The Art of Manliness - How Your Expectations Can Change Your Life

00:00:00.000 brett mckay here and welcome to another edition of the art of manliness podcast during world war

00:00:11.540 ii henry beecher an anesthesiologist serving in the u.s army noticed that 32 percent of the

00:00:16.340 soldiers he treated for horrific battle wounds felt no pain a further 44 percent experienced

00:00:20.940 only slight or mild discomfort despite the fact they had shrapnel embedded in their bodies

00:00:25.320 beecher hypothesized that the euphoria surviving battle resulted in the release of a natural

00:00:29.800 painkiller when morphine was running low in europe beecher thought he could harness the mind seeming

00:00:34.140 ability to produce natural painkillers in a different way by injecting soldiers who were

00:00:38.080 about to undergo surgery with a simple saline solution while telling the soldiers they were

00:00:42.160 receiving morphine about 90 of these patients underwent the surgery with little or no pain

00:00:46.660 beecher's field expedient placebo treatments would go on to open up decades of research into the power

00:00:51.080 of our expectations on today's show my guest will walk us through that fascinating research and how

00:00:55.520 the connection between the body and the mind is a lot stronger and wilder than we know his name is

00:00:59.760 david robson and he's an award-winning science writer and the author of the expectation effect

00:01:03.840 how your mindset can change your world david and i begin our conversation with how and why the brain

00:01:08.600 operates as a prediction machine and how the expectations it generates can shape the reality

00:01:12.600 we experience we then discuss how even when someone's pain or condition is very real the placebo effect

00:01:17.440 have an equally real effect on their physiology even when people know they're taking a placebo

00:01:21.760 we also get into the nocebo effect where your expectation that a drug will have negative side

00:01:25.780 effects in fact produces those side effects from there we turn to how the expectation effect has

00:01:30.060 powerful results beyond the medical world and shows up in the areas of sleep diet and fitness

00:01:34.560 including how thinking of doing chores as exercise actually increases the health benefits of that

00:01:38.740 activity how reframing your anxiety can turn into a performance enhancing boost and how your

00:01:42.820 perception of getting older hugely affects how you'll actually physically and mentally age

00:01:47.180 after the show's over check out our show notes at awim.is expectation effect

00:01:51.640 david robson welcome to the show thanks so much for having me so you got a new book out called the

00:02:10.160 expectation effect how your mindset can change your world you're a science writer how did a science

00:02:16.480 writer end up taking a deep dive into the power of expectations over our lives yeah i mean it was

00:02:23.180 kind of a coincidence with like an event that was happening in my private life and then one that was

00:02:28.580 also happening professionally so in my private life i had kind of i've been suffering from depression

00:02:34.580 i've been put on these antidepressant pills and my doctor just happened to mention that one of the

00:02:40.120 side effects that i might experience would be bad headaches and almost straight away you know the

00:02:45.940 next day i started having these migraines that were quite debilitating actually like really hard to

00:02:51.060 concentrate at work you know it felt a bit like a ice pick was kind of penetrating my skull you know

00:02:56.240 enough that i would have probably soon discontinued using the pills but just by pure coincidence as i was

00:03:02.440 experiencing this i happened to be writing an article about the mind-body connection and i discovered

00:03:08.600 about this phenomenon called the nocebo effect so the placebo effect is where our expectations of a

00:03:15.400 treatment's success will actually help to make it more beneficial for us and the nocebo effect is the

00:03:21.380 exact opposite so that's when we're told that we might become ill that we actually do become ill and

00:03:28.320 this is a really common reason that lots of people experience drug side effects so when your doctor

00:03:33.400 warns you that you might experience a side effect like these headaches that warning in itself makes

00:03:40.100 the presence of the headaches a lot more likely for an expectation effect so purely for expectation

00:03:46.380 not for the chemical action of the drugs themselves yeah and i want to dig more into this placebo nocebo

00:03:51.840 effect this is really fascinating but before we do i think we need to understand why is it the

00:03:58.220 placebo effect or the nocebo effect can actually be a thing and you make the case that the reason the

00:04:04.340 our expectations in our mind can influence everything from our physiology to how creative we are how smart

00:04:12.420 we are even sometimes and on tests it all goes back to the fact that our minds are prediction machines

00:04:21.160 so how does our brain this prediction machine well yes i mean it's not our brain so this is it brain or

00:04:27.780 mind that's all is it the i guess it'd be the mind right the mind is a prediction machine how does

00:04:33.220 this prediction machine construct the world that we experience yeah i mean you know you can make the

00:04:39.840 distinction between the brain and the mind but actually here i think it really is so central to

00:04:44.580 the kind of brains processing you know the actual things that the neurons are doing that you can really

00:04:49.620 talk of the brain as a prediction machine and what we mean by that is that it's constantly forming

00:04:55.560 these simulations of the world around us and preempting what's going to happen next um so that's really

00:05:03.140 important in sensory perception because you know in lots of situations almost every situation we find

00:05:09.380 ourselves in the raw data hitting our eyes and our ears it's just really kind of ambiguous you know

00:05:15.960 it's very messy and what the prediction machine does is you know knowing the context of where you are

00:05:22.280 and knowing what it's experienced previously it forms these simulations which then help it to

00:05:27.460 make sense of that sensory data so it actually tidies up that sensory data and turns it into something

00:05:33.500 meaningful and what we're experiencing is that kind of combination of the brain's predictions those

00:05:40.100 simulations and the sensory data we're not experiencing the sensory data kind of as it is kind of in its raw

00:05:46.780 form at all it's very much it's been processed and cut up and you know edited into into something quite

00:05:52.720 different from what what you would see if you only saw what is landing on the retina so that's how the

00:05:57.780 prediction machine is kind of shaping our sensory experience but then what it's also doing is then

00:06:03.380 helping to kind of prepare us for action um so those simulations are then telling the brain what commands

00:06:10.260 to send to the body to change our physiology so you know the kind of hormonal balance that's going to be

00:06:15.860 most useful for the situation we find ourselves in blood pressure you know even the actions of the gut

00:06:21.680 like all of these things are being influenced by the brain's predictions by that prediction machine

00:06:27.900 and that's where the placebo effect and the nocebo effect come from is because when we're kind of

00:06:33.460 given information by a doctor that's actually changing the brain's predictions and then that in turn

00:06:39.040 is then changing our physiology it's adapting our physiology okay so yeah this prediction machine it

00:06:45.740 incorporates a whole bunch of different factors when shaping or constructing reality in our brain

00:06:51.340 so it's not only you know we use uh the data we receive from our retina how we you know the light

00:06:56.860 that bounces in our eye we construct reality with that it's also emotions can color our predictions

00:07:02.440 information from a doctor can color our predictions consequences that we you know we did did an action we

00:07:08.880 experienced this result that is also going to shape our brain's predicting machine

00:07:14.720 yeah that's exactly it so essentially like we have to use whatever information is available and you

00:07:21.720 know that like you said that can just be perceptual or sensory but also like it you know so much useful

00:07:27.700 information comes from you know that our social interactions our culture you know all of these

00:07:33.360 things are feeding into the prediction machine they're all helping to calibrate those simulations

00:07:38.040 and do we so you talk about this too in the book why we would evolve to predict reality

00:07:43.820 right i mean you think it makes sense that our brains would just be like okay i'm going to take

00:07:47.820 raw data from the outside world and construct reality you know but we don't do that and because we sort of

00:07:54.220 we're sort of guessing like our brain is making these guesses you know mostly most of the times it's right but

00:07:59.420 that means it can sometimes be wrong and that's not good so what's the benefit of guessing at reality

00:08:04.860 what do we get for that you know so there is some kind of error in these brains predictions but actually

00:08:11.900 it's accurate enough of the time that it's you know it's still the best way for the brain to process

00:08:18.240 the world and there's a couple of reasons why that is the first one is that it's actually really

00:08:22.840 efficient if you're building these simulations and then you're receiving this sensory data the

00:08:28.420 simulations are actually helping to direct your brain to the most important information to process so

00:08:34.320 you know the bits of the scene that are surprising for example so it just cuts down the kind of amount

00:08:40.100 of data you're processing because you're relying on your experiences but also and i think this is the

00:08:45.380 main one is that it just helps us to deal with ambiguity and makes us more adaptive and flexible

00:08:50.940 you know if you're if you're pre-empting what's going to happen next that's helped just giving you a

00:08:56.600 head start so you know if you see a predator coming and your brain is already helping to pump

00:09:03.580 adrenaline through your system you know that's giving you a head start in dealing with that danger

00:09:08.240 so it's very much adaptive very useful for the way we interact with the world and navigate the

00:09:13.480 challenges around us right even if that predator just turned out to be a little mouse there's still

00:09:18.760 a benefit to that because like hey well if it was a predator that would have been really bad

00:09:22.520 because you would have died if it's a mouse like well no harm no foul

00:09:26.520 no exactly it's better to be safe than sorry right you know same i mean the classic example is that

00:09:32.980 you know in the forest you might be kind of on a hunt and then like you kind of jump because you

00:09:37.160 think there's a snake in front of you if it turns out that that is actually a just a kind of piece of

00:09:43.220 wood you know or a piece of rope that's no big deal but if you mistake a snake for a piece of wood

00:09:49.340 well then if it's the other way around i mean so if you you actually see a snake there is a snake

00:09:54.540 there but you see it as a piece of wood that's much more dangerous for you so we are naturally

00:09:58.880 conservative in our uh kind of brain uh simulations where we do have this kind of bias that we are more

00:10:04.660 likely to see a threat than we would be otherwise because that just helps us to to kind of it helps

00:10:09.960 to improve our survival okay so our brains are prediction machine it's constantly predicting what

00:10:14.180 reality is it's mostly right most of the time but sometimes there are errors and for my take on it

00:10:20.380 these errors can benefit us through the placebo effect right like you take a sham medicine it

00:10:27.560 actually doesn't do anything to you like physiologically but because you think it is

00:10:31.860 like you make this error this prediction error it does end up having an effect on you so let's talk

00:10:36.380 about the placebo effect i'm sure everyone has heard about it but how do scientists define it

00:10:41.580 yeah so i mean the placebo effect as scientists define it is very much as you described it as where you

00:10:48.020 receive a sham treatment but through expectations of receiving some benefits that you do see some

00:10:53.620 noticeable improvement in your symptoms and so some of those improvements could just be subjective you

00:10:59.500 know maybe you just feel a bit more relaxed but actually what we now know is that a lot of the

00:11:04.760 improvements are objective as well so there's actual physiological change this could be for example if

00:11:11.640 someone takes a placebo analgesic a placebo painkiller you actually see the expression of the brain's own

00:11:18.740 endogenous opioids so it's our natural painkillers the levels are increased after you receive this placebo pill

00:11:26.500 but also we can see all of those other changes like changes in blood pressure changes to our digestion

00:11:31.960 you know changes to things like the activity of our muscles you know all of these things that can be really

00:11:37.040 important changes to inflammation is one of the main ones when we're ill we have higher inflammation

00:11:42.300 when we receive a placebo it can actually reduce that inflammation and in some cases the differences

00:11:48.040 can even be visible to the naked eye so people have had rashes and then they've received a placebo cream

00:11:53.560 and it's actually removed that rash it's helped the swelling to go down so it can be quite profound

00:11:58.740 the placebo effect okay so that's a good point that i want to hit home here the placebo effect isn't

00:12:03.600 just subjective though it can be but a fake treatment can actually have objective outcomes

00:12:08.740 on your physiology like it can change your body physically absolutely and you know like i'm not saying

00:12:16.680 here that like a placebo uh treatment could cure cancer you know we're not talking about miracles here

00:12:23.000 but actually the results are still really profound and actually you know another question i'm asked is

00:12:28.820 often like are we do we have to deceive ourselves to benefit from these expectation effects

00:12:33.360 and the answer is that you don't and so we see that with placebo treatments in medicine that

00:12:38.580 actually it is possible to get a placebo response even when people realize they're taking a sham

00:12:45.220 medicine um so we call these open label placebos and one of the most noteworthy studies that i came

00:12:52.280 across was from a trial of people with chronic lower back pain in portugal and they were given these

00:12:58.440 uh clearly labeled placebos you know it was a a jar of like bright orange pills and it said

00:13:03.600 you know like placebo pills take two a day so there was no deception there at all but beforehand the

00:13:09.940 participants had been given this presentation about the mind-body connection how the placebo effect works

00:13:15.600 they'd kind of had their expectations raised of what the placebo pills could achieve and what they found

00:13:21.460 was that after a week of taking these pills they had a clinically significant improvement in their

00:13:26.320 symptoms so that in itself was really remarkable it was about 30 percent reduction in their pain and

00:13:32.120 disability okay so you so yeah i think oftentimes when people think about a placebo they think you

00:13:37.640 have to like not know you're getting a placebo for the placebo to work but you're saying that's not the

00:13:42.820 case you can actually know that the treatment you're getting is completely fake and it will still

00:13:47.200 have a benefit some sometimes not all the time but sometimes yeah i mean it sounds incredible but

00:13:52.800 actually this has been repeated in numerous situations so people with inflammatory bowel

00:13:57.700 syndrome have really benefited from open label placebos it's actually been shown to help with

00:14:03.100 a certain kinds of fatigue you know that can be related say to kind of different cancer treatments having

00:14:08.740 these open label placebos have been really empowering for these patients even things that allergies can

00:14:14.480 benefit from open label placebos and you know i try to work out in my mind like how this could be

00:14:21.600 possible and i think there's a couple of mechanisms there and one is is the fact that there's the

00:14:26.880 ritual of receiving the treatment so the placebo pill is kind of capturing that and we know that

00:14:32.860 actually just the feeling that something proactive is happening that you're being taken cared of that in

00:14:38.920 itself can help to trigger some physiological benefits so it can help to do things like reduce

00:14:44.420 inflammation so so that's one potential means by which this can be useful and then there's also a

00:14:50.540 process called conditioning so if you've previously received painkillers your brain was probably

00:14:56.920 already kind of producing its own endogenous painkillers to kind of help that treatment along

00:15:01.860 a little bit that's part of the expectation effect is conditioning and what seems to be happening then is

00:15:07.160 that you know even when you're taking these pills just the fact that they resemble your previous

00:15:11.940 treatments can kind of take advantage of that even if you know consciously that they're not actually

00:15:17.740 the real pills and so yeah i think it's beneficial for a number of different pathways when you also

00:15:24.400 highlight this idea of conditioning the invasiveness of the placebo can actually strengthen the effect so

00:15:31.040 a pill if you take a pill that can have an effect your condition to think well if i take a pill it's

00:15:35.060 going to have some sort of effect on me it's going to reduce the pain if you want to go a step above

00:15:38.780 that an injection right and they've actually done this with i think athletes we're going to inject you

00:15:44.400 we're going to tell you it's like a athletic performance drug but it's actually just saline

00:15:48.640 like their level of performance increased significantly and i guess the ultimate

00:15:53.640 intervention would be like a surgery so like a sham back surgery and as you go up oftentimes the

00:15:59.940 intensity of the placebo effect also increases as well yeah that's right and actually placebo

00:16:05.240 surgeries have been shown to be beneficial in so many different areas you know people who have

00:16:10.960 gastric bands fitted to control their appetite you know a big part of those benefits that they

00:16:16.300 receive at the placebo effect because you know that if someone's had like a sham operation where there

00:16:21.800 might have been an incision but the band wasn't actually fitted you know you still still see a big

00:16:27.080 amount of weight loss afterwards and reduction in appetite also with it seems like when surgical

00:16:33.140 stents are added for people who are experiencing angina in the heart that actually a lot of that pain

00:16:39.300 reduction and improvement in things like their mobility and capacity to exercise the a substantial

00:16:45.120 part of that seems to come from the placebo effect too so it's actually quite common and the problem

00:16:50.320 with surgery in the past has been that we haven't really conducted clinically controlled kind of

00:16:57.460 placebo controlled trials with surgery traditionally so we're only just really beginning to understand

00:17:03.420 kind of how big a part the placebo effect plays in lots of different surgical procedures well yes you

00:17:10.240 this is an interesting point you make in the book so medicine or science uses placebo to test drugs

00:17:16.280 right so for a drug to get approved by the FDA here in the United States it has to perform significantly

00:17:22.060 more than a placebo so they do these studies they're going to give one group the actual drug another

00:17:26.660 group a placebo if the placebo does better then it's like well this drug actually doesn't do anything

00:17:31.720 we're not going to approve it one of the problems you highlight is that over time the placebo effect

00:17:37.600 is getting stronger and stronger so it's getting harder and harder for drugs to get approved he walk

00:17:42.700 us through this dynamics that that was really interesting yeah i mean it's actually been seen

00:17:47.140 in like a whole bunch of different drugs so you know we see it with antidepressants we see it with

00:17:52.960 painkillers we even see it with some things like epilepsy drugs as well you know there's probably

00:17:58.580 different causes of this increasing placebo effect in each case but one explanation that i found

00:18:05.000 especially uh kind of attractive was this idea that actually what's maybe causing that that increased

00:18:12.440 potency of the placebos is actually our knowledge of the mind body connection so the researchers

00:18:18.600 actually looked at how often the placebo effect had been mentioned in the international media and they

00:18:24.420 found that in the countries where there had been a lot of media coverage of the placebo effect and the

00:18:29.500 mind body connection that actually it was in those regions where the placebo effect had increased most in

00:18:35.920 these clinical trials which is quite remarkable but i think then that also kind of ties in very nicely

00:18:41.660 with these studies of the open label placebos because it's almost like just once you know that your brain

00:18:47.540 has this capacity to heal your body in some way that that's empowering enough that you can see these

00:18:53.540 benefits and the more people have realized that over the last few decades with all of these documentaries

00:18:58.300 and magazine articles the more they've experienced that are doctors starting to use placebos just

00:19:05.340 proscriptively like they're using like instead of just giving a drug they're just starting to prescribe

00:19:09.780 placebos is that happening because that's sort of that's that's an ethical quandary right

00:19:14.000 yeah i mean it's a real ethical issue and actually i think at least in the uk a doctor shouldn't be

00:19:21.060 prescribing a placebo and telling the patient that it's an active drug now whether doctors actually do

00:19:27.580 that is another question so i have seen a survey that suggested you know quite a big proportion of

00:19:32.700 doctors say that they have given a placebo at least once in their career you know how they got around

00:19:38.600 the kind of ethical quandary i'm not sure sometimes i think it could just be that they kind of

00:19:43.500 prescribe something like a vitamin pill and they just tell the patient not necessarily dishonestly

00:19:50.860 oh this could help you to feel better so they're not making any grand claims but they're just saying

00:19:56.780 oh this might you know be useful to you and and then i think the patient could still benefit from the

00:20:03.140 placebo effect there without having been overtly lied to it's not as if they were claiming the the pill was

00:20:08.360 something that it wasn't they were kind of being vague enough there for it to be just about ethical

00:20:13.140 but actually i think there's a lot more excitement now in ways that we can use these open label

00:20:18.140 placebos and one of them is to reduce opioid addiction so there was a study in the us at harvard

00:20:24.780 university that looked at people who were in rehabilitation that you know suffered from various types of

00:20:30.820 injuries and they were taking opioid drugs and the scientists prescribed first of all the the kind of

00:20:38.200 real drugs but they accompanied that with an open label placebo pill and to strengthen the association

00:20:44.080 even more they also asked the participants to sniff the really strong scents of cardamom now what this

00:20:50.900 was doing was conditioning the patients to associate pain relief with the smell and the placebo pill and

00:20:57.360 then after a few days they just they didn't tell the the patients they couldn't take their original drugs but

00:21:03.800 they tried to encourage them not to so they tried to encourage them only to take the placebo pills and

00:21:09.460 to sniff the cardamom as well and they actually found a really big benefit there so actually a lot of the

00:21:15.140 patients were really able to experience exactly the same pain relief with a much bigger reduction in their

00:21:21.740 dosage through this open label placebo effect we're going to take a quick break for a word from our sponsors

00:21:28.100 and now back to the show okay so we talked about the placebo so placebo effect can have an objective

00:21:34.480 effect on your physiology let's talk about the nocebo effect what are some examples of the nocebo

00:21:41.160 effects this is the opposite of placebo what are some examples you came across in your research

00:21:45.320 i mean the the big one was that kind of personal experience which then i found actually had played out

00:21:51.560 in the research as well so that's this idea that actually the warnings that were given about the

00:21:56.760 side effects of drugs that actually they can create those side effects so the headaches that i was

00:22:02.800 experiencing when i was on my antidepressant pills they were almost certainly the product of my

00:22:07.960 expectations not the chemical effect of the pills and we know that that can actually be reflected in

00:22:13.960 these objective changes in the brain's physiology so things like the vasodilation and constriction

00:22:19.900 in the brain seems to respond to these expectations of having a headache and so it can actually produce

00:22:25.600 you know real changes that would produce real pain there's no way that this kind of imagined or

00:22:30.820 malingering you know people who are experiencing the placebo effects are really suffering the real

00:22:36.200 symptoms i think that's really important to emphasize but there are lots of other examples and i think some

00:22:41.600 that you know go beyond just kind of the the clinic you know i think like we've seen a big rise in

00:22:48.520 things like um wheat or gluten sensitivity now some of these people really do have a kind of direct

00:22:55.960 allergic reaction to the components of wheat especially the gluten protein but actually what

00:23:02.020 the research has shown is that a lot of people with wheat sensitivity they actually showed the same

00:23:07.320 symptoms even when they're given a placebo pill placebo food so that doesn't include any wheat products

00:23:14.340 at all and so it really seems that for these people it's the expectation that they're going to become

00:23:20.040 ill that's leading them to have all of these horrible symptoms and it could be that the huge amount of media

00:23:25.620 coverage we've had around wheat sensitivities has actually implanted that expectation in their minds

00:23:31.540 and is then contributing to these symptoms and has contributed to that huge rise in the number of people

00:23:36.780 reporting these illnesses and you also make the case that understanding the nocebo effect can also help

00:23:42.280 individuals with chronic pain how so yeah because one of the problems when people experience chronic

00:23:48.180 pain is that they catastrophize their feelings and i can totally relate to this and i don't have chronic

00:23:54.740 pain but absolutely when you know i experience migraines for example i do tend to catastrophize that

00:24:00.620 feeling so it's it's all of those concerns that you might have and those expectations that you know maybe

00:24:05.820 like the pain is just never going to go away at all but if you have a kind of flare-up that it's just

00:24:11.520 never going to disappear and that you're always going to be in that kind of agony that's the kind of

00:24:16.420 catastrophic thought that can really contribute to your pain and what we know is that when we have

00:24:21.380 these negative expectations and the more anxious we become about a symptom the more the brain responds in

00:24:28.020 a way that will then amplify the pain signals so it actually releases this chemical called cck that is

00:24:34.800 kind of like adding a loud speaker to our pain nerves and it's like amplifying the signals that

00:24:40.760 they're sending to the brain and just increasing the experience um so that that's the explanation and then

00:24:46.220 the interventions is really aimed at helping people to just avoid that catastrophic thinking so

00:24:51.840 trying to get them to be a bit more objective to try to remember times in the past where they might have

00:24:56.620 had a flare-up and then to also remember when it dissipated that pain and to to realize that the pain

00:25:02.880 may not be there all along and also to sometimes realize that pain can be functional even so you know

00:25:09.840 just telling people that that maybe their pain isn't coming from tissue damage and they don't have to

00:25:15.580 be so worried about that pain as they are that it might not reflect a kind of serious injury that's kind of

00:25:21.400 getting worse and worse that it could have this psychological component that realization can also help

00:25:26.400 people to manage their symptoms so yeah the intervention is that simple just talking to a doctor saying yeah

00:25:31.900 actually it might not be a big deal and that can have a dramatic effect yeah it really is i mean you know

00:25:37.680 it's very similar i think to the cognitive behavioral therapy that we might experience for you know dealing

00:25:43.400 with things like depression or anxiety there's now a lot of research showing that a similar process of talking to

00:25:49.460 a therapist and helping to kind of unpack all of those thoughts and fears that you might have about

00:25:54.500 your symptoms that that can be very useful you also talk about how the nocebo effect likely plays a role

00:26:00.980 in insomnia how so yeah i mean it plays a role in insomnia in multiple ways i think the first is that if

00:26:08.400 you once you start becoming anxious about not getting enough sleep those kind of negative cycles of

00:26:14.240 thinking that kind of rumination is going to make it much harder to fall asleep at night so

00:26:19.160 as soon as you've been laying awake for a few minutes not being able to get off to sleep you

00:26:23.900 you have all of this catastrophic thinking that then kind of keeps you awake for much longer and

00:26:29.120 amazingly there have been some studies that have shown that in these cases actually consciously just

00:26:35.040 trying to stay awake can help break that cycle of thinking and ironically means that you're then quicker to

00:26:42.820 get to sleep afterwards so you know you really you really do just want to kind of try to break that

00:26:50.100 negative cycle of thinking however you can the break the rumination to to kind of try to improve your

00:26:55.680 insomnia but even more intriguingly to me is the fact that often the symptoms of sleep loss that can

00:27:02.760 also be the result of an expectation effect so when people have had a disturbed night if they catastrophize

00:27:10.160 they're thinking about that sleep loss and if they kind of really focus on it and they expect to

00:27:15.100 suffer from a bad mood poor concentration serious fatigue throughout the day they're much more likely to

00:27:20.940 experience that and actually a lot of these people who we call complaining good sleepers because if you

00:27:27.720 put them in the lab you can see that actually these complaining good sleepers often do get seven or eight

00:27:32.940 hours sleep night that actually you know they can even it can those negative expectations can even

00:27:39.820 influence things like the higher blood pressure that can often come from insomnia so it's a combination

00:27:45.040 of subjective and objective symptoms again that are resulting from our expectations and then there's

00:27:51.340 also people who don't sleep well at night don't get don't get any sleep but then they wake up they feel

00:27:56.080 fine and they don't have any of those ill effects of not getting enough sleep yeah that's exactly it so

00:28:02.300 we call these people the non-complaining bad sleepers and you know despite the fact that they might have

00:28:07.880 really disturbed sleep they are remarkably free of any ill effects so obviously the best combination is

00:28:14.100 to have great sleep and great expectations of your sleep but you know these people who have bad sleep

00:28:20.300 but actually have a positive attitude they fare almost as well you know reading about the placebo nocebo

00:28:26.480 effects made me start to re-evaluate all you know this health tracking we're doing with our

00:28:32.220 smartphones because i can see it just messing with people's minds right like like i think a lot of

00:28:36.840 you know if you have an apple watch you can track your sleep and let's say you wake up and you see

00:28:42.060 your phone says you didn't get enough sleep last night i could see i just be like wow my day's gonna

00:28:46.260 be crappy i'm gonna be tired my workout's not gonna be good you know they have like i guess there's

00:28:50.760 heart rate variability which is supposed to show how fatigued you are i can see someone looking at their

00:28:56.240 phones like oh my heart rate variability sucks i'm gonna have a bad training session and then they have

00:29:00.380 a bad training session so i'm wondering if this health tracking might backfire on us is had you

00:29:06.780 come across any research on that yeah i had come across like researchers expressing concern about

00:29:11.520 this and it totally makes sense to me i think the problem is that often the kind of trackers that

00:29:16.440 we're wearing you know they're not to the same standard that you would have in like a scientific

00:29:20.720 laboratory so there's lots of room for kind of error in the readings that we're getting and you know

00:29:26.340 sometimes that could be beneficial like maybe you're telling people that they've had more sleep

00:29:30.400 than they really have had and then that might actually improve their functioning in the day

00:29:35.220 but equally you could be you could have someone who has slept pretty well but for some reason some

00:29:40.720 fault with the device you know it's kind of overestimating how disturbed their sleep was

00:29:45.500 and then that kind of obsessive anxiety about that you know constantly checking it then that's going to

00:29:50.960 contribute to a nocebo effect and and could reduce well-being in the long term and this is really

00:29:56.660 like where it's the reason i wrote the book was that actually you know i find the placebo effect and

00:30:02.400 the nocebo effects in medicine really fascinating but actually you know i was tracking all of this

00:30:07.700 research that showed that it's just our expectations are playing equally important roles in all other

00:30:12.940 areas of our lives including fitness you know there's one study recently from stanford university

00:30:18.640 where they got participants in the lab and they gave them a genetic test and some of the participants

00:30:24.480 were told that they had a kind of good version of this gene crev1 that should improve their endurance

00:30:29.840 exercise capacity so you know we know that these people do generally do a bit better on the treadmill

00:30:35.060 and that it even relates to some physiological measures such as the kind of gas exchange within the

00:30:40.480 lungs other people were told that they had the bad version of the gene so they were going to find the

00:30:45.300 exercise harder they just weren't naturally so cut out for exercise so they did the gene test the

00:30:51.140 results were recorded but the feedback was it was sham feedback it wasn't the real result that they had

00:30:56.500 received and then the researchers put these people on a treadmill and actually measured their physiology

00:31:02.240 and they found that those expectations were really important in determining their actual performance

00:31:07.260 so you know how long they could run on the treadmill how efficient their lungs were at

00:31:12.220 exchanging oxygen for carbon dioxide you know all of these things seem to depend on their expectations

00:31:18.300 and in some cases actually the expectations were much more important than the actual gene they were

00:31:23.440 carrying yeah that's another source of nocebo is these genetic tests you can take that can tell you

00:31:28.260 oh you have this gene for aerobic activity as opposed to anaerobic that could mess with you as well

00:31:34.060 yeah totally and what worries me about this is that it's quite rare for something complex like a physical

00:31:40.100 fitness to depend on just one gene so you know probably depends on tens or hundreds or even

00:31:45.320 thousands of genes but the genetic test that we're doing at the moment often just cherry picks a few of

00:31:50.940 these genes so we might actually be giving people false feedback unwittingly that could then be damaging

00:31:56.920 you know their performance or even their overall kind of enthusiasm and motivation for doing exercise

00:32:02.500 because they've been given this inaccurate information well another area where you saw the expectation

00:32:07.760 effect influence fitness is with a research on housekeepers at a hotel tell us about that i thought

00:32:13.320 that was really interesting yeah so this is really looking at the long-term effects of our exercise and it

00:32:18.900 seems that expectations play a huge role there as well so these researchers from harvard university

00:32:25.200 they visited seven hotels in total um in three of the hotels they kind of told the hotel cleaners

00:32:33.700 absolutely you know verified scientific facts but they just explained to them that their the work they

00:32:38.960 were doing which didn't really feel like exercise it didn't feel like going to the gym they weren't

00:32:44.620 interpreting the physical activity as being like going to the gym but the researchers told them that

00:32:49.600 actually they were burning a lot of calories they were exercising their heart and lungs and that you

00:32:54.380 know over the course of a week they were easily getting the same amount of exercise as was

00:32:59.340 recommended by the u.s surgeon general so you know it was really important it was a really you know a good

00:33:05.700 physically active job and they just weren't appreciating that exercise as much as they could be

00:33:10.420 they left some flyers and posters around the hotel so these cleaners could you know remind themselves

00:33:15.500 of those facts and then a month later they came back and measured their physiology so things like their

00:33:20.900 blood pressure you know their bmi their body mass index and the kind of hip to waist ratio and in all of

00:33:27.480 these cases they actually saw that despite there being no real difference in the cleaners lifestyles

00:33:33.280 just the change in expectations seem to have made them a bit more healthy a bit fitter than they had

00:33:40.460 been before compared to cleaners in the other hotels who hadn't been given that positive information

00:33:45.780 all right so thinking of your just daily chores as exercise can prime your body to actually think of it as

00:33:52.940 exercise yeah exactly and actually i think i called this invisible exercise and i think there's a you

00:33:58.780 know huge load of it that we all do about acknowledging that so you know carrying the groceries walking to

00:34:05.540 you know the bus stop or the train station you know standing on the train if you're you have to during

00:34:11.200 your commute playing with the kids doing kind of diy in your house you know all of these things are

00:34:17.740 exercise but we just don't see them as exercise we don't really consider that they're actually

00:34:21.880 benefiting our bodies and if we did reframe that interpretation we could actually get more benefits

00:34:27.580 from that physical activity any insights from research that how the expectation effect can influence

00:34:34.640 our diet i know a lot of people they want to eat better anything there that the expect we can

00:34:39.020 kind of rejigger the expectation effect to help us diet better yeah i mean there's loads so you know

00:34:44.380 there was a study from the 70s that just looked at people's attitudes to the meals they were eating

00:34:49.840 and what they found was that actually people who kind of saw the food as being nutritious and kind of

00:34:57.040 a treat that they actually absorbed more iron from their food than people who didn't like the meal that

00:35:02.900 they were eating it seems to me that the explanation there although it wasn't tested is quite obvious

00:35:07.900 it's that when you have this kind of healthy anticipation of what you're going to be eating

00:35:11.900 you're producing more digestive enzymes that help you to extract the nutrients so pleasure in the food

00:35:18.300 we're eating and you know having a good attitude to our food that's definitely important physiologically

00:35:23.100 as well as mentally but there's also some fascinating research on hormonal response to food and this in

00:35:29.400 particular looked at the hormone ghrelin which is is called the hunger hormone because it stimulates

00:35:35.320 appetite and essentially when you eat a meal you want your levels of ghrelin to drop and that is what

00:35:43.360 happens when we have like a big satisfying meal but what the researchers found was that actually our

00:35:47.780 expectations can shape that hormonal response and they found that when people were drank a milkshake

00:35:53.760 that was labeled in this really insipid way as this kind of sensible health shake with and they were told

00:35:59.820 it had a few calories and you know it wasn't made to feel very uh appetizing that actually just those

00:36:05.420 expectations caused by that label like really reduced the benefit of the meal for the ghrelin response so

00:36:12.900 even after eating that milkshake they still had high levels of this hunger hormone that was

00:36:17.980 stimulating their appetite and again i think that really shows that even when we're dieting we really

00:36:22.940 want to eat foods that feel satisfying and pleasurable and we want to increase our psychological

00:36:28.560 anticipation of that meal to be sure that the body can respond in the best way possible to the

00:36:33.840 nutrients that we're eating yeah this is interesting the words that you use to describe food can affect

00:36:39.360 that so yeah you gave an example here light and low carb green beans and shallots lighter choice

00:36:44.900 zucchini that's not going to produce the satiating result that you want but if you describe it as

00:36:49.580 zesty ginger turmeric sweet potatoes or sweet sizzling green beans and crispy shallots like oh yeah

00:36:55.360 it causes that response in us yeah exactly you know i think i guess she's like famous in the u.s like

00:37:01.280 nigella lawson you know like the way she describes food in this very sensual way what this research shows is

00:37:07.180 that doesn't just make it more appetizing it can actually change how we digest and use that food

00:37:13.080 and that energy that we've eaten all right when i drink my protein shake i'm going to say this is a

00:37:17.700 thick delicious milkshake we'll see if that does anything that's exactly it yeah so you mentioned

00:37:25.040 earlier this uh this whole research into the expectation effect started off with you dealing with

00:37:29.760 depression particularly the placebo or the nocebo effect you had to the drug you were taking uh has

00:37:37.500 there been any research done on the expectation effect with just in regards to anxiety and depression

00:37:42.740 directly yeah i mean this really helped me actually so you know i actually before i started writing the

00:37:48.400 book i'd already kind of weaned myself off those antidepressants but you know i still had bouts of

00:37:54.060 kind of anxiety i'd feel very stressed you know when i had to do things like public speaking so i was

00:37:59.380 really pleased to find that there was a lot of research on the ways that we can turn stress and

00:38:04.240 anxiety to our advantage by using the expectation effect and it's i think like the danger and i was

00:38:11.340 quite worried about this to start with was that it was this research was going to just suggest that

00:38:16.900 you kind of try to have a positive attitude and just ignore the stress and you know tell yourself

00:38:21.940 you're going to be brilliant and you will be and that's how it works in reality the research isn't

00:38:25.900 asking you to do that at all it's much more kind of asking you to set realistic expectations and

00:38:31.720 essentially it all revolves around this idea that our stress response evolved for a good reason it's

00:38:38.440 adaptive and actually the changes that we experience that might be uncomfortable can also be useful so

00:38:45.400 if you have that beating heart which can feel quite scary you know when it's racing because you're

00:38:50.560 nervous when you're on stage just about to speak well actually that is helping to pump oxygenated

00:38:57.260 blood to your brain which is you know fueling your thinking it's keeping you kind of on the ball

00:39:03.000 similarly things like the hormone cortisol you know that makes you feel quite on edge but that's

00:39:09.040 also just sharpening your thoughts so that you're you're more likely to be engaged with the audience

00:39:13.660 while you're giving your talk what the research has found is that just encouraging the participants

00:39:18.340 to recognize those potential benefits of the uncomfortable feelings that they were experiencing

00:39:23.600 that that in itself could then improve their performance and it could also change the physiological

00:39:29.520 reaction it kind of just muted it a little bit so that you were still feeling charged up but you

00:39:34.900 weren't kind of descending into that panic that can be a real problem for people who who suffer from

00:39:40.060 anxiety and even more importantly it also changes the physiological reaction after the stressful event

00:39:46.860 so people who are able to reframe their feelings in this way they actually recover from the stress

00:39:53.000 a lot more quickly so their body can go back to all of those other important functions like

00:39:57.480 you know digestion and tissue repair that it would put on hold when we're feeling stressed

00:40:02.600 and what this seems to do then is actually reduce the long-term effects of anxiety and stress so

00:40:09.380 people who are able to reframe their feelings in this way they're less likely to experience some of

00:40:15.100 those things like you know higher risk of burnout or even a high risk of cardiovascular disease that

00:40:21.740 would normally come from people experiencing stress and anxiety yeah dr kelly mcgonigal wrote a book

00:40:27.640 about that the upside of stress and her big thesis there is yeah what you were saying reframe the stress

00:40:33.600 response to the challenge response right so instead of interpreting these feelings and physical not only

00:40:39.300 emotional but physiological feelings as something bad reframe it as this is actually my body and mind

00:40:45.600 is getting ready to do take on this challenge so this is actually a good thing and it has all these

00:40:49.780 beneficial effects that you talked about yeah that's exactly it and i think it's also about kind of

00:40:54.900 reframing the situation sometimes too so i think in the past when i was doing public speaking i would

00:41:00.360 feel this sense of dread and i would kind of feel angry with myself for having agreed to to do the event

00:41:06.940 and you know like it was a very negative attitude whereas actually i've changed that now to to

00:41:12.900 recognize that you know this is important for my personal growth that i've got this message that i want

00:41:18.340 to communicate to people and it's actually a privilege for me to be able to do that and then i tell myself

00:41:23.760 that actually the stress that i'm experiencing that's because it really matters to me and because i want

00:41:29.240 to do the best job i can and it's actually helping me to do that so it's that overall change in mindset

00:41:35.320 that i think has been so powerful for me personally no i've been doing that with my own kids like they

00:41:40.460 have like a test and i'm feeling nervous and i'm like well that's good like you're actually your body

00:41:44.260 your mind is getting ready to take on this challenge or i coach flag football a bunch of 11 year old

00:41:49.480 boys and before game starts they're like i'm feeling really nervous i've got butterflies in my stomach and

00:41:53.660 then i try to reframe it's like that's okay like you're you're getting ready to take on a game you're

00:41:57.620 having the right response i take that energy and make it useful in the game and play your best and it

00:42:02.580 seems to work it seems like they're catching on yeah i mean i think it really is powerful and

00:42:07.080 actually i mean maybe it's a bit cliched but one of the researchers put it like this that when you

00:42:12.200 have those butterflies in your stomach and you change your mindset you're getting them to kind of fly

00:42:16.480 in formation and i quite like that metaphor actually it's just that you're actually

00:42:21.440 you know you're turning what could be uncomfortable you're turning it to your advantage

00:42:26.700 so let's talk about aging because i thought this was really fascinating what effect

00:42:31.000 does the expectation effect have on our physical aging oh you know the expectation effect is hugely

00:42:37.060 important for physical aging in a way that i was initially really skeptical because it's not often

00:42:43.320 you see such big effects in in science but actually it's been replicated reproduced and then you know we

00:42:50.040 know the mechanisms now so it's very good science but essentially in 2002 there was a study of

00:42:56.660 longitudinal data so a study that looked at i think around a thousand participants over the whole course

00:43:03.840 of their life and at around middle age these people had been asked about their expectations

00:43:09.040 of what would happen in the next few years as they got older did they think their life was going to get

00:43:13.920 better or worse you know stay roughly the same and what they found was that the people who expected

00:43:19.980 their life to get a lot worse as they got older maybe because they were associating old age with things like

00:43:25.620 disability and vulnerability that they actually lived for seven and a half years less than the people

00:43:32.700 who had the positive views of aging so a really big difference in lifespan now what's happened since then

00:43:39.380 apart from the replications that i mentioned is scientists have also looked at the mechanisms behind

00:43:44.620 this and you know some of them are behavioral mechanisms so if you have a very defeatist attitude towards

00:43:52.500 aging you're just less likely to do exercise or to eat a healthy diet you know you're going to kind of

00:43:57.320 let yourself go more easily and that's going to then have a knock-on effect for the diseases that you

00:44:02.820 suffer from and your ultimate longevity but equally important there's a direct physiological mechanism here

00:44:10.120 and what happens there is that if you if you feel vulnerable all of the challenges around you are

00:44:16.700 actually going to feel threatening and dangerous and you're going to have a heightened stress response

00:44:21.940 so it's going to be more extreme in the moment and you're going to experience that again and again

00:44:27.020 you know if you're just walking to the post office going to the supermarket and you're worried about

00:44:31.560 getting lost or having a fall you know each time you're going to kind of have a heightened stress

00:44:36.900 response and over time those higher levels of cortisol and higher levels of inflammation

00:44:42.580 they're going to bring about bodily wear and tear that actually makes it more likely that you're going to

00:44:47.720 experience different diseases from cardiovascular illness to alzheimer's disease and we can even see

00:44:54.120 these changes in the cells themselves so scientists have been able to kind of chart epigenetic markers of

00:45:01.820 aging so changes to the way that genes are expressed over time follow a kind of similar pattern as people

00:45:08.180 get older and what you find is that that epigenetic clock is actually ticking a lot faster for the people

00:45:14.960 of the negative views of aging compared to those with the positive views of aging so it's actually

00:45:20.440 changing their physical aging at the cellular level okay so if you think aging is going to be terrible

00:45:26.600 then it's going to be terrible and you're actually going to age faster basically yeah exactly and i think

00:45:31.740 what's important to emphasize here is that the people who see a positive view of aging i don't think

00:45:36.820 that they're really denying that actually you know you do have a heightened risk of certain diseases as you get

00:45:43.540 older so that you know it's not totally irrational to worry about getting older but i think what these people

00:45:50.000 are also doing is recognizing that there are lots of benefits to being older as well you know you may have

00:45:56.340 more free time to kind of grow personally you have greater wisdom there's been lots of studies showing that

00:46:02.920 actually older adults decision making skills are far superior to younger adults decision making skills your general

00:46:09.600 knowledge is greater your vocabulary is greater so you're more expressive in your 70s than you ever were

00:46:16.060 in the rest of your life and so i think these people are just kind of recognizing that the good comes with the bad

00:46:21.400 and that actually there's still a lot of opportunity for excitement and growth as they get older and it's that

00:46:26.800 that's really then helping to protect them from some of the things that the people with the negative views are

00:46:32.860 experiencing well also too so not only does our outlook on aging affect us physically but also can

00:46:38.120 affect us mentally i think we have this idea as you get as you age you're going to get mentally slower

00:46:42.200 you're going to be less creative less vibrant but if that's what you think it's going to be a self-fulfilling

00:46:46.880 prophecy but those who have a more positive view of aging they don't tend to have that like mental slowdown

00:46:53.200 that we often think happens yeah exactly i mean i think the big one is memory so what scientists have shown

00:47:00.160 is that older adults often just stop relying on their memory prematurely they're so worried about

00:47:05.500 forgetting that they use those kinds of physical crutches to replace their memory so things like

00:47:11.020 the gps in the car or you know they'll note things down in a physical list rather than trying to

00:47:15.940 remember them mentally and you know it's use it or lose it essentially so the more you start to rely

00:47:21.300 on these crutches the weaker your memory is going to get and then that becomes this self-fulfilling prophecy

00:47:27.000 so something this reminds me of is something my wife and i like to do when we're watching old

00:47:31.660 movies i'm talking like from the 1940s or 1950s and there's an older person on there they just look

00:47:37.840 really old they're all hobbled over you know the guy will have a cane the grandma has got a a shawl

00:47:43.920 around her shoulders and they talk like this and you think man they must be really old and then they

00:47:51.300 finally reveal how old they are and they're like i'm 65 years old and you're like wait you look like

00:47:58.700 you're 90 and i think what happened was you know 75 years ago people expected to be old at 65 and

00:48:06.320 they expect them to sell themselves to get slow and frail and diminished so they experienced old age that

00:48:12.940 way and nowadays we expect to be vibrant longer so you got you know 70 year old grandmas wearing tank

00:48:19.420 tops doing taibo and so i think that just goes to show you the powerful effect expectations can have

00:48:25.400 on both our physiology and our psychology and our experience and you know what we expect becomes a

00:48:32.180 self-fulfilling prophecy well david this has been a fascinating conversation where can people go to

00:48:36.220 learn more about you and your work cool so the book should be available from all good bookstores you

00:48:41.520 know amazon like barnes and noble like wherever you'd normally go to get books you can also find more

00:48:46.500 information on my website which is www.davidrobson that's r-o-b-s-o-n dot m-e you could also search

00:48:56.260 for it on the henry holt website which is my publisher and i'm on twitter d underscore a underscore

00:49:03.120 robson and also on instagram david a robson fantastic with david robson thanks for your time

00:49:09.220 it's been a pleasure thanks so much i've really enjoyed the conversation my guest is david robson he's

00:49:15.020 the author of the book the expectation effect it's available on amazon.com and bookstores everywhere

00:49:19.020 to learn more information about his work check out his website davidrobson.me also check out our

00:49:23.380 show notes at aom.is expectation effect where you find links to resources where you delve deeper into

00:49:28.300 this topic well that wraps up another edition of the aom podcast make sure to check out our website

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00:50:13.140 heard into action

The Art of Manliness - May 18, 2022

How Your Expectations Can Change Your Life

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