Extending the Tradition of Giving Thanks Recognizing the Health Benefits of Gratitude

The word gratitude originates from the Latin word gratus, meaning “thankfulness, appreciation of kindness.”³ Gratitude has been categorized and conceptualized as an attitude, moral virtue, emotion, personality trait, feeling, motive and coping device.⁴ Some early discussion of the nature of gratitude classified it as one of the empathetic emotions.⁵ A theme prevalent throughout descriptions of this emotion involves acknowledgment with appreciation of an altruistic gift.⁴ The specific nature of that gift or gain may be either tangible or intangible and can be the gesture or intent that the kindness represents rather than the actual item or benefit conveyed.⁶ 

Fitzgerald⁷ distinguished 3 components of gratitude that define and encompass the process for its expression:

• A warm sense of appreciation for something or somebody

• A sense of goodwill toward that thing or person

• A resulting disposition to act positively due to that appreciation

Formal definitions of the term gratitude reflect one or more of the triad of components enumerated by Fitzgerald. A few of these definitions include the following:

• Quality or condition of being thankful; the appreciation of an inclination to return kindness³ 

• A felt sense of wonder, thankfulness and appreciation for life^8 (p460)

• A cognitive-affective state, prototypically related to the perception that one has received a personal benefit that was neither earned nor deserved, but bestowed through the good intentions of some benevolent source^4,6 

Some of the seminal research on the effects of practicing gratitude on a recurring basis was provided via a series of 3 experiments conducted by Emmons and McCullough.⁴ In order to maximize the potential generalizability of the results, the sample participants for the first 2 studies consisted of healthy college students, whereas participants in the third study were adults with various congenital and acquired neuromuscular disorders. Within each study, some participants were instructed to maintain a journal on a weekly basis (for 10 weeks) and others, on a daily basis (for 2 or 3 weeks). The entire sample kept records of both positive and negative affects experienced as well as their coping behaviors, health behaviors, physical symptoms, and overall appraisals of life. Subgroups in each study were directed to focus their journal entries on different things:

• Group A recorded things for which they were grateful (ie, they were “counting their blessings’’)

• Group B recorded things they found annoying and/or irritating

• Group C recorded things that had a major impact on them

When the data from all 3 studies were compiled and analyzed, 2 overarching trends were readily discernable⁴:

1. Participants in the group monitoring things for which they were grateful evidenced higher levels of well-being than those in either of the 2 comparison groups, but particularly when compared to group B (tabulating things they experienced as annoying or irritating).

2. The positive effects of a grateful outlook for participants in the longer study duration (10 weeks vs 2 or 3 weeks) included not only overall well-being, but social and physical benefits as well.

Emmons and McCullough’s⁶ conclusion that the habit of noting and savoring gratitude for aspects of one’s life plays a significant role in a person’s sense of well-being is supported by studies that preceded^9,–11 and followed (S. Lyubomirsky et al, unpublished data, 2005) their own. This noted effect of gratitude on well-being, moreover, has more recently been distinguished as unique.¹² In addition to enhancing one’s general sense of well-being, those who engage in practicing gratitude report significantly greater happiness, optimism, and satisfaction with their lives, greater progress in attaining important life goals, higher frequency of feeling loved, and lower reported incidence of stress and depression compared to their counterparts tallying neutral or negative aspects.

A Gallup survey titled Thankfulness: America’s Saving Grace,¹³ reported more than a decade ago, found that expressing gratitude leads to a number of positive subjective experiences such as feeling happy. Other studies^4,14 have concurred with the conclusion that counting your blessings on a frequent basis is associated with increased happiness. Emmons and McCullough⁶ summarize this effect by relating that practicing gratitude can enhance happiness levels by approximately 25%. In addition, the duration of these increases in happiness are not fleeting, but persist for at least many months.¹⁵ Can this influence of gratitude on happiness be augmented further by more frequent use of gratitude? Although no universally agreed upon frequency for exercising gratitude is identified in the literature, at least one report noted a diminished effect with higher frequency. When researchers¹⁶ compared the effects of practicing gratitude 3 times per week with only once per week, they found that only those who carried out the exercise on a weekly basis reported greater happiness.

Considering the direct, positive relationship between expression of gratitude and one’s sense of well-being, it is not surprising to find that research supports that the intrinsically rewarding experience of gratitude is also associated with greater optimism for the future,^4,17,–19 as well as with higher levels of contentment and satisfaction with one’s life.²⁰ Rather than ruminating over the deficient or negative aspects of one’s life, those who appreciate and extend gratitude seem able to extract enjoyment from whatever their current circumstances may be. This correlation between gratitude and optimism is especially relevant, owing to emerging evidence that an optimistic outlook has some notable health-related effects:

• Optimistic individuals report faster recovery and better quality of life after significant cardiac interventions such as coronary artery bypass surgery or disorders such as myocardial infarction^21,22 

• Optimism is inversely related to perceived levels of distress and rapid disease progression and is directly correlated with improved survival rates in persons with HIV,²³ in some forms of cancer,^24,–26 in college students adapting to their initial semester,²⁷ in pregnant women,²⁸ and in elderly people.²⁹ 

• Optimists experience significantly lower risks of fatal cardiovascular events and a reduced risk of mortality from all causes.^30 –32 

• Those who engage in practicing gratitude make more progress in achieving important personal goals^4,33 and are more likely to report feeling loved.^4,34 

In addition to enhancing numerous positive psychological outcomes, the exercise of gratitude is also associated with mitigation of negative affective states such as stress and depression. As an antidote for neutralizing negative emotions, ongoing use of gratitude is thought to represent an effective psychological strategy for adapting to or coping with adverse life circumstances.^35,–37 Within this context, psychologists postulate that gratitude may be incompatible with negative emotional states, thereby suppressing emergence of anger, greed, envy, or bitterness.³⁴ Also, as with happiness, the beneficial effects of thankfulness on depression endure rather than evaporate over time. In a randomized, placebo-controlled study, Seligman et al³⁸ found that participants who completed the gratitude exercise continued to report significantly greater happiness and a lower incidence of depression compared to the control groups when measured 6 months later.

Psychologists use the term prosociality to characterize the beneficial interpersonal effects of gratitude and typically summarize those effects as the facilitation and strengthening of social bonds, often with an altruistic focus.^39,40 It has been recognized for some time that people who report the highest levels of happiness are those who report having strong social supports and many close relationships,¹⁵ and that gratitude builds and strengthens social bonds, friendships, and social supports, leaving those who appreciate life and others feeling more loved and cared for by others.⁴¹ Recalling Fitzgerald’s 3 components of gratitude (appreciation, goodwill, acting on appreciation⁷) mentioned previously, the mechanism often used to explain how these events transpire relates to reciprocity or pay-back of good will to the original benefactor or some surrogate, representative, or suitable replacement for them as well as pay-forward to other third parties deemed suitable for this purpose.⁴⁰ From this broad premise, gratitude can be further augmented when the benefit is perceived as more costly to the benefactor, when the recipient highly values the benefit, when the benefit is perceived as having been bestowed with purely benevolent rather than self-serving intentions, and when there are no “strings” attached to the benevolence.³⁹ When gratitude is evidenced as a motivator of prosocial behavior, the ripple effects of this sense of indebtedness may include reciprocal kindness in some of the following forms:

• Helping someone with a personal problem

• Offering emotional support to someone in need

• Making efforts to consider the perspective of others and being more empathetic to their needs^34,40 

• Acknowledging a responsibility to others³⁴ 

• Showing greater generosity and helpfulness to others in their social network^34,40 

A related contribution identified in those who demonstrate gratitude is mitigation of the tendency to take people or fortunate circumstances for granted.^42,–44 This phenomenon, termed hedonic adaptation by psychologists, is thought to be counteracted by the grateful person’s recognition and communication of the value of these provisions to those individuals.¹⁵ When we feel grateful for the people and specific details of our lives, we may demonstrate that appreciation by spending more time with these important people and treating them better during that time.⁸ 

One more recent thread woven into the social fabric of gratitude effects is announcement of what is purported to be “the first evidence that gratitude is associated with relationship formation.” In contrast to most research in this area, which describes the effect of gratitude on augmentation of preexisting relationships via the reciprocal/repayment mechanism, Algoe et al⁴⁵ designed a study to determine whether gratitude might also promote the establishment of new relationships. Their design tapped into an existing college campus sorority system Big Sister Week, when Big Sisters bestow pampering activities and other gifts on Little Sisters with whom they have no previous relationship, to welcome them as new sorority members. Although this beneficence was provided anonymously, results indicated that the Little Sister’s relationship to the Big Sister could be predicted based on the nature and extent of gratitude that developed over the course of that week. As the authors concluded, “Gratitude may initiate a relationship-building cycle between recipient and benefactor.”^45 (p428)

Much of the existing body of research on gratitude has been completed by psychologists and, not surprisingly, has focused primarily on aspects related to psychological and interpersonal outcomes. Despite major research interests devoted to those areas, however, some of this work has afforded findings that inform how a grateful disposition may enhance one’s physiologic health:

Some of the physical health benefits of practicing gratitude identified include the following^4,14,15,34:

• Have higher levels of alertness, vitality, enthusiasm, determination, attentiveness, and energy

• Spend more time exercising

• Report more hours of nightly sleep

• Report a better quality sleep

• Experience fewer physical symptoms such as headaches, coughing, nausea, or pain

• Show heightened immunity in both healthy and sick persons⁴⁷ 

Considering the myriad of psychological and prosociologic benefits enjoyed by those who recognize and share in the benevolence of others, the realization that direct and concrete physical benefits may also accrue seems like dessert complementing a gourmet dining experience. With all of these potential gains awaiting our beckoning, then, how does one actually engage in practicing gratitude?

Meaningful expressions of gratitude do not include the thank-you’s mumbled reflexively following miniscule acts on our behalf such as holding a door open or delivering our mocha latte. Rather, the warm sense of appreciation that Fitzgerald⁷ cited as the first component of gratitude demands an investment of our time to reflect on the gain received, to consider what it means to us, savor its influence, and recognize its source.¹⁶ For some, especially those accustomed to recognizing the nuances that make their life enjoyable and satisfying, that process may require little time; for others, particularly those who only exercise this process for a few moments on the fourth Thursday of every November, it may take longer to elucidate their objects of gratitude and benefactors. At whatever frequency and time work for you, perhaps nightly as your day comes to an end, once every few days as you begin the day, or weekly on Fridays as you commute home from work, compile a mental list of 3 to 5 things for which you are truly grateful; they do not need be complex or lengthy and may sound trivial to some one else. The only person they need to be meaningful to is you. Some examples might include the following:

Once you have gained some proficiency in this reflective process for identifying things that warrant appreciation, follow through where benefactors are identifiable by sharing what you are grateful for and why it means so much to you. Some strategies for expressing gratitude include^6,8,15,16:

• Sending thank-you notes that detail the basis for your gratitude

• Meeting with special people to explain what their thoughtfulness means to you

• Taking an extra minute to clarify how helpful someone’s assistance was to your endeavors

• Reserving some time at each staff meeting to laud the accomplishments of a colleague or to point out some kindness that a colleague extended to you that others were not aware of

• Asking a colleague how you can reciprocate when they need some assistance

• Letting your coworkers know how much you enjoy working with them

• Spending a few quiet moments in thankful repose at your place of worship or at any naturally quiet or beautiful setting in your area

As you gather with friends and family this holiday season, enjoying each other’s company, kindness, and affection, try to hold onto that warm glow that emanates when you let your loved ones know just how important they are and how much they mean to you. Rather than allowing that glow to evaporate, keep regenerating it throughout the year and distributing it as often as you can to those who mean the most to you. Gratitude is good for your head, good for your heart, and good for your soul. And just so you know we take you very seriously, thanks for taking the time to read this message.

Best for the holidays to you and yours.