gratitude

The Role of Gratitude in Improving Mental Health 

Focusing on the Good 

Gratitude has its foundational roots in the humanities, from ancient philosophical studies, to religious conceptualizations, and evolutionary theories. Though gratitude has traditionally been understood and studied in this way, novel insights, questions, and understandings are being developed under the lens of contemporary scientific research today. In the past few decades gratitude has been studied in increasingly precise contexts, from early childhood education, to prosocial behavior in the workplace and potential for chronic disease treatment. Nevertheless, gratitude is still quite difficult to define. Is it an emotion, a virtue or a behavior? The APA gives a general description of gratitude as part of a wider outlook on life that involves noticing and appreciating the positive aspects of life.[1] Though there are many conceptualizations of gratitude, Emmons & McCullough (2003) defined gratitude in two parts: 1) recognizing that one has obtained a positive outcome and 2) recognizing that there is an external source for this positive outcome.[2]

In general, gratitude has been shown to present a plethora of benefits for one’s mental and physical health. It may foster a more positive mood, induce better sleep, and even lower disease markers and inflammation in the body.[3] Additionally, depressive symptoms, substance abuse, anxiety, chronic pain, and risk of disease may be lowered with the implementation of daily gratitude practices.[4] Cultivating feelings of gratitude through practices of mindfulness and daily journaling can fortify relationships with others as well as increase empathy and prosocial behavior. Overall, expressions and practices of gratitude have been extensively studied for its ability to increase well-being, longevity, and happiness. 

The origins of gratitude 

Though gratitude has often been thought of as merely an intuitive emotion or feeling, there have been key developments in various fields that have led to our increased understanding of gratitude and the ways it can be qualitatively and quantitatively measured. 

Evolutionary

The questions surrounding gratitude and its origins can be traced back centuries to evolutionist Darwin. In The Descent of Man (1871), he offers the possibility that humans and other animals share collective emotions, “even the more complex ones such as jealousy, suspicion, emulation, gratitude, and magnanimity.”[5] With this, gratitude may have played a unique role in human social evolution. It has been posited that gratitude is an adaptation for what Robert Trivers first coined as “Reciprocal Altruism” in 1971, or the sequential exchange of costly benefits between non relatives.[6] This is supported by a series of studies by prominent gratitude researchers Mccullough et al. (2008) which explain that a positive feeling of gratitude can alert us to the benefits we’ve received from others and inspire us to show appreciation, which will in turn make others more likely to help us again in the future.[7] The evolutionary advantage is that we become more interconnected and collectively stronger as a society, as strangers become friends and new allyships are created. 

Neurobiological

There have also been more recent studies which incorporate systematic ways of studying and measuring the biological origins of gratitude. In one key fMRI based study by Fox et al. (2015), higher ratings of gratitude correlated with increased brain activity in participants’ anterior cingulate cortex and medial prefrontal cortex. Activity in these regions has been linked to moral cognitive processes, social reward and interpersonal bonding, as well as emotion perception and theory of mind. Previously, it was unknown how the brain generated the range of feelings associated with gratitude; however, this study provides a window into gratitudes origins, as well as its relationship to mental health and resilience.[8]   

Factors that contribute to gratitude

Multiple studies have honed in on certain individual factors that may contribute to increased or decreased expressions of gratitude including personality, cognitive factors, and gender. 

  1. Personality Traits: Recently, Szcześniak et al. (2020) studied the interaction among personality traits, emotional intelligence, and a grateful disposition. They found that both gratitude and emotional intelligence correlated positively and significantly with extraversion, openness to experience, agreeableness, and conscientiousness. Conversely, gratitude and emotional intelligence correlated negatively and significantly with neuroticism.[9]

  2. Cognitive Factors: Certain cognitive factors may also influence the amount of gratitude one feels in a particular situation. Some examples include the perceived intention of the benefactor, the apparent cost to the benefactor, or the value of the gift which vary based on the situation.[10] This differs based on personal experience and background, perception of the situation, and even some larger cultural norms.   

  3. Gender: In particular, Kashdan et al. (2009) hypothesized that women possess an advantage over men in experiencing and benefiting from gratitude. In this comparative study of reaction to gift appraisals, women viewed gratitude expression to be exciting and interesting while men were less likely to feel and express gratitude, made more critical evaluations of gratitude, and derived fewer benefits.[11]   

Along with the numerous individual factors which show variance in either lending to or inhibiting expressions of gratitude, there is also a wider discussion on gratitude as it relates to the complex interplay of religion, culture, and social norms. 

  1. Religion: Gratitude has often been associated with and studied in conjunction with religion and spirituality. Specifically looking at the United States, a study by Krause (2009) found that more frequent church attendance and stronger God-mediated control beliefs are associated with positive changes in gratitude over time.[12] In accordance with these findings, a more generalized study of intergroup differences conducted by Ferenczi et al. (2021) examined religiousness, gratitude, and well-being over time and found that religiousness is linked to higher gratitude and moreover, an increase in gratitude can result in an increase in subjective well-being.[13] 

  2. Culture: Cross cultural research often looks at the difference between individualist and collectivist cultures in the context of behavior, values, practices, and more. Srirangarajan et al. (2020) found evidence that across East Asian and Western cultures, being grateful generally seems to have a similar relationship with a wide variety of psychological variables including but not limited to life-satisfaction, stress and social anxiety, and anger.[14] Another more recent study carried out by Freitas et al. (2022) sampled a participant pool with diverse cultural backgrounds ranging from countries such as China, Brazil, Russia, and Turkey to investigate gratitude as a moral virtue. The main findings indicated that despite the broad array of cultures represented, gratitude as a virtue develops during childhood and is influenced by one's cultural group.[15] 

  3. Parenting Style: As gratitude has been shown to have developmental roots, parenting styles and gratitude in children has also been examined. Obeldobel & Kerns (2021) conducted a literature review that showed how children’s gratitude was higher when parents modeled gratitude, there was a more secure parent–child attachment, and parents employed more supportive, autonomy granting, and warm parenting styles. These findings align with attachment theory, social learning and emotion socialization theories, and the find-remind-and-bind theory.[16] 

Individual Benefits 

Researchers have been interested in gratitude particularly in regard to its potential for improving one’s mental and emotional health for decades. Many key mechanisms and rationales for significant findings have been identified and discussed throughout the existing literature. More recent studies, though, have also begun to incorporate physical health and well-being into experimental design. 

  1. Improving Physical Health: UCLA Health notes that gratitude supports heart health through the improvement of depression symptoms, increased sleep, improved diet and more frequent exercise - which all reduce the risk of heart disease.[17] Additionally, several studies show that a grateful mindset positively affects biomarkers associated with the risk for heart disease. One recent study by Jans-Beken et al. (2021) sought to provide an updated overview of the literature on the connection of gratitude to human health, specifically focusing on experimental study findings. The researchers state that gratitude interventions appear to positively affect a number of cardiovascular and inflammatory parameters, (e.g., a decrease in diastolic blood pressure with daily gratitude journaling) as well as improving sleep quality.[18] In addition, not only has gratitude journaling been shown to lessen depressive symptoms related to chronic illness, but has been shown to lessen inflammatory chronic disease biomarkers such as HbA1c (which is involved in blood sugar control). This is especially important given that high levels of HbA1c have been associated with chronic kidney disease, a number of cancers, and diabetes.[19] 

  2. Improving Well-being: In addition to the evidence of improvements to physical health, many more studies support the idea that a grateful disposition is associated with greater life satisfaction, optimism, subjective well-being, positive affect, and overall happiness.[20] Some mechanisms by which gratitude can positively intervene in one’s life to improve general well-being include counteracting materialism and protecting against burnout. Specifically looking at student culture, Tsang et al. (2014) found that undergraduate students reported less life satisfaction, which could be explained by their lowered levels of gratitude. The study concluded that gratitude played an important mediating role for the negative relationship between materialism and life satisfaction. Grateful people may be less materialistic because they feel more satisfied with their lives - and thus, don’t feel much of a need to acquire new things in order to feel more satisfied.[21] 

  3. Treating Mental Illness: While there is clearly strong evidence for gratitude’s role in improving both mental and physical health, several more studies are concentrating on gratitude interventions for specific psychological challenges and the related mechanisms by which these may elicit significant positive changes. 

    Through various meta-analysis and literature review studies, it is now commonly accepted that gratitude can play a key role in improving depressive symptoms. One recent development, though, comes from a study carried out by Tomczyk et al. (2022), examining gratitude and acceptance of illness for women who were at risk for clinical depression. They identified that women with elevated depressive symptoms who were more grateful (compared to those who were less grateful) were more accepting of their condition, which was related to increased well-being and decreased feelings of depression and anxiety.[22] 

    Gratitude can help promote long-term recovery from substance misuse. In particular, the Narcotic Anonymous (NA) program has adopted gratitude as a key component of recovery and urges members to practice gratitude on a daily basis on their journey toward successful recovery.[23] 

    Several more studies have been conducted under the topic of gratitude’s effect on mitigating stress and anxiety disorders, PTSD, and suicidal ideation. For example, Vieselmeyer et al. (2017) looked at the role that gratitude and resilience played in post-traumatic stress. Particularly relevant to contemporary events and the dramatic increase in the prevalence of community trauma like school shootings, these researchers found that people with high trait gratitude four months following the 2014 Seattle Pacific University shooting showed a stronger relationship between post-traumatic stress and post-traumatic growth, implying that very grateful people are also more resilient and willing to adopt a growth mindset post-trauma.[24] Another study by Li et al. (2015) examined the relationship between suicide ideation and gratitude, finding that the odds of suicidal ideation and suicide attempts were lower among adolescents who scored higher on gratitude, and furthermore, these results were mediated by both prevalence of stressful life events and self-esteem.[25]

    Perhaps one of the most widely studied and supported topics related to mental health and gratitude, though, is its effect on stress and depression. A comprehensive study by Wood et al. 2008 examined the direction of the relationships between trait gratitude, perceived social support, stress, and depression during a life transition. The key findings from this study is that gratitude seems to directly foster social support, and to protect people from stress and depression, which has major implications for clinical interventions.[26] 

  4. Child/Adolescent Health: The Anxiety and Depression Association of America outlines the mental health benefits of gratitude for kids and teens including improving mood, increasing social connection, reducing suicide risk, and improving sleep. Many of the existing studies on child/adolescent gratitude and mental health examine a specific type of intervention (e.g., gratitude journaling) and its longitudinal effects. For example, one study by Tara et al. (2016) sought out to promote positive psychology evidence-based interventions for use in schools. They found that students who completed the gratitude intervention demonstrated enhanced school belonging and gratitude relative to the control group. Thus, a link was established between gratitude, sense of belonging and well-being for school-aged children.[27] The generalizability of this result, however, may not be definitive. In one gratitude article featured in the Journal of Positive Psychology, Hussong et al. (2018) states that children and adolescents often display wider variance in ways of expressing gratitude. In other words, there are different aspects of gratitude moments (i.e., awareness, thoughts, feelings, and actions) and the way that these facets appear in children.[28]

Social Benefits

A major implication of gratitude is in its social benefits. Studies have looked at how gratitude improves relationships between individuals, enhances productivity in the workplace, boosts well-being among students, and stimulates more helping behavior within collective spaces. Especially relevant to the demanding and highly stressful work environment of healthcare since the Covid-19 pandemic, Kersten et al. (2021) was motivated to investigate the effect of gratitude in mitigating and alleviating the effects of burnout in the workplace. They carried out a study, surveying an international sample of employees, showing a clear negative relationship between work-specific gratitude and disengagement, mediated by Interpersonal Helping Behavior (IHB).[29] 

Similarly, other studies have been interested in the relationship between gratitude and prosocial behavior. Prosocial behavior refers to a range of positive behaviors including positive interactions (e.g., friendly play or peaceful conflict resolutions), altruism (e.g., sharing, offering help), and behaviors that reduce stereotypes.[30]

Zhang (2022) was able to identify a positive relationship between gratitude and adolescents’ prosocial behavior as well as further clarify the mechanism by which the effect operates. Two factors in particular were identified as important to cultivating greater prosocial behavior: the sense of meaning in life and self-esteem. Researchers rationalized that the sense of meaning in life generally refers to an awareness of life goals, tasks, and missions, and hence is intertwined with positive physical and mental health, improved mood, and life satisfaction to promote gratitude and prosocial behavior. Moreover, higher self-esteem is recognized as a key factor in adolescents being more attuned to the behavior of others to then form a positive cognition of themself and others.[31]

Gratitude interventions 

It’s clear that gratitude has been conceptualized in many different ways throughout history and utilized within various disciplines and subfields of psychological study. Because of its applicability, gratitude is extremely well-studied and universally accepted as an intervention which can aid mental health struggles and increase life-satisfaction. From maintaining and improving relationships, fostering a more secure sense of self and well-being, as well as being more attuned to others around us, gratitude is an economical, effective, and comprehensive intervention. What are some ways, then, to cultivate a gratitude practice? 

  1. Noting the Positive: One relatively simple practice is “counting blessings” or gratitude journaling (e.g., writing down things one is grateful for either daily or weekly). Another gratitude practice under the same paradigm as journaling is,“mental subtraction.” This activity involves imagining what life would be like if a positive event had not occurred and has been shown to greatly improve mood.[32] 

  2. Mindfulness: According to Ochsner Health, mindfulness is defined as paying attention, on purpose, in the present moment, non-judgmentally. To practice mindfulness is simply to invite yourself to where you already are and to experience and acknowledge that moment without judgment or expectation.[33] Mindfulness has been shown to bring emotional regulation, steady attention, and physical healing over the past few decades with the emergence of modern neuroscience and numerous evidence-based studies.[34] While gratitude is central to happiness, mindfulness can help us cultivate it as it enables us to be present with the feelings and sensations of goodness in our life. Like gratitude, mindfulness is a practice which can be practiced daily and refined over time. 

  3. Acceptance and Commitment Therapy (ACT): This psychotherapeutic intervention integrates the principles of both acceptance and mindfulness in order to increase flexibility in thinking and outcomes. In addition, this therapy hones in on defusion, engagement with emotions, articulation of life values, self-compassion, mindful gratitude, and stepwise movement in accord with one’s life values.[35] An article from positivepsychology.com states “gratitude is about feeling the right way, about the right things, and at the right time. It is inseparably linked with self-discipline and motivation.” Commitment to action and mindful behavior are both tenets of ACT and will also contribute to a stronger, more consistent gratitude practice.[36] 

Though both mindfulness and ACT are well studied and relatively easy to implement in daily life, there are some factors and limitations that have hindered one’s willingness to adopt practices and express gratitude. These include narcissism, gratitude turning into indebtedness or obligation, and cultural differences and cultural contexts which all affect the way we may experience and perceive gratitude. Generally though, gratitude has been posited as social glue which fortifies relationships. At its most effective, gratitude interventions have been shown to elicit positive changes behaviorally, mentally, and physically. It provides a wealth of benefits to those who commit to this principle as a daily practice and lens through which to view life rather than a short term solution. 

If you or someone you know would like to learn more about how to incorporate gratitude in daily life, learn about mindfulness and ACT, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for additional guidance and support.  

Contributed by: Kaylin Ong

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

1 American Psychological Association. (2015, April 9). A grateful heart is a healthier heart [Press release]. https://www.apa.org/news/press/releases/2015/04/grateful-heart 

2 Emmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377–389. https://doi.org/10.1037/0022-3514.84.2.377 

3 APA (2015) 

4 American Psychological Association. (2012, August 5). Growing up grateful gives teens multiple mental health benefits, new research shows [Press release]. https://www.apa.org/news/press/releases/2012/08/health-benefits 

5 Trivers, R. L. (1971). The Evolution of Reciprocal Altruism. The Quarterly Review of Biology, 46(1), 35–57. http://www.jstor.org/stable/2822435 

6 McCullough, M. E., Kimeldorf, M. B., & Cohen, A. D. (2008). An Adaptation for Altruism: The Social Causes, Social Effects, and Social Evolution of Gratitude. Current Directions in Psychological Science, 17(4), 281–285. https://doi.org/10.1111/j.1467-8721.2008.00590.x

7 Suchak, M. (2017, February 1). The Evolution of Gratitude [Review of The Evolution of Gratitude]. Greater Good Magazine. https://greatergood.berkeley.edu/article/item/the_evolution_of_gratitude 

8 Fox, G. R., Kaplan, J., Damasio, H., & Damasio, A. (2015). Neural correlates of gratitude. Frontiers in psychology, 6, 1491. https://doi.org/10.3389/fpsyg.2015.01491 

9 Szcześniak, M., Rodzeń, W., Malinowska, A., & Kroplewski, Z. (2020). Big Five Personality Traits and Gratitude: The Role of Emotional Intelligence. Psychology Research and Behavior Management, Volume 13, 977–988. https://doi.org/10.2147/prbm.s268643 

10 Allen, S. (2018). The Science of Gratitude. https://ggsc.berkeley.edu/images/uploads/GGSC-JTF_White_Paper-Gratitude-FINAL.pdf?_ga=2.82610261.2142947331.1637096170-1362583773.1634590861 

11 Kashdan, T. B., Mishra, A., Breen, W. E., & Froh, J. J. (2009). Gender Differences in Gratitude: Examining Appraisals, Narratives, the Willingness to Express Emotions, and Changes in Psychological Needs. Journal of Personality, 77(3), 691–730. https://doi.org/10.1111/j.1467-6494.2009.00562.x 

12 Krause, N. (2009). Religious Involvement, Gratitude, and Change in Depressive Symptoms Over Time. International Journal for the Psychology of Religion, 19(3), 155–172. https://doi.org/10.1080/10508610902880204 

13 Ferenczi, A., Tanyi, Z., Mirnics, Z., Kovács, D., Mészáros, V., Hübner, A., & Kövi, Z. (2021). Gratitude, Religiousness and Well-Being. Psychiatria Danubina, 33(Suppl 4), 827–832.https://pubmed.ncbi.nlm.nih.gov/35026809/ 

14 Srirangarajan, T., Oshio, A., Yamaguchi, A., & Akutsu, S. (2020). Cross-Cultural Nomological Network of Gratitude: Findings From Midlife in the United States (MIDUS) and Japan (MIDJA). Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.00571 

15 Freitas, L. B. L., Palhares, F., Cao, H., Liang, Y., Zhou, N., Mokrova, I. L., Lee, S., Payir, A., Kiang, L., Mendonça, S. E., Merçon-Vargas, E. A., O’Brien, L., & Tudge, J. R. H. (2022). How weird is the development of children’s gratitude in the United States? Cross-cultural comparisons. Developmental Psychology. https://doi.org/10.1037/dev0001383 

16 Obeldobel, C. A., & Kerns, K. A. (2021). A literature review of gratitude, parent–child relationships, and well-being in children. Developmental Review, 61, 100948. https://doi.org/10.1016/j.dr.2021.100948 

17 Health benefits of Gratitude. UCLA Health System. (n.d.). https://www.uclahealth.org/news/health-benefits-gratitude   

18 Jans-Beken, L., Jacobs, N., Janssens, M., Peeters, S., Reijnders, J., Lechner, L., & Lataster, J. (2019). Gratitude and health: An updated review. The Journal of Positive Psychology, 15(6), 1–40. https://doi.org/10.1080/17439760.2019.1651888 

19 Allen, S. (2018). The Science of Gratitude. https://ggsc.berkeley.edu/images/uploads/GGSC-JTF_White_Paper-Gratitude-FINAL.pdf?_ga=2.82610261.2142947331.1637096170-1362583773.1634590861 

20 Ibid. 

21 Tsang, J.-A., Carpenter, T. P., Roberts, J. A., Frisch, M. B., & Carlisle, R. D. (2014). Why are materialists less happy? The role of gratitude and need satisfaction in the relationship between materialism and life satisfaction. Personality and Individual Differences, 64, 62–66. https://doi.org/10.1016/j.paid.2014.02.009 

22 Tomczyk, J., Nezlek, J. B., & Krejtz, I. (2022). Gratitude Can Help Women At-Risk for Depression Accept Their Depressive Symptoms, Which Leads to Improved Mental Health. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.878819 

23 Chen, G. (2016). Does gratitude promote recovery from substance misuse? Addiction Research & Theory, 25(2), 121–128. https://doi.org/10.1080/16066359.2016.1212337 

24 Vieselmeyer, J., Holguin, J., & Mezulis, A. (2017). The role of resilience and gratitude in posttraumatic stress and growth following a campus shooting. Psychological Trauma: Theory, Research, Practice, and Policy, 9(1), 62–69. https://doi.org/10.1037/tra0000149 

25 Li, D., Zhang, W., Li, X., Li, N., & Ye, B. (2012). Gratitude and suicidal ideation and suicide attempts among Chinese Adolescents: Direct, mediated, and moderated effects. Journal of Adolescence, 35(1), 55–66. https://doi.org/10.1016/j.adolescence.2011.06.005 

26 Wood, A. M., Maltby, J., Gillett, R., Linley, P. A., & Joseph, S. (2008). The role of gratitude in the development of social support, stress, and depression: Two longitudinal studies. Journal of Research in Personality, 42(4), 854–871. https://doi.org/10.1016/j.jrp.2007.11.003 

27 Diebel, T., Woodcock, C., Cooper, C., & Brignell, C. (2016). Establishing the effectiveness of a gratitude diary intervention on children’s sense of school belonging. Educational and Child Psychology, 33(2), 117–129. https://doi.org/10.53841/bpsecp.2016.33.2.117 

28 Hussong, A. M., Langley, H. A., Thomas, T. E., Coffman, J. L., Halberstadt, A. G., Costanzo, P. R., & Rothenberg, W. A. (2018). Measuring gratitude in children. The Journal of Positive Psychology, 14(5), 563–575. https://doi.org/10.1080/17439760.2018.1497692 

29 Kersten, A., van Woerkom, M., Kooij, D. T. A. M., & Bauwens, R. (2021). Paying Gratitude Forward at Work. Journal of Personnel Psychology. https://doi.org/10.1027/1866-5888/a000296

30 Wright, J. D. (2015). International Encyclopedia of the Social & Behavioral Sciences |ScienceDirect. Sciencedirect.com. https://www.sciencedirect.com/referencework/9780080970875/international-encyclopedia-of-the-social-and-behavioral-sciences 

31 Zhang, D. (2022). The relationship between gratitude and adolescents’ prosocial behavior: A moderated mediation model. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.1024312 

32 Allen (2018) 

33 How Mindfulness and Gratitude Can Improve Your Well-Being | Ochsner Health. Ochsner Health System. https://blog.ochsner.org/articles/giving-thanks-how-mindfulness-and-gratitude-can-improve-your-well-being 

34 Gregoire, C. (2014, March 19). Mind and Body: Jack Kornfield on Gratitude and Mindfulness [Review of Mind and Body: Jack Kornfield on Gratitude and Mindfulness]. Greater Good Magazine. https://greatergood.berkeley.edu/article/item/jack_kornfield_on_gratitude_and_mindfulness 

35 Fradkin, C. (2017). Janina Scarlet: Superhero Therapy: A Hero’s Journey Through Acceptance and Commitment Therapy. Journal of Youth and Adolescence, 46(7), 1629–1632. https://doi.org/10.1007/s10964-017-0658-8 

36 The Neuroscience of Gratitude and How It Affects Anxiety & Grief. (2019, April 9). PositivePsychology.com. https://positivepsychology.com/neuroscience-of-gratitude/#brain-changes