CAN GRATITUDE IMPROVE HEALTH?

Ryan Bradley, ND, MPH November, 2014

Thanksgiving is upon us, and it is an important reminder that we all have lots to be thankful for in our lives. If you are reading this, you already have lots to be thankful for- the fact that you can read; you are likely in a warm dry place; you have access to electronics and have the mental capacities to operate them. Expressing, or being in a state of, gratitude often requires reframing our current situation through mindfulness, or acute awareness, of how fortunate many of us are in our lives. Although many pay lip service to giving thanks (especially on Thanksgiving during the blessing before chowing down), how many of us regularly stop to express our gratitude for the food before us, the love between us, and the friends among us*? Or for the smooth experiences that keep us going, and the challenging experiences that test our will and provide opportunities for learning, patience and personal growth? May diabetes be one of those challenges? 


Wait a minute…what is gratitude anyway? An emotion? An expression? A state of being? Is there any science suggesting expressing gratitude is good for anything other than delaying dinner? How might be expressing gratitude be helpful for diabetes? Read on.

 

Gratitude 

According to leading gratitude researcher Alex Wood and colleagues1, gratitude is difficult to conceptualize because it is not one thing, action or state. Current definitions include at least seven diverse aspects of gratitude:

  • Appreciation of other people,

  • A focus on things we have,

  • Feelings of awe when encountering beauty,

  • Behaviors that express gratitude,

  • Choices that focus on the positive in the present moment,

  • Appreciation that life is short, and

  • Positive social comparisons.


Interestingly, because having more gratitude, or being in a state of gratitude more often, has been associated with increased quality of life, general happiness, better self-esteem and less depression, investigators are starting to explore ways to increase gratitude(1). Some examples of gratitude practices that have been researched include:

  • Create a list of 5 things you are grateful for every day or every week;

  • List experiences or events for which you are grateful;

  • Write about someone you are grateful for;

  • Write a gratitude letter to a living person, and give it to them;

  • List 5 things about your body, mental capacities, emotions, etc. that you are grateful for.


While relatively simple, these interventions tended to increase measures of gratitude, life satisfaction, positive attitude and body satisfaction. Although the interventions evaluated in the various research studies required creating written lists, or writing letters etc., many of the examples above take only moments in self-reflection to experience the state of gratitude and a connection to people and events outside of our “selves”. Creating this state of mindfulness, even moments per day, helps provide perspective on the blessings we have received, and the challenges others may experience.

 

Are there health benefits from gratitude?

I think all would agree in theory that creating time for expressing gratitude, either in writing, self-reflection or prayer, is a worthwhile practice - but does it actually change our health? Although the health effects of gratitude have only begun to be studied, one domain of health closely linked to gratitude is sleep. Specifically, experiencing increased gratitude was related to total sleep quality, optimal sleep duration, less time to get to sleep, personal reports of sleep quality, and less daytime sleepiness and dysfunction 2. Reinforcing a relationship between gratitude and sleep, interventions designed to increase gratitude (like those described above) improved sleep duration and feeling refreshed upon waking 3.Although it can be challenging to take those few extra minutes some days or nights to express our appreciations, this research reinforces the concept that taking those few extra minutes to express gratitude (either by creating the state of being through our thoughts and feelings or by formally writing down things/people we are grateful for) pays for itself many times over with minutes or hours avoiding poor sleep quality plus increased productivity and energy during our wakeful hours!


Additionally, in addition to increases quality of life and reduced depression, sleep is another area of health relevant to diabetes that may be improved through gratitude. Poor sleep quality is both a risk factor for developing diabetes, and is linked to poor glucose control in diabetes (4-7), and taking a few minutes to express gratitude sure beats taking another drug!

 

Does gratitude directly impact other elements of diabetes?

Very few studies have investigated whether or not increasing gratitude impacts diabetes care or management. However, the few studies that have been performed suggest there may be benefits. Reinforcing the relationship between gratitude and depression, clinical research performed by Cohn and colleagues demonstrated that using a self-paced online training to increase gratitude directly improved mood and reduced symptoms of depression in adults with diabetes8. As depression is a known barrier to improving self care (i.e., making dietary changes or getting more physical activity), learning to practice more gratitude may be a strategy toward behavior change for those with diabetes.
 

When I stop to consider how this strategy could be used in the clinic to help people modify their behaviors, I find this approach - recommending patients take a few minutes every day to be grateful for their lives, their breath, their food, their families, etc.- a very refreshing alternative to recommending another drug, or spending endless breaths trying to rationally educate people on all the reasons why changing their behaviors might be good for them. Instead, taking a few minutes to be grateful may actually be self-reinforcing, helping us to make changes that are better for us, thus we become even more grateful for our lives and our health, and more self-care is stimulated. I like the concept! This concept is supported by research by Jaser and colleagues who studied a “positive psychology” intervention (which included lots of attention to gratitude) in people with type 1 diabetes- after the intervention the participants improved their glucose monitoring suggesting they were more motivated for self-care. Hmmm…could it be that gratitude is also related to self-love… and that sometimes we need to give ourselves reminders that we are doing the best we can and to love ourselves in the process as we try to “do better”?

 

Remembering to Give Thanks

In addition to intuitively being a “good” thing to do, building a deeper practice of gratitude, whether as a direct expression or simply holding gratitude as a state of being, has positive health implications related directly to diabetes, including mood, life satisfaction, sleep quality and removing barriers to improving self-care. This Thanksgiving, try to tap back into the true intention of the holiday by taking a few extra moments to express verbally or internally your gratitude for life, your breath, and the loving relationships in your life. Spend some extra time being thankful for yourself and acknowledging you are doing the best you can with the tools you have. Focusing on the positive is a choice we make, and a skill I try hard to practice (and be grateful for) every day!

 

In health, Ryan Bradley, ND, MPH

 

*“Thank you for the food before us, the love between us, and the friends among us.” Is a real blessing often spoken before meals by the young Evangeline Allen along with the rest of the Mischley-Allen family in Seattle, WA. I am eternally thankful for sharing food and laughter with their family.

 

References:

  1. Wood, A.M., Froh, J.J., and Geraghty, A.W. 2010. Gratitude and well-being: a review and theoretical integration. Clin Psychol Rev 30:890-905.

  2. Wood, A.M., Joseph, S., Lloyd, J., and Atkins, S. 2009. Gratitude influences sleep through the mechanism of pre-sleep cognitions. J Psychosom Res 66:43-48.

  3. Emmons, R.A., and McCullough, M.E. 2003. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol 84:377-389.

  4. Tang, Y., Meng, L., Li, D., Yang, M., Zhu, Y., Li, C., Jiang, Z., Yu, P., Li, Z., Song, H., et al. 2014. Interaction of sleep quality and sleep duration on glycemic control in patients with type 2 diabetes mellitus. Chin Med J (Engl) 127:3543-3547.

  5. Knutson, K.L., Ryden, A.M., Mander, B.A., and Van Cauter, E. 2006. Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Arch Intern Med 166:1768-1774.

  6. Tsai, Y.W., Kann, N.H., Tung, T.H., Chao, Y.J., Lin, C.J., Chang, K.C., Chang, S.S., and Chen, J.Y. 2012. Impact of subjective sleep quality on glycemic control in type 2 diabetes mellitus. Fam Pract 29:30-35.

  7. Trento, M., Broglio, F., Riganti, F., Basile, M., Borgo, E., Kucich, C., Passera, P., Tibaldi, P., Tomelini, M., Cavallo, F., et al. 2008. Sleep abnormalities in type 2 diabetes may be associated with glycemic control. Acta Diabetol 45:225-229.

  8. Cohn, M.A., Pietrucha, M.E., Saslow, L.R., Hult, J.R., and Moskowitz, J.T. 2014. An online positive affect skills intervention reduces depression in adults with type 2 diabetes. J Posit Psychol 9:523-534.