Broaching the Topic of Gratitude


How can you foster gratitude in your patients?



It can be difficult for individuals to maintain a positive outlook when confronted with stressors and challenging circumstances in their lives. As a result, the negative emotional response can overshadow the positive. Over the past 2 decades, attention has shifted to ways to aid patients using positive inferences to improve overall well-being and favor a more positive outcome. The key is to identify situations in which individuals are most vulnerable to downward spirals and then develop interventions that foster positive perceptions.

Individuals express their gratitude in a variety of ways. It can be past-oriented (recalling happy memories and being grateful for previous blessings), present-oriented (not taking good health or fortune for granted as it comes), or future-oriented (maintaining a hopeful and optimistic attitude). Regardless of an individual’s level of gratitude, it is a quality that can be successfully cultivated. Gratitude practice has the potential to be a catalyzing and relational healing force that is frequently underutilized in clinical practice.1 Recognizing gratitude in our daily lives requires greater effort, especially in our fast-paced culture.

What is Gratitude?

Gratitude is often defined as a positive psychological state that involves an individual being thankful and appreciative of the positive aspects of their life.2 Gratitude assists individuals in feeling more positive emotions, appreciating good experiences, improving their health, dealing with adversity, and developing strong relationships. Having gratitude means appreciating what you receive, whether it is something material or something intangible. Individuals acknowledge the goodness in their lives with gratitude, and during this process, they typically realize that the source of that kindness is largely external to themselves. Because of this, feeling grateful also fosters a connection with something bigger than oneself, such as others, the natural world, or greater power.

Gratitude improves one’s ability to experience more joyful feelings, enjoy pleasant memories, maintain excellent health, overcome challenges, and forge close personal bonds. By practicing gratitude, individuals can learn to appreciate what they already have rather than always seeking out more, or believing that they will not be content until all their monetary and bodily needs have been addressed. Refocusing on what they have rather than what they want is aided by gratitude.

Benefits of Gratitude

It is common to hear that gratitude acts as a buffer against psychopathology and promotes healthy functioning. A number of studies provide evidence that positive affect (in the form of gratitude) can moderate both physical and psychological health problems. Research suggests that experiencing and expressing gratitude can positively influence one’s psychological health, helping individuals to feel positive emotions, live in the moment, build strong relationships, and reduce stress.1,3 Researchers have found that using a positive psychology approach can be integrated into helping individuals flourish and live healthy, happy lives by focusing on happy experiences, positive individual characteristics, and positive institutions. Practices associated with positive psychology, such as gratitude interventions, can improve social and emotional well-being.

Additional studies have described how fostering a sense of gratitude can help individuals keep a more optimistic outlook daily, contribute to higher mental well-being, and have social benefits as well.4,5 Gratitude has been found to play an important role in moral reasoning, especially within the empathic process.6 Studies have shown that a brief session of gratitude practice involving thoughts about the good things in one’s life can significantly improve well-being for days to weeks and even influence sleep.7 Whereas the benefits of practicing gratitude persist, the positive impact of negative self-statements tends to be short-lived.

Integrating Gratitude into Practice

Gratitude practice is a powerful but often underutilized tool to increase a patient’s sense of self-worth and overall life satisfaction. Practicing gratitude involves encouraging patients to employ exercises to connect them with positive emotions, allowing them to focus on recognizing the good things in their lives. The key is to help the patient identify situations in which they are most vulnerable to downward spirals and then develop interventions that foster positive perceptions. By fostering an ability to focus on positive emotions and being thankful for the good in their lives, patients can be encouraged to focus on the opportunities they have rather than dwelling on the negative.

Engaging a patient in a discussion about gratitude can be a difficult topic to broach. The patient may be unwilling to change because of an attachment to being right or a feeling that they deserve to feel bad. One way to initiate the conversation is by giving them examples of others who demonstrate this trait and have found success in life. Another approach is to assist them in looking at one area of life that they feel grateful for, encouraging them to look at the gifts they have and develop an appreciation, and then develop a habit of gratitude for this every day. Another strategy is to elicit their strengths by asking them questions that require a positive response. This positive response can be written down in a journal, kept in a picture frame, or placed on a bulletin board for the patient to review each day. Another approach is encouraging patients to acknowledge and express appreciation by observing the generosity of others.

Concluding Thoughts

The practice of gratitude can have profound and lasting positive effects on an individual’s life. It can lower blood pressure, improve immune function, promote happiness and well-being, and spur acts of helpfulness, generosity, and cooperation. Gratitude reduces the lifetime risk for depression, anxiety, and substance use disorders. Most studies on this topic support a link between gratitude and happiness. People who are more grateful report feeling more satisfied with their lives and having a greater ability to experience positive emotions.2 They tend to be much more optimistic about their future, which can lead to improved health.

Cultivating gratitude is one of the simpler routes to a greater sense of emotional well-being and overall life satisfaction. Gratitude is not a one size fits all approach to psychotherapy; therefore, it is important to consider the protective factors of the client. The key is to help patients develop a habit of gratitude and recognize its positive effects on both their emotions and their lives. Individuals who are more grateful report feeling more satisfied with their lives and having a greater ability to experience positive emotions.2 When individuals are grateful, they do not focus on what they lack or fear losing but instead appreciate what they have.

Dr Thompson is a psychotherapist and part of the core faculty at the University of Phoenix.


1. Emmons RA, Stern R. Gratitude as a psychotherapeutic intervention. J Clin Psychol. 2013;69(8):846-855.

2. McCullough ME, Tsang JA, Emmons RA. Gratitude in intermediate affective terrain: links of grateful moods to individual differences and daily emotional experience. J Pers Soc Psychol. 2004;86(2):295-309.

3. Lasota A, Tomaszek K, Bosacki S. How to become more grateful? The mediating role of resilience between empathy and gratitude. Curr Psychol. 2022;41(10):6848-6857.

4. Watkins PC, Uhder J, Pichinevskiy S. Grateful recounting enhances subjective well-being: the importance of grateful processing. J Posit Psychol. 2015;10(2):91-98.

5. Lyubomirsky S, Sheldon KM, Schkade D. Pursuing happiness: the architecture of sustainable change. Rev Gen Psychol. 2005;9(2):111-131.

6. McCullough ME, Kilpatrick SD, Emmons RA, Larson DB. Is gratitude a moral affect? Psychol Bull. 2001;127(2):249-266.

7. 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(2):377-389.

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