Contributor: Linda Roszak Burton, ACC, BBC, BS,
To learn more about Linda, click here.
“At times, our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.” ~Albert Schweitzer
In the first article in this series on gratitude, we looked at the impact gratitude has on building resilience and well-being for physicians, nurses, and other clinicians bearing much of the brunt of the COVID-19 pandemic. An extensive body of research documents the many mental and emotional health benefits of gratitude, including:
- Lower levels of depression and anxiety and reduced risk of substance abuse disorders
- Mitigation or serving as a protective factor against Post-Traumatic Stress Disorder (PTSD)
- Greater appreciation of life, fueling Post-Traumatic Growth (PTG)
We are well aware of the personal and professional toll the pandemic is having on caregivers’ mental and emotional well-being. Additionally, there’s a heightened awareness of clinicians dealing with survivor’s and/or sideline guilt.
In the March 2020 JAMA Open Network article, the authors recommended special interventions be implemented immediately. Other resources indicate not enough is being done for various reasons, not the least of which was the state of overwhelm, burnout, and moral injury that existed in physicians, nurses, and other clinicians before the COVID-19 outbreak. Many healthcare institutions were already lacking systemic policies and programs to support mental and emotional needs adequately.
Gratitude and Guilt
Fortunately, resources reveal gratitude can mitigate the impact of both types.
- Survivor’s Guilt - a strong and persistent feeling of remorse, personal responsibility, and sadness, having survived when others have died. This study found gratitude can partly mediate the relation between survivor's guilt and both PTSD and PTG.
- Sideline Guilt (or non-contributor guilt) - relates to clinicians feeling they are not doing enough on the front line of care delivery. The July 2020 JAMA Perspective publication recommends “supporting healthcare colleagues who are at the front line with acts of gratitude, generosity, and kindness.”
A Calling for Radical Gratitude
We view these wide-ranging studies as an opportunity to practice “radical gratitude.” Radical gratitude recognizes vulnerability and the need to be mindful and fully present when practicing (1) reflective, (2) expressive, and (3) responsive gratitude. Radical gratitude is non-judgmental and opens the door to greater inclusion and an awareness of other positive emotions often overlooked or defined as weak or self-absorbed. Radical gratitude is a strength that will maximize clinicians’ abilities to achieve the highest level of optimum health and well-being.
Practicing radical gratitude is universal and all-inclusive. It goes beyond the people you know and the environments you inhabit. Radical gratitude is an openness to appreciating humanity beyond social-economic status and opposing beliefs. It’s at the core of social justice, prosocial behaviors, and organizational citizenship behaviors.
Radical Gratitude and Growth
Consider these approaches to begin to ease and reverse the pandemic’s negative impacts and enhance overall health and well-being.
Radical Gratitude - starts with you. Fully embrace gratitude as a resource for yourself. This is not merely saying thank you or solely an attitude of gratitude. It’s the cultivation of a systemic practice of gratitude by which your brain’s neural pathways change, are strengthened and reorganized to achieve these healing benefits.
Radical Gratitude – Genuinely make it a part of your leadership brand. Check-in, one-on-one with each of your colleagues, direct reports, etc. Create a safe environment for this check-in, actively listen so they feel heard, and ensure you have fully connected with each person. This allows you to genuinely express gratitude for their role, recent actions, and behaviors that are worthy of your attention and recognition. Specifically state how you’ve benefited and how they contribute to the clinical team, patients, and the institution.
Radical Gratitude - Give up the term soft skill and define gratitude as a hard skill. Positive psychology defines gratitude as a strength. When viewed as a strength, clinicians become more trusted, respected, resilient, and hopeful.
Radical Gratitude - helps create a psychologically safe work environment. Amy Edmonson, PhD, author of The Fearless Organization, defines psychological safety as “a shared belief held by members of a team that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes.”
A 2020 editorial in the Surgical Practice Journal posits gratitude to counteract the threat associated with speaking up about a potential error.
What does gratitude have to do with psychological safety, you ask? Based on a slight variation of her questions designed to boost psychological safety, consider:
- How can you practice expressing gratitude when someone is vulnerable and asks for help because of the impact the pandemic has on their mental well-being?
- How can you practice expressing gratitude when someone on your team speaks up about difficult issues relative to overall health and well-being?
- How can you practice expressing gratitude when your team identifies their diverse needs for dealing with the pandemic?
- How can you practice expressing gratitude when someone raises concerns about what the team needs to do to be mentally fit and committed to the institution?
Finally, there is an opportunity to consider insights between gratitude and Post-Traumatic Growth (PTG). PTG is a concept developed by psychologists Richard Tedeschi, PhD, and Lawrence Calhoun, PhD. Unlike being resilient, which is the ability to bounce back from stressful events, PTG refers to a transformation following trauma. This transformation leads to someone “developing a new understanding of themselves, the world they live in, how to relate to other people, the kind of future they might have, and a better understanding of how to live life.” ~ Richard G Tedeschi
PTG is not to deny the negative events that have occurred or the potential need for professional counseling. Based on their work, there are several domains of outcomes assessed in PTG:
- Appreciation of Life – being grateful for what you already have, including the small things;
- Personal Strength – appreciating you are stronger than you thought you were and better equipped for further challenges;
- New Opportunities – recognizing new interests and possible career paths;
- Relating with Others – recognizing your willingness to ask for help and helping others; a true sense of gratitude for your relationships;
- Spiritual Change – recognizing the purpose and meaning of your life.
Consider these questions to advance your gratitude practice:
- What’s one individual gratitude practice that will support your well-being?
- What must you do to ensure this is sustained two months from now?
- What’s one gratitude practice that will support your organization’s well-being?
- What must you do to ensure this is sustained two months from now?
Worldwide, people entered the pandemic at different levels of resilience, with varying abilities to cope and manage the associated stress. Some wonder how it’s possible to think about gratitude with the impact of the pandemic on family dynamics, financial decisions, and personal and professional sacrifices. Practicing radical gratitude is not always easy to do, especially when there’s pain and suffering. And yet, it can help process difficult experiences. Practicing gratitude is not to deny the negative event but promote the healing of troubled memories that arise from negative experiences.
Contact Linda at:
[email protected] or 410.707.3118
To help sustain your gratitude practice, email Linda for a free copy of Gratitude Heals -Supporting Healthcare During the COVID-19 Pandemic.
If you are overwhelmed by stress and difficult challenges, seek help from a health professional. If you are in crisis, an additional resource may be the toll-free, 24-hour National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).
If you or someone in your family is facing mental and/or substance use disorders, seek help from a health professional. An additional resource may be the toll-free, 24-hour Substance, and Mental Health Services Administration at 1-800-662-HELP (1-800-662-4357).