Practicing Gratitude for Ultimate Self-Care

In the U.S., the Thanksgiving holiday is upon us - a day traditionally set aside to gather, feast and give thanks. Aside from the holiday that reminds us to be thankful, gratitude in and of itself brings on powerful emotions of contentment, satisfaction, and resilience. There is an abundance of research on the benefits of spending even 5 minutes expressing, writing about, or meditating on gratitude on a regular basis. In fact, experts say expressions of gratitude can help fortify the foundation for our overall well-being and healthy relationships with others. 

Gratitude is not only a feeling that arises following help from others, but also a habitual practice of appreciation and focus on the positive aspects of life. By intentionally shifting our attention, we can gradually change our perceptions, as what we focus on seems to expand.  

In a holiday season rife with overindulgence, overspending and for some, social isolation or painful memories, gratitude helps bring perspective and balance. When we spend time practicing thankfulness to self and others, we generate hormones and neurotransmitters that help sustain positive emotions, protecting us from adversity and guiding healthier choices from a place of peace and strength.

In this post we will look at some of the demonstrated benefits of gratitude on health and well-being, and how to incorporate a gratitude practice into your self-care routine.

Gratitude May Help Reduce Stress and Depression

We can probably all agree that it is easiest to experience gratitude when things seem to be going smoothly. Yet the benefits may be greatest when we look for the positive in a stressful transition or health challenge. Two recent clinical trials demonstrated the benefits of a gratitude intervention for mental health during prenatal stress and chronic illness.

In a pilot randomized controlled trial conducted with 46 pregnant women, participants used an online mindfulness and gratitude intervention 4 times a week for 3 weeks. Measures of prenatal stress, salivary cortisol, gratitude, mindfulness, and satisfaction with life were completed at baseline, 1.5 weeks later, and 3 weeks later. Women who participated in the gratitude intervention demonstrated reduced prenatal stress in comparison to the control group, with significant reductions in waking and evening cortisol observed for intervention participants [1].

A separate study on the longitudinal associations of gratitude to psychological well-being in the context of two chronic illnesses (inflammatory bowel disease and arthritis) showed that gratitude uniquely predicted lower depression in these chronically ill populations [2].

A Gratitude Journal May Promote Physical Health, Well-being and Better Sleep

Keeping a gratitude journal resulted in participants reporting 16% fewer physical symptoms and 10% less physical pain.

According to the study Counting Blessings Versus Burdens [3], keeping a gratitude journal resulted in participants reporting 16% fewer physical symptoms, 10% less physical pain, 8% more sleep and 25% better sleep quality

In a 2 week study of a gratitude intervention compared to a control of everyday events reporting, the gratitude group experienced increases in hedonic well-being, optimism and sleep quality, along with decreases in diastolic blood pressure. Improvements in subjective well-being were correlated with increased sleep quality and reductions in blood pressure, but there were no relationships with cortisol found in this study. This brief intervention suggests that subjective well-being may contribute to lower morbidity and mortality through healthier physiological function and restorative health behaviors [4].

More recent studies have shown that gratitude journaling may improve biomarkers related to heart failure morbidity, such as reduced inflammatory markers over time and increased parasympathetic heart rate variability (HRV) responses during the gratitude journaling task [5].

Practicing Gratitude Enables You to Take Better Care of Yourself

In the Counting Blessings Versus Burdens study [3], the gratitude journal group reported spending 19% more time exercising. Although that finding has yet to be replicated, a study of patients with post-acute coronary syndrome (ACS) did show that optimism and gratitude at 2 weeks post-ACS were associated with higher self-reported health behavior adherence and improved emotional well-being 6 months later [6].

Body Gratitude May Improve Your Body Image

Internalized weight bias and body dissatisfaction are associated with a number of negative psychological and physical health outcomes. A recent study examined the effectiveness of a body-focused gratitude intervention, delivered as a short writing exercise, as a strategy to reduce internalized weight bias and improve body image. Young adults were randomly assigned to either a body gratitude group or a control group. The gratitude group reported significantly lower weight bias internalization and significantly more favorable appearance evaluation, as well as greater body satisfaction when compared to the control condition. These effects were small and were not moderated by gender or BMI. These findings provide preliminary support for body-focused gratitude writing exercises as an effective individual-level strategy for reducing internalized weight bias and improving body image [7].

Gratitude May Help Expand Your Social Support

According to a recent headline, we are in the midst of a loneliness epidemic, and the health effects are as damaging as smoking 15 cigarettes per day.

According to a recent headline, we are in the midst of a loneliness epidemic, and the health effects are as damaging as smoking 15 cigarettes per day [8]. The good news is that studies suggest gratitude generates “social capital.” In other words, gratitude makes us nicer, more trusting, more social, and more appreciative. As a result, it helps us to make new friends, deepen existing relationships, and improve our marriages. It has been suggested that the positive effects of gratitude on physical health are significantly mediated by lower levels of perceived loneliness and stress. These findings are important, given the existing evidence that gratitude can be cultivated, and by buffering against stress and loneliness may improve somatic health symptoms [9].

Gratitude Can Enhance Your Financial Well-being

Gratitude has been shown to reduce economic impatience – that is, spending time feeling grateful for what you have helps you to save versus spend. In particular, individuals experiencing gratitude are more willing to choose delayed larger rewards over immediate smaller rewards, and display evidence of gratitude-induced changes in brain activity as measured by electroencephalogram [10].

Outward Expressions of Gratitude Improve Well-being for Both Parties

Expressing gratitude improves well-being for both expressers and recipients. However, expressers tend to systematically undervalue the positive impact of gratitude on recipients. Participants in 3 experiments wrote gratitude letters and then predicted how surprised, happy, and awkward recipients would feel. Compared to actual reports by the recipients, these predictions significantly underestimated how surprised recipients would be about why expressers were grateful, overestimated how awkward recipients would feel, and underestimated how positive recipients would feel. Underestimating the value of prosocial actions, such as expressing gratitude, may keep people from engaging more often in behavior that would maximize well-being for themselves and others [11].

Get Started with a Simple Gratitude Practice

A gratitude practice doesn’t need to take a lot of time to be effective. Writing a short list of 3 to 5 people, events, strengths or things you are grateful for, first thing in the morning or last thing at night, is enough to start or end your day in a peaceful and positive way. Collecting these in a dedicated journal allows you to look back over past days for inspiration. 

If you aren’t feeling particularly grateful at first, that’s okay. Sit with your thoughts and dig a little deeper. If you are struggling with a problem, see if you can connect with gratitude for the resources you have at your disposal or a person you can count on to help you. If you are feeling a lack of abundance, begin by looking at what you do have and give thanks for that – even if that means just being thankful for the day. 

If you have more time and are so inclined, consider a guided gratitude meditation to jump start your gratitude practice; there are plenty of options online, such as this 10-minute example. Writing a thank you letter to someone who has meant a lot to you is another way to practice gratitude; you can decide later whether to send the letter or not, but remember that expressing gratitude is good for both parties!

With time and practice, gratitude becomes habitual, and a lens through which we view the world. To kick start this season of gratitude, we at ZRT would like to thank the patients and health care providers who have helped us to grow and evolve over the past 21 years and 10 million tests. We wish you a holiday season full of peace, health and blessings to count.

Related Resources


[1] Matvienko-Sikar K, Dockray S. Effects of a novel positive psychological intervention on prenatal stress and well-being: A pilot randomised controlled trial. Women Birth. 2017;30:e111-e118

[2] Sirois FM, Wood AM. Gratitude uniquely predicts lower depression in chronic illness populations: A longitudinal study of inflammatory bowel disease and arthritis. Health Psychol. 2017;36:122-132.  

[3] Emmons RA, McCullough ME. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol. 2003;84:377-89

[4] Jackowska M, et al. The impact of a brief gratitude intervention on subjective well-being, biology and sleep. J Health Psychol. 2016;21:2207-17

[5] Redwine LS, et al. 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;78:667-76

[6] Millstein RA, et al. The effects of optimism and gratitude on adherence, functioning and mental health following an acute coronary syndrome. Gen Hosp Psychiatry. 2016;43:17-22

[7] Dunaev J, et al. An attitude of gratitude: The effects of body-focused gratitude on weight bias internalization and body image. Body Image. 2018;25:9-13.

[8] Health Resources & Services Administration. The “Loneliness Epidemic”.

[9] O'Connell BH, Killeen-Byrt M. Psychosocial health mediates the gratitude-physical health link. Psychol Health Med. 2018;23:1145-1150.

[10] Patalano AL, et al. Gratitude intervention modulates P3 amplitude in a temporal discounting task. Int J Psychophysiol. 2018;133:202-210.  

[11] Kumar A, Epley N. Undervaluing Gratitude: Expressers Misunderstand the Consequences of Showing Appreciation. Psychol Sci. 2018;29:1423-1435.