It’s National Gratitude Month—in a World of Woe


In tough times, the cultivation of gratitude can help our patients—and us, too.




Some of us fondly recall that classic New Yorker cartoon by Bob Mankoff, showing a woman standing next to her worried-looking husband and asking, “But why not be happy about all the diseases that you don’t have?”

The tone is humorous, but the message is serious. Gratitude is an important part of mental and emotional health. As a Yiddish proverb aptly puts it, “If you cannot be grateful for what you have received, then be thankful for what you have been spared.”1

As the holidays approach, many of us are struggling to connect with feelings of gratitude. The world, after all, is a hellacious mess. Two terrible wars bring us bad news nearly every day, as the maw of civil unrest and burgeoning bigotry seems to devour our “domestic tranquility.” So—what on earth are we supposed to make of “National Gratitude Month”?2

This event has been celebrated since the early 2000s, when it was first created to “recognize all of the wonderful people in our lives that we are thankful for” and to “reflect on how far we’ve come, and to appreciate all of the little things that make life special.”2 Fair enough, although cynics may find this description a bit reminiscent of those grating “Hallmark moments” that bombard us around the holidays.

Perhaps a better approach is to ask what the term gratitude is supposed to mean and how it might figure into the work we do as healers and therapists.

What is Gratitude?

One of the preeminent authorities on gratitude is psychology professor Robert Emmons, PhD, who directs the Emmons Lab at the University of California, Davis. Emmons and his colleague, Charles M. Shelton, tell us that, “as a psychological state, gratitude is a felt sense of wonder, thankfulness, and appreciation for life. It can be expressed toward others, as well as toward impersonal (nature) or non-human sources (God, animals).”3

Gratitude is sometimes used synonymously with “thankfulness,” although some scholars distinguish the terms. As someone with a very poor sense of direction, I would express the difference as follows: I am thankful for the GPS that reliably guides me when I drive, but I am grateful to the individuals who designed it.

In short, thankfulness may be in response to an object, device, or situation. Gratitude is almost always used in connection with some person or rational agent who has altruistically provided us with a gift or benefit. (The altruism part is important. Gifting someone in order to curry favor or land a job is not worthy of the recipient’s gratitude.)

So, is gratitude merely a psychological state? A feeling or emotion? Emma Green, writing in The Atlantic, says no: “Gratitude isn’t just an emotion: It’s also a value. In most cultures, but especially in America around Thanksgiving time, being grateful is seen as a virtue.”4

In fact, in the tradition of Western secular philosophy, the Roman statesman, Cicero (106 BCE-43 BCE) declared, “Gratitude is not only the greatest of virtues, but the parent of all the others.”5

Gratitude for Both Good and Bad Fortune?

Gratitude is also a central value in most of the world’s great religions and spiritual traditions.3,6 Counterintuitively, most of these traditions counsel gratitude for both good and bad fortune. This is a big ask, is it not? After all: How can we possibly be grateful for, say, contracting a serious illness? How can we be grateful for war, famine, or pestilence? Urging gratitude when “bad things happen to good people” seems not merely strange, but frankly, perverse.

And yet, there is a case to be made for a measured kind of gratitude—properly understood—even when we are faced with misfortune. That is, when we examine misfortune closely, we can often find some aspect of the event that contains a positive element.

I learned this in the course of giving a lecture on Stoicism, after which I asked the attendees, “Have you ever had a bad experience that turned out to be for the good?” One woman responded almost immediately. “Absolutely!” she said. “When I went through my divorce, it felt like the worst thing that had ever happened to me in my entire life. But years later, I found that it was really one of the best things, because it allowed me to start a new chapter in my life.”

Perhaps this is what Shakespeare had in mind when he wrote, “Sweet are the uses of adversity” (As You Like It, II.1.12-17).

The Health Benefits of Gratitude

There is a voluminous and growing literature on the physical, emotional, and psychological benefits of gratitude. As a report from UCLA summarized the research:7,8

“A review of 70 studies that include responses from more than 26,000 people found an association between higher levels of gratitude and lower levels of depression… Gratitude seems to reduce depression symptoms—people with a grateful mindset report higher satisfaction with life, strong social relationships, and more self-esteem than those who don’t practice gratitude… Gratitude can [also] be a coping tool for anxiety. Regularly practicing gratitude combats negative thinking patterns by keeping thoughts focused on the present… Many benefits of gratitude also support heart health. Improving depression symptoms, sleep, diet, and exercise reduces the risk of heart disease. Several studies show that a grateful mindset positively affects biomarkers associated with the risk for heart disease…Gratitude and the response it causes help bring down your blood pressure, heart rate, and breathing to help with overall relaxation.”

Gratitude in Psychotherapy

In recent years, there has been growing interest in gratitude as an adjunctive intervention in the course of psychotherapy. Most gratitude interventions involve writing letters expressing gratitude to another person or listing things for which one is grateful.

Although the data are preliminary and gathered mostly from non-clinical samples, there is modest evidence showing that “gratitude interventions have… been found to be effective with clinically distressed samples, such as individuals [with] impaired body image.”9 Adjunctive “gratitude writing” also proved effective in a randomized controlled trial in 293 adults seeking university-based psychotherapy services.10

Gratitude, Resilience, and Burnout

It hardly needs emphasizing that medical professionals today are under a great deal of stress, and that burnout—although not uniformly defined—is a commonly-reported syndrome in the medical field. Indeed, “approximately 1 in 3 physicians is experiencing burnout at any given time.”11

There is growing evidence that gratitude can increase emotional resilience, potentially fortifying us against burnout. Specifically, “gratitude fosters adaptive coping mechanisms. By managing positive emotions like satisfaction, happiness, and pleasure, gratitude enhances our emotional resilience and builds our inner strength to combat stress.”12,13

Speaking from personal experience, I have found that, in times of great stress or periods of low mood, recalling the individuals and things for which I am most grateful has been the most useful self-coping mechanism I have found. Gratitude is also low in calories and completely without adverse effects. And for that, I am very grateful!

Dr Pies is Professor Emeritus of Psychiatry and Lecturer on Bioethics and Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry Emeritus, Tufts University School of Medicine; and Editor in Chief Emeritus of Psychiatric Times (2007-2010). Dr Pies is the author of several books. A collection of his works can be found on Amazon.


1. National Gratitude Month. Holiday Calendar. Accessed October 20, 2023.

2. Gratitude for what you’ve been spared. Spirituality & Practice. Accessed October 20, 2023.

3. Emmons RA, Shelton CM. Gratitude and the science of positive psychology. In: Snyder CR, Lopez SJ (Eds). Handbook of Positive Psychology. Oxford University Press;2001.

4. Green E. Gratitude without God. The Atlantic. November 26, 2014. Accessed October 20, 2023.

5. Ly S. Gratitude, the parent of all virtues. University of Colorado Boulder. April 29, 2020. Accessed October 20, 2023.

6. Pies RW. The Three-Petalled Rose: How the Synthesis of Judaism, Buddhism, and Stoicism Can Create a Healthy, Fulfilled and Flourishing Life. iUniverse;2013.

7. Health benefits of gratitude. UCLA Health. March 22, 2023. Accessed October 20, 2023.

8. Iodice JA, Malouff JM, Schutte NS. The association between gratitude and depression: a meta-analysis. Int J Depress Anxiety. 2021;4(1):2643-4059.

9. Geraghty AW, Wood AM, Hyland ME. Attrition from self-directed interventions: investigating the relationship between psychological predictors, intervention content and dropout from a body dissatisfaction interventionSoc Sci Med. 2010;71(1):30-37.

10. Wong YJ, Owen J, Gabana NT, et al. Does gratitude writing improve the mental health of psychotherapy clients? evidence from a randomized controlled trialPsychother Res. 2018;28(2):192-202.

11. De Hert S. Burnout in healthcare workers: prevalence, impact and preventative strategiesLocal Reg Anesth. 2020;13:171-183.

12. Chowdhury MR. The neuroscience of gratitude and effects on the brain. April 9, 2019. Accessed October 20, 2023.

13. Gloria CT, Steinhardt MA. Relationships among positive emotions, coping, resilience and mental healthStress Health. 2016;32(2):145-156.

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