continuum-Short Form (MHC-SF)</measure>
    <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
    <description>Hedonic well-being, eudaimonic well-being, and overall well-being were assessed at baseline and post-intervention. Well-being was measured with the Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). Participants rated how often they felt 14 different emotions or statements, such as &quot;happy&quot; and &quot;satisfied with life&quot;. Items are rated on a 6-point likert scale (0 = never, 5 = everyday). This measure assesses both hedonic and eudaimonic well-being. The MHC-SF is both reliable and valid for use with young adults (Robitschek &amp; Keyes, 2009). Total scores are created by the sum of scores for all 14 items, with a range of 0-70. Higher scores indicate greater overall well-being.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Mental Health Continuum-Short Form (MHC-SF): Hedonic Well-Being SubScale</measure>
    <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
    <description>Well-being was measured with the Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). Participants rated how often they felt 14 different emotions or statements, such as &quot;happy&quot; and &quot;satisfied with life&quot;. Items are rated on a 6-point likert scale (0 = never, 5 = everyday), with higher numbers indicating greater well-being. This measure assesses both hedonic and eudaimonic well-being. The MHC-SF is both reliable and valid for use with young adults (Robitschek &amp; Keyes, 2009). The Hedonic Well-Being Subscale is the sum of items 1-3 on the Mental Health Continuum Short-Form. Total scores range from 0-15, with higher scores indicating greater hedonic well-being. Scoring a 4 or 5 on at least one of the 3 items on the Hedonic Well-Being Subscale indicates a diagnosis of flourishing mental health.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Mental Health Continuum-Short Form (MHC-SF): Eudaimonic Well-Being SubScale</measure>
    <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
    <description>Well-being was measured with the Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). Participants rated how often they felt 14 different emotions or statements, such as &quot;happy&quot; and &quot;satisfied with life&quot;. Items are rated on a 6-point likert scale (0 = never, 5 = everyday), with higher numbers indicating greater well-being. This measure assesses both hedonic and eudaimonic well-being. The MHC-SF is both reliable and valid for use with young adults (Robitschek &amp; Keyes, 2009). The score of the Eudaimonic Subscale is the sum of items 4-14 on the MHC-SF. Scores range from 0-55. Higher scores indicate greater eudaimonic well-being (i.e., greater social and psychological well-being).</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Scale</measure>
    <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
    <description>Sleep quality was measured with the 8-item PROMIS sleep disturbance short form (Yu et al., 2012). Participants rated their level of agreement with eight different statements about their sleep in the past seven days such as &quot;My sleep was restless&quot; and &quot;I had difficulty falling asleep&quot;. Participants rated each item on a 5 point scale (1 = not at all, 5 = very much). Items 2, 3, 7, and 8 were reverse scored. The total score of the PROMIS Sleep Disturbance Scale is the sum of the scores for all 8 items. Total scores range from 8-40, with higher scores indicating more severe sleep disturbance.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Pittsburg Sleep Quality Index (PSQI) Duration Items</measure>
    <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
    <description>Sleep quantity was measured with the Pittsburgh Sleep Quality Index Duration Items (PSQI-4), which asks participants questions such as when they went to bed and when they woke up in the morning (Buysse et al., 1989). PSQI duration items are questions 1-4 on the PSQI, which measure how much sleep respondents have been getting. Higher hours of sleep is a better outcome.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Modified Differential Emotions Scale (MDES): Positive Emotions Subscale</measure>
    <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
    <description>Positive affect was measured with the ten-item Positive Emotions (PE) subscale of the Modified Differential Emotions Scale (mDES) (Fredrickson, Tugade, Waugh, and Larkin, 2003). Participants rated how often they felt ten different groups of positive emotions such as &quot;amused, fun-loving, silly&quot; on a 5-point scale (0 = not at all, 4 = most of the time). The average of the items was calculated to measure positive affect, with higher numbers indicating greater positive affect.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Perceived Stress Scale - 4 (PSS-4)</measure>
    <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
    <description>Stress was measured with the 4-item Perceived Stress Scale (PSS-4; Cohen, Kamarack, and Mermelstein, 1983). Participants rated how often they felt a certain way in the last week on four different items such as &quot;How often have you felt confident about your ability to handle your personal problems?&quot; and &quot;How often have you felt that things were going your way?&quot; on a 5- point scale (0 = never, 4 = very often). The total score of the PSS-4 is the sum of all 4 items. Total scores range from 0-16, and higher scores indicate greater perceived stress.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Center for Epidemiologic Studies Depression Scale (CES-D)</measure>
    <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
    <description>Depressive symptoms were measured by the Center for Epidemiological Studies - Depression Scale (CES-D, Radloff, 1977). Participants rated how often they experienced 20 different statements such as &quot;I was bothered by things that usually don't bother me&quot; and &quot;I felt like everything I did was an effort&quot; in the past week. Participants scored each item on a 4-point scale (0 = rarely or none of the time 3 = all of the time). The total score for the CES-D is the sum of all 20 items, with a range of 0-60, with higher scores indicating greater depressive symptoms.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Modified Differential Emotions Scale (MDES): State Gratitude</measure>
    <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
    <description>State gratitude was measured with item one of the mDES (Fredrickson, Tugade, Waugh, and Larkin, 2003), which asks participants how often they felt &quot;grateful, appreciative, or thankful&quot; in the past two weeks. Participants rated this item on a 5-point scale (0 = not at all, 4 = most of the time), with a higher number indicating higher feelings of gratitude.</description>
  </secondary_outcome>
  <number_of_arms>3</number_of_arms>
  <enrollment type="Actual">125</enrollment>
  <condition>Gratitude + No Expectations</condition>
  <condition>Gratitude + Expectations</condition>
  <condition>Events Control</condition>
  <arm_group>
    <arm_group_label>Gratitude + No Expectations</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>Participants will type online lists of up to five items they are grateful for, every two days for two weeks.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Gratitude + Expectations</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Participants will type online lists of up to five items they are grateful for, every two days for two weeks. They will also be told a benefit of gratitude each time they write an online gratitude list.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Events Control</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>Participants will type online lists of up to five events from their day, every two day for two weeks.</description>
  </arm_group>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Gratitude + No Expectations Intervention</intervention_name>
    <description>Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Additionally, the first form will include a demographics questionnaire and the first and sixth forms will include questionnaires assessing all outcomes of interest</description>
    <arm_group_label>Gratitude + No Expectations</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Gratitude + Expectations Intervention</intervention_name>
    <description>Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Participants will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: &quot;Practicing gratitude may increase social connectedness&quot; and &quot;Cultivating gratitude was shown to improve school satisfaction in a UK sample of students&quot;. Additionally, the first form will include a demographics questionnaire and the first and sixth forms will include questionnaires assessing all outcomes of interest</description>
    <arm_group_label>Gratitude + Expectations</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Events Control Intervention</intervention_name>
    <description>Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a list of up to five items about events from their day. Additionally, the first form will include a demographics questionnaire and the first and sixth forms will include questionnaires assessing all outcomes of interest.</description>
    <arm_group_label>Events Control</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Undergraduate Student&#xD;
&#xD;
          -  Proficient in English&#xD;
&#xD;
          -  18 years of age or older&#xD;
&#xD;
          -  Has a valid email address&#xD;
&#xD;
          -  Access to the internet&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
        -No other exclusion criteria (aside from meeting the inclusion criteria above)&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Tanera van Diggelen</last_name>
    <role>Principal Investigator</role>
    <affiliation>University of California, Los Angeles</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>UCLA</name>
      <address>
        <city>Los Angeles</city>
        <state>California</state>
        <zip>90024</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <reference>
    <citation>Froh JJ, Sefick WJ, Emmons RA. Counting blessings in early adolescents: an experimental study of gratitude and subjective well-being. J Sch Psychol. 2008 Apr;46(2):213-33. doi: 10.1016/j.jsp.2007.03.005. Epub 2007 May 4.</citation>
    <PMID>19083358</PMID>
  </reference>
  <reference>
    <citation>Bartlett MY, DeSteno D. Gratitude and prosocial behavior: helping when it costs you. Psychol Sci. 2006 Apr;17(4):319-25. doi: 10.1111/j.1467-9280.2006.01705.x.</citation>
    <PMID>16623689</PMID>
  </reference>
  <reference>
    <citation>Watkins, P., Woodward, K., Stone, T., &amp; Kolts, R. (2003). Gratitude and happiness: Development of a measure of gratitude and relationships with subjective well-being. Social Behavior and Personality: An international journal, 31, 431-452. doi: 10.2224/sbp.2003.31.5.431</citation>
  </reference>
  <reference>
    <citation>Kruse, E., Chancellor, J., Ruberton, P.M., &amp; Lyubomirsky, S. (2014). An upward spiral between gratitude and humility. Social Psychological and Personality Science. 5(7), 805-814. doi: 10.1177/1948550614534700</citation>
  </reference>
  <reference>
    <citation>Rash, J. A., Matsuba, M. K., &amp; Prkachin, K. M. (2011). Gratitude and well-being: who benefits the most from a gratitude intervention? Applied Psychology: Health and Well-Being, 3(3), 350-369. doi: 10.1111/j.1758-0854.2011.01058.x</citation>
  </reference>
  <reference>
    <citation>Zion SR, Crum AJ. Mindsets Matter: A New Framework for Harnessing the Placebo Effect in Modern Medicine. Int Rev Neurobiol. 2018;138:137-160. doi: 10.1016/bs.irn.2018.02.002. Epub 2018 Mar 20.</citation>
    <PMID>29681322</PMID>
  </reference>
  <reference>
    <citation>Colloca L, Lopiano L, Lanotte M, Benedetti F. Overt versus covert treatment for pain, anxiety, and Parkinson's disease. Lancet Neurol. 2004 Nov;3(11):679-84. doi: 10.1016/S1474-4422(04)00908-1.</citation>
    <PMID>15488461</PMID>
  </reference>
  <reference>
    <citation>Emmons RA, McCullough ME. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol. 2003 Feb;84(2):377-89. doi: 10.1037//0022-3514.84.2.377.</citation>
    <PMID>12585811</PMID>
  </reference>
  <reference>
    <citation>Sheldon, K.M. &amp; Lyubomirsky, S. 2006. How to increase and sustain positive emotion: The effects of expressing gratitude and visualizing best possible selves. The Journal of Positive Psychology. 1(2). 73-82. doi:10.1080/17439760500510676</citation>
  </reference>
  <reference>
    <citation>Jackowska M, Brown J, Ronaldson A, Steptoe A. The impact of a brief gratitude intervention on subjective well-being, biology and sleep. J Health Psychol. 2016 Oct;21(10):2207-17. doi: 10.1177/1359105315572455. Epub 2015 Mar 2.</citation>
    <PMID>25736389</PMID>
  </reference>
  <verification_date>May 2020</verification_date>
  <study_first_submitted>December 19, 2018</study_first_submitted>
  <study_first_submitted_qc>December 20, 2018</study_first_submitted_qc>
  <study_first_posted type="Actual">December 21, 2018</study_first_posted>
  <results_first_submitted>March 26, 2020</results_first_submitted>
  <results_first_submitted_qc>May 24, 2020</results_first_submitted_qc>
  <results_first_posted type="Actual">June 9, 2020</results_first_posted>
  <last_update_submitted>May 24, 2020</last_update_submitted>
  <last_update_submitted_qc>May 24, 2020</last_update_submitted_qc>
  <last_update_posted type="Actual">June 9, 2020</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>University of California, Los Angeles</investigator_affiliation>
    <investigator_full_name>Tanera van Diggelen</investigator_full_name>
    <investigator_title>Principal Investigator</investigator_title>
  </responsible_party>
  <keyword>Gratitude, Expectations, Well-being</keyword>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <provided_document_section>
    <provided_document>
      <document_type>Study Protocol and Statistical Analysis Plan</document_type>
      <document_has_protocol>Yes</document_has_protocol>
      <document_has_icf>No</document_has_icf>
      <document_has_sap>Yes</document_has_sap>
      <document_date>January 10, 2019</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/01/NCT03784001/Prot_SAP_000.pdf</document_url>
    </provided_document>
  </provided_document_section>

  <clinical_results>

    <participant_flow>
      <group_list>
        <group group_id="P1">
          <title>Gratitude + No Expectations (GNE)</title>
          <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days.&#xD;
Gratitude Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items.</description>
        </group>
        <group group_id="P2">
          <title>Gratitude + Expectation (GE)</title>
          <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days. They will also be told a benefit of gratitude each time they write an online gratitude list.&#xD;
Gratitude + Expectations Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Participants will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: &quot;Practicing gratitude may increase social connectedness&quot; and &quot;Cultivating gratitude was shown to improve school satisfaction in a UK sample of students&quot;.</description>
        </group>
        <group group_id="P3">
          <title>Events Control</title>
          <description>Participants will type online lists of up to five events from their day, every two day for 13 days.&#xD;
Events Control Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a list of up to five items about events from their day.</description>
        </group>
      </group_list>
      <period_list>
        <period>
          <title>Overall Study</title>
          <milestone_list>
            <milestone>
              <title>STARTED</title>
              <participants_list>
                <participants group_id="P1" count="46"/>
                <participants group_id="P2" count="38"/>
                <participants group_id="P3" count="41"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="44"/>
                <participants group_id="P2" count="38"/>
                <participants group_id="P3" count="40"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>NOT COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="2"/>
                <participants group_id="P2" count="0"/>
                <participants group_id="P3" count="1"/>
              </participants_list>
            </milestone>
          </milestone_list>
        </period>
      </period_list>
    </participant_flow>

    <baseline>
      <group_list>
        <group group_id="B1">
          <title>Gratitude + No Expectations (GNE)</title>
          <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days.&#xD;
Gratitude Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items.</description>
        </group>
        <group group_id="B2">
          <title>Gratitude + Expectation (GE)</title>
          <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days. They will also be told a benefit of gratitude each time they write an online gratitude list.&#xD;
Gratitude + Expectations Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Participants will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: &quot;Practicing gratitude may increase social connectedness&quot; and &quot;Cultivating gratitude was shown to improve school satisfaction in a UK sample of students&quot;.</description>
        </group>
        <group group_id="B3">
          <title>Events Control</title>
          <description>Participants will type online lists of up to five events from their day, every two day for 13 days.&#xD;
Events Control Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a list of up to five items about events from their day.</description>
        </group>
        <group group_id="B4">
          <title>Total</title>
          <description>Total of all reporting groups</description>
        </group>
      </group_list>
      <analyzed_list>
        <analyzed>
          <units>Participants</units>
          <scope>Overall</scope>
          <count_list>
            <count group_id="B1" value="46"/>
            <count group_id="B2" value="38"/>
            <count group_id="B3" value="41"/>
            <count group_id="B4" value="125"/>
          </count_list>
        </analyzed>
      </analyzed_list>
      <measure_list>
        <measure>
          <title>Age</title>
          <units>years</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="21.46" spread="2.43"/>
                    <measurement group_id="B2" value="22.00" spread="3.30"/>
                    <measurement group_id="B3" value="21.27" spread="1.18"/>
                    <measurement group_id="B4" value="21.56" spread="2.44"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Sex: Female, Male</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>Female</title>
                  <measurement_list>
                    <measurement group_id="B1" value="38"/>
                    <measurement group_id="B2" value="28"/>
                    <measurement group_id="B3" value="30"/>
                    <measurement group_id="B4" value="96"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Male</title>
                  <measurement_list>
                    <measurement group_id="B1" value="8"/>
                    <measurement group_id="B2" value="10"/>
                    <measurement group_id="B3" value="11"/>
                    <measurement group_id="B4" value="29"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Race/Ethnicity, Customized</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <title>White/ Caucasian</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="23"/>
                    <measurement group_id="B2" value="9"/>
                    <measurement group_id="B3" value="13"/>
                    <measurement group_id="B4" value="45"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Hispanic/ Latino/a</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="9"/>
                    <measurement group_id="B2" value="7"/>
                    <measurement group_id="B3" value="5"/>
                    <measurement group_id="B4" value="21"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Asian</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="10"/>
                    <measurement group_id="B2" value="14"/>
                    <measurement group_id="B3" value="18"/>
                    <measurement group_id="B4" value="42"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Native Hawaiian, American Indian or Alaska Native</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="3"/>
                    <measurement group_id="B2" value="6"/>
                    <measurement group_id="B3" value="2"/>
                    <measurement group_id="B4" value="11"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Black or African American</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="1"/>
                    <measurement group_id="B2" value="2"/>
                    <measurement group_id="B3" value="3"/>
                    <measurement group_id="B4" value="6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>School Year (4th Year of Undergraduate Study)</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="33"/>
                    <measurement group_id="B2" value="29"/>
                    <measurement group_id="B3" value="28"/>
                    <measurement group_id="B4" value="90"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Family Income, Categorical (&gt; $100,000/ year)</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="22"/>
                    <measurement group_id="B2" value="14"/>
                    <measurement group_id="B3" value="20"/>
                    <measurement group_id="B4" value="56"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </measure_list>
    </baseline>

    <outcome_list>
      <outcome>
        <type>Primary</type>
        <title>Mental Health Continuum-Short Form (MHC-SF)</title>
        <description>Hedonic well-being, eudaimonic well-being, and overall well-being were assessed at baseline and post-intervention. Well-being was measured with the Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). Participants rated how often they felt 14 different emotions or statements, such as &quot;happy&quot; and &quot;satisfied with life&quot;. Items are rated on a 6-point likert scale (0 = never, 5 = everyday). This measure assesses both hedonic and eudaimonic well-being. The MHC-SF is both reliable and valid for use with young adults (Robitschek &amp; Keyes, 2009). Total scores are created by the sum of scores for all 14 items, with a range of 0-70. Higher scores indicate greater overall well-being.</description>
        <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
        <population>These are the numbers analyzed when assessing overall well-being</population>
        <group_list>
          <group group_id="O1">
            <title>Gratitude + No Expectations (GNE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days.&#xD;
Gratitude Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items.</description>
          </group>
          <group group_id="O2">
            <title>Gratitude + Expectation (GE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days. They will also be told a benefit of gratitude each time they write an online gratitude list.&#xD;
Gratitude + Expectations Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Participants will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: &quot;Practicing gratitude may increase social connectedness&quot; and &quot;Cultivating gratitude was shown to improve school satisfaction in a UK sample of students&quot;.</description>
          </group>
          <group group_id="O3">
            <title>Events Control</title>
            <description>Participants will type online lists of up to five events from their day, every two day for 13 days.&#xD;
Events Control Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a list of up to five items about events from their day.</description>
          </group>
        </group_list>
        <measure>
          <title>Mental Health Continuum-Short Form (MHC-SF)</title>
          <description>Hedonic well-being, eudaimonic well-being, and overall well-being were assessed at baseline and post-intervention. Well-being was measured with the Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). Participants rated how often they felt 14 different emotions or statements, such as &quot;happy&quot; and &quot;satisfied with life&quot;. Items are rated on a 6-point likert scale (0 = never, 5 = everyday). This measure assesses both hedonic and eudaimonic well-being. The MHC-SF is both reliable and valid for use with young adults (Robitschek &amp; Keyes, 2009). Total scores are created by the sum of scores for all 14 items, with a range of 0-70. Higher scores indicate greater overall well-being.</description>
          <population>These are the numbers analyzed when assessing overall well-being</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="41"/>
                <count group_id="O2" value="38"/>
                <count group_id="O3" value="38"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Pre-Intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="26.15" spread="7.512"/>
                    <measurement group_id="O2" value="21.29" spread="8.60"/>
                    <measurement group_id="O3" value="24.37" spread="9.35"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Post-intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="26.78" spread="7.82"/>
                    <measurement group_id="O2" value="23.21" spread="9.19"/>
                    <measurement group_id="O3" value="23.95" spread="10.21"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Mental Health Continuum-Short Form (MHC-SF): Hedonic Well-Being SubScale</title>
        <description>Well-being was measured with the Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). Participants rated how often they felt 14 different emotions or statements, such as &quot;happy&quot; and &quot;satisfied with life&quot;. Items are rated on a 6-point likert scale (0 = never, 5 = everyday), with higher numbers indicating greater well-being. This measure assesses both hedonic and eudaimonic well-being. The MHC-SF is both reliable and valid for use with young adults (Robitschek &amp; Keyes, 2009). The Hedonic Well-Being Subscale is the sum of items 1-3 on the Mental Health Continuum Short-Form. Total scores range from 0-15, with higher scores indicating greater hedonic well-being. Scoring a 4 or 5 on at least one of the 3 items on the Hedonic Well-Being Subscale indicates a diagnosis of flourishing mental health.</description>
        <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Gratitude + No Expectations (GNE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days.&#xD;
Gratitude Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items.</description>
          </group>
          <group group_id="O2">
            <title>Gratitude + Expectation (GE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days. They will also be told a benefit of gratitude each time they write an online gratitude list.&#xD;
Gratitude + Expectations Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Participants will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: &quot;Practicing gratitude may increase social connectedness&quot; and &quot;Cultivating gratitude was shown to improve school satisfaction in a UK sample of students&quot;.</description>
          </group>
          <group group_id="O3">
            <title>Events Control</title>
            <description>Participants will type online lists of up to five events from their day, every two day for 13 days.&#xD;
Events Control Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a list of up to five items about events from their day.</description>
          </group>
        </group_list>
        <measure>
          <title>Mental Health Continuum-Short Form (MHC-SF): Hedonic Well-Being SubScale</title>
          <description>Well-being was measured with the Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). Participants rated how often they felt 14 different emotions or statements, such as &quot;happy&quot; and &quot;satisfied with life&quot;. Items are rated on a 6-point likert scale (0 = never, 5 = everyday), with higher numbers indicating greater well-being. This measure assesses both hedonic and eudaimonic well-being. The MHC-SF is both reliable and valid for use with young adults (Robitschek &amp; Keyes, 2009). The Hedonic Well-Being Subscale is the sum of items 1-3 on the Mental Health Continuum Short-Form. Total scores range from 0-15, with higher scores indicating greater hedonic well-being. Scoring a 4 or 5 on at least one of the 3 items on the Hedonic Well-Being Subscale indicates a diagnosis of flourishing mental health.</description>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="42"/>
                <count group_id="O2" value="38"/>
                <count group_id="O3" value="38"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Pre-Intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5.86" spread="1.84"/>
                    <measurement group_id="O2" value="4.95" spread="2.36"/>
                    <measurement group_id="O3" value="5.84" spread="1.84"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Post-intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="6.24" spread="1.79"/>
                    <measurement group_id="O2" value="5.03" spread="2.50"/>
                    <measurement group_id="O3" value="5.39" spread="2.56"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Mental Health Continuum-Short Form (MHC-SF): Eudaimonic Well-Being SubScale</title>
        <description>Well-being was measured with the Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). Participants rated how often they felt 14 different emotions or statements, such as &quot;happy&quot; and &quot;satisfied with life&quot;. Items are rated on a 6-point likert scale (0 = never, 5 = everyday), with higher numbers indicating greater well-being. This measure assesses both hedonic and eudaimonic well-being. The MHC-SF is both reliable and valid for use with young adults (Robitschek &amp; Keyes, 2009). The score of the Eudaimonic Subscale is the sum of items 4-14 on the MHC-SF. Scores range from 0-55. Higher scores indicate greater eudaimonic well-being (i.e., greater social and psychological well-being).</description>
        <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Gratitude + No Expectations (GNE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days.&#xD;
Gratitude Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items.</description>
          </group>
          <group group_id="O2">
            <title>Gratitude + Expectation (GE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days. They will also be told a benefit of gratitude each time they write an online gratitude list.&#xD;
Gratitude + Expectations Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Participants will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: &quot;Practicing gratitude may increase social connectedness&quot; and &quot;Cultivating gratitude was shown to improve school satisfaction in a UK sample of students&quot;.</description>
          </group>
          <group group_id="O3">
            <title>Events Control</title>
            <description>Participants will type online lists of up to five events from their day, every two day for 13 days.&#xD;
Events Control Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a list of up to five items about events from their day.</description>
          </group>
        </group_list>
        <measure>
          <title>Mental Health Continuum-Short Form (MHC-SF): Eudaimonic Well-Being SubScale</title>
          <description>Well-being was measured with the Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). Participants rated how often they felt 14 different emotions or statements, such as &quot;happy&quot; and &quot;satisfied with life&quot;. Items are rated on a 6-point likert scale (0 = never, 5 = everyday), with higher numbers indicating greater well-being. This measure assesses both hedonic and eudaimonic well-being. The MHC-SF is both reliable and valid for use with young adults (Robitschek &amp; Keyes, 2009). The score of the Eudaimonic Subscale is the sum of items 4-14 on the MHC-SF. Scores range from 0-55. Higher scores indicate greater eudaimonic well-being (i.e., greater social and psychological well-being).</description>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="42"/>
                <count group_id="O2" value="38"/>
                <count group_id="O3" value="38"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Pre-Intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="20.21" spread="5.94"/>
                    <measurement group_id="O2" value="16.34" spread="6.51"/>
                    <measurement group_id="O3" value="18.53" spread="7.53"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Post-intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="20.52" spread="6.31"/>
                    <measurement group_id="O2" value="18.18" spread="7.02"/>
                    <measurement group_id="O3" value="18.55" spread="7.96"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Scale</title>
        <description>Sleep quality was measured with the 8-item PROMIS sleep disturbance short form (Yu et al., 2012). Participants rated their level of agreement with eight different statements about their sleep in the past seven days such as &quot;My sleep was restless&quot; and &quot;I had difficulty falling asleep&quot;. Participants rated each item on a 5 point scale (1 = not at all, 5 = very much). Items 2, 3, 7, and 8 were reverse scored. The total score of the PROMIS Sleep Disturbance Scale is the sum of the scores for all 8 items. Total scores range from 8-40, with higher scores indicating more severe sleep disturbance.</description>
        <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Gratitude + No Expectations (GNE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days.&#xD;
Gratitude Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items.</description>
          </group>
          <group group_id="O2">
            <title>Gratitude + Expectation (GE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days. They will also be told a benefit of gratitude each time they write an online gratitude list.&#xD;
Gratitude + Expectations Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Participants will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: &quot;Practicing gratitude may increase social connectedness&quot; and &quot;Cultivating gratitude was shown to improve school satisfaction in a UK sample of students&quot;.</description>
          </group>
          <group group_id="O3">
            <title>Events Control</title>
            <description>Participants will type online lists of up to five events from their day, every two day for 13 days.&#xD;
Events Control Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a list of up to five items about events from their day.</description>
          </group>
        </group_list>
        <measure>
          <title>Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Scale</title>
          <description>Sleep quality was measured with the 8-item PROMIS sleep disturbance short form (Yu et al., 2012). Participants rated their level of agreement with eight different statements about their sleep in the past seven days such as &quot;My sleep was restless&quot; and &quot;I had difficulty falling asleep&quot;. Participants rated each item on a 5 point scale (1 = not at all, 5 = very much). Items 2, 3, 7, and 8 were reverse scored. The total score of the PROMIS Sleep Disturbance Scale is the sum of the scores for all 8 items. Total scores range from 8-40, with higher scores indicating more severe sleep disturbance.</description>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="41"/>
                <count group_id="O2" value="37"/>
                <count group_id="O3" value="38"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Pre-Intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="21.05" spread="6.62"/>
                    <measurement group_id="O2" value="25.43" spread="7.08"/>
                    <measurement group_id="O3" value="20.71" spread="6.90"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Post-intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="19.17" spread="7.52"/>
                    <measurement group_id="O2" value="23.38" spread="7.8"/>
                    <measurement group_id="O3" value="20.61" spread="6.98"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Pittsburg Sleep Quality Index (PSQI) Duration Items</title>
        <description>Sleep quantity was measured with the Pittsburgh Sleep Quality Index Duration Items (PSQI-4), which asks participants questions such as when they went to bed and when they woke up in the morning (Buysse et al., 1989). PSQI duration items are questions 1-4 on the PSQI, which measure how much sleep respondents have been getting. Higher hours of sleep is a better outcome.</description>
        <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Gratitude + No Expectations (GNE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days.&#xD;
Gratitude Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items.</description>
          </group>
          <group group_id="O2">
            <title>Gratitude + Expectation (GE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days. They will also be told a benefit of gratitude each time they write an online gratitude list.&#xD;
Gratitude + Expectations Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Participants will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: &quot;Practicing gratitude may increase social connectedness&quot; and &quot;Cultivating gratitude was shown to improve school satisfaction in a UK sample of students&quot;.</description>
          </group>
          <group group_id="O3">
            <title>Events Control</title>
            <description>Participants will type online lists of up to five events from their day, every two day for 13 days.&#xD;
Events Control Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a list of up to five items about events from their day.</description>
          </group>
        </group_list>
        <measure>
          <title>Pittsburg Sleep Quality Index (PSQI) Duration Items</title>
          <description>Sleep quantity was measured with the Pittsburgh Sleep Quality Index Duration Items (PSQI-4), which asks participants questions such as when they went to bed and when they woke up in the morning (Buysse et al., 1989). PSQI duration items are questions 1-4 on the PSQI, which measure how much sleep respondents have been getting. Higher hours of sleep is a better outcome.</description>
          <units>hours</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="41"/>
                <count group_id="O2" value="37"/>
                <count group_id="O3" value="38"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Pre-Intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="6.56" spread="1.42"/>
                    <measurement group_id="O2" value="5.91" spread="1.29"/>
                    <measurement group_id="O3" value="6.30" spread="1.09"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Post-intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="6.86" spread="0.95"/>
                    <measurement group_id="O2" value="6.26" spread="1.60"/>
                    <measurement group_id="O3" value="6.68" spread="1.45"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Modified Differential Emotions Scale (MDES): Positive Emotions Subscale</title>
        <description>Positive affect was measured with the ten-item Positive Emotions (PE) subscale of the Modified Differential Emotions Scale (mDES) (Fredrickson, Tugade, Waugh, and Larkin, 2003). Participants rated how often they felt ten different groups of positive emotions such as &quot;amused, fun-loving, silly&quot; on a 5-point scale (0 = not at all, 4 = most of the time). The average of the items was calculated to measure positive affect, with higher numbers indicating greater positive affect.</description>
        <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Gratitude + No Expectations (GNE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days.&#xD;
Gratitude Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items.</description>
          </group>
          <group group_id="O2">
            <title>Gratitude + Expectation (GE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days. They will also be told a benefit of gratitude each time they write an online gratitude list.&#xD;
Gratitude + Expectations Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Participants will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: &quot;Practicing gratitude may increase social connectedness&quot; and &quot;Cultivating gratitude was shown to improve school satisfaction in a UK sample of students&quot;.</description>
          </group>
          <group group_id="O3">
            <title>Events Control</title>
            <description>Participants will type online lists of up to five events from their day, every two day for 13 days.&#xD;
Events Control Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a list of up to five items about events from their day.</description>
          </group>
        </group_list>
        <measure>
          <title>Modified Differential Emotions Scale (MDES): Positive Emotions Subscale</title>
          <description>Positive affect was measured with the ten-item Positive Emotions (PE) subscale of the Modified Differential Emotions Scale (mDES) (Fredrickson, Tugade, Waugh, and Larkin, 2003). Participants rated how often they felt ten different groups of positive emotions such as &quot;amused, fun-loving, silly&quot; on a 5-point scale (0 = not at all, 4 = most of the time). The average of the items was calculated to measure positive affect, with higher numbers indicating greater positive affect.</description>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="43"/>
                <count group_id="O2" value="37"/>
                <count group_id="O3" value="38"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Pre-Intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.86" spread="0.72"/>
                    <measurement group_id="O2" value="2.57" spread="0.80"/>
                    <measurement group_id="O3" value="2.78" spread="0.76"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Post-intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.85" spread="0.80"/>
                    <measurement group_id="O2" value="2.71" spread="0.85"/>
                    <measurement group_id="O3" value="2.84" spread="0.84"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Perceived Stress Scale - 4 (PSS-4)</title>
        <description>Stress was measured with the 4-item Perceived Stress Scale (PSS-4; Cohen, Kamarack, and Mermelstein, 1983). Participants rated how often they felt a certain way in the last week on four different items such as &quot;How often have you felt confident about your ability to handle your personal problems?&quot; and &quot;How often have you felt that things were going your way?&quot; on a 5- point scale (0 = never, 4 = very often). The total score of the PSS-4 is the sum of all 4 items. Total scores range from 0-16, and higher scores indicate greater perceived stress.</description>
        <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Gratitude + No Expectations (GNE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days.&#xD;
Gratitude Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items.</description>
          </group>
          <group group_id="O2">
            <title>Gratitude + Expectation (GE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days. They will also be told a benefit of gratitude each time they write an online gratitude list.&#xD;
Gratitude + Expectations Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Participants will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: &quot;Practicing gratitude may increase social connectedness&quot; and &quot;Cultivating gratitude was shown to improve school satisfaction in a UK sample of students&quot;.</description>
          </group>
          <group group_id="O3">
            <title>Events Control</title>
            <description>Participants will type online lists of up to five events from their day, every two day for 13 days.&#xD;
Events Control Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a list of up to five items about events from their day.</description>
          </group>
        </group_list>
        <measure>
          <title>Perceived Stress Scale - 4 (PSS-4)</title>
          <description>Stress was measured with the 4-item Perceived Stress Scale (PSS-4; Cohen, Kamarack, and Mermelstein, 1983). Participants rated how often they felt a certain way in the last week on four different items such as &quot;How often have you felt confident about your ability to handle your personal problems?&quot; and &quot;How often have you felt that things were going your way?&quot; on a 5- point scale (0 = never, 4 = very often). The total score of the PSS-4 is the sum of all 4 items. Total scores range from 0-16, and higher scores indicate greater perceived stress.</description>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="42"/>
                <count group_id="O2" value="38"/>
                <count group_id="O3" value="38"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Pre-Intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="7.05" spread="3.17"/>
                    <measurement group_id="O2" value="7.95" spread="3.17"/>
                    <measurement group_id="O3" value="6.03" spread="3.18"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Post-intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="6.62" spread="3.22"/>
                    <measurement group_id="O2" value="6.89" spread="3.03"/>
                    <measurement group_id="O3" value="6.16" spread="3.33"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Center for Epidemiologic Studies Depression Scale (CES-D)</title>
        <description>Depressive symptoms were measured by the Center for Epidemiological Studies - Depression Scale (CES-D, Radloff, 1977). Participants rated how often they experienced 20 different statements such as &quot;I was bothered by things that usually don't bother me&quot; and &quot;I felt like everything I did was an effort&quot; in the past week. Participants scored each item on a 4-point scale (0 = rarely or none of the time 3 = all of the time). The total score for the CES-D is the sum of all 20 items, with a range of 0-60, with higher scores indicating greater depressive symptoms.</description>
        <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Gratitude + No Expectations (GNE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days.&#xD;
Gratitude Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items.</description>
          </group>
          <group group_id="O2">
            <title>Gratitude + Expectation (GE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days. They will also be told a benefit of gratitude each time they write an online gratitude list.&#xD;
Gratitude + Expectations Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Participants will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: &quot;Practicing gratitude may increase social connectedness&quot; and &quot;Cultivating gratitude was shown to improve school satisfaction in a UK sample of students&quot;.</description>
          </group>
          <group group_id="O3">
            <title>Events Control</title>
            <description>Participants will type online lists of up to five events from their day, every two day for 13 days.&#xD;
Events Control Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a list of up to five items about events from their day.</description>
          </group>
        </group_list>
        <measure>
          <title>Center for Epidemiologic Studies Depression Scale (CES-D)</title>
          <description>Depressive symptoms were measured by the Center for Epidemiological Studies - Depression Scale (CES-D, Radloff, 1977). Participants rated how often they experienced 20 different statements such as &quot;I was bothered by things that usually don't bother me&quot; and &quot;I felt like everything I did was an effort&quot; in the past week. Participants scored each item on a 4-point scale (0 = rarely or none of the time 3 = all of the time). The total score for the CES-D is the sum of all 20 items, with a range of 0-60, with higher scores indicating greater depressive symptoms.</description>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="42"/>
                <count group_id="O2" value="38"/>
                <count group_id="O3" value="37"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Pre-Intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="17.21" spread="9.97"/>
                    <measurement group_id="O2" value="21.95" spread="13.12"/>
                    <measurement group_id="O3" value="17.08" spread="11.19"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Post-intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="17.40" spread="12.45"/>
                    <measurement group_id="O2" value="18.47" spread="12.96"/>
                    <measurement group_id="O3" value="17.08" spread="12.96"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Modified Differential Emotions Scale (MDES): State Gratitude</title>
        <description>State gratitude was measured with item one of the mDES (Fredrickson, Tugade, Waugh, and Larkin, 2003), which asks participants how often they felt &quot;grateful, appreciative, or thankful&quot; in the past two weeks. Participants rated this item on a 5-point scale (0 = not at all, 4 = most of the time), with a higher number indicating higher feelings of gratitude.</description>
        <time_frame>Assessed at Pre- and Post- Intervention (2 weeks apart)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Gratitude + No Expectations (GNE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days.&#xD;
Gratitude Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items.</description>
          </group>
          <group group_id="O2">
            <title>Gratitude + Expectation (GE)</title>
            <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days. They will also be told a benefit of gratitude each time they write an online gratitude list.&#xD;
Gratitude + Expectations Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Participants will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: &quot;Practicing gratitude may increase social connectedness&quot; and &quot;Cultivating gratitude was shown to improve school satisfaction in a UK sample of students&quot;.</description>
          </group>
          <group group_id="O3">
            <title>Events Control</title>
            <description>Participants will type online lists of up to five events from their day, every two day for 13 days.&#xD;
Events Control Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a list of up to five items about events from their day.</description>
          </group>
        </group_list>
        <measure>
          <title>Modified Differential Emotions Scale (MDES): State Gratitude</title>
          <description>State gratitude was measured with item one of the mDES (Fredrickson, Tugade, Waugh, and Larkin, 2003), which asks participants how often they felt &quot;grateful, appreciative, or thankful&quot; in the past two weeks. Participants rated this item on a 5-point scale (0 = not at all, 4 = most of the time), with a higher number indicating higher feelings of gratitude.</description>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="43"/>
                <count group_id="O2" value="37"/>
                <count group_id="O3" value="38"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Pre-Intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.07" spread="0.74"/>
                    <measurement group_id="O2" value="2.95" spread="0.98"/>
                    <measurement group_id="O3" value="3.11" spread="0.83"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Post-intervention</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.05" spread="0.84"/>
                    <measurement group_id="O2" value="3.05" spread="0.91"/>
                    <measurement group_id="O3" value="3.13" spread="0.91"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
    </outcome_list>

    <reported_events>
      <time_frame>Because this was a short behavioral study of minimal risk to participants, we did not monitor for adverse events. We let participants know that they could drop out of the study at any time and could choose not to answer any questions that they would not like to answer on the questionnaires.</time_frame>
      <desc>Because this was a short behavioral study of minimal risk to participants, we did not monitor for adverse events. We let participants know that they could drop out of the study at any time and could choose not to answer any questions that they would not like to answer on the questionnaires.</desc>
      <group_list>
        <group group_id="E1">
          <title>Gratitude + No Expectations (GNE)</title>
          <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days.&#xD;
Gratitude Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items.</description>
        </group>
        <group group_id="E2">
          <title>Gratitude + Expectation (GE)</title>
          <description>Participants will type online lists of up to five items they are grateful for, every two days for 13 days. They will also be told a benefit of gratitude each time they write an online gratitude list.&#xD;
Gratitude + Expectations Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Participants will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: &quot;Practicing gratitude may increase social connectedness&quot; and &quot;Cultivating gratitude was shown to improve school satisfaction in a UK sample of students&quot;.</description>
        </group>
        <group group_id="E3">
          <title>Events Control</title>
          <description>Participants will type online lists of up to five events from their day, every two day for 13 days.&#xD;
Events Control Intervention: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a list of up to five items about events from their day.</description>
        </group>
      </group_list>
      <serious_events>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, all-cause mortality</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="0"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="0"/>
                <counts group_id="E3" subjects_affected="0" subjects_at_risk="0"/>
              </event>
              <event>
                <sub_title>Total, serious adverse events</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="0"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="0"/>
                <counts group_id="E3" subjects_affected="0" subjects_at_risk="0"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </serious_events>
      <other_events>
        <frequency_threshold>0</frequency_threshold>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, other adverse events</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="0"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="0"/>
                <counts group_id="E3" subjects_affected="0" subjects_at_risk="0"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </other_events>
    </reported_events>

    <certain_agreements>
      <pi_employee>Principal Investigators are NOT employed by the organization sponsoring the study.</pi_employee>
      <restrictive_agreement>There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed. </restrictive_agreement>
    </certain_agreements>
    <point_of_contact>
      <name_or_title>Tanera van Diggelen</name_or_title>
      <organization>University of California, Los Angeles</organization>
      <phone>4086231219</phone>
      <email>tvandiggelen@gmail.com</email>
    </point_of_contact>
  </clinical_results>
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03784001
org study id: 1997
nct id: NCT03784001
lead sponsor: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
Gratitude - an emotion felt when an individual receives something beneficial from other
      people or entities - has been shown to positively affect well-being. Beginning in 2003,
      "count your blessings" interventions - in which participants list items they are grateful
      for, and gratitude letter writing interventions were designed to cultivate gratitude.
      Gratitude interventions have many positive outcomes; they can increase well-being and life
      satisfaction (Froh, Sefick, & Emmons, 2008) and increase self-esteem (Rash, Matsuba, &
      Prkachin, 2011) to name a few.

      Knowing the benefits of gratitude prior to an intervention could affect participant behavior
      and health outcomes. Past studies have illustrated that sharing information about treatments
      changes expectations and improves outcomes (Zion & Crum, 2018). For instance, overt medical
      treatments are more effective than hidden ones (Colloca, Lopiano, Lanotte, & Benedetti,
      2004).

      The proposed study is designed to evaluate whether expectations about intervention efficacy
      can enhance the benefits of a brief gratitude intervention. Specifically, the investigators
      will test if providing information on the benefits of gratitude will enhance intervention
      outcomes. This 3-armed randomized controlled trial will have the following conditions:
      gratitude + expectation, gratitude, and events control. Participants will be undergraduate
      college students and the online intervention will last two weeks.

      Participants in the two gratitude conditions will login to an online form three times a week
      for two weeks and make entries of up to five things they are grateful for. The form for
      participants in the gratitude + expectation condition will also provide information about
      benefits of gratitude. An everyday events control will be used to provide a neutral
      comparison condition. This group will be instructed to type up to five things or events of
      note from their day on their form.

      Outcome measures will be collected via an online survey before and immediately after the
      intervention. The primary outcome is well-being and the secondary outcomes are sleep quality
      and quantity, state gratitude, positive affect, healthcare self-efficacy, stress, and
      depressive symptoms. The investigators predict that participants in the gratitude +
      expectation condition will have enhanced intervention outcomes compared to participants in
      comparison conditions.
Overview: Potential participants will be recruited from an undergraduate psychology class.
      Participants will have one week after initial study advertisement to read the consent form
      and decide if they wish to participate. When participants turn in a signed consent form, they
      will be officially enrolled in the study and issued a personal identification (PI) number to
      use throughout the study.

      Participants will be randomly assigned to one of three conditions: gratitude + expectations,
      gratitude, or an everyday events control condition. Participants will be emailed six
      different times, once every two days, with a link to an anonymous Google form. Each Google
      form will instruct participants to type either a short gratitude list (for gratitude +
      expectations and gratitude conditions) or an events list (for everyday events control), and
      will have a section for participants to enter their personal identification numbers.
      Additionally, the first form will include a demographics questionnaire and the first and
      sixth forms will include questionnaires assessing all outcomes of interest.The primary
      outcome of interest is well-being. The secondary outcomes of interest are sleep, state
      gratitude, healthcare self-efficacy, stress, and depressive symptoms.

      Participants in the gratitude + expectations condition will have a statement at the top of
      their Google form about the benefits of gratitude. Examples of these statements are:
      "Practicing gratitude may increase social connectedness" and "Cultivating gratitude was shown
      to improve school satisfaction in a sample of students". By the end of the study,
      participants will have completed six gratitude or everyday events lists and two
      questionnaires.

      Interventions:

        1. Gratitude + No Expectations: Participants in the gratitude condition will practice a
           counting your blessings intervention for two weeks. Participants will be instructed to
           list up to five things they are grateful for every two days for the two weeks of the
           intervention (six times total).

        2. Gratitude + expectations: Participants in this condition will be given the same
           instructions as the gratitude condition and will also be given the regular reminders of
           the benefits of gratitude.

        3. Everyday events: Participants will be instructed to list up to five details about their
           day, such as activities they engaged in, or conversations they had. Participants will
           make these lists every two days for two weeks (six times total).

      Questionnaires:

      Self-report questionnaires with high test-retest reliability and internal validity will be
      administered at baseline and post intervention to access changes in outcomes of interest,
      such as well-being, depressive symptoms, and anxiety.

      Questionnaires administered only at baseline: Communication and Attitudinal Self-Efficacy
      Scale (CASE) and demographic questionnaire

      Questionnaires administered pre- and post-intervention: Mental Health Continuum-Short Form,
      Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Scale,
      Pittsburg Sleep Quality Index (PSQI) duration items, Modified Differential Emotions Scale,
      Center for Epidemiologic Studies Depression Scale (CES-D), Perceived Stress Scale 4
allocation: Randomized
intervention model: Parallel Assignment
intervention model description: Participants will be randomly assigned to one of three conditions: Gratitude, Gratitude + Expectations, or Events Control Participants in the two gratitude conditions will login to an online Google form three times a week for two weeks and make entries of up to five things they are grateful for. The form for participants in the gratitude + expectation condition will also provide information about benefits of gratitude. An everyday events control will be used to provide a neutral comparison condition. This group will be instructed to type up to five things or events of note from their day on their form.
primary purpose: Other
masking: Single (Participant)
masking description: Participants will only know they are taking part in a "Mood and Writing Study" and will not know which condition they are in.
measure: Mental Health Continuum-Short Form (MHC-SF)
time frame: Assessed at Pre- and Post- Intervention (2 weeks apart)
description: Hedonic well-being, eudaimonic well-being, and overall well-being were assessed at baseline and post-intervention. Well-being was measured with the Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). Participants rated how often they felt 14 different emotions or statements, such as "happy" and "satisfied with life". Items are rated on a 6-point likert scale (0 = never, 5 = everyday). This measure assesses both hedonic and eudaimonic well-being. The MHC-SF is both reliable and valid for use with young adults (Robitschek & Keyes, 2009). Total scores are created by the sum of scores for all 14 items, with a range of 0-70. Higher scores indicate greater overall well-being.
measure: Mental Health Continuum-Short Form (MHC-SF): Hedonic Well-Being SubScale
time frame: Assessed at Pre- and Post- Intervention (2 weeks apart)
description: Well-being was measured with the Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). Participants rated how often they felt 14 different emotions or statements, such as "happy" and "satisfied with life". Items are rated on a 6-point likert scale (0 = never, 5 = everyday), with higher numbers indicating greater well-being. This measure assesses both hedonic and eudaimonic well-being. The MHC-SF is both reliable and valid for use with young adults (Robitschek & Keyes, 2009). The Hedonic Well-Being Subscale is the sum of items 1-3 on the Mental Health Continuum Short-Form. Total scores range from 0-15, with higher scores indicating greater hedonic well-being. Scoring a 4 or 5 on at least one of the 3 items on the Hedonic Well-Being Subscale indicates a diagnosis of flourishing mental health.
measure: Mental Health Continuum-Short Form (MHC-SF): Eudaimonic Well-Being SubScale
time frame: Assessed at Pre- and Post- Intervention (2 weeks apart)
description: Well-being was measured with the Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). Participants rated how often they felt 14 different emotions or statements, such as "happy" and "satisfied with life". Items are rated on a 6-point likert scale (0 = never, 5 = everyday), with higher numbers indicating greater well-being. This measure assesses both hedonic and eudaimonic well-being. The MHC-SF is both reliable and valid for use with young adults (Robitschek & Keyes, 2009). The score of the Eudaimonic Subscale is the sum of items 4-14 on the MHC-SF. Scores range from 0-55. Higher scores indicate greater eudaimonic well-being (i.e., greater social and psychological well-being).
measure: Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Scale
time frame: Assessed at Pre- and Post- Intervention (2 weeks apart)
description: Sleep quality was measured with the 8-item PROMIS sleep disturbance short form (Yu et al., 2012). Participants rated their level of agreement with eight different statements about their sleep in the past seven days such as "My sleep was restless" and "I had difficulty falling asleep". Participants rated each item on a 5 point scale (1 = not at all, 5 = very much). Items 2, 3, 7, and 8 were reverse scored. The total score of the PROMIS Sleep Disturbance Scale is the sum of the scores for all 8 items. Total scores range from 8-40, with higher scores indicating more severe sleep disturbance.
measure: Pittsburg Sleep Quality Index (PSQI) Duration Items
time frame: Assessed at Pre- and Post- Intervention (2 weeks apart)
description: Sleep quantity was measured with the Pittsburgh Sleep Quality Index Duration Items (PSQI-4), which asks participants questions such as when they went to bed and when they woke up in the morning (Buysse et al., 1989). PSQI duration items are questions 1-4 on the PSQI, which measure how much sleep respondents have been getting. Higher hours of sleep is a better outcome.
measure: Modified Differential Emotions Scale (MDES): Positive Emotions Subscale
time frame: Assessed at Pre- and Post- Intervention (2 weeks apart)
description: Positive affect was measured with the ten-item Positive Emotions (PE) subscale of the Modified Differential Emotions Scale (mDES) (Fredrickson, Tugade, Waugh, and Larkin, 2003). Participants rated how often they felt ten different groups of positive emotions such as "amused, fun-loving, silly" on a 5-point scale (0 = not at all, 4 = most of the time). The average of the items was calculated to measure positive affect, with higher numbers indicating greater positive affect.
measure: Perceived Stress Scale - 4 (PSS-4)
time frame: Assessed at Pre- and Post- Intervention (2 weeks apart)
description: Stress was measured with the 4-item Perceived Stress Scale (PSS-4; Cohen, Kamarack, and Mermelstein, 1983). Participants rated how often they felt a certain way in the last week on four different items such as "How often have you felt confident about your ability to handle your personal problems?" and "How often have you felt that things were going your way?" on a 5- point scale (0 = never, 4 = very often). The total score of the PSS-4 is the sum of all 4 items. Total scores range from 0-16, and higher scores indicate greater perceived stress.
measure: Center for Epidemiologic Studies Depression Scale (CES-D)
time frame: Assessed at Pre- and Post- Intervention (2 weeks apart)
description: Depressive symptoms were measured by the Center for Epidemiological Studies - Depression Scale (CES-D, Radloff, 1977). Participants rated how often they experienced 20 different statements such as "I was bothered by things that usually don't bother me" and "I felt like everything I did was an effort" in the past week. Participants scored each item on a 4-point scale (0 = rarely or none of the time 3 = all of the time). The total score for the CES-D is the sum of all 20 items, with a range of 0-60, with higher scores indicating greater depressive symptoms.
measure: Modified Differential Emotions Scale (MDES): State Gratitude
time frame: Assessed at Pre- and Post- Intervention (2 weeks apart)
description: State gratitude was measured with item one of the mDES (Fredrickson, Tugade, Waugh, and Larkin, 2003), which asks participants how often they felt "grateful, appreciative, or thankful" in the past two weeks. Participants rated this item on a 5-point scale (0 = not at all, 4 = most of the time), with a higher number indicating higher feelings of gratitude.
arm group label: Gratitude + No Expectations
arm group type: Active Comparator
description: Participants will type online lists of up to five items they are grateful for, every two days for two weeks.
arm group label: Gratitude + Expectations
arm group type: Experimental
description: Participants will type online lists of up to five items they are grateful for, every two days for two weeks. They will also be told a benefit of gratitude each time they write an online gratitude list.
arm group label: Events Control
arm group type: Active Comparator
description: Participants will type online lists of up to five events from their day, every two day for two weeks.
intervention type: Behavioral
intervention name: Gratitude + No Expectations Intervention
description: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Additionally, the first form will include a demographics questionnaire and the first and sixth forms will include questionnaires assessing all outcomes of interest
arm group label: Gratitude + No Expectations
intervention type: Behavioral
intervention name: Gratitude + Expectations Intervention
description: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a short gratitude list of up to five items. Participants will have a statement at the top of their Google form about the benefits of gratitude. Examples of these statements are: "Practicing gratitude may increase social connectedness" and "Cultivating gratitude was shown to improve school satisfaction in a UK sample of students". Additionally, the first form will include a demographics questionnaire and the first and sixth forms will include questionnaires assessing all outcomes of interest
arm group label: Gratitude + Expectations
intervention type: Behavioral
intervention name: Events Control Intervention
description: Participants will be emailed six different times, once every two days, with a link to an anonymous Google form. Each Google form will instruct participants to type a list of up to five items about events from their day. Additionally, the first form will include a demographics questionnaire and the first and sixth forms will include questionnaires assessing all outcomes of interest.
arm group label: Events Control
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: Accepts Healthy Volunteers
last name: Tanera van Diggelen
role: Principal Investigator
affiliation: University of California, Los Angeles
facility: 
country: United States
citation: Froh JJ, Sefick WJ, Emmons RA. Counting blessings in early adolescents: an experimental study of gratitude and subjective well-being. J Sch Psychol. 2008 Apr;46(2):213-33. doi: 10.1016/j.jsp.2007.03.005. Epub 2007 May 4.
PMID: 19083358
citation: Bartlett MY, DeSteno D. Gratitude and prosocial behavior: helping when it costs you. Psychol Sci. 2006 Apr;17(4):319-25. doi: 10.1111/j.1467-9280.2006.01705.x.
PMID: 16623689
citation: Watkins, P., Woodward, K., Stone, T., & Kolts, R. (2003). Gratitude and happiness: Development of a measure of gratitude and relationships with subjective well-being. Social Behavior and Personality: An international journal, 31, 431-452. doi: 10.2224/sbp.2003.31.5.431
citation: Kruse, E., Chancellor, J., Ruberton, P.M., & Lyubomirsky, S. (2014). An upward spiral between gratitude and humility. Social Psychological and Personality Science. 5(7), 805-814. doi: 10.1177/1948550614534700
citation: Rash, J. A., Matsuba, M. K., & Prkachin, K. M. (2011). Gratitude and well-being: who benefits the most from a gratitude intervention? Applied Psychology: Health and Well-Being, 3(3), 350-369. doi: 10.1111/j.1758-0854.2011.01058.x
citation: Zion SR, Crum AJ. Mindsets Matter: A New Framework for Harnessing the Placebo Effect in Modern Medicine. Int Rev Neurobiol. 2018;138:137-160. doi: 10.1016/bs.irn.2018.02.002. Epub 2018 Mar 20.
PMID: 29681322
citation: Colloca L, Lopiano L, Lanotte M, Benedetti F. Overt versus covert treatment for pain, anxiety, and Parkinson's disease. Lancet Neurol. 2004 Nov;3(11):679-84. doi: 10.1016/S1474-4422(04)00908-1.
PMID: 15488461
citation: Emmons RA, McCullough ME. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol. 2003 Feb;84(2):377-89. doi: 10.1037//0022-3514.84.2.377.
PMID: 12585811
citation: Sheldon, K.M. & Lyubomirsky, S. 2006. How to increase and sustain positive emotion: The effects of expressing gratitude and visualizing best possible selves. The Journal of Positive Psychology. 1(2). 73-82. doi:10.1080/17439760500510676
citation: Jackowska M, Brown J, Ronaldson A, Steptoe A. The impact of a brief gratitude intervention on subjective well-being, biology and sleep. J Health Psychol. 2016 Oct;21(10):2207-17. doi: 10.1177/1359105315572455. Epub 2015 Mar 2.
PMID: 25736389
responsible party type: Principal Investigator
investigator affiliation: University of California, Los Angeles
investigator full name: Tanera van Diggelen
investigator title: Principal Investigator
sharing ipd: No
provided document: 
participant flow: 
baseline: 
outcome list: 
reported events: 
certain agreements: 
point of contact: 