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Gratitude journaling experiences of adults who participated in a 20-day clinical intervention to mitigate stress, anxiety and depression in the Covid-19 pandemic era in Zimbabwe

Gratitude journaling experiences of adults who participated in a 20-day clinical intervention to mitigate stress, anxiety and depression in the Covid-19 pandemic era in Zimbabwe by  Tanyaradzwa Dianah Mutseura, Julia Mutambara, and Tobias Magadure

Author(s): Tanyaradzwa Dianah Mutseura, Julia Mutambara, and Tobias Magadure

Abstract:

The COVID-19 pandemic which was first reported in 2019 in Wuhan, China brought about devastating conditions and eventually ballooned into a global pandemic. Some of the devastating consequences of Covid-19 included loss of lives, closure of businesses, job cuts coupled with on-going daily life challenges. In this dark hour brought about by Covid-19, the health of people became top priority and their mental health a cause for concern. This study sought to investigate the experiences of a Zimbabwean sample that participated in a 20-day gratitude journaling intervention with a clinical psychologist to mitigate stress, anxiety and depression in the Covid-19 pandemic era. A purposive sampling of forty-two men and women (age range 20 to 40) who at one point requested the services of a clinical psychologist was done. Participant selection was not necessarily based on diagnosis. Qualitative questionnaires, in-depth interviews and WhatsApp group discussions were used to collect data. Data were grouped into themes and analysed using content analysis. Participants reported improved sleep, positive coping, reduced symptoms of anxiety and depression, strengthening of social relationships, improved physical health and, psychological health, heightened empathy, and an increase in happiness and creativity. Gratitude journalizing is an important intervention for people grappling with a myriad of psychological problems and/or uncertainties brought about by the Covid-19 pandemic.


Article:

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Introduction

 

Covid-19 remains one of the world’s most challenging pandemics. Prevention was key in halting the spread. Guided by the World Health Organisation, measures to prevent the spread of Covid-19 include lockdowns, compulsion wearing of face masks in public places, social distancing and voluntary vaccination. Though these drastic changes and adjustments to normal life were informed by science the majority of people the world over lived in fear and were reluctant to voluntarily implement them. In addition, unfounded information about Covid-19 vaccines and their effects triggered stress and symptoms of anxiety and depression among people. Mental health care became imperative given the psychological challenges brought about by the pandemic. Interventions like gratitude journaling were found to help foster positive mental outlook and helped people to anticipate positive outcomes.

 

Hart (2013) notes that gratitude has the ability to cause a shift in one’s mind-set and energy that attract positive experiences into one’s life. Therefore, gratitude can help an individual to adopt a fresh perspective in life. Gratitude is an emotion preceded by the perception that one has benefitted from the efforts of another (Emmons & Mishra, 2011). An expanding body of research associates gratitude journaling with physical and psychological health benefits (Wood et al., 2010). Some researchers regard gratitude as a habit, an attitude or a coping response (Allen, 2018; Sansone & Sansone, 2010).  According to research gratitude is stable and directed towards others, God, nature, etc (Allen, 2018; McCullough et al., 2008; McCullough, Emmons & Tsang, 2002; Rosenberg, 1998).

 

There has been increased interest among mental health researchers to investigate health benefits of gratitude journaling (Bono, Emmons & McCullough, 2012). One longitudinal study conducted by Malin et al. (2017) found a small but significant relationship between gratitude and a sense of purpose, suggesting that gratitude may play a role in developing purpose. Another study conducted by Shoshani and Steinmetz (2014) which lasted for a year revealed significant decreases in symptoms of distress, anxiety, and depression occurring among participants in the experimental gratitude group as compared to increasing symptoms among participants in the control group. A further study conducted by Harbaugh and Vasey (2014) indicated that counting blessings mitigated symptoms of depression, and increased positive affect, among participants who had reported high levels of depressive symptoms. Similarly, Lo et al. (2017) found that gratitude had a significant moderating effect on suicidal ideation, suggesting the importance of including elements of gratitude in preventive and clinical interventions. A meta-analysis that analysed the results of 38 gratitude studies concluded that gratitude interventions can have positive benefits for people in terms of their well-being, happiness, life satisfaction, grateful mood, grateful disposition, and positive affect, and can also result in decreases in depressive symptoms (Dickens, 2017). Salvador- Ferrer (2017) concluded that gratitude significantly predicts life satisfaction, psychological and physical well-being. Therefore, gratitude can help an individual to adopt a fresh perspective in life. Other contemporary studies have shown that grateful people sleep better, have improved self-esteem and can cope better with the stress (Hofman & Serlachiu, 2020). Gratitude studies have also provided evidence that gratitude journaling is associated with adjustment to university life, life satisfaction and positive affect (Isik & Erguner-Tekinalp, 2017). Schnitker and Richardson (2019) have investigated gratitude within religion and concluded that gratitude is commonly practiced in prayer and sometimes yields positive outcomes. In a study conducted by Flinchbaugh, Moore, Chang and May (2000) in Turkey, students who practiced gratitude journaling showed a heightened understanding of the meaning of learning and engaged well in the classroom.

 

The aim of the current study was to explore gratitude journaling experiences of 42 adults who participated in a 20-day online intervention to mitigate stress, anxiety and depression in the Covid-19 pandemic era in Zimbabwe. Findings might advance and/or inform future applications of gratitude journaling in clinical settings especially in resource constrained environments.

 

Materials and methods

 

The study sought to foster an attitude of gratitude during the lockdown period and restrictions brought about by the Covid-19 pandemic and thereby adopt a positive, hopeful outlook in life leading to a decrease in depression, anxiety and fear. All ethical procedures were observed, participant consent was granted and the research was approved by the ethics committee at Midlands State University in Gweru, Zimbabwe.

 

Data collection procedures

 

The intervention consisted of a daily gratitude journaling activity, wherein participants were asked to list at least three things for which they were grateful in a journal provided by the researcher. The intervention lasted for 20 days and was administered daily by the researcher online. The participants were required to complete a journal entry during each session. Twice weekly, on Tuesdays and Thursdays participants were given the opportunity to share online what they had written with the researcher or with their colleagues if they wished. When the intervention concluded, the participants were asked to complete a self-report qualitative questionnaire adopted and modified from the Gratitude Questionnaire (GQ-6) which was prepared by McCullough et al. (2002) twice, first after every session and then after 20 days. Each questionnaire could be completed in 5 minutes. Interviews were carried out at the end of the exercise to also gather the experiences of the participants. The length of each interview was about 20-30 minutes. Questions on both questionnaire and the interview guide were constructed in English then translated to Shona (one of the major local languages) and back translated to English by a language expert.

 

Sampling

 

The research made use of purposive sampling to reach the required target. These were individuals who at one point requested the services of a Clinical psychologist. However, their diagnosis was not the major reason for their selection. From the available register participants were then randomly selected. Purposive sampling technique was used because it gave a sample that can be logically assumed to be representative of the population.

 

Results

 

Characteristics of research participants

 

Pre- and post- qualitative questionnaires, interviews and WhatsApp discussions were conducted with 38 females and 4 males that took part in the 20-day gratitude journaling. Participants were within the 20-40 age range. Twenty-three participants had tertiary level training and in full employment. Forty participants were black while two were white. Each participant was affiliated to his/her own religion.

 

Themes

 

From the interviews with the participants and the survey questions the following themes emerged, that showed how gratitude journaling was helping them cope despite the uncertainties brought about by the covid-19 pandemic - improved psychological wellbeing; improved healthy habits; enhanced appreciation and awareness and stronger faith and hope. The main themes and sub-themes are shown in table 1(Download the PDF version to access the complete article, including figures and tables.).

 

Theme one: Improved psychological wellbeing

 

From the research, participants reported that the gratitude journaling enabled them to handle the stressful events and cope with loss which created happiness in their lives. For example, Participant A said: “I’m now an old woman, and I deal with a lot of stressful situations and have been through a lot. I now have high blood pressure. However, this exercise has totally changed my outlook in life, it lifted a heavy burden from my shoulders I can now deal with stressful situations knowing that this too shall pass.

 

Another participant said, “It has helped me not to get stressed as each day is important, not to carry yesterday’s stressful moments into the next day and get all worked up.

 

On coping with the loss of loved ones during the Covid-19 pandemic, one of the participants also noted that;

 

“… When we were doing this exercise, I think on day 8 or 9, my father passed on and it was really difficult to be grateful of something in those difficult moments. But at the end of it all, I was grateful for the time that we had with our father he was an old man and had lived a long life.

 

This might even suggest that in very stressful situations like death, one is capable of finding the positive aspects. Gratitude journaling helped the participants to realize that there is more to life than the by focusing on the positive. It helped rewire the brain to evoke positive emotions and thus made individuals happy. From the responses of the participants the exercise brought them happiness. One participant said; “The exercise brought so much joy. I am happy and I have a lot to give, a lot was also given to me.

 

Another responded;

 

“I could clear my mind, focus on the positive. I am a negative person and spend most of my time thinking about the bad situations that can happen and as a result I fail to enjoy the moment. The exercise made me rethink and I find myself thinking about happy thoughts.”

 

One of the participants also noted that, “It’s been great reading the stories of others and getting to realise what you have, for me I gained much psychologically.”

 

On top of the journaling the daily pictures that were sent helped the participant’s value and appreciate themselves. Self-love and self-care have been known to help people cope and bring about feelings of happiness from within. One of the participants said;

 

“I now take care of my health more than I used to, I watch what I eat, and exercise regularly. I distract myself from negative news and try to find things that make me happy like the gratitude journaling exercise.”

 

From the responses it showed that gratitude journaling did help with improving the psychological wellbeing of the participants.

 

Theme two: Improved healthy habits

 

One of the gratitude exercises involved participants taking a walk, or a bike ride whilst appreciating the beauty of nature or reporting on the physical exercise they had conducted. When asked how the exercise helped them improve or enhance their physical wellbeing, the participants responded;

 

“Today even after the exercise I was motivated to take a walk in my garden. I have arthritis and I haven’t been sleeping well of late, it just then dawned upon me, if it was during the exercise a reminder would have come to my phone to let me know I should take time to breathe, pause, reflect and take a walk. As I was walking in the garden I couldn’t help it but smile at the sprouting garlic I had planted a few days back. I was grateful, the soil doesn’t know about Covid, germination is still occurring isn’t it something to be grateful about?”

 

Participants noted that there was need to put our mind at rest, as the constant thinking would eventually wear off the body. Another participant said; “On the day we did a walk, I was really happy. It allowed me to exercise my legs especially now that the Covid-19 pandemic is here I have to always stay fit and I eat healthy foods.”

 

The importance of gratitude certainly goes a long way and its benefits were evident. Some individuals reported that their sleeping pattern improved because of the gratitude journaling exercises. One participant said,

 

“I have come to a point where I have come to peace with everything and now I can sleep well, I am grateful for what I have and this gives me peace of mind, I can sleep for more than eight hours now compared to the four hours I used to sleep.”

 

Theme three: Appreciation and awareness

 

The gratitude journaling exercise was not only for the participants to write things they were grateful for each day, daily motivating messages and reminders were sent. Participants indicated that the exercises helped them to pause and reflect as reflected in the extract below,

 

“I really did not take note of the sunrise or sunset and how we have been blessed with warm nights and beautiful summer days here in Zimbabwe. The exercise helped me turn my attention into these seemingly unimportant things and I really enjoyed it.”

 

Another participant said,“Ohhh sunset how beautiful it is, I enjoyed watching the sun set, thinking about nothing but just observing and saying I am lucky, I am fortunate to see this someone never got to see this.”

 

One more participant remarked; “It has really helped me realise who I am, to stop and pause and reflect my actions. To retrace my steps and realise this is actually a moment worth of being grateful.”

 

These responses indicated that most times people do not really know what it entails to be grateful and that most of the time good things are overlooked or taken for granted. Clearly given the socio-economic environment and the Covid-19 pandemic it was difficult to find something to smile about let alone to be grateful for, but the exercise made the participants realise that even in the midst of it all there was something that could bring hope.

 

Due to the pandemic restrictions some relationships got strained at some point. However for some participants connectedness as indicated in the extracts below,

 

“I can now communicate well with others and can talk with my other colleagues because I realised that I should not get overworked by events in life so much that I lose out on the good things no matter how small they might seem.”

 

One participant noted, “I appreciate those around me and value their presence it was an eye-opener, the exercise was very helpful it showed me that I should make the most of it.”

 

Another also responded saying, “I now can go back to my colleagues and say thank you for what they would have done for me, previously I could not say thank you no matter how big the thing that would have been done for me.”

 

Self-reflection was also noted as one of the benefits of participating in the journaling exercise,

 

“The daily gratitude journaling has helped me self-introspect and to be more empathetic - I closely look at the person I am and what I want to become.”

 

Theme four: Beliefs and faith

 

From the responses of the participants it was evident that beliefs or religion have played an important role in helping them cope during this period of the Covid-19 pandemic. All of the participants were affiliated to a certain religion. Beliefs and faith have played a central role in making people more grateful or appreciate the concept of gratitude. As well as having a greater dispositional effect of gratitude. One participant said;

 

“I really enjoyed diarising, I thank God for everything and appreciating the exercise, it took me time to really understand what this was all about, but once I started to pay attention I started to enjoy and looked forward to the daily messages and journaling.”

 

On beliefs and faith, another participant also said;

 

“It was helpful, so helpful. I thank God, the Covid-19 pandemic seems not to be going away and the news everyday gives us statistics on the number of deaths it’s really frightening, I fail to find a reason to wake up, let alone to be grateful for anything. God has been my source of strength. This gratitude exercise showed me another angle…  I have drank tea in the morning, my kids are alive, I am grateful.”

 

One of the participants said;

 

“It is beyond us all, we believe God will hear our prayers and one day we will hear no more of Covid-19, our hope lies in God and in God alone.”

 

Faith and belief became the hope of many and a coping mechanism during this time.

 

Many of the participants noted that the gratitude journaling exercise helped them count their blessings and not to focus on that which they had lost. One participant said;

 

“I see now that every day is a blessing, the little things that we ignore are blessings, I cannot count them all, God has been faithful, yes Covid is here but I can also count the good in my life, I am grateful.”

 

The benefits of gratitude journaling surely have come a long way in helping people cope with the myriad of stressors brought about by the novel Corona virus.

 

Discussion

 

The results from the research showed that being grateful could become a coping mechanism in times of stressful events. Similarly, other studies that have been carried out with different participants particularly students have also shown that students who practiced gratitude journaling showed a heightened level of understanding the learning process and engagement in the classroom (Flinchbaugh, Moore, Chang and May, 2000). In addition, the findings from this research revealed that gratitude journaling allows one to concentrate on the positive aspect trying to find out exactly what it is they are grateful for. Wilson (2016) also affirms that gratitude journaling helped lessen stressful events and quelled anxieties. Another study by Hart (2013) also revealed that gratitude journaling shifts a person’s thinking and that this shift in thinking is good for health.  Therefore, gratitude journaling does help in relieving stress by shifting one’s mind-set enabling him/her to concentrate on the positives.

 

As reported in this research, researchers have acknowledged that gratitude journaling and grateful contemplation can be used to enhance long-term well-being (Rash, Matsuba & Prkachin, 2011). Gratitude journaling facilitates the development of healthy habits which results in benefits like improved sleep quality. Hofman and Serlachiu (2020) called for more research on the efficacy of gratitude interventions on improving health outcomes with particular attention to sleep. Despite this, Salvador- Ferrer (2017) noted that gratitude significantly improves overall life satisfaction which enhances psychological and physical well-being.

 

Enhanced ability to cope with stress and uncertainty was reported by individuals who took part in gratitude journaling. This echoes the findings of a study that was conducted by Isik and Erguner- Tekinalp (2017) in which students in the experimental group that kept a gratitude journal for 3 weeks had significantly higher post-test scores on gratitude, adjustment to university life, life satisfaction, and positive affect than their counterparts in the control group. Though growing evidence suggests that gratitude journaling can be effective (Boehm, Lyubomirsky & Sheldon, 2011), noted that one needs to regularly engage in this activity to reap desired benefits. However, engaging in gratitude journaling requires discipline and dedication. The findings from the research showed that all of the participants were affiliated to a certain religion. This could have helped them to be more forthcoming and appreciate the practise of gratitude as it is valued by most religions. Research suggests that belief in God and religion were important dispositional traits in fostering gratitude. It is important to find out whether the same benefits of gratitude could be reported by individuals who are not affiliated to any religion.

 

Fostering social relationships is another finding that was drawn from the research. Gratitude enables one to become appreciative of the people they live or work with. People with a grateful disposition tend to experience gratitude more frequently, more intensely, toward more people, and for more things in their life at any given moment (McCullough, Emmons & Tsang, 2002). Like in the research conducted by Kaczmarek et al. (2013) the majority of participants in current research were women. The possible explanation for women wanting to participate in gratitude journaling research is that they are eager to share their experiences and view the gratitude journaling exercise as useful. Future research studies on gratitude journaling could include more male participants.

 

Conclusion

 

Gratitude journaling has been seen to help reduce negative affect and promote people`s wellbeing during difficult situations. The study has implications for mental health experts providing interventions during periods of mass disasters and pandemics. The reported intervention is important in that it allows for the participation of large groups of people rather than focusing on individuals. In addition, group online interventions are suitable for low resource settings where therapy may be expensive or unavailable.

 

References

 

Flinchbaugh, C. L., Moore, W. G., Chang, Y. K., and May, D. R. (2011). Student Well-Being Interventions: The Effects of Stress Management Techniques and Gratitude Journaling in the Management Education Classroom. Journal of Management Education, 36(2)191–219.

 

Bertocci, P. A., & Millard, R. M. (1963). Personality and the good: Psychological and ethical perspectives. New York: McKay.

 

Boehm, J. K., Lyubomirsky, S., and Sheldon, K. M. (2011). A longitudinal experimental study comparing the effectiveness of happiness enhancing strategies in Anglo-Americans and Asian Americans. Cognition & Emotion, 25, 1263-1272.

 

Bono, G., Emmons, R and McCullough, M. (2012). Gratitude in Practice and the Practice of Gratitude. 10.1002/9780470939338.ch29

 

Bono, G., Emmons, R. A., & McCullough, M. E. (2004). Gratitude in practice and the practice of gratitude. In P. A. Linley & S. Joseph (Eds.), Positive psychology in practice (pp.464–481).

 

Emmons, R. A. (2004). The Psychology of Gratitude: An Introduction. In R. A. Emmons & M. E. McCullough (Eds.), the psychology of gratitude (pp. 3–16). Oxford University Press.

 

Hart, J. (2013). Practicing Gratitude Linked to Better Health: A Discussion with Robert Emmons, PhD. Jane Hart. Published Online: 23 Dec 2013. Alternative and contemporary therapies, Vol 19, NO 6.

 

Hofman, P. L. and Serlachiu, A. S. (2020). A systematic review of gratitude interventions: Effects on physical health and health behaviours. Journal of Psychosomatic research, 135.

 

Isik, S. and Erguner-Tekinalp, B. (2017). The effects of gratitude Journaling on Turkish first year college students’ college adjustment, life satisfaction and positive affect. Int Journal of Adv Counselling, 39, 164-175.

 

O’ Leary, K. (2013) Gratitude works! A twenty-one-day program for creating emotional prosperity, The Journal of Positive Psychology, 8:4, 361-3.

 

Rash, J., Matsuba, K., and Prkachin, K. (2011). Gratitude and Well-Being: Who Benefits the Most from a Gratitude Intervention? Applied Psychology Health and Well-Being. 3, 350-369.  

 

Salvador-Ferrer, C. (2017). The relationship between gratitude and life satisfaction in a sample of Spanish university student. The moderation of role of gender. Anales de Psicologia, 33 (1), pp114-119.

 

Sansone, R. A., & Sansone, L. A. (2010). Gratitude and well-being: The benefits of appreciation. Psychiatry, 7, 11, 18-22.

 

Seligman, M. E. P. (2002). Authentic happiness: Using the new positive psychology to realize your potential for lasting fulfilment. New York: Free Press.

 

Seligman, M., Steen, T., Park, N. and Peterson, C. (2005). Positive Psychology Progress: Empirical Validation of Interventions. The American psychologist. 60.

 

Schnitker, S. A., and Richardson, K. L. (2019). Framing gratitude journaling as prayer amplifies its hedonic and eudaimonic well-being, but not health, benefits, The Journal of Positive Psychology, 14:4, 427-439.

 

Wilson, J.T. (2016). Brightening the mind: The impact of practising gratitude on focus and resilience in learning. Journal of scholarship of teaching and learning. Vol 16, (4), pp1-13.


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Table 1. Themes

Author(s)

Tanyaradzwa Dianah Mutseura, Julia Mutambara, and Tobias Magadure Tanyaradzwa Dianah Mutseura, Julia Mutambara, and Tobias Magadure

Tanyaradzwa Dianah Mutseura, registered Community Psychologist in Zimbabwe. She holds an MSc in Community Psychology from Midlands State University and a BSc in Psychology from Midlands State University. Her research interests include primary and secondary prevention interventions for children’s mental well-being, social justice, and qualitative research.

 

Julia Mutambara, Ph.D. is a behavioural scientist and senior lecturer in the Department of Psychiatry. She holds a Doctor of Philosophy (PhD) from the University of Limpopo (SA) and an MSc in Clinical Psychology from UZ. 

 

Tobias Magadure, has a BSc in Psychology from Midlands State University, in Gweru Zimbabwe. His research interests include qualitative research, positive psychology, and community mental health engagements. 


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Keywords: gratitude, journaling, healthy habits, appreciation