The evidence for the power of expectation just keeps mounting up.

If we are told something and accept it as true, which probably happens far more than we would care to admit, our mind and our body will prove it to us.

And medical research into the ‘placebo effect’ is starting to explain how.

The Placebo Effect

A ‘placebo’ is basically a ‘sugar pill’; an otherwise ineffectual ‘treatment’ that is given in place of a supposedly effective one. The intention behind them is to allow, or even encourage, the receiver to believe that they are receiving treatment that will have a beneficial effect on them.

Placebos have traditionally been used in trials of new medical products as a control factor. They allow researchers to compare the results of the new product or technique with those of non-treatment.

However patients on a placebo will often experience the same benefits as those patients taking actual medication and researchers are finding that results are closely linked to beliefs.

For example, osteo-arthritis of the knee is often treated using an arthroscopy operation . This involves making small incisions into the knee and inserting a tiny camera and other small instruments to repair or remove damaged tissue.

However a placebo-controlled trial was published in 2002 in the New England Journal of Medicine, . The patients in the placebo group had incisions made in their knees and were given reason to believe that they were having the complete sugery, but nothing more was done. The results showed that patients undergoing ‘sham surgery’ did as well as those having the arthroscopy procedures. Same belief, different treatment, same outcome.

The placebo effect is now recognised as a common factor in medical (and other) treatments, and is being taken increasingly seriously in the scientific field as evidence of the power of the mind. The main effect comes from the belief that a treatment will provide relief or improve symptoms.

Another aspect to this is that pain and anxiety medication have been shown to be less effective when they are given without the patient’s knowledge. The doctor-patient relationship is key.

The Nocebo Effect: When Harm Is Expected

The other side of the placebo effect is the ‘nocebo’, when a ‘patient’ is primed to expect a negative outcome.
In a 2014 study, a group of asthmatics who were sensitive to fragrances and strong odours were exposed to a harmless scent. About half of them were told that the scent was likely to cause asthma symptoms. The rest were informed that it was beneficial.

In the first, nocebo group, their airways became more inflamed almost immediately after the exposure. The second, placebo group were unaffected by it – even those people who were sensitive to fragrances.

You could liken the nocebo effect to ‘bone pointing‘, which is practised by some indigenous cultures. In bone pointing practices, a person is cursed and told they will die, and then they do, one way or another – and often very quickly. It is expected.

Research Findings

A lot of research has now been done into how the placebo and nocebo effect actually work.

In a 2011 study, ‘The Effect of Treatment Expectation on Drug Efficacy‘, the same painkilling drug was given to three groups, under different conditions. One group had no expectations of the drug, one group expected pain relief and the rest expected the pain to get worse. And the patients experienced the results they were expecting.

MRI recordings were also used in this study. They showed that the effects experienced by the patients were physical, and not just imagined. The different expectations affected different centres in the brain. The authors wrote:
“On the basis of subjective and objective evidence, we contend that an individual’s expectation of a drug’s effect critically influences its therapeutic efficacy and that regulatory brain mechanisms differ as a function of expectancy.”

Fabrizio Benedetti, an Italian neuroscientist, is considered a leading expert on the placebo effect. He has found that there are two different kinds of placebo responses; those brought about by conditioning, and those influenced by expectancy.

An example of conditioning is where a certain result is associated with a repeated stimulus: a bell rings and food is brought, for example, leading to a dog unconsciously learning to salivate whenever he hears the bell.

Expectation can be created with a simple verbal suggestion; for example, ‘This is going to hurt’.

In their study on ‘Conscious Expectation and Unconscious Conditioning…’ , Benedetti and his team concluded that:
“placebo responses are mediated by conditioning when unconscious physiological functions such as hormonal secretion are involved, whereas they are mediated by expectation when conscious physiological processes such as pain and motor performance come into play, even though a conditioning procedure is performed”.

Taking It Further – Setting Back the Clock

Ellen Langer, a professor of psychology at Harvard University, has created many unconventional experiments that have explored the placebo effect and how far-reaching it can be.

Her first ‘counter-clockwise’ study, conducted in 1981, placed eight men in their ‘seventies’ in a converted monastery that had been converted into a time warp, with every detail of their surroundings set back to 1959. That included the black and white TV, the magazines, newspapers, entertainers, their clothes, and portraits of their 22-years younger selves. They were also treated as if they were younger.

There were no mirrors. The men were told to make a deliberate attempt to behave and talk like, and be, the people they were in 1959. They were also instructed to talk about their 1959 memories in the present tense. Langer told them, “We have good reason to believe that, if you are successful at this, you will feel as you did in 1959”.

According to an account in the New York Times, the men were tested before and after their five-day stay on “such measures as dexterity, grip strength, flexibility, hearing and vision, memory and cognition”. At the end of the experiment, they “were suppler, showed greater manual dexterity and sat taller — just as Langer had guessed. Perhaps most improbable, their sight improved. Independent judges said they looked younger.”

The experiment was recreated later in England, using ‘ageing celebrities’ as test subjects, and filmed by the BBC. The results were very similar and just as powerful.

The Ultimate Nocebo?

So what do you think? Is it possible that we are all ‘pointing the bone’ at each other? For example, what if the belief that ‘ageing is inevitable’ was just another nocebo?

And what might be possible when we all realise the power of our beliefs, and start changing them?


More Reading:

This is a slightly updated version of a previous post, published in 2015.