Gratitude is part of a wider outlook on life that involves noticing and appreciating the positive aspects of life. It can be attributed to an external source another person or an entity (and as such is a common aspect of spirituality). Previously, some studies suggest that people who considered themselves more spiritual had greater overall well-being, including physical health, Paul J. Mills, from University of California/San Diego (California, USA), and colleagues explored the role of both spirituality and gratitude on potential health markers in patients with a heart condition. The study involved 186 men and women who had been diagnosed with asymptomatic (Stage B – structural damage but no symptoms) heart failure for at least three months. The team used standard psychological tests to obtain scores for gratitude and spiritual well-being. They then compared those scores with the patients’ scores for depressive symptom severity, sleep quality, fatigue, self-efficacy (belief in one’s ability to deal with a situation) and inflammatory markers. Data analysis revealed that higher gratitude scores associated with better mood, higher quality sleep, more self-efficacy and less inflammation. Interestingly, gratitude fully or partially accounted for the beneficial effects of spiritual well-being. In further research, the investigators asked some of the patients to write down three things for which they were thankful most days of the week for eight weeks. Both groups continued to receive regular clinical care during that time. Those patients who kept gratitude journals for those eight weeks showed reductions in circulating levels of several important inflammatory biomarkers, as well as an increase in heart rate variability while they wrote. Writing that: “we report that gratitude and spiritual well-being are related to better mood and sleep, less fatigue, and more self-efficacy, and that gratitude fully or partially mediates the beneficial effects of spiritual well-being on these endpoints,” the study authors urge for: “Efforts to increase gratitude may be a treatment for improving well-being in [heart failure] patients’ lives and be of potential clinical value.”