The placebo effect–an update

I’m fascinated by the placebo effect, and hypnosis as a way of activating it, so I was particularly interested in reading about some of the current research in Cure, A Journey Into the Science of Mind Over Body, by British science writer Jo Marchant.

But first I should clarify what a placebo is. Here’s a very mainstream definition from Dictionary.com: “an inactive substance or other sham form of therapy administered to a patient usually to compare its effects with those of a real drug or treatment, but sometimes for the psychological benefit to the patient through his believing he is receiving treatment.”

Here it is in black and white, the prevailing assumption that physical ailments require dosing with a “real” medical treatment, and that “psychological” benefits from “sham” treatments affect the mind but not the body.

To me, the word “placebo” instead refers to the mind’s ability to activate the body’s natural healing abilities, including, for example, the immune system. This explanation makes so much more sense when I think about the way we experience everything in this life through the dual lens of our bodies’ experiences and our minds’ interpretations of those experiences.

Cure is a fascinating look at some of the cutting edge research into the interaction between our thoughts and our physical experience. In particular, the meaning, or value, we find in the experience or the treatment makes the treatment more powerful, and more likely to result in either a cure or a lessening of symptoms.

In some cases, the mind-body connection changes both our experience of our physical state and changes the underlying condition, as in IBS, for example, which responds well to hypnosis. In other cases, although the symptoms get better, the underlying condition stays the same. For example, the pain we experience from a slipped disk becomes less severe when we use hypnosis, although the damage from the disc injury is unchanged.

I loved the book—available at the Bellingham Public Library—and its thorough discussion of the current research that’s challenging the old model of a separate, mechanical physical experience and a separate psychological experience of the mind. I recommend it.

The secret to robbing cravings of their power?

The way I understand the phenomenon of cravings is like this: there’s a trigger, probably established through behavior that’s learned through diligent though not necessarily fully conscious behavior. In other words, over time, we create a habit of using something—a cigarette, a sweet, alcohol, etc.—to change our experience.

And after a while, when the part of us that’s learned this lesson decides that we need a distraction from some source of anxiety or other emotional challenge, it creates a craving to send us off in search of a reward. It doesn’t really care about the reward, it just wants us to feel energized and focused instead of whatever else we were feeling. It doesn’t care if the carrot it’s dangling is something we really do or don’t want; it just knows from experience that the shift in focus to whatever the false promise is—a piece of cake, ice cream, a glass of wine—is enough to temporarily take our minds off whatever we are feeling.

I’ve noticed both through my own experience and from talking to hundreds of people about their cravings that if we can consistently ignore them, they really do weaken over time. We may find that they come back intermittently when we are vulnerable, but the more we can “just say no,” the more power they lose.

A useful suggestion for dealing with cravings for foods that we don’t really want—that phenomenon of being driven to a behavior that we already know won’t make us feel good—is to distract ourselves, since a craving, though intense, is brief in duration.

A recent study used people’s real-world experience of fighting cravings by playing Tetris versus just waiting out the cravings. All the study participants reported their cravings, rating each one’s strength, vividness and intrusiveness. Then they either played Tetris or waited until the craving passed, and then they reported on how much the cravings had been affected. When the cravings began, both groups rated their cravings similarly, but after, the participants who had played Tetris had significantly lower craving and less vivid craving imagery—24% less, in fact—than the ones who had just waited.

The authors of the study suggest that one of the factors that makes this kind of distraction work so well is that playing Tetris engages what’s called the visuospatial working memory. “Working memory” refers to the function of memory when performing tasks, and in this case, the task also includes processing visual and spatial cues. In other words, they are suggesting that the task that draws on these two factors interrupts a craving, perhaps by diverting the brainpower that enables those cravings in the first place.

I’ve never played Tetris, but what I take away from this study’s finding is that we can further weaken cravings by making sure that our plan for distracting ourselves during cravings includes those elements of working memory and visual-spatial processing.

Lots of video games would include that, I think, although I’m not sure that would be a good recommendation for some folks—we wouldn’t want to replace one unhealthy behavior with another equally bad, or worse. So what else would work? Doing a few minutes on a jigsaw? Drawing something from memory? Knitting? Playing music? What about just watching a sunset? Any other suggestions?

Last night, just after I’d written these paragraphs, I experienced a real live craving as I was getting dinner ready before I had to rush off to an evening appointment. I thought about the options I’d just listed and realized that none of them would be helpful in my situation. But as I was making a salad, giving it my undivided attention—slicing red pepper, green onions, cucumber, a Bosc pear, some tomato—I unexpectedly found the activity very calming. It turns out that simply giving my undivided, mindful attention to the task at hand was enough to lessen the craving.

Maybe it’s really the mindful attention that sets up the processing and interrupts the cravings.

A week off, thanks to the snow . . .

Here in Bellingham, it feels as if we are newly released from a snowy dream of real winter, back into our normal February transition from the cold and wet winter mode to the slightly less cold but even wetter spring mode. Some years it’s hard to notice the transition unless we make a point of getting outside everyday—but this year Winter has been unmistakable.

It’s been interesting, this past week—with kids out of school and the usual (for here) snow-related halt to normal activity. No class, for example, for the newest group doing the Weight Control with Hypnosis class this last Wednesday at Whatcom Community College, and I confess I missed it. I really like getting to know the people who’ve chosen to try something new in the interests of their own health and wellbeing, and I love being part of the process as we all get to know, understand, and help each other with our separate and shared concerns.

These classes ask people to try new things—new ways of thinking and acting—and it’s not always comfortable or easy. Lately I’ve come to think of it as a learning process, more than anything else. We’re using our good minds, and hearts, our powers of attention and creativity, and all the other tools we’ve developed over the years, to study and learn how we can get from where we are now, to where we want to be, to where we belong, as healthy as it’s possible for us to be.

It can take a lot of energy and time and thought, this project—this process—of identifying what we need to change to bring ourselves back into a healthy relationship with food and activity. The process is full of surprises, and fortunately it has enormous rewards. Some of those rewards comes from being able to share the process with each other, to support each other, and it may also be the most powerful thing we do, not just for each other, but for ourselves. The compassion we give each other—and ourselves—counteracts so many of the negative effects of our stressful lives and gives us energy we need to stay positive and focused on our goals.

A little activity can take us a long way

People love to talk about how much exercise we “should” get. I wonder how helpful it is to approach the notion of exercise from that perspective: how much should I get? I suppose for the folks who are into doing everything right, it might be helpful. Or the folks who are seriously into exploring and quantifying every aspect of their lives—and they at least will be evaluating the recommendations against their experience.

But lots of people suffer from a learned aversion to exercise, and I know this kind of direction is not helpful. So if this is you, take heart. It turns out that when it comes to the health benefits of moving around—a little goes a long way.

This news is from a British study of 63,591 middle-aged people, over 8 years. It didn’t matter whether they followed the recommended guidelines for a certain number of hours of exercise per day, or simply went for a long walk on a weekend day—a lesser amount of exercise was still effective in preventing disease.

In terms of physical health, although there are studies supporting specific benefits of many different kinds of strenuous exercise—weight training, running, yoga, etc.—all those recommendations about how much of each kind of exercise we need don’t matter as much as making sure we get any exercise at all. A little bit of activity still conveys real health benefits.

I suspect it also has similar benefits in the other areas that regular, more frequent exercise is known to provide. I’m thinking about one of my favorite passages from Kelly McGonigal’s The Willpower Instinct, in which she lists the surprise effects of a study on enhancing self control (also known as willpower). The participants, who had all been sedentary before the study, were given a gym membership for two months. Typically they used it once a week at first, but most were up to 3 times per week by the end of the study. The results? Improvements in attention (less distractible), a reduction in smoking, drinking, caffeine use, eating junk food, and watching TV. They also made more healthy food choices, and spent more time studying. They spent less money on impulse purchases, and saved more money. They felt more in control of their emotions.

Truly, moving around makes everything work better. And it doesn’t matter how small the initial effort is—you’ll feel the benefits. By the way, here’s a list of things to try, in case you don’t have a favorite activity already.

A Morning Gratitude Practice

Well, January is almost over, and I remember promising to give an update on my resolve to start each day with an expression of gratitude.

It’s been a seriously mixed experience. It’s been a crazy mixed up month, with our new president electing to disregard rights and protections that we have taken for granted for many many years.

I don’t need to go into details here, since anyone who cares is already following these events, except to say that it’s time for all of us to educate ourselves. History is full of examples of the folly of appeasing demagogues.

I’m not going to claim that there’s anything to be grateful for in this current political situation, since so many people are already suffering, and unfortunately so many more people will suffer. But I am grateful that I personally know people who have concrete suggestions for positive steps to deal with and hopefully change the situation for the better.

I lost the impetus to keep my morning record as the month went on, but this is what I did write down:

  • After starting the day with a focus on gratitude, it’s easier to notice what I’m grateful for during the day
  • Grateful for a wonderful night’s sleep, waking relaxed and restored, and I noticed how that feeling in my body changed as my thoughts came back online.
  • Grateful for the B vitamins that I’ve started taking again—because I had another night of great sleep and I think they contribute to that.
  • Grateful for the help I have from health providers—doctors, dentists, and therapists.

And that’s as far as the written record went. But I’m aware that other things that came to mind more than once included the support of my husband and a couple of good friends.

As I write this, I’m grateful that I have health insurance, and I can still afford it, although it is the single biggest expense—more than twice my mortgage payment. But that didn’t occur to me during my morning gratitude experiment.

This has been a difficult couple of months for many people—I’ve seen more people struggling with anxieties, and I’m sure it’s a common reaction. So anything we can do to stay grounded, and positive, and focused on the need to take good care of ourselves and each other is good. Gratitude as a practice can help us with that, I’m sure.

Weight loss goals that matter

Last night was our monthly drop-in-for-a-refresher meeting, open to anyone who’s taken the hypnosis for weight control classes that I lead at Whatcom Community College. Some of the regulars have their own names for it. I’ve heard “brainwashing,” and “tune up,” for example.

It’s always fun for me to see who comes—it could be someone who took the classes years ago and wants a refresher before an event like a holiday or a trip. Or it could be a few of the regulars, and that’s always cozy. Every once in a while it’s a bigger group, and it gets a little cramped, and that’s fine too. I look forward to this every month.

We talk about how things are going—it’s usually a mixed bag, of course, just like everything else in life. And then I lead a hypnosis session focused on whatever concerns are highlighted.

Last night was nice—just two good friends sharing updates and challenges. The highlight for me, though, came after, as we were all walking to the door. One friend said, “I have a goal.” Her goal is an adventure, not a set of numbers. It’s a fun adventure, to be shared at a date in the future, as a celebration. (I’d give the details, but it’s not my story to share, and if I’d thought of this last night, I would have asked her permission to give those details, but since I didn’t, I won’t.)

But I loved it! So many of us focus on the numbers, and that can be a real source of stress, especially when it’s a set of numbers that’s tormented us in the past. How much better to focus on something that has its own meaning. Meaning that is much more personal—an activity that’s been out of reach in the past, that can be shared with the people we love, who love us. It’s exciting to think about this kind of goal—it’s really about growing into the person we have the potential to be—and bringing our friends and family along for the ride.

Weight gain is another reason to avoid BPA

Bisphenol A, or BPA, is an endocrine disruptor—that means it’s a substance that can disrupt a hormone system, so it can cause cancerous tumors, birth defects, and other developmental disorders. It’s been suggested that BPA may also contribute to cardiovascular disease and diabetes. For some reason, BPA concentrations are higher in women than in men. I wonder if it has to do with BPA’s use in personal hygiene products and makeup.

BPA is used extensively in food containers, including water bottles, and metal products like cans and bottle tops. It’s also used in dental sealants and composites. Some research has shown that BPA from containers can seep into food or beverages.

A recent study looked at the effect of a three-week intervention designed to encourage women to make choices that reduce their exposure to BPAs from packaging (food, makeup, feminine hygiene products, etc.). The intervention included weekly meetings about reducing BPA exposure from packaging, and a requirement to monitor and record their BPA exposure. The women were also provided with make-up, hygiene products and glass food/water containers that were BPA-free.

Over the study period, the women who participated in the intervention did show a decrease in the amount of BPA in urine, and they also had significant weight loss, as reported in the Journal of Women’s Health. The women in the control group who did not take part in the BPA-limiting intervention had significant increases in both urinary BPA levels and weight gain after 3 weeks.

The next step for this research is to look at the effects of reducing exposure to BPA and other endocrine disrupting chemicals on our risk for developing Type 2 Diabetes and cardiovascular disease.

This study gives me another reason to be glad that I like simple foods.

Note for parents: BPA use has been banned in baby bottles and children’s cups, but apparently not in teethers.  A recent test analyzed 59 solid, gel-filled or water-filled teethers purchased in the U.S. for BPA and 25 other endocrine disruptor chemicals—and found BPA in all of them, including the ones labeled non-toxic or BPA-free. Yikes.

Stage hypnosis vs. hypnotherapy

I’m not a fan of stage hypnosis shows. I don’t enjoy watching people being influenced to behave in ways that would make me feel embarrassed. So I’m not likely to show up on stage as either the hypnotist or the hypnotized entertainment—not anytime soon, anyway.

What’s interesting to me about stage hypnotists is that when I get over my aversion to embarrassing myself or others, I can appreciate the way they demonstrate the power we have when we’re in that naturally-occurring altered state we call hypnosis.

In a hypnosis show, there’s a specific social context. The participants are the hypnotist, the volunteers on stage, and the audience. Everyone is involved in creating the show, the spectacle. The shared expectation is that the participants and the audience will be involved together in creating an entertaining experience. There will be surprises; people will surprise themselves and others by behaving oddly.

That shared expectation is an important component of the hypnosis experience, whether the context is a stage show, or a quiet office during a hypnotherapy session. In the stage show, the expectation is shared among all the participants. In a hypnotherapy session, it’s shared between the hypnotist and the client.

When potential clients contact me, I offer a (free) brief introductory session; I do it because it becomes an opportunity to establish that shared expectation—not for the purpose of entertainment, but to help clients benefit from the innately healing nature of the hypnosis trance state.

I say it’s innately healing, and what I’m referring to is the healing effect of being deeply relaxed—something I think we all could use more of.

Many of the people I see in my practice have seen hypnosis shows. They already know I’m not going to embarrass them in public, but they also have to trust that I have the skill to help them into that altered state of heightened, self-directed, focused attention—and then help them use that state in a healthy and productive way.

So I have mixed feelings about stage hypnosis. It makes me cringe, but I’m happy that other people have a chance to witness the power of the mind to change our perceptions and our behavior.

Happy Holidays all!

Now that the longest night of the year is over, I’m ready to count my blessings–we’re turning the corner, heading slowly but surely toward the longer days of Spring. (And I’m ready to think about something other than dangerous processed foods–it gets depressing!)

Other than more daylight, most of the blessings I’m counting are people, and I’m feeling lucky to be able to celebrate the holiday with so many of the people I love and care for, who love and care for me.  There are other blessings, too, like the opportunity to do work that matters, work that makes me happy.

And today I remind myself that, although I have the ordinary human desire for more, more of everything, the basic stuff, the food and shelter and clothing and safety and enough money–all of that–I know how lucky I am just to have enough, and how lucky to be able to take that for granted.

We’re human, and impermanent, and inevitably all things will change, but it sure feels good right now to stop and cherish these gifts, the blessings of the day.

Happy Holidays, all.

No more sodas—diet or otherwise—for kids, please

Last week’s post talked about aspartame and sucralose (Splenda), commonly used sweeteners in diet drinks and processed food. According to the studies I looked at, both sweeteners had the effect of increasing appetite, and increasing our desire for sweets by stimulating neuron activity.

I’ve mentioned only a small sample of the research here, but there’s a lot more. It seems clear to me that these sweeteners are far more harmful to health than plain sugar. I’m not advocating eating a lot of plain sugar, don’t get me wrong, but even though plain sugar is a nutritional disaster in processed food, its bad effects seem less far-reaching than the sweeteners’.

A small study looked at concentrations of sucralose in the blood of healthy adults (age 18-45) and children (age 6-12). The study found that children had double the concentrations of sucralose in the blood after drinking a single diet soda than adults.

A previous study had found sucralose in the breast milk of mothers who consumed various products containing sucralose. The study report said that since infants’ kidneys do not filter substances from the blood as efficiently as older children’s, their blood concentration of sucralose may be much higher.

Given the effects of sucralose on the brain, particularly the effects of altering our response to sweets and increasing appetite beyond the normal satiety point, aren’t we handing our kids a prescription for obesity and metabolic disorders with every diet soda?

On that note, kudos to Bellingham’s School District—they took sodas out of the schools here in 2005.