Experts call for looking into mindset for placebo response

As a growing body of research has shown that people's mindsets have measurable physical results, a group of experts called for more healthcare professionals to place emphasis on the importance of individual mindset and social context in healing.

It has been known that people's expectations to heal and the social context surrounding them, including their relationships with doctors, drive these placebo responses, where a patient's health changes without being treated, the experts at Stanford University believe that the benefits of these psychological and social forces are receiving much less attention than drug and device treatments in healthcare.

In a report published recently in The BMJ, titled "Making mindset matter," the experts also call for more studies to measure the physical effects of these psychosocial elements in order to understand and quantify patients' subjective experiences of expectations, connection and trust.

A healthcare professional's bedside manner is important and what patients think and expect about treatments can influence health outcomes, noted Alia Crum, an assistant professor of psychology and the lead author of the report. Together with co-authors Abraham Verghese, professor of medicine, and psychology doctoral candidate Kari Leibowitz, Crum argued that the healthcare and education systems in the United States need to prioritize the role of psychological and social forces in healing.

"We have long been mystified by the placebo effect," Crum was quoted as saying in a news release from Stanford in Northern California on the U.S. West Coast.

"But the placebo effect isn't some mysterious response to a sugar pill. It is the robust and measurable effect of three components: the body's natural ability to heal, the patient mindset and the social context. When we start to see the placebo effect for what it really is, we can stop discounting it as medically superfluous and can work to deliberately harness its underlying components to improve healthcare."

Over the past 30 years, neurobiological research has shown that the placebo effect, which stems in part from an individual's mindset or expectation to heal, triggers distinct brain areas associated with anxiety and pain that activate physiological effects that lead to healing outcomes.

Mindsets can also lead to negative, or "nocebo," effects. For example, patients had a heightened pain response after they were informed that an injection will hurt. Those who were told about possible negative side effects of a medication had an increased presence of those effects.

But the healthcare and education systems in the United States generally do not emphasize psychosocial training. As a result, new doctors and healthcare workers take few courses on how to effectively form meaningful relationships with patients and how best to help them adopt useful mindsets.

Verghese, who is also a director of the Stanford interdisciplinary center Presence, which champions the patient experience in medicine, has been teaching the value of connection and bedside manner for years.

"The wise and seasoned physician does much of this intuitively," Verghese said. "What is missing is the science behind it and the structure to help physicians understand these psychological and social forces so they can deliberately leverage them in healthcare."

"It should be about designing a formal curriculum for medical school that weaves all of this throughout the training, so it's not just mentioned in one or two classes or taught for one semester and then forgotten about," Leibowitz said.

"Taking time and energy to develop provider-patient relationships is crucial and we know that it makes a difference. But you have to be able to justify why structural changes like increasing the length of time spent with a patient to build trusting relationships and shape adaptive mindsets actually saves all of us money." Endit