For many decades, behavioral cardiology studied only the impact of so-called “negative traits”—such as stress, depression, and anxiety—on people with cardiovascular disease. The field got its start in the late 1950s with the work of cardiologists Meyer Friedman and Ray Rosenman, who found that “Type A” behavior—characterized by hostility, time urgency, and competitiveness—doubled the risk of coronary heart disease. Over the next five decades, thousands of studies showed that such negative traits are adversely associated with disease and mortality in cardiac patients.
That’s what we’ve been working to understand in our own research, focusing specifically on gratitude—which is, according to U.K. researcher Alex Wood, part of a wider life orientation towards noticing and appreciating the positive aspects of life. Studies to date indicate that feelings of gratitude (or of awe or compassion) facilitate perceptions and cognitions that take people who are ill beyond their illness, helping them to recognize positive aspects of themselves and the people around them in the face of disease. Some studies have noted that cultivating gratitude doesn’t necessarily reduce seeing the negative features of life—people seem to have no trouble seeing the bad stuff—but rather often encourages people to more readily acknowledge the good things in life.
At the Center of Excellence for Research and Training in Integrative Health at the University of California, San Diego, we are finding that expressing gratitude isn’t just good manners. If you’re suffering from cardiovascular disease, gratitude may just help save your life.
Discovering the grateful heart
Asymptomatic heart failure is a condition where the heart has undergone some type of structural damage but the individual has yet to develop any overt symptoms of heart failure itself, including shortness of breath upon exertion or excessive fatigue. In our initial cross-sectional research study with approximately 185 patients, we found that those patients with more dispositional—or “trait”—gratitude sleep better, are less depressed, have less fatigue, have more self-confidence to take care of themselves, and have less systemic inflammation. All of these factors are highly relevant to supporting greater well-being.
This work suggested that grateful people are indeed healthier, as previous studies also suggested. To take this research further, we conducted a statistical analysis to see how spirituality might lead to enhanced well-being by considering the effect of gratitude. We found that gratitude fully or partially accounted for the beneficial effects of spiritual well-being on sleep quality, mood, confidence in self-care, and fatigue. That is, the observed relationships between spiritual well-being and better mood and sleep quality in our patients were in fact due to the specific contributions of gratefulness.
Based on the promising findings of those studies, we conducted a pilot study where we examined the impact of keeping a gratitude journal for two months on patients with heart failure. This was a randomized controlled trial using journaling as a way to cultivate gratitude, with the aim of increasing its presence in the patients’ lives and thus enhancing its potentially beneficial effects on their well-being.
We gave patients journals and instructed them to write daily entries on two or three things that they were grateful for. We found that those patients who engaged in gratitude journaling—and received their usual care—showed reduced markers of inflammation as well as increased heart rate variability (HRV), when compared to patients who received usual care alone. HRV refers to the variation in time interval between heartbeats (influenced by components of the autonomic nervous system), and is considered an important indicator of health. Heart failure is typically characterized by a loss of HRV as the disease progresses.
How does gratitude help the heart?
Our findings so far suggest that gratitude—by facilitating positive evaluations of events—is likely incompatible with the triad of beliefs associated with depression: negative views of the world, of oneself, and about the future. Indeed, gratitude is related to both hedonic well-being—that is, good feelings and life satisfaction—and eudaimonic well-being, characterized by aspects like personal autonomy, purpose in life, positive relations with others, and personal growth. In turn, both hedonic and eudaimonic well-being have been linked to reduced likelihood of stress and depression, as well as better health. It’s therefore possible that gratitude promotes better cardiovascular health in cardiac disease through the enhancement of both hedonic and eudaimonic well-being.
(It is worth noting that while gratitude is considered a positive psychological factor, it is not necessarily good for all people under all circumstances—as with, for example, displaced gratitude under conditions of exploitation.)
What’s next? We are currently in the process of analyzing the patients’ journals in order to explore how the specific things they wrote about relate to the observed benefits. (Thus far, an examination of the journals reveals that patients most commonly expressed their gratitude about family, friends, and the weather.) We are also extending this more traditional line of research by examining how gratitude might lead to human energy changes as measured by the BioWell device, which captures electro-photonic emissions to assess the human energy of different organs and systems. So far, we find that even a brief 10-minute bout of journaling on the topic of gratitude improves the energy profile of the heart and the cardiovascular system at large.
There are many ways to cultivate gratitude. Praying more often has also been found to help people to be more grateful. The simple act of writing down what we’re grateful for, which we used in our research, can increase gratitude. No matter what the form, simply asking each day “What am I grateful for?” can bring awareness and appreciation to the positive features within and around us, helping us to embrace life as it is with all of its imperfections. When gratitude is present in our awareness, everything changes and we can find ourselves transformed. By cultivating gratitude, our research suggests, we cultivate well-being.