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Gratitude and Mental Health: On Thankfulness and Depression

Last year, my client bawled at the Thanksgiving table. She reported being met with disapproval, and later being told that she had ‘upset the children’ (teens).

Gratitude is not a magic act. You can experience gratitude and other feelings simultaneously. It’s important to understand that you can experience feelings of sadness, anger, grief, anxiety, and loneliness alongside gratitude. A societal message is that just because something terrible happens in your life, that doesn’t mean you can’t also be grateful (look for the silver lining/it could’ve been worse/thoughts and prayers). But this rule applies in reverse. Just because you’re grateful doesn’t mean your negative emotions aren’t valid.

While practicing gratitude alone won’t “cure” depression, it does positively impact your life. Several studies have shown that mindfully practicing gratitude may diminish symptoms of mood and anxiety disorders OVER TIME. There are measurable benefits to practicing gratitude (see research from the Positive Psychology Center at the University of Pennsylvania ).

Gratitude is associated with:
better sleep quality
a greater likelihood of seeking help for health concerns
increased self-esteem
feeling more optimistic
improved relationships
greater emotional resilience during difficult times
higher self-efficacy expectations (your own belief that you can do well at a task)

Focusing on positive aspects of your physical and mental health requires mindful decisions. While depression can do a number on both your body and mind, it is possible to exercise your gratitude muscle to strengthen it. Gratitude takes time, practice, and self-compassion.

How to have gratitude when you’re depressed:
Recognize that it’s okay if you struggle with feeling grateful. Your feelings are neither “good” nor “bad.” Feelings just are. So if you find yourself feeling ungrateful, it’s okay. You’re not doing anything wrong. Attempting to focus on things that foster gratitude is a practice.

This isn’t a fake-it-till-you-make-it situation. Pretending you’re grateful when you’re actually not will just serve to bury your feelings. You don’t need to force yourself to think about your life in a way that isn’t true to you.

Stones Across the River
If you’re struggling to find things you’re authentically grateful for, then try to think little over big. In my practice, I have termed this stones across the river. What are the things on a daily basis that get you across the rapids without tumbling in?

Validation of the Gestalt
The German term gestalt means an overall wholeness that is bigger than the singular elements contained within. Practice validation alongside gratitude. Don’t think you must choose gratitude or being upset. Think of it as feeling distressed/anxious/depressed and you also practice gratitude.

Your experience can exist at the same time as others who “have it worse” and be equally worthy of receiving help. This doesn’t mean you’re ungrateful. Some of my clients are told they should have more gratitude, that low moods stem from a cup-half-empty perspective. Being compared to others who have less can make a depressed individual feel guilty and even more depressed.

Practice Self-Compassion
A client told me something that has stayed in my head for years; “that gratitude actually contributed to the pain because, while I could intellectually see all of this goodness before me, I was incapable of enjoying it.” The dichotomy was heart-wrenching for him and led to further self-bashing.

Connect with others
When learning how to practice gratitude when depressed, you have to make a conscious effort to spend time with others who are important to you. Doing so can help you combat loneliness and depression. Obviously, it would be best to spend time with supportive people, not people who drain or criticize you.

Focus on something that doesn’t hurt
Depression can manifest itself as physical discomfort. You may get headaches, body aches, or stomach pain. One client sleeps with her soft, favorite blanket and wakes up to her dog staring at her and joyfully wagging his tail. It gets her going for the day. Another looks in the mirror and notices that her eyebrows are perfect. A third gets a good morning text from a dear friend every day. Focusing on things that feel loving and nurturing IS gratitude.

Write an ingratitude list
Yes, an ingratitude list. Sometimes, separating out the things you’re not grateful for can help determine what you are grateful for. Do you do things out of sheer obligation? Do you have piles of possessions or clothing you don’t use? When you determine the things you’re ungrateful for, remove them, so you don’t have to feel ungrateful every time you see or do them.

Focus on when you experienced kindness
Depression and gratitude may not seem to go together, especially when you have feelings of self-depreciation and worthlessness. Perhaps you feel like nobody does anything for you because you don’t feel worth it right now. Try to visualize a time when someone extended a kindness to you and made you feel special or happy. Think about mentors, family members, friends, or even the kindness of strangers. Focusing on these memories and being grateful for them can help you feel a sense of love and worth. See also The Kindness of Strangers.

Do something nice for someone
Most people are familiar with the term “pay it forward.” Finding the energy or desire to do something nice to help someone else can be challenging. But helping others is a great mood-booster. The gratitude of others can help us be kinder to ourselves.

Neural Pathways Take Time
Gratitude affects the parasympathetic nervous system and can rewire neural pathways through breathing exercises, meditation, cognitive-behavioral therapies, and mindfulness strategies. This takes time and practice.

How to feel grateful when you don’t

Photo: Cape May, with Sage and Asia

Got Gratitude?

Happy Thanksgiving.
Some days it’s tough to feel true gratitude, or hard to find anything to be grateful for at all. Some days you might wonder why you should feel grateful because nothing seems okay. Like life, gratitude practice is not an eternal upward slope. Anyone can feel challenged as struggles diminish our energy to appreciate.
It’s okay if you spend some days without feeling grateful. Attempting to force yourself to feel what you can’t truly isn’t going to improve your head space. Acceptance of our reality is the most crucial step towards healing from wounds. You don’t have to keep a gratitude journal. You already have one in your head.

1. Think small
When you’re at a loss of things to feel grateful for, think about what you actually do on a given day. For example, your strong hands help you interact with everything around you. You pat your dog or cat, scratch an itch, pour your coffee, swat away a mosquito. Without them, it would be quite a struggle. But, how many times a day do you appreciate how fundamental they are to your day-to-day life?
Similarly, things like clean water, healthy food, access to transportation, paved roads, music, the MCU, cool wind, flowers, technology, education, books, sleep, friendship, intimacy, warmth, light, are some of the things that we engage with regularly in one way or another but somehow forget to mention as enthusiastically as we do other great achievements. These are the small parts of our lives that have mostly been with us through thick and thin, like that friend who stays with you through successes and failures. See also Stones Across the River, Mindfulness Practice.

2. Reflect on negative experiences you have overcome
During the hard times, it’s hard to remember that you’ve already been through hard times. You survived. Every single thing that ever happened brought you to this space and time.

3. Start gratitude conversations
Ask people what they are thankful for. Better yet, ask, “Who are you grateful to?” Learning about others and their struggles, touchstones, goals, and experiences can be moving, inspiring, and downright connecting.  More at The Psychology of Nostalgia.

4. Practice mindful verbal expression
Say, “I appreciate you.”
Say, “I notice xyz. Thank you for doing that.”
Say, “You look absolutely amazing in that sari.”
Also see The Power of Words Through Text, The Power of Texting.

5. Be generous
Another way is to take the focus away from ourselves and express gratitude to all the people that care and have made our lives easier or more beautiful with their presence. Gifting is not fancy. It’s an acknowledgment through deed, word, action, or a significant object that someone matters to you.  See also The Mental Health Benefits of Random Acts of Kindness.

Gratitude has lasting effects on the brain: The neuropsychology of giving thanks

Recent evidence suggests that a promising approach is to complement psychological counseling and treatment with additional activities that are not too taxing for clients, but yield high results. Research has zeroed in on one such activity: the practice of gratitude. Indeed, many studies over the past decade have found that people who consciously count their blessings on a regular basis tend to be happier and less depressed. I often have my patients write a daily list of three things that they are grateful for. It increases mindfulness, and the emerging research indicates that it’s an adjunct treatment for depression.

A conundrum is that most research studies on gratitude have been conducted with well-functioning people, not those who have clinical levels of distress. A landmark study from the University of California at Berkeley studied individuals with a high degree of distress to see if active practice of gratitude would make a difference in their mental health. After three months of mental health treatment, during which patients wrote gratitude letters or journals, participants were compared with those who didn’t do any writing. The researchers wanted to know if grateful brains were processing information differently.

An MRI was used to measure brain activity people from each group. Those with a gratitude practice showed significantly elevated activity in the ‘pleasure centers’ of the brain, which are affected by the neurotransmitters serotonin and dopamine.

This is the summary of my research on gratitude:

Gratitude improves health
Gratitude impacts on mental and physical well-being. Positive psychology and mental health researchers in the past few decades have established a significant connection between gratitude and good health. Keeping a gratitude journal reduces stress, improves the quality of sleep, and builds emotional awareness (a great study to read on this is Seligman, Steen, Park and Peterson, 2005).

Gratitude builds professional commitment
Grateful workers are more efficient, more productive and more responsible. Expressing gratitude in the workplace is a proactive action toward building interpersonal bonds and trigger feelings of closeness and bonding (see Algoe, 2012). Gratitude is positively correlated to more vitality, energy, and enthusiasm to work harder.

Employees who practice expressing gratitude at work are more likely to volunteer for more tasks, willing to take an extra step to accomplish their tasks, and happily work as a part of the team. Also, managers and supervisors who feel grateful and remember to convey the same, have a stronger group cohesiveness and better productivity. They recognize good work, gives everyone their due importance in the group and actively communicates with the team members.

The Neuroscientific Research Into Gratitude
Gratitude was significant in ancient philosophies and cultures, for example, in ancient Roman writings, where Cicero mentioned gratitude as the ‘mother’ of all human feelings. As an area of neuropsychological research, however, it was a rare subject of concern until the last two decades.

Gratitude And The Brain
Neural mechanisms that are responsible for feelings of gratitude have grabbed attention. Studies have demonstrated that at the brain level, personal judgments involving feelings of gratefulness are evoked in the right anterior temporal cortex (see Zahn et al. 2008, 2014). In the same study, it was revealed that the reason why some of us are naturally more grateful than others, is the neurochemical differences at the Central Nervous System (CNS). In other words, there is an increase in availability of both dopamine and serotonin, which are pleasure neurotransmitters, when we experience gratitude. People who express and feel gratitude have also a higher volume of grey matter in the right inferior temporal gyrus. Gratitude makes us sharper, and possibly brighter.

While the research shows a clear benefit of gratitude, it also makes a clear distinction. Realizing that other people are worse off than you is NOT gratitude. Gratitude requires an appreciation of the positive aspects of your own situation. It is not a comparison. You actually have to show appreciation for what you have, for it to have an effect.

Gratitude improves mental health. That is a daily Thanksgiving.

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