Crozet Annals of Medicine: Gratia, Grazie, Gracias, Grace, Grateful


The holiday season is upon us and I am grateful. Although the weather has turned cold and the nights are longer, I have a warm house and plenty of food, and family to share it with. Soon the Christmas cards will start arriving and each one will trigger a smile and a remembrance. I always vow to respond in kind but I am not a diligent correspondent. But I should be. The health benefits of gratitude go hand in hand with the pleasure others get from receiving a note. There is a lot of science behind this. 

In 2005 researcher Martin Seligman performed a landmark study of interventions to increase personal happiness. He and his colleagues studied six different interventions in over 400 people. The first was a placebo; participants were asked to write about their early memories every night for one week. This actually boosted happiness in a measurable way that lasted for about a week and then returned to baseline.

Two of the interventions focused on visualizing the positive things in one’s life. These boosted happiness above placebo and lasted for at least six months. 

Another two of the interventions focused on visualizing personal strengths and using them in daily situations. These interventions had a similar modest bump in personal happiness that lasted at least six months.

The last intervention centered on gratitude; Participants were given one week to write and then deliver a letter of gratitude in person to someone who had been especially kind to them but had never been properly thanked. This intervention increased the subjects’ happiness by the most of any of the interventions, essentially doubling it. This benefit slowly faded over time and by six months the subjects’ happiness had returned to their baseline state. I guess you have to keep writing letters. 

Writing unsolicited letters of gratitude may feel awkward and unwelcome to many people, but this too has been studied with positive results. 

In 2018, researchers asked a group of 100 participants to write letters of gratitude to someone whom they were thankful for, like a friend or teacher. The gratitude letters took less than five minutes to write.

Participants were then asked to rate how surprised, happy, and awkward they predicted the participant would feel. And finally, the recipients were asked to assess how the letter actually made them feel.

It turns out the note writers greatly overestimated how awkward recipients would feel, and they greatly underestimated the positive effects they would have. Many said they were “ecstatic,” scoring the happiness rating at 4 of 5. The senders typically guessed that they’d evoke a 3.

I tried this recently, writing to one of my former residents to respond to her Christmas card of last year. Like I said, I am not a diligent correspondent. She was an ER nurse before becoming a doctor and so she has a cynical and snarky sense of humor that meshed well with my own. I mentioned that I missed our banter and told her that I thought her humor was protective for her from burnout. 

She wrote me back with a lovely letter of gratitude for all the small things I had taught her, some of which she listed. Happiness rating 5!

Maybe this holiday season, in addition to Christmas cards and yearly newsletters you could find 5 minutes to write a letter to someone you owe a debt of gratitude to. I know I have a lot more letters I could write. 


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