This blog explores the science of gratitude for physicians, how it may tackle burnout, and gives some suggestions for gratitude practice.
As physicians, we (rightly) have much to complain about. But we also have a lot to be grateful for. While we may be in the throes of a triple pandemic – physician burnout and mental illness with a little thing called a pandemic to contend with — this article argues that we are also fortunate in so many ways. It takes practice to recognize and appreciate what we have. While I’m not going to try and convince you that all is good, there is evidence that gratitude practice helps improve our perspective and wellbeing.
While the exact mechanism of action for gratitude is unclear, there are several plausible hypotheses on how gratitude practice works, and we believe that this applies to gratitude for physicians, too.
In his essay on gratitude, “Why Gratitude Is Good,” Robert Emmons, considered one of the world’s leading scientific experts on gratitude, argues that gratitude has two key components:
A 2015 meta-analysis study evaluated the results of 26 studies of various gratitude interventions (Davis et al., 2015). Gratitude interventions examined included gratitude lists, journals, letters, group gratitude sessions, and imagery exercises. It found that people who participated in gratitude interventions showed greater psychological well-being (but, interestingly, not gratitude per se) than people in control groups who did not do an intervention.
Davis and colleagues found that people in gratitude interventions also showed greater improvements in psychological well-being and gratitude—but not reduced levels of anxiety— when compared with people in control groups who did non-gratitude activities. This study also found that gratitude interventions generally performed about as well as other psychologically active interventions, such as acts of kindness.
...Gratitude interventions showed greater psychological well-being (but, interestingly, not gratitude per se) than people in control groups who did not do an intervention.
A more recent meta-analysis study that analyzed the results of 38 gratitude studies concluded that “gratitude interventions can have positive benefits for people in terms of their well-being, happiness, life satisfaction, grateful mood, grateful disposition, and positive affect, and they can result in decreases in depressive symptoms” (Dickens, 2017). However, it also notes that the findings regarding negative affect and stress were mixed, and there were not significant findings around improvements in physical health, sleep, prosocial behavior, or self-esteem. Additionally, gratitude interventions were rarely more effective than other kinds of positive interventions.
Whether or not these attitudes come to us naturally, paying attention to life’s positives can train us to notice more and more of them, which will help us learn to be more grateful and, arguably, happier.
In one gratitude study, researchers divided participants into three groups. Although all three groups received counseling services, the first group was also instructed to write one letter of gratitude to another person each week for three weeks, whereas the second group was asked to write about their deepest thoughts and feelings about negative experiences. The third group did not do any writing activity.
What did they find? Compared with the participants who wrote about negative experiences or only received counseling, those who wrote gratitude letters reported significantly better mental health four weeks and 12 weeks after their writing exercise ended.
They later used an fMRI scanner to measure brain activity while people from each group did a “pay it forward” task.
The researchers found that the gratitude letter writers showed greater activation in the medial prefrontal cortex when they experienced gratitude in the fMRI scanner. This is striking as this effect was found three months after the letter writing began. This suggests that simply expressing gratitude may have lasting effects on the brain.
Below, we give a number of evidence-based types of Interventions that we think may help improve gratitude for physicians.
In a 2003 study, Emmons and McCullough introduced an intervention designed to increase gratitude that they called “counting blessings” (Emmons & McCullough, 2003).
This activity involves writing down five things for which participants were grateful (the “counting blessings”) either daily or weekly. In the years since Emmons and McCullough published this study, many other researchers have conducted experiments using variations of the counting blessings/gratitude journal activity.
In a 2005 study, Martin Seligman and colleagues tested a variation of the counting blessings intervention, which they called “Three Good Things” (Seligman et al., 2005). This activity involves not only writing down three things that went well but also identifying the causes of those good things.
All seem to improve different measures of wellbeing.
Another variation of the counting blessings paradigm is called “mental subtraction.” This activity involves imagining what life would be like if a positive event had not occurred (Koo, Algoe, Wilson, & Gilbert, 2008).
In one set of experiments, people who wrote about what it would be like if positive events in their life had not occurred reported improved mood, providing evidence for what the researchers call the “George Bailey effect” after the protagonist in the famous 1946 movie It’s A Wonderful Life.
Seligman’s 2005 study also included a “gratitude visit” intervention in which participants wrote and delivered a letter of gratitude in person to someone who they had never properly thanked (Seligman et al., 2005).
Reflecting on one’s death can also increase gratitude (Frias, Watkins, Webber, & Froh, 2011). In one study, undergraduate students who were asked to either imagine dying in a very specific and visceral manner, or to more generally imagine their death, experienced more gratitude after the intervention than did students asked to reflect on a “typical day.” “Because our very existence is a constant benefit that we adapt to easily, this is a benefit that is easily taken for granted,” write the researchers. “Reflecting on one’s own death might help individuals take stock of this benefit and consequently increase their appreciation for life.”
Another study points to what might be a surprising method for increasing gratitude: “experiential consumption,” meaning spending money on experiences rather than things (Walker, Kumar, & Gilovich, 2016).
Across six experiments, this study found that people felt and expressed more gratitude following a purchase of an experience (e.g., concert tickets or meals out) than a purchase of a material good (e.g., clothing or jewelry).
What would experiential consumption look like for physicians?
In this article, we summarized the science of gratitude for physicians and listed 5 types of gratitude approaches with evidence of efficacy. Feel free to try them out, give it time, and a few weeks down the line see if your perspectives have changed.
As for this writer, I have 2 main gratitudes in mind right now:
1. A rewarding, if challenging, medical career where I really did help people.
2. A rewarding, if challenging post-medical career where I am in a team tackling physician burnout, mental illness, addiction, and suicide: Physicians Anonymous.
If you would like to access more support, consider joining our safe, Physicians Anonymous peer-support groups.
