As a medical oncologist, I am often asked whether the way we think and feel can influence our physical health. Gratitude is one area where researchers have begun investigating this relationship, with some intriguing findings.

Gratitude has long been considered a virtue. It appears in religious traditions, philosophical teachings, and cultural rituals around the world. We are taught from an early age to appreciate what we have.

But can gratitude actually improve our health?

Over the past two decades, scientists have investigated whether gratitude influences psychological well-being, brain activity, inflammation, cardiovascular health, and even longevity.

The evidence is strongest for psychological well-being. Research into the physical health benefits of gratitude is still emerging, although some studies have identified measurable physiological changes.

What Does Science Tell Us About Gratitude?

In 2003, psychologists Robert Emmons and Michael McCullough published a landmark study in the Journal of Personality and Social Psychology.

Participants were randomly assigned to write about things they were grateful for, daily frustrations, or relatively neutral events.

Across three experiments, participants who focused on gratitude reported improvements in several measures of psychological well-being, particularly positive emotions.

This was an important finding because gratitude had often been studied as a personality trait. The research suggested that it could also be cultivated by deliberately choosing where we direct our attention.

How Gratitude Affects the Brain

In 2016, Prathik Kini, Joel Wong, Joshua Brown and colleagues at Indiana University published a study in NeuroImage examining brain activity in people who had participated in a gratitude-letter-writing intervention.

Three months later, participants assigned to gratitude writing showed greater neural responses to gratitude in the medial prefrontal cortex, a region involved in social cognition and assigning value to experiences.

The study was small and did not include brain scans before the intervention, so it could not establish how individual brains had changed over time.

Nevertheless, the findings suggest a possible relationship between practising gratitude and how the brain subsequently processes grateful experiences.

Can Gratitude Reduce Inflammation?

The relationship between gratitude and physical health is an emerging area of research.

We know that chronic psychological stress can influence the nervous system, cortisol secretion, immune signalling, and inflammation. Researchers have begun investigating whether positive emotional experiences, including gratitude, might influence some of these same pathways.

In 2016, Laura Redwine and colleagues at the University of California, San Diego, published a randomized trial in Psychosomatic Medicine involving 70 patients with asymptomatic heart failure.

Participants were randomly assigned to eight weeks of gratitude journaling or usual care.

Those assigned to gratitude journaling showed a greater reduction in a composite measure of inflammatory biomarkers compared with the control group. Researchers also observed changes in heart-rate variability during a gratitude-writing exercise that were consistent with greater parasympathetic nervous system activity.

These findings are interesting because they involved measurable physiological changes, rather than relying exclusively on how participants reported feeling.

However, this was a small pilot study, and larger trials are needed to determine whether these effects are reproducible. Changes in inflammatory biomarkers do not necessarily translate into a reduced risk of chronic disease or improved survival.

Does Gratitude Help You Live Longer?

In 2024, Ying Chen and colleagues at the Harvard T.H. Chan School of Public Health published a study in JAMA Psychiatry examining gratitude and longevity.

Using data from the Nurses’ Health Study, the researchers followed 49,275 women with an average age of 79 for approximately four years.

Women reporting the highest levels of gratitude had a 9% lower adjusted mortality hazard compared with those reporting the lowest levels. Higher gratitude was also associated with a lower hazard of cardiovascular mortality.

What makes this study particularly interesting is how the association changed as researchers accounted for other aspects of the women’s lives.

In the initial analysis, which accounted for demographic and social factors, women with the highest gratitude scores had a 29% lower mortality hazard. After further adjustments for physical health, lifestyle behaviours, mental health, cognitive function, and psychological well-being, the association narrowed to 9%.

This illustrates how closely gratitude is connected to other aspects of health. People who experience greater gratitude may also have stronger relationships, healthier behaviours, and better psychological well-being.

Importantly, this was an observational study. It cannot establish that practising gratitude extends life. People in better health may find it easier to experience gratitude, and other factors may help explain the association.

The findings are intriguing, but whether gratitude itself contributes to longevity remains an open question.

Gratitude and Grief Can Coexist

As a medical oncologist, I spend much of my professional life with people navigating serious illness, uncertainty, grief, and loss.

I would never want a patient to believe that their recovery depends on maintaining a positive attitude or finding something to be grateful for every day.

There are circumstances in life when gratitude feels difficult, and sometimes impossible.

Emotional distress is a natural response to suffering. Gratitude should never become another expectation placed on someone who is already struggling.

Human beings are capable of experiencing several emotions simultaneously.

We can feel grateful for the support of someone we love while feeling frightened about the future. We can appreciate a beautiful moment while grieving something we have lost.

How to Practise Gratitude

Throughout the day, our minds are constantly identifying problems, anticipating difficulties, and responding to things that require action.

Meanwhile, many positive experiences receive relatively little attention. An unexpected kindness. A conversation with a friend. A quiet morning. A meal shared with people we love.

Gratitude practices encourage us to notice these experiences. Many of the interventions studied by researchers are simple enough to incorporate into everyday life.

1. Keep a weekly gratitude list
In Emmons and McCullough’s original experiments, some participants were asked to write down up to five things they were grateful for once a week.

This simple exercise was associated with improvements in certain measures of psychological well-being compared with control conditions.

2. Try a daily gratitude journal
In Redwine’s heart failure trial, participants were asked to record things they were grateful for on most days of the week over eight weeks.

The intervention was associated with changes in inflammatory biomarkers, although further research is needed to understand the clinical significance of these findings.

3. Write a gratitude letter
In research conducted at Indiana University, participants receiving psychotherapy were asked to write a letter expressing gratitude to another person each week for three weeks. They were not required to send the letters.

A related randomized study found that participants assigned to gratitude writing reported greater improvements in mental health at later follow-up assessments compared with those who received psychotherapy without a writing assignment.

These findings suggest that taking time to reflect on our appreciation for another person may have psychological benefits, even if the letter is never delivered.

A Few Practical Suggestions

• Be specific. Rather than writing that you are grateful for a friend, reflect on something that person did and why it mattered to you.
• Give it time. Some gratitude interventions have demonstrated benefits that emerge over several weeks.
• Find a manageable rhythm. Both weekly and more frequent gratitude exercises have been studied. There is no established ideal frequency.

The goal is to develop a practice that feels meaningful rather than turning gratitude into another task to complete.

What We Know So Far

Gratitude is not a treatment for illness, and it should never become another expectation placed on someone who is struggling.

The research suggests that deliberately practising gratitude can improve aspects of psychological well-being. Whether these effects translate into meaningful long-term improvements in physical health remains an open question.

What I find most interesting is how a simple shift in attention can influence the way we experience our lives, even when our circumstances remain unchanged.

References

1. Emmons RA, McCullough ME. Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology. 2003;84(2):377–389.
2. Kini P, Wong J, McInnis S, Gabana N, Brown JW. The effects of gratitude expression on neural activity. NeuroImage. 2016;128:1–10.
3. Redwine LS, Henry BL, Pung MA, et al. Pilot randomized study of a gratitude journaling intervention on heart rate variability and inflammatory biomarkers in patients with stage B heart failure. Psychosomatic Medicine. 2016;78(6):667–676.
4. Chen Y, Okereke OI, Kim ES, Tiemeier H, Kubzansky LD, VanderWeele TJ. Gratitude and mortality among older US female nurses. JAMA Psychiatry. 2024. https://doi.org/10.1001/jamapsychiatry.2024.1687
5. Wong YJ, Owen J, Gabana NT, et al. Does gratitude writing improve the mental health of psychotherapy clients? Evidence from a randomized controlled trial. Psychotherapy Research. 2018;28(2):192–202.