Could saying “thank you” help you to live longer?

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.

But what about the impact of positive traits? Could they conversely improve cardiovascular health?

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.

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Learn How to Inspire Gratitude at Work

Gratitude makes us happier and more productive. Why aren’t more organizations adding it to their strategic plans? Attend the Greater Good Science Center’s Nov. 17 event to find out how you can incorporate more gratitude into your workplace.[/message]

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.