By Jo Marchant
We tend to think of medicine as being all
about pills and potions recommended to us by another person—a doctor. But
science is starting to reveal that for many conditions another ingredient could
be critical to the success of these drugs, or perhaps even replace them. That
ingredient is nothing more than your own mind.
1. Better believe it
“I talk
to my pills,” says Dan Moerman, an anthropologist at the University of
Michigan-Dearborn. “I say, ‘Hey guys, I know you’re going to do a terrific
job.’”
That
might sound eccentric, but based on what we’ve learned about the placebo
effect, there is good reason to think that talking to your pills really can
make them do a terrific job. The way we think and feel about medical treatments
can dramatically influence how our bodies respond.
Simply
believing that a treatment will work may trigger the desired effect even if the
treatment is inert—a sugar pill, say, or a saline injection. For a wide range
of conditions, from depression to Parkinson’s, osteoarthritis and multiple
sclerosis, it is clear that the placebo response is far from imaginary. Trials
have shown measurable changes such as the release of natural painkillers, altered
neuronal firing patterns, lowered blood pressure or heart rate and boosted
immune response, all depending on the beliefs of the patient.
It has
always been assumed that the placebo effect only works if people are conned
into believing that they are getting an actual active drug. But now it seems
this may not be true. Belief in the placebo effect itself—rather than a
particular drug—might be enough to encourage our bodies to heal.
In a
recent study, Ted Kaptchuk of Harvard Medical School in Boston and his
colleagues gave people with irritable bowel syndrome an inert pill. They told
them that the pills were “made of an inert substance, like sugar pills, that
have been shown in clinical studies to produce significant improvement in IBS
symptoms through mind-body self-healing processes,” which is perfectly true.
Despite knowing the pills were inert, on average the volunteers rated their
symptoms as moderately improved after taking them, whereas those given no pills
said there was only a slight change.
“Everybody
thought it wouldn’t happen,” says the study’s co-author Irving Kirsch, a
psychologist at the University of Hull. He thinks that the key was giving
patients something to believe in. “We didn’t just say ‘here’s a sugar pill.’ We
explained to the patients why it should work, in a way that was convincing to
them.”
As well
as having implications for the medical profession, the study raises the
possibility that we could all use the placebo effect to convince ourselves that
sucking on a sweet or downing a glass of water, for example, will banish a
headache, clear up a skin condition or boost the effectiveness of any drugs
that we take. “Our study suggests that might indeed help,” says Kirsch. While
Moerman talks to his pills, Kirsch recommends visualizing the desired
improvement and telling yourself that something is going to get better.
2. Think positive
“Everything’s
going to be fine.” Go on, try to convince yourself, because realism can be bad
for your health. Optimists recover better from medical procedures such as
coronary bypass surgery, have healthier immune systems and live longer, both in
general and when suffering from conditions such as cancer, heart disease and
kidney failure.
It is
well accepted that negative thoughts and anxiety can make us ill. Stress—the
belief that we are at risk—triggers physiological pathways such as the
“fight-or-flight” response, mediated by the sympathetic nervous system. These
have evolved to protect us from danger, but if switched on long-term they
increase the risk of conditions such as diabetes and dementia.
What
researchers are now realizing is that positive beliefs don’t just work by
quelling stress. They have a positive effect too—feeling safe and secure, or
believing things will turn out fine, seems to help the body maintain and repair
itself. A recent analysis of various studies concluded that the health benefits
of such positive thinking happen independently of the harm caused by negative
states such as pessimism or stress, and are roughly comparable in magnitude.
Optimism
seems to reduce stress-induced inflammation and levels of stress hormones such
as cortisol. It may also reduce susceptibility to disease by dampening
sympathetic nervous system activity and stimulating the parasympathetic nervous
system. The latter governs what’s called the “rest-and-digest” response—the
opposite of fight-or-flight.
Just as
helpful as taking a rosy view of the future is having a rosy view of yourself.
High “self-enhancers”—people who see themselves in a more positive light than
others see them—have lower cardiovascular responses to stress and recover
faster, as well as lower baseline cortisol levels.
Some
people are just born optimists. But whatever your natural disposition, you can
train yourself to think more positively, and it seems that the more stressed or
pessimistic you are to begin with, the better it will work.
David
Creswell from Carnegie Mellon University in Pittsburgh, Pennsylvania, and his
colleagues asked students facing exams to write short essays on times when they
had displayed qualities that were important to them, such as creativity or
independence. The aim was to boost their sense of self-worth. Compared with a
control group, students who “self-affirmed” in this way had lower levels of
adrenaline and other fight-or-flight hormones in their urine at the time of
their exam. The effect was greatest in those who started off most worried about
their exam results.
3. Trust people
Your
attitude toward other people can have a big effect on your health. Being lonely
increases the risk of everything from heart attacks to dementia, depression and
death, whereas people who are satisfied with their social lives sleep better,
age more slowly and respond better to vaccines. The effect is so strong that
curing loneliness is as good for your health as giving up smoking, according to
John Cacioppo of the University of Chicago, Illinois, who has spent his career
studying the effects of social isolation.
“It’s
probably the single most powerful behavioral finding in the world,” agrees
Charles Raison of Emory University in Atlanta, Georgia, who studies mind–body
interactions. “People who have rich social lives and warm, open relationships
don’t get sick and they live longer.” This is partly because people who are
lonely often don’t look after themselves well, but Cacioppo says there are
direct physiological mechanisms too—related to, but not identical to, the
effects of stress.
In
2011, Cacioppo reported that in lonely people, genes involved in cortisol
signaling and the inflammatory response were up-regulated, and that immune
cells important in fighting bacteria were more active, too. He suggests that
our bodies may have evolved so that in situations of perceived social
isolation, they trigger branches of the immune system involved in wound healing
and bacterial infection. An isolated person would be at greater risk of
physical trauma, whereas being in a group might favor the immune responses
necessary for fighting viruses, which spread easily between people in close
contact.
Crucially,
these differences relate most strongly to how lonely people think they are,
rather than to the actual size of their social network. That also makes sense
from an evolutionary point of view, says Cacioppo, because being among hostile
strangers can be just as dangerous as being alone. So ending loneliness is not
about spending more time with people. Cacioppo thinks it is all about our
attitude to others: lonely people become overly sensitive to social threats and
come to see others as potentially dangerous. In a review of previous studies,
published in 2010, he found that tackling this attitude reduced loneliness more
effectively than giving people more opportunities for interaction, or teaching
social skills.
If you
feel satisfied with your social life, whether you have one or two close friends
or quite a few, there is nothing to worry about. “But if you’re sitting there
feeling threatened by others and as if you’re alone in the world, that’s
probably a reason to take steps,” Cacioppo says.
4. Meditate
Monks
have been meditating on mountaintops for millennia, hoping to gain spiritual
enlightenment. Their efforts have probably enhanced their physical health, too.
Trials
looking at the effects of meditation have mostly been small, but they have
suggested a range of benefits. There is some evidence that meditation boosts
the immune response in vaccine recipients and people with cancer, protects
against a relapse in major depression, soothes skin conditions and even slows
the progression of HIV.
Meditation
might even slow the aging process. Telomeres, the protective caps on the ends
of chromosomes, get shorter every time a cell divides and so play a role in
aging. Clifford Saron of the Center for Mind and Brain at the University of
California, Davis, and colleagues showed in 2011 that levels of an enzyme that
builds up telomeres were higher in people who attended a threemonth meditation
retreat than in a control group.
As with
social interaction, meditation probably works largely by influencing stress
response pathways. People who meditate have lower cortisol levels, and one
study showed they have changes in their amygdala, a brain area involved in fear
and the response to threat.
One of
the co-authors of Saron’s study, Elissa Epel, a psychiatrist at the University
of California, San Francisco, believes that meditation may also boost “pathways
of restoration and health enhancement,” perhaps by triggering a release of
growth and sex hormones.
If you
don’t have time for a three-month retreat, don’t worry. Imaging studies show
that meditation can cause structural changes in the brain after as little as 11
hours of training. Epel suggests fitting in short “mini-meditations” throughout
the day, taking a few minutes at your desk to focus on your breathing, for
example: “Little moments here and there all matter.”
5. Hypnotize yourself
Hypnotherapy
has struggled for scientific acceptance ever since Franz Mesmer claimed in the
18th century that he could cure all manner of ills with what he termed “animal
magnetism.” “The whole field is plagued by people who don’t feel research is
necessary,” says Peter Whorwell of the University of Manchester.
Whorwell
has spent much of his professional life building a body of evidence for the use
of hypnosis to treat just one condition: irritable bowel syndrome. IBS is
considered a “functional” disorder—a rather derogatory term used when a patient
suffers symptoms but doctors can’t see anything wrong. Whorwell felt that his
patients, some of whom had such severe symptoms they were suicidal, were being
let down by the medical profession. “I got into hypnosis because the
conventional treatment of these conditions is abysmal.”
Whorwell
gives patients a brief tutorial on how the gut functions, then gets them to use
visual or tactile sensations—the feeling of warmth, for example—to imagine
their bowel working normally. It seems to work—IBS is the only condition for
which hypnosis is recommended by the UK’s National Institute for Health and
Clinical Excellence. Despite this, Whorwell still has trouble convincing
doctors to prescribe it. “We’ve produced a lot of incontrovertible research,”
he says. “Yet people are still loath to agree to it.”
Part of
the problem is that it isn’t clear exactly how hypnosis works. What is clear is
that when hypnotized, people can influence parts of their body in novel ways.
Whorwell has shown that under hypnosis, some IBS patients can reduce the
contractions of their bowel, something not normally under conscious control.
Their bowel lining also becomes less sensitive to pain.
Hypnosis
probably taps into physiological pathways similar to those involved in the
placebo effect, says Kirsch. For one thing, the medical conditions that the two
can improve are similar, and both are underpinned by suggestion and
expectation—in other words, believing in a particular outcome. The downside is
that some people do not respond as strongly to hypnosis as others.
Most
clinical trials involving hypnosis are small, largely because of a lack of
funding, but they suggest that hypnosis may help pain management, anxiety,
depression, sleep disorders, obesity, asthma and skin conditions such as
psoriasis and warts. Finding a good hypnotherapist can be tricky, as the
profession is not regulated, but hypnotizing yourself seems to work just as
well. “Self-hypnosis is the most important part,” says Whorwell.
6. Know your purpose
In a
study of 50 people with advanced lung cancer, those judged by their doctors to
have high “spiritual faith” responded better to chemotherapy and survived
longer. More than 40 percent were still alive after three years, compared with
less than 10 percent of those judged to have little faith. Are your hackles
rising? You’re not alone. Of all the research into the healing potential of
thoughts and beliefs, studies into the effects of religion are the most
controversial.
There
are thousands of studies purporting to show a link between some aspect of
religion—such as attending church or praying—and better health. Religion has
been associated with lower rates of cardiovascular disease, stroke, blood
pressure and metabolic disorders, better immune functioning, improved outcomes
for infections such as HIV and meningitis, and lower risk of developing cancer.
Critics
of these studies, such as Richard Sloan of Columbia University Medical Center
in New York, point out that many of them don’t adequately tease out other
factors. For instance, religious people often have lower-risk lifestyles and
churchgoers tend to enjoy strong social support, and seriously ill people are
less likely to attend church. Nonetheless, a 2009 analysis of studies in the
area concluded, after trying to control for these factors, that
“religiosity/spirituality” does have a protective effect, though only in
healthy people. The authors warned that there might be a publication bias,
though, with researchers failing to publish negative results.
Even if
the link between religion and better health is genuine, there is no need to
invoke divine intervention to explain it. Some researchers attribute it to the
placebo effect—trusting that some deity or other will heal you may be just as
effective as belief in a drug or doctor. Others, like Paolo Lissoni of San
Gerardo Hospital in Milan, who did the lung-cancer study mentioned above,
believe that positive emotions associated with “spirituality” promote
beneficial physiological responses.
Yet
others think that what really matters is having a sense of purpose in life,
whatever it might be. Having an idea of why you are here and what is important
increases our sense of control over events, rendering them less stressful. In
Saron’s three-month meditation study, the increase in levels of the enzyme that
repairs telomeres correlated with an increased sense of control and an
increased sense of purpose in life. In fact, Saron argues, this psychological
shift may have been more important than the meditation itself.
He
points out that the participants were already keen meditators, so the study
gave them the chance to spend three months doing something important to them.
Spending more time doing what you love, whether it’s gardening or voluntary
work, might have a similar effect on health. The big news from the study, Saron
says, is “the profound impact of having the opportunity to live your life in a
way that you find meaningful.”
Excerpted
from Nothing: Surprising Insights Everywhere from Zero to Oblivion,
copyright © 2014. Reprinted by permission of the publisher, The Experiment.
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