The Myriad Benefits of a Daily Reflective Practice of Gratitude


How can gratitude improve our mental health?


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At the end of our gross anatomy course—a human cadaver dissection that takes place over the course of an entire year—we first year medical students typically take part in a Gratitude Ceremony. The ceremony is a way for each of us to express our deep appreciation for this profoundly moving experience. Families of the body donors are invited to attend and although we never know if our cadaver’s family is present, the fact that some families are there adds to the solemnity of the event.

Some students read poetry or short stories or essays written for the occasion. Others compose songs or play guitars, all of us trying to capture and express what this foundational experience has meant to us. I remember being brought to tears watching a fellow first year student perform a self-choreographed ballet, his lithe dark body contorting and stretching with unnerving, contagious emotion.

If a Gratitude Ceremony can provide the reflective space for medical students to process deeply felt emotions and profoundly meaningful experiences, mightn’t a similar daily practice of gratitude benefit all of us? Perhaps one that utilizes simple writing techniques? The research on this topic delivers a resounding yes.1,2

Gratitude can be broadly defined as a feeling or attitude of thankfulness or appreciation for things we value or find meaningful. The obvious targets of appreciation often include family members and friends. But with a daily writing practice focused on gratitude, this list of objects can grow and become (as my yoga teacher says at the end of every practice) “long, flowing, and continuous.” Whether reflective writing practices of gratitude occurred daily or weekly, researchers have found the link between gratitude and well-being to be equally strong.

Gratitude interventions such as writing have been proven to reduce stress and alleviate depressive symptoms.1 One theory as to why writing works so well is based on the transactional model of stress and coping, which recognizes that the way we respond to stress depends in part on how we assess our ability to deal with it. If we change the way we appraise our abilities from negative to positive, we can improve our well-being. Writing allows us to craft our own narrative; it gives us agency over our lived experiences, which promotes confidence and security.

Another theory as to the healing power of gratitude may be as simple as the power of positive thinking. Identifying aspects of our daily lives to be grateful for can leave us less likely to feel envious (a helpful trait to cultivate in our social media driven world).

Joan Didion famously said, “I write entirely to find out what I’m thinking. What I’m looking at, what I see and what it means. What I want and what I fear.”3 Indeed, setting pen to paper is a clarifying experience. We only live through any given experience once. But in writing about an event or interaction, by representing in a physical way on paper what we saw, heard, felt, and understood, we can examine it from all sides. We make discoveries unavailable to us in the moment. We can identify new things to be grateful for.

Researcher Barbara L. Frederickson, PhD, tells us that gratitude “broadens and builds,” expanding our repertoire of positive feelings in a kind of “upward spiral.” Explicitly naming our gratitude in a daily journal can inspire us to “pay it forward,” giving of ourselves to others.4 In retrospect, I believe it was this kind of side benefit of gratitude that was at work when, as a retired physician, I came to volunteer as a writer-in-residence and narrative medicine facilitator at a family medicine residency program. In a generative process, I am giving back to the medical community that gave me the best working years of my life.

Gratitude journaling can transform us, creating opportunities for growth, generating positive feelings, and building resources within us that we can continue to draw upon in future situations. It can also transform those around us. In a process Fredrickson calls “elevation,” just the act of witnessing helpfulness can prompt others to repay their own kindnesses.4 Gratitude is indeed the gift that keeps on giving. And a reflective writing practice of gratitude is a gift we can give ourselves… every day.

Dr Roy-Bornstein is a retired pediatrician and the Writer-in-Residence at the Lawrence Family Medicine Residency program in Lawrence, Massachusetts. Her work has been published in the New York Times, the Washington Post, the Boston Globe, JAMA, Poets & Writers, and many other places. She is the author of 4 books, most recently Writing Through Burnout: How to Thrive While Working in Healthcare.


1. Sansone RA, Sansone LA. Gratitude and well-being: the benefits of appreciation. Psychiatry (Edgmont). 2010;7(11):18-22.

2. Cheng S-T, Tsui PK, Lam JHM. Improving mental health in healthcare practitioners: randomized controlled trial of a gratitude intervention. J Consult Clin Psychol. 2015;83(1):177-186.

3. Didion J. Why I write. New York Times. December 5, 1976. Accessed April 23, 2024.

4. Frederickson BL. Gratitude, like other positive emotions, broadens and builds. In: Emmons RA, McCullough ME, eds. The Psychology of Gratitude. Oxford University Press; 2004.

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