Science shows our expectations can shape real health outcomes—proof that belief, mindset, and even faith can change the body.
In 2013, my colleagues and I at the Multicenter Orthopaedic Outcomes Network Shoulder Group published a research paper as part of a longitudinal study on rotator cuff tears. This was a multi-center trial that involved around 12 centers at that time, and during the study we randomized patients to operative or nonoperative treatment of non-traumatic tears. The nonoperative group could decide at any point that they would rather have an operation to fix their cuff tear and thus cross over to the operative group. The interesting finding in this study was that the biggest predictor of failure of nonoperative treatment was the patient’s expectation. If the patient believed that nonoperative treatment was not going to work, then it did not. This was irrespective of anatomic parameters like tear size and pattern, BMI, etc. It was the patient’s belief in the treatment that mattered most.
I found this result fascinating. And I began to wonder: Is this belief effect found in other areas? We know that there is a placebo effect in which a patient demonstrates a change in symptoms based on a sham intervention, but this is a little different. In our case, the belief is an expectation that comes to fruition.
So, I decided to do some research on, what I’m calling, the belief effect in medicine. What I found was so interesting, that it not only changed the way I communicated therapeutic interventions with my patients, but also what I believed myself.
The Belief Effect in Action
One of the more intriguing studies that demonstrates just how impactful a belief can be in medicine was performed with Parkinson’s Disease (PD) patients. In general, PD patients have lower levels of dopamine in a certain part of their brain that causes the typical tremor, rigidity, and balance issues. In this study, the PD patients were randomized to various groups. One group was told that they had a 25 percent chance of improvement with a pill, another was told that they had a 50 percent chance of improvement, and yet another group was informed that they had a 75 percent chance of improvement. However, all the patients were given the same sham pill. Via special PET (positron emission tomography), the researchers could determine if the patient actually had an increase in dopamine in the brain area that was deficient. Judging by the tenor of this article, you probably guessed that the group that was told that they had a 75 percent chance of improvement actually had a demonstrable production of dopamine in the appropriate brain area. This was also associated with clinical improvement in rigidity and movement. The patient’s expectation had true physiologic ramifications and, in this case, they were positive. This goes beyond a patient simply saying, “Yep. I feel better now after taking a pill.” This is true cognitive control over physiology.
Dr. Alia Crum, a well-know psychologist and Stanford professor, has done a lot of research in this area. Recently in her podcast, she discussed her milkshake experiment, one in which participants were told different descriptors about the shakes, but were all given the same shake. One group was told that it was a sensible low-calorie shake and the other group that it was a high-calorie indulgent shake. Ghrelin response was measured in each group after consumption. Ghrelin is a hormone secreted by the stomach and brain that stimulates hunger; and lower levels indicate satiety.
The group that was informed that they were consuming a high-calorie shake had significantly lower ghrelin levels compared to the sensible group that had a relatively flat-line response. Thus, the expectation/belief of the participant had a measurable physiologic effect, despite an equivalent stimulus.
Here we see that the mind has effects on the body just as we have seen in previous articles how the body has effects on the mind. Our frontal cortex in our brain can be used to change our physiologic response to stimuli. But can this go further with a response to stress? Additionally, can our belief system impact our response to injury or surgery?
The Truth about Stress
Stress definitely has a negative connotation, but it isn’t all bad. Acute stressors like training transiently increase cortisol levels in the moment, but in the long run, it can actually decrease chronic stress and allow the body to handle cortisol better. However, chronic stress is this invidious, almost ineffable, feeling inextricably wound into our thoughts that can have an unmitigated effect on our reactions. Or is it?
Shouldn’t we expect stress and suffering? In Buddhism, the presence of suffering is the first of the noble truths. Jesus said in John 16:33, “in this world you will have trouble, but take heart, I have overcome the world.”
Some of the troubling aspects of stress and suffering are the loss of control and unpredictability. We are no longer the determiners of our destination and we wistfully adjure resolution. But is that really the case? Do we have more control than we think? Can we use our minds and beliefs to alter our physiologic response to stress?
Research would suggest that a positive mindset regarding stress does in fact decrease cortisol levels, lower blood pressure and heart rate. This involves accepting the stress and then not trying to defeat it, but rather understand that, in the midst of adversity, there is opportunity. The way that we perceive a stressful situation alters our physiologic response and thus our physical response in measurable ways.
Faith as a Model
So does your positive mindset actually give you more control or render the situation more predictable? It really depends. Take our spiritual belief systems, for example. Personally, I believe that we have God not only as our creator, but our comforter and healer. In control of all things with a plan for all things, our God loves us and demonstrated that love by allowing his only son, Jesus, to be sacrificed for us so that at the end of our days, we can spend eternity with Him. I can submit to God and know that He has complete control and that He will plan my days. That gives me peace, and it is truly a peace that transcends all understanding. Believe me, that has physiologic ramifications on every health metric and my view of others.
Now that I have exposed my furry underbelly, does faith have an effect on health in the literature? In fact, it does. A 1995 study on heart transplant patients stratified them into three self-described groups. Group one described themselves as deeply religious, group two was involved in community groups, and group three was uninvolved in religion or community. The researchers evaluated the six-month survivorship of all three groups which were otherwise equivalent in other co-morbid metrics. At six months after surgery, 14 percent of the uninvolved group had died, 4 percent of the community-involved group had passed while none of the deeply religious group had died. Other studies have demonstrated that religious people (regularly attending services and praying) have lower blood pressure, lower incidence of cardiovascular disease, and greater levels of happiness and satisfaction. This does not mean that going to church will cure all your ills, but it does mean that those who frame their stressors in a religious manner seem to have better health metrics and even survive major surgery better. This seems to be an extension of the belief effect.
Changing the Way We Serve
This data has changed how I approach patients and their expectations. This was a means not to obfuscate medicine, supplements, or surgery but rather to augment their application. One step further is the real meat and potatoes of personal application to stress and life. The literature is replete with the positive effects of gratitude and meditation on health metrics such as blood pressure and heart rate. For example, if we give gratitude to God for all of His provisions, we acknowledge a higher power. This takes the focus off of self and onto God, which has an exceptional impact on recovery.
We as humans have a special ability to alter our physiology by the way we think and perceive situations. This gives us an even greater degree of control of our physical and mental health than we probably know. It might not be as powerful as Obi Wan Kenobi saying, “these are not the droids you are looking for,” but it does come close. I encourage you to explore this belief effect in your own lives to harness the potential benefits.
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