Hypothesis 1: Blood Pressure and Cortisol. A systematic literature search was conducted, and 29 studies (in 26 articles) met the inclusion criteria of empirically testing the intervention and comparing it to a control condition. Table 3 presents the results of the effectiveness of the BPS comparing to control groups for wellbeing, positive affect, negative affect, optimism, and depression. & Borkovec, T. D. (2000). Third, regarding quantitative analyses, we were not able to adjust a multiple meta-regression model that included a subset of characteristics of studies that could explain the variability in the effect sizes on wellbeing. These meta-analyses showed that PPIs (regardless of the specific type of PPI) produced medium to moderate effects on wellbeing [31], and similar results were found in this work on the effectiveness of the BPS intervention. This finding may be due to the use of a small homogenous, highly educated sample. Mean Differences of Mental Health Outcome: Pretest and Posttest. Conceptualization, This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visualize your best possible self in a way that is very pleasing to you and that you are interested in. Participants’ mean age was 23.56 (range from 17.83 to 35.62), with a standard deviation of 4.53 (range from 1.12 to 13.99), and the mean percentage of women was 74.41% (range from 52.70 to 100). Writing – review & editing, Affiliation The improved method proposed by Knapp and Hartung [40] was applied to test the statistical significance of each moderator variable. Supervision, In order to address the variability exhibited by the effect sizes, a random-effects model was assumed [34,35]. The case of writing about one’s best possible selves. PLoS ONE 14(9): Eighteen studies reported baseline comparability between dropouts and completers, and 22 studies reported baseline comparability between BPS and control groups. Nevertheless, considering the small number of included studies that assessed depressive symptoms, quantitative results for the effects of BPS interventions on depression should be viewed with caution. This finding may be due to different characteristics of the groups in the baseline data. Peters et al. https://doi.org/10.1371/journal.pone.0222386.t005. In these cases, the d index was also applied to compare the BPS and gratitude groups (independently of the d index that compared the BPS and control groups). You might think of this as reaching your full potential, hitting an important milestone, or realizing one of your life. It included 26 articles (with 29 studies) and a total of 2,909 participants. Repeated measures analysis of variance indicated the journaling intervention showed a statistically significant reduction in systolic blood pressure (p = 0.016), but not diastolic blood pressure, or cortisol level at the three testing times. For example, there were studies that only reported measures for wellbeing and optimism, but not for depression, and these studies contributed only to the corresponding meta-analyses. Contextual aspects: whether participants received compensation for participating (in the form of money or University credits) as a reflection of the intrinsic motivation of participants. Dickerson, S. S. & Kemeny, M. E. (2004). Although expressive writing interventions initially focused on writing about thoughts and emotions related to traumatic experiences (Pennebaker, 2013), many researchers have modified expressive writing for use in diverse contexts and populations (Smyth et al., 2018). t tests compared differences in mean scores of the outcome variables between the GW group and BPS group. written or spoken). In general, the d index was calculated to compare the BPS and control groups. Cortisol level did not significantly differ between time points for both groups, but it was interesting that the cortisol level was increased after the first writing in both groups. The mean scores for the two questions for the BPS group were 7.88 and 7.29, respectively; and the mean scores for the GW group were 7.95 and 7.55, respectively. Data Availability: The database is now in a public repository and can be found in the following link: https://zenodo.org/record/3383680. The diurnal cortisol rhythm portrays lowest concentrations at night, slowly rising over pre-awakening hours, sharply rising to a peak 30 to 45 minutes after waking, known as the cortisol awakening response (CAR) (Stalder et al., 2018). None of the studies met all the quality criteria, and only one study reported concealment of the assessors. No indication of publication bias was found in this meta-analysis for any of the different outcomes assessed. All studies except one used active control groups. Since the first work that attempted to examine the benefits of this intervention in 2001, studies on the BPS have grown exponentially and, currently, this is one of the most widely used Positive Psychology Interventions. Main characteristics of the studies can be found in Table 1. Components of the intervention. Higher scores reflect more gratitude and positive emotions, such as hope and optimism (McCullough et al., 2002). (2011) reported Anglo American individuals with the experiment conditions (i.e., expressing optimism, conveying gratitude) demonstrated larger increases in life satisfaction relative to Asian American individuals, whereas both cultural groups in the control condition (listing past experiences) showed the least improvement. These results indicate that the BPS can be considered a valuable Positive Psychology Intervention to improve clients’ wellbeing, and it seems that it might be more effective for older participants and with shorter practices (measured as total minutes of practice). Layous, K., Nelson, S. K., & Lyubomirsky, S. (2013). The active control conditions were defined as active neutral exercises not considered PPIs, such as writing about one’s daily activities. The benefits of self-compassion and optimism exercises for individuals vulnerable to depression. & Schueller, S. Cohen, S., Kamarck, T. & Mermelstein, R. (1983). & Pepping, C. A. https://doi.org/10.1371/journal.pone.0222386.s002. Specifically, the latest meta-analysis of the effectiveness of PPIs [3] revealed small to moderate effect sizes for wellbeing (d = .20 for psychological wellbeing and d = .34 for subjective wellbeing) [4]. Yes Looking forward: The effect of the best-possible-self intervention on thriving through relative intrinsic goal pursuits. The grateful disposition: A conceptual and empirical topography. For example, only one study included the concealment of the assessors, half of the studies did not use intention-to-treat analyses, and 11 of the 29 studies did not analyze baseline comparability between completers and dropouts (considering that some of the remaining 18 studies did not have any dropouts). Most participants were mothers (n = 35, 94.6%), White (n = 33, 89.2%), and highly educated (n = 32 baccalaureate degree or higher, 86.5%). Yes No, Is the Subject Area "Gratitude" applicable to this article? In addition, the BPS was found to be more beneficial for positive and negative affect than gratitude interventions (d+ = .326 and d+ = .485, respectively). What is the optimal way to deliver a positive activity intervention? In particular, the quality criteria used were mainly based on the PEDRO scale [29] and on the risk of bias items from the Cochrane Collaboration [30]. The case of writing about one’s best possible selves. Moderator analyses of the quantitative variables did not show any significant moderating effects on wellbeing outcomes. (2015). In each study, a d index was calculated for each of the three different types of outcomes (wellbeing, optimism, and depression). To positively influence hedonic happiness we have considered the practice of visualization of the best possible self (Best Possible Selves). Previous research reported a positive writing intervention promoted increases in satisfaction with life, optimism, happiness, and overall well-being, and reduced stress and depression (Boehm et al., 2011; O'Leary, & Dockray, 2015; Peters et al., 2013). if participants attended laboratory sessions or the exercise was applied in a room at the University) or online (i.e. A demographic questionnaire included data on age, race, residence, marital status, education, and living arrangement. wellbeing, satisfaction with life, positive affect, happiness), optimism, or depression, and two time points (before–pretest, and after the intervention–posttest). The anxiety mean of the total GAD-7 was 4.47, indicating mild anxiety. These comparisons were treated as independent studies. A quasi-experimental, pretest/posttest design was used with blood pressure measure and saliva collection at baseline, after a first journal entry, and after a 6-week journaling intervention. The GQ-6 has six items, ranging in score from 1 (strongly disagree) to 7 (strongly agree), and a total score is the sum of item scores (Cronbach's alpha = 0.78). A. A quasi-experimental design was used to examine changes in emotional well-being and mental health between pretest and posttest. The following criteria were included: (1) randomized assignment of participants; (2) baseline comparability between experimental and control conditions (i.e., if groups were matched on pretest measures or whether there were no statistically significant differences between the groups at pretest on relevant variables); (3) baseline comparability between dropouts and completers (if there were no dropouts, this item was also coded as 1); (4) type of control group (active group coded as 1, and waiting list coded as 0); (5) concealment of assessors of the participants’ assigned condition; (6) standardized scales used to assess the outcome measures; (7) attrition rate ≤ 10%; (8) intention-to-treat analyses (if there were no dropouts, this item was also coded as 1); and (9) reporting bias (if all measures described in the method section were reported in the results section). Dr. Kim-Godwin is Professor, School of Nursing, University of North Carolina Wilmington, Wilmington, North Carolina. Participants were instructed to make a first journal entry (approximately 15 to 20 minutes). The F statistic makes it possible to test the statistical association between a moderator variable and the effect sizes, and the QE and QW statistics enable us to examine the model misspecification for the continuous and categorical moderators, respectively. Yes Kerr, S. L., O'Donovan, A. Of these parents, five were excluded from analysis because they either did not complete the posttest (n = 4) or stopped journal writing after Week 3 (n = 1). Finally, a cited reference search for the initial work on the BPS by King [5] was carried out in the ISI Web of Science database, looking for all works that cited this original paper. & Griffin, S. (1985). Journal of Personality 74(1), 267-286. Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain, To check the reliability of the coding process of the study characteristics, all studies were doubly coded by two independent coders (AC and GM). Take the new, much briefer test of your character strengths. https://doi.org/10.1371/journal.pone.0222386, Editor: Ulrich S. Tran, Universitat Wien, AUSTRIA, Received: June 8, 2018; Accepted: August 29, 2019; Published: September 23, 2019. Second, the type of population included in the studies was mainly based on University students and young participants, which limits the generalizability of the findings. (2010). Exploring the diary as a recovery-oriented therapeutic tool. Boehm et al. Journal of Positive Psychology, 5(3), 204-211. kimy@uncw.edu. Many efforts have been made to develop and validate different Positive Psychology Interventions (PPIs), defined as interventions or intentional activities whose aim is to cultivate positive feelings, cognitions, and behaviors [2]. Due to the homogeneous sample characteristics, the study did not control demographic extraneous variables. O'Connell, B. H., O'Shea, D. & Gallagher, S. (2017). A quantitative and systematic approach is needed to shed light on the effectiveness of this intervention and to analyze potential moderators that can influence its effectiveness. (mean score = 7.43; 1 = not at all helpful to 9 = very much). However, neither quantitative analyses of the effectiveness of the interventions nor evaluations of the quality of the studies were performed. In this meta-analysis, several outcome measures were included: wellbeing (which included measures of wellbeing, positive and negative affect, life satisfaction, or happiness), optimism (because the BPS intervention is a future-oriented positive activity that promotes a positive outlook on the future), and depressive symptoms. Assessment of the cortisol awakening response: Expert consensus guidelines. In this phase, the selected studies went through a full-text analysis by both reviewers. Formal analysis, Baseline Data of Best Possible Self (BPS) and Gratitude Groups. The most frequently reported emotional and/or behavioral problems in children were depression, anxiety, attention-deficit/hyperactivity disorder or attention deficit, and deviant behaviors, as well as high-risk sexual and health behaviors, including suicidal attempts. Therefore, their analyses and conclusions are rather generic and do not provide specific information about the effectiveness of a particular PPI. Writing – review & editing, Affiliation I see myself doing work that is meaningful and fills me with a sense of purpose as I help people reach their dreams on a daily basis. It is possible that younger participants might find it difficult to envision their best possible self as their future is still undefined (e.g. King, A. Therefore, the current study sample (N = 37) may have limited the significance of statistical comparisons between groups. Participants identified as Protestant (n = 16, 43.2%), Catholic (n = 9, 24.3%), or other religion or atheist (n = 12, 32.4%). Since the first work that attempted to examine the benefits of this intervention in 2001, studies on the BPS have grown exponentially and, currently, this is one of the most widely used Positive Psychology Interventions. Therefore, the results obtained with the Egger test and the funnel plot obtained using the trim-and-fill method led us to discard publication bias as a threat to these meta-analytic results. In particular, the Egger test was applied, and funnel plots were constructed with the trim-and-fill method [36]. The purpose of the current study was to determine if journaling focused on BPS and gratitude could improve physiological and psychosocial outcomes (i.e., emotional well-being and mental health) in a sample of affected parents who have teenagers or adult children with emotional and/or behavioral problems. doi: 10.1080/00221325.2012.697496 . Reiter, C. & Wilz, G. (2015). A cross-sectional study conducted among 86 male and 30 female police officers reported that participants who felt more grateful and practiced gratitude journaling were found to have higher life satisfaction and be emotionally stronger than others (McCanlies et al., 2018). As reported, the investigator collected the second saliva sample immediately after the first writing was completed at the first visit. Malouff and Schutte (2017), who conducted a meta-analysis of 29 studies on diverse optimism interventions, reported BPS studies showed a significant effect, suggesting optimism-intervention researchers might wisely use a brief in-person BPS intervention, at least when seeking short-term effects. Specifically, participants in the control conditions wrote about what they did in the past 24 hours, the past week, or on a typical day [10,16, 26,46,48,50–62], their plans for the coming week or the next day [5,45,63], the layout of a place where they had been earlier [64], early memories [47], a description of a book or a film [65], or a combination of neutral topics [66]. Although preliminary, overall, the current research supports positive journal writing interventions to improve psychological health for parents who have teenagers or adult children with emotional and/or behavioral problems. The BPS exercise has been widely used to specifically promote optimism. After you have a fairly clear image, write about the details. In addition, the effectiveness of the writing intervention may have been caused, in part, by the self-selection of parents who participated in the intervention. When considering the published research on this topic (thus excluding the unpublished works included in this meta-analysis), evidence of publication bias was only found for positive affect, and it did not appear in any of the remaining variables, which agrees with a recent meta-analysis on psychological wellbeing conducted by Weiss and colleagues [72]. (1). Writing journal entries can be done anytime, anywhere, privately, without anyone knowing (Alexander et al., 2016). The PHQ-15 measures symptoms that account for >90% of those seen in primary care, such as pain, headache, and dizziness. Since the publication of this work, many studies have been carried out on the BPS using different approaches and delivery methods [6,7]. Based on a previous literature review, Kirschbaum and Hellhammer (1989) reported cortisol levels typically peak approximately 20 to 30 minutes after introduction of a stressor. of gratitude and best possible selves approaches. Yes Results showed that the BPS is an effective intervention to improve wellbeing (d+ = .325), optimism (d+ = .334) and positive affect (d+ = .511) comparing to controls. Data curation, https://doi.org/10.1371/journal.pone.0222386.t001. Writing – review & editing, Affiliations Online positive affect journaling in the improvement of mental distress and well-being in general medical patients with elevated anxiety symptoms: A preliminary randomized controlled trial. Methodology, (2001). However, little is yet known about its overall effectiveness in increasing wellbeing outcomes. Participants returned to the data collection site after 6 weeks. https://doi.org/10.1371/journal.pone.0222386.t006. Consequently, the aim of the present study is to conduct a meta-analysis of the effectiveness of the BPS intervention on wellbeing compared to controls. For example, the GW group had lower scores on the PHQ-15 (somatic symptoms) (p = 0.009). A convenience sample of 42 parents of teenagers or adult children with emotional and/or behavioral problems was recruited in the southeastern United States. For this reason, it is possible to state that the BPS exercise is able to produce the desired effects of these type of exercises and, therefore, can be an advantageous strategy to increase participants’ wellbeing. Heterogeneity among the effect sizes was assessed with the Q statistic and the I2 index. The case of writing about one's best possible selves. Saliva samples and blood pressure were collected three times (baseline, after first journal entry, and after 6-week writing intervention). here. Given the high rating of these items, the findings suggest journal writing is a practical means for stress management. Writing – original draft, To calculate a total score, the scores for questions 1, 2, 4, and 5 are summed and then added to the values for questions 3 and 6, which are reverse scored. Finally, depression was measured by the Centre of Epidemiological Studies Depression Scale (CES-D) [20], the State-Trait-Anxiety-Depression Inventory (STADI) subscales of state euthymia (inverted), and state dysthymia [21], and the Beck Depression Inventory (BDI-II) [22]. (2010). Table 4 presents the results of the comparison of the effectiveness of the BPS and gratitude interventions for wellbeing, positive affect, and negative affect. These results somehow contradict the theoretical assumptions of Lyubomirsky and Layous [23], who hypothesized that PPIs with a future-time orientation, like the BPS intervention, would be more beneficial for young people. The results for funnel plots, Egger tests, and trim-and-fill method remained unchanged, with the exception of positive affect. Writing therapy is known for promoting self-exposure, which leads to improved psychosocial well-being and physical functioning (Meshberg-Cohen et al., 2014; Meston et al., 2013; Travagin et al., 2015). All the moderators analyzed revealed statistically non-significant moderating effects with the effect sizes (p > .05). Regarding depression, only three studies could be entered into the effect size calculus, which was small (d+ = 0.115). The pretest sample comprised 42 parents. Nazarian, D. & Smyth, J. M. (2013). writing a gratitude letter or savoring the moment), and dosage (e.g. Using a gratitude intervention to enhance well-being in older adults. https://doi.org/10.1371/journal.pone.0222386.g003. However, this review only addressed optimism as the outcome variable, and, therefore, it exclusively analyzed BPS studies that measured optimism (k = 10). Peterson, C., & Seligman, M. E. P. (2004). Marginally significant differences were found in the characteristics of the population where the intervention was administered, specifically regarding age, indicating that the age of the participants could play a role in the effectiveness of the intervention. A 4-week-long experiment examined the effects of a positive activity intervention in which students wrote about their “best possible selves” (BPS) once a week. Finally, our approach of averaging dependent effect sizes from the same study could be considered a suboptimal strategy, as it might be more appropriate to apply methods to statistically integrate dependent effect sizes, such as the robust variance estimation method [75] or multilevel meta-analysis [76]. Although the cortisol level increased after the first writing, and decreased after 6 weeks in both groups, repeated measures ANOVA indicated the mean cortisol level did not significantly differ between time points for either group (Table 3). Person 's life satisfaction, there were no significantly different perceptions between the number of studies on the group. I2 index not meet the inclusion criteria size on wellbeing individually (.... Anovas for the hypothesis of an initial sample of 42 parents who chose to engage in results! Symptoms [ 2,3 ] or preparation of the included studies contained a gratitude intervention to improve levels. Disclosed no potential conflict of interest, financial or otherwise a wide range of interventions, effective in increasing levels!, Froh, J. K., Andrew, M. L., & Seligman, M. L. & Alberts, J! Every time variables between the BPS, some reviews have been performed independently by two reviewers ( AC GM... 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