Imagine a drug that promises to help people exercise more, sleep better, feel more optimistic, and increase overall happiness with life. In a large clinical trial, patients assigned to receive the drug in question significantly outranked the control group in all of these categories in as little as 9 weeks. The cherry on top? There were no adverse effects.
This study was a reality, but the drug was not. It wasn’t a pill, it was a practice: Gratitude. In the 2003 study, psychologists Emmons and McCullough asked university students to submit weekly lists of things they were grateful for. By the end of the study, it appeared their lives had changed for the better.
An “attitude of gratitude” has long been associated with positive psychological outcomes. As early as 1924, philosopher and writer GK Chesterton extolled gratitude for its ability to produce “the most purely joyful moments that have been known to man.” In the 1980s, gratitude, along with other positive psychological constructs, caught the attention of academic psychologists. It’s since been shown to lead to increased happiness, emotional well-being, and satisfaction with life, as well as decreased stress, depression, and anxiety.
It’s not just in your head
More recent evidence has pointed toward gratitude’s beneficial effects on physical health. In the Emmons and McCullough study, for instance, the college students who were instructed to practice regular expressions of gratitude self-reported lower rates of physical ailments, like headaches and stomach upset. Researchers in Switzerland found that grateful individuals experience higher levels of physical well-being, are significantly more likely to engage in health care, and have a greater propensity to perform health-promoting behaviors like choosing healthy foods and abstaining from drugs.
Grateful people even appear objectively healthier than those who don’t regularly express appreciation. Increased heart rate variability—a measure that has repeatedly predicted decreased mortality in patients with coronary artery disease and heart failure—has been observed in research subjects who were asked to focus on a feeling of sincere appreciation. Gratitude has been related to improved sleep, measured not only by subjective sleep quality, but also by sleep duration, sleep latency, and daytime dysfunction attributed to fatigue. Researchers from the University of California, San Diego reported lower levels of inflammatory markers in patients with heart failure who scored highly on a gratitude questionnaire. A wealth of data shows that gratitude and other positive psychological constructs are even associated with decreased all-cause mortality in both healthy and medically diseased populations.
Is gratitude the chicken or the egg?
None of this research addresses the issue of whether gratitude is a cause of well-being, per se, or merely a positive emotion that people with high well-being frequently experience. Experimental studies have begun to answer this question.
One of these studies asked 119 women to keep a daily record of their lives for two weeks. Half the women were told to record specifically those things they were grateful for. The other half were told to objectively record events without any emotional associations. At the end of the 2-weeks, those in the gratitude group had significantly higher levels of well-being, increased sleep quality, and even decreased blood pressure.
NPR recently reported the early findings of a yet unpublished study in which patients with heart failure were asked to keep a gratitude journal most days of the week, noting 2 or 3 things they were thankful for. After 2 months of this practice, patients had higher levels of heart rate variability and decreased levels of inflammatory markers as compared to pre-intervention testing, suggesting a lower risk of adverse cardiac events.
Adopt a practice of gratitude
Good news for anyone who wasn’t born with a grateful disposition: The benefits of gratitude seem to be attainable through a directed practice of thankfulness. Intentionally establishing an attitude of appreciation likely leads to the same health benefits that naturally grateful people already enjoy.
An even more welcoming news is that cultivating gratitude is surprisingly simple. In fact, one study demonstrated that positive psychological effects of writing just one thank you letter lasted for up to one month.
To harness the benefits of appreciation, try keeping a daily gratitude journal. Write a hand-written thank you note. Make a point to express your appreciation for someone who helps you—the barista, the bus driver, the bank teller—every day. You can even incorporate gratitude in mindfulness-based meditation by focusing on what you’re grateful for, even things as simple as warm sunlight or a pleasant sound. Committing to these free, easy, and simple practices will create a ripple effect of improved health, happiness, and well-being throughout your life.
This was first published on 05/25/16. It has been reviewed and republished on 12/24/17.
Nicole Van Groningen, MD
Nicole Van Groningen is a third-year internal medicine resident at NYU, where she has been involved in high-value quality improvement projects as part of the national ACP/ABIM Choosing Wisely High Value Care In Action Fellowship. She also has a passion for medical innovation, which she blogs about at AvantMed. She is an avid tweeter at @NVanGronigenMD.