Patient mindset matters in healing and deserves more study, experts say

Researchers encourage more health care providers to place emphasis on the importance of people’s mindsets and social context in healing.

Psychology professor Alia Crum’s research focuses on the importance of mindsets and social context in the healing process.
L.A. Cicero/Stanford News Service

A growing body of research has shown that people’s mindsets can measurably affect physical healing.

Social context, including patients’ relationships with their doctors, as well as patients’ expectations about healing can drive these placebo responses.

Despite this research, the benefits of these psychological and social forces still receive much less attention than drug and device treatments.

In a report published online Feb. 15 in The BMJ, researchers at Stanford call for more health care providers to place emphasis on the importance of individual mindsets and social context in healing.

Alia Crum, PhD, assistant professor of psychology, is the lead author of the report. The senior author is Abraham Verghese, MD, professor of medicine.

Crum and her co-authors urge researchers to develop more studies that measure the physical effects of these psychosocial elements to understand and quantify patients’ subjective experiences of expectations, connection and trust.

“We have long been mystified by the placebo effect,” Crum said. “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 health care.”

Power of mindset

A health care provider’s bedside manner is important, and what patients think and expect about treatments can influence health outcomes, Crum said.

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

Crum and her colleagues argue that the health care and education systems need to prioritize the role of psychological and social forces in healing.

Abraham Verghese

For example, medical schools should develop more training that helps students and residents use their personal strengths to connect with patients and learn the best ways to harness social context and patient mindset.

“It should be about designing a formal curriculum for medical school that weaves all of this throughout the training,” said Kari Leibowitz, a graduate student and co-author of the paper. “So it’s not just mentioned in one or two classes or taught for one semester and then forgotten about.”

The authors also call for a reform of standard randomized trials in the health care system. When examining the effects of a new drug, researchers should include, in addition to placebos, natural conditions, which don’t use placebos, alongside conditions that include altered social context and mindset. This, Crum said, will help researchers understand how beliefs, labels and context can help magnify or reduce the effects of the drug and treatment.

These reforms, however, would require additional research that builds more scientific evidence for the importance of the effects of social context and mindsets, they said.

“Taking time and energy to develop provider-patient relationships is crucial, and we know that it makes a difference,” Leibowitz said. “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.”

Verghese, who is also 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,” said Verghese, who holds the Linda R. Meier and Joan F. Lane Provostial Professorship. “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 health care.”

The placebo effect

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 have been shown to have a heightened pain response after being 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.

Crum has produced research suggesting that people’s mindsets also influence the benefits they get from certain behaviors. For example, she co-authored a 2011 study showing that the physical effects of food depend on how caloric or indulgent it is in a person’s mind. A study she co-authored two years later demonstrated that viewing stress as a helpful part of life, rather than as harmful, is associated with better health, emotional well-being and productivity at work.

Crum said she intends to continue to contribute research on the components that make up placebo effects, such as people’s mindsets. She said several studies are in progress, on which Crum’s Mind and Body Lab has partnered with Presence.

But more work remains to be done, Crum said.

“We know that psychological and social forces are at work in health in healing, for better or for worse,” Crum said. “But we need to develop more rigorous research to measure their physiological effects. It is time we start taking these forces more seriously in both the science and practice of medicine.”

Stanford’s departments of Medicine and of Psychology supported the work.



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