Gratitude in Veterinary Medicine
Gratitude is not only the greatest of virtues, but the parent of all the others — Cicero
Introduction
Many people know what gratitude is and when asked to define it, we can reflect upon our own experiences, which is having received a positive outcome as a result of another person’s actions.
Gratitude predates the Before Common Era (BCE) as seen by the quote by Cicero. More recently, gratitude has been found to be a positive mitigating factor in health-related outcomes, including reducing stress.
Today’s article, Gratitude in Veterinary Medicine, will explore the concept and origins of gratitude and how veterinary medicine can benefit from using it in their practice.
What is gratitude?
Gratitude was also written about by Adam Smith, considered the father modern economic theory, who in 1790 described gratitude as one of the principles of human nature, a person’s most basic social emotion.1 Gratitude, Smith proposed, is “crucial for maintaining a society that is to be based upon goodwill [and] an important emotional resource for promoting social stability.” [1]
More recently, the definition has expanded thanks in large part to McCullough, et al., and will be the definition used for this article, which defines gratitude as an affective trait (grateful disposition), specifically:
A generalized tendency to recognize and respond with grateful emotion to the roles of other people’s benevolence in the positive experiences and outcomes that one obtains. [2]
From the research by McCullough, et al., the Gratitude Questionnaire (GQ-6) was developed and validated, and is now used throughout the world. The GQ-6 is a self-report six item questionnaire developed for measuring “trait” gratitude. The GQ-6 has been found to be positively related to “optimism, life satisfaction, hope, spirituality and religiousness, forgiveness, empathy and prosocial behavior, and negatively related to depression, anxiety, materialism and envy.” [2,3]
Healthcare Outcomes of Gratitude
Within the past 20 years, gratitude has been researched and its outcomes published in both the psychological and healthcare literature. Gratitude has been found to increase feelings of connection and satisfaction in interpersonal relationships, including friendships and marital relationships as well as:
Foster social support
Lower levels of stress
Lower levels of depression in chronic illnesses
Lower levels of inflammatory biomarkers in cardiac patients
Benefits social relationships
Enhances psychological wellbeing
Enhances adolescent psychological adjustment
Increases prosocial behavior [4-12]
Science Behind Gratitude
Gratitude has also been studied through the use of functional MRI (fMRI) to determine its effects on the brain for a variety of groups of people. Gratitude has been found to activate the anterior cingulate cortex, which is responsible for:
Empathy related responses
Socially driven interactions
Emotion
Decision making [13-14]
Gratitude also has a positive effect on the medial prefrontal cortex (mPFC), which is responsible for:
Self-reflection
Person perception
Understanding self and others
Learning and predicting likely outcomes of actions
Theory of mind/mentalizing, i.e., ability to attribute mental states to self and others [13, 15]
How to Incorporate Gratitude into Veterinary Medicine
Now that we know gratitude influences emotions, decision making, and the understanding of self and others, there are three categories of gratitude interventions that veterinarians and their staff can incorporate into the lives. All of the following gratitude interventions were found to have improved wellbeing [16]
Daily Listing of Things to be Grateful
This approach has been reported to be used in many gratitude intervention studies and is one of the simpler ones to incorporate into one’s daily routing. As its name implies, a daily listing involves writing a list of three things they are grateful for at the end of their day, typically just before bedtime. Gratitude lists were found to be effective in improved functioning in people with neuromuscular diseases, improved satisfaction with school for children, ages 11-14, and its effects were also reported to remain up to six months for some groups. [11, 16-18]
2. Grateful Contemplation
This approach while less specific than a daily list, is more contemplative as it requires someone to think about a recent past event in which they are grateful. It can be as specific as targeted activities they participated in over the course of a vacation or over the course of a season of the year. Outcome studies found those who focused on what they were grateful for reported a more positive mood. [19-20]
3. Behavioral Expressions of Gratitude
This approach involves writing a letter thanking someone whose action(s) brought to them gratitude and reading the letter to them. Outcome studies reported greater positive affect with both adults and middle school students. [21-22]
Resources
Veterinary-specific Resources
AVMA Reading List: Work-life Balance
This list offers resources that can help establish and maintain a good work-life balance.
This self-check guide suggests ways to lower stress and reduce your chances for health problems.
AVMA—Stress Management for Veterinarians
This link provides strategies for coping with stress as well as additional links on tips to help manage stress and the negative health effects of stress.
Creating Wellbeing and Building Resilience in the Veterinary Profession: A Call to Life
Written by Sonja A. Olson, DVM, this book aims to help veterinary caregivers increase self-efficacy, decrease unnecessary suffering, and increase sustainability in their mission to support animal health around the world.
Other Resources
Gratitude Questionnaires
The Gratitude Questionnaire (GQ-6) is one of the most frequently used measures for gratitude and as been translated into several languages. The GQ-6 has been found to be positively related to optimism, life satisfaction, hope, spirituality and religiousness, forgiveness, empathy and prosocial behavior.
The Gratitude Resentment and Appreciation Scale (GRAT) is another gratitude questionnaire that measures an individual’s dispositional gratitude, i.e., the tendency to notice and appreciate positive aspects of life.
Centers for Disease and Prevention: Practicing Gratitude Works is a resource to learn more about ways to practice gratitude and find resources that can help.
Conclusion
We discussed how gratitude has been an on-going discussion since before Biblical times and its importance to not only the individual but an important resource to society as well. More recently, we learned gratitude has been shown to have positive effects on physical health, emotional health, and mental health with numerous populations reporting increases in their wellbeing. Neuroscience has also provided confirmation of the influence that gratitude has on our ability to make decisions, feel empathy, and understand ourselves and others.
We’ve provided several resources specific for veterinarians and their staff as well as links to gratitude questionnaires and to the CDC. We hope you will explore these resources and find them helpful.
References
[1] McCullough ME, Emmons RA, Kilpatrick SD, Larson DB. Is gratitude a moral affect? Psychological Bulletin. 2001;127(2):249-266. DOI: 10.1037//0033-2909.127.2.249.
[2] McCullough ME, Emmons RA, Tsang JA. The grateful disposition: A conceptual and empirical topography. Journal of Personality and Social Psychology. 2002;82(1):112-127. DOI: 10.1037//0022-3514.82.1.112.
[3] University of Pennsylvania, Positive Psychology Center. Gratitude Questionnaire. 2002. https://ppc.sas.upenn.edu/resources/questionnaires-researchers/gratitude-questionnaire. Accessed September 20, 2022.
[4] Bono G, Sender JT. How gratitude connects humans to the best in themselves and in others. Research in Human Development. 2018;15:224-237. DOI: https://doi.org/10.1080/15427609.2018.1499350.
[5] Wood AM, Maltby J, Gillett R, Linley PA, Joseph S. The role of gratitude in the development of social support, stress, and depression: Two longitudinal studies. Journal of Research in Personality. 2008;42:854-871. DOI:10.1016/j.jrp.2007.11.003
[6] Sirois F, Wood M. Gratitude uniquely predicts lower depression in chronic illness populations: A longitudinal study of inflammatory bowel disease and arthritis. Health Psychology. 2017;36(2):122-132. DOI.org/10.1037/hea0000436.
[7] Mills PJ, Redwine L, Wilson K, et al. The role of gratitude in spiritual well-being in asymptomatic heart failure patients. Spirituality in Clinical Practice. 2015;2(1);5-17. https://doi/10.1037/scp0000050.
[8] Algoe SB, Haidt J, Gable SL. Beyond reciprocity: Gratitude and relationships in everyday life. Emotion. 2008;8(3):425-429. DOI:10.1037/1528-3542.8.3.425.
[9] Wood AM, Joseph S, Maltby J. Gratitude uniquely predicts satisfaction with life: Incremental validity above the domains and facets of the five factor model. Personality and Individual Differences. 2008;45:49-54. DOI: 10.1016/j.paid.2008.02.019.
[10] Wood AM, Joseph S, Maltby J. Gratitude predicts psychological wellbeing above the Big Five facets. Personality and Individual Differences. 2009;46:443-447.
[11] Froh JJ, Sefick WJ, Emmons RA. Counting blessings in early adolescence: An experimental study of gratitude and subjective well-being. Journal of School Psychology. 2008;46:213-233.
[12] Grant AM, Gino F. A little thanks goes a long way: Explaining why gratitude expressions motivate prosocial behavior. Journal of Personality and Social Psychology. 2010;98(6):946-955. DOI: 10.1037/a0017935.
[13] Fox GR, Kaplan J, Damasio H, Damasio A. Neural correlates of gratitude. 2015. Frontiers in Science. 2015;6:1491. DOI.org/10.3389/fpsyg.2015.01491.
[14] Lavin C, Melis C, Mikulan E, Gelormini C, Huepe D, Ibanez A. The anterior cingulate cortex: An integrative hub for human socially-driven interactions. Frontiers in Neuroscience. 2013;7:64. DOI: 10.3389/fnins.2013.00064.
[15] Grossmann T. The role of medial prefrontal cortex in early social cognition. Frontiers in Human Neuroscience. 2013;7:340. DOI: 10.3389/fnhum.2013.00340.
[16] Wood AM, Froh JJ, Geraghty AWA. Gratitude and well-being: A review and theoretical integration. Clinical Psychology Review. 2010. DOI:10.1016/j.cpr.2010.03.00.
[17] 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. DOI: 10.1037/0022-3514.84.2.377.
[18] Seligman MEP, Steen TA, Park N, Peterson C. Positive psychology progress: Empirical validation of interventions. American Psychologist. 2005;60(5): 410-421. DOI: 10.1037/0003-066X.60.5.410.
[19] Watkins PC, Woodward K, Stone T, Kolts RL. Gratitude and happiness: Development of a measure of gratitude, and relationships with subjective well-being. Social Behavior and Personality. 2003;31(5):431-452.
[20] Koo M, Algoe SB, Wilson TD, Gilbert DT. It’s a wonderful life: Mentally subtracting positive events improves people’s affective states, contrary to their affective forecasts. . Journal of Personality and Social Psychology. 2008;95(5):1217-1224. DOI:10.1037/a0013316.
[21] Froh JJ, Kashdan TB, Ozimkowaki KM, Miller N. Who benefits the most from a gratitude intervention in children and adolescents? Examining positive affect as a moderator. The Journal of Positive Psychology. 2009;4(5):408-422. DOI: 10.1080/17439760902992464.
[22] Froh JJ, Yurkewicz C, Kashdan TB. Gratitude and subjective well-being in early adolescence: Examining gender differences. Journal of Adolescence. 2009;32:633-650. DOI:10.1016/j.adolescence.2008.06.006.