Anusha Shivji - Medical Student expresses the importance of gratitude journaling as a self care tool for mental health management.
As a medical student, I am always being advised to look after my mental health. However, this is highly challenging. As would be expected, there is no defined time limit in a day anyone should spend on direct mental health self-care or indirect self-care activities (e.g. socialising). Further, I have also found it can be hard to prioritise mental health well-being and keep up with the ever- growing amount of work I have. Indeed, I have explored multiple activities to try and maintain good mental health such as talking to others, reading for enjoyment and playing hockey, to socialise with others but also give me the opportunity to clear my mind of the pressures of life and work. However, one strategy I have found has worked well for me has been gratitude journaling, which I am going to reflect on. I am going to do this through my own personal experience and reading about the benefits, such as physical health and improvements in psychological wellbeing.
What is Gratitude?
Gratitude is defined as ‘the feeling of appreciation for benefits of life’ (Bono and Sender, 2018). I started gratitude journaling at what I considered a key pivotal moment in my life. Initially when I started, I was feeling worried and quite upset moving from sixth form to university, as this has been much more difficult than I originally anticipated. I tried gratitude journaling as I thought that by reflecting on things that I was grateful for each day, it would help me to stay positive and be able to look back on my good memories fondly without spending a long-time daily writing. I started sporadically gratitude journaling in November 2022 but struggled to continue with it. Upon reflection, I think this is because I did not like the template I had originally chosen. In January 2023, I downloaded a new template which guided me to write five things I was grateful for, a daily affirmation and five good things that had happened that day. I found this structure much more stimulating and enjoyable to fill out. However, I found writing a journal of every single thought and feeling is not plausible for me, given the pressure of studying and living a balanced life. Further, I have always struggled with my organisation and time management skills, something which when I entered medical school was only exacerbated, despite these skills developing as I passed throughout school. However, on hard days, gratitude journaling has helped me to find the good aspects and encouraged me to stay positive. Indeed, challenges have persisted in maintaining a positive work-life balance and to deal with the unexpected worry of not finding my good friends instantly despite gratitude journaling.
Overall gratitude journaling helped me to improve my mood, especially at the end of each day when I sit down to do it, rather than completely allowing me to forget my worries. This has helped me with sleeping as I do not go to bed fully thinking a day has been completely awful, but rather allows me to develop a balanced understanding of the outcomes of my day.
Research on Gratitude Journaling:
To support my understanding of the area I read a study on the effects of gratitude journaling on sleep quality (Jackowska et al., 2016). The study compared two groups, one being an active control and the other gratitude journaling in 119 women with no treatments in place. The results showed that there was an increase in sleep quality amongst other aspects such as a decrease in diastolic blood pressure for the gratitude journaling subjects. Furthermore, another study about the effects of gratitude journaling on heart failure (Boggiss et al., 2020), where 70 patients with a mean age of approximately 66 years old were placed in either a group undergoing normal treatment for heart failure or an 8-week gratitude journaling arm showed that whilst gratitude journaling is not a treatment for heart disease, it may lead to reduced inflammation. This was important to me as I have a family history of cardiovascular disease, including the passing of my grandfather in December from heart failure. Further this study suggests gratitude journaling might help to reduce my stress levels which could in turn lead to reduced inflammation and subsequently lower my risk of developing heart disease long-term.
In addition, I have also seen that gratitude journaling has had a significant impact on my psychological wellbeing. It has been reported that mental health issues are prevalent in healthcare professionals (Saragih et al., 2021). The authors suggested a reason for this is that every day healthcare professionals experience difficult situations such as not being able to save a patient or not being able to find a cause for a patient’s symptoms. This in turn may be heavily impacting their day-to-day lives and leave a healthcare professional feeling powerless. As a future doctor, I am concerned about how I will deal with seeing and experiencing such difficult things and whilst I understand that support exists that I can readily access, I am worried about aspects that may weigh heavily on my mind and impact my day-to-day life outside of working. Further, a study that I found really interesting and relevant to me, given I will be a future healthcare professional (Ko et al., 2021), looked at nurses’ gratitude journaling whilst working during the COVID-19 pandemic. A total of 128 students were involved in the study and 53 reflective essays were analysed. One of the particular comments made by a nurse really stood out to me as they thought that as a result of gratitude journaling, their perspective had changed from having a pessimistic outlook of life to becoming more positive. This resonated with me as I am mainly a positive person, but sometimes in difficult situations I will only consider the negative aspects.
In conclusion, after researching more about gratitude journaling, I think even more positively about it. I think that gratitude journaling helps you to evaluate our day-to-day lives and to draw out the positives in our day. This is something that has been important for me to reflect on as I have transitioned into a new environment with new experiences, as well as working within the healthcare system. I have found that gratitude journaling can have potential benefits on sleep quality, cardiovascular health and improving psychological wellbeing. This has helped me to realise gratitude journaling is something I will continue with long-term, as it makes me feel hopeful for the next day and reminisce on my good memories. However, my early research into the area has made me realise that gratitude journaling does not maintain good mental health on its own, but rather works best alongside other direct and indirect self-care strategies, as evidenced for me earlier. I have found that engaging in these other mental health strategies makes it easier for me to reflect on what I am grateful for especially during stressful periods such as examinations. Whilst engaging in all of these strategies together, I have found these have been when I have had my most positive moments at university and that one of the highlights of my day is coming back to my room and writing about all the good moments of my day and the little things that I am grateful for. It can be difficult at times, but I think that with building my resilience further and by trying to maintain a positive mind-set I can succeed.
Written by Anusha Shivji - Medical Student
References:
Boggiss, A.L, Consedine, N.S., Brenton-Peters, J.M., Hofman, P.L., Serlachius, A.S. (2020), 'A systematic review of gratitude interventions: Effects on physical health and health behaviours', Journal of Psychosomatic Research, Volume 135, Available at: https://doi.org/10.1016/j.jpsychores.2020.110165
Bono, G. , Sender, J.T. (2018) 'How gratitude connects humans to the best of themselves and in others', Research in human development, Volume 15, pp.224-237. Available at: https://doi.org/10.1080/15427609.2018.1499350
Jackowska, M., Brown, J., Ronaldson, A., Steptoe, A. (2016) 'The impact of a brief gratitude intervention on subjective well-being, biology and sleep', Journal of Health Psychology, Volume 21, pp. 2207-2217. Available at: 10.1177/1359105315572455
Ko, H., Kim, S., Kim, E. (2021) 'Nursing Students' Experiences of Gratitude Journaling during the COVID-19 Pandemic', MDPI, Volume 9, Issue 11, Available at: https://doi.org/10.3390/healthcare9111473
Saragih, I.D., Tonapa, S.I., Saragih, I.S., Advani, S., Batubara, S.O., Suarilah, I., Lin, C-J., (2021) 'Global prevalence of mental health problems among healthcare workers during the Covid-19 pandemic: A systematic review and meta-analysis', International journal of nursing studies, Volume 121, Available at: https://doi.org/10.1016/j.ijnurstu.2021.104002