By: Teri Crawford Brown
Aspen University
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Attitude is everything. Gratitude is
the ultimate attitude adjustment.
Researchers have conducted
numerous studies on the effect and
benefits of gratitude. Gratitude, it
turns out, is a very powerful and
often overlooked emotion. Gratitude
is a powerful force which instantly
begins propelling people forward
toward happiness, success, and
health. Once established as a force
within a person gratitude naturally
begins radiating out toward others.
This literary review is designed to
help nurses see the proven value of
using gratitude in their daily lives to
positively affect their attitude and to
show the proven affects that
gratitude can have on the patient’s
outcomes and perceptions of their
illness.
The idea of reviewing the available literature on gratitude began
three years ago as I started on a personal journey to make me the
best version of myself. This journey has led me to the realization
that gratitude is the secret to happiness; it is the foundation of
wanting what you have, and to being present in the moment with a
happy heart. I made a vision board and every morning and night I
gave gratitude for the things that were presently in my life and for
the things that were coming into my life. I began to write in my
journal three things I was grateful for everyday and I started making
a conscious effort to give gratitude for every circumstance I was
faced with: good or bad. I learned to have gratitude for the lessons
that these circumstances came to teach me and not to view
unpleasant situations as bad but rather as lessons
These small changes created a complete shift in my thinking and led me
to a peace filled, joyful, life. During this time my uncle, that I was very
close to, was diagnosed with and being treated for Metastatic
Melanoma. He was 50 years old when he was diagnosed and from the
beginning we realized that he had a very small chance of survival.
Together we practiced positive thinking and gratitude throughout his
treatment. As we all know, cancer is a cruel disease, and its treatments
almost as cruel. It was a struggle for me to keep an attitude of gratitude
seeing the amount of suffering that my uncle was going through. Then,
on a Friday, the week before my uncle passed, I was driving him to the
hospital to be admitted for rectal bleeding, he weighed 108 pounds, the
cancer had come to the outside of his chest, neck, throat, it was
horrible, he was in dreadful pain. As we were driving to the hospital my
uncle said to me “you know Teri, I am so grateful for my vision, it would
be awful to not be able to see” This sentence shook me to the core. He
was grateful. Even with everything his body was suffering, all the pain,
all the vomiting, deformity, and the certainty that his days were
numbered, he still chose to be grateful.
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Although gratitude has most often been
conceived of as a discrete emotion, gratitude is
also an affective trait. (McCullough, Emmons, &
Tsang, 2002) The grateful disposition is a
generalized tendency to recognize and respond
with positive emotions to the role of other moral
agents' benevolence. At the dispositional level,
grateful people report higher levels of positive
emotions, life satisfaction, vitality, optimism, and
lower levels of depression and stress (Pozgar,
2013). They also experience relatively low levels
of negative effects such as resentment,
depression, and envy.
Judaism
In Judaism, gratitude is a vital component of worship and
permeates every aspect of the worshipers’ daily life
. Thankfulness for everything is appropriate in
Judaism because all things come from God. In
the Hebrew worldview, the Jewish life is filled
with thankfulness. A prayer is said upon
hearing good or bad news, and God is praised
for everything. In this way, a divine perspective
on life is kept
Christianity
Gratitude has always been central among the
Christian virtues. Being created by a personal God,
Christians are obligated to praise and thank the
source of life. It is argued that gratitude molds and
shapes the entire Christian life, thus being,
inextricably, connected to mental, physical, and
relational well-being. An indebtedness to others
enables followers of Christ to share a common
bond, which shapes not only emotions and
thoughts, but actions and deeds. In Christian
gratitude, God becomes the giver of all good gifts,
the ultimate foundation of thankfulness, gratitude
is a state of well-being and righteousness, these
stem from a profound sense of indebtedness to the
Creator, Sustainer, and Redeemer.
The Holy Koran repeatedly asserts the necessity for gratitude and thankfulness to God
throughout its chapters. For instance, in Sura fourteen, it is written “If you are grateful, I will
give you more” (14:7). A traditional Islamic saying states that, “The first who will be summoned
to paradise are those who have praised God in every circumstance.” The prophet Mohammad
also said “Gratitude for the abundance you have received is the best insurance that the abundance
will continue.” (Fadiman & Frager, 1997) True gratitude, it is taught, brings more abundance
upon the believer.
Islam
Psychological
perspectives on
gratitude
. Virtually ignored in psychology's past, the importance of gratitude for personality and social behavior
has recently been rediscovered. In their analysis of gratitude, McCullough, Kilpatrick, Emmons, and
Larson conceptualize gratitude as having three morally relevant functions, which of a moral barometer, a
moral motivator, and a moral reinforcer. They hypothesized that by experiencing gratitude, a person is
motivated to carry out prosocial behavior, energized to sustain moral behaviors, and is inhibited from
committing destructive interpersonal behaviors. As a moral barometer, gratitude provides individuals with
an affective readout that accompanies the perception that another person has treated them prosocially. As
a moral motive, gratitude stimulates people to behave prosocially after they have been the beneficiaries of
other people's prosocial behavior. As a moral reinforcer, gratitude encourages prosocial behavior by
reinforcing people for their previous prosocial behavior.
Giving Thanks: Spiritual and
Religious Correlates of
Gratitude was published in
2005 in the Journal of
Psychology and Christianity
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This is the first empirical article on gratitude to
appear in a journal of Christian psychology.
Outlines a study done on 199 people. The purpose of the
study, according to the authors, is if there are sufficient
theological and psychological reasons to anticipate that
individuals who are religious report higher levels of
gratitude compared to their less religious counterparts.
They predicted they would observe strong,
positive associations between gratitude and
religion/spirituality. In that spiritual issues
are at the forefront of quality of life
concerns for people with chronic disease,
they employed a unique sample: Adults with
congenital or later-onset neuromuscular
diseases.
• The results of this study suggest one explanation
for why religiously involved people are at a lower
risk for depressive symptoms or other mental
health difficulties
• The authors hope that future research will refine
their understanding of gratitude within a spiritual
and religious frame work and will lead to new and
testable hypotheses concerning religion, emotion,
and psychological well-being.
• The association between gratitude and religion may reflect the fact
that people who are highly religious and/or spiritual tend to
perceive positive circumstances in their lives that are not caused
by human action (e.g., eyesight, a sunny day) as nevertheless
resulting from the intentional behavior of a benevolent moral
agent (i.e., God or a higher power). In contrast, less religious or
spiritual individuals might attribute these same events as due to
chance, and therefore, be less inclined to feel grateful in response.
The Role of Gratitude in
Breast Cancer: Its
Relationships with Posttraumatic Growth,
Psychological Well-Being
and Distress By: Chiara Ruini
and Francesca Vescovelli
-The sample consisted of 70 consecutive women recruited from
the Breast Cancer Center of the Santa Croce Hospital in Loreto
(Italy).
-The findings of this investigation provide confirmation of the
strong association between gratitude and post-traumatic growth
in oncological settings. Indeed, people’s recovery from potentially
traumatic experiences is modulated by the extent to which they
are able to discover some benefit in the experience. Focusing on
these benefits and on the positivity that patients perceive, seems
to be very important for activating growth processes that are
related to a better psychological adaptation to the medical
condition.
The role of gratitude in medical settings remains largely under- investigated, as opposed
to post-traumatic growth, which has increasingly being studied in life-threatening illnesses. This
study hypothesis is that gratitude, conceived as a personality disposition, might be an important
ingredient for PTG and thus associated with a higher well-being and to lower distress also in a
life-threatening illness such as breast cancer. As far as the authors knew, this was the first study
in a breast cancer patient sample that aims to assess the role of gratitude in promoting posttraumatic growth, well-being, and in reducing distress.
• The aims of this study were to: (a) examine the role of gratitude
in a breast cancer sample and its correlations with posttraumatic growth, psychological well-being, and psycho- logical
distress; (b) compare patients reporting higher levels of gratitude
(High Gratitude Individuals, HGI) versus those reporting lower
levels of gratitude (Low Gratitude Individuals, LGI) in the above
measures, in order to determine if dispositional gratitude may
contribute to better mental health indicators.
• The sample consisted of 70 consecutive women recruited from the Breast
Cancer Center of the Santa Croce Hospital in Loreto.
• The findings of this investigation provide confirmation of the
strong association between gratitude and post-traumatic growth
in oncological settings. Indeed, people’s recovery from
potentially traumatic experiences is modulated by the extent to
which they are able to discover some benefit in the experience.
Focusing on these benefits and on the positivity that patients
perceive, seems to be very important for activating growth
processes that are related to a better psychological adaptation to
the medical condition.
• 2012 explores the efficacy of a character strengths and gratitude
intervention to reduce pain and increase positive affect in people with
chronic back pain. The following two questions guided the research: 1)
what is the efficacy of a character strengths and gratitude intervention
significantly improving mood in people with chronic back pain? 2) To
what extent would a character strengths and gratitude intervention
significantly reduce the experience of pain in people with chronic back
pain compared to an alternative positive memories intervention? The
primary intent of the present study was to provide initial indications of
the efficacy of a positive psychology intervention in a sample of people
with chronic back pain.
• Data was collected from eight participants (females = 4). The mean age
was 54.63 (SD = 8.25), ranging from 39 to 67. Participants had lived
with chronic back pain for an average of 8 years (SD = 8.72), ranging
from 1.50 to 27 years, in addition to a number of other concurrent
medical conditions. The initial incidents associated with the onset of
pain were varied.
• Visual examination of the daily ratings reflected in these figures showed that for six of
the eight participants happiness was highest during the character strengths and gratitude
intervention, while anger was lowest for all participants during this condition. No trends
were apparent for anxiety, nor depression. There was a significant difference in anger
ratings between the conditions in favor of the character strengths intervention
(Friedman's test, F (2) = 11.267, p = 0.004). That means anger was lower in the
• The present study showed that the character strengths
and gratitude intervention significantly reduced anger
and improved daily happiness for the majority of
participants. While it was not effective in improving
sadness, anxiety, depression, pain catastrophizing or
pain, a number of factors were not controlled for. These
included medication changes and adherence. Positive
psychology intervention may be effective for people with
chronic back pain.
Dispositional gratitude did not predict burnout and job
satisfaction after controlling for demographic/job
contextual factors and hope. However, when controlling
only for demographic/job contextual factors,
dispositional gratitude predicted personal
accomplishment. Thus, dispositional gratitude may play
a role in the sense of personal accomplishment similar
to that of other positive emotions, such as hope.
Dispositional gratitude is more distal to workplace
attitudes than workplace-specific gratitude, which may
explain why it did not relate to emotional exhaustion
and depersonalization. Also, it is possible to feel
gratitude across a variety of situations but still have a
particular aspect of life (e.g., work) where gratitude is
more difficult to cultivate. These findings highlight the
importance of measuring both dispositional and
situational gratitude, because they may impact different
Prosocial responses to gratitude-operationalized as the distribution of
resources to another-were paired with a self-report measure of
gratitude to test the prosocial effect of gratitude. To investigate
positive mood as an alternative explanation, this experiment
compared responses of individuals receiving a favor to responses of
individuals receiving a positive outcome by chance. A total of 40
participants were randomly assigned to either a Favor or Chance
condition. Participants receiving a favor helped more and reported
more gratitude compared to participants in the Chance condition.
• The current experiment creates a laboratory induction of gratitude
using a larger favor, and includes a control group to compare the
effects of gratitude with those of positive mood. Both behavioral and
self- report measures of gratitude are included. If gratitude motivates
individuals to act prosocially toward their benefactor, then participants
receiving a favor should experience more gratitude and reciprocate
more resources to their partners than participants who receive a
positive outcome by chance.
• Participants were forty undergraduate psychology students at Baylor
University
• The data support the prosocial nature of gratitude. Participants reported being more
motivated by gratitude when they had received a favor, compared to individuals who
had received the same positive outcome by chance. This emotion seemed to translate
itself into different patterns of behavior toward their partner: Participants who
believed they had received a favor from the other participant gave her more money
•
These results also suggest that gratitude may have
unique effects independent of positive mood. If
gratitude's prosocial effect was due solely to the effects
of positive mood, participants who also received a
positive outcome by chance should have given similar
amounts of resources to the other person as did
participants who received the positive outcome as a
favor.
Gratitude as a psychotherapeutic
intervention
• A number of rigorous, controlled experimental trials have examined the
benefits of gratitude. Gratitude has one of the strongest links to mental
health and satisfaction with life of any personality trait—more so than even
optimism, hope, or compassion. Grateful people experience higher levels of
positive emotions such as joy, enthusiasm, love, happiness, and optimism,
and gratitude as a discipline protects us from the destructive impulses of
envy, resentment, greed, and bitterness.
• People who experience gratitude can cope more effectively with everyday stress, show
increased resilience in the face of trauma-induced stress, recover more quickly from illness,
and enjoy more robust physical health. Taken together, these results indicate that gratitude is
incompatible with negative emotions and pathological conditions and that it may even offer
protection against psychiatric disorders.
• A daily gratitude journal-keeping exercise with young adults resulted in higher reported levels
of the positive states of alertness, enthusiasm, determination, attentiveness, and energy
compared with a focus on hassles or a downward social comparison (ways in which
participants thought they were better off than others
• In these studies, participants in the gratitude condition are given the
following instructions: “We want to focus for a moment on benefits or gifts
that you have received in life. These gifts could be simple everyday pleasures,
people in your life, personal strengths or talents, moments of natural beauty,
or gestures of kindness from others. We might not normally think about
these things as gifts, but that is how we want you to think about them. Take
a moment to really savor or relish these gifts, think about their value, and
then write them down every night before going to sleep.”
• Importantly, these data showing that gratitude is correlated
with beneficial outcomes are not limited to self-report. Notably,
the family, friends, partners, and others that surround them
consistently report that people who practice gratitude seem
measurably happier and are more pleasant to be around.
Grateful people are rated by others as more helpful, outgoing,
optimistic, and trustworthy.
• By writing each day, we magnify and expand on these sources
of goodness. Setting aside time on a daily basis to recall
moments of gratitude associated with even mundane or
ordinary events, personal attributes one has, or valued people
one encounters has the potential to weave together a
sustainable life theme of gratefulness just as it nourishes a
fundamentally affirming life stance.
• One of the first steps in gratitude practice is attention.
Attention is noticing and becoming aware of blessings that we
normally take for granted. It is tuning into the many reasons for
gratitude that already exist in our lives.
• The act of writing, of systematically recording blessings,
translates a person’s thoughts into words, and writing has been
shown to have advantages over just thinking the thoughts.
Writing helps to organize thoughts, facilitate integration, and
helps individuals accept their own experiences and put them
• Gratitude practice is systematically paying attention to what is going
right in one’s life, to see the contributions that others make in these
good things, and then expressing gratitude verbally and behaviorally.
Gratitude practice is intentionally shifting your attention from the
negative to the positive and allowing your inner voice to speak that
truth. Gratitude practice is acknowledging that even difficult and
painful moments are our teachers, and we can be grateful for them.
Does gratitude work as a psychotherapeutic
intervention? The evidence to date suggests that it
does. Gratitude is a key, underappreciated quality in
the clinical practice of psychology, its relevance
deriving from its strong, unique, and causal
relationship with well-being, as well as its dynamic
healing influence on the therapist-patient
relationship.
The evaluated research shows gratitude is associated
with happiness and well-being, indicative of an ability
to adapt to life circumstances. Multiple studies have
shown that long-term happiness varies only slightly in
spite of life circumstances and supports the idea that
positive attitudes, forgiveness, and gratitude contribute
to longevity and satisfaction. The study by Emmons and
McCullough investigated the possible links between
gratitude and subjective well- being, the benefits
suggesting that gratitude is a crucial component of
happiness.
Recommendation
The research on gratitude has found over and over that people who remind
themselves every day of the things they are grateful for demonstrate
improved mental and physical health. Further, saying a meaningful "thank
you" and counting your blessings plays a significant role in a person's sense
of wellbeing and happiness. Participants in some of the studies who
exhibited gratitude reported higher levels of alertness, enthusiasm,
determination, optimism, and energy. They also experienced less depression
and stress, and were more likely to help others, exercise more regularly, and
make more progress toward personal goals. The results of these studies
appear to be equally true whether for healthy college students or people with
incurable diseases.
The research, to date, has usually been conducted from a non-spiritual
focus. Moreover, the research is largely focused on correlations, leaving the
direction somewhat unclear. This papers review of the relevant literature
shows that a single, spirituality-oriented research, guided by theory, could
potentially contribute a great deal to the field.
Across time, religious thought, and multiple
cultures, the emotional mechanisms of gratitude
and forgiveness have been viewed as positive and
desirable aspects of society. Yet both are somewhat
difficult to define or categorize.
The evaluated research shows gratitude is
associated with happiness and well-being,
indicative of an ability to adapt to life
circumstances. Multiple studies have shown that
long-term happiness varies only slightly in spite of
life circumstances and supports the idea that
positive attitudes, forgiveness, and gratitude
contribute to longevity and life satisfaction. The
study by Emmons and McCullough investigated the
possible links between gratitude and subjective
well- being, the benefits suggesting that gratitude
is a crucial component of happiness
The literature that has been reviewed shows different people using
gratitude in their lives: the patients with breast cancer, people dealing
with post-traumatic stress disorder, health care workers, and also just
everyday people incorporating gratitude into their day to day lives. All of
the studies showed an increase in measured happiness levels and lower
levels of stress. The most interesting data came in the study of gratitude
as a therapeutic intervention. This study showed that one of the first
steps in gratitude practice is attention. Attention is noticing and
becoming aware of blessings that we normally take for granted. It is
tuning into the many reasons for gratitude that already exist in our lives.
Simultaneously, directing our attention this way in a focused manner
blocks thoughts and perceptions that are contrary to gratitude.
The emerging discoveries support
knowledge of the value of a grateful
disposition. Gratitude connects us to the
kindness of others and intensifies
interpersonal relationships. As we give to
others, we strengthen ourselves. As we
receive from others, we allow them to also
grow. We reap what we sow. Feelings are
very personal and only each person can
determine what is significant for them.
However, when one is conscious and
purposeful in their emotions and their use
of gratitude, they have the power to
influence everyone.