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      A pilot randomized study of a gratitude journaling intervention on HRV and inflammatory biomarkers in Stage B heart failure patients

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          Stage B, asymptomatic heart failure (HF) presents a therapeutic window for attenuating disease progression and development of HF symptoms, and improving quality of life. Gratitude, the practice of appreciating positive life features, is highly related to quality of life, leading to development of promising clinical interventions. However, few gratitude studies have investigated objective measures of physical health; most relied on self-report measures. We conducted a pilot study in Stage B HF patients to examine whether gratitude journaling improved biomarkers related to HF prognosis.


          Patients (N = 70; mean age = 66.2 years, SD = 7.6) were randomized to an 8-week gratitude journaling intervention or treatment as usual (TAU). Baseline (T1) assessments included 6-item Gratitude Questionnaire (GQ-6), resting heart rate variability (HRV), and an inflammatory biomarker index. At T2 (mid-intervention) GQ6 was measured. At T3 (post-intervention), T1 measures were repeated but also included a gratitude journaling task.


          The gratitude intervention was associated with improved trait gratitude scores (F = 6.0, p = .017, η 2 = .10), reduced inflammatory biomarker index score over time (F = 9.7, p = .004, η 2 = .21) and increased parasympathetic HRV responses during the gratitude journaling task (F = 4.2, p = .036, η 2 = .15), compared with TAU. However, there were no resting pre- to post-intervention group differences in HRV (p's > .10).


          Gratitude journaling may improve biomarkers related to HF morbidity, such as reduced inflammation; large-scale studies with active control conditions are needed to confirm these findings.

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          Most cited references 32

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          The grateful disposition: a conceptual and empirical topography.

          In four studies, the authors examined the correlates of the disposition toward gratitude. Study I revealed that self-ratings and observer ratings of the grateful disposition are associated with positive affect and well-being, prosocial behaviors and traits, and religiousness/spirituality. Study 2 replicated these findings in a large nonstudent sample. Study 3 yielded similar results to Studies I and 2 and provided evidence that gratitude is negatively associated with envy and materialistic attitudes. Study 4 yielded evidence that these associations persist after controlling for Extraversion/positive affectivity. Neuroticism/negative affectivity, and Agreeableness. The development of the Gratitude Questionnaire, a unidimensional measure with good psychometric properties, is also described.
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            Prevalence and prognostic significance of heart failure stages: application of the American College of Cardiology/American Heart Association heart failure staging criteria in the community.

            Heart failure (HF) is a progressive disorder associated with frequent morbidity and mortality. An American Heart Association/American College of Cardiology staging classification of HF has been developed to emphasize early detection and prevention. The prevalence of HF stages and their association with mortality are unknown. We sought to estimate HF stage prevalence in the community and to measure the association of HF stages with mortality. A population-based, cross-sectional, random sample of 2029 Olmsted County, Minnesota, residents aged > or = 45 years was identified. Participants were classified by medical record review, symptom questionnaire, physical examination, and echocardiogram as follows: stage 0, healthy; stage A, HF risk factors; stage B, asymptomatic cardiac structural or functional abnormalities; stage C, HF symptoms; and stage D, severe HF. In the cohort, 32% were stage 0, 22% stage A, 34% stage B, 12% stage C, and 0.2% stage D. Mean B-type natriuretic peptide concentrations (in pg/mL) increased by stages: stage 0=26, stage A=32, stage B=53, stage C=137, and stage D=353. Survival at 5 years was 99% in stage 0, 97% in stage A, 96% in stage B, 75% in stage C, and 20% in stage D. The present study provides prevalence estimates and prognostic validation for HF staging in a community cohort. Of note, 56% of adults > or = 45 years of age were classified as being in stage A (risk factors) or B (asymptomatic ventricular dysfunction). HF staging underscores the magnitude of the population at risk for progression to overt HF.
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              Attrition from self-directed interventions: investigating the relationship between psychological predictors, intervention content and dropout from a body dissatisfaction intervention.

              The aims of this study were to (a) identify the predictors of attrition from a fully self-directed intervention, and (b) to test whether an intervention to increase gratitude is an effective way to reduce body dissatisfaction. Participants (N=479, from the United Kingdom) aged 18-76 years took part in a self-help study via the Internet and were randomized to receive one of two interventions, gratitude diaries (n=130), or thought monitoring and restructuring (n=118) or a waitlist control (n=231) for a two week body dissatisfaction intervention. The gratitude intervention (n=40) was as effective as monitoring and restructuring (n=22) in reducing body dissatisfaction, and both interventions were significantly more effective than the control condition (n=120). Participants in the gratitude group were more than twice as likely to complete the intervention compared to those in the monitoring and restructuring group. Intervention content, baseline expectancy and internal locus of control significantly predicted attrition. This study shows that a gratitude intervention can be as effective as a technique commonly used in cognitive therapy and is superior in retaining participants. Prediction of attrition is possible from both intervention content and psychological variables. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

                Author and article information

                Psychosom Med
                Psychosom Med
                Psychosomatic medicine
                5 February 2016
                Jul-Aug 2016
                01 July 2017
                : 78
                : 6
                : 667-676
                [1 ]Department of Psychiatry, University of California, San Diego, CA
                [2 ]Department of Family Medicine and Public Health, University of California, San Diego, CA.
                [3 ]Department of Medicine, University of California, San Diego, CA
                Author notes
                Correspondence concerning this article should be addressed to: Laura Redwine, Department of Psychiatry, University of California, 9500 Gilman Dr. San Diego, CA. 92093. Mail Code 0804, lredwine@ 123456ucsd.edu
                PMC4927423 PMC4927423 4927423 nihpa748792


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