“Gratitude is not only the greatest of the virtues,” wrote the Roman statesman Cicero, “but the parent of all of the others.” Indeed, the qualities of thankfulness and appreciation are well-established spiritual and social values. In recent years, however, gratitude has also emerged as a focus of intervention in medical and mental health treatment.
Researchers in the area of positive psychology – the study of factors that lead to human flourishing and fulfillment – have found that cultivating gratitude in one’s day-to-day life is associated with a number of physical and mental health benefits. Making an effort to tune into and express gratitude has been found to improve sleep quality, reduce stress, mitigate depression symptoms, support coping with chronic pain, and enhance subjective well-being and self-rated health.
Interventions that promote gratitude may have particular relevance for service members. Military life is often stressful, and can require considerable hardship and sacrifice. Purposeful efforts to acknowledge the good things in one’s life may serve as a protective factor against mental health impacts of unavoidable life and military stressors. While there is limited research into the influence of gratitude on active-duty service members, studies focusing on military veterans support this notion. For example, a recent national study found that among military veterans with high levels of lifetime trauma exposure, dispositional gratitude was one of several factors associated with resilience to symptoms of post-traumatic stress, depression, and anxiety.
Strategies for Health Care Providers
Providers who want to incorporate gratitude into treatment might start with one of these interventions:
- Gratitude Journaling: This is the practice of recording day-to-day events, interactions, and experiences for which one is grateful – typically on a daily or weekly basis. This writing exercise can encompass happenings from the present day, as well as past events that the service member may not have appreciated fully in the moment. You might encourage service members to reflect on positive personal developments, such as encouraging words from a commander or assignment to one’s first-choice duty station, as well as larger national or world events, like new legislation that benefits veterans (or other causes or communities to which the service member feels connected). The key is for service members to journal regularly to support the development of a gratitude practice, with effects that build over time as gratitude becomes a positive habit.
- Gratitude Letter Writing: This intervention emphasizes the expression of gratitude to someone who has had a positive influence on the service member. The service member might select someone who is currently an important source of support, like a spouse or senior enlisted leader, or someone from the past who might not be aware of their impact on the service member, like a former teacher or coach. You might then encourage the service member to write a brief letter (a page or less, 15-30 minutes is typical) explaining in detail why they are grateful to the recipient, how the person’s actions affected them, and how often they think about the recipient and their actions. Gratitude letter writing can be done as a one-time activity, or as a letter-writing campaign to multiple recipients; again, research suggests that additional letters yield an incremental benefit.
- Stop-Look-Go: This gratitude-inflected mindfulness exercise may be a good option for service members who are open to gratitude activities but aren’t keen on writing. This activity calls on the participant to: Stop whatever you are doing and become aware of your surroundings and the present moment, Look at what life is offering you right now (What can I be grateful for in this moment? What opportunity is life presenting me?), and then Go do something with it, whether it’s simply enjoying the moment or – when life is challenging – embracing the opportunity to learn or grow from those circumstances. Of course, simply remembering to be mindful is half the battle, so it may also be helpful to encourage service members to create reminders (or “stop signs”) to practice this technique one to two times per day, perhaps by setting a phone alarm or placing a sticker next to a mirror or light switch.
Each of the above exercises can be completed in session, assigned as homework between appointments, or simply recommended to service members who you’re seeing for a one-time visit.
Thinking about trying some of these strategies yourself? You might reap some professional as well as personal benefit: health care providers who maintain a gratitude practice have been found to experience reduced stress and burnout related to their work.
Dr. Alexandra Kelly is a contracted psychological health subject matter expert at the Psychological Health Center of Excellence. She has a master’s degree in counseling and psychological services and a Ph.D. in counseling psychology. She specializes in trauma, vocational psychology, and multicultural counseling.
The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.