Sticks and Stonesand Words can hurt you the Nocebo Effect

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when i was in high school

i was a bit clumsy because i grew too

fast so when i tried out for the

basketball team

i missed a really easy shot the

basketball coach said i can’t teach you

to play ball

you’re too clumsy or too goofy so i

focused on studying

i studied really hard and ended up

skipping a year of high school to get

into university

where my plan was to keep on studying

really hard

but then one day in the first week of

university i was wandering around

a little bit lost looking at my campus

map

when a really tall guy stopped me and

said i want you to try out for the

rowing team

i said rowing i’ve never even seen a

boat

and in any case i’m a little bit clumsy

he smiled and said

don’t worry i had never rode before i

went to university either

but we trained really hard and we ended

up winning a national championship

and i went on to compete internationally

i’m building a team here

that can do the same thing if you train

really hard and i want you to be part of

it

so i forgot about studying and focused

on rowing within a few years

we also won a national championship and

i ended up competing

internationally then when i

stopped rowing when i retired from

rowing i paused to think

how did i go from being bad to quite

good at sports

the answer was obvious the coach helped

me believe in myself

i decided on a career path i wanted to

discover

the scientific basis for the belief

effect

now in medicine the belief effect is

called the placebo effect

a placebo is like a sugar pill that can

work because people

believe it works i’ve now studied the

placebo

for 15 years i’ve done studies involving

thousands of patients i’ve even written

a book about it

it turns out that the placebo effect is

quite powerful

as powerful as most over-the-counter

drugs for headaches and back pain for

example

placebos work by triggering the body’s

inner pharmacy

so that it produces its own painkilling

chemicals like endorphins

the word endorphin is just two words

endogenous

and morphine endogenous means

made by your body morphine means

morphine

take those two words squish them

together you get endorphin

endorphin is literally morphine that

your body makes

but in my studies of placebos i came

across

the curious case of mr a a true story

mr a was a 26 year old man who was in a

clinical trial

of a new antidepressant medication

he had received a prescription bottle

the day before

and that morning had impulsively taken

all his pills

all 29 of them he immediately felt he’d

made a mistake so asked his neighbor to

drive him to the hospital

he was fearful he would die of an

overdose

when he got to the hospital he said help

me i’ve taken all my pills

and then collapsed as he fell

the empty prescription bottle fell from

his pocket

the doctors had a look and it confirmed

the label confirmed

that the bottle contained pills to be

taken as part of a clinical trial

of a new antidepressant drug

but the label didn’t say whether the

pills were the placebo or the real drug

mr a’s blood pressure was dangerously

low 80 over 40.

his heart rate dangerously high 110

he was breathing rapidly and lethargic

over a period of four hours he had to be

given six

liters of fluid to keep his

blood pressure in the normal range at

that point

the head doctor from the clinical trial

turned up

and ascertained that mr a had taken

placebos so he hadn’t overdosed on

drugs he had overdosed on fear

within 15 minutes his blood pressure and

heart rate

were normal he was fully alert and able

to leave the hospital

so it wasn’t the drugs that caused him

to have this

physical reaction it was fear expecting

something bad to happen

now the negative effect of expecting

something bad to happen

is called the nocebo effect

the nocebo effect is like the placebo’s

naughty cousin

whereas the placebo effect is the

positive effect

of anticipating something good the

nocebo effect is the negative effect

of anticipating something bad

it turns out the nocebo effect is

widespread

together with some amazing colleagues i

did a mega study

involving over 250 000 people

like mr a who had all taken placebos

like sugar pills

in clinical trials now in clinical

trials

people don’t know whether they got the

real drug or the placebo

it turns out that half of these people

got at least

one negative side effect like insomnia

anxiety depression pain

one in 20 of them so five percent had

such bad negative side effects

that they had to drop out of the trial

all together

now not all these side effects were no

sibo effects some of them were artifacts

due to the way we collect data about

side effects in clinical trials

but we did some deeper analyses and many

of them were

real nocebo effects like self-fulfilling

prophecies

here’s how it happens in a clinical

trial

people are forced to read about to learn

about

everything bad that might happen to them

now in routine daily life

we ignore the small print if we buy

something we think is safe which is

usually safe

like paracetamol but if you read the

small print

here’s what might happen to you allergic

reactions

mouth ulcers difficulty breathing and if

that’s not enough to scare you

it can also cause unexplained bleeding

and hepatitis

so we ignore this stuff it doesn’t

affect us but if you’re force-fed it

it can actually cause these bad things

to happen

brain scan studies are telling us more

and more about how it happens

basically when you’re scared something

bad might happen the fight-or-flight

response in your body

gets activated starting in your brain

the fight-or-flight response does all

kinds of things to our brains

and bodies like making it easier to

transmit pain messages from the body to

the brain

or it makes it easy to trick the brain

whereby

normal sensations somewhere in the body

get misinterpreted as pain

or nausea for example

this got me wondering why were we

designed or why were we like this

you know why were we so easily harmed by

what amounts to words

it just didn’t seem true that sticks and

stones could break our bones but words

could never hurt us

well it turns out that nocebo effects

are there to protect us

it’s very important for our survival to

react

appropriately to negative stuff

for example if someone says there’s a

saber-tooth tiger

around the corner and he’s hungry he’s

coming to get you

you’d better run like hell or else you

might end up end up being

the tiger’s dinner on the other hand if

someone tells you

you look fantastic you’re going to have

an amazing day

and you don’t react appropriately you’re

not going to die

so basically the nocebo effect is there

to protect us our brains are hardwired

that way

the problem arises when we can’t

distinguish between real tigers

and imaginary ones

as you may have gathered my research has

always been personal

so this got me wondering how can we

apply this knowledge of nocebos

to help us well it turns out it’s

important to do this

because we have thousands and thousands

of thoughts every day

no one knows the exact number but it’s

many thousands of thoughts

and most are negative regrets about the

past

worries about the future things we don’t

like things we like but don’t have and

want

this basically means we’re no siboing

ourselves all day long

what’s even worse when we’re in this

negative state we are more likely to

express it to others

to be like that grumpy basketball coach

who said i was too clumsy to play

basketball

fortunately there is an antidote to the

nocebo effect

this may surprise you it’s not positive

thinking

positive thinking is wonderful but it

can also

increase anxiety if we try to engage

with it but don’t succeed

remember that the root cause of the

nocebo effect

is the fight-or-flight response well the

antidote to the fight-or-flight response

is the relaxation response

the relaxation response also does all

kinds of things to our brains

and bodies good things like helping the

body produce

happy chemicals like endorphins or

dopamine

they make nocebo effects irrelevant by

putting us in a spontaneously optimistic

state

how do we achieve this how do we induce

this relaxation response

the best way is to meditate or pray for

an hour in the morning

and an hour in the evening but the good

news is that you can do it in just a few

seconds

in fact just taking three conscious

slow breaths is enough shall we do it

together

so i’ll ask you to breathe in as my hand

comes up for about three seconds

and then exhale for about six or seven

seconds

as my hand goes down preferably breathe

in

and breathe out through your nose

breathe in

deeply filling your lungs

and exhale completely

letting go inhale deeply

exhale completely

last time inhale deeply

exhale completely

letting go you can carry

on breathing slowly as i finish my talk

if you like there’s just one side effect

of this technique i’ll inform you of

putting yourself

in this positive optimistic state

will end up sending ripples of optimism

and positivity

to those around you literally

making the world a better place

thank you

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