Alia J. Crum

Mind-Set Matters Exercise and the Placebo Effect

In a study testing whether the relationship between exercise and health is moderated by ones mindset, 84 female room attendants working in seven different hotels were measured on physiological health variables affected by exercise. Those in the informed condition were told that the work they do (cleaning hotel rooms) is good exercise and satisfies the Surgeon Generals recommendations for an active lifestyle. Examples of how their work was exercise were provided. Subjects in the control group were not given this information. Although actual behavior did not change, 4 weeks after the intervention, the informed group perceived themselves to be getting significantly more exercise than before. As a result, compared with the control group, they showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index. These results support the hypothesis that exercise affects health in part or in whole via the placebo effect.

Rethinking stress: the role of mindsets in determining the stress response.

This article describes 3 studies that explore the role of mindsets in the context of stress. In Study 1, we present data supporting the reliability and validity of an 8-item instrument, the Stress Mindset Measure (SMM), designed to assess the extent to which an individual believes that the effects of stress are either enhancing or debilitating. In Study 2, we demonstrate that stress mindsets can be altered by watching short, multimedia film clips presenting factual information biased toward defining the nature of stress in 1 of 2 ways (stress-is-enhancing vs. stress-is-debilitating). In Study 3, we demonstrate the effect of stress mindset on physiological and behavioral outcomes, showing that a stress-is-enhancing mindset is associated with moderate cortisol reactivity and high desire for feedback under stress. Together, these 3 studies suggest that stress mindset is a distinct and meaningful variable in determining the stress response.

Association Between Indulgent Descriptions and Vegetable Consumption: Twisted Carrots and Dynamite Beets

Association Between Indulgent Descriptions and Vegetable Consumption: Twisted Carrots and Dynamite Beets In response to increasing rates of obesity, many dining establishments have focused on promoting the health properties and benefits of nutritious foods to encourage people to choose healthier options.1 Ironically however, health-focused labeling of food may be counter-effective, as people rate foods that they perceive to be healthier as less tasty.2 Healthy labeling is even associated with higher hunger hormone levels after consuming a meal compared with when the same meal is labeled indulgently.3 How can we make healthy foods just as appealing as more classically indulgent and unhealthy foods? Because healthy foods are routinely labeled with fewer appealing descriptors than standard foods,1 this study tested whether labeling vegetables with the flavorful, exciting, and indulgent descriptors typically reserved for less healthy foods could increase vegetable consumption.

Harnessing the placebo effect: Exploring the influence of physician characteristics on placebo response.

Objective: Research on placebo/nocebo effects suggests that expectations can influence treatment outcomes, but placebo/nocebo effects are not always evident. This research demonstrates that a provider’s social behavior moderates the effect of expectations on physiological outcomes. Methods: After inducing an allergic reaction in participants through a histamine skin prick test, a health care provider administered a cream with no active ingredients and set either positive expectations (cream will reduce reaction) or negative expectations (cream will increase reaction). The provider demonstrated either high or low warmth, or either high or low competence. Results: The impact of expectations on allergic response was enhanced when the provider acted both warmer and more competent and negated when the provider acted colder and less competent. Conclusion: This study suggests that placebo effects should be construed not as a nuisance variable with mysterious impact but instead as a psychological phenomenon that can be understood and harnessed to improve treatment outcomes.

Changing Mindsets to Enhance Treatment Effectiveness

During the past few decades, significant biomedical advances have increased diagnostic and treatment effectiveness. Recent research from psychology provides a special opportunity to add value to the traditional cornerstone of medicine: the patient-clinician relationship. What is it about the conversation between patient and physician that gives it therapeutic value? At the most basic level, physicians and other clinicians gather information and communicate disease and treatment information. At an emotional level, the conversation can evoke a sense of mutual trust, empathy, support, and reassurance. This Viewpoint discusses research on mindsets, a critical feature of the conversation between patients and physicians because of their ability to drive motivation and alter physiology to enhance clinical outcomes.

Making mindset matter

Alia Crum and colleagues argue that acting on the growing evidence about the influence of patient mindset and social context on response to healthcare can improve outcomes

The role of stress mindset in shaping cognitive, emotional, and physiological responses to challenging and threatening stress.

ABSTRACT Background and objectives: Prior research suggests that altering situation-specific evaluations of stress as challenging versus threatening can improve responses to stress. The aim of the current study was to explore whether cognitive, physiological and affective stress responses can be altered independent of situation-specific evaluations by changing individuals’ mindsets about the nature of stress in general. Design: Using a 2 × 2 design, we experimentally manipulated stress mindset using multi-media film clips orienting participants (N = 113) to either the enhancing or debilitating nature of stress. We also manipulated challenge and threat evaluations by providing positive or negative feedback to participants during a social stress test. Results: Results revealed that under both threat and challenge stress evaluations, a stress-is-enhancing mindset produced sharper increases in anabolic (“growth”) hormones relative to a stress-is-debilitating mindset. Furthermore, when the stress was evaluated as a challenge, a stress-is-enhancing mindset produced sharper increases in positive affect, heightened attentional bias towards positive stimuli, and greater cognitive flexibility, whereas a stress-is-debilitating mindset produced worse cognitive and affective outcomes. Conclusions: These findings advance stress management theory and practice by demonstrating that a short manipulation designed to generate a stress-is-enhancing mindset can improve responses to both challenging and threatening stress.

Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus

Background: Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching interdisciplinary field that is unravelling the neurobiological, behavioural and clinical underpinnings of these phenomena in a broad variety of medical conditions. As a consequence, there is an increasing demand from health professionals to develop expert recommendations about evidence-based and ethical use of placebo and nocebo effects for clinical practice. Methods: A survey and interdisciplinary expert meeting by invitation was organized as part of the 1st Society for Interdisciplinary Placebo Studies (SIPS) conference in 2017. Twenty-nine internationally recognized placebo researchers participated. Results: There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects. Experts particularly agreed on the importance of informing patients about placebo and nocebo effects and training health professionals in patient-clinician communication to maximize placebo and minimize nocebo effects. Conclusions: The current paper forms a first step towards developing evidence-based and ethical recommendations about the implications of placebo and nocebo research for medical practice, based on the current state of evidence and the consensus of experts. Future research might focus on how to implement these recommendations, including how to optimize conditions for educating patients about placebo and nocebo effects and providing training for the implementation in clinical practice.

Reading between the menu lines: Are restaurants’ descriptions of “healthy” foods unappealing?

Objective: As obesity rates continue to climb in America, much of the blame has fallen on the high-calorie meals at popular chain restaurants. Many restaurants have responded by offering “healthy” menu options. Yet menus’ descriptions of healthy options may be less attractive than their descriptions of less healthy, standard options. This study examined the hypothesis that the words describing items in healthy menu sections are less appealing than the words describing items in standard menu sections. Method: Menus from the top-selling American casual-dining chain restaurants with dedicated healthy submenus (N = 26) were examined, and the library of words from health-labeled items (N = 5,873) was compared to that from standard menu items (N = 38,343) across 22 qualitative themes (e.g., taste, texture). Results: Log-likelihood ratios revealed that restaurants described healthy items with significantly less appealing themes and significantly more health-related themes. Specifically, healthy items were described as less exciting, fun, traditional, American regional, textured, provocative, spicy hot, artisanal, tasty, and indulgent than standard menu items, but were described with significantly more foreign, fresh, simple, macronutrient, deprivation, thinness, and nutritious words. Conclusion: Describing the most nutritious menu options in less appealing terms may perpetuate beliefs that healthy foods are not flavorful or indulgent, and may undermine customers’ choice of healthier dining options. From a public health perspective, incorporating more appealing descriptive language to boost the appeal of nutritious foods may be one avenue to improve dietary health.

Perceived physical activity and mortality: Evidence from three nationally representative U.S. samples.

Objective: This research sought to examine the relationship of individuals’ perceptions about their level of physical activity with mortality outcomes at the population level. Method: This study used 3 nationally representative samples with a total sample size of 61,141 U.S. adults (weighted N = 476 million). Data from the 1990 National Health Interview Survey (NHIS) and the 1999–2002/2003–2006 National Health and Nutrition Examination Survey (NHANES) were linked to prospective National Death Index mortality data through 2011, yielding follow-up periods of up to 21 years. Cox proportional hazards models were used to determine the association between respondents’ perceptions of their relative level of physical activity (compared with other people their age) and all-cause mortality, adjusting for actual levels of physical activity, health status and behavior, and sociodemographic variables. Results: Perceived physical activity relative to peers was associated with mortality risk. Individuals who perceived themselves as less active than others were up to 71% more likely to die in the follow-up period than those who perceived themselves as more active. This finding held across 3 samples and after adjusting for actual levels of physical activity and other covariates. Conclusions: Individuals’ perceptions about their level of physical activity strongly predicted mortality, even after accounting for the effects of actual physical activity and other known determinants of mortality. This suggests that perceptions about health behaviors may play an important role in shaping health outcomes.