gratitude

Gratitude when you’re in pain? You’ve got to be kidding!


ResearchBlogging.orgOr – introducing the “parent of all virtues” (Wood, Joseph & Linley, 2007).

For some time now I’ve been exploring the contribution of positive psychology on wellbeing in people with chronic pain.  Positive psychology is the ” scientific study of the strengths and virtues that enable individuals and communities to thrive”. (Seligman, ND). It strikes me that in chronic pain management, we’ve responded to the issues raised by people who don’t “live well” with their pain, leaving the group of people who do cope well largely ignored. We have much to learn, I believe, from those who have faced their situation and either been stoic – or in a surprising number, grown from their experiences.  Some excellent resources in the field of positive psychology in general can be found at The Positive Psychology Center and Authentic Happiness, and for Kiwi’s, the New Zealand Association of Positive Psychology.

Gratitude is an emotion that most people feel frequently and strongly (McCullough et al., 2002).  Most people say that feeling grateful makes them feel happy. And oddly enough, gratitude seems to emerge despite difficult circumstances – with some research suggesting that it is in times of intense personal challenge that gratitude is most prominent (Peterson & Seligman, 2003). Immediately after the earthquakes in Christchurch nearly a year ago, people frequently expressed gratitude for one another, for the workers who kept the city running, and for the simple things in life like water, shelter and social support.

The question then arises – is experiencing gratitude empirically related to psychological wellbeing? And the answer is, not unexpectedly, yes! One study showed that gratitude was associated with wellbeing more than the “big five” personality model (Wood, Joseph and Maltby, 2009). It appears that gratitude influences wellbeing in two ways: “directly, as a causal agent of well-being; and indirectly, as a means of buffering against negative states and emotions.” (Nelson, 2009).

The next question is – can we influence wellbeing by increasing gratitude? And so far, research seems to support it.  For instance, in Catherine Nelson’s 2009 review of gratitude interventions, she cites studies in which one group of participants were asked to write down five things they were grateful for each week over 10 weeks, while two other groups were asked to carry this out daily either for two weeks or three weeks. At the completion of the study, it was found that positive affect was increased, and that there appeared to be a dose-response effect. In other words, the more often gratitude was expressed, and the longer this was carried out, the more positively people felt (Emmons & McCullough,
2003).

Interestingly, although we think of gratitude as having an effect on emotion, expressing gratitude can have a direct influence on “physiological coherence”.  This is “increased synchronization between the two branches of the ANS, a shift in autonomic balance toward increased parasympathetic activity, increased heart-brain synchronization, increased vascular resonance, and entrainment between diverse physiological oscillatory systems. The coherent mode is reflected by a smooth, sine wave-like pattern in the heart rhythms (heart rhythm coherence) and a narrow-band, high-amplitude peak in the low frequency range of the HRV power spectrum, at a frequency of about 0.1 hertz.”(McCraty & Atkinson, 2003). What this means is that by expressing gratitude, we may be improving our physiological response to life events.

How do we introduce the idea of expressing gratitude when life is difficult? – for this part of my post today, I’m using my approach, because I haven’t yet found research that identifies “the best way” to do it!

My way is to begin with some mindfulness. Sitting with the person and asking them to be present with what is happening right now. This can be done through focusing the mind on breathing, really experiencing the sensations that occur while breathing – the rise and fall of the abdomen, the cool air in the nostrils when breathing in, the warmer air when breathing out, the heart beat, the weight of the body pressing against the surface of the chair or support, the warmth of hands on lap.

I then ask the person to think of something that they appreciate right then and there. I might say “What comes to mind when you think of something you’re grateful for right now.” If they seem stumped, I might suggest that they express appreciation for being able to breathe; or being able to hear – and I might guide them to sounds of nature; or having a chair to sit on – and I might guide them to experience the sensation of being supported by the chair.

I try to guide the person to identify at least four or five things they appreciate then and there, so they can experience what it feels like to mindfully notice the good that is around them, and to notice the emotions that arise from doing so.

Ongoing practice I then give people is to write down three things they appreciate or are grateful for at the end of each day just before going to sleep.  Research has shown that doing this can influence sleep quality (Wood, Joseph, Lloyd & Atkins, 2009).

So, here’s a thought: what about trying this strategy out for yourself? It’s easy, quick and has some surprising results. Let me know how it works for you.

Emmons, R.A. & McCullough, M.E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377–389.

McCraty, R. & Atkinson, M. (2003). Psychophysiological coherence. Boulder Creek, CA: HeartMath Research Center, Institude of HeartMath, Publication No. 03-016.

Nelson, C. (2009). Appreciating gratitude: Can gratitude be used as a psychological intervention to improve individual well-being? Counselling Psychology Review, 24(3-4), 38-50.

Wood, A., Joseph, S., & Linley, A. (2007). Gratitude – Parent of all virtues. The Psychologist, 20(1), 18-21.

Wood, A. M., Joseph, S., Lloyd, J., & Atkins, S. (2009). Gratitude influences sleep through the mechanism of pre-sleep cognitions. Journal of Psychosomatic Research, 66(1), 43-48.

Wood, A. M., Joseph, S., & Maltby, J. (2009). Gratitude predicts psychological well-being above the Big Five facets. Personality and Individual Differences, 46(4), 443-447.
A Wood,, S Joseph, & A. Linley (2007). Gratitude – Parent of all virtues The Psychologist, 20 (1), 18-21

Quick update from earthquake city


The aftershocks seem to have slowed a little, and they are not as powerful so hopefully things will settle down a bit. We still don’t have water, so we’re having to use our emergency stash (60 litres!) and boil it to wash, do dishes etc. Even when the water comes back on, we’ve been advised to boil the water again because there’s damage to the sewers.
I feel OK in myself, in that I’m not fearful of the quakes (a bit fatalistic really, but there is so little time to react when a quake hits, there seems little point in being afraid – you can’t do anything!), but I am very tired and not sleeping all that well.
I think the difference for people in Christchurch now, compared with the previous two big earthquakes is that the adrenaline rush that was there last time hasn’t been available this time. There’s less energy reserve to draw upon and the daily hassles of dodging potholes and cleaning up liquefaction and working out which shops are still open and where they’ve relocated to – all of that practical ‘stuff’ that is usually there in the background – these things take cognitive effort. Routines and habits make life easier, mean the brain can be freed for more important things. For me anyway, the routines and habits are disrupted and require thinking and planning and time.
I ask myself how are these changes I’m working through any different from the sort of changes in “how to do” that a person with disability needs to make? How often do clinicians forget that doing things “differently” takes mental effort – and in pain management, we’re often asking people to do almost everything in life “differently”. No wonder there are times when people who have limited resource to draw on (maybe fewer social supports, fewer original habits and routines, mental health problems, less flexibility in the ways they are able to view their world) struggle to cope with the demands of both a pain problem (which already makes demands on them) AND our suggestions for change!

I’m off to work shortly, to work with a group of people who have chronic pain and who have been incredibly courageous in wanting to keep going with the last week of their programme despite the earthquake. They were given the choice to stop, to defer the programme and return again, but they chose to stay. That is strength and resilience folks. I am so lucky to work in this field, with the team and patients I work with.

Wobbles in the Quakey Isles


By now, if you’re a regular reader of my blog, you’ll know that I’m from Christchurch, NZ, and yes, we’ve had a few earthquakes recently! I’m happy to report that while we’ve had some more damage to the surrounds of our house, and there are a few more cracks in the ceiling and bricks, we’re pretty well off. No serious damage done except a rather disrupted night!
My nerves are a bit frayed and I keep monitoring any deep rumbling sound or rattle of the windows just in case it’s the beginning of another one – and yes, it’s a bit wearing. I’ll keep blogging but will keep the number of posts down, as I have been, just to reduce some of the (internal) pressure I put on myself to post often!
It’s tempting to say something a bit trite like “we’re all tough here” or something but really, it seems to me there is little I can do to change our situation, much to be grateful for, and more reasons to be positive than not. So if being tough is equal to being occasionally grumpy, tearful for a moment or two, laughing often, taking time out, and finding good things to appreciate, then I suppose I’m being tough! This is life, and life can randomly throw challenges as well as delights. That sounds awfully philosophical, but seriously folks – that’s my way of getting through and being OK.

Temporary downtime: Christchurch earthquake aftermath


We’re fine after the earthquake, but things are not back to normal in Christchurch – to give visitors an idea of the damage, here are a couple of shots I took on Saturday morning. I was having a week off work anyway, which is well-timed given the circumstances, and I’ll blog occasionally over this time.
My story: I was fast asleep until about 4.35am on Saturday morning.  The bed started to jiggle, a bit like when Manly Jack gets the leg twitch thing going, but instead of stopping, this became much more violent.  We could both hear crashing, tinkling sounds as things were falling off shelving, and we leaped out of bed to grab a torch and stand in the doorway.  We must have stood there for at least a minute while the house shook and a deep rumble continued.  The power was off, and for a brief moment it was quiet – then another series of shakes and that rumble and dogs barking, birds chirping, more tinkling sounds and I immediately thought of bottles and glasses and ornaments and books falling off shelves.  The shaking stopped and this strange silence emerged, punctuated by dogs barking and people’s voices.  We toured around the house by torchlight – no power, no water, nothing.  After very briefly checking for damage, we headed back to bed, thinking that it would be safest to remain there until light.   We’d packed everything ready to go camping at first light, so much of our usual emergency supply equipment was packed in the garage.  We couldn’t open the garage because it’s electric, and the torch we had was a bit dim, but sufficient for that quick tiki tour.

Our neighbourhood watch was working extremely well – our next-door-neighbour hammered on the door to see if we were OK, and she and the rest of the neighbours were checking the older neighbours next door and across the road.  I tried to text my daughter and my son – the cellphone system wasn’t working very well, but I got a couple of messages through.  I grabbed my ipod – it was pretty funny to have Manly Jack and I both listening to the radio using one set of headphones!  We kept updated via National Radio (hats off to them, fantastic work) until it started to get light.  With no power, no internet (waaah!), no coffee (WAAAH!) and with no water, no sewage, and lots of texts from family members, it was a bit chaotic.

Our place sustained no damage, but TV, bookcase, computer and other heavier things had moved across the floor – I cannot believe nothing broken! It had been so hard to stand up during the quake I felt certain we’d have glass shards and things strewn across the kitchen, but although things had moved, nothing at all was broken.

We headed out at first light to see Manly Jack’s relatives – their place a real mess, the roading had subsided, water mains burst, house has sagged and various cracks throughout the place.  Thankfully my family were fine, no harm, no damage.  And on a beautiful day, sun shining and gorgeous weather, we started to examine the mess and do what we could to help.

“Let us rise up and be thankful, for if we didn’t learn a lot today, at least we learned a little, and if we didn’t learn a little, at least we didn’t get sick, and if we got sick, at least we didn’t die; so, let us all be thankful.” – Buddha

Pre-Christmas gratitude – 5 things I’m grateful for


In these couple of days before Christmas, it’s traditional to review some of the ‘best of’ 2008. It’s been just over a year since I started this blog, and the topic list and readership has grown a whole lot!

What am I grateful for in 2008?

  1. Teamwork – the people I work with are fantastic. You can’t work alone in pain management IMHO,  a team of like-minded people to support you both professionally and personally just can’t be beaten.  I take my hat off to the team at Burwood Pain Management Centre who keep me honest, deflate my ego (gently), cushion my falls, keep me standing and give me inspiration to keep on caring about what I do.
  2. Motivation – using motivational approaches like motivational interviewing to help people make their own choices rather than remaining ambivalent.  Whatever the choice, it’s easier to make changes once you’re moving than remain stuck.  I’m grateful for the sense of freedom that using motivational approaches has given me, and that I’ve been able to apply it in my work.  Now if only it could work with my kids?!
  3. The magic of the interweb – and so many dedicated bloggers. I find it unbelievable that there are so many people who spend time writing intelligent, interesting, provoking and inspiring posts on topics dear to my heart – and it’s all free (provided you can get on the internet).  There are so many topics to choose from, and the quality can be stunning.  I’m not a ‘Web 2.0’ kind of person, and I’m not about to rave about the wonders of interactivity, I’m simply awed at how many people spend time putting up resources so the rest of us can find them. (more…)