Gratitude Journal

May 3, 2013 Written by JP    [Font too small?]

A primary tenet of my health care philosophy is that almost any action that improves your well being will likely benefit those around you. But, making inspiring, positive changes in your lifestyle goes far beyond obvious strategies such as changing your diet, exercising regularly and getting enough sleep. Your attitude is at least as important. The trouble is that for many, a change in attitude seems even more formidable than giving up junk food, going to the gym or setting a consistent sleep schedule.

Adopting an “attitude of gratitude” is a free, powerful resource that virtually everyone can access. And, thankfully, researchers from highly respected institutions such as the University of California, Davis and the University of Miami have come up with evidence-based guidelines to help incorporate more gratitude into our daily lives. If interested, here’s all you’ll need to do: Once a week, write down five things that you’re grateful for in your life. It’s best to be specific, but keep each item to a maximum of one sentence. According to pioneering research by Drs. Michael E. McCullough and Robert A. Emmons, this simple practice has been shown to improve: a) a variety of physical symptoms including low energy, pain perception and sleep quality; b) personal goal attainment; c) optimism and social connectedness; d) positive attitudes toward family and school activities in children. Interestingly, more is not necessarily better. Writing a gratitude journal on a daily basis is not as effective or sustainable as practicing this exercise once or twice a week.

Personally, I suggest taking the practice of gratitude journaling one step further. The additional step I recommend is to seek out a gratitude partner. This can be a family member, friend or someone at school or work. Each week, email that person your list of five things that inspire gratitude in you. In turn, your partner should send you their list. After reading each others’ lists, a brief confirmation of receipt is all that’s needed. “Thanks! Got it!”. No commentary or judgement should be made. This style of partnership acts to inspire acceptance, gratitude and reflection in the recipients and writers alike. Also, it’s a gentle reminder for those hectic times when one might otherwise forget to write a weekly list. I hope you’ll join me and many of my clients in starting and maintaining a gratitude journal right now. And! I am grateful for your attention and time.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – Examining the Pathways Between Gratitude & Self-Rated Physical (link)

Study 2 – The Effects of Counting Blessings On Subjective Well-Being: A Gratitude (link)

Study 3 – Gratitude and Well-Being: A Review and Theoretical Integration(link)

Study 4 – Gratitude Influences Sleep Through the Mechanism of Pre-Sleep … (link)

Study 5 – Counting Blessings Versus Burdens: An Experimental Investigation … (link)

Study 6 – Becoming Happier Takes Both a Will & A Proper Way: An Experimental (link)

Study 7 – A Spirituality Teaching Program for Depression: Qualitative Findings (link)

Study 8 – The New York Times: A Serving of Gratitude May Save the Day (link)

Study 9 – UC Davis Emmons Lab: Gratitude and Well-Being (link)

Study 10 – University of California, Berkeley: Tips for Keeping a Gratitude Journal (link)

Free, Natural and Safe Ways of Increasing Feelings of Gratitude

Source: Psychiatry (Edgmont). 2010 November; 7(11): 18–22. (link)

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Posted in Alternative Therapies, General Health, Mental Health

14 Comments & Updates to “Gratitude Journal”

  1. Emily Says:

    Just wanted to let you know that I LOVE your blog. I think you have the perfect attitude towards conventional and alternative/complimentary/natural medicine…they both have strengths and limitations and both should or can have a place in people’s lives. I am a current nursing student and too often hear of people on the two ends of the spectrum. Thanks for supporting the natural health cause and providing great evidence-based suggestions!

  2. JP Says:

    Thank so much, Emily! I’m thrilled that you’re pursuing a career in nursing. IMO, having more medical professionals with an open mind re: (evidence-based) integrative medicine will benefit patients, families and the modern medicine as a whole. Let’s make it happen!

    Be well!


  3. JP Says:

    Update: 4/13/15

    J Health Psychol. 2015 Mar 2.

    The impact of a brief gratitude intervention on subjective well-being, biology and sleep.

    This randomised controlled experiment tested whether a brief subjective well-being intervention would have favourable effects on cardiovascular and neuroendocrine function and on sleep. We compared 2 weeks of a gratitude intervention with an active control (everyday events reporting) and no treatment conditions in 119 young women. The treatment elicited increases in hedonic well-being, optimism and sleep quality along with decreases in diastolic blood pressure. Improvements in subjective well-being were correlated with increased sleep quality and reductions in blood pressure, but there were no relationships with cortisol. This brief intervention suggests that subjective well-being may contribute towards lower morbidity and mortality through healthier biological function and restorative health behaviours.

    Be well!


  4. JP Says:

    Updated 08/11/15:

    Spritual Clin Pract. 2015 Mar;2(1):5-17.

    The Role of Gratitude in Spiritual Well-being in Asymptomatic Heart Failure Patients.

    Spirituality and gratitude are associated with wellbeing. Few if any studies have examined the role of gratitude in heart failure (HF) patients or whether it is a mechanism through which spirituality may exert its beneficial effects on physical and mental health in this clinical population. This study examined associations bet ween gratitude, spiritual wellbeing, sleep, mood, fatigue, cardiac-specific self-efficacy, and inflammation in 186 men and women with Stage B asymptomatic HF (age 66.5 years ±10). In correlational analysis, gratitude was associated with better sleep (r=-.25, p<0.01), less depressed mood (r=-.41, p<0.01), less fatigue (r=-.46, p<0.01), and better self-efficacy to maintain cardiac function (r=.42, p<0.01). Patients expressing more gratitude also had lower levels of inflammatory biomarkers (r=-.17, p<0.05). We further explored relationships among these variables by examining a putative pathway to determine whether spirituality exerts its beneficial effects through gratitude. We found that gratitude fully mediated the relationship between spiritual wellbeing and sleep quality (z=-2.35, SE=.03, p=.02) and also the relationship between spiritual wellbeing and depressed mood (z=-4.00, SE=.075, p<.001). Gratitude also partially mediated the relationships between spiritual wellbeing and fatigue (z=-3.85, SE=.18, p<.001), and between spiritual wellbeing and self-efficacy (z=2.91, SE=.04, p=.003). In sum, we report that gratitude and spiritual wellbeing are related to better mood and sleep, less fatigue, and more self-efficacy, and that gratitude fully or partially mediates the beneficial effects of spiritual wellbeing on these endpoints. Efforts to increase gratitude may be a treatment for improving wellbeing in HF patients' lives and be of potential clinical value. Be well! JP

  5. JP Says:

    Updated 08/11/15:

    Front Psychol. 2015 Jun 15;6:815.

    Friendly touch increases gratitude by inducing communal feelings.

    Communion among people is easily identifiable. Close friends or relatives frequently touch each other and this physical contact helps identifying the type of relationship they have. We tested whether a friendly touch and benefits elicit the emotion of gratitude given the close link between gratitude and communal relations. In Study 1, we induced a communal mindset and manipulated friendly touch (vs. non-touch) and benefit to female participants by a female confederate. We measured pre- and post-benefit gratitude, communal feelings, and liking toward the toucher, as well as general affect. In Study 2, we manipulated mindset, friendly touch and benefit, and measured the same variables in female pairs (confederate and participants). In both studies the results showed a main effect of touch on pre-benefit gratitude: participants who were touched by the confederate indicated more gratitude than those not touched. Moreover, benefit increased gratitude toward a confederate in the absence of touch, but not in the presence of touch. Additionally, perceiving the relationship as communal, and not merely liking the confederate, or a positive mood mediated the link between touch and gratitude. The results further support a causal model where touch increases communal feelings, which in turn increase gratitude at the end of the interaction, after having received a benefit from the interaction partner. These results support a broader definition of gratitude as an emotion embodied in communal relationship cues.

    Be well!


  6. JP Says:

    Updated 08/11/15:

    Scand J Psychol. 2015 Jun 30.

    Longitudinal relationships between gratitude, deliberate rumination, and posttraumatic growth in adolescents following the Wenchuan earthquake in China.

    To examine the longitudinal relationship between gratitude, deliberate rumination and posttraumatic growth (PTG) in the adolescent survivors after the Wenchuan earthquake, 217 adolescent survivors were randomly selected from several primary and secondary schools in the county of Wenchuan, and were assessed by questionnaires at three and a half years (T1), four and a half years (T2), five and a half years (T3) after the Wenchuan earthquake, respectively. The results found that there was a one-way predictive relationship of gratitude onto PTG from T1 to T3, and gratitude predicted deliberate rumination from T1 to T2 but not T2 to T3. Deliberate rumination only had a significant positive effect on PTG from T2 to T3, and PTG only predicted deliberate rumination from T1 to T2. These results indicated that gratitude could be a stable predictive factor for the development of PTG, and gratitude could also affect PTG by deliberate rumination. In addition, the predictive effect between deliberate rumination and PTG is unstable with time change.

    Be well!


  7. JP Says:

    Updated 09/27/15:

    J Relig Health. 2015 Jun 19.

    The Source and Impact of Specific Parameters that Enhance Well-Being in Daily Life.

    The purpose of this study was to review four parameters (forgiveness, gratitude, hope and empathy) frequently noted when evaluating well-being. We reviewed clinical studies from 1966 to present. We included 63 articles. All four of the parameters were shown to generally improve an individual’s well-being. These parameters demonstrated a positive influence within more specific societal issues including improvement in social relationships, delinquent behavior and physical health. These parameters were generally derived from training and religion. This study suggests that these parameters may improve either one of general well-being, pro-social and positive relational behavior and demonstrate positive health effects.

    Be well!


  8. JP Says:

    Updated 12/29/15:

    J Couns Psychol. 2015 Nov 16.

    Thankful for the Little Things: A Meta-Analysis of Gratitude Interventions.

    A recent qualitative review by Wood, Froh, and Geraghty (2010) cast doubt on the efficacy of gratitude interventions, suggesting the need to carefully attend to the quality of comparison groups. Accordingly, in a series of meta-analyses, we evaluate the efficacy of gratitude interventions (ks = 4-18; Ns = 395-1,755) relative to a measurement-only control or an alternative-activity condition across 3 outcomes (i.e., gratitude, anxiety, psychological well-being). Gratitude interventions outperformed a measurement-only control on measures of psychological well-being (d = .31, 95% confidence interval [CI = .04, .58]; k = 5) but not gratitude (d = .20; 95% CI [-.04, .44]; k = 4). Gratitude interventions outperformed an alternative-activity condition on measures of gratitude (d = .46, 95% CI [.27, .64]; k = 15) and psychological well-being (d = .17, 95% CI [.09, .24]; k = 20) but not anxiety (d = .11, 95% CI [-.08, .31]; k = 5). More-detailed subdivision was possible on studies with outcomes assessing psychological well-being. Among these, gratitude interventions outperformed an activity-matched comparison (d = .14; 95% CI [.01, .27]; k = 18). Gratitude interventions performed as well as, but not better than, a psychologically active comparison (d = -.03, 95% CI [-.13, .07]; k = 9). On the basis of these findings, we summarize the current state of the literature and make suggestions for future applied research on gratitude.

    Be well!


  9. JP Says:

    Updated 07/29/16:

    Psychosom Med. 2016 Jul-Aug;78(6):667-76.

    Pilot Randomized Study of a Gratitude Journaling Intervention on Heart Rate Variability and Inflammatory Biomarkers in Patients With Stage B Heart Failure.

    OBJECTIVE: 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.

    METHODS: Patients (n = 70; mean [standard deviation] age = 66.2 [7.6] years) were randomized to an 8-week gratitude journaling intervention or treatment as usual. Baseline (T1) assessments included the six-item Gratitude Questionnaire, resting heart rate variability (HRV), and an inflammatory biomarker index. At T2 (midintervention), the six-item Gratitude Questionnaire was measured. At T3 (postintervention), T1 measures were repeated but also included a gratitude journaling task.

    RESULTS: The gratitude intervention was associated with improved trait gratitude scores (F = 6.0, p = .017, η = 0.10), reduced inflammatory biomarker index score over time (F = 9.7, p = .004, η = 0.21), and increased parasympathetic HRV responses during the gratitude journaling task (F = 4.2, p = .036, η = 0.15), compared with treatment as usual. However, there were no resting preintervention to postintervention group differences in HRV (p values > .10).

    CONCLUSIONS: 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.

    Be well!


  10. JP Says:

    Updated 08/02/16:

    Psychother Res. 2016 May 3:1-11.

    Does gratitude writing improve the mental health of psychotherapy clients? Evidence from a randomized controlled trial.

    Although the past decade has witnessed growing research interest in positive psychological interventions (PPIs), their potential as adjunctive interventions for psychotherapy remains relatively unexplored. Therefore, this article expands the frontiers of PPI research by reporting the first randomized controlled trial to test a gratitude writing adjunctive intervention for psychotherapy clients. Participants were 293 adults seeking university-based psychotherapy services. Participants were randomly assigned to one of three conditions: (a) control (psychotherapy only), (b) a psychotherapy plus expressive writing, and (c) a psychotherapy plus gratitude writing. Participants in the gratitude condition wrote letters expressing gratitude to others, whereas those in the expressive writing condition wrote about their deepest thoughts and feelings about stressful experiences. About 4 weeks as well as 12 weeks after the conclusion of the writing intervention, participants in the gratitude condition reported significantly better mental health than those in the expressive and control conditions, whereas those in the expressive and control conditions did not differ significantly. Moreover, lower proportions of negative emotion words in participants’ writing mediated the positive effect of condition (gratitude versus expressive writing) on mental health. These findings are discussed in light of the use of gratitude interventions as adjunctive interventions for psychotherapy clients.

    Be well!


  11. JP Says:

    Updated 05/03/17:

    J Clin Psychol. 2017 Mar 6.

    Feeling Thanks and Saying Thanks: A Randomized Controlled Trial Examining If and How Socially Oriented Gratitude Journals Work.

    OBJECTIVE: This study examined the effect of a reflective interpersonal gratitude journal, a reflective-behavioral interpersonal gratitude journal and an active control journal, on primary qualities of well-being and depression.

    METHOD: Participants (n = 192; 67.2% female) completed this 3-month longitudinal randomized controlled design.

    RESULTS: Participants in the reflective-behavioral condition experienced the greatest improvements in affect balance and reductions in depression at immediate posttest. Both gratitude interventions improved affect balance at 1 month, compared to the control. Changes in affect balance for those in the reflective-behavioral condition were mediated by the rate at which people expressed gratitude in their existing relationships. This effect was moderated by participant’s baseline depressive status.

    CONCLUSION: Expressing felt gratitude to others appears to be a crucial step in deriving benefits, and these benefits may not be limited to the emotionally healthy. Given the applied popularity of gratitude interventions, understanding not only if but also how they work is essential.

    Be well!


  12. JP Says:

    Updated 08/03/17:

    Sci Rep. 2017 Jul 11;7(1):5058.

    Effects of gratitude meditation on neural network functional connectivity and brain-heart coupling.

    A sense of gratitude is a powerful and positive experience that can promote a happier life, whereas resentment is associated with life dissatisfaction. To explore the effects of gratitude and resentment on mental well-being, we acquired functional magnetic resonance imaging and heart rate (HR) data before, during, and after the gratitude and resentment interventions. Functional connectivity (FC) analysis was conducted to identify the modulatory effects of gratitude on the default mode, emotion, and reward-motivation networks. The average HR was significantly lower during the gratitude intervention than during the resentment intervention. Temporostriatal FC showed a positive correlation with HR during the gratitude intervention, but not during the resentment intervention. Temporostriatal resting-state FC was significantly decreased after the gratitude intervention compared to the resentment intervention. After the gratitude intervention, resting-state FC of the amygdala with the right dorsomedial prefrontal cortex and left dorsal anterior cingulate cortex were positively correlated with anxiety scale and depression scale, respectively. Taken together, our findings shed light on the effect of gratitude meditation on an individual’s mental well-being, and indicate that it may be a means of improving both emotion regulation and self-motivation by modulating resting-state FC in emotion and motivation-related brain regions.

    Be well!


  13. JP Says:

    Updated 01/20/19:

    Depress Anxiety. 2019 Jan 18.

    Gratitude diary for the management of suicidal inpatients: A randomized controlled trial.

    BACKGROUND: The management of suicidal crisis remains a major issue for clinicians, driving the development of new strategies.

    METHODS: We conducted a randomized controlled trial based on a 7-day add-on positive psychology program: gratitude diary (intervention) versus food diary (control) in adults hospitalized for current suicidal ideation or a suicide attempt. The primary effectiveness outcome was between-group differences for mean change of current psychological pain, between the beginning and the end of the 7-day intervention. We measured between-group differences for mean change of suicidal ideation, hopelessness and optimism, and depression and anxiety between inclusion and after the completion of the 7-day intervention. We compared mean change of current psychological pain, suicidal ideation, and hopelessness and optimism between immediate pre and post daily journal completion.

    RESULTS: Two hundred and one participants were enrolled and randomized. Between pretherapy and posttherapy: There were no significant between-group differences for mean change of severity and intensity of suicidal ideation and current hopelessness. Between-group difference for mean change of current psychological pain was trending (P = 0.05). Mean change of depression, anxiety, and optimism was significantly higher in the intervention than in the control group. Between immediate pre and post daily journal completion: Between-group differences favored gratitude (vs. food) diary for all outcomes (psychological pain, suicidal ideation, and hopelessness and optimism; P < 10-3 ). Participants found the intervention to be more useful than the food diary. CONCLUSIONS: Through gratitude diary appears a very straightforward intervention that could be developed as an adjunctive strategy for suicidal patients. Be well! JP

  14. JP Says:

    Updated 02/22/19:

    J Altern Complement Med. 2019 Feb 20.

    Outcomes of a Gratitude Practice in an Online Community of Caring.

    OBJECTIVES: CaringBridge (CB) is a web-based social network where people share information, enlist support, and access resources following a difficult diagnosis; it can also be used to disseminate supportive self-care tools, such as a gratitude practice, for its users. Gratitude practices are shown to reduce stress and fear, improve sleep, and increase positive emotions and overall well-being. The purpose of this article was to report the findings of a brief gratitude intervention delivered to CB users.

    Design, Setting/Location, Subjects: This is a nonrandomized, prospective, pre- and post-evaluation study in an online community. Inclusion criteria were adults 18 years or older, English literate, willingness to participate in a mind-body practice, and active users of CB: patient, caregiver, or visitor to a site.

    INTERVENTIONS: Participants were engaged in a daily, 21-day brief gratitude practice and were given weekly automated reminders to do their practice.

    OUTCOME MEASURES: Outcomes included perceived stress, gratitude, social connectedness, and social assurance scales. Paired t tests were used to assess changes in outcomes; multivariate regression models were used to assess the relationship between the frequency of gratitude practice and change in outcomes.

    RESULTS: Follow-up data were collected from 882/1598 participants, and nearly 70% self-reported engaging in the gratitude practice five or more days/week. Participants reported statistically significant improvement in all outcomes with small standardized effect sizes for gratitude (0.39), social connectedness (0.24), and social assurance (0.10). Changes in perceived stress (-0.73) were larger in magnitude and increased with more frequent practice.

    CONCLUSIONS: Among this online community, there was a high level of engagement with a brief gratitude practice, and improvements in stress, gratitude, and social support were observed. This design did not control for changes in outcomes that may be due to time trends, placebo or contextual effects, regression to the mean, or selection bias.

    Be well!


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