The December Countdown—Gratitude for the Gritty Times

Every year, as leaves change color, days shorten, and clocks fall back an hour, the vibe and flow of life have an undeniable shift in gears. The lack of sunshine may at times lead to sadness and discontent.¹ In some ways, it may harken the end of yet another year and perhaps a rise in pace of activities to accomplish the “to-do list” before December 31. It also signals the start of the season of “Out of Office” emails and a renewed discussion on how soon is too soon for Christmas music. In almost all these scenarios, there is an undercurrent of reflection on the year past and planning for the year ahead.

Many have uttered the words “Can’t believe it is already Thanksgiving!” many times over the past years. This year, these words carry more weight: COVID-19 has seemed to dull the sense of time, through the multiple waves, travel restrictions, and hospital visitation rules. But, in the midst of the sense of time simultaneously flying and yet standing still, in this time of reflection, there is also an opportunity for gratitude.

The Merriam-Webster dictionary defines gratitude as a feeling of appreciation and thanks.² This feeling may be expressed for things, actions, people, situations—for anything that is. As a junior-faculty working in a cardiac critical care unit in Texas, I will be the first to admit that gratitude has become somewhat of a buzzword in recent times—alongside wellness, burnout, and resilience, all words generally followed by a link to online training on the topic. But the medical and cardiovascular benefits of gratitude and thankfulness are fascinating and go to show that gratitude can be so much more than a buzzword. Mills et al, in a population of adults with heart failure, showed that gratitude trait was associated with better sleep, less depressed mood, less fatigue, and lower inflammatory biomarker index.³ This group then studied an intervention targeted at increasing cultivation of gratitude through an 8-week gratitude journaling exercise.⁴ In a group of patients with heart failure, those randomized to the gratitude journaling arm not only had higher gratitude trait scores but also lower inflammatory biomarker index. They also found that gratitude may be associated with better medication adherence through a positive impact on self-efficacy.⁵ Among other populations, gratitude has been found to be associated with higher quality of life in patients with advanced cancer and with lower internalizing psychiatric problems in single mothers (during COVID-19).^6,7 Expression of gratitude towards team members is associated with improved workplace engagement and better team performance.^8,9 Amongst caregivers for elderly with chronic medical needs, expression of gratitude by care-receivers to caregivers prior to their illness was associated with less burden felt by the caregiver.¹⁰

It is no wonder that our professional organizations, including the American Academy of Pediatrics, the American Heart Association, and the American College of Cardiology, have recommended the power of gratitude for all—patients, families, and providers, leaders and team-members alike (for we are often in a position to be both).^{11, 12, 13, 14} In a year when everyone is overworked, when hospital staffing shortages seem to have no end in sight, and frustrations about medical misinformation continue to abound—gratitude may not always be the first emotion at hand. But, as we look ahead, in a year that also saw the speedy development of an incredibly safe and effective vaccine for a novel virus, the benefits of gratitude as a tool for improving outcomes and building better teams call to us - to believe.^{15, 16}

References:

1. Melrose S. Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Depress Res Treat. 2015;2015:178564. doi: 10.1155/2015/178564. Epub 2015 Nov 25. PMID: 26688752; PMCID: PMC4673349.
2. https://www.merriam-webster.com/dictionary/gratitude. Accessed November 22, 2021.
3. Mills PJ, Redwine L, Wilson K, Pung MA, Chinh K, Greenberg BH, Lunde O, Maisel A, Raisinghani A, Wood A, Chopra D. The Role of Gratitude in Spiritual Well-being in Asymptomatic Heart Failure Patients. Spiritual Clin Pract (Wash D C ). 2015 Mar;2(1):5-17. doi: 10.1037/scp0000050. PMID: 26203459; PMCID: PMC4507265.
4. Redwine LS, Henry BL, Pung MA, Wilson K, Chinh K, Knight B, Jain S, Rutledge T, Greenberg B, Maisel A, Mills PJ. Pilot Randomized Study of a Gratitude Journaling Intervention on Heart Rate Variability and Inflammatory Biomarkers in Patients With Stage B Heart Failure. Psychosom Med. 2016 Jul-Aug;78(6):667-76. doi: 10.1097/PSY.0000000000000316. PMID: 27187845; PMCID: PMC4927423.
5. Cousin L, Buck H, Benitez B, Mills P, Redwine L. A Structural Equation Model of Gratitude, Self-efficacy, and Medication Adherence in Patients With Stage B Heart Failure. J Cardiovasc Nurs. 2020 Nov/Dec;35(6):E18-E24. doi: 10.1097/JCN.0000000000000721. PMID: 32649372.
6. Tan TT, Tan MP, Lam CL, Loh EC, Capelle DP, Zainuddin SI, Ang BT, Lim MA, Lai NZ, Tung YZ, Yee HA, Ng CG, Ho GF, See MH, Teh MS, Lai LL, Pritam Singh RK, Chai CS, Ng DLC, Tan SB. Mindful gratitude journaling: psychological distress, quality of life and suffering in advanced cancer: a randomised controlled trial. BMJ Support Palliat Care. 2021 Jul 8:bmjspcare-2021-003068. doi: 10.1136/bmjspcare-2021-003068. Epub ahead of print. PMID: 34244182.
7. Taylor ZE, Bailey K, Herrera F, Nair N, Adams A. Strengths of the heart: Stressors, gratitude, and mental health in single mothers during the COVID-19 pandemic. J Fam Psychol. 2021 Nov 4. doi: 10.1037/fam0000928. Epub ahead of print. PMID: 34735179.
8. Komase Y, Watanabe K, Sasaki N, Kawakami N. The Effect of Perceived Gratitude From Others on Work Engagement: A Cross-Sectional Study. J Occup Environ Med. 2021 Sep 1;63(9):e592-e595. doi: 10.1097/JOM.0000000000002294. PMID: 34491968.
9. Riskin A, Bamberger P, Erez A, Riskin-Guez K, Riskin Y, Sela R, Foulk T, Cooper B, Ziv A, Pessach-Gelblum L, Bamberger E. Expressions of Gratitude and Medical Team Performance. Pediatrics. 2019 Apr;143(4):e20182043. doi: 10.1542/peds.2018-2043. Epub 2019 Mar 7. PMID: 30846617.
10. Otobe Y, Suzuki M, Kimura Y, Koyama S, Kojima I, Ichikawa T, Terao Y, Yamada M. Relationship between expression of gratitude by home-based care receivers and caregiver burden among family caregivers. Arch Gerontol Geriatr. 2021 Nov-Dec;97:104507. doi: 10.1016/j.archger.2021.104507. Epub 2021 Aug 19. PMID: 34461428.
11. Munshi D. How to Practice Gratitude & Improve Your Family’s Mental Health. https://www.healthychildren.org/English/healthy-living/emotional-wellness/Building-Resilience/Pages/how-to-practice-gratitude.aspx
12. Serwint JR. How Expressing Gratitude can Lead to Positive Changes. https://publications.aap.org/aapnews/news/16721?autologincheck=redirected.
13. The Grateful Leader. https://www.acc.org/about-acc/leadership/features/bog/2015/11/1120
14. Thankfulness: How Gratitude Can Help Your Health. https://www.heart.org/en/healthy-living/healthy-lifestyle/mental-health-and-wellbeing/thankfulness-how-gratitude-can-help-your-health
15. https://www.psychologytoday.com/us/basics/gratitude
16. Giving thanks can make you happier - https://www.health.harvard.edu/healthbeat/giving-thanks-can-make-you-happier