From the AOSW Spirituality SIG 

In a world filled with daily loss, chaos, challenges, crises and rising mental health needs, we are immersed in opportunities to help our patients find sources of comfort, meaningful connections with themselves, and live through the beauty and the tragedies of life.  

Gratitude has been a spiritual practice for many worldwide for generations, and it is a beacon of hope to see it be increasingly studied and recognized as an important mediator of health and happiness. Evidence-informed research has shown that the practice of gratitude is not just beneficial to individuals who already have higher levels of wellbeing, but also for those who experience mental health concerns. As a component of holistic care, gratitude has shown a positive impact related to enhancing well-being, increasing the immune response, lowering hypertension, depression and anxiety, improving sleep, and promoting happiness. Gratitude is recognized as a key positive emotion in positive psychology and the science of gratitude is definitely growing! 

And yet, gratitude is not a “magic bullet,” a short-term intervention or a dosed treatment that results in outcomes in the immediate short term. The benefits come out of a practice of gratitude that accrues over time. Gratitude is like a muscle – it becomes stronger with use as we look for ways to express it in our daily lives.  

“I am often reminded that gratitude is found in the little things – a warm smile, a welcomed gentle touch, a kind gesture, a listening ear, a favorite song, a cozy warm blanket, the blue sky, the clouds, or getting lost for just a moment in the wonders of nature. These little things can bring a grateful heart the warmth, comfort and hope to carry on.”  

~Lynne Steele, MSW 

There are many definitions of gratitude as is common with a term that is so expansive and individually expressed. Psychologist Robert Emmons has studied gratitude for more than 30 years and describes gratitude as both a state (feeling grateful in response to a benefit we have received) and a trait (a state of mind and more integrated orientation toward all aspects of one’s daily life). This distinction recognizes that there is an important difference between feeling grateful (more transient and self-focused on what we have received) and being grateful (more lasting and other-focused as one recognizes sources of goodness outside of self that lead to giving and caring for others). Emmons further validates the relational benefits of gratitude to encourage appreciation of the value of someone or something, to be more participators in life rather than merely spectators, and to increase social ties and self-work and to be more resilient. 

How might gratitude be a tool for oncology social workers to support patients and families in the throes of a life-changing cancer diagnosis and grueling treatment? Gratitude serves a purpose. It is not just about us and what we receive, but also about a connection to forces of good outside of our individual lives. Gratitude practices are powerful tools we can teach ourselves first (it is always hard to teach others about what we ourselves have not practiced), then our patients and our team.  

How might gratitude fit into coping with cancer? It is clear that cancer is not something that patients would ever be thankful for! Yet, we all can likely think of a patient who has expressed some type of gratitude as they forged their way through their experience of cancer. Thankful for their family, appreciative for caring staff and grateful for just today. David Steindl-Rast, a monk, interfaith scholar and author gives insight into gratitude in hardship. He affirms that we may not be grateful for every situation in which we find ourselves, and we can be grateful in it.  

Mary Pipher, a clinical psychologist, states, ”Gratitude is not a virtue but a survival skill, and our capacity for it grows with our suffering.” This is not what some have termed as “toxic positivity,” but rather an awareness that life is both good and awful; that there are things that are gone and things that are left. There is sadness and there is gratitude. In his insightful TED Talk, Steindl-Rast further clarifies that we often see happiness as a criteria for being grateful – we are happy and this leads to gratitude. However, he posits that this is not the order in which gratitude and happiness are related. Happiness does not lead us to be grateful. Rather, it is being grateful that leads us to feel joy.  

This type of perspective is a key component of developing a gratitude practice. Consider these gratitude-based questions that offer an invitation to shift perspectives:    

• What if we didn’t take things for granted? 
• What if we were able to shift our attention and rumination away from negative emotions? 
•  What if we moved away from thinking about what we don’t have to what we do have? 
• What if we stopped making unhelpful comparisons of ourselves to others regarding “more,” “better,” “different,” and instead engaged in our own potential? 

“I started with a gratitude journal. I was able to slow down enough to see what I had in a tangible way. It allowed me to process my feelings with my counselor or trusted friend, and learn from my experiences. It gave me opportunities to practice reframing.”  
~Mary Ripper, MSW  

Expressing gratitude is a good start – gratitude for people, animals, nature, memories, dreams. Speaking words of gratitude to our colleagues who we have the honor to work along side, to our patients for sharing vulnerability in a support group, to the community agency who is there to take our calls whether or not they are ultimately able to provide all that we might want.  

Speaking words of thankfulness is linguistic medicine that benefits the speaker and the receiver.” 
~Robert Emmons 

But expressing thanks and appreciation is not enough for our “gratitude muscle” to fully develop. We must move beyond noticing what is good in our lives, to start expressing, start acting and start becoming more grateful. Developing a daily gratitude practice can eventually rewire our brains. The Reticular Activating System (RAS) is a network of neurons in our brain stem that filters the multitude of information coming into our brain so what is most important gets through. For example, parents can block out and sleep through the noise of snoring right next to them, while being about to hear and wake up to the cry of a child in the next room. Over time, our RAS has been trained to filter for what is most important, and thus allows us to hear what we need to hear most above the noise. A gratitude practice can train our brains to filter for gratitude above the noise of a cancer experience, a demanding workday, the fears that we are not enough. The noise is still there, we just attend and experience it differently through a trained gratitude filter. 

“When done mindfully and daily, gratitude is a wonderful exercise in training our brain to see or look for: the beauty around us, the blessings and/or things we currently have, had, or plan, or a moment to share one’s appreciation or return a kindness, or the possibilities that arise out of negative experiences. 
~Mary Ripper 

Positive psychology research suggests that expressions of gratitude are not only beneficial to the person receiving the gratitude, but even more so to the person who is expressing the gratitude. As oncology social workers, we have the opportunity to use this free, highly accessible and effective intervention to help our patients, our team colleagues and ourselves have greater health and happiness through all the wonderful and awful parts of life. We can help our patients, our teams and ourselves begin an intentional practice of gratitude. Might you choose to begin wherever you are now and develop a intentional gratitude practice that has the potential power and impact to shift the experience of your daily life, your work, your connections with self and others? Below are resources to explore in developing your own personal gratitude practice, supporting and guiding your patients and infusing your working environment with gratitude.  

Gratitude Inventory/Quiz: 

Use these quizzes for a baseline gratitude measurement for yourself, in a patient support group or for a staff lunch and learn about gratitude. 

• Greater Good Science Center Gratitude Quiz  
• Gratitude Questionnaire-Six (GQ-6) (McCullough, Emmons & Tsang, 2022) 

Gratitude Exercises/Activities 

Select from a variety of gratitude exercises as a start to a daily gratitude practice and/or to use as clinical engagement with patients. 

• General Activity Resources 
  Gratitude Exercises 
  Kids Activities that Encourage a Heart of Gratitude 

• Gratitude Jars 
  The Gratitude Jar 

• Gratitude Walls 
  Create a dedicated wall space at a cancer survivor event, in patient waiting rooms, staff lounge/charting areas to express positive feelings and foster gratitude.
  Why Appreciation & Gratitude in the Workplace Are Important 
  Gratitude Wall in the Workplace: Answers to What, How and Why 

• Gratitude Huddles 
  Start your day, shift, clinic rounds or end your week with a quick huddle in person or by email with a quick check in. This collective focus on gratitude adds positive energy knowing the team is “in this together”. 
  Practice tip: 5 ways to renew your morning huddle 

• Gratitude Letters:
  An Experiment in Gratitude: The Science of Happiness 
  Writing Gratitude letters 

• Gratitude Journal 
  Gratitude Journal Three Good Things 
  Gratitude Journal: 66 Templates & Ideas for Daily Journaling 
  Gratitude Journal 
  How to Start a Gratitude Journal 

Helpful Websites 

• Greater Good Magazine 
• What is Gratitude and Why Is It So Important?