Health Effects of a Thankful Attitude and Practical Tips for Being Grateful

Health Effects of Gratitude

As many in the United States are celebrating Thanksgiving today, I began to reflect on how being thankful might play a role in improving health. Can an attitude of gratitude help one enjoy a healthier lifestyle? How might we incorporate being grateful into our daily lives?

Study Results Looking at the Benefits of Gratitude

Numerous studies have found that being grateful may improve one's health. If people choose to be thankful, they may enjoy more positive emotions, improve approaches to adversity, and build better relationships. Gratitude may create an environment in which we become better connected to other people, nature, or experience a more meaningful spiritual relationship with a higher power.

A study by Dr. Emmons and Dr. McCullough at the University of Miami divided participants into three different groups. Each group was directed to write a few sentences each week regarding events that had happened that week: one wrote about things for which they were grateful, another about the week's irritations, and the third about events without a directive to remain positive or negative. Results of the study found that the group that focused on being grateful enjoyed a more optimistic attitude and tended to feel better about their lives. The thankful group also exercised more and enjoyed fewer doctor visits than the group that focused on aggravations.

Additional studies found similar positive results related to adopting a thankful attitude. People who take the time to give thanks may also eat a healthier diet and seek regular physical examinations. They may have better methods of coping with stress and may tend to be more optimistic. Optimism is associated with improved immune function.

Dr. Seligman of the University of Pennsylvania led a study in which subjects were instructed to write and personally deliver a thank you note to someone whom had never been properly thanked for a kindness. Happiness scores were significantly higher for the thankful group when compared to the control group with resulting positive effects lasting a month.

Studies looking at relationships found that couples who consciously express gratefulness for one's partner felt more positive about him or her. Interestingly, those same people also felt more comfortable expressing concerns about the relationship, perhaps leading to a deeper, more genuine connection.

University students who had trouble falling asleep because they were bombarded with thoughts before bedtime found that a daily gratitude intervention helped them to quiet their minds and sleep better. Those interventions were administered via email.

One study looked at subjects who had heart failure without symptoms. Results indicated that gratitude and spiritual well-being were associated with better mood, better sleep, and less fatigue. Subjects who reported gratitude and spiritual well-being also tended to have stronger beliefs in their ability to complete tasks and reach goals.

Another study at the University of Pennsylvania looked at work relationships. Both study groups were asked to solicit donations from alumni. The director of the campaign specifically told one group that she was grateful for all of their efforts before starting the campaign. The group that was thanked made 50% more calls than the group that did not receive the pep talk, indicating that employees who are thanked may work harder than those who are simply expected to work without any recognition.

Perhaps one important concept to becoming more grateful is to turn one's attention from self, which may lead to feelings of despair and depression as a response to challenging life circumstances, to focusing on others, which may lead to feelings of hope. As we begin to share our feelings of gratitude for what others have done for us, others might also express thankfulness for something we have done. Perhaps being grateful is a win-win situation.

Tips for Living a Thankful Life

Thank others

• Write thank you notes. Taking the time and effort to write a personal note, get a stamp, and mail it may make the thank you more meaningful.
• Thank people in person or on the phone. Be sincere.
• Begin to notice all the things we might take for granted and give specific credit to those people who are instrumental in helping us - this might be things the person currently does or things he or she did in the past.

Utilize additional ways to express thankfulness

• Write a journal of thankfulness. The journal does not have to be fancy - a small notebook or computer document will suffice. A few sentences each week might be associated with positive benefits lasting longer than a week. If you have trouble sleeping due to racing thoughts, try writing an entry in your gratefulness journal each night before bedtime.
• Draw a thankfulness picture, using an art style that appeals to you.
• Write poems about being thankful. Explore different poem styles.
• Sing songs that focus on being thankful.
• Write things for which you are thankful on pieces of paper and place them in a box or jar. You might refer to these during tough times or review them on a regular basis, perhaps at the end of a season or year.

Mentally give thanks

• Offer specific prayers of thanks.
• Incorporate a mindset of looking at the present moment in order to discover something for which we are thankful, incorporating various senses and remembering past blessings during those times when being thankful does not come naturally.

Additional Articles

• A Healthier Lifestyle One Day at a Time: A Positive Attitude
• Words of Encouragement for People who Struggle with Weight
• How to Get Motivated to Exercise: Internal and External Personality Types

Sources

• Digdon, N. and Koble, A. (2011), Effects of Constructive Worry, Imagery Distraction, and Gratitude Interventions on Sleep Quality: A Pilot Trial. Applied Psychology: Health and Well-Being, 3: 193–206. doi: 10.1111/j.1758-0854.2011.01049.x
• Heubeck, Elizabeth, Boost Your Health With a Dose of Gratitude, WebMD article accessed on 11/26/2015.
• Miller, Michael Craig MD, The Mental Health Benefits of Gratitude, Harvard Commentaries on Health (Aug 2013).
• Mills, Paul J. et. al., The Role of Gratitude in Well-being in Asymptomatic Heart Failure Patients, Integrative Medicine 14.1 (Feb/March 2015): 51.

End of Life Issues

End of Life Issues - Photo by ariadna

Most of the posts in my Fit Tips 4 Life blog include quite a few articles from evidence-based sources. For this article, I will lean heavily on my own experience as a bone marrow transplant nurse for nearly 18 years and my more recent experience as a Faith Community Nurse as well as personal experiences of family and friends.

One of my friends posted a message on Facebook about a highly publicized case in which a woman who was diagnosed with a terminal illness chose to end her own life. My friend's post asked friends to give their own opinions about that choice, and it generated quite a bit of meaningful, helpful, and lively conversation. I'd like to share some points that stemmed from that conversation regarding end of life issues.

Consider Talking About Your Wishes

The conversation might seem a bit awkward, but talking with loved ones about what medical procedures you would or would not want to have done if you cannot make decisions for yourself is a good idea. Many family members of patients who become unable to make medical decisions do not know what treatments that person would have chosen. Family members who are uncertain may choose more aggressive treatments due to that uncertainty factor, and sometimes those who are making a decision have a hard time coming to an agreement, particularly if those wishes are unknown.

Many of my cancer patients mentioned that they would be okay with dying and mentioned that they were seeking aggressive treatment more out of concern for loved ones rather than themselves. If you have strong feelings about the matter and voice those thoughts to others, it might make the decision-making process a bit clearer. I'm not saying any decisions about end of life are easy, but information learned from that conversation might help and perhaps give that person peace regarding decisions made.

Consider Putting Your Wishes in Writing

A living will is a legal document that specifies one's wishes if he or she is unable to make medical decisions for him or herself. Different states may have slightly different forms, but if you are traveling and carry your living will with you into other states, they typically honor that document in other states as well. Living will forms have changed over the years with additions of more specific information. Check to ensure that the form you have is the latest version to avoid some loopholes that might exist in previous versions. Keep the original form in a safe place where someone else is aware of its location.

This document should be available to one's healthcare team and anyone you have designated to make decisions for you in the event that you cannot make decisions for yourself. Your primary care physician and specialists should have a current copy of your living will. In order for those wishes to be carried out, a doctor will still need to write an order regarding life-sustaining treatments in order for the staff to carry out those wishes. It is a good idea to review your living will once a year and date and initial that you still agree with the existing one.

You may wish to complete a living will to make your wishes known; however, you have the right to change the living will or to do away with it if you change your mind. If you decide to revise your living will, you should collect all copies of the previous one and destroy them. This document may specify treatments that you might not have considered, so it might be helpful to look at a living will document even if you do not wish to complete one so that you can speak with loved ones about specific information regarding your wishes.

Another document you might wish to consider completing is a healthcare power of attorney. In the event that you cannot make medical decisions for yourself, the healthcare team will typically ask your legal next of kin to make decisions for you. If you do not feel your legal next of kin would be the best person(s) to make decisions for you, a healthcare power of attorney might be a good choice. Note that if your legal next of kin is more than one person, those people generally must come to an agreement regarding care choices.

Some choose to complete additional paperwork, such as a mental health power of attorney. In addition, people may choose to complete a last will and testament and make many additional arrangements, such as pre-planning a funeral, life celebration, burial, cremation, plans for a pet, etc. Some people choose to write their own obituaries in advance. Ensure that the appropriate people will have access to these documents when needed.

Some people have a deep mistrust of the healthcare system and are afraid to complete any written documents for fear that appropriate care will be withheld. Nobody should be forced to complete these forms. I have a glimpse of those deep scars and understand why some choose not to put end of life issues in writing. I apologize to you if you or someone you love was wronged by our healthcare system – I always tried to provide the very best care to every one of my patients, but I know that our healthcare system is far from perfect or even altruistic in many ways.

The Caregiver Side

End of life issues affect caregivers, especially if the caregiver is a family member or close friend. Several comments in that Facebook discussion were words of affirmation for people who care for a family member who is chronically or terminally ill. Those small, seemingly insignificant caregiver acts might seem huge to the recipients of care.

I would encourage friends and other family members of those caregivers to offer specific help if possible and to provide encouraging words on a regular basis. Many caregivers struggle with burnout and extreme fatigue; many times insurance will not cover the cost of needed home care. A break for a few hours or even a heartfelt, kind word of encouragement might help tremendously.

The grief of loss often begins before a loved one dies, particularly if the illness is lengthy and progressive. Grief has a myriad of different stages, such as anger, bargaining, depression, acceptance, etc. A person might stay in one stage for a long time or might move through several different stages quickly. People can return to a previous stage years later. Many may feel guilty that someone for whom they cared died.

Caregivers may be surrounded by friends and family immediately after the death of a loved one, but the support often quickly fades. Continuing to offer moral support and specific help can go a long way to help that caregiver heal. Many caregivers feel guilty regarding the person's death; it takes time to work through those feelings.

To Speak or Not to Speak

In an effort to help, some people say things that may be quite hurtful to someone who is grieving a loss. If in doubt, it is best not to say it. Simply being there is often a welcome gift. Listen in a loving, kind, caring way. Offer a hug if appropriate, and keep holding on until she is ready to let go. If the person has a religious faith, ask what scripture passages bring peace to him and offer to read that passage if desired. If he would like for you to pray, a simple, heartfelt prayer may be helpful.

Avoid saying things to try to make it all better – you cannot make it all better. Loss hurts. Tears can help one to heal. Grief is a process that takes time. Sometimes a long time. Be willing to visit on a regular basis in the months after a loss when the grief really sinks in. Let the other person talk and simply listen. It might not seem like it at the time, but you are helping when you keep your mouth shut. Maintain confidentiality – assume that what that person says is meant only for your ears unless the person specifically mentions that he would like for you to share that information with others.

Fancy Isn't Necessary

Offering to help in a simple, tangible way may also be well received. Washing the clothes, cleaning the toilets, dusting the furniture, writing thank-you notes, mowing the yard, or taking the dog for a walk might seem less than exciting, but a caring act does not have to be exciting to be meaningful. Avoid mentioning those good deeds to others – doing kind acts incognito can help build trust.

Working with numerous cancer patients put me in a unique position in which I have learned to appreciate things that I did not even realize I took for granted. Even though I often used state-of-the-art equipment, I never forgot that I was caring for unique human beings who deserved my respect and the best holistic care that I could provide. My care included not only the one in the bed but also those who grieved beside the bed. No two patients were exactly alike; I learned to assess needs and respond accordingly. Grief is the same way, ever evolving. We can look for changes and adjust as needed.

A Cane and a Casket

In some cultures, a relative sits by the casket and leans on a cane, symbolizing how much he leaned on the loved one now gone and how he now needs support. May we all find someone on whom we can lean when times are tough.