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Ready to tinker with your expectations?

What if I told you that your brain is largely in the prediction business? And your capacity to tinker creatively with expectation will influence how you cope with adversity?

It’s unsurprising that positive thinking taps into a wellspring of healing potential. But how?

Suggestible You: the Curious Science of Your Brain’s Ability to Deceive, Transform and Heal, by Eric Vance suggests some possible clues to why expectation lies at the crux of this mystery.

Vance grew up in a Christian Science community who largely rejected medical intervention and embraced faith in the body’s capacity for healing. What was going on? Vance turns to placebo researchers, psychologists, and geneticists for answers. He moves outside Western medicine to learn from traditional Chinese medicine, experience hypnotism, even stretch the bounds of credulity by visiting a witch doctor. Where does healing occur and to whom? At the heart of these questions is the elusive placebo effect.

Placebo is Latin for “I shall please”. In medicine it refers to anything inert – chemically inactive – that causes an effect on a patient. It could be a sugar pill. “The theater of medicine”, as Vance puts it, the white coat the doctor wears, a patient’s desire to please – all influence expectation. My husband was diagnosed with Parkinson’s over 15 years ago. He sees his neurologist once a year and truly pumps up for the visit. We get there early and mentally and physically he’s at his best, standing taller and steadier. He desires to be his healthiest. Hope, predicting something good is ahead, in this case, a progress report on how well he’s managing Parkinson’s, is a powerful motivator.

In Western medicine randomized placebo-controlled clinical trials are the gold standard. In fact, any new prescription drug or treatment procedure must exceed the benefits of a placebo. Interestingly, one 2005 NIH study found that sleeping pills, for example, Ambien, on average boost sleep by only an additional ten minutes compared to sugar pills. The expectations for another drug, Prozac, have declined since the mid-1980s when it was the new thing. Would Prozac beat the placebo today?

Nocebo is Latin for “I shall harm”. Fear, predicting something bad is ahead, triggers our reaction to threats in our environment – internal and external. Wired for threats, the primitive amygdala cues the fight or flight reaction to unfamiliar stimuli – a stranger, uncomfortable sensation, a new situation. “Our suggestibility to manipulations”, Vance writes, “whether positive or negative, is fundamental to being human.” In short, the brain plays tricks on us.

Nociceptors, the peripheral nerve cell endings, are the first responders to pain although not always accurate in discriminating between sensation and pain. These sensory neurons signal potential threats to the spinal cord and the brain. Vance reports that 100 million Americans suffer from chronic pain. What is going on? And why is chronic pain receptive to placebos?

Scientists have evolved in their understanding of what might be happening. Here’s the current thinking: pain begins in the body (those peripheral nerve endings), moves up the spine into the brain distributing information to different places including the prefrontal cortex where thinking takes place. It is here that expectation (placebo) can reduce activity in parts of the brain processing pain. Vance describes it as “a sort of collision of information”. The body perceives pain; the higher-level part of the brain interprets it. Expectation is key.

How can we tame the fear, the nocebo effect, amplifying the pain, stress, and anxiety coursing up our spinal cord into the brain? (remember nocebo means “I shall harm”) We can rein in the destructive, accelerating thought patterns with awareness. We can put on the brakes to our spiraling worries. Recognition alone can turn the volume down.

Is there an easy fix? No. How do we steady our minds to ride the waves of life? With practice we can pay attention to our body’s sensations, our mind’s story, our breath’s capacity to restore calm.

We can unlock our “inner pharmacy”, Vance’s words, sending the chemical messengers, endorphins, to reduce pain and stress, and the ‘happy hormone’ dopamine to improve mood. Yoga, meditation, friends, family and travel unlock mine. What unlocks yours?


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