The Science of Gratitude: How It Improves Your Health

David Fawcett, Ph.D., LCSW

The holiday season elicits plentiful although sometimes superficial expressions of gratitude, the appreciation of the positive aspects in life. But gratitude is not just a nice idea. When incorporated into daily routines, it can impact people's physical and emotional life in very meaningful ways. Gratitude has been documented to increase one's sense of wellbeing through stirring more positive emotions; feeling more alert and awake; and experiencing more joy, pleasure, optimism, and happiness. The practice of gratitude has physical benefits, as well, strengthening the immune system; improving sleep; and reducing pain, blood pressure, and even A1C, a measure of blood glucose.

HIV and other health challenges can complicate embracing gratitude, but the ability to identify blessings in one's life has real power. Practicing gratitude doesn't deny the very real issues that face every person living with HIV, but encourages the willingness to identify those things for which we can be grateful.

The benefits of gratitude have been described in numerous clinical settings. In one study of persons with neuromuscular disease, individuals randomly assigned to a "gratitude-outlook group" (incorporating a regular gratitude practice) exhibited heightened wellbeing, especially in their ability to maintain positive moods despite their medical condition. While the physiological mechanisms are not entirely understood, gratitude clearly plays a role in reducing stress and resulting inflammation. Furthermore, positive emotions such as gratitude have been shown to impact immune activity directly via endocrine and behavioral processes. One study documented associations between positive affectivity (traits such as gratitude, enthusiasm, and energy) and lower morbidity and decreased symptoms of pain.

Those living with HIV can benefit, as well. Gratitude and a positive affect have been shown to improve psychological health for both those newly diagnosed with HIV and long-term survivors. In a study of 159 individuals diagnosed with HIV within the prior three months, a five-session, in-person intervention that taught positive affect skills significantly improved psychological health. This could lead to further interventions that support adjustment to a new HIV diagnosis.

A 17-year longitudinal study of people living with HIV/AIDS found that, even after controlling for health behaviors (medication adherence and substance use), so-called spiritual (not religious) coping strategies, including practicing gratitude, clearly predicted greater survival. Remarkably, the study found that people using these strategies were two to four times more likely to survive.

Related: Our Own Worst Enemy: Putting a Lid on Negative Self-Talk

Developing a Gratitude Practice

Many people living with HIV, each of whose lives has been touched by some degree of negativity (and often tragedy), find it difficult, at least initially, to embrace the idea of gratitude. They might be unable to identify anything for which they can be grateful. They might feel like a victim or have righteous indignation toward others or the drugs or behavior that led to losses in their lives. While these strong feelings should certainly be expressed and processed, real health benefits derive from consciously incorporating gratitude into daily, self-care practices. One of the more effective ways to do this is to maintain a gratitude journal. Richard Emmons has proposed some guidelines for keeping such a journal. Here are his tips:

• Don't just go through the motions: Give a few minutes of quiet thought to this process. Setting a conscious intention to become happier and grateful plays a role in the effectiveness of gratitude journaling. Such an intention can be as simple as saying, "I am open to feeling more happiness and gratitude in my life."
• Go deeper with fewer items: It can become easy to simply create a quick gratitude list including numerous things. Many people have found it useful to limit their daily gratitude list to fewer items and, for what is listed, elaborate in greater detail how those things have benefitted their lives. This not only deepens appreciation of these specifics but also enhances the overall health benefits of the gratitude journal process.
• Imagine what your life would be like in other circumstances: Sometimes it is easier to gain perspective by considering what your life would be like without certain blessings. Most of us have survived through a combination of the help of other people, our own commitment to our health, and random events or circumstances. Be aware how your life might look without the positive impact of certain people, places, or things.
• Don't overdo it: It is common to jump enthusiastically into something new with exaggerated expectations and enthusiasm, persist for a few days (or hours), and then become overwhelmed and give up. Try journaling once or twice per week instead of every day, which in the long run will be more beneficial and effective than daily entries.

In addition to journaling, many practices foster positive moods and create better physical and psychological health outcomes. These include mindfulness, connecting with nature, learning to observe our own thoughts, and being vigilant to the dance between both the positive and negative energies in our lives.

Keep the following guidelines in mind as you experiment to find the gratitude practices that work best for you:

• Slow down and appreciate the present moment: Each of us, especially during the busy and (sometimes) emotionally wrought holiday season, frequently gets pulled into thinking about the past or worrying about the future. Step out of your busy-ness to savor the gifts in your life today, focusing on positive things in the present moment.
• Honor the special people in your life: Identifying and appreciating the people in your life for whom you are grateful has a greater impact than naming things or events. Think about who those people are, the qualities they share, and the gifts you have received from them. If possible, you might consider letting them know how they have impacted your life.
• Consider revisiting your "life story": Most of us living with HIV (especially long-term survivors) can easily identify how the virus hijacked our lives and significantly altered our health and our futures. It is easy to become trapped in a narrative that highlights everything that has gone wrong. Over time, it becomes increasingly difficult to identify positive aspects of our lives (this is called a negativity bias or the negativity effect). Getting stuck in that psychological space is not only emotionally painful and unsatisfying but also harmful to our health.

Practicing gratitude does not mean denying the bad and even terrible things that have happened to us. However, for our very survival, it is necessary to notice and acknowledge the positive, life-affirming forces that are all around us, as well.

David Fawcett, Ph.D., L.C.S.W., is a substance abuse expert, certified sex therapist and clinical hypnotherapist in private practice in Ft. Lauderdale, Florida. He is the author of Lust, Men and Meth: A Gay Man's Guide to Sex and Recovery.