Gratitude, its Benefits, Toxic Positivity, and How to Feel Grateful in Hard Times


Monday November 7, 2022


Gratitude may be one of the best ways we can support our health and wellbeing.  But it’s much more than giving thanks.  It isn’t easy when we’re living with cancer and its effects, and used in the wrong way, it can do much harm.  In the first of two posts, Rb survivor Abby White explores what gratitude is, what it is not, the benefits, and how we can practice gratitude – even in tough times.

In part 2 of this article, we explore “the gratitude gap” – a big challenge to gratitude that’s easy to overcome when we know about it, and why it is key to helping children develop gratitude skills early.  Plus 10 varied ways to practice and strengthen gratitude year-round, and during the Holidays.


Tall trees reach towards one another in a park, forming a bright golden canopy. Below, a carpet of red and gold leaves covers the ground.

As another busy harvest season ends, festivals of thanksgiving are taking place around the world.  They prompt us to reflect on all we are thankful for in our own lives, and how we can express our gratitude.

Thoughts powerfully influence our mood.  A single thought can quickly leach colour away, and the gathering grey mood separates us from potential to experience joy.  Holiday hype especially can evoke unreasonably high expectations, and cause us to feel overwhelmed and alone.

Gratitude may be one of the most powerful ways we can support our health and wellbeing at these times.  But it’s much more than being thankful and giving thanks.  It isn’t a one-time experience, and it isn’t easy when life is tough.  If it is misused, it can even be harmful.

So what exactly is gratitude?  What are the benefits? How does it differ from thanksgiving?  When does it become toxic?  How can we practice gratitude, even in tough times? And how can we help children develop this important skill?  Read on for answers to all these questions, and more.

What is Gratitude?

Robert Emmons, a world-leading scientific researcher on the subject, says gratitude is a two-part process.  First, it is a deep appreciation for what we have received, whether tangible or intangible.  As we affirm this goodness in our lives, we also acknowledge that much of it comes from a source outside ourselves.

In this way, practicing gratitude connects us to the wider world – to individuals, communities, systems, nature, and often a higher power.  Emmons says “I see it as a relationship-strengthening emotion because it requires us to see how we’ve been supported and affirmed by other people”.  This can be particularly beneficial when we feel physically and psychologically isolated.

Gratitude is a very mindful practice, rooted in the present moment.  But we can look back and forward with gratitude:

  • Past: revisiting memories with gratitude for positive aspects of those experiences, even if the event included negative experiences.
  • Present: recognising blessings large and small when we receive them; not taking them for granted.
  • Future: cultivating optimism, hope, and calm for the road ahead.

How Do Gratitude and Thankfulness Differ?

“Thankful” and “Grateful” are often used to mean the same thing, but they have subtle, significant differences.

Being thankful or saying “thank you” acknowledges something someone has given us or done for us.  This response is usually automatic and momentary, and is expected good manners.  For example, when someone holds open a door, or a driver stops to let you cross the road.

We feel grateful and express gratitude when we are deeply moved by another person, thing, or experience.  This lingering emotion rises when we actively reflect on an event or series of events that have positively affected us.  For example, a conversation or piece of information added to your knowledge at just the right time to help you advocate, or a friend supported you through a tough day.

Gratitude nurtures feelings like contentment and joy, and grows over time with practice.  This is the heart of its positive impacts on health and wellbeing.

Finally, unlike saying thank you, showing gratitude is not expected.  The feeling and desire to act run deep, and gratitude may be expressed to people or things that have no connection to the experience for which we are grateful.  Perhaps you make a meal for a struggling neighbour because you remember the support you received during your own struggles.  Or you want to share the joy that comes with much needed good news, so you perform a random act of kindness.

Last year, after a difficult ophthalmology appointment in London, I had dinner at the Serpentine café in Hyde Park.  Four months after my dear friend Ffion died, I looked out over the water, reflecting on many long conversations shared with her there; calm space during busy West End theatre weekends.  Those memories conjured a mixture of intense pain and gratitude.

A little later, as I paid my bill at the counter, I spontaneously paid the bill of a fellow customer who had guided me through the food options, and shared a lovely relaxed conversation in the process, despite COVID restrictions.  This was much more than a thank you.

While my heart felt heavy with Ffion’s absence, it was also singing with memories of her glorious capacity to start joyful conversations with anyone.  That stranger’s openness helped my heart heal just a little, and that needed to be celebrated.

How Does Gratitude Benefit Our Health?

Gratitude is a skill and practice anyone can develop, regardless of experience or circumstance.  It may seem ridiculously simple and fluffy, but mounting evidence shows that gratitude is very good medicine, for both adults and children.  Research with children and youth suggests the skill develops along with emotional maturity.  See part 2 of this series for more about gratitude and children.

Among many benefits, gratitude can:

Gratitude and Mental Health

Gratitude may reduce symptoms of, or risk for, burnout, depression, suicidal thoughts, and post-traumatic stress disorder (PTSD).  However, the effects for some people may be modest and temporary.  While it can improve wellbeing and outlook even in the darkest times, and is a valuable coping tool alongside professional mental health care, gratitude should never be used as a substitute for depression, anxiety or PTSD therapy.

Regular gratitude practice literally rewires the brain.  It helps stimulate and regulate the flow of key neurotransmitters like dopamine (the “happy hormone”), norepinephrine (the “energy” hormone), and oxytocin (the “love hormone”) while also reducing cortisol (the “stress hormone”).  Together, this helps us feel calmer, brighter and more focused, which in turn boosts concentration, healthy decision-making, and productivity.  Gratitude is well-known to improve workplace wellbeing and performance.

Gratitude is a great social connector, but in some circumstances, it can increase feelings of guilt and indebtedness.  To date, most gratitude research has focused on North America and Europe, which are generally individualistic (me-focused) societies.  Quality research is needed to understand how gratitude affects people from more collectivistic (we-focused) cultures in North America and Europe, and populations around the world.

Gratitude and Physical Health

Discussion continues in the scientific community about gratitude’s effect on physical health, but research indicates that regular practice can improve heart health and reduce levels of chronic pain.  As well as improving sleep – which is vital for healing and mental and physical wellbeing.

It’s difficult to prove cause and effect.  But the link between gratitude and well-being is well-established.  When we feel happier, more emotionally balanced, and energized, we are also more motivated to do things that help improve other areas of our physical and mental health.

Importantly for our oncology community, gratitude may indirectly boost the immune system.  Sustained stress reduces the immune response, making us more vulnerable to infection and illness.  Gratitude helps lower the stress hormone, cortisol, and improves sleep.  Together with generally improved wellbeing, this may help us better fend off physical illness.

Gratitude and Wellbeing During Cancer Care

Gratitude can transform our journey through childhood cancer, the life-long cancer effects and risks, and the daily experience of providing professional care, support, and advocacy.  It can help us:

  • Cope better with stress, uncertainty, and crisis.
  • Improve emotional awareness and personal growth.
  • Become more patient, and able to adapt to the unexpected.
  • Find acceptance, and reassess expectations and priorities.
  • Be mindful, compassionate advocates and decision-makers.
  • Regulate physiological responses such as blood pressure, immunity, stress hormones, and sleep, helping to protect both physical and mental health.
  • Make healthy choices regarding diet, exercise, and proactive health care.
  • Build uplifting relationships with family, friends, colleagues, medical team, and our wider community.

Christina Costa is a psychologist who studies well-being.  Below, she describes how she applied her own research when diagnosed with a highly malignant brain tumour.  She ventures beyond the “fight” narrative of cancer to show the powerful benefits of an empowering gratitude practice.

How Can Gratitude Be Toxic?

There’s a common and dangerous misconception about gratitude – that it’s a quick way to banish a bad experience.  In fact it’s one step on the road to healing.

When we feel uncomfortable, we naturally want to replace the negativity with something positive – whether real or imagined.  For example, recalling only positive memories, or focusing entirely on a desired outcome, regardless of how realistic it may be.

Other people can push positivity on us too when they feel overwhelmed by our emotions and don’t know what else to say or do.  They might say something like:

  • Hang in there.
  • Keep fighting.
  • Stay positive.
  • Look on the bright side.
  • There’s always a silver lining.
  • Everything happens for a reason.
  • It wasn’t meant to be.
  • Better luck next time.

Positive thinking itself isn’t bad.  Indeed it is a valuable coping tool to help patients manage heightened fear during medical procedures.  But when it blocks our ability to recognize, validate, and process feelings, it can be very harmful.  This is called toxic positivity (sometimes “toxic gratitude”), and it is often confused with the regular practice of genuine gratitude.

I must add here that no one has the right to tell us what we do or don’t feel, or how they think we should feel.  When you experience that, gently discard the person’s words so they don’t shut down your real and valid thoughts and feelings.

Gratitude and toxic positivity are very different.  Here are the key differences.

Toxic Positivity

Toxic positivity demands that we only view experiences in a positive light, no matter how challenging they are.  It deliberately denies the existence of difficult thoughts and feelings, and their quiet truths that can help us identify our needs and begin to heal.  It criticizes “Why are you not more grateful?  Look at everything you have…”

We can never process and heal emotions we ignore, and we cannot sustain the false narrative of perfection.  Eventually, we have to face reality; those buried feelings will resurface stronger and more insistent than before.

When we use gratitude as a smokescreen, we fail to hear what our emotions need to say.  Suppressing our feelings will only lead to more stress, and increases risk for a host of mental health issues.

Gratitude Shaming is related to toxic positivity.  It’s the act of criticizing oneself or others for feeling negative emotions while lacking gratitude that the perpetrator believes should be felt.  We might say something like “there’s always someone worse off…”  That’s probably true, but bullying yourself or someone else into thinking positive undermines the personal experience, and harms healing.

Retinoblastoma and its lifelong impacts are a bad deal.  Sometimes we need to complain, to express that we feel grief, anger, confusion, anxiety, and fear so we can process our experiences.  Only then can we reach out for help, make changes, find acceptance, and cultivate genuine gratitude.

Genuine Gratitude

Gratitude makes a conscious effort to reflect on life’s gifts and cultivate appreciation.  We can value what we have while also recognizing that life is often far from perfect.

Gratitude accepts the imperfection and challenge of life, and asks that we do not censor our feelings about them.  It encourages us to feel all our emotions.  To be truly healing, it must encompass the entire experience, including the anger, grief, stress, and fear that is so common on this retinoblastoma journey.

In gratitude, we can acknowledge the difficult stuff as well as the good.  Gratitude balances our perspective, broadens our awareness of reality, and supports our mental health and wellbeing.

In summary, gratitude makes the most of reality, and embraces all emotions.  Toxic positivity creates a fantasy land that suppresses and denies difficult emotions, and only masks reality for a while.

Gratitude and Social Competition

Gratitude involves expressing appreciation for someone or something.  Often, those gestures are delivered in public (especially on social media) with some performance, and hidden agenda.  Gratitude is not a means to exhibit our qualities, achievements, possessions, connections, or experiences, anticipating that we will receive recognition and favour.  Genuine gratitude does not diminish other people to feed the giver’s ego.

Would you feel the same gratitude by journaling about it, or sharing your appreciation directly in private?  This is genuine gratitude.  You can still make a public gesture, but asking this question will clarify your motives.

More myths and misconceptions about gratitude

So to recap, gratitude is not good manners, nor a substitute for professional mental health care.  It is not competitive, and it is not forced cheerfulness in a bad situation.  Burying negative thoughts and feelings under endless positivity is harmful.  Stay open to genuine gratitude alongside the reality of all your emotions.

How Can We Practice Gratitude in Tough Times?

Many people believe gratitude blocks out negative aspects of life experiences like cancer and loss, focusing only on the positives – whether real or imagined.  But in fact it connects us with reality and empowers us to validate all that we feel while reframing our entire experience.  Genuine gratitude lifts us up, helps us heal, and cultivates hope.

Children who received prolonged cancer treatment are more likely to experience complex trauma, as are their families.  These early experiences can have a profound impact on the child’s growing brain, and their emotional, social, psychological, and physical development – effects that may remain throughout life.

Retinoblastoma litters our lives with its insidious scars – treatment late effects, ongoing cancer risks, vision loss challenges, broken dreams, many griefs…  Those experiences can often bring unexpected blessings and valuable lessons for growth, but no one should tell us to be grateful for them, or for the cancer experience that led to them.

Just like people, gratitude comes in many forms.  There is no one right way for everyone, and forcing gratitude will never be helpful.  In fact, it may cause harmful feelings of guilt and frustration.

If you don’t feel grateful for any part of an experience, honour what you do feel about it – you have the right to feel sorrow, grief, anger, resentment, and so many other emotions!  Let them speak.  True gratitude evolves when we allow those tough emotions, not by forcing them away with something more appealing.

Validate All Your Emotions

There are no “bad” or “wrong” emotions – they all bring important messages.  Hard emotions tell us that something is wrong and we need to take action to rebalance ourselves.  When we ignore those messages, we trap their energy in our body, we cannot address the underlying concerns, and we cannot experience real gratitude.

Validating hard emotions is the only way to release them.  Accurately naming them and describing what we feel also cultivates gratitude because it helps root us in the present moment.  When we are present, we are more able to notice the good in our life.

For example, while writing about self-compassion, care, and love, I described the flashes of intense envy I sometimes feel about other survivors’ beautiful prosthetic eyes, of good vision, of surgery that can correct a drooping eyelid without exposing the seeing-eye to more damage.  Choosing to explore that envy, I can recognize it comes from a place of lack – you have something I want and can’t have.

Here, I can choose to recognize that I feel sadness about my eyes and decreasing sight – and even fear about the latter.  I can give myself comfort, and from here, I can feel gratitude for the prosthetic eye and sight I do have.  I can find other ways to feel beautiful, and take care of my remaining sight and my whole self, and feel gratitude for those opportunities.  I can value and respect myself, even though my eyes look the way they do and my sight is poor.

When we can find the truths beneath our loud attention-seeking emotions, we find deeper understanding, and a pathway to acceptance and genuine gratitude.

To begin, simply bring awareness to your feelings and accept that they are there.  What are you thinking and saying to yourself?  Try naming your emotions and the sensations your body feels.  For example: “I feel anxious because I don’t know what will happen.  My shoulders are tense and my heart is racing”.

Try to notice all these things without judgement.  Strong emotions control us when we don’t give them close attention.  Actively focusing on them, and how they make you think and feel, reduces their power.  As you reduce their intensity, you will nurture positive mental health, and more organic gratitude.

Our article on The Gift of Listening to Ourselves provides a more detailed explanation of how we can validate and reframe our thoughts and feelings.

A fennec fox with a small round white face, dark round eyes and nose and very large ears is framed against the orange-brown desert of North Africa. Text above and below the picture reads “Tell me more… I’m all ears.”

We all need to be heard, but how often do we truly listen to ourselves? In our April 2021 blog “The Gift of Listening to Ourselves”, we explore how compassionate self-enquiry can us cope with challenging thoughts and strong emotions like anger, fear and worry.

Gratitude Insights from Childhood Cancer Parents and Survivors

These three articles share valuable insights from childhood and adolescent cancer survivors and parents.

Sabrina describes how she noticed she still had eyebrows and lashes during a make-up session for teenagers with cancer.  The discovery created a vibrant joy within her, and caused her to ask why she hadn’t noticed this obvious fact before? She realised she had been too preoccupied with all that was going wrong in her life to see them.  She writes:

“That was the first time I experienced the magic of gratitude – something I had always heard before but never truly understood.  Gratitude would go on to become a key part of my healing process and help me through those dark days, as well as the even darker nights to come.”

Sabrina is a two-time Leukaemia survivor and recipient of a Bone Marrow Transplant; and lives with a rare, progressive, and irreversible lung condition called Bronchiolitis Obliterans.  She is also “The Budding Optimist”.  In this article, she shares five habits that have helped her find gratitude in trying times:

  1. Noticing
  2. Reframing
  3. Adjusting expectations
  4. Celebrating the little things
  5. Surrounding yourself with grateful people

Megan Roberts’ oldest son, Declan, was diagnosed at 3 years and 7 months old with primary CNS rhabdomyosarcoma, a cancer with very poor prognosis.  Declan showed his family how to be both present and grateful, and his curious, joyful spirit fuelled them all through his last year of life.  Megan describes her gratitude for the comfort of sharing both grief and joy at a bereavement retreat five years later:

“Sometimes gratitude whispers, and you have to push hard against the fear just to touch it. And sometimes gratitude swells so big and so deep inside that it lights up your face and falls out in a mass of tears. However gratitude comes to you today, know that you have the grace in your heart to feel it.”

Mary Beth Collins’ son, Joshua, was diagnosed with neuroblastoma just before his second birthday, and today lives with a range of chronic side effects from chemotherapy and bone marrow transplant.  She highlights the duality of gratitude in survivorship and ongoing support and medical care:

“It is time to provide real options that make a difference in our childhood cancer survivors’ lives, as it is their quality of life that serves as the barometer of our success…The gratitude is real. But so too is the challenge.”

Grateful: “Retinoblastoma is such a rollercoaster. We don’t ever know what the future will bring but it has taught me that every day is a gift. My daughter is a warrior and I am grateful to be in this battle with her.” Diana, mother to a 17 month old Rb survivor. Image to the right shows a waterfall cascading down a green mountainside. A rainbow streaks across the front from the top right corner to the bottom left corner.

Letter G from our 2020 Alphabet of Hope.

In the second of our two-part post, discover a big challenge to gratitude that’s easy to overcome when we know about it, and how that knowledge helps children develop gratitude skills early.  Plus 10 varied ways to practice and strengthen gratitude year-round, and during the Holidays.

About the Author

Abby’s father was diagnosed with bilateral retinoblastoma in Kenya in 1946. Abby was also born with cancer in both eyes. She has an artificial eye and limited vision in her left eye that is now failing due to late effects of radiotherapy in infancy.

Abby studied geography at university, with emphasis on development in sub-Saharan Africa. She co-founded WE C Hope with Brenda Gallie, responding to the needs of one child and the desire to help many in developing countries.  After receiving many requests for help from American families and adult survivors, she co-founded the US chapter to bring hope and encourage action across the country.

Abby enjoys listening to audio books, creative writing, open water swimming and long country walks.

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