The Science Behind Gratitude

[00:00:00] Leah: Oh, hello, Tina.

[00:00:01] Tina: hello, Leah. Thank you for showing up today. I'm so grateful. 

[00:00:04] Leah: I almost didn't.

[00:00:05] Tina: Well, we'll, we'll talk about that. I had to talk you into this one. 

[00:00:08] Leah: I know, you really did. Um, okay, so we're talking about gratitude today. Um, tomorrow is Thanksgiving. I mean, not like actually. We're recording this before then. But yes, if you're listening to this the day it drops, tomorrow is Thanksgiving. And we decided to jump on the gratitude bandwagon.

[00:00:28] Tina: Yeah. Yeah. I thought I was all, you know, like, Oh, look at that. Our episode drops the day before Thanksgiving. We should talk about gratitude, which we haven't done yet. 

[00:00:35] Leah: No, and we were going to record this a while ago, and we've just, life has come up, and so we've put it off, but, yeah, the drop date was always going to be the same.

[00:00:45] Tina: yes, but I didn't realize that this is like, not an original thought. 

[00:00:49] Leah: No, no, there's a, there are a lot of, um, surprisingly, Thanksgiving kind of, uh, brings this out in people, so.

[00:00:59] Tina: Yeah. so.

we're going to talk about gratitude in a. Physical sense, not just psychological sense. 

[00:01:04] Leah: Right, because I think one thing that we're not really reading is, you know, a lot of people are doing like listicles, you know, you see it like on, I don't know, Buzzsprout type things on like, these are ways that you can practice gratitude.

[00:01:17] Tina: And a listicle is basically a list, I mean, it's Google's word for a list. most people don't know what a listicle is. I don't 

think 

it's a search engine optimization tool that is being overused right now. 

[00:01:28] Leah: I'm grateful that you gave that definition. 

yeah. So, so people are, you know, different health websites and stuff are all, you know, they post these things, they post ways of, Um, expressing or practicing gratitude and oh, I didn't even tell you I did a survey on our, on our Instagram. 

[00:01:45] Tina: Oh, I saw something go by 

[00:01:47] Leah: Oh, you did. 

[00:01:48] Tina: yeah, in passing, 

[00:01:49] Leah: because I have I have results from our survey to about gratitude.

But, um, yeah, I don't really see people talking like about the science of it. And so we're going to Delve into it in the shallow end of the pool. I say suppose, right?

[00:02:03] Tina: oh, yeah, because to me, in the grand scheme of things, when I'm talking with people or patients or even thinking about it for myself, my own health, um, some things I don't need as much evidence for, and gratitude would be one of those, like, I don't need to, I don't need an evidence based approach to say gratitude is probably a good idea to practice. In my mind, it's kind of a given. 

[00:02:24] Leah: Well, apparently there is evidence. So there you go

[00:02:27] Tina: know, I know, I file it under proving the obvious, but okay, let's go

[00:02:32] Tina (2): I'm Dr. Tina Kayser, and as Leia likes to say, I'm the science y one. 

[00:02:36] Leah: And I'm Dr. Leia Sherman, and I'm the cancer insider. 

[00:02:40] Tina (2): And we're two naturopathic doctors who practice integrative cancer care. 

[00:02:44] Leah: But we're not your doctors. 

[00:02:46] Tina (2): This is for education, entertainment, and informational purposes only. 

[00:02:50] Leah: Do not apply any of this information without first speaking to your doctor.

[00:02:55] Tina (2): The views and opinions expressed on this podcast by the hosts and their guests are solely their own. 

[00:03:01] Leah: Welcome to the Cancer Pod.

Okay, so I want to kind of talk about first I did a survey to see if our Instagram followers if they practice gratitude 89 percent of them said that they do 

[00:03:32] Tina: they 

practice it. 

[00:03:34] Leah: Well, they have some, some gratitude practice. Yeah. And then I asked, um, how do you practice gratitude?

And I got a bunch of different answers. So should I read them? 

[00:03:44] Tina: Yeah. I'm curious. 

[00:03:45] Leah: Okay. someone said, I thank the angels for watching over me. I think everyone in my medical team, I thank God every morning. And then someone else said, I try to be mindful all year, but November, especially, I follow 30 days of gratitude prompts, which I don't know what that is.

[00:04:02] Tina: There must be something online or an app that prompts you to think about 

[00:04:05] Leah: Gratitude. Yeah, I'm, we should look into that. Um, and then somebody said, sometimes writing in a journal, sometimes just thinking about it and then someone said, I try to live in the now be grateful for the time. I do have. 

[00:04:20] Tina: Nice. 

[00:04:20] Leah: Yeah. And then of course, because of my, of 

my, 

opinions, I asked, do you struggle with practicing gratitude?

And this is my favorite answer. Yes. That was the answer. And I, that was not my answer. I did not answer our own. I did not take our, our questionnaire. I just want you to know. So yeah, somebody said yes. And I appreciate that person because I do too. So, okay. And then here's someone else. Yes, because I teeter between happy to be alive and what the actual QUACK will happen to me next.

Um, someone else said, not really. I use it to bring myself back when I'm feeling particularly salty. 

[00:05:01] Tina: Oh, 

[00:05:02] Leah: um, I'm gonna, you know what, I'm going to be beeping a lot of this stuff out today. So it's going to get a lot of quacks. Someone else said, yes, Some days I just say, QUACK you, cancer, no more.

[00:05:14] Tina: All right. 

[00:05:15] Leah: Um,

[00:05:16] Tina: Yes. Yes. As in they struggle 

[00:05:18] Leah: they struggle with practicing gratitude. 

[00:05:19] Tina: and then that's when they say F you, 

[00:05:21] Leah: F you. F you. Um, yes, especially when I'm in physical pain.

[00:05:28] Tina: Yeah, that makes perfect sense. 

[00:05:30] Leah: And then someone says, sometimes I just outright forget to be grateful, to be honest. Then I realize, and I'm like, Oh, whoops.

[00:05:37] Tina: Well, you know, what's interesting. most of what you're reading You know, I did a cursory review because it's my job to look at the literature, the scientific aspects. So, I went straight to the physical because I'm like, psychologically, gratitude must foster a sense of well being. And sure enough, that is the direction of all the research.

Various ways of expressing gratitude, whether it's verbal or writing or journaling. There's a lot of different studies out there in the psychology world. That said, I came across gratitude is both a state and a trait. So what you're talking about and in your survey is gratitude as a state, as in a state of mind where it's found in individual moments, where you're feeling grateful and you appreciate some moment or positive outcome.

And there's also a trait. they define it as a wider predisposition to notice and appreciate the world in a positive light. Transcribed So, even in the literature they actually differentiate between a state and a trait, where, I mean, I think a trait would also be like, you know, kind of the very optimistic people, right?

So they tend to be always, almost like Pollyanna, but,

[00:06:47] Leah: Well, I think that's where it's like some of my issues with it comes in is that toxic positivity part. 

And I mean, there is that aspect of it. Oh, and I do want to say there were a couple more comments. And one of the comments was about keeping, they keep a gratitude journal. And then someone else says that they practice gratitude by telling their loved ones how grateful that they are that they're in their life.

And I thought that was really nice. 

Um, But, yeah, so, yeah, there's, there's I think a little bit of an overlap with gratitude and toxic positivity.

[00:07:19] Tina: Is that right? 

Okay. Tell me about that. 

[00:07:22] Leah: Yeah, I do think so. Well, no, I mean, it was something that like I encountered in my little research and I didn't delve into it, but I recognize myself. Um, but yeah, and I found that there are three three levels of gratitude. There's the effective trait, which is

There's a mood, which are daily fluctuations in overall gratitude, and then there's an emotion, which is a more temporary feeling of gratitude that one may feel after receiving a gift or a favor from someone. And I recognize that emotion. 

[00:07:54] Tina: Mm hmm. Mm 

[00:07:57] Leah: But, yeah, I feel like that effective trait one, in my mind, borders on a little bit of toxic positivity.

[00:08:06] Tina: Oh, wow. I think we have to talk about what is toxic positivity.

exactly. I mean, I know it when I see it, but I don't know how to really define 

[00:08:15] Leah: I don't even know how to define it. it's almost like being so positive that I'm going to look it up because I know what I want to say, but I don't know how to say it. So hold on, let me look it up.

[00:08:28] Tina: Toxic positivity. It's almost an oxymoron. 

[00:08:33] Leah: well, I'm not going to go by AI's definition. It occurs when encouraging statements are expected to minimize or eliminate painful emotions, creating pressure to be unrealistically optimistic. That's from the Anxiety and Depression Association of America. That's the first definition that popped up in front of me.

Okay. So, um, So gratitude. I read a little, about, Robert Emmons, a professor of psychology at UC Davis, who is the founder and editor in chief of the journal of positive psychology. 

[00:09:03] Tina: Okay. 

[00:09:03] Leah: And his definition of gratitude is recognizing that one has obtained a positive.

outcome and recognizing that there is an external source for this positive outcome. So that could be God, fate, nature, 

[00:09:17] Tina: a person. 

[00:09:18] Leah: a person. Yeah. 

[00:09:20] Tina: Okay. 

[00:09:22] Leah: do you want to know what barriers to gratitude can be? 

[00:09:25] Tina: Yeah. 

[00:09:26] Leah: Okay. So, 

cause I looked it up and I'm going to tell you. 

[00:09:29] Tina: I'm interested. Yes. 

[00:09:31] Leah: so girls and women tend to, um, feel more grateful than boys and men.

And according to this white paper that I was reading from 2008 on the science of gratitude, it could be because, in the U. S. at least, gratitude is associated with weakness or indebtedness. So that could be, you know, an issue with boys or men feeling gratitude, apparently. 

[00:09:54] Tina: what 

[00:09:55] Leah: That's 

what the science, 

[00:09:56] Tina: That's shocking. okay. 

Women feel more in general. Can't we just stop right there? Women feel more 

fill in the blank. 

[00:10:02] Leah: just saying what the paper said, what the first four pages of the paper said. No, um, and then, okay, so then other barriers. include

[00:10:11] Tina: These are going to be surprising, aren't they? Go ahead. Gosh, 

[00:10:14] Leah: envy, materialism, narcissism, and cynicism.

[00:10:21] Tina: I have a lot to learn about psychology. Yes, you 

[00:10:23] Leah: So wait, so, but don't you recognize 

[00:10:25] Tina: Yes, it's true. It's 

[00:10:26] Leah: one of those? I'm such a 

[00:10:27] Tina: that's where you're like, 

[00:10:29] Leah: You don't find me cynical? 

[00:10:31] Tina: Interesting. 

[00:10:32] Leah: I find me cynical. Okay. Okay. So I think that's where it all comes from. that explains it. Yeah. And then social factors that influence gratitude are religion, cultural influences, and parenting styles.

And so it could also be. The way I was raised. Uh huh. Yeah. Yeah, I didn't ask my sister if she practices gratitude, too. That'd be really interesting. 

[00:10:59] Tina: Yes. I 

wonder. 

[00:11:00] Leah: So, for those listening, I don't practice gratitude. Am I grateful for things? I think you made me realize that I am. 

[00:11:09] Tina: had to talk you into it. 

[00:11:10] Leah: You had to talk me into it. You had to, you had to explain to me that yes, Leia, are grateful for things.

[00:11:18] Tina: You just don't, you don't bring it to the forefront of your mind and say, I am super grateful for this moment. 

[00:11:26] Leah: Right?

[00:11:28] Tina: But you do now, you're going to, 

[00:11:30] Leah: Am I? 

[00:11:31] Tina: I think so. 

[00:11:32] Leah: Okay. 

So, um, 

[00:11:34] Tina: it more. 

[00:11:34] Leah: well, 

okay, 

[00:11:38] Tina: we'll see.

[00:11:38] Leah: we'll see.

[00:11:42] Tina: Yeah, I, um, I do have a lot to learn about psychology because I just, to me so much is, I mean, I looked at some of these studies and I really didn't spend a whole lot of time until I, I wanted to look at the physical because I don't know, it's just like, well, yeah, of course you want to, and not to be toxically positive, but you do want to flip things around and look at the silver linings when things are bad.

And I mean, that's just, I was raised that way maybe, and 

maybe it's hardwired. I don't know. 

[00:12:07] Leah: maybe, maybe it was, I mean, maybe it is. Yeah. Maybe it is the, because that's how you were raised to look at the silver lining. Um, was I raised by a bunch of cynics? Maybe? 

[00:12:20] Tina: Is it nature or nurture? 

We may never know, 

[00:12:23] Leah: but, but yeah, like. I don't think I've ever been a silver lining person. I think I'm just kind of like, I don't know if I'm more of a realist type of I don't know, not to say silver lining isn't being realistic, but 

[00:12:37] Tina: No, it's true. I

mean, there's a little bit of, do you know, when I was in a group of naturopathic oncologists and I was on stage and I had this in my head where I'm like, you know, to, to do cancer care all day, every day, especially as a naturopath, where you Really?

just want people to be well and healthy as possible.

I was like, you have to be unreasonably optimistic in some ways to believe that, You know, everyone can get better and everyone can heal and there's potential in every person that you meet when you meet hundreds and hundreds of people and unfortunately, many people who succumb to their disease. But you still get up and you do it again and again.

And I thought, I wonder if there's a, like a special personality type that's out here in the audience. And this was in front of the oncology association of naturopathic physicians. So mostly people sing oncology most of their days. And I said, how many people here buy lottery tickets? Like that optimistic, like, yeah, there's one in a million, but that could be me.

You know, one in 10 million could be me. And, you know, I was, I would say like half or over half of the people bought lottery tickets. Mm hmm. A lot of hands went up. I was like, see, I mean, I probably bought 

[00:13:40] Leah: three lottery tickets in my life. Like, but not like on a regular basis. I know. You know what? And when I worked in New York, when I worked at the graphic design studio, no, our office would, because if we, whatever we won, we would eat by ourselves lunch, or we would just buy more tickets.

So it was kind of a pool thing, but that was, that was more peer pressure.

[00:13:59] Tina: and I, I understand that the math is not in the favor of the, of the person who buys a ticket for a dollar or 2, but here's my flip side to that. Cause I had this discussion with a good friend of mine who really, you know, was telling, telling me that, you know, it really is a waste of money. I said, okay, but here's the thing.

Yeah. When there's a lightning storm, do you let your kids go out in it? It's the same, it's the same risk. Somehow you can see the risk when it's a negative. Like my kid could get hit by lightning. It's the same risk as winning the lottery. So why do you listen to it then? But not in the flip. So anyways, yes, it has to go with like how you see things, you know,

[00:14:31] Leah: So if you want to buy a lottery ticket, go during a thunderstorm where there's a lot of lightning.

[00:14:37] Tina: I'm just saying it's the same risks. It's easier to, it's easier to see them negative than it is to see them in a positive light. 

[00:14:44] Leah: Um, there have been studies, there have been studies on gratitude. Um, there was one where, they took a group of people and had them either pray for their partner or just pray in general for four weeks. And at the end of those four weeks, the people who, uh, there were other groups too, but the people who were assigned to the praying group, They reported higher gratitude.

So that's not really like, it's not saying like the results of practicing gratitude, but then there were studies that showed that, people who were more grateful, like cardiac patients, um, had better sleep, less fatigue, lower, levels of cellular inflammation. and then heart failure patients who kept a gratitude journal for eight weeks were more grateful and had signs of reduced inflammation.

[00:15:32] Tina: Yeah. So physically. There are effects on the physical self. I think sleep, in a review that I looked at of, I think they whinnied it down to 19 different papers that looked at physical effects of gratitude, and sleep was the one that had the most evidence, that people who showed gratitude slept better. Various ways of showing the gratitude. There was, you know, obviously there's biases in the studies. There's all those, limiting factors to looking at this. Cause looking at the physical effects of gratitude is, it's much newer than looking at the psychological effects in the literature. but this year, this was interesting.

There was a study published this year, gratitude and mortality among older U S female nurses. That one got my attention. Cause the question they asked was, do people who more frequently notice and feel grateful for positive experiences tend to live longer? And this was observational, right? So they looked at just under 50, 000 women nurses, and there was 4, 600, just over 4, 600 incident deaths, over time when they looked at who showed gratitude and who didn't show gratitude, the highest third of people compared to the lowest third of people that, you know, how much gratitude they showed.

 those who showed the highest gratitude had a, almost 10 percent less risk of dying over the time period of this, study. And then for cardiovascular disease, it was even more, deaths from cardiovascular disease was 15 percent less than those who showed the most gratitude.

[00:16:54] Leah: Yeah. Cause it seems like there are, there are like there do seem to be studies on cardiac patients and the physical, 

effects of gratitude. 

[00:17:01] Tina: This is the first one that showed anything to do with gratitude and actual 

dying. 

Yeah.

This is the first, and it just came out, I think earlier this year. 

[00:17:09] Leah: Well, I also was reading that there are studies that have found that, people who are more grateful, they have, um, less depression and tend to be more resilient, after a traumatic event.

[00:17:21] Tina: Yes. I came across, um, it was. The Broaden and Build Theory. Okay, the Broaden and Build Theory posits that experiences of positive emotions broaden people's momentary thought action repertoires. Which in turn serve to build their enduring personal resources, ranging from physical intellectual resources to social and psychological resources.

So basically it's like a positive feedback cycle where gratitude makes you more resilient. That's a lot of big words to say that, but yeah, I read that straight from the abstract. That was, that was a lot of hoopla, a lot of jargon just to say positivity breeds more positivity and more resilience. 

[00:18:00] Leah: I think one of my, my, uh, My barriers to practicing gratitude is the thought that it's, the external forces. I mean, I recognize like being grateful for other people for sure. I mean, that, that I completely recognize. I just don't think of it as being like gratitude, but no, I'm definitely grateful for other people and the actions of other people.

I'm able to recognize that, but it's just that sort of like, It's that, it's that idea of like an external force, whether it's fate or a higher power of some sort. 

[00:18:37] Tina: Yeah. 

[00:18:37] Leah: To be grateful. 

That's, I think, where my barriers come 

[00:18:41] Tina: Yeah, yeah, I guess I can see that. I guess I do think of a higher power. 

I I, I guess I, I think of a higher power. I'm grateful to the powers that be 

[00:18:52] Leah: I don't know what I'm See, I'm just sticking with the cynic thing. I 

[00:18:55] Tina: Yeah, 

[00:18:56] Leah: a cynic.

[00:18:57] Tina: I think I'm just trying to touch on the, like, is there a higher power for you? Is there a larger, like, something other than what you're looking at in front of you? Because I also think of, like, I feel when I'm in awe, you know, if I'm at the ocean or in a massive, old growth forest, then I will have such gratitude at that moment of just the existence of this beauty.

 when you're awe inspired at those moments is when it seems that, to me, to have more of that spirituality to it, 

[00:19:30] Leah: Hmm.

[00:19:31] Tina: where I'm, I'm thankful just for it existing, and whoever and whatever allowed it to be. 

[00:19:37] Leah: Right. 

Hmm. 

[00:19:40] Tina: Can't relate. 

[00:19:42] Leah: No, I mean, I, you know, I appreciate the beauty in things, for sure. But I don't know. I mean, I think things kind of are the way they are. Like, I don't, because of, I don't know. I don't want to get into a, like, a religious conversation. 

[00:19:56] Tina: Right. I'll give you, I'll give you a small moment of massive gratitude. I was sitting downstairs in a little ante room for this building. And it was after hours, I don't know, five, six o'clock, whatever. I'm sitting there. I was talking to my mom on the phone. so I'm just sitting at the bench all by myself.

And this dude comes out of the coffee shop with a whole platter of baked goods. He knelt down. He's like, you want one? And I looked at him. He's like, he's like, he's like, just take whichever one you want. There was like a cookie and a muffin and a croissant. And I was like, really? Thank you. Like, I was like, there was no reason for this guy to just like walk up to me and give me free baked goods, but I felt incredibly grateful at that moment.

Like, thank you so much. I so need a muffin right now. So I guess it's the little things and the big things. 

[00:20:39] Leah: I appreciate offers like that. I don't, I don't know. I mean, I, like, that's the difference, though, like I'm saying. Like, I mean, I, I, I, I feel grateful for things. I just don't practice gratitude.

[00:20:52] Tina: Right. You see that as two different things in 

[00:20:54] Leah: Absolutely. Yeah. Like, of course, like if something like that happened to me and it was a tray full of gluten free pastries, I would be, you know, like, thank you. Of course I would be, you know, I 

do, I feel I feel grateful. Yes. But I don't look at things as like a higher power. And I don't, um, I don't think like this person was sent from the heavens to give me a pastry.

Not that you did either, but you know what I mean? Like, I don't see it as a higher power and I don't go out of my way to practice gratitude. 

[00:21:24] Tina: Uh huh. 

[00:21:25] Leah: But I recognize that, thanks to you, that, 

[00:21:30] Tina: Speaking of. 

[00:21:32] Leah: that I, am, yes, um, I'm grateful That you showed me that I am grateful for things.

[00:21:42] Tina: Yeah. Yeah. And 

[00:21:43] Leah: I'm sticking with the cynic part. When I read that, I was like, envy? No. Materialism? No. Narcissism? I hope not. Cynicism. Ding, ding, ding, ding, ding.

[00:21:54] Tina: I did refer to that when we were chatting, like we got to take off the gray glasses, put on some rosy, little rosy tint to those glasses once in a while, and then it'll look better. 

[00:22:13] Leah: Do you have any other, studies looking at, Gratitude and, and health. It, the, the reduced inflammation in those cardiac studies that I mentioned, that's really interesting.

[00:22:24] Tina: Yeah. That, that is the most interesting, I think. I think the fact that. That mood, thoughts, gratitude, can affect cardiovascular risk, you know, that makes sense because I think of the flip side of that when they look at what causes blood clots. And so that means strokes and, deep vein thrombosis or DVTs and embolisms and things like that.

When people are highly stress, the coagulation. Of blood changes. So if you look at the flip side of this and you think, okay, someone's really stressed out, they are more likely to throw a clot because stress hormones will raise the clotting risk in someone really quickly. So, I guess if you take it to the other side of the extreme and you're all stressed out and it's the opposite of feeling, cause I think gratitude is very de stressing.

In my mind, like you can't be stressed out and feel gratitude at the same time in my book. It's much more a relaxing feeling just in the physical self. So, yeah, I guess it's, it's not shocking. I didn't look at the, the biology of it, though, with cardiovascular disease, I did look at the outcomes and it's pretty consistent that people who practice gratitude have less cardiovascular risk in general of all sorts of cardiovascular events, strokes, heart attacks, the whole bit.

It's not as strong with, with cancer care. We don't have as much outcome data, you know, like do people who express gratitude have less recurrence? I don't know. That, that kind of thing isn't, I haven't, didn't sign, find anything on that. 

[00:23:47] Leah: so you looked for studies 

correlating? No, no, but with cancer care, with, with cancer, you looked for studies for cancer and gratitude and you didn't find them or you didn't that deep.

I'm 

[00:23:58] Tina: I didn't dive that deep. I looked at all the reviews and the reviews said the evidence is all in 

Cardiovascular. 

[00:24:05] Leah: Okay. I 

just wasn't sure 

[00:24:06] Tina: that there's, you know, there's disproven, there's unproven. 

[00:24:09] Leah: right, right, 

[00:24:10] Tina: not, been disproven. 

It is 

unproven. because I mean, inflammation and, you know, cancer kind of go hand in hand. I mean, inflammation and pain, right? pain I would consider a stressor. Like when I said stress and gratitude can't happen at the same time and you mentioned that person who said, you know, when I'm in pain, I have a hard time. I was like, well, I don't blame them. When you're in pain, it'd be hard to stop and feel grateful. But physically, I don't even know if it's possible because pain is a stress on the body.

And when you're in a high stress mode, it's really hard to feel gratitude. 

there are so many studies in Journal of Psychology, Affective Science, Psychology journals here, there, and everywhere, Nature, Human Behavior, There is so much information that I started to go, I'll just stick to the, to the reviews, and not delve too deep.

Because you can get in the weeds pretty deep, look at every single study. 

[00:25:04] Leah: And they, I mean, it is a pretty new area that people are studying. I mean, it is pretty new.

[00:25:11] Tina: yeah, and we know that, like, again, we know stress better than we know gratitude. I mean, if you want to find studies of the physical aspects of stress and how that changes neurotransmitters and, your, Adrenaline or epinephrine levels and all of that and how that affects your immune system or how that affects cancer ton more information on that the flip side and looking at gratitude and how That ameliorates things or makes things better is definitely a distant second in the amount of evidence we have. so I don't know. There's also the thought of, it certainly doesn't hurt our quality of life. Whether it affects our quantity on the planet and whether it affects disease processes is almost secondary to the moment. Where, to me, it's like, why wouldn't you? try to make a practice of practicing gratitude because it's certainly going to improve well being, quality of life, day to day.

However you do it. I mean, and everyone can have their own way. They can keep a diary. They can make a point of it. They can do the 30 day prompts once a day. that's a 

that's a nice tool. 

[00:26:13] Leah: I'm gonna I'm gonna look that up

[00:26:15] Tina: I think Mayo Clinic had, if I'm not mistaken, I think it was Mayo that had a, a methodology for, creating gratitude in your life. I'll have to find that again. I was, I was perusing something. I think Mayo had an active, practicing gratitude offering. 

[00:26:30] Leah: Yeah, it seems like there are a lot of sources The whole being Institute has a 30 day challenge

There seemed to be a number of places that have mind body green Yeah . Mm hmm,

[00:26:46] Tina: over quite a bit with praying. I think when people are apt to meditate or pray or that kind of idea of framing a moment in every day where they give thanks or they have gratefulness, I think that makes it more of a habit for folks. So I think in some of these studies that looked at gratitude, they included praying as a means of expressing gratitude every day. 

[00:27:10] Leah: right

[00:27:11] Tina: And the majority of Americans do have some, some type of spiritual practice. So in that, in that large nurses study that I mentioned, that showed those with more gratitude had less cardiovascular disease and actually were less at risk of dying. they took a questionnaire and it's a six item gratitude questionnaire. This is from the Nurses Health Study.

This is a very large and well known study. I'm gonna find it. find that table. All right, ready? 

[00:27:38] Leah: hmm.

[00:27:39] Tina: your options are this. One to seven. Strongly disagree is one. Okay. 

Strongly agree is seven. 

[00:27:47] Leah: Okay, that's a lot of numbers in between.

[00:27:48] Tina: I know. Yeah, they didn't make It easy. Because items three and six are reverse scored. But, okay, I'm just going to go with the not reverse scored. This is why studies get convoluted so 

quickly, right? 

[00:28:00] Leah: be five, right? 

[00:28:01] Tina: I agree with you. Yeah. Why would you? Yes, 

anyways. Ready? Strongly agree or strongly disagree? 

[00:28:08] Leah: Wait, and one is disagree seven is agree. 

[00:28:11] Tina: Correct. 

Okay. 

ready? I have so much in life to be thankful for. 

[00:28:15] Leah: Hmm five Oh, that's horrible. Really five. Hmm. 

[00:28:20] Tina: I don't know. Do you strongly agree?

[00:28:22] Leah: I mean I did Let's go six

[00:28:26] Tina: Oh. Are you just saying that because people are listening? 

[00:28:29] Leah: No, I'm trying to think I'm trying to think like I mean there's stuff that I'm grateful for but do I strongly agree? Don't know. I don't like can I I'm gonna fail this quiz 

[00:28:40] Tina: There's no failure. 

It's just, there's no such thing. 

Alright, 

ready? If I had to list everything that I felt grateful for, it would be a very long list.

[00:28:51] Leah: Probably.

[00:28:54] Tina: Even 

[00:28:54] Leah: to give a number. 

[00:28:55] Tina: think of a damn thing. 

[00:28:56] Leah: I couldn't, but then you made me realize. You opened my eyes. 

[00:29:00] Tina: Okay. 

[00:29:01] Leah: No, I mean, it would be a list.

[00:29:04] Tina: So, what are you going to give that one? A five? Seven? Six? 

[00:29:06] Leah: I'm gonna stick with five or six. 

[00:29:08] Tina: Okay. Okay. 

You're 

[00:29:09] Leah: I'd get,

[00:29:10] Tina: All 

[00:29:10] Leah: hedging. 

yes, I'm hedging. I'm hedging.

[00:29:14] Tina: All right. I'm skipping the two that are backwards. So, I am grateful to a wide variety of people. 

[00:29:20] Leah: Yes, I'm gonna say seven. Look at that. No, I am and you know what because I have said that and in interviews when I would get interviewed, you know For whatever reason I always said that I am grateful for my patients

[00:29:34] Tina: I agree. I think, I think I've heard you, if I had to say, if I had to fill this one out for you, I would say that.

[00:29:41] Leah: Yes, I mean I'm grateful for my parents and you know all of that kind of stuff too, but I have a Lot of gratitude for my patients

[00:29:52] Tina: And for people in general. 

[00:29:54] Leah: Some people.

[00:29:55] Tina: You have, no, just for your, you know, your, your girlfriends 

[00:29:59] Leah: My girls. Yeah, no, I know. I know my people. Yeah. No, but, but really like I, yeah. Maybe I just, maybe I didn't even realize that I had gratitude until I had all of my patients. You know, I, since I've, until I started working in oncology 

[00:30:14] Tina: Right. 

[00:30:14] Leah: meeting all of the people that I've met. Yeah. Okay. 

[00:30:18] Tina: All right. Ready? 

[00:30:19] Leah: Look at, you're going to get me all emotional. Go on next.

[00:30:22] Tina: Next one is As I get older, I find myself more able to appreciate the people, events, and situations that have been part of my life history.

Mm 

[00:30:32] Leah: Huh.

Sure, I'm gonna give it a six. I'm not, you know what, this seven part is really hard. It's like on a pain scale, I never say 10. 

[00:30:42] Tina: hmm. 

[00:30:43] Leah: Cause there could always be another level. So I'm going to say six.

[00:30:47] Tina: Okay. So, so that one's six. So, now we have the two items that are reverse scored. Gosh, Ready? When I look at the world, I don't see much to be grateful for. You agree or disagree with that? When I look at the world, I don't see much to be grateful for. 

[00:31:02] Leah: Huh.

I'm going to say four or five, 

[00:31:07] Tina: Okay. And the other one, long amounts of time can go by before I feel grateful for something or someone. 

[00:31:13] Leah: Oh, I think, yeah, I think there are long.

[00:31:16] Tina: So, you agree with that one? 

[00:31:17] Leah: Yeah. Not like seven level, but 

I'm also not working. So I'm not around patients, not around people. Hmm.

[00:31:24] Tina: That, that, that is the questionnaire that they used in the nurse's health study. 

[00:31:28] Leah: Interesting.

[00:31:30] Tina: That's the six item gratitude questionnaire, so it means it's some validated gratitude tool. 

[00:31:35] Leah: Yeah, I'm still leaning on me being a cynic.

[00:31:39] Tina: I think, I, I will say, I think you just like to prepare yourself just in case. 

How's that? Yes. That's what I sense. I don't know if it's cynical so much as, 

[00:31:49] Leah: Protection. 

[00:31:50] Tina: for the worst and I'm gonna be pleasantly surprised when everything is better than that. 

[00:31:53] Leah: Absolutely. And you know what, that's what my mom actually used to say. Something to that effect. She said, don't expect anything from anyone and you won't get disappointed. So yeah, I think that, there you go. I think that's part of it. All right, Tina. So, um. Let's do our little listicle. So what are ways that people can, practice gratitude? I mean, we've already mentioned journaling, right? A couple people mentioned keeping a journal. Mm hmm. I guess telling people that you are grateful for them, telling people that you appreciate them in some way, whether it's a phone call, a note, 

a text. I think, yes, expressing it to whomever you're feeling it towards at that moment, which might not, which may be challenging if it's not something you're taught or something that you're used to doing. I know that, um, I probably don't say it as much as I think it, for sure. I'm grateful all the I'd never say out loud.

[00:32:50] Tina: So maybe expressing it is something we can train ourselves to do better. I think that that would be helpful. That, that is the gratitude found in individual moments. I mean, someone offered me a muffin. I was super grateful, but you know, but when it's, it's almost easier to do it when it's a stranger offering you something small than it is, thanks so much for, you know, I don't know, making dinner, that happens every single day and you might take it for granted at some point in your life, 

[00:33:16] Leah: Right. 

No, I think, yeah, I definitely see that. I think that when Yeah, when you're surrounded by someone who's, you know, or by people who are doing things for you on a day to day when it is a surprising, display of kindness or whatever from a stranger. I think that definitely does, yeah, it's, it does speak louder.

Sure. 

[00:33:39] Tina: like making. 

Making an assessment in our own day to days, in our own lives, to say what or who might we be taking for granted. Because it's a good thing, but it's become such a normal good thing that you stop voicing appreciation. 

And 

that might be a nice exercise, too, just to find that balance. gratefulness that you you feel but you've stopped expressing because they've become so commonplace.

[00:34:02] Leah: Right.

[00:34:02] Tina: I think the meditation or prayer moment of taking an assessment and most people do it at the end of the day because you can remember what happened that day and in order to get in touch with those moments of gratitude. One, you can think back to everyone you said thank you to that day. Right.

you can kind of assess, who did you thank that day, just as a matter of being polite. Um, and just give it a little bit more intention and say, that was nice of so and so to hold the door open. Or it was, you know, you're grateful to all these little things that happen throughout the day. And just do a reflection at the end, whether you write it down or not, but just take a moment to reflect. Make it a habit, though. Like, you brush your teeth every night. Do it then. Like, somewhere where you know you're going to be doing this. So, if it's not a habit already, creating a new habit, um, takes repetition, but it can be done. 

[00:34:49] Leah: I saw something where it said, um, do like a, have a morning gratitude. And um, that, that reminds me of, we have this dog, Panda, who is, we don't know how old she is. Um, but she has survived two cancers so far. 

[00:35:05] Tina: Mm. 

[00:35:05] Leah: Um, and then from imaging that we got evaluating her, her cancer status, um, we found out that she has.

shrapnel lodged in her. So she's been shot and she has probably broken a hip because she was hit by a car at some point. So she was at rescue. We like we have no idea what her history is. Um, but my husband and I always joke about every day she wakes up and she's in chronic pain. Like she's on a lot of medication for pandas and a lot of pain, but she wakes up and every day is a good day.

You know, so it's, so he and I joke that it's, you know, like, be like Panda, 

you know, wake up every day, 

[00:35:48] Tina: Mm hmm. 

[00:35:49] Leah: grateful for a new day. 

[00:35:51] Tina: Be like Panda. 

[00:35:52] Leah: yeah, I know. I gotta live like Panda. 

LLP. Live like Panda. I have to be a little more Panda like. But it is funny because it is. It's like you see her and she's like trying to push herself up to stand up, you know, and she, you know, she's got a lot going on there.

And, um, yeah, she just, she just wants her breakfast. She just wants her walk, you 

[00:36:12] Tina: Mm hmm. Mm

hmm. 

[00:36:13] Leah: scratches live like panda.

[00:36:15] Tina: I was going to say, there's a bit of living for the moment, too, in a dog's life, right? Like, right now. 

[00:36:21] Leah: Well every day, you know every day she 

wakes up She's like every day that i'm awake. It's a good day 

[00:36:25] Tina: Yeah. 

[00:36:27] Leah: So, so, so that's like that, that morning gratitude in the morning, if you don't feel like, 

if you're not feeling it, just, just live like Panda, just be, you know, looking forward to that.

[00:36:37] Tina: Yeah. 

[00:36:38] Leah: The sunrise or the, the coffee smell or, or the people around you. I guess that was one thing that the Mayo Clinic says that their website talks about, um, it doesn't have to be things, it can be the people, you know, like think about the people, not so 

much the things. 

[00:36:52] Tina: Yeah. 

Yeah. 

That 

[00:36:53] Leah: Cause a lot of people are struggling, a lot of people, you know.

Are, are having hard times, not only if they're going through cancer treatment or you know, or beyond, but just, you know, just the way that, you know, times have been so, 

[00:37:07] Tina: Mm hmm. 

[00:37:08] Leah: I like that. I like how somebody said that they feel gratitude for, you know, their oncology team, 

[00:37:13] Tina: Mm hmm. Yeah. Yeah. And the little habits. I'm just remembering that, you know,

giving thanks before meals was a routine growing up. 

We always, mm hmm. 

[00:37:24] Leah: Oh yeah. Not enough 

[00:37:25] Tina: Yeah. When you say grace before a meal, generally you're giving thanks for the food on the table and the people who grow it. And Yeah. 

[00:37:30] Leah: Yeah. But when your grandmother's name is Grace and somebody says, everybody say, you know, somebody say Grace. Then you literally said. 

Grace. 

We did not grow up. But yeah, so it's interesting, that is really interesting. 

[00:37:44] Tina: yeah, 

Yeah. 

[00:37:46] Leah: why, yeah. Hmm.

[00:37:47] Tina: Yeah. And to this day, I think about it. And when I look at food, I, I think to myself, somebody had to grow that, somebody had to pick that, somebody had to kill that, somebody had to, whatever. I actually think about it. 

[00:37:57] Leah: I 

know, I have a friend, a girlfriend that um, I don't see her that often anymore, but um, yeah, when we're together she always will say a prayer before she eats. And of course me, I'm the one who's like reaching for the food and then I'm like, oh my god, I'm so sorry, I'm so sorry. I'm sorry. But, yeah, no, it is a nice practice.

It's not something that I ever grew up with, so, yeah.

[00:38:20] Tina: yeah, it's just one of those simple things. And also I think that it has to do with just pausing. You know, anytime, we don't pause enough in our lives, you know, unless you do stop to meditate or pray or something. I mean, we just go. 

[00:38:30] Leah: Oh, have you ever eaten around me? I'm a hoover. I don't 

pause. It's gonna get cold! It's gonna get cold! I gotta eat!

alright. 

alright. So, um, if you've made it this far, 

then 

[00:38:46] Tina: we're super grateful for that. 

[00:38:47] Leah: We are super grateful that you made it through this conversation on gratitude. Um, we would be most grateful if you share this episode, or perhaps another one, with somebody who you think would find it, or interesting.

[00:39:03] Tina: Oh, yeah, and the other thing is we should say, I know this is the end and hardly anyone's listening anymore, but we do have a membership now that where you can join us and we're going to do live events and answer your questions on cancer care, even though we didn't talk about that very much today. Um, that is our expertise.

So, uh, you can join us and become a member of the cancer pod. Just go to our website and you'll see a big button that says, join us. That's your best bet. we also have a link in our episode notes. 

[00:39:30] Leah: And on that note, I'm Dr. Leia Sherman 

[00:39:32] Tina: And I'm Dr. Tina Kazer.

[00:39:33] Leah: And this is the Cancer Pod

[00:39:35] Tina: Until next time. Thanks for listening to the cancer pod. Remember to subscribe, review and rate us wherever you get your podcasts. Follow us on social media for updates, and as always, this is not medical advice. These are our opinions. Talk to your doctor before changing anything related to your treatment plan. The cancer pod is hosted by me, Dr.

Lea Sherman. And by Dr. Tina Caer music is by Kevin McLeod. See you next time.