Anticipation and Great Expectations

Last time we peeked behind the curtain into the world of the placebo effect and how it is a component in health care - even in the most impersonal of interactions - like taking a pill. We looked at how we’ve inadvertently trained our body to respond to our actions, today we’ll check out how we’ve also trained our mind to anticipate healing and dictate our body’s response. 

Let’s start with a non-healthcare example that sheds some light on how our expectations can alter the way we act. Everybody has a different “tolerance” for alcohol. Some drink one or two and are feeling no pain, others..well…it takes just a tad bit more. Regardless, most people know what it “feels” like to lose a bit of their inhibition when intoxicated, and most can also appreciate that the more they consume, the more “drunk” they feel. So, what might happen if someone “thinks” they are drinking alcohol - even when they aren’t? You guessed it, they’ve studied this too. Researchers told the participants that they were giving them alcoholic drinks and measuring their blood alcohol level and responses over time. Not everyone, but many people felt a little bit tipsy, got a little bit louder and a little more outgoing the more beverages they consumed and the higher they were told their blood alcohol level was. As you may imagine, they felt rather perplexed and “foolish” when they were told later on that there wasn’t actually any alcohol in the drinks and that their blood alcohol level was actually 0.00. They should chin up though, it’s not foolish, this is just the power of suggestion mixed with what our mind and body have learned in past experiences, it’s the power of placebo at work.

In healthcare and healing, as our human interaction and our human expectations grow, so too can the amount of placebo involved. Picture this, you’re in agony, you call the office for an appointment and the dang doctor is booking 5 days out. You drag yourself through 4 days, pain every step, and as you fall asleep on the 4th day you are counting down the minutes to that appointment. Then you wake up the next morning, and your pain is almost gone! You show up to the appointment with your tail between your legs because you’ve spent the last 4 days suffering and now there is nothing to show for it and you made such a scene with the receptionist reporting that you might have been dying just days before. Ever happened to you? Maybe not quite to that extreme,  but have you ever felt your symptoms improved right before that appointment finally arrived? You aren’t alone. I can’t even count the number of times someone has come into my office and said they have been sore, but today is better. Yes, it is true that things will naturally improve over time, but it is uncanny how it will finally be better the day that appointment arrives -  regardless if the wait was 2 days or 10 days. So what’s up with that? Well…remember how last time we looked at how we trained our body to respond to prescriptions? We’ve also trained it to respond to the mere act of going to a healthcare provider who we trust. Our body seems to “know” that this person often has a solution and will do something that will help it. Our expectations and anticipation seem to somehow trigger our body to do what it needs to do to start feeling better - even before we go!  

Another interesting finding, is that how much importance we place on an appointment or intervention, or how “serious” we think it is, can also affect the placebo component. For example as we’ve discussed, the act of taking a prescription, has a little bit. Getting injections or IVs, perhaps a little bit more. Surgery - now that is serious business and despite how sterile and impersonal that experience may be, it still has a placebo component, likely because we hold it in high regard. So as the “invasiveness” or “seriousness” of the procedure increases, the expectations and value we place on it also increases and then so too can the placebo effect. 

A study was done with patients with significant osteoarthritis in their knees. One group had knee surgery. The other group didn’t, but thought that they did. All the same steps were followed for both groups. The patients who weren’t given the surgery were still sedated for the same length of time and an incision was made. Video of a knee surgery was playing on the scope screen and tools were passed between doctors and nurses just as they would in a normal surgery. Years later, all of the patients reported that they had significant improvement in their pain and in their function. Surgery or no surgery! So you tell me then, what did the healing? Was it the surgery or was it the patient’s body? - once they “believed” that they had received an intervention that was game changing and going to help them. Or shall we say, once they allowed themselves to believe that they could now get better. Maybe it was that they behaved as they would after surgery and gave their body a chance to heal - maybe all of the above! Need to see it for yourself? Here ya go:  https://www.youtube.com/watch?v=HqGSeFOUsLI

The power of our mind is amazing, albeit hard to harness and leverage. We sometimes have a hard time convincing ourselves that things can be different, especially in the case of chronic pain or illness. It’s hard to imagine that we can heal and that we can feel better. This isn’t to say that surgery, medications and therapies have no place - obviously they do! And medicine and healthcare have done wonders for so many, saved countless lives, and helped to restore a lot of people’s function. It’s just curious to consider that maybe in some situations we just might be able to skip the pain and expense of interventions and be able to achieve similar outcomes ourselves - if only we allow ourselves to believe that we can do it.