We intended to analyze whether and how often patients with MS or psychiatric disorders experience feelings of Gratitude, wondering Awe, and Beauty in life. Our data show that Gratitude and Awe were noticed and appreciated by a small group (34% and 23% often or frequently, respectively) of the individuals investigated. In contrast, most participants have experienced and appreciated Beauty in life (64% often or frequently). The mean scores of the Gratitude/Awe scale, which measures the frequency of these feelings and experiences, are in the lower intermediate range (42.4 ± 23.8). Previously, in a positively selected group of Catholic priests, we observed much higher mean scores of 70.1 ± 21.6 . Another sample of patients with chronic diseases (70% chronic pain diseases), reached mean scores of 50.3 ± 23.7 on the respective scale .
With respect to our assumption that the perceptions of Gratitude, and experience of Beauty in life may differ according to gender, we indeed observed lower scores of Gratitude/Awe in male patients. This finding is in line with the findings of other studies . This might not mean that men are less capable of experiencing feelings of gratitude or beauty, but, as found by Kashdan et al. , women have a higher willingness to express their emotions than men.
Interestingly, there were no significant differences with respect to the underlying disease categories. The only exception was that patients with depressive orders had significantly lower experiences of Beauty.
Because one of our hypotheses was that religious/spiritual patients may experience Gratitude, Awe and Beauty more often than non-religious/skeptical persons, we analyzed the respective variables with respect to the spiritual/religious self-categorization of the patients and their engagement in specific forms of spirituality. We found that persons lacking a spiritual/religious attitude (R-S-) had significantly lower Gratitude/Awe scores than patients with spiritual/religious attitudes. In line with this finding, Gratitude/Awe correlated most strongly with the frequency of engagement in Religious practices, but also secular forms of spirituality, particularly Humanistic practices. Both activities, religious and humanistic, are associated with relational activities. This can be expressed either through connectedness to a transcendent source (resulting in praying, church attendance, etc.) or connectedness to concrete others (resulting in a helping and caring attitude), and both religious and humanistic practices are primarily active. A previous study also showed that the best predictors of Gratitude/Awe were religious trust (in terms of an intrinsic religiosity) . Among the three target items analyzed in this study, feelings of Gratitude as well as Awe correlated most strongly with Religious practices. Experienced Beauty was most strongly associated with Humanistic practices and only weakly with Religious practices. Thus, it is the experience of feelings of Gratitude and wondering Awe more than awareness of Beauty in life that might have a positive spiritual/religious connotation.
Keltner and Haidt  recommended that research should concentrate on similarities and differences between gratitude and awe. In our study, both were strongly interconnected (r = .59). However, Awe was experienced less often than Gratitude. Interestingly, significantly more women than men experience Gratitude, whereas there were no significant gender differences with respect to Awe.
Wood et al.  argued that an “ungrateful person is less likely to notice help, and less likely to reciprocate the help, making their benefactor less willing to provide further aid”. In turn, grateful people benefit from “better social relationships, characterized by greater closeness and heightened reciprocal social support”. Patients with reduced experience of gratitude and awe, or low awareness of the (still existing) positive aspects in life (including beauty in nature, situations, and relationships) receive help to focus their attention on these aspects of their life. The persons investigated in this study (particularly those with psychiatric disorders) may benefit from such interventions, which have the potential to increase their life satisfaction and well-being. Gratitude interventions to increase well-being and decrease depressive symptoms might be a meaningful option [14, 35].
Previous research has shown that gratitude is strongly related to well-being . However, in this study we measured satisfaction with various dimensions of life concerns and not simply well-being. We observed only a weak association between life satisfaction and Gratitude, yet a moderate association with the experience of Beauty in life. However, general life satisfaction was among the best predictors of Gratitude/Awe. What is measured as life satisfaction or quality of life might differ from what patients and people in general consider as authentic happiness or as lasting personal fulfillment, and from what may constitute elements of personal “well-being”. Fagley  found that awe correlated moderately with life satisfaction (r = .35) and only weakly with gratitude (r = .28); their hierarchical multiple regression analysis indicated that after controlling for demographic variables, personality factors and gratitude, a grateful attitude made a “significant unique contribution (11% of the variance, p < .001) to life satisfaction”. In our study, Gratitude/Awe explained only a small amount of life satisfaction (4%), and thus it should be regarded as an independent dimension. Our findings emphasize the fact that more frequent experiences of Gratitude/Awe will not necessarily result in higher life satisfaction with all its usually scored aspects, both objectively and subjectively. Rather, it may indicate an ability of patients with a spiritual/religious attitude to “look deeper” and to appreciate life as such – a trait or attitude which can be predicted best by an engagement in Religious practices and Humanistic practices.
Findings of Diener et al.  showed that the association between religiosity and higher subjective well-being is mediated by social support, feeling respected, and meaning in life. Interestingly, the prevalence of religiousness was dependent on the characteristics of the society and underlying difficulties of life conditions. They found that in societies with more favorable circumstances, individuals’ religiosity was lower, and the level of well-being was similar among religious and non-religious individuals . Also, in the German patients investigated in this study, the percentage of religious individuals was low (65% non-religious), and their relatively low life satisfaction scores did not differ with respect to the underlying spiritual/religious self-perception. This means religious/spiritual patients from our sample are not more satisfied with their life concerns (as measured by life satisfaction scales) than non-religious patients.
Although religious self-perception appears to have no significant influence on life satisfaction, a study among healthy individuals showed that higher levels of trait gratitude are associated with “more positive beneficial appraisals” . Because previous studies found that positive spirituality/religiosity was significantly associated with positive appraisals of chronic illness , one may suggest that patients in our sample also draw on spiritual/religious resources to cope with chronic illness (in terms of finding meaning and hope) and to value the moments of beauty and show gratitude for the positive aspects in life despite illness. This attitude might be a dispositional trait, which can be developed (i.e., gratitude interventions (reviewed by ). Wood et al.  stated that there might be a “higher order grateful personality” that exists beyond particular aspects of gratitude and may represent a “life orientation towards the positive”, involving a “worldview towards noticing and appreciating the positive in life”.
In cancer patients, Strack et al.  reported that the “cognitive reappraisal of emotion, gratitude finding, and openness to experience” was associated with post-traumatic growth in patients’. In our study, we focused on two groups of patients with primarily non-fatal, chronic diseases, who have to find strategies to adapt to their often recurring symptoms. In this sample of non-cancer patients, we have evidence of relatively low life satisfaction, particularly in the patients with psychiatric disorders. Detailed analyses showed that Gratitude and Awe are not experienced or noticed very often. However, the participants have still experienced and valued Beauty in life. One may hypothesize that patients lack reasons to be grateful because of their frustrations with the disease and associated dissatisfaction with life; or they give less attention to issues other than the symptoms of their illness. However, it seems that religious individuals are able to value other aspects in their life despite the disease – though they need not necessarily be more satisfied with their life in the usual understanding of “life satisfaction”.
This study was not designed to specifically measure gratitude as a short-term emotion. Rather, it is measured here as a disposition of gratefulness and an attention to beauty in life as a specific aspect of spiritual activities and experiences. Therefore, the three items of the Gratitude/Awe scale measure a specific aspect of patients’ experience of feelings of Gratitude, wondering Awe and perception of Beauty in life. These can be observed even in patients lacking any interest in spiritual or religious issues.
Further, the study was cross-sectional, and thus we cannot draw conclusions on the directions of causality in the observed associations. Thus, longitudinal studies are strongly needed. Moreover, the perceptions of patients with psychiatric disorders may be significantly different during their “silent” and asymptomatic phases. Similarly, the respective scores might also be lower in patients with MS during acute or relapsing phases of disease. In addition, we have no data on whether or not analyzed patients with MS had frontal lobe lesions or ideation/thought disturbances. Such neurological affections may have an impact on states of consciousness, ideations, and self-reflection. Further research might focus on such altering impacts which have not been pursued by our investigation. Moreover, it would be desirable that future research compares also non-clinical populations and different clinic al populations with regard to the variables at stake.
Nevertheless, the strength of this cross-sectional study is its focus on participants with primarily non-fatal diseases. Instead of choosing a sample of relatively young and healthy students and confronting them with hypothetical situations to induce feelings of gratitude, we chose a sample of patients that has had to deal with the ups and downs of chronic disease. However, we do not know any specific details about our patients’ concrete feelings of gratitude and awe or their specific causes.
Of course there are some additional findings on the putative association between patients’ spirituality and further health-related and psychological measures. Among patients with MS for example, their engagement in religious practices was only marginally associated with negative mood states such as grief, despair or tiredness (r < .20; p < .05), while there were no significant correlations with cognitive or motoric MS related fatigue (r < .10; n.s.) (Wirth et al., in preparation). These and other details will be topic of independent papers of the Freiburg group on patients with psychiatric diseases (Reiser et al., in preparation) and the Herdecke group on patients with MS (Wirth et al., in preparation).