A free drug can help treat many disorders with no side effects: our minds. Jo Marchant reveals six ways to exploit its power.
Heal thyself: Think positive
“Everything’s going to be fine.” Go on, try to convince yourself, because realism can be bad for your health. Optimists recover better from medical procedures such as coronary bypass surgery, have healthier immune systems and live longer, both in general and when suffering from conditions such as cancer, heart disease and kidney failure (Annals of Behavioral Medicine, vol 39, p 4).
It is well accepted that negative thoughts and anxiety can make us ill. Stress – the belief that we are at risk – triggers physiological pathways such as the “fight-or-flight” response, mediated by the sympathetic nervous system. These have evolved to protect us from danger, but if switched on long-term they increase the risk of conditions such as diabetes and dementia.
What researchers are now realising is that positive beliefs don’t just work by quelling stress. They have a positive effect too – feeling safe and secure, or believing things will turn out fine, seems to help the body maintain and repair itself. A recent analysis of various studies concluded that the health benefits of such positive thinking happen independently of the harm caused by negative states such as pessimism or stress, and are roughly comparable in magnitude (Psychosomatic Medicine, vol 70, p 741).
Optimism seems to reduce stress-induced inflammation and levels of stress hormones such as cortisol. It may also reduce susceptibility to disease by dampening sympathetic nervous system activity and stimulating the parasympathetic nervous system. The latter governs the so-called “rest and digest” response – the opposite of fight-or-flight.
Just as helpful as taking a rosy view of the future is having a rosy view of yourself. High “self-enhancers” – people who see themselves in a more positive light than others see them – have lower cardiovascular responses to stress and recover faster, as well as lower baseline cortisol levels (Journal of Personality and Social Psychology, vol 85, p 605).
Some people are just born optimists. But whatever your natural disposition, you can train yourself to think more positively, and it seems that the more stressed or pessimistic you are to begin with, the better it will work.
David Creswell from Carnegie Mellon University in Pittsburgh, Pennsylvania, and his colleagues asked students facing exams to write short essays on times when they had displayed qualities that were important to them, such as creativity or independence. The aim was to boost their sense of self-worth. Compared with a control group, students who “self-affirmed” in this way had lower levels of adrenaline and other fight-or-flight hormones in their urine on exam day (Health Psychology, vol 28, p 554). The effect was greatest in those who started off most worried about their exam results.
Heal thyself: Trust people
Your attitude towards other people can have a big effect on your health. Being lonely increases the risk of everything from heart attacks to dementia, depression and death, whereas people who are satisfied with their social lives sleep better, age more slowly and respond better to vaccines. The effect is so strong that curing loneliness is as good for your health as giving up smoking, according to John Cacioppo of the University of Chicago, Illinois, who has spent his career studying the effects of social isolation.
“It’s probably the single most powerful behavioural finding in the world,” agrees Charles Raison of Emory University in Atlanta, Georgia, who studies mind-body interactions. “People who have rich social lives and warm, open relationships don’t get sick and they live longer.” This is partly because people who are lonely often don’t look after themselves well, but Cacioppo says there are direct physiological mechanisms too – related to, but not identical to, the effects of stress.
Earlier this year, Cacioppo reported that in lonely people, genes involved in cortisol signalling and the inflammatory response were up-regulated, and that immune cells important in fighting bacteria were more active, too. He suggests that our bodies may have evolved so that in situations of perceived social isolation, they trigger branches of the immune system involved in wound healing and bacterial infection. An isolated person would be at greater risk of physical trauma, whereas being in a group might favour the immune responses necessary for fighting viruses, which spread easily between people in close contact.
Crucially, these differences relate most strongly to how lonely people believe themselves to be, rather than to the actual size of their social network. That also makes sense from an evolutionary point of view, says Cacioppo, because being among hostile strangers can be just as dangerous as being alone. So ending loneliness is not about spending more time with people. Cacioppo thinks it is all about our attitude to others: lonely people become overly sensitive to social threats and come to see others as potentially dangerous. In a review of previous studies, published last year, he found that tackling this attitude reduced loneliness more effectively than giving people more opportunities for interaction, or teaching social skills (Annals of Behavioral Medicine, vol 40, p 218).
If you feel satisfied with your social life, whether you have one or two close friends or quite a few, there is nothing to worry about. “But if you’re sitting there feeling threatened by others and as if you’re alone in the world, that’s probably a reason to take steps,” Cacioppo says.
Heal thyself: Meditate
Monks have been meditating on mountaintops for millennia, hoping to gain spiritual enlightenment. Their efforts have probably enhanced their physical health, too.
Trials looking at the effects of meditation have mostly been small, but they have suggested a range of benefits. There is some evidence that meditation boosts the immune response in vaccine recipients and people with cancer, protects against a relapse in major depression, soothes skin conditions and even slows the progression of HIV.
Meditation might even slow the ageing process. Telomeres, the protective caps on the ends of chromosomes, get shorter every time a cell divides and so play a role in ageing. Clifford Saron of the Center for Mind and Brain at the University of California, Davis, and colleagues recently showed that levels of an enzyme that builds up telomeres were higher in people who attended a three-month meditation retreat than in a control group (Psychoneuroendocrinology, vol 36, p 664).
As with social interaction, meditation probably works largely by influencing stress response pathways. People who meditate have lower cortisol levels, and one study showed they have changes in their amygdala, a brain area involved in fear and the response to threat (Social Cognitive and Affective Neuroscience, vol 5, p 11).
One of the co-authors of Saron’s study, Elissa Epel, a psychiatrist at the University of California, San Francisco, believes that meditation may also boost “pathways of restoration and health enhancement”, perhaps by triggering a release of growth and sex hormones.
If you don’t have time for a three-month retreat, don’t worry. Imaging studies show that meditation can cause structural changes in the brain after as little as 11 hours of training. Epel suggests fitting in short “mini-meditations” throughout the day, taking a few minutes at your desk to focus on your breathing, for example: “Little moments here and there all matter.”
Heal thyself: Self-hypnosis
Hypnotherapy has struggled for scientific acceptance ever since Franz Mesmer claimed in the 18th century that he could cure all manner of ills with what he termed “animal magnetism”. “The whole field is plagued by people who don’t feel research is necessary,” says Peter Whorwell of the University of Manchester in the UK.
Whorwell has spent much of his professional life building a body of evidence for the use of hypnosis to treat just one condition: irritable bowel syndrome. IBS is considered a “functional” disorder – a rather derogatory term used when a patient suffers symptoms but doctors can’t see anything wrong. Whorwell felt that his patients, some of whom had such severe symptoms they were suicidal, were being let down by the medical profession. “I got into hypnosis because the conventional treatment of these conditions is abysmal.”
Whorwell gives patients a brief tutorial on how the gut functions, then gets them to use visual or tactile sensations – the feeling of warmth, for example – to imagine their bowel working normally. It seems to work – IBS is the only condition for which hypnosis is recommended by the UK’s National Institute for Health and Clinical Excellence. Despite this, Whorwell still has trouble convincing doctors to prescribe it. “We’ve produced a lot of incontrovertible research,” he says. “Yet people are still loath to agree to it.”
Part of the problem is that it isn’t clear exactly how hypnosis works. What is clear is that when hypnotised, people can influence parts of their body in novel ways. Whorwell has shown that under hypnosis, some IBS patients can reduce the contractions of their bowel, something not normally under conscious control (Journal of Psychosomatic Research, vol 64, p 621). Their bowel lining also becomes less sensitive to pain.
Hypnosis probably taps into physiological pathways similar to those involved in the placebo effect, says Irving Kirsch of the University of Hull, UK. For one thing, the medical conditions that the two can benefit are similar, and both are underpinned by suggestion and expectation – believing in a particular outcome. The downside is that some people do not respond as strongly to hypnosis as others.
Most clinical trials involving hypnosis are small, largely because of a lack of funding, but they suggest that hypnosis may help pain management, anxiety, depression, sleep disorders, obesity, asthma and skin conditions such as psoriasis and warts (Papeles des Psicólogo, vol 30, p 98). Finding a good hypnotherapist can be tricky as the profession is not regulated, but hypnotising yourself seems to work just as well. “Self-hypnosis is the most important part,” says Whorwell.
Heal thyself: Know your purpose
In a study of 50 people with advanced lung cancer, those judged by their doctors to have high “spiritual faith” responded better to chemotherapy and survived longer. Over 40 per cent were still alive after three years, compared with less than 10 per cent of those judged to have little faith (In Vivo, vol 22, p 577). Are your hackles rising? Of all the research into the healing potential of thoughts and beliefs, studies into the effects of religion are the most controversial.
There are thousands of studies purporting to show a link between some aspect of religion – such as attending church or praying – and better health. Religion has been associated with lower rates of cardiovascular disease, stroke, blood pressure and metabolic disorders, better immune functioning, improved outcomes for infections such as HIV and meningitis, and lower risk of developing cancer.
Critics of these studies, such as Richard Sloan of Columbia University Medical Center in New York, point out that many of them don’t adequately tease out other factors. For instance, religious people often have lower-risk lifestyles and churchgoers tend to enjoy strong social support, and seriously ill people are less likely to attend church. Nonetheless, a recent analysis of studies in the area concluded, after trying to control for these factors, that “religiosity/spirituality” does have a protective effect, though only in healthy people (Psychotherapy and Psychosomatics, vol 78, p 81). The authors warned there might be a publication bias, though, with researchers failing to publish negative results.
Even if the link between religion and better health is genuine, there is no need to invoke divine intervention to explain it. Some researchers attribute it to the placebo effect – trusting that some deity or other will heal you may be just as effective as belief in a drug or doctor (Philosophical Transactions of the Royal Society B, vol 366, p 1838). Others, like Paolo Lissoni of San Gerardo Hospital in Milan, Italy, who did the lung-cancer study mentioned above, believe that the positive emotions associated with “spirituality” promote beneficial physiological responses.
Yet others think that what really matters is having a sense of purpose in life, whatever it might be. Having an idea of why you are here and what is important increases our sense of control over events, rendering them less stressful. In Saron’s three-month meditation study (see “Meditate”, page 34), the increase in levels of the enzyme that repairs telomeres correlated with an increased sense of control and an increased sense of purpose in life. In fact, Saron argues, this psychological shift may have been more important than the meditation itself.
He points out that the participants were already keen meditators, so the study gave them the chance to spend three months doing something important to them. Spending more time doing what you love, whether it’s gardening or voluntary work, might have a similar effect on health. The big news from the study, Saron says, is “the profound impact of having the opportunity to live your life in a way that you find meaningful”.
~ Jo Marchant