Using Gratitude & Happiness in Trauma-Informed Therapy

Nov 17, 2025UncategorizedComments (0)

As a trauma therapist, I’ve had a complex relationship with prescribing my clients “gratitude work.”

I have seen how the suggestion to “be grateful” can land as dismissive for clients navigating deep pain. When misused, gratitude can become a tool of toxic positivity, potentially pushing people in emotional pain to bypass their grief rather than process it.

In my younger therapist days, I spent time reflecting deeply on whether gratitude had a safe place in trauma-informed work. And that is when I realized the reframe.

What if gratitude isn’t meant to replace your pain, but to help you carry it differently?

Gratitude is not about denying what’s hard. When approached with care, it can be a tool to help our clients learn how to hold both truth and tenderness at once. This is the heart of what I call “emotional bothness,” or the capacity to feel sorrow and still recognize goodness.

In this article, we’ll explore gratitude and happiness in a new way: not as a forced mood but as a practice of integration, connection, and resilience.


The Psychology of Gratitude and Happiness

Imagine holding up a blank white sheet of paper for your client. In the center, you draw a large red circle and ask, “What do you see?” Almost always they’ll say, “A red circle,” rarely mentioning the white, open space surrounding it.

Emotional wounds work this way: they demand attention, and pain is loud. It dominates our awareness and makes it difficult to notice anything else.

Next, imagine drawing a small green square in the corner of the same paper and asking, “Now what do you see?” Something shifts. That green square is what gratitude represents. It doesn’t erase the red circle. It simply invites us to also notice what else is present.

Isn’t that a more accurate reflection of reality? Many emotional experiences and parts of the self can coexist at once.

Gratitude helps us notice and acknowledge beauty or meaning even while pain exists. This is what I call “holding the bothness.”

What does gratitude mean?

Gratitude extends far beyond a polite “thank you” or deflecting with positivity. Instead, see it as a relational emotion. Gratitude exists because something else outside of us is giving it permission to be experienced.

For example, you realize a mentor’s encouragement during childhood planted seeds of self-worth. A stranger holds the door or offers help, prompting a small but meaningful sense of connection. After surviving a health crisis, you find yourself feeling thankful for the moments when people showed up for you and helped you endure.

Researchers have developed frameworks to help us better understand and study gratitude (Emmons & McCullough, 2003). One of the most widely accepted models breaks it down into two key components:

  1. Recognizing a positive outcome This means consciously noticing that something beneficial has happened in your life. It might be a moment of relief, a kind gesture, a new opportunity, or even a small shift in perspective. This step requires presence and awareness. It invites us to pause, decatastrophize, and acknowledge that not everything is going wrong.
  2. Acknowledging an external source Gratitude deepens when we recognize that this positive outcome wasn’t entirely self-generated. It could have originated from the thoughtfulness of another person, the generosity of a community, a stroke of good luck, or even the natural world offering beauty or serenity. This awareness fosters connection and humility by reminding us that we are supported by forces beyond our control.

Algoe et al. (2020) add that gratitude arises when we recognize goodness in our lives, typically sourced from others. It requires both awareness of these moments and the humility to acknowledge that it did not originate solely from us.

This is a prompt I often use in my practice when introducing gratitude in a trauma-informed way:

“Can you recall a moment, however small, when someone showed up for you and it mattered? Tell me about it.”

This is how you can begin creating space for the “bothness,” where the wound and the support can be held in the same breath.

Gratitude theory

Gratitude theory encompasses multiple dimensions, from neuroscience and evolutionary psychology to social bonding and emotional regulation. Across these fields, gratitude is increasingly understood as a deeply relational and regulatory process that supports our emotional wellbeing, psychological resilience, and capacity for connection.

For example, the neuroscience of gratitude shows activated areas of the brain, the medial prefrontal cortex and anterior cingulate cortex, that are associated with empathy, reward, and moral reasoning (Kini et al., 2016). In other words, gratitude helps us reflect, connect, and recover.

In therapy, gratitude should never be used to minimize pain. Instead, it needs to be introduced as a way to widen perspective, build relational safety, and support post-traumatic growth.

Other theories of gratitude include:

  1. Sara Algoe’s (2012) find–remind–bind theory This is a useful framework to understand how gratitude functions in our relationships. Gratitude helps us identify people who support us, reminds us of their significance, and reinforces our connection to them.

From an evolutionary perspective, this kind of emotion likely helped early human communities build trust and reciprocity and made social bonding a matter of survival.

  1. Barbara Fredrickson’s (2013) broaden-and-build theory Gratitude also contributes to psychological resilience. According to the broaden-and-build theory, positive emotions like gratitude help expand our awareness and strengthen our ability to cope with challenges.

When clients begin to access gratitude as a gentle noticing of what supports them instead of forced optimism, it often creates just enough space to shift their nervous system out of hypervigilance and into a more regulated state.

  1. Sonja Lyubomirsky’s (2007) how of happiness research The power of gratitude is that it is one of the most effective intentional practices for improving wellbeing over time.

Unlike life changes that lose their impact, regularly practiced gratitude continues to build emotional resources and support long-term contentment.

Why Gratitude Makes Us Happier: The Evidence

So, why is gratitude so important? Something I have experienced with gratitude in my trauma work is that it is not often an overwhelming experience but rather emerges as a quiet recalibration.

It nudges our attention toward what’s steady, what’s supportive, and what’s still here.

While that may seem subtle, research shows that this shift has profound ripple effects on our emotional wellbeing (Kerr et al., 2021).

Rather than chasing fleeting dopamine hits, gratitude helps build the foundation for sustainable contentment. From regulating stress hormones to deepening relationships, the science is clear. Gratitude strengthens our capacity to move through suffering with greater clarity and connection (Algoe et al., 2020).

How does gratitude bring happiness?

Gratitude begins cultivating the foundation of happiness when we begin expanding our emotional awareness to include what is still working or what is still there. That is how we shift attention from threat to support. This widened awareness promotes stability, connection, and self-trust and can be accessed even during hard times.

Clinical literature on gratitude also shows that it enhances:

  • Emotional regulation by calming the nervous system and increasing serotonin and dopamine (Kerr et al., 2021)
  • Neural integration by activating brain regions involved in empathy, moral reasoning, and reward, specifically the medial prefrontal cortex and anterior cingulate cortex (Kini et al., 2016)
  • Cognitive flexibility by making it easier to reframe hardship and tolerate ambiguity (Kini et al., 2016)
  • Relational safety by expressing appreciation, strengthening social bonds, and building trust (Algoe, 2012; Chang et al., 2022)
  • Physical health by improving sleep, reducing inflammation, and lowering mortality risk (Chen et al., 2024)
  • Mental health by integrating gratitude practices known to reduce anxiety, depression, and trauma symptoms (Kerr et al., 2021)

Perhaps you can even add to this list. Think back to a recent moment when you felt genuine appreciation. What shifted in your body, mind, or relationships at that moment? How might returning to that feeling help anchor you in calm or clarity today?

Does gratitude multiply happiness?

It certainly does! And it does so structurally by rewiring attention, improving memory, enhancing emotion, and deepening social wellbeing (Algoe et al., 2020; Chang et al., 2022; Kini et al., 2016).

Lyubomirsky (2007) adds that when gratitude and happiness are used as an intentional activity, it can increase both momentary joy (state happiness) and long-term wellbeing (trait happiness).

Routine and intentional gratitude practices, like journaling or writing thank-you notes, can lead to:

  • Higher life satisfaction by reducing depressive symptoms and providing longer-lasting mood boosts (Emmons & McCullough, 2003; Seligman et al., 2005)
  • Enhanced memory recall by making positive memories more accessible and reinforcing a positive outlook (Kini et al., 2016)
  • Social reciprocity by sharing and witnessing gratitude, which contributes to generous behavior and relational openness (Algoe et al., 2020; Chang et al., 2022)
  • Meaning-making by helping us see even small blessings amid adversity as significant, which supports narrative coherence and emotional resilience (Harvard Health Publishing, 2021)

Over time, gratitude practice cultivates the capacity to hold both gratitude and grief together, strengthening emotional resilience and sustained wellbeing.


Implementing Gratitude in Everyday Life

What should you do with gratitude once you feel it?

You engage with it. Deeply. You pause long enough to let it register in the body. You reflect on how it connects you to others and how it sustains you even in difficulty.

To do something with gratitude and happiness means approaching life from a place of acknowledgment. As therapists, that means guiding clients to explore what helps hold them up. What relationships, gestures, or moments of care remind them they’re not alone?

6 ways to practice gratitude in life

Practicing gratitude and happiness requires intentionally recognizing what sustains you. That might mean acknowledging the people who helped carry you through, the moments of grace that softened a challenging moment, or the presence of something meaningful that kept you grounded.

Here are clinically informed gratitude exercises to help clients practice gratitude deliberately:

  1. Gratitude letter or visit Write a letter to someone you’ve never properly thanked. Even if it’s not delivered, the act of expressing gratitude increases wellbeing and relational warmth. Delivering the letter face-to-face often enhances this effect (Seligman et al., 2005).
  2. Mental subtraction Reflect on how your life might be different if a key relationship, opportunity, or experience had never happened. This technique helps highlight what’s meaningful by imagining its absence (Koo et al., 2008).
  3. Three good things End your day by writing down three things that went well and why. This practice fosters positive recall and helps shift attention toward daily micro moments of support or meaning (Seligman et al., 2005).
  4. Co-regulated gratitude Expressing gratitude and happiness directly, whether through a shared memory or a moment of appreciation, reinforces bonding and increases emotional safety in relationships (Algoe et al., 2020).
  5. Existential or spiritual gratitude Encourage clients to reflect on a moment of awe, spiritual connection, or personal transformation when gratitude and happiness arose from the experience of being alive, held by nature, or guided through hardship. These moments cultivate meaning, coherence, and emotional depth (Allen, 2018).
  6. Somatic gratitude practice Gratitude can be felt through embodiment practices. Invite clients to place a hand over their heart, recall a moment of care or support, inhale slowly while visualizing that memory, and exhale with a soft “thank you.” This integrates gratitude with nervous system regulation. It helps clients feel safety and connection through the body.

Gratitude becomes most powerful when it’s not just practiced, but felt — in our stories, our bodies, and our relationships. What part of your life have you overlooked because it felt too ordinary, and how might gratitude help you see its significance now?


Misconceptions About Gratitude (and What to Do Instead)

Gratitude is not always understood. In both pop psychology and therapy rooms, it’s often misused as a shortcut to emotional relief or to deflect pain. Sadly, some therapists may even use it to bypass their own discomfort with a client’s trauma story.

True gratitude isn’t performative or prescriptive. Gratitude is an invitation to widen our emotional frame to see the “bothness” of our reality, with beauty and pain coexisting.

Here are five misconceptions about gratitude:

  1. Misconception: Gratitude is the same as toxic positivity. Reality: Gratitude doesn’t require denying unpleasant feelings. When practiced authentically, it enhances emotional integration by allowing clients to feel supported even while suffering. Studies show this coexisting awareness fosters greater psychological resilience over time (Folkman & Moskowitz, 2000).
  2. Misconception: Gratitude is a quick fix. Reality: Gratitude is a resource, not the ultimate solution. It helps regulate emotion, improve relational connection, and reframe perception (Chang et al., 2022). It is not about erasure. It may work best when integrated into deeper therapeutic processes like somatic work, narrative therapy, and boundary repair.
  3. Misconception: Gratitude practices work the same for everyone. Reality: Not all gratitude interventions resonate equally. Cultural norms and personality traits shape how gratitude is received and practiced (Boehm et al., 2011). Some clients prefer interpersonal expressions, while others find spiritual, embodied, or nature-based gratitude more accessible.
  4. Misconception: Gratitude journals are always helpful. Reality: Gratitude journaling can backfire when clients feel forced or inauthentic. In individuals with unresolved trauma, it may trigger guilt or comparison. Journaling is most effective when approached with flexibility, emotional safety, and personalization (Kerr et al., 2021).
  5. Misconception: Gratitude must be directed toward others. Reality: While gratitude is often interpersonal, it can also be existential. Clients may feel grateful for moments of awe in nature, timing that felt meaningful, or a deep sense of spiritual presence. These experiences expand the reach of gratitude into meaning-making and emotional depth (Allen, 2018).

When practiced wisely, gratitude should help us feel more whole. As Wood et al. (2010) note, gratitude enhances psychological wellbeing by helping us authentically integrate thoughts and emotions into a broader, more connected experience of life.



A Take-Home Message

Gratitude work is about creating space for more balanced attention, clearer emotional insight, and the possibility of meaning even in difficulty.

In clinical work, gratitude becomes most impactful when it’s introduced as a steadying counterbalance to pain. Gratitude and happiness help widen the emotional frame to include both threats and sources of support.

As you reflect on your own life (or guide clients through theirs) consider this:

  • What moments of support have quietly shaped you, even if you’ve never put them into words?
  • What role has gratitude played in your healing so far?
  • How might gratitude expand from a feeling to a relational practice that deepens meaning and connection?

Because when done well, gratitude doesn’t demand happiness. It creates space for happiness to return.


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