Pod Post Ep. 4 Gratitude is Not All Woo Woo

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You are listening to the Beat Physician Burnout Podcast Episode #4.

So on to today’s topic of gratitude. I titled this podcast “Gratitude is not all WooWoo", because there is science to support it. And that science tells us that gratitude is the way to a happier, more fulfilling life. The result of gratitude isn't just superficial; it has the power to change your brain and create significant and lasting happiness.

So what is Gratitude?

Gratitude is a word derived from the Latin word gratia. It means grace or graciousness. To have gratitude means to live a life of appreciation for what you have, whether tangible or intangible. It is the intentional acknowledgment of all the goodness you regularly experience. I want to repeat this part because it is crucial. You should intentionally think about what you are grateful for. Often, gratitude includes the possibility that there is an outside source of the good in your life. Many people feel even more gratitude as they sense a connection to something larger than themselves. This doesn't have to be a religious experience (although it can be); it can also be a connection to nature or other people.

So I know we hear a lot about gratitude and you may be rolling your eyes at me right now. I know it seems a little woo woo, but there is the science to back it up. I love this brain neuroscience stuff because I am a nerd and I feel as physicians and scientists; we are more likely to participate in things when we understand the mechanism of action. I initially planned to go through the studies in detail in this podcast, but then it became way too long. So, I am going to hit the main physiology and then add the detailed studies in the references.

So much of our thinking is on autopilot. When we take the time to think about thoughts of gratitude and even write them down, our brain then starts to look for more things to be grateful for. Our brain seeks evidence for what we believe. Taking those thoughts out of your brain and writing them down on a piece of paper makes it even easier for your brain. Your brain can then offer these thoughts of gratitude up to you randomly during the day. Our brain is lazy and tries to expend as little energy as possible, so it likes easy and repeats thoughts. Our whole goal in coaching and managing our minds is to create more positive and valuable thoughts throughout our day. We are re-training our brain. We are creating neuro- pathways. "Neurons that fire together, wire together." We want to increase these positive pathways.

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Benefits

Here are a few benefits of a gratitude practice

1 Boosts Self Esteem

The process of noticing and being grateful for all the good in your life includes seeing all the good that you have accomplished, all the good that you are, and all the people in your life who love you. Gratitude will boost your self-esteem. When you start to have self-doubt or imposter syndrome, your brain will have evidence to the contrary.

2 Separates You From Negative Emotions

It's not that you never feel any negative emotions, but gratitude will cause you to let go of negative emotions and self-defeating beliefs more quickly. It will keep you in a positive feedback loop. There is no way your body can have negative or toxic emotions and gratitude at the same time. Think about it. You cannot be envious and grateful at the same time. By having gratitude, you're essentially blocking negative emotions by filling up your thought space with positives.

3 Makes You Fun to Be Around

Gratitude keeps you in a positive mind space, and people enjoy being around positive people far more than negative ones. Grateful people are more social, nicer, trusting, and appreciative - all things that help us bond with other people in deeper relationships.

4 Enhances Your Career

Gratitude will make you more appreciative of the people's efforts and more sensitive to what is happening around you. Gratitude makes you more productive and increases your capacity to make good decisions. You're also more apt to give genuine behavior-focused praise to your colleagues.

5 Makes Your Love Life Better

One study showed that gratitude motivated people to do more things that strengthen romantic relationships, like showing appreciation for their partner, be prepared to discuss issues openly, and having more positive perceptions of their partner.

6 Keeps You Calm

Gratitude reminds you that you have been in challenging circumstances before and prevailed. You are more optimistic, calm, and relaxed in general, but especially when things get tough. Gratitude will help you deal with stress and trauma, and studies have shown that a regular gratitude practice will decrease anxiety.

7 Improves Your Sleep

A 2009 NIH study showed that our hypothalamus is activated when we feel gratitude. The hypothalamus controls our appetite, sleep, temperature, metabolism, and growth.

8 Makes Your Feel Good

This one is obvious, focusing on the good around you will lift your mood. I am not saying you “drink the Koolaid” and walk around all day, everyday in a state of fake positivity. You can acknowledge that everything isn't perfect while still feeling gratitude and getting benefits from all that is going well. Studies have shown that having a regular gratitude practice will decrease depression and possibly even chronic pain syndrome. Now gratitude will likely feel different for all of us, but almost universally is a positive emotion. Some people describe it as warm, safe, whole, pleasant, enjoyable, or just happy. Feelings of gratitude flood our brains with dopamine. When we are genuinely grateful, our brains reward us with this natural high. Because this feeling is so good, we are often motivated to feel it again and become more inclined to give thanks and do good for others.

First, I want to give you an example of the wrong way gratitude is used. There is a lot of gaslighting happening in medicine right now, and when we are upset about something, even if it's a legitimate issue, we are told that we should "just be grateful that we have a job"!! This is gaslighting. And having gratitude in your life does not mean that you still can't have legitimate concerns and want things to improve. So I don't recommend trying to go directly from upset/angry immediately to grateful (unless you want to). You are allowed to feel all the human emotions. Sometimes when we try to change our thoughts quickly, to feel better, it doesn't work. We may want to be upset and angry about things in the world. This is why I generally recommend doing a routine gratitude practice that has nothing to do with the circumstances in your day.

How to Have More Gratitude

Here are a few ways to express more gratitude in your life and reap the benefits of being a happier person. I'm going to give you many options because different things work for different people. When starting any new thing that you want to make into a habit, you should start slowly. You want to guarantee yourself that you can be successful. As physicians, we often try to do everything at once and create an unsustainable goal. Then we feel like a failure. This is absolutely not what your goal should be. Start with the minimal first step, and then convince yourself it is the perfect plan. This plan is all I'm going to do for now. I like adding the words “for now” at the end. It give me space to go slow and learn. Whatever goal you decide, I want you to be at least 80% sure that it is something you can do. I want you to be honest with yourself and build trust with yourself that you will be able to complete the things you say. I am a person who does what I say I will. If you're not 80% sure you can do your plan, you need to back it off. There's no sense in creating a goal you're going to fail at. And if you don't think you can do it every day, then change it to once a week. If you don't believe you can do it once a week, change it to something less. For example, I will practice gratitude more often in the next month than I am doing it now. We are constantly striving for some improvement, but none of these activities on these podcasts should be used to make you feel bad about yourself.

Maybe you want to go all-in and do everything, get a journal, and do all possible exercises. Remember, these are all just options and opportunities for you.

Acknowledge Your Blessings Daily

It may seem trivial, but just notice and be thankful for the small things - that maybe aren't that small. And even if you are not ready yet to take the time to write them down, even awareness will benefit you.

Your morning cup of coffee
Your bed, pillows, and cozy comforter.
A clear glass of water to drink
The people you see daily who are kind
The teachers at your child's school who seem to care for your child genuinely
Your friends who have weathered many storms with you and whose company you enjoy
The person who gave way to you in traffic
Your brother is always there for you despite things they're dealing with in their own life.
Don't worry; your brain will find something, even on the hardest of days. Sometimes, it may even need to be as basic as being grateful that you're alive, or that you can see, or how beautiful the flower is. Remember that no matter how small it is, starting to train your brain to search for more things in your life that you can be grateful for will make you feel better during the day. Think of all the little things that add up to make your extraordinary life.

Do Gratitude Exercises

Here are a few ideas of gratitude exercises you may enjoy.

Keep a gratitude journal. It doesn’t have to be a specific new journal. You can write in a spot on your regular planner or calendar.
Pick a time. "I'm going to do this first thing in the morning. I'm going to talk to text into my phone on the drive to work. I am going to do this before I go to bed at night." It doesn't matter. Some people like to do it in the morning. On really stressful days, I sometimes realize my mind has already begun spinning with a massive list of things I need to get done before I even get out of the shower. This could be the perfect time to fill my brain with some gratitude instead of all those overwhelm thoughts
How often? Maybe start with “I am going to do this once a week”. “I am going to write down 1-3 things I am grateful for once a week”. Work your way up so that you contribute to it regularly. You can even let technology help you and find a gratitude app. It doesn't have to be fancy. You could even write down one thing you are grateful for on the top of your patient list today and look at it all day.
Any new habit is always easier if you tack it on to another thing you frequently do. It is helpful to add a gratitude thought every time you knock on a patient door, every time you wash your hands, every time you open the refrigerator door, or every time you tab into the computer.

Some other gratitude exercises are

Express appreciation to someone by sending them a card or phoning them.
Take a walk and be grateful for everything you see - flowers, trees, other people, animals, etc.
Make a gratitude jar or box. Write about it on a slip of paper and put it in your jar whenever something good happens. Even if you never go back and read each slip of paper, you will feel grateful just watching the paper increase.
Send a letter of appreciation to someone who did something significant for you a long time ago.
Take magazine pictures and create a collage of things for which you're grateful.

GIVE YOUR DAY EAT (EQUAL AIR TIME)

I want to remind you that it is normal for our brain to focus on the negative things that happen during our day. Our brain is trying to protect us and therefore looks for anything harmful or dangerous. Have you ever noticed how you could take great care of 19 patients, but the one patient with a bad interaction, that maybe even isn't your fault, will cause you to feel failure for your whole day? You forget about the 19 good patient interactions and spend the next many hours ruminating on what you could've done differently or what you should've said. That is a normal function of our brain, and on average, 85% of our thoughts every day are negative. So this is where we start to rewire and bring our brain back towards 50/50. That's what I call equal air time. Equal positive, equal negative. Your brain will automatically want to only think about that one negative interaction, so at first, you are going to have to actively think about the good you did during the day. Write it down. Remind your brain. Rewire your brain to remember the positive things so that next time it will offer them up quickly. We want our brains to easily offer up, "What went well today?" Remember, our brain is going to look for evidence of the thoughts that we believe. Focusing on gratitude takes practice, but this will help you if you are one of the people who beat yourself up at the end of the day. If you tend to think, "I feel exhausted. I am overwhelmed. I'm wiped out. This day was awful." Those thoughts are going to help your brain look for adverse events. Make sure you give "equal air time" to the good things that went well during the day, and the positive feelings will come along as well. Sometimes the good, nice things that people do for us throughout the day are small. Maybe a patient hugged you. Maybe your partner switched call for you. Maybe you got home, and your kids had cleaned the kitchen. These are not significant events, and if not brought to your brain's attention, they may just have slipped through the cracks. But what happens is if you start to bring them consciously and actively to your brain's attention, your brain will remember. So the next time you start to think you had an awful day, your brain will be able to remember all of the small but nice things that happened. It will have evidence to the contrary. Now I'm not going to BS you and tell you that this can turn an awful day into “I had a perfect day with absolution no problems” but maybe a compromise. "Today my job was OK and I have good kids." Make sense?

Talk to you soon, bye.

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The Neuroscience of Gratitude

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