The Practice of Gratitude

Cultivating gratitude takes effort but pays off with profound effects on your health and happiness

The Practice of Gratitude
Tatiana Denning


/ˈɡradəˌt(y)o͞od/ - the quality of being thankful; readiness to show appreciation for and to return kindness

It’s been called a virtue, an attitude, an emotion, and even a skill.

Poets such as Ralph Waldo Emerson opined its merit, saying, “Cultivate the habit of being grateful for every good thing that comes to you, and to give thanks continuously,” while philosophers such as the stoic Cicero espoused, “Gratitude is not only the greatest of virtues, but the parent of all others.”

Of course, religions have long emphasized the importance of gratitude. In the East, Buddha said, “A person of integrity is grateful and thankful” (Katannu Sutta), while in the West, the Bible says, "Give thanks in all circumstances; for this is the will of God in Christ Jesus for you.” (1 Thessalonians 5:18).
In fact, its importance is valued so much that cultures around the world have holiday celebrations focused on gratitude; celebrations such as the Moon Festival in China, Sikkot in Israel, Erntedankfest in Germany, and our own American Thanksgiving, to name but a few.

As we gather with family and friends this holiday season, and pause to practice the age-old adage of counting our blessings, perhaps we should ask ourselves a question: How often do we really practice gratitude, without a holiday to remind us?

We may find our answer is “not often enough.” But the good news is, with a little self-awareness and conscious effort, we can strengthen our gratitude muscle—and live a better life for doing so.

Improved Relationships

Relationships form the cornerstone of our lives. Because they have such a profound impact on our lives, nurturing them is imperative—and showing gratitude is a great place to start.
Just ask Robert Emmons, professor of psychology at UC–Davis, and the founding editor-in-chief of The Journal of Positive Psychology. Considered the world’s leading scientific expert on gratitude, Emmons says gratitude has a significant positive impact on relationships.

“People with a strong disposition toward gratitude have the capacity to be empathic and to take the perspective of others. They're rated as more generous and more helpful by people in their social networks,” he writes on his website.

Emmons says grateful people place less importance on material things, tend not to judge the success of others based on what they’ve accumulated, are less envious of others, and share more readily with others.

The practice of gratitude can also lead to the pay-it-forward effect, meaning the more grateful we feel, the more likely we are to practice helpful behaviors, and the more likely those that we help will go on to help others. A study in Psychological Science showed gratitude drives these helping behaviors, and can even increase levels of assistance provided to strangers.
Gratitude can also have a positive impact in the workplace. According to Emmons, gratitude is “the ultimate performance-enhancing substance.” It drives people to be more helpful and kind, exhibit compassion, encourage others, and even volunteer for extra work assignments.
The growing plague of excessive entitlement, whereby people feel life or others owe them something, can actually be thwarted through the practice of gratitude. Entitlement harms not only relationships with others, but oneself, and can manifest in the form of aggression and violence, theft, hostility, poor work performance, envy, greed, resentment, lack of accountability, and blaming others. According to Emmons, “A person who feels entitled to everything will be grateful for nothing; gratitude is the antidote to entitlement.”

Better Sleep

Sleep impacts our performance at work and how we go about our entire day. Without a good night’s sleep, we feel foggy, unfocused, lethargic, and even irritable. Poor sleep is also associated with an increased risk of obesity, heart disease, and diabetes. It exerts significant harm to our health.
A number of studies have found that gratitude helps improve sleep. For example, a study in the journal Behavioral Sleep Medicine found that the practice of gratitude can help us sleep longer and more soundly, perhaps by acting as a remedy for pre-sleep worries or depression.
So the next time you’re having trouble falling asleep, instead of reaching for that bottle of medication, why not reach for a gratitude journal? Or try a gratitude sleep technique. Lie in bed with your eyes closed, and focus on something you're grateful for, recalling all the reasons why. Then relax, as the good feelings wash over you. You can also do a breathing technique, inhaling gratitude, while exhaling any unwanted feelings, tension, and negativity.

Improved Physical Health

While we’re continually discovering the impact our minds have on physical health, it may surprise you to know that something as simple as the practice of gratitude can be so beneficial.
Studies have shown that gratitude can help improve fibromyalgia, memory, blood pressure, and heart rate variability. Gratitude also leads to lower levels of endothelial dysfunction, and even improves cardiovascular outcomes.
And according to UC–Davis Medical Center, gratitude lowers LDL (bad) cholesterol, while raising HDL (good) cholesterol. It can also lower cortisol levels and improve immune function.
While research in this area is still limited, studies are promising. With all the potential health benefits from the simple act of practicing gratitude, why not give it a try? Your body will thank you.

Greater Mental Well-Being

Perhaps the most significant impact of gratitude comes from an improved sense of mental health. Emmons’s many studies have revealed this fact.

“Grateful people report higher levels of positive emotions, life satisfaction, vitality, optimism and lower levels of depression and stress,” he writes.

Sonja Lyubomirsky, professor of psychology at UC–Riverside and author of “The How of Happiness” and “The Myths of Happiness,” has studied the positive impact gratitude has on happiness. She says gratitude not only helps us savor the good things, but also helps us to not take things for granted. Gratitude also leads us to be more helpful to others, and when all combined, these things increase our feelings of happiness.

Lyubomirsky says gratitude also neutralizes negative emotions and experiences.

“It’s almost impossible to feel grateful and at the same time to feel greedy, or envious, or bitter, or anxious,” she said in a presentation shared by the Greater Good Science Center.

I’d never looked at it in this light, but how true this is.

Research presented at the American Psychological Association’s 2012 annual conference confirms that gratitude can not only make us happier, but can lead us to make positive life choices.

“Grateful teens are more likely than their less grateful peers to be happy, less likely to abuse drugs and alcohol and less likely to have behavior problems at school,” the study found, according to a summary by Science Daily.

Gratitude can also play a major role in overcoming trauma. A study of Vietnam veterans with PTSD, in the journal Behavior and Research Therapy, found that gratitude can foster resilience and improve PTSD, while a study in The Journal of Positive Psychology showed that gratitude confers a protective effect against mental distress in the wake of natural disasters.

It’s important to note that while studies show that gratitude has many mental health benefits, some of these benefits require time and regular practice to be fully realized. This is a key reason why it’s important to not just practice gratitude during the holidays, but to make it a regular habit.

Practicing gratitude can even produce changes in the brain. A study published in NeuroImage in 2015 found that months after doing a simple gratitude writing task, participant’s brains were still wired to feel extra thankful. Another study published in Frontiers in Psychology showed that “gratitude intensity correlated with brain activity in distinct regions of the medial pre-frontal cortex associated with social reward and moral cognition.” The authors proposed that gratitude may even impact mu-opioid receptors, affecting the brain similarly to pain medication.

Putting It Into Practice

So is it true that you either have gratitude or you don’t? The answer is no. Gratitude, like other virtues and good habits, can be cultivated.
To discover your level of gratitude, Greater Good Magazine has an online test you can take to find out where you rank. There are a number of other gratitude tests, with the GQ-6 test being one of the most commonly used by psychologists and researchers.

If our gratitude level is low, we may take things for granted and lack appreciation when life is going well. Then, when life hits a rocky patch, we may focus on the problem and forget about the good things.

To help cultivate gratitude, Emmons recommends a simple exercise. “First, think about one of the unhappiest events you have experienced. How often do you find yourself thinking about this event today? Does the contrast with the present make you feel grateful and pleased? Do you realize your current life situation is not as bad as it could be? Try to realize and appreciate just how much better your life is now.”
Even in hardship, we should be grateful for the lessons contained therein. To complete Ralph Waldo Emerson’s quote above, “And because all things have contributed to your advancement, you should include all things in your gratitude.” And without the rain, we would never appreciate the sunshine.
According to the site The Daily Stoic, gratitude is an integral part of stoicism. “The Stoics saw gratitude as a kind of medicine, that saying 'Thank you' for every experience was the key to mental health.”

Cultivating gratitude isn’t difficult. It just takes a little mindfulness and mental effort. Simple things, such as keeping a gratitude list or journal, saying a heartfelt thank you to someone, or writing a thank you note, all strengthen our sense of gratitude. Keeping thoughts of gratitude, by recognizing things we’re grateful for, is also important.

Other possibilities include using gratitude cues, such as keeping positive notes or pictures around, or a gratitude jar for you and your family to contribute to and share around the dinner table. Or try getting a gratitude buddy to share the things you're both grateful for each week.

While it won’t happen overnight, with consistent practice, gratitude will strengthen and grow. The more effort we make today, the easier it will come tomorrow. And remember, true happiness comes not from the occasional thank you, but from cultivating a disposition of gratitude.

Perhaps the best words we can remember during this season of thanks are those that Emmons quotes from our 16th president, Abraham Lincoln:

“We have grown in numbers, wealth, and power as no other nation ever has grown; but we have forgotten God! We have forgotten the gracious Hand which preserved us in peace, and multiplied and enriched and strengthened us; and we have vainly imagined, in the deceitfulness of our hearts, that all these blessings were produced by some superior wisdom and virtue of our own.”

Gratitude. It requires humility. It requires self-reflection. It requires recognizing that there is a force greater than ourselves, to which we owe a world of thanks.

There are so many things to be grateful for.  So, what are you grateful for today?

Tatiana Denning, D.O., is a family medicine physician who focuses on wellness and prevention. She believes in empowering her patients with the knowledge and skills necessary to maintain and improve their own health.
Tatiana Denning, D.O. is a preventive family medicine physician. She believes in empowering patients with the tools, knowledge and skills needed to improve their health by focusing on mindfulness, healthy habits, and weight management.
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