Sticks and Stonesand Words can hurt you the Nocebo Effect
[Music]
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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