In early summer of 2021, I donned my disposable face shield, cap, and gown, and then entered the room of 85-year-old Ms. A. After 10 days, she was losing her battle with COVID-19, and the family was with her one last time. With her oxygen mask removed for comfort and her long grey hair freshly braided, she looked beautiful and at peace. On the son’s phone were hymns in Spanish. Twenty crying family members sat with Ms. A. through the daughter’s phone. As I watched the most amazing end of a life I had ever seen, I got a flash of goosebumps and tears came to my eyes.
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The COVID pandemic caused much pain over its two- and half-year course, but I believe most of us can say we learned some things, too, such as importance of friends and community. As a hospitalist, I discovered how to find moments of awe and wonder in unexpected places. That’s what I experienced that day with the Ms. A and her family.
What happens when we experience awe during periods of great stress, such as when someone is dying? Can that awe still be positive? A new research study by Maria Monroy, Dacher Keltner, and colleagues aimed to find out. They conducted the study during the COVID pandemic and worked with a community population and a group of health care workers. The results tell us a lot about how feeling connected to something larger than ourselves can help us to find meaning, even in suffering.
What is awe and how does it shape us?
When asked to think of awesome experiences, we might think first of, say, the Eiffel Tower or the Grand Canyon. But we can find awe in the smallest moments as well. So, what exactly is awe and how do these experiences support us?
For many years social scientists saw awe as complex state that was hard to characterize. After more than a decade of thoughtful work, researchers now see it as a distinct emotion with specific vocalizations, facial expressions, and physiological response. Awe arises when we confront a phenomenon that, by virtue of its vastness, challenges our understanding of the world. We tend to think of this vastness is physically big, but the stimuli can be “deep,” as an idea or an experience. Awe is the process by which we mark the encounter with emotion. This process helps us incorporate what we have experienced into a slightly changed world view. And as a social emotion, it helps us share the experience so we can grow as a group. Specifically, awe leads to five processes:
- Shifts in neurophysiology: This can entail, for example, lower levels of interleukin-6 (IL-6), a marker of inflammation, as well as heart rate changes and and the sensation of chills.
- A diminished focus on the self: Awe can be the antidote to self-absorption, which helps us gain perspective.
- Increased prosocial relationality: Many studies suggest that awe can help us to be generous and empathic.
- Greater social integration: Research to date suggests that feeling awe together makes people more likely to feel like part of a group and to cooperate with each other.
- A heightened sense of meaning and purpose: Awe seems to drive both spiritual feelings and scientific curiosity.
Not all awe is positive. According to a 2017 study, 10-20% of awe is evoke by frightening or dreadful experience and trigger a stress response. But positive awe creates psychological and social situations which can increase well-being for all who are touched by it.
When Maria Monroy and her colleagues conducted their study of awe under stress, the pandemic was still raging—and since people were seldom traveling, the sources of awe were likely to be smaller, more everyday events.
The health care population examined in this study is important because this group of people were under particularly high stress due to risk of infections and really tough working conditions. Because distress in health care workers remains high to this day, anything that aids them will be immediately applicable. So, when people were able to find everyday awe in stressful situations, did it lead to a greater sense of wellness or less stress?
Finding awe in tough times
In the study, participants first went through an hour-long zoom educational and orientation session. Then, for 22 days they received an online questionnaire asking about experiences of awe, other positive emotions, and bodily complaints such as fatigue and pain. It also asked about stress and overall sense of well-being.
They found that there was statistically less stress and greater sense of well-being on days with more awe in both the community sample and the healthcare workers. For community members days with more awe was associated with fewer bodily complaints such as back pain and headache; the healthcare group derived no such benefit.
“The data were organized in a way that every person had their own average level of awe and how much it increased or decreased from their own average,” says Monroy, now at the University of California, San Francisco. “This allowed us to ask questions like, when people experience more awe than typical, do they report better sleep?”
One might be concerned that awe and other positive emotions could track together, so that awe could be falsely interpreted the source of well-being or less stress, but Dr Monroy says that they found “daily experiences of awe were associated with less stress and improved well-being when controlling for positive emotions, suggesting that the influence of awe on stress and well-being was independent of daily positive emotional experiences.”
What types of experiences trigger awe in the study population? Examples she gives include: “Listening to the thunder rumble in the distance and watch[ing] the droplets of rain traveling down the windowpane” and “While walking in the woods I felt mesmerized by the various shapes around me and the beauty of the sunlight peaking in between the trees.” This suggests people found awe in ways likely don’t require tremendous amounts time or resources.
Awe also helped participants to see meaning in stressful situations. Here’s an example from a health care worker: “I work in the ICU. We had a patient that had their heart stop for about five seconds and then spontaneously come back. I was in awe of the fragility of life.” Seeing death is often experienced as a source of stress and adverse emotions, including of negative awe. It’s encouraging to see that it even during a public-health crisis, some practitioners were able to find a sense of wonder from the hardest parts of the work.
A prescription for awe
The timing of the study also is the source of its weakness. Because of the pandemic, they needed to use a convenient sample of people who volunteered to be in the study. Thus, we should not assume that the results are widely applicable to the general populations. Even so, the results can now justify repeating the study in broader settings or particularly vulnerable groups living through challenging circumstances.
It is also worth noting that this was not a simple observational study. The participants were subject to interventions: they had an hour zoom session where research staff educated participants on ways to find awe in everyday life by paying attention to the environment, slowing down and pausing, and expanding on those moments. The questionnaire/diary was an intervention as well, because it primed the participants to look for awe. Asking people about awe one day might make them more likely to see it the next.
This does not diminish the results of the current study but rather raises the question: Would people not inclined to volunteer for this study benefit from this intervention? Does the ability to find awe last beyond a few weeks—and would the increase in well-being persist?
Those are not academic questions for me—and for others, I’m sure, who are charged to improve the psychological well-being of clients, patients, and colleagues. This process of looking for awe suggested by the researchers—paying attention to the environment, slowing down and pausing, and expanding on those moments—sounds similar to those for mindfulness practices. Anyone who has tried these practices knows they are called “practices” for a reason! We need to regularly return to the practice to turn it into a daily habit.
How should we practice? For my patients, I prescribe, “Look for beauty as you move through your day.” The act of prescribing keeps me paying attention, too.
While making my rounds on the morning I finished this article, I found a group of kids and adults in front of my patient’s room. “It warms my heart to see this crowd,” I said to her daughter.
“You ain’t seen the half of it, Dr Hass. This beautiful woman is LOVED!” Goosebumps, tearing eyes. “Wow…” was I could manage to reply for a moment.
Does feeling awe increase our well-being? My experience certainty suggests it can. And I hope that this research will inspire others to remember awe as they try to find joy, beauty and meaning in their lives.