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The

Gratitude Toolkit Let’s cultivate our culture!

Introduction This toolkit is based on the science of gratitude and supporting insights from neuroscience and positive psychology. By putting it into practice, you will further your awareness of the health and well-being benefits associated with gratitude and kindness. WHAT IS WAMBI? Using patient-driven recognition alongside peers and leaders, Wambi helps organizations engage all stakeholders impacting patient experience and driving employee engagement. This creates transparency and actionable insights, driving kindness in each interaction. With Wambi, you can cultivate a workplace culture centered on gratitude, high performance, and compassionate care.

Leverage these tools to reflect and practice gratitude. You can complete exercises individually or as part of a team — try it during your next shift huddle, staff meeting, or break!

A SPECIAL ACKNOWLEDGEMENT TO LINDA ROSZAK BURTON. This toolkit is an adaptation from Gratitude Heals: A Workbook for Supporting Healthcare in the COVID-19 Crisis.

Defining Gratitude According to Roszak Burton (2020), gratitude has been defined as a strength, a memory of the heart, a pathway to greater health and well-being, and the parent of all virtues. Living gratefully has been linked to a stronger bond with your local communities, more satisfying relationships, and greater resilience in the face of adversity and trauma. It is a sense of abundance. Research shows regularly reflecting and expressing gratitude leads to a stronger immune system, reduced symptoms of depression and anxiety, better sleep, and even faster recovery from Post-Traumatic Stress Disorder (PTSD). It gives you hope, strength, energy, wisdom, and the serenity to meet life's many challenges of grief, anxiety, depression, loneliness, and fear. Building a discipline of gratitude takes commitment and is cultivated over time. Thanks to your brain's neuroplasticity, practicing gratitude will strengthen existing brain pathways and create new ones! Keep in mind that gratitude is not indebtedness. If you feel beholden to someone who has done something for you, the benefits of gratitude are stifled. And finally, gratitude is never about comparing what you have versus what someone else does not. We each have our own perspective of gratitude. How do you define it? Start with this exercise.

EXERCISE

MY DEFINITION OF GRATITUDE

How do you define gratitude?

Explain how you are a grateful person.

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Three Good Things In times of extremely disruptive and uncertain events like the COVID-19 pandemic, it may feel like practicing gratitude is unachievable. Thinking about what you’re grateful for may lead to guilt, especially since 80% of one study’s research participants cited their health and the health of family members as the number one reason for feeling grateful amid the pandemic. Having a grateful perspective on life can help you cope and build greater personal resilience. Resilience is defined as a commitment to finding purpose in whatever’s happening, believing in your ability to create a positive outcome, and being better prepared for the inevitable setbacks that occur. If you find it hard to practice gratitude during this crisis, start with a simple reflective practice of My Three Good Things. Capture three good things over the past 24 hours: they can be positive interactions, positive emotions, and positive thoughts. Write them down and explain why you think this. Do this each day for two weeks to build a routine, perhaps in the morning or at bedtime. If you miss a day, it is OK, try again the next day. You may want to find a friend/family member as a partner who can do this with you.

EXERCISE

MY THREE GOOD THINGS TODAY

1.

Today is a good day!

2. 3. Wambi.org

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The Heliotropic Effects of Gratitude Researchers refer to the heliotropic effect of gratitude, which is the tendency of living organisms to move toward the light and away from the dark—toward the positive and away from the negative. Focusing on the good in your life (life-giving energy) through reflecting and expressing gratitude creates greater abundance and well-being and makes you healthier (Emmons & McCullough, 2003).

If you concentrate on finding whatever is good in every situation, you will discover that your life will suddenly be filled with gratitude, a feeling that nurtures the soul. RABBI HAROLD KUSHNER

When feeling grateful is hard amidst COVID-19, think about using a technique called “remembering the bad.” This involves considering a previous time in your life that was difficult. While this may be painful, write down a few key memories. This healing practice helps you turn toward life-giving energy and create a more grateful perspective.

EXERCISE

REFLECTION THROUGH GRATITUDE In hindsight, who and what resources helped you through a difficult time? Perhaps it was a family member, friend, coworker, professor, mentor, or boss. A resource might be a meditation, books, music, videos, or a sermon.

Who? What? Consider difficult challenges you may be facing today and reflect on how you can tap into similar resources.

Who can you reach out to? What is your next step to reach out? What resources can you leverage? Wambi.org

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Gratitude for a Stronger Support System The science of positive psychology is defined as the scientific study of how strengths enable individuals, communities, and institutions to thrive. Just as being fearless is not the absence of fear, positive psychology does not imply the absence of pain and suffering or denying negative events. What’s more, the science defines gratitude as a strength and is considered one of the key strengths for human flourishing. By drawing on this strength and creating an awareness of what is going well in your life, your positive emotions, your positive relationships, and your well-being combine to enable you to truly flourish. Additionally, positive psychology suggests using your strengths in the service of something larger than yourself is the strongest contributor to well-being. No doubt, the meaningfulness of your work during this pandemic has called upon all your strengths. What strengths have you noticed about yourself? A recent article Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic (JAMA, 2020) noted: “the importance of simple and genuine expressions of gratitude for the commitment of health care professionals and their willingness to put themselves in harm’s way for patients and colleagues cannot be overstated.” Leaders are called on to express gratitude to help overcome the negative impact of these enormously challenging clinical environments.

EXERCISE

RECOGNIZE A COLLEAGUE OR COWORKER

Identify a colleague or coworker that you would like to recognize for his/her/their strengths and contributions.

Express your gratitude for your colleague/coworker by using one of these three options: a. Send a free Carepostcard or Award through Carepostcard.com. b. Craft a note of gratitude to share with this person (see page 8 for help).

After you do this, journal about the person’s reaction and how this made you feel.

4x/MO: PRACTICE MAKES PERFECT! Hardwire your recognition of colleagues/coworkers.

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The Healing Benefits of Gratitude

As human beings, part of our job is to be able to recognize what causes us pain, to work toward healing, and to learn how to live in the world with empathy, forgiveness, and gratitude.

There is no timeline for how long it can take to heal from the adversities DIANA BUTLER BASS you have experienced from living through and experiencing the pain and suffering brought on by the COVID-19 pandemic. Practicing gratitude to help process this difficult experience is not to deny the negative events. What is clear from the research is how gratitude offers a less negative impact on emotional health and a greater ability, mentally, to bring some closure. Thinking with gratitude can help promote the healing of troubled memories that arise from your negative experiences. Also, gratitude leads to a protective response in the body. Think of expressing gratitude as a technique to block the release of the stress hormone, cortisol. Studies have shown gratitude stimulates the release of oxytocin, a neurochemical that blocks the release of cortisol (Emmons, 2007). Additionally, expressing gratitude activates the parasympathetic nervous system (calming part of the nervous system.) In doing so, you can achieve many positive health benefits, including a better quality and duration of sleep, lower blood pressure, and a stronger immune system (Wood, Joseph, Lloyd, & Atkins, 2009). Your gratitude practice may need to start with a very small step of reflection. Use a “trigger”, such as washing your hands, as your mental cue to think about something that you are grateful for. Next time you are washing your hands (or whatever your new gratitude trigger is), practice gratitude, and reflect on something that you are grateful for. Name the positive emotions you feel and capture the reflection in the exercise below.

EXERCISE

QUICK REFLECTIONS OF GRATITUDE Be sure to identify your new gratitude trigger. For each reflection:

What/who are you grateful for?

Did the person, experience, or situation bring you comfort or peace?

How did this reflection make you feel?

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Acts of Receiving Gratitude

Forget injuries. Never forget kindness. CONFUCIUS

Gratitude is linked to many benefits across the well-being spectrum, including physical, mental, emotional, and spiritual. Accessing these benefits includes reflecting, expressing, and receiving gratitude. Being on the receiving end of gratitude can sometimes make us feel uncomfortable. You may be quick to dismiss or brush off someone’s grateful thoughts and words with an obligatory “thanks” or “that’s my job.”

It can be helpful to put more attention on your own awareness of other’s gratitude. Research suggests that receiving an expression of gratitude creates a psychological need to reciprocate to someone else, often a third party. When someone does something nice for you, you do something nice in return, this is better known as a “pay it forward” response to an act of kindness or thoughtfulness. Because these benefits are crucial to good teamwork, it’s especially worth reflecting on the meaningful nature of a coworker’s expression of gratitude during this time of high stress and anxiety. The next time someone expresses gratitude to you for something you’ve done, fight the urge to deflect the expression. Additionally, brain scans show that being grateful activates regions of the brain associated with improving psychological well-being, connecting with others, and taking their perspective. With these pro-social benefits, you’re more likely to want to help others, leading to stronger emotional well-being for all (Fox, Kaplan, Damasio, & Damasio, 2015).

EXERCISE

WHEN SOMEONE SAYS THANK YOU... How did it make you feel?

How did you benefit by receiving this message of gratitude?

What does this experience say about the person expressing gratitude toward you?

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Gratitude: A Link to Stronger Mental Health No one is immune to the trauma, grief, and human suffering brought on by the COVID-19 pandemic. The gratitude exercises in this workbook are designed to help you continue to build your reserve of resilience: a personal ability that enables you to rebound and recover from the inevitable negative impact of this crisis. Now consider gratitude, with its immense power to restore, rejuvenate, and heal—serving as a pathway to greater emotional and mental well-being throughout all areas of your life. Gratitude is one of the strongest links to mental health, more than optimism, hope, or compassion. Research demonstrates a strong link between practicing gratitude and improved mental health, including lower levels of depression and anxiety and a reduced risk of substance abuse disorders (Petrocchi & Couyoumdjian, 2016). Keep in mind that practicing gratitude is much more than merely feeling thankful. Gratitude reflections and expressions about what’s good in life contribute to both your and other’s overall health and well-being. And yet, your brain’s built-in negativity bias often causes negative emotions to affect you significantly more than the positive. Negative emotions are more powerful, contagious, and long-lasting—setting up what researchers refer to as a downward spiral of negativity with potentially damaging impact on physical, emotional, and mental well-being. Writing a letter of gratitude to someone who has made a difference in your life is one of the most recommended and meaningful activities to promote healing and well-being. Multiple studies have shown this practice technique to support post-traumatic growth following traumatic experiences, reduce feelings of hopelessness, and increase levels of optimism.

EXERCISE

A LETTER OF GRATITUDE Who comes to mind as someone who has made a difference in your life? Why?

Schedule a gratitude call with this person in the next week and plan to read your letter. (If they’re no longer living, read your letter to someone who truly knew this person or someone close to you). The Gratitude Letter Template can be found on page 8.

What was the recipient’s reaction?

How did this make you feel? Wambi.org Page 7

Let’s Write a Letter!

Writing a letter of gratitude to someone who has made a difference in your life is one of the most recommended and meaningful activities in practicing gratitude.

Identify an individual in your life for whom you are grateful.

Name Describe why you are grateful.

Describe specifically how you have benefitted.

Describe specifically why this was meaningful.

Thank them for allowing you to share your gratitude with them. There is a gratitude circuit in your brain, badly in need of a workout. Strengthening that circuit brings the power to elevate your physical and mental health, boost happiness, and help you feel more connected to other people.

ALEX KORB

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Additional Resources For more information on Wambi, visit:

wambi.org HELPFUL WEBSITES

u DRW, Inc.: https://www.drwcoaching.com/gratitude-resources/ u Greater Good Science Center at UC Berkeley: https://greatergood.berkeley.edu/ u Greater Good in Action: https://ggia.berkeley.edu/ u Access Insight MD: https://accessinsightmd.com/ u PeopleTweaker: https://peopletweaker.com/ u HeartMath Institute: www.heartmath.org u Gratefulness: www.gratefulness.org u Authentic Happiness: www.authentichappiness.sas.upenn.edu/home u The Positive Psychology Center: https://ppc.sas.upenn.edu/ u Positive Psychology Center, Univ of Penn: https://ppc.sas.upenn.edu/ u Discovering the Health and Well-Being Benefits of Gratitude: http://www.whartonhealthcare.org/discovering_the_health u The Neuroscience of Gratitude: http://www.whartonhealthcare.org/the_neuroscience_of_gratitude

Click these links to learn more!

ASSESSMENTS AND TOOLKITS u For a variety of positive psychology assessments, go to Authentic Happiness: www.authentichappiness.sas.upenn.edu/home - VIA Character Strengths: https://www.authentichappiness.sas.upenn.edu/home u Gratitude Quiz: https://greatergood.berkeley.edu/quizzes/take_quiz/gratitude u The Gratitude Questionnaire (GQ-6): http://www.psy.miami.edu/faculty/mmccullough/gratitude/GQ-6-scoring-interp.pdf

BOOKS u Gratitude Heals ~ A Journal for Inspiration and Guidance by Linda Roszak Burton u Thanks: How Practicing Gratitude Can Make You Happier by Robert A. Emmons u The Little Book of Gratitude: Create a Life of Happiness and Well-Being by Giving Thanks by Robert A. Emmons u Gratitude Works! A 21-Day Program for Creating Emotional Prosperity by Robert A. Emmons u Be Less Stressed by Z. Colette Edwards, MD, MBA, aka “The Insight Doctor” u Buddha’s Brain—The Practical Neuroscience of Happiness, Love & Wisdom by Rick Hanson u Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life by Jon Kabat-Zinn u The How of Happiness—A New Approach to Getting the Life You Want by Sonja Lyubomirsky u The Gratitude Diaries by Janice Kaplan u Gratitude by Oliver Sacks u Grateful: The Transformative Power of Giving Thanks by Diana Butler Bass

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Additional Resources GRATITUDE VIDEOS/REFLECTIONS u A Gratitude Reflection—Guided Meditation, Linda Roszak Burton: https://www.drwcoaching.com/gratitude-resources/ u A Meditation on Gratitude—Guided Meditation, Deepak Chopra: https://www.sonima.com/meditation/meditation-on-gratitude/ u Gratitude Revealed: https://movingart.com/gratitude-revealed

RESOURCES u Sexton, J. B., & Adair, K. C. (2019). Forty-five good things: a prospective pilot study of the Three Good Things well-being intervention in the USA for healthcare worker emotional exhaustion, depression, work-life balance and happiness. British Medical Journal Open, 9(3). doi: 10.1136/bmjopen-2018-022695. u 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. https://doi.org/10.1037/0022-3514.84.2.377. u Shanafelt, T., Ripp, J., & Trockel, M. (2020). Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA. https://doi.org/10.1001/jama.2020.5893. u Patel, J., & Patel, P. (2019). Consequences of Repression of Emotion: Physical Health, Mental Health and General Well Being. International Journal of Psychotherapy Practice and Research, 1(3), 16–21. doi: 10.14302/ issn.2574-612x.ijpr-18-2564. u Emmons, R. A. (2008). Thanks!: How practicing gratitude can make you happier. Houghton Mifflin Harcourt. u 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. https://doi.org/10.1016/j.jpsychores.2008.09.002. u Fox, G. R., Kaplan, J., Damasio, H., & Damasio, A. (2015). Neural correlates of gratitude. Frontiers in Psychology, 6. https://doi.org/10.3389/fpsyg.2015.01491. u Petrocchi, N., & Couyoumdjian, A. (2015). The impact of gratitude on depression and anxiety: The mediating role of criticizing, attacking, and reassuring the self. Self and Identity, 15(2), 191- 205. https://doi.org/10.1080/15298868.2015.1095794. u Roszak Burton, L. (2020). The Neuroscience and Positive Impact of Gratitude in the Workplace. The Journal of Medical Practice Management. 35(4) 215-218. https://www.physicianleaders.org/.

Special thanks to Linda Roszak Burton

www.drwcoaching.com Gratitude Heals™ Supporting Healthcare in a COVID-19 Crisis, Gratitude Heals and img4 are trademarks, or service marks of I Am Grateful For, LLC ("LLC"), and may not be used without the express written permission of Linda Roszak Burton ([email protected]).

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