Deepak Chopra

Laura Redwine

Paul J Mills

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A Grateful Heart May Be a Healthier Heart
Paul J. Mills and Laura Redwine
University of California, San Diego
Deepak Chopra
University of California, San Diego, and Chopra
Center for Wellbeing, Carlsbad, California
In their thoughtful commentaries, Doraiswamy
and Oz (2015) and McClintock (2015) draw on
poets, mystics, and the biomedical literature to
increase our appreciation of the importance of
gratitude for cardiac health as well as overall spir-
itual well-being.
The field of behavioral cardiology (Pickering,
Clemow, Davidson, & Gerin, 2003) has under-
gone a significant transition over the past de-
cade or so. Early research focused primarily on
so called negative psychological traits, with
Friedman and Rosenman’s Type A behavior
pattern, which was first identified in cardiovas-
cular disease patients and characterized by hos-
tility, competitiveness, and time urgency (Fried-
man & Rosenman, 1959), setting the stage.
Over the ensuing decades most studies contin-
ued with this focus and expanded it to include
topics of stress, anger, anxiety, and depression
(Rozanski, Blumenthal, & Kaplan, 1999; Sheps
& Sheffield, 2001). Numerous articles docu-
ment the significant adverse associations of
such traits with morbidity and mortality in car-
diac patients (Chida & Steptoe, 2009; Rutledge,
Reis, Linke, Greenberg, & Mills, 2006).
The transition in behavioral cardiology has
been of an increasing interest in the effects of
more positive psychological attributes such as
compassion, empathy, and gratitude, among oth-
ers. For gratitude research in particular, Figure 1
shows the number of studies that have appeared in
the scientific literature since 1965, with the num-
ber of articles appearing between 2010 and the
present being greater than all the prior years’ pub-
lications combined. In contrast to the adverse as-
sociations and effects of negative psychological
traits on well-being and outcomes, studies of pos-
itive psychological attributes indicate beneficial
effects on overall quality of life as well as physical
health in cardiac patients (DuBois et al., 2012). In
heart failure patients in particular, gratitude has
been identified as a significant resource for alle-
viating the struggles associated with symptom-
atology (Sacco, Park, Suresh, & Bliss, 2014).
In their commentary, Doraiswamy and Oz
(2015) correctly point out that our “cross-sectional
study cannot determine causality.” In this regard,
we recently completed a randomized, controlled
trial of an 8-week gratitude journaling intervention
in 40 Stage B patients. In his commentary, Mc-
Clintock (2015) notes that gratitude “can be con-
sciously cultivated” to “shift one’s attention away
from the negative . . . and into the good and the
beautiful.” We used journaling as such a way to
cultivate gratitude, with the aim of increasing its
presence in the patients’ lives and thus enhancing
its potentially beneficial effects on their wellbeing.
In this trial we found that those patients who were
randomized to gratitude journaling plus their usual
care, versus patients who were randomized to
usual care alone, showed increased heart rate vari-
ability as well as reduced circulating levels of
inflammatory biomarkers IL-6 and sTNFr1 (Red-
wine et al., in press).
We are currently in the process of conducting
qualitative assessments of the journals them-
selves to explore potential associations of
journaling content and the observed beneficial
outcomes. Gratitude journaling is a low-cost
Paul J. Mills, Department of Family Medicine and Public
Health, Department of Psychiatry, and UC San Diego Cen-
ter of Excellence for Research and Training in Global
Integrative Health, University of California, San Diego;
Laura Redwine, Department of Psychiatry and UC San
Diego Center of Excellence for Research and Training in
Global Integrative Health, University of California, San
Diego; Deepak Chopra, Department of Family Medicine
and Public Health, University of California, San Diego, and
Chopra Center for Wellbeing, Carlsbad, California.
Correspondence concerning this article should be ad-
dressed to Paul J. Mills, UCSD, 9500 Gilman Drive #0725,
La Jolla, CA 92093-0725. E-mail: pmills@ucsd.edu
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Spirituality in Clinical Practice © 2015 American Psychological Association
2015, Vol. 2, No. 1, 23–24 2326-4500/15/$12.00 http://dx.doi.org/10.1037/scp0000063
23
and easily implementable intervention that may
have significant beneficial effects to enhance
health in cardiac patients.
A more grateful heart may indeed be a more
healthy heart.
References
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anger and hostility with future coronary heart dis-
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.jacc.2008.11.044
Doraiswamy, P. M., & Oz, M. C. (2015). The spiri-
tual heart: Can gratitude change cardiac biology?
Spirituality in Clinical Practice, 2, 18–20. http://
dx.doi.org/10.1037/scp0000061
DuBois, C. M., Beach, S. R., Kashdan, T. B., Nyer,
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Rutledge, T., Reis, V. A., Linke, S. E., Greenberg,
B. H., & Mills, P. J. (2006). Depression in heart
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comes. Journal of the American College of Cardi-
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.hrtlng.2014.01.012
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Received February 23, 2015
Accepted February 24, 2015 
Figure 1. The number of publications appearing in PubMed by 5-year increments from
1965–1970 to the present using the search word “gratitude.”
24 MILLS, REDWINE, AND CHOPRA
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A Grateful Heart May Be a Healthier Heart

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A Grateful Heart May Be a Healthier Heart

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