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When we experience disappointment or sadness, we’re often told to be grateful for what we have. Gratitude is a powerful sentiment, and combining gratitude with expressive writing through gratitude journaling is an asset to overall health and wellness for both clinical and non-clinical populations. Gratitude exercises can improve physiological health in that practicing gratitude can significantly improve sleep quality, reduce the concentration of biomarkers for stress and inflammation, and reduce both anxiety and depression. Furthermore, written expressions of gratitude have been shown to reduce aggression and increase optimism and resilience.

These qualities of resilience, optimism, and quality sleep are imperative to the success of individuals who experience chronic pain, and contemporary studies demonstrate that gratitude journaling poses similar health benefits and many more pain-specific benefits to improve chronic pain management.

Gratitude journaling and the chronic pain cycle

A 2019 study on the effect of gratitude journaling on managing pain and disability for adults with arthritis hypothesized that brief, self-directed gratitude journaling would effectively reduce fear of movement, pain self-efficacy, and pain anxiety. Fear of movement is a common grievance among chronic pain patients and is especially profound in individuals who suffer from chronic pain due to an accident or injury. Pain anxiety is another prevalent comorbidity in chronic pain patients, as the expectation of pain can be all-consuming.

A separate survey revealed that over 90 percent of chronic pain patients experience pain anxiety. Furthermore, pain self-efficacy refers to confidence that one can function effectively in pain and is an important predictor of overall success in individuals with chronic pain. In the study, participants’ baseline levels of fear of movement, pain self-efficacy, and pain anxiety were assessed using the Tampa Scale of Kinesiophobia (TSK), Pain Self-Efficacy Questionnaire (PSEQ), and Pain Anxiety Symptoms Scale (PASS), respectively. Participants completed a four-week online gratitude journaling program where they engaged in gratitude journaling for roughly 20-30 minutes daily and retook the TSK, PSEQ, and PASS.

After engaging in the gratitude journaling program, participants showed significant improvements in fear of movement, pain self-efficacy, and pain anxiety (Swain et al., 2019). The implications of these findings are especially rich, given the direct relevance of the variables studied. Fear of movement, pain self-efficacy, and pain anxiety can synergize to create an extremely harmful cycle for individuals who experience chronic pain. This is because a profound fear of movement can create a decreased sense of pain self-efficacy, creating more pain anxiety, and the cycle repeats. Gratitude journaling shows promise as an accessible non-pharmacological therapy with the potential to interrupt this chronic pain cycle.

Gratitude promotes flourishing and an abundance mindset for chronic pain patients.

A study on the effect of daily journaling on chronic pain symptoms in older adults identified an important link between fluctuating daily levels of gratitude and reported levels of pain, fatigue, and positive or negative affect. Researchers analyzed the content of daily journal entries written by individuals with chronic pain and specifically screened for language indicating gratitude. The findings of this study suggest that when daily gratitude is lower than average, individuals with chronic pain report more pain, fatigue, and negative affect. Furthermore, the content analysis showed that specific variables related to an overall sense of gratitude were associated with sleep quality, flourishing, and reported pain levels.

Quality sleep is imperative for the success of any patient who experiences chronic pain, and the aforementioned research also suggests that possessing a sense of abundance was significantly associated with less reported pain and better sleep quality. A sense of abundance, for example, could be reflected in a patient’s feeling of having choices or options and seeing the potential within themselves or others to achieve and progress. It can be very difficult for individuals with chronic pain to feel a sense of abundance, considering the burden of disease on choices and opportunities. Although ruminating on the choices or opportunities a disease has stolen can be tempting, recreating a sense of abundance through gratitude journaling is possible and poses undeniable benefits.

Tips for successful gratitude journaling

To reap the most benefits from gratitude journaling, experts recommend aiming for depth, not breadth: a few sentences about a meaningful card you received or a person you’re thankful for will be much more efficacious than a long superficial list. Experts also suggest reflecting on what life would be like without certain blessings in journal entries to practice gratitude organically. For an individual with chronic pain, this could be an ode to their heating pad or an entry about a caregiver they appreciate. Lastly, savor surprises! Journaling about surprise events, like receiving flowers from a loved one or achieving an unexpected goal at physical therapy, tend to elicit stronger gratitude responses than routine events.

Summing it up

Gratitude journaling is an easy, effective way for individuals with chronic pain to interrupt the chronic pain cycle and build a sense of abundance that leads to positive health outcomes.