The spiritual heart: Can gratitude change cardiac biology?

Perhaps the poets were correct after all. Their correlation of emotional status with our hearts—cold, broken, and so forth—is now being supported by high-quality correlational analysis and even some controlled studies. This represents a huge opportunity for preventing cardiovascular diseases (CVD), the leading cause of death and disability worldwide. Heart failure (HF) is a particular deadly form of CVD (Bui, Horwich, & Fonarow, 2011) where despite much progress in preventive strategies (e.g., medications, exercise, diet), prognosis remains poor and 5-year mortality rates are still about 50% (Bui et al., 2011). The magnificent 13th century poet Rumi also noted that we should “ignore those that make you fearful and sad, that degrade you back toward disease and death.” But only over the past 50 years or so has modern medicine accepted that negative psychological attributes, such as hostility, stress, or depression, may be linked to adverse CVD outcomes (Steptoe & Molloy, 2007). However, medical interventions for negative affective traits, such as antidepressant pills, have not consistently improved cardiac outcomes (Thombs et al., 2013). For example, in the 12-week SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial of 469 patients (LVEF 45%), antidepressant therapy did not produce significant improvements in either depression or HF status (O’Connor et al., 2010). In this issue of the journal, Mills et al. (2015) report on a highly intriguing association between spirituality, gratitude, and HF selfefficacy profiles. In a study of 186 subjects, higher levels of self-reported gratitude were correlated with better sleep, reduced depression and fatigue, reduced inflammatory markers, and higher levels of self-efficacy to maintain heart function. Further, a path analysis found that gratitude fully or partially mediated the links between self-reported spiritual well-being and psychological well-being (sleep and mood). The findings point to the need for behavioral cardiology to move beyond just a focus on negative psychology. A core tenet of the field of positive psychology (Layous, Chancellor, Lyubomirsky, Wang, & Doraiswamy, 2011) is that we can learn more about humans by studying what’s right (e.g., gratitude, happiness) in flourishing individuals than by studying what’s wrong (e.g., depression). Research over several decades has elucidated not only why some people are more likely P. Murali Doraiswamy, Department of Psychiatry, Duke Medicine and the Duke Institute for Brain Sciences; Mehmet C. Oz, Department of Surgery, New York-Presbyterian Hospital and Columbia University. P. Murali Doraiswamy has received research grants and advisory fees from several health companies for other studies/talks. He also owns stock in companies whose products are not discussed here. He is a collaborative investigator in the SBTI study. Mehmet C. Oz is the host of The Dr. Oz Show. Correspondence concerning this article should be addressed to P. Murali Doraiswamy, DUMC-3018, Duke University Medical Center, Durham, NC 27710. E-mail: murali .doraiswamy@duke.edu T hi s do cu m en t is co py ri gh te d by th e A m er ic an Ps yc ho lo gi ca l A ss oc ia tio n or on e of its al lie d pu bl is he rs .