The Astonishing Power of Placebo

Doctors have long observed the immense power of expectation in medical settings. The well-known 'placebo effect' might just as well be called the 'expectation effect'.

Are your expectations generally positive? What do you expect for yourself and others? For your future health, wealth, and happiness?

Research has found that positive expectations can, in some instances, make us healthier, fitter, and more likely to lose weight. Expectations can even help us feel and look younger, as well as live longer and happier lives.

Doctors have long observed the immense power of expectation in medical settings. Indeed, the well-known 'placebo effect' might just as well be called the 'expectation effect'.

But it's not just conscious expectations that impact our lives.

Your unconscious expectations have a profound and often underappreciated effect on the quality of your experiences. They can make or break you.

This is where hypnosis can be immensely helpful. In fact, one of the primary uses of hypnosis is to alter expectations, both on the physical and emotional level.

But before we delve into that, I want to share with you a few examples of how expectation operates in our everyday lives.

As above, so below

We have conscious expectations (my train leaves at 6.22) as well as unconscious expectations (you hold out your hand and I unthinkingly shake it). What's more, sometimes even when we consciously forget an expectation, it's actually still there - just at a level beneath our awareness. And that's when it can really be powerful.

Let me give you an example I can almost guarantee you'll identify with.

I'm struggling to recall an actor's name. I can picture his face, I can name at least three movies he's been in, and I know I know his name. But no matter how hard I try, I simply can't recall it.

Hours later, long after my conscious mind has forgotten all about it, my unconscious mind is still working on the problem. Suddenly, the actor's name pops into my consciousness.

What happened here?

My conscious expectation of recalling the actor's name passed into my unconscious mind, which eventually fulfilled that expectation by producing his name. And all this happened even though consciously I'd forgotten all about it. Pretty cool, huh?

We tend to underestimate how important these kinds of expectations are in determining our lives, and this is partly because we're seldom aware of our own expectations and how they help or damage us. But by becoming more aware of our expectations and working to actively change them (or sometimes simply by learning to calm them and live more mindfully), we can change the very nature of our lives.

Let me tell you about a time I witnessed the powerful effect of instilled expectations on an injured child.

The enlightened doctor

Many years ago, I found myself in the accident and emergency department with a busted elbow.

There's nothing like going to the emergency department to make you feel like your accident is not an emergency. As I waited for medical attention, managing to control the pain through self-hypnosis, I saw a small boy of about six come in with his mother.

The woman told the staff her son had been injured playing football. He was literally howling in pain, and his foot was visibly swollen. It was painful to see this child's agony. But then something strange happened.

Suddenly a doctor strode out and bellowed, "What's all this about?", staring directly at the child. Astonished, the boy stopped crying. "I'll tell you what. I'm going to give you a magic pill!" said the doctor. "It will make you feel lovely and relaxed and soothe the pain very quickly. Would you like that?"

The boy nodded, still stunned by the doctor's antics.

"And best of all, it's hidden inside a lovely piece of Turkish delight!" the doctor went on. Many of the other patients were smiling by now. "Don't go anywhere!" he instructed. "I need to go and collect your magic medicine from our special locked cabinet."

Magical mind medicine

The doctor swept out of the admissions area and returned in no time with a piece of Turkish delight on a plate. All the while the expression on his face was as serious as if he were administering a life-saving injection.

"Are you ready for your medicine?" he demanded theatrically, as if invoking some religious deity. The boy nodded eagerly and picked up the sweet. But just before he put it into his mouth, the doctor stopped him.

"This will take about two minutes to work! Are you clear on that?"

The boy nodded again and ate the sweet as the doctor left as quickly as he'd arrived. Almost immediately the youngster relaxed, staring intently at the clock on the wall. After two minutes he announced to his mother that his foot no longer hurt but felt kind of numb. He looked much happier and began reading comics.

An hour and a half later, we were all still there. A nurse came out and noted with surprise how much the swelling had gone down in the boy's foot. I couldn't help myself - I took her aside and asked about the doctor's dramatic treatment. She laughed as she told me, "He often does that kind of thing. He keeps a supply of Turkish delight."

"No meds inside the sweet?"

"No, he's a great believer in the placebo response."

So what exactly is going on here?

Great expectations

There are several things to note about the way the emergency doctor handled the situation. First, the doctor grabbed the boy's attention, then narrowed it by talking loudly while staring at him. Second, the fact that the doctor was obviously an authority figure further compelled the boy to focus his attention. Third, the doctor delivered some very powerful suggestions to the boy, telling him precisely when the pain would get better. In doing so, he was also implicitly instructing the boy to think about time, not pain.

The doctor even went off to collect the so-called medicine from another part of the hospital. All this magnified the boy's sense of expectancy and made it more likely that the hypnotic suggestion for pain relief would be accepted and acted upon by the boy's unconscious mind.

The doctor was a skilled hypnotist, whether he knew it or not. He gained, then narrowed the boy's attention, and delivered a clear set of instructions for the boy's unconscious to act upon. If the boy's mother had just handed him the sweet and said, "this might help", the placebo response probably wouldn't have kicked in at all.

Impressed? Believe it or not, the power of expectation can be even more amazing.

Your miraculous mind

The placebo effect refers to measurable, observable, or perceived improvement in health and/or behaviour that cannot be attributed to medication or other medical intervention.

The modern notion of placebo (Latin for 'I shall please') was established in 1955 by Henry K. Beecher. Beecher researched 15 clinical trials involving 1,082 patients suffering from a variety of diseases. He observed that a considerable number of the patients had experienced satisfactory relief from their symptoms with the placebo alone.

Since then, many studies have shown objective improvements in health with the use of a placebo.

In one study, doctors eliminated warts by painting them with a colourful dye and reassuring patients that the warts would disappear when the dye faded.¹ Another study found that hypnotic induction for wart disappearance and simple placebo were equally effective.² And in one case study, a child with 82 warts that had been refractory to dermatological treatment experienced complete resolution of the warts following hypnosis with suggestions for the warts to disappear.³

Another study found that the inhalation of a placebo significantly reduced "hyperreactivity" of the airways of asthmatics compared with baseline - that is, the airways constricted less in response to administration of a bronchoconstrictor (a substance that is known to constrict the airways).⁴

Patients who had their wisdom teeth extracted experienced just as much pain relief with a fake ultrasound application as with a real one (thereby casting further doubt on the already questionable utility of ultrasound in this context).⁵

A meta-analysis found that administration of a placebo conferred measurable benefits for approximately 30% of colitis patients, with a remission rate of 10%. This is a startling result for such a severe, painful inflammatory condition.⁶

Parkinson's disease diminishes the brain's ability to produce dopamine, but a 2001 study showed that a placebo actually caused the production of dopamine to surge!⁷

If there's one thing you draw from all this evidence, let it be this: What we expect matters. When it comes to your everyday practice, what this means is that what your clients expect to experience - anxiety, nausea, withdrawal from tobacco, benefits from antidepressants,⁸ or whatever the case may be - may carry huge implications for whether they actually produce those responses.

One startling study compared outcomes among patients receiving arthroscopic procedures for debilitating arthritic knee pain. One group received arthroscopic lavage, one received arthroscopic debridement, and one received a placebo procedure (they were told they would receive an arthroscopic procedure but only received the arthroscopy itself). Across two years, pain and function outcomes were no different between the groups - that is, those who received the placebo improved just as much as those who actually received the 'therapeutic' treatments!⁹

But as amazing as the effects of placebo in medical settings are, for me the most exciting part is that it just goes to show that we can utilize expectation to powerful effect in our everyday lives.

The power of self-fulfilling prophecies

The human brain is an 'anticipation machine': it is organized to act on what we predict will happen next. This idea, known as expectancy theory, helps explain why our perceptions - what we think will happen - partly determine what actually occurs.

Neuroscientist Marcel Kingbourne, from the New School of Social Research, reports that our expectations of an event activate the same complex set of neurons in the brain as if the event was actually taking place.¹⁰

Our unconscious mind cannot tell the difference between something experienced and something vividly imagined. That's why hypnotic rehearsal is the perfect way to help people experience proficiency, confidence, and even happiness in situations that would previously have produced the opposite feelings.

In a particularly amazing Japanese study, researchers blindfolded a group of 13 students who had reported that they were highly allergic to the lacquer tree or wax tree, plants that are considered similar to poison ivy. They told the students that their right arm was being rubbed with lacquer or wax tree leaves, and their left with a harmless shrub.¹¹

All the students developed itching, boils, and redness on the right arm, while very few experienced a reaction on the left. Their beliefs were powerful enough not only to create physical symptoms in response to an innocuous stimulus, but also to prevent symptoms when an actual irritant was applied.

This experiment neatly demonstrates not just the placebo effect but also its evil twin, the nocebo effect. In medical settings, the nocebo effect - where bad outcomes seem to be produced by negative expectations even in the absence of any actual disease or objective harm - is referred to as 'medical hexing'.

We all hold biases and presumptions as to how things will go for us. What are your expectations of aging, or the effects of activity on your weight and fitness? And more importantly, how might these expectations affect your actual youthfulness and vitality?

Expecting to get fitter may just make it happen

One particularly amazing Yale study examined fifty members of cleaning staff from seven separate Boston hotels.¹² Half of the participants were told how much exercise they were getting and how many calories were being burned in the course of their daily tasks, and that their efforts surpassed the Surgeon General's requirement for losing weight. The other half were given no information.

Six weeks later, the researchers found that the group whose mindset (and therefore expectations) regarding work and exercise had changed not only lost more weight but also experienced a reduction in cholesterol levels and blood pressure. But here's the thing: both groups did the exact same physical activity.

This remarkable study showed that the mental constructs we develop in our daily lives are as influential in defining our reality as the activities we undertake - maybe even more so.

So how are our expectations actually shaped?

Our expectations are, in part, created by our environment, including who we hang out with. Expectations to be fit and healthy, creative, or even continually youthful are all influenced by who we are and what our day-to-day environment is like. Conversely, surrounding ourselves with negative, unfit, depressed, or anxious people can also shape our expectations as to how our lives will be.¹³

How to reverse the ageing process

Expecting to feel younger has been shown to produce amazing results.

In 1979, Harvard psychologist Ellen Langer conducted a now famous study.¹⁴ She took a bunch of elderly men in their late 70s and early 80s and relocated them to an isolated house in New England. The house had been retrofitted so that every visible sign - furniture, TV shows, books, music, clothes - suggested it was 20 years earlier. There were no mirrors and no photos to spoil the illusion.

The men were told not to reminisce about the past, but to actually act as if it were 1959. The researchers wanted to see if acting younger and being surrounded by cues from decades before might lead to actual changes in health and fitness. Langer even said to the participants, "We have good reason to believe that if you are successful at this, you will feel as you did in 1959."

The results were amazing. After only a week, the "physical strength, manual dexterity, gait, posture, perception, memory, cognition, taste sensitivity, hearing, and vision" of the men in the experimental group had all significantly improved. A control group, who were living in a retrofitted house but were not told to act as though they were back in 1959, also experienced improvements in these parameters, but to a lesser extent.

Their mental acuity had risen measurably, and they had improved gait and posture. What's more, outsiders who were shown the men's photographs judged them to be significantly younger than the controls.

In other words, the ageing process had in some measure been reversed! For these men, acting as though they were younger than they actually were created a set of expectations that reached not just an emotional level, but deep into their physical realities.

So what has all this got to do with hypnosis?

The hypnotic placebos of life

During hypnosis the placebo response can be greatly magnified. After years working in psychiatric institutions, it wasn't until I left and started using hypnosis to help people that I realized the incredible power and versatility of this technique. I was amazed to discover that verbal communication, when delivered in the right way, could help ease all sorts of physical conditions. Blood pressure, pain, migraines, even allergic reactions could be helped or even healed through hypnosis.

Life, including our circumstances, our experiences, and the influence of other people, shapes our expectations to a much greater extent than we are aware of. Whenever our attention is captured and focused, the mind becomes open to suggestion and expectations are created.

If I am being bullied terribly at school, my mind is certainly focused, my attention is narrowed, and my expectations are being shaped. Of course, I may have little awareness of these expectations - until they start causing problems for me, that is.

Unconscious expectations formed in the schoolyard, for example, may make me feel anxious and scared in social situations even decades after the bullying. If you expect to feel bad, to fail, or for others to dislike you, that expectation may play some or even a large part in how things turn out.

People seldom think of emotional experiences as hypnotic, and therefore having the power to program our expectations, but they certainly are in some ways. Emotions narrow our focus of attention and make us more suggestible, and this paves the way for a natural nocebo response within us.

Of course, life isn't only what we expect. I can expect all I like to float upwards instead of plummeting downwards when I jump from a tree. But reality has something to do with it! And although placebo, a subtle and often unrecognized application of hypnotic suggestion, works well for certain conditions, there's no evidence that a placebo will help regrow an amputated limb or make your teeth whiter!

Nevertheless, I suspect we haven't yet seen the full extent of the possibilities of positive expectancy.

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