Have you ever been told to “just be grateful” when you were anxious?
If so, there is a good chance it didn’t help.
When your nervous system is scanning for what might go wrong, making a list of everything you should appreciate can feel less like healing and more like one more thing you’re failing at.
That’s not the kind of gratitude I’m interested in.
I don’t think gratitude asks us to pretend everything is okay.
I think gratitude gives us a way to notice that even when everything isn’t okay, not everything is wrong.
And that distinction matters, especially for an anxious nervous system.
We tend to think of gratitude as a feeling. Something good happens, we feel grateful, and then we express that gratitude.
But I think there’s another way to understand it.
We don’t have to wait until we feel grateful to practice gratitude.
Gratitude can certainly occur as an emotion. Neuroscience research has identified brain activity associated with the experience of gratitude. But gratitude can also become an intentional behavior, something we deliberately and repeatedly do.
I can stop.
I can notice.
I can identify something good.
I can recognize that another person contributed something meaningful to my life.
I can put words to my appreciation.
And, perhaps most importantly, I can stay with that experience for a moment before my brain races toward the next problem.
That’s where I think gratitude becomes especially interesting for anxiety.
Anxiety asks, “What could go wrong?”
An anxious brain is remarkably good at anticipating problems.
What if something happens?
What if I mess this up?
Why hasn’t she texted me back?
What if this feeling means something is wrong?
What if I finally let my guard down and that’s exactly when something bad happens?
For somebody with a history of trauma, chronic stress, loss, or relational instability, that vigilance may have once been incredibly adaptive.
A person who learned to closely monitor changes in somebody else’s mood isn’t necessarily “overreacting.” Their nervous system may have learned that predicting another person’s behavior helped them stay safer.
A person who mentally rehearses every possible problem isn’t necessarily negative. Their brain may have learned that anticipating danger creates some sense of control.
These are protective adaptations.
The problem is that a brain trained to search for danger can become extremely efficient at finding it.
And when our attention is continually searching for evidence that something is wrong, ordinary moments of safety, connection, goodness, and okay-ness can pass by almost unnoticed.
This is where gratitude becomes less about positivity and more about attention.
Brené Brown, anxiety, and the fear of joy.
One of the things I’ve appreciated about Brené Brown’s work is the connection she makes between gratitude, vulnerability, fear, and joy.
She has described experiencing joy about her children and then abruptly imagining something terrible happening to them. In her writing, she connects that experience with fear, scarcity, vulnerability, and difficulty fully embracing joy and gratitude.
I think a lot of people recognize that experience.
Something wonderful happens and almost immediately the mind answers:
Don’t get too comfortable.
Don’t get your hopes up.
This probably won’t last.
Something bad could happen.
On the surface, we call that anxiety.
But underneath it, I sometimes hear something much more tender:
If I don’t allow myself to fully experience this, maybe it won’t hurt as much if I lose it.
The problem is that anticipating loss doesn’t protect us from grief.
Sometimes it just makes us experience the loss before anything has actually happened.
That’s one reason I like thinking about gratitude as an antidote to anxiety, with a very important qualification.
An antidote isn’t an eraser.
Gratitude doesn’t eliminate anxiety. It doesn’t make legitimate danger disappear. And it certainly doesn’t mean that someone struggling with an anxiety disorder simply needs to become more thankful.
Instead, gratitude gives our attention somewhere else to go.
Anxiety says:
What might go wrong?
Gratitude asks:
What is here right now that I don’t want to miss?
Gratitude isn’t something you wait to feel…
This may be the most important distinction in the entire conversation.
Gratitude isn’t a test of whether you’re naturally a positive person.
And we don’t have to wait for spontaneous feelings of appreciation before we can practice it.
Behavior can come first.
We can intentionally search for something good. We can name it. We can write about it. We can express appreciation to another human being.
Then we can do it again tomorrow.
That’s what makes gratitude a practice.
And neuroscience gives us an interesting window into why practice might matter.
What gratitude practice actually does in the brain.
I want to slow down here because this is where gratitude becomes much more than a nice idea.
When I talk about practicing gratitude, I’m not suggesting that we paste a positive thought over an anxious one.
I’m talking about repeatedly asking the brain and body to participate in a different experience.
The practice itself matters.
When we intentionally practice gratitude, several things have to happen.
Our attention has to shift.
We have to notice something.
We have to evaluate its meaning.
We have to recognize its value.
And, often, gratitude contains a relational component. We recognize that another human being has contributed something meaningful or beneficial to our experience.
Neuroimaging research provides some fascinating evidence of what happens during these experiences.
Research has associated gratitude with activity in the medial prefrontal cortex, and another fMRI study found that the intensity of reported gratitude correlated with activity in the anterior cingulate cortex and medial prefrontal cortex (pubmed.ncb…lm.nih.gov; pmc.ncbi.nlm.nih.gov).
But what interests me even more is what researchers have found when people actually practice gratitude.
I want to be careful about how we interpret this.
It doesn’t mean we have discovered a “gratitude center.”
And it doesn’t justify saying that writing three things in a journal every night magically “rewires your brain.”
The research supports something more grounded and, frankly, more interesting.
Repeated gratitude practice can be associated with measurable differences in how the brain responds.
Our brains respond to experience.
And practice is repeated experience.
Your brain gets good at what it repeatedly practices.
Think about anxiety from this perspective.
If I spend hours rehearsing:
What if something goes wrong?
What did I miss?
What if they’re upset with me?
What if I can’t handle tomorrow?
my brain is receiving enormous amounts of practice searching for threat, uncertainty, and problems.
That isn’t a criticism.
In many cases, it’s a deeply practiced protective strategy.
But gratitude gives us another behavior to rehearse.
I intentionally search for something worth appreciating.
I stop long enough to notice it.
I assign meaning to it.
I allow it to register.
Then I repeat the process.
Gratitude isn’t asking the brain to stop noticing danger. It’s giving the brain practice noticing something else, too.
That difference matters.
And the body is practicing with us.
This is where the conversation gets even more interesting.
For a long time, we’ve talked about mental health as though the brain somehow exists separately from the rest of the body.
It doesn’t.
Anxiety is physiological.
Anyone who has experienced significant anxiety already knows that.
The heart can race.
Breathing can change.
The jaw clenches.
The stomach reacts.
The muscles brace.
The body prepares to respond to something that may not have even happened yet.
Our autonomic nervous system helps regulate many of these involuntary bodily processes.
So if gratitude is something we’re repeatedly practicing in the brain, an important question becomes:
Is the body participating too?
Research suggests that it may be.
A 2023 systematic review identified 19 gratitude-intervention studies involving 2,951 participants and reported potential effects involving cardiovascular function, cardiovascular-risk biomarkers, and autonomic nervous-system activity. The authors also make clear that this remains an area requiring additional research.
One smaller randomized study gives us an especially interesting glimpse into what might be occurring physiologically.
One of the things they measured was heart-rate variability, or HRV.
HRV refers to variation in the amount of time between heartbeats and is used as one way of examining autonomic nervous-system activity.
That distinction is really important.
It would be tempting to turn this into:
Gratitude activates your parasympathetic nervous system and calms your body.
That’s much cleaner.
It’s also more than this study actually demonstrated.
What the research gives us is something subtler:
The physiology of the participants responded differently while they were practicing gratitude.
The body wasn’t sitting this one out.
Gratitude and the body’s stress biology.
There is another intriguing piece of that same study.
Researchers also measured an index of inflammatory biomarkers. The gratitude-journaling intervention was associated with a reduction in that inflammatory biomarker index over time compared with treatment as usual. The researchers explicitly cautioned that larger studies with active control conditions are needed to confirm the finding (pubmed.ncb…lm.nih.gov).
So I don’t think we should say:
Gratitude reduces inflammation.
We don’t have the evidence to make that sweeping promise.
But we can say that gratitude is being studied not only through self-reported happiness or emotional well-being, but through objective physiological measures involving autonomic activity, cardiovascular functioning, and biomarkers. A systematic review of cardiovascular research similarly concluded that gratitude interventions may have effects involving cardiovascular-disease risk biomarkers, cardiovascular function, and autonomic nervous-system activity. (pmc.ncbi.nlm.nih.gov).
To me, that changes the conversation.
Gratitude isn’t simply an intellectual exercise happening somewhere inside our thoughts.
The mind isn’t practicing gratitude while the body sits on the sidelines.
The brain is part of the body.
Attention happens in a body.
Threat happens in a body.
Connection happens in a body.
And gratitude happens there too.
Practice before feeling…
This is why I want to change the order in which we typically think about gratitude.
Usually, it’s:
Feel grateful → express gratitude.
I’d like us to experiment with reversing that:
Practice gratitude → allow whatever experience follows.
That’s especially important for someone whose nervous system is activated.
Asking yourself to suddenly feel grateful can become another demand.
But behavior is concrete.
I can look around.
I can remember.
I can write.
I can speak.
I can thank.
I can notice.
And I can do each of those things even while part of me remains anxious.
That’s the beauty of practice.
You don’t have to feel it perfectly in order to begin.
Gratitude doesn’t require denying pain.
There is an important boundary here.
Gratitude can become emotional bypassing remarkably quickly.
At least you have…
Other people have it worse.
Look on the bright side.
That’s not what I’m talking about.
I’m not going to ask someone to be grateful for trauma.
Or betrayal.
Or abuse.
Or illness.
Or grief.
Gratitude isn’t pretending something painful doesn’t hurt.
In fact, genuine gratitude asks us to become more accurate about reality, not less.
You can be grateful and grieving.
You can deeply appreciate your partner and still be angry with them.
You can recognize the privilege in your life and still be exhausted.
You can love your life and desperately want something about it to change.
Both things get to be true.
Maybe one of the most psychologically mature sentences available to us is:
This is hard, and something good is here too.
The second half does not invalidate the first.
Why your gratitude list may have stopped working…
There’s another problem with the way many of us practice gratitude.
It becomes automatic.
Every night:
My family.
My health.
My house.
Done.
There is absolutely nothing wrong with being grateful for those things.
But if the purpose of the exercise is to practice noticing, we need to actually notice.
Instead of asking only:
What am I grateful for?
try:
What happened today that I don’t want my brain to overlook?
Maybe someone remembered your coffee order.
Maybe your teenager actually told you something about their day.
Maybe the weather was beautiful when you walked outside.
Maybe somebody made you laugh at exactly the right time.
Maybe the dog acted like your return from the mailbox was the greatest reunion in human history.
Maybe somebody checked on you.
Maybe your body hurt less today.
Maybe you had ten peaceful minutes.
Maybe nothing extraordinary happened.
That’s actually the point.
Brené Brown’s work repeatedly emphasizes gratitude for ordinary moments rather than endlessly chasing extraordinary ones.
We aren’t trying to convince ourselves that our lives are wonderful.
We are practicing noticing the parts of our lives our brains might otherwise race past.
A gratitude practice for anxious brains.
Here’s the version I’d rather people try.
At the end of the day, identify one specific moment that was good, safe, beautiful, meaningful, connecting, funny, or simply okay.
Be specific.
Don’t just write:
I’m grateful for my husband.
Try:
I’m grateful he brought me coffee this morning without asking because he noticed I’d had a rough night.
Then stop for a moment.
Don’t immediately race to number two.
Remember what happened.
Notice what you experience as you remember it.
Maybe something changes in your body.
Maybe you smile.
Maybe you feel warmth or connection.
Maybe you don’t feel anything particularly noticeable.
That’s okay too.
The goal isn’t to perform the emotion correctly.
The practice is noticing.
Tomorrow, do it again.
Does practicing gratitude actually improve well-being?
The broader research is encouraging, but I think it’s important to keep it proportionate.
A 2025 meta-analysis synthesized 145 studies from 28 countries and found that gratitude interventions produced small increases in well-being, with effectiveness varying across countries and according to methodological factors. (pmc.ncbi.nlm.nih.gov).
I actually like that finding.
Small matters.
We don’t need gratitude to cure anxiety to justify practicing it.
We don’t need a gratitude journal to transform our lives in seven days.
And we don’t need to turn a meaningful human practice into another wellness miracle.
Maybe gratitude does something quieter.
It interrupts the assumption that whatever is frightening, painful, uncertain, or unfinished is the only information worth noticing.
It helps us become more capable of registering a fuller version of reality.
This is why we call it a practice.
There’s a reason I keep coming back to that word.
Practice.
Not gratitude achievement.
Not gratitude personality.
Not gratitude perfection.
Practice.
If my nervous system has spent years rehearsing threat, I’m not going to shame it for being good at threat detection.
I’m going to respect what it learned to do.
And then I’m going to give it opportunities to learn something else, too.
I’m going to notice the person who stayed.
The conversation that went well.
The ordinary morning when nothing terrible happened.
The body that carried me through another day.
The person who made me laugh.
The five peaceful minutes I almost didn’t notice.
And I’m going to let that information count.
Not because danger isn’t real.
Not because suffering isn’t real.
Not because anxiety can be wished away with positive thinking.
But because goodness is information too.
Anxiety asks:
What if something terrible happens?
Gratitude doesn’t have to argue with it.
It can simply ask another question:
What is here right now that I don’t want to miss?
And perhaps that is the practice.
Not becoming someone who is grateful all the time.
Not forcing ourselves into positivity.
Not getting our nervous systems to behave.
Just deliberately, repeatedly giving our brains and bodies an opportunity to register what anxiety can so easily overlook.
This mattered.
This was good.
Someone showed up.
For this moment, I was okay.
And then tomorrow, we practice noticing again.
References
Choi, H., Cha, Y., McCullough, M. E., Coles, N. A., & Oishi, S. (2025). A meta-analysis of the effectiveness of gratitude interventions on well-being across cultures. Proceedings of the National Academy of Sciences of the United States of America, 122(28), e2425193122. https://doi.org/10.1073/pnas.2425193122 [https://do…2425193122]
Fox, G. R., Kaplan, J., Damasio, H., & Damasio, A. (2015). Neural correlates of gratitude. Frontiers in Psychology, 6, 1491. https://doi.org/10.3389/fpsyg.2015.01491 [https://do…2015.01491]
Karns, C. M., Moore, W. E., III, & Mayr, U. (2017). The cultivation of pure altruism via gratitude: A functional MRI study of change with gratitude practice. Frontiers in Human Neuroscience, 11, 599. https://doi.org/10.3389/fnhum.2017.00599
Kini, P., Wong, J., McInnis, S., Gabana, N., & Brown, J. W. (2016). The effects of gratitude expression on neural activity. NeuroImage, 128, 1–10. https://doi.org/10.1016/j.neuroimage.2015.12.040
Redwine, L. S., Henry, B. L., Pung, M. A., Wilson, K., Chinh, K., Knight, B., Jain, S., Rutledge, T., Greenberg, B., Maisel, A., & Mills, P. J. (2016). Pilot randomized study of a gratitude journaling intervention on heart rate variability and inflammatory biomarkers in patients with stage B heart failure. Psychosomatic Medicine, 78(6), 667–676. https://doi.org/10.1097/PSY.0000000000000316
Wang, X., & Song, C. (2023). The impact of gratitude interventions on patients with cardiovascular disease: A systematic review. Frontiers in Psychology, 14, 1243598. https://doi.org/10.3389/fpsyg.2023.1243598