My research focuses on how changes in subjective mindsets - the lenses through which information is perceived, organized, and interpreted - can alter objective reality through behavioral, psychological, and physiological mechanisms. My work is, in part, inspired by research on the placebo effect, a remarkable and consistent demonstration of the ability of the mindset to elicit healing properties in the body. I am interested in understanding how mindsets affect important outcomes outside the realm of medicine, in the domains of behavioral health and organizational behavior. More specifically, I aim to understand how mindsets can be consciously and deliberately changed through intervention to affect organizational and individual performance, physiological and psychological well-being, and interpersonal effectiveness.
AB, Harvard University, Psychology (2005)
PhD, Yale University, Clinical Psychology (2012)
Current Research and Scholarly Interests
Our lab focuses on how subjective mindsets (e.g., thoughts, beliefs and expectations) can alter objective reality through behavioral, psychological, and physiological mechanisms. Our work is, in part, inspired by research on the placebo effect, a robust demonstration of the ability of the mindset to elicit healing properties in the body. We are interested in understanding how mindsets affect important outcomes both within and beyond the realm of medicine, in the domains such as exercise, diet and stress. More specifically, we aim to understand how selective information through modalities such as media, marketing and labeling can inform mindsets, and how mindsets can be consciously and deliberately changed through intervention to affect physiological and psychological health.
Our research draws upon and integrates the psychology of schemas and appraisals within a range of disciplines including the science of the placebo effect, the behavioral economics of framing, and the sociology of valuation. We collaborate with an interdisciplinary web of scholars including psychologists, sociologists, organizational behavior scholars, and neurobiologists and employ a variety of methods, from experimental studies to surveys to field interventions. Though our approach is interdisciplinary and our methods multi-modal, our focus is precise: to bring together related streams of research to a) understand how mindsets shape reality and b) design interventions that can positively change health, performance and wellbeing.
- Advanced Studies in Health Psychology
PSYCH 298 (Spr)
- How Beliefs Create Reality
PSYCH 20N (Spr)
- Independent Studies (5)
Prior Year Courses
- How Beliefs Create Reality
PSYCH 20N (Sum)
- Self and Society: Introduction to Social Psychology
PSYCH 70, SOC 2 (Aut, Sum)
- Self and Society: Introduction to Social Psychology
PSYCH 70, SOC 2 (Spr)
- What Is a Mindset and How Does it Work?
PSYCH 277 (Spr)
- How Beliefs Create Reality
- "Consensus on Placebo and Nocebo Effects Connects Science with Practice:" Reply to "Questioning the Consensus on Placebo and Nocebo Effects". Psychotherapy and psychosomatics 2021: 1–2
Changing mindsets about side effects.
2021; 11 (2): e040134
Given research showing that the very act of communicating side effects can increase their likelihood, how can providers inform patients about side effects while upholding their oath to do no unnecessary harm? An emerging approach provides a potential solution: truthfully describe certain minor side effects as a sign the treatment is active and working in the body. This approach focuses on instilling adaptive mindsets about the meaning of side effects while still keeping patients informed. This article describes existing research suggesting that this approach can be helpful in improving experience and outcomes in treatments for pain, hypertension and allergy. Compared with control groups given a standard, empathetic message about side effects, patients who were informed that side effects are a sign treatment is working were less anxious about side effects and rated them as less threatening and intense. A longitudinal, randomised controlled trial of this approach in patients receiving oral immunotherapy for food allergies found that describing side effects as a sign treatment was working reduced the rate at which patients contacted providers with concerns about side effects and led to greater increases in a biomarker of allergic tolerance from pretreatment to post-treatment (peanut-specific blood IgG4). In unveiling this approach, this article also raises important issues regarding which treatments and symptoms this approach should be applied to. Finally, we outline questions future research should address to further understand and leverage this approach.
View details for DOI 10.1136/bmjopen-2020-040134
View details for PubMedID 33526496
Nutritional Analysis of Foods and Beverages Depicted in Top-Grossing US Movies, 1994-2018.
JAMA internal medicine
Importance: Many countries now restrict advertisements for unhealthy foods. However, movies depict foods and beverages with nutritional quality that is unknown, unregulated, and underappreciated as a source of dietary influence.Objective: To compare nutritional content depicted in top-grossing US movies with established nutrition rating systems, dietary recommendations, and US individuals' actual consumption.Design and Setting: In this qualitative study, a content analysis was performed from April 2019 to May 2020 of the 250 top-grossing US movies released from 1994 to 2018.Main Outcomes and Measures: The proportion of movies with less healthy nutrition ratings using the Nutrient Profile Index, the proportion of movies with medium or high food nutrition ratings according to the United Kingdom's "traffic light" guidelines (in which green is low and indicates the healthiest foods; amber, medium; and red is high and indicates the least healthy foods), and how the movie-depicted nutritional content compared with US Food and Drug Administration-recommended daily levels and US individuals' actual consumption according to National Health and Nutrition Examination Survey 2015-2016 data. Secondary outcomes compared branded and nonbranded items and tested whether outcomes changed over time or for movies targeting youths.Results: Across 9198 foods and 5748 beverages, snacks and sweets (2173 [23.6%]) and alcoholic beverages (2303 [40.1%]) were most commonly depicted. Alcohol comprised 23 of 127 beverages (18.1%) in G-rated movies, 268 of 992 beverages (27.0%) in PG-rated movies, 1503 of 3592 beverages (41.8%) in PG-13-rated movies, and 509 of 1037 beverages (49.1%) in R-rated movies. Overall, 178 of 245 movies (72.7%) earned less healthy Nutrient Profile Index food ratings and 222 of 246 movies (90.2%) earned less healthy beverage ratings, which would be unhealthy enough to fail legal limits for advertising to youths in the United Kingdom. Among foods, most movies depicted medium or high (amber or red traffic light) levels of sugar (229 of 245 [93.5%]), saturated fat (208 of 245 [84.9%]), total fat (228 of 245 [93.1%]), and, to a lesser extent, sodium (123 of 245 [50.2%]). Only 1721 foods and beverages (11.5%) were visibly branded, but branded items received less healthy nutrition ratings than nonbranded items. Overall, movies failed recommended levels of saturated fat per 2000 kcal by 25.0% (95% CI, 20.6%-29.9%), sodium per 2000 kcal by 3.9% (95% CI, 0.2%-7.9%), and fiber per 2000 kcal by 45.1% (95% CI, 42.9%-47.0%). Movies also depicted 16.5% (95% CI, 12.3%-21.0%) higher total sugar content per 2000 kcal and 313% (95% CI, 298%-329%) higher alcohol content per 2000 kcal than US individuals consume. Neither food nor beverage nutrition scores improved over time or among movies targeting youths.Conclusions and Relevance: This study suggests that popular US movies depict an unhealthy diet that fails national dietary recommendations, akin to US individuals' actual diets. Depicting unhealthy consumption in media is a sociocultural problem that extends beyond advertisements and branded product placements.
View details for DOI 10.1001/jamainternmed.2020.5421
View details for PubMedID 33226424
Five-Star Prices, Appealing Healthy Item Descriptions? Expensive Restaurants' Descriptive Menu Language
2020; 39 (11): 975–85
Objective: Prior research shows that America's top-selling inexpensive casual dining restaurants use less appealing language to describe healthy menu items than standard items. This may suggest to diners that healthy options are less tasty and enjoyable. The present research asked whether expensive restaurants also use less appealing language to describe healthy items, or whether healthy items are described with equally appealing language as standard items in high status dining contexts. Method: Using Yelp, the name and description of every food item were recorded from the menus of 160 top-rated expensive restaurants across 8 U.S. cities (Nitems = 3,295; Nwords = 32,516). Healthy menu items were defined as salads and side vegetables, and standard items as all other dishes (excluding desserts), with high interrater reliability (K = .89). Descriptive words were categorized into 22 predefined themes, and log likelihood analyses compared normalized theme frequencies from standard item and healthy item descriptions. Results: Healthy items were described with 4.8-times fewer American region words, 2.7-times fewer exciting words, 1.4-times fewer tasty words, and significantly fewer portion size, spicy, artisanal, and foreign region words. Unlike inexpensive restaurants, however, expensive restaurants did not use any health-focused themes to promote healthy items and used several appealing themes more frequently in healthy item descriptions. Conclusions: Like inexpensive restaurants, expensive American restaurants described healthy items as less appealing and less authentically American than standard foods, but to a lesser extent. Implications for ordering behavior and solutions for improving the appeal of healthy menu items are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
View details for DOI 10.1037/hea0001025
View details for Web of Science ID 000582383700004
View details for PubMedID 32940527
What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus.
Psychotherapy and psychosomatics
INTRODUCTION: Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments.OBJECTIVE: There is an increasing need for up-to-date recommendations on how to inform patients about placebo and nocebo effects in clinical practice and train clinicians how to disclose this information.METHODS: Based on previous clinical recommendations concerning placebo and nocebo effects, a 3-step, invitation-only Delphi study was conducted among an interdisciplinary group of internationally recognized experts. The study consisted of open- and closed-ended survey questions followed by a final expert meeting. The surveys were subdivided into 3 parts: (1) informing patients about placebo effects, (2) informing patients about nocebo effects, and (3) training clinicians how to communicate this information to the patients.RESULTS: There was consensus that communicating general information about placebo and nocebo effects to patients (e.g., explaining their role in treatment) could be beneficial, but that such information needs to be adjusted to match the specific clinical context (e.g., condition and treatment). Experts also agreed that training clinicians to communicate about placebo and nocebo effects should be a regular and integrated part of medical education that makes use of multiple formats, including face-to-face and online modalities.CONCLUSIONS: The current 3-step Delphi study provides consensus-based recommendations and practical considerations for disclosures about placebo and nocebo effects in clinical practice. Future research is needed on how to optimally tailor information to specific clinical conditions and patients' needs, and on developing standardized disclosure training modules for clinicians.
View details for DOI 10.1159/000510738
View details for PubMedID 33075796
The Future of Women in Psychological Science.
Perspectives on psychological science : a journal of the Association for Psychological Science
There has been extensive discussion about gender gaps in representation and career advancement in the sciences. However, psychological science itself has yet to be the focus of discussion or systematic review, despite our field's investment in questions of equity, status, well-being, gender bias, and gender disparities. In the present article, we consider 10 topics relevant for women's career advancement in psychological science. We focus on issues that have been the subject of empirical study, discuss relevant evidence within and outside of psychological science, and draw on established psychological theory and social-science research to begin to chart a path forward. We hope that better understanding of these issues within the field will shed light on areas of existing gender gaps in the discipline and areas where positive change has happened, and spark conversation within our field about how to create lasting change to mitigate remaining gender differences in psychological science.
View details for DOI 10.1177/1745691620952789
View details for PubMedID 32901575
- Cancer Survivorship-Considering Mindsets. JAMA oncology 2020
- Integrating Wearables in Stress Management Interventions: Promising Evidence From a Randomized Trial INTERNATIONAL JOURNAL OF STRESS MANAGEMENT 2020; 27 (2): 172–82
Using social and behavioural science to support COVID-19 pandemic response.
Nature human behaviour
The COVID-19 pandemic represents a massive global health crisis. Because the crisis requires large-scale behaviour change and places significant psychological burdens on individuals, insights from the social and behavioural sciences can be used to help align human behaviour with the recommendations of epidemiologists and public health experts. Here we discuss evidence from a selection of research topics relevant to pandemics, including work on navigating threats, social and cultural influences on behaviour, science communication, moral decision-making, leadership, and stress and coping. In each section, we note the nature and quality of prior research, including uncertainty and unsettled issues. We identify several insights for effective response to the COVID-19 pandemic and highlight important gaps researchers should move quickly to fill in the coming weeks and months.
View details for DOI 10.1038/s41562-020-0884-z
View details for PubMedID 32355299
Optimizing stress: An integrated intervention for regulating stress responses.
Emotion (Washington, D.C.)
2020; 20 (1): 120–25
The dominant cultural valuation of stress is that it is "bad for me." This valuation leads to regulatory goals of reducing or avoiding stress. In this article, we propose an alternative approach-stress optimization-which integrates theory and research on stress mindset (e.g., Crum, Salovey, & Achor, 2013) and stress reappraisal (e.g., Jamieson, Mendes, Blackstock, & Schmader, 2010) interventions. We further integrate these theories with the extended process model of emotion regulation (Gross, 2015). In so doing, we explain how altering second-level valuation systems-shifting the valuation of stress from "is bad for me" to "can be good for me"-fundamentally changes the overarching goal of stress regulation from reducing stress to optimizing stress responses to achieve valued goals. With this optimization goal in mind, individuals are invited to flexibly identify, select, and engage in specific regulation tactics (e.g., situation selection, attentional control, cognitive change, and response modulation) in ways that help them achieve valued ends as opposed to merely reducing or avoiding stressful experiences. We discuss definitions and issues related to key terms including stress, stressors, stress responses, and stress regulation and outline a research agenda for testing this new integrated theory as an intervention. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
View details for DOI 10.1037/emo0000670
View details for PubMedID 31961190
Effects of physical activity recommendations on mindset, behavior and perceived health.
Preventive medicine reports
2020; 17: 101027
This research sought to understand if physical activity recommendations--an integral component of many interventions aiming to promote physical activity--may have unexpected effects on individuals' mindsets (in this case about the adequacy and health consequences of their physical activity) that can strengthen or weaken recommendation effectiveness. Participants were students and staff at a U.S. West Coast private university, recruited between 2016 and 2019. Two experiments with one-week follow-up periods investigated the effects of viewing recommendations that prescribe a lower (vs. higher) amount of physical activity and provide a liberal (vs. stringent) definition of what counts as physical activity on individuals' mindsets about the adequacy and health consequences of their physical activity, as well as physical activity-related self-efficacy, physical activity behavior, and perceived health. Study 1 (N = 157) showed that exposure to low-and-liberal recommendations (vs. high-and-stringent recommendations) caused participants to adopt the mindset that their physical activity was more adequate, which in turn predicted greater engagement in physical activity and perceived health one week later. Study 2 (N = 272) showed that regardless of definition of physical activity (liberal vs. stringent), a lower (vs. higher) amount of recommended physical activity led participants to adopt the mindset that their activity was more adequate. This more adaptive mindset predicted greater self-efficacy and engagement in physical activity in the following week, in addition to better perceived health. Rather than inducing complacency, recommendations prescribing a relatively lower (vs. higher) amount of physical activity may be more effective at promoting physical activity and health by inducing adaptive mindsets.
View details for DOI 10.1016/j.pmedr.2019.101027
View details for PubMedID 31921575
View details for PubMedCentralID PMC6948259
What constitutes a 'successful' recovery? Patient perceptions of the recovery process after a traumatic injury.
Trauma surgery & acute care open
2020; 5 (1): e000427
Background: As the number of patients surviving traumatic injuries has grown, understanding the factors that shape the recovery process has become increasingly important. However, the psychosocial factors affecting recovery from trauma have received limited attention. We conducted an exploratory qualitative study to better understand how patients view recovery after traumatic injury.Methods: This qualitative, descriptive study was conducted at a Level One university trauma center. Participants 1-3years postinjury were purposefully sampled to include common blunt-force mechanisms of injuries and a range of ages, socioeconomic backgrounds and injury severities. Semi-structured interviews explored participants' perceptions of self and the recovery process after traumatic injury. Interviews were transcribed verbatim; the data were inductively coded and thematically analyzed.Results: We conducted 15 interviews, 13 of which were with male participants (87%); average hospital length of stay was 8.9 days and mean injury severity score was 18.3. An essential aspect of the patient experience centered around the recovery of both the body and the 'self', a composite of one's roles, values, identities and beliefs. The process of regaining a sound sense of self was essential to achieving favorable subjective outcomes. Participants expressed varying levels of engagement in their recovery process, with those on the high end of the engagement spectrum tending to speak more positively about their outcomes. Participants described their own subjective interpretations of their recovery as most important, which was primarily influenced by their engagement in the recovery process and ability to recover their sense of self.Discussion: Patients who are able to maintain or regain a cohesive sense of self after injury and who are highly engaged in the recovery process have more positive assessments of their outcomes. Our findings offer a novel framework for healthcare providers and researchers to use as they approach the issue of recovery after injury with patients.Level of evidence: III-descriptive, exploratory study.
View details for DOI 10.1136/tsaco-2019-000427
View details for PubMedID 32154383
Increasing Vegetable Intake by Emphasizing Tasty and Enjoyable Attributes: A Randomized Controlled Multisite Intervention for Taste-Focused Labeling.
Healthy food labels tout health benefits, yet most people prioritize tastiness in the moment of food choice. In a preregistered intervention, we tested whether taste-focused labels compared with health-focused labels increased vegetable intake at five university dining halls throughout the United States. Across 137,842 diner decisions, 185 days, and 24 vegetable types, taste-focused labels increased vegetable selection by 29% compared with health-focused labels and by 14% compared with basic labels. Vegetable consumption also increased. Supplementary studies further probed the mediators, moderators, and boundaries of these effects. Increased expectations of a positive taste experience mediated the effect of taste-focused labels on vegetable selection. Moderation tests revealed greater effects in settings that served tastier vegetable recipes. Taste-focused labels outperformed labels that merely contained positive words, fancy words, or lists of ingredients. Together, these studies show that emphasizing tasty and enjoyable attributes increases vegetable intake in real-world settings in which vegetables compete with less healthy options.
View details for DOI 10.1177/0956797619872191
View details for PubMedID 31577177
- When Your Doctor "Gets It" and "Gets You": The Critical Role of Competence and Warmth in the Patient-Provider Interaction FRONTIERS IN PSYCHIATRY 2019; 10
The Role of Patient Beliefs in Open-Label Placebo Effects
2019; 38 (7): 613–22
Recent research on open-label placebos, or placebos administered without deception or concealment, suggests that they can be effective in a variety of conditions. The current research sought to unpack the mechanisms underlying the treatment efficacy of open-label placebos.A health care provider induced an allergic reaction in 148 participants via a histamine skin prick test. Participants were then exposed to 1 of 4 conditions additively leveraging various mechanisms of open-label placebo treatments: a supportive patient-provider relationship, a medical ritual, positive expectations, and a rationale about the power of placebos.There were no main effects of condition on allergic responses. However, participant beliefs about placebos moderated the effect of open-label placebo treatment condition on physiological allergic reactions: the condition including all 4 components of open-label placebos (a supportive patient-provider relationship, a medical ritual, positive expectations, and a rationale about the power of placebos) significantly reduced physiological allergic reaction among participants with a strong belief in placebos compared with participants in the control group.Participants' beliefs about placebos interact with information from the provider to reduce physiological allergic reactions in response to an open-label placebo treatment. This study underscores the importance of measuring and understanding how participants' beliefs influence outcomes of treatment, and furthers our understanding of when and how open-label placebo treatments work. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
View details for DOI 10.1037/hea0000751
View details for Web of Science ID 000472220600006
View details for PubMedID 31021124
- Smart food policy for healthy food labeling: Leading with taste, not healthiness, to shift consumption and enjoyment of healthy foods (vol 119, pg 7, 2019) PREVENTIVE MEDICINE 2019; 123: 344
- Changing Patient Mindsets about Non-Life-Threatening Symptoms During Oral Immunotherapy: A Randomized Clinical Trial JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7 (5): 1550–59
- Americans' Health Mindsets: Content, Cultural Patterning, and Associations With Physical and Mental Health ANNALS OF BEHAVIORAL MEDICINE 2019; 53 (4): 321–32
Americans' Health Mindsets: Content, Cultural Patterning, and Associations With Physical and Mental Health.
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine
2019; 53 (4): 321–32
BACKGROUND: Health mindsets are mental frameworks that help people recognize, organize, interpret, and respond to health-relevant information. Although mindsets shape health behaviors and outcomes, no study has examined the health mindsets of ethnically and socioeconomically diverse Americans.PURPOSE: We explored the content, cultural patterning, and health correlates of diverse Americans' health mindsets.METHODS: Two studies surveyed approximately equal numbers of African American, Asian American, European American, and Latinx American men and women of lower and higher socioeconomic status (SES). Study 1 (N = 334) used open-ended questions to elicit participants' mindsets about the definitions, causes, and benefits of health. Study 2 (N = 320) used Study 1's results to develop a closed-ended instrument.RESULTS: In Study 1, open-ended questioning revealed six overarching mindset themes: behavioral, medical, physical, psychological, social, and spiritual. The most prevalent mindsets were psychological definitions, behavioral causes, and psychological benefits. Participants mentioned more cause themes than definition or benefit themes, and mindset theme mentions correlated with worse health. Older participants mentioned more themes than younger, women mentioned more definition themes than men, and low-SES participants mentioned more cause themes than high-SES participants. In Study 2, closed-ended scales uncovered more complex and positive health mindsets. Psychological and spiritual benefit mindsets correlated with good mental health. African Americans and women endorsed the widest array of mindsets, and the spiritual benefit mindset partially explained the superior mental health of African Americans.CONCLUSIONS: Many Americans hold simplistic, illness-focused health mindsets. Cultivating more complex, benefit-focused, and culturally appropriate health mindsets could support health.
View details for PubMedID 30892642
- Smart food policy for healthy food labeling: Leading with taste, not healthiness, to shift consumption and enjoyment of healthy foods PREVENTIVE MEDICINE 2019; 119: 7–13
Changing Patient Mindsets About Non-Life-Threatening Symptoms During Oral Immunotherapy: A Randomized Clinical Trial.
The journal of allergy and clinical immunology. In practice
BACKGROUND: Oral immunotherapy (OIT) can lead to desensitization to food allergens, but patients can experience treatment-related symptoms of allergic reactions that cause anxiety and treatment dropout. Interventions to improve OIT for patients are needed.OBJECTIVE: To determine whether fostering the mindset that non-life-threatening symptoms during OIT can signal desensitization improves treatment experience and outcomes.METHODS: In a randomized, blinded, controlled phase II study, 50 children/adolescents (28% girls, aged 7-17, M=10.82, SD=3.01) completed six-month OIT for peanut allergies. Patients and their parent(s) had monthly clinic visits at the Sean N. Parker Center for Allergy & Asthma Research between 1/5/2017-8/3/2017. All families received identical symptom management training. In a 1:1 approach, 24 patients and their families were informed that non-life-threatening symptoms during OIT were unfortunate side effects of treatment, and 26 patients and their families were informed that non-life-threatening symptoms could signal desensitization. Families participated in activities to reinforce these symptom mindsets.RESULTS: Compared to families informed that symptoms are side effects, families informed that symptoms can signal desensitization were less anxious (B=-0.46, 95% CI (-0.76 to -0.16), p=0.003), less likely to contact staff about symptoms (5/24[9.4%] vs. 27/154[17.5%] instances, p=0.036), experienced fewer non-life-threatening symptoms as doses increased (BInteraction=-0.54(-0.83 to -0.27), p<0.001), less likely to skip/reduce doses (1/26[4%] vs. 5/24[21%] patients, p=0.065), and showed greater increase in patient peanut-specific blood IgG4 levels (BInteraction=0.76(0.36 to 1.17), p<0.001).CONCLUSION: Fostering the mindset that symptoms can signal desensitization improves OIT experience and outcomes. Changing how providers inform patients about non-life-threatening symptoms is a promising avenue for improving treatment.
View details for PubMedID 30682576
Learning one's genetic risk changes physiology independent of actual genetic risk
Nature Human Behaviour
2019; 3: 48-56
View details for DOI 10.1038/s41562-018-0483-4
Targeting Mindsets, Not Just Tumors
Trends in Cancer
View details for DOI 10.1016/j.trecan.2019.08.001
Learning one's genetic risk changes physiology independent of actual genetic risk.
Nature human behaviour
2019; 3 (1): 48–56
Millions of people now access personal genetic risk estimates for diseases such as Alzheimer's, cancer and obesity1. While this information can be informative2-4, research on placebo and nocebo effects5-8 suggests that learning of one's genetic risk may evoke physiological changes consistent with the expected risk profile. Here we tested whether merely learning of one's genetic risk for disease alters one's actual risk by making people more likely to exhibit the expected changes in gene-related physiology, behaviour and subjective experience. Individuals were genotyped for actual genetic risk and then randomly assigned to receive either a 'high-risk' or 'protected' genetic test result for obesity via cardiorespiratory exercise capacity (experiment 1, N = 116) or physiological satiety (experiment 2, N = 107) before engaging in a task in which genetic risk was salient. Merely receiving genetic risk information changed individuals' cardiorespiratory physiology, perceived exertion and running endurance during exercise, and changed satiety physiology and perceived fullness after food consumption in a self-fulfilling manner. Effects of perceived genetic risk on outcomes were sometimes greater than the effects associated with actual genetic risk. If simply conveying genetic risk information can alter actual risk, clinicians and ethicists should wrestle with appropriate thresholds for when revealing genetic risk is warranted.
View details for PubMedID 30932047
When Your Doctor "Gets It" and "Gets You": The Critical Role of Competence and Warmth in the Patient-Provider Interaction.
Frontiers in psychiatry
2019; 10: 475
Background: Research demonstrates that the placebo effect can influence the effectiveness of medical treatments and accounts for a significant proportion of healing in many conditions. However, providers may differ in the degree to which they consciously or unconsciously leverage the forces that produce placebo effects in clinical practice. Some studies suggest that the manner in which providers interact with patients shapes the magnitude of placebo effects, but this research has yet to distill the specific dimensions of patient-provider interactions that are most likely to influence placebo response and the mechanisms through which aspects of patient-provider interactions impact placebo response. Methods: We offer a simplifying and unifying framework in which interactions that boost placebo response can be dissected into two key dimensions: patients' perceptions of competence, or whether a doctor "gets it" (i.e., displays of efficiency, knowledge, and skill), and patients' perceptions of warmth, or whether a doctor "gets me" (i.e., displays of personal engagement, connection, and care for the patient). Results: First, we discuss how this framework builds on past research in psychology on social perception of competence and warmth and in medical literature on models of effective medical care, patient satisfaction, and patient-provider interactions. Then we consider possible mechanisms through which competence and warmth may affect the placebo response in healthcare. Finally, we share original data from patients and providers highlighting how this framework applies to healthcare. Both patient and provider data illustrate actionable ways providers can demonstrate competence and warmth to patients. Discussion: We conclude with recommendations for how researchers and practitioners alike can more systematically consider the role of provider competence and warmth in patient-provider interactions to deepen our understanding of placebo effects and, ultimately, enable providers to boost placebo effects alongside active medications (i.e., with known medical ingredients) and treatment in clinical care.
View details for DOI 10.3389/fpsyt.2019.00475
View details for PubMedID 31333518
View details for PubMedCentralID PMC6619399
Stress, Mindsets, and Success in Navy SEALs Special Warfare Training.
Frontiers in psychology
2019; 10: 2962
Mindsets can impact an individual's performance in stressful experiences such as public speaking or receiving negative feedback. Yet we know little about the boundary conditions of where these mindsets predict success, and where they may become irrelevant or even maladaptive. The current research asks whether mindsets are beneficial in environments of extreme physical and mental stress using participants undergoing the notoriously challenging Navy SEALs training. We hypothesized that participants with stress-is-enhancing mindsets - who believe stress enhances their health, performance and wellbeing - will outperform those with stress-is-debilitating mindsets. In addition, we explore whether other mindsets about willpower and failure predict success in a similar manner. Following 174 Navy SEALs candidates, we find that, even in this extreme setting, stress-is-enhancing mindsets predict greater persistence through training, faster obstacle course times, and fewer negative evaluations from peers and instructors. We also find evidence that failure-is-enhancing mindsets may be detrimental to candidates' success, and non-limited willpower mindsets prompt negative evaluations from others. Multiverse analyses were conducted to test for the robustness of these effects across researcher analytical decisions, which produced consistent results. We discuss how findings in this unique environment can provide insight into the importance of mindsets in other organizations and propose future avenues of research to further understand the causal role of mindsets in diverse workplace contexts.
View details for DOI 10.3389/fpsyg.2019.02962
View details for PubMedID 32010023
Smart food policy for healthy food labeling: Leading with taste, not healthiness, to shift consumption and enjoyment of healthy foods.
Smart food policy models for improving dietary intake recommend tailoring interventions to people's food preferences. Yet, despite people citing tastiness as their leading concern when making food choices, healthy food labels overwhelmingly emphasize health attributes (e.g., low caloric content, reductions in fat or sugar) rather than tastiness. Here we compared the effects of this traditional health-focused labeling approach to a taste-focused labeling approach on adults' selection and enjoyment of healthy foods. Four field studies (total N = 4273) across several dining settings in northern California in 2016-2017 tested whether changing healthy food labels to emphasize taste and satisfaction rather than nutritional properties would encourage more people to choose them (Studies 1-2), sustain healthy purchases over the long-term (Study 3), and improve both the perceived taste of and mindsets about healthy foods (Study 4). Compared to health-focused labeling, taste-focused labeling increased choice of vegetables (OR = 1.73, 95% CI: 1.32, 2.26), salads (OR = 2.06, 95% CI: 1.06, 4.06), and vegetable wraps (OR = 3.09, 95% CI: 1.73, 5.65) in Studies 1-2. In Study 3, taste-focused labeling sustained vegetarian entree purchases over a two-month period, while health-focused labeling led to a 45.1% decrease. In Study 4, taste-focused labeling significantly enhanced post-consumption ratings of vegetable deliciousness and improved mindsets about the deliciousness of healthy foods compared to health-focused labeling. These studies demonstrate that taste-focused labeling is a low-cost strategy that increased healthy food selection by 38% and outperforms health-focused labeling on multiple smart food policy mechanisms.
View details for PubMedID 30508553
Beliefs About Stress Attenuate the Relation Among Adverse Life Events, Perceived Distress, and Self-Control.
2018; 89 (6): 2059–69
Prior research has shown that adverse events in the lives of adolescents precipitate psychological distress, which in turn impairs self-control. This study (N=1,343) examined the protective effects of stress mindsets-beliefs about the extent to which stress might be beneficial or strictly detrimental. The results confirmed that increasing the number of adverse life events across the school year predicted rank order increases in perceived distress, which in turn predicted rank order decreases in self-control. Adolescents who believed in the potential benefits of stress were less prone to feeling stressed in the wake of adverse life events. These findings suggest that changing the way adolescents think about stress may help protect them from acting impulsively when confronted with adversity.
View details for PubMedID 28872676
Providers' Demeanor Impacts Patient Perceptions of Visit Length.
Journal of general internal medicine
View details for PubMedID 30215175
Physician Assurance Reduces Patient Symptoms in US Adults: an Experimental Study.
Journal of general internal medicine
View details for PubMedID 30128787
Catechol-O-Methyltransferase moderates effect of stress mindset on affect and cognition
2018; 13 (4): e0195883
There is evidence that altering stress mindset-the belief that stress is enhancing vs. debilitating-can change cognitive, affective and physiological responses to stress. However individual differences in responsiveness to stress mindset manipulations have not been explored. Given the previously established role of catecholamines in both placebo effects and stress, we hypothesized that genetic variation in catechol-O-methyltransferase (COMT), an enzyme that metabolizes catecholamines, would moderate responses to an intervention intended to alter participants' mindsets about stress. Participants (N = 107) were exposed to a stress mindset manipulation (videos highlighting either the enhancing or debilitating effects of stress) prior to engaging in a Trier Social Stress task and subsequent cognitive tasks. The associations of the COMT rs4680 polymorphism with the effect of stress mindset video manipulations on cognitive and affective responses were examined. Genetic variation at rs4680 modified the effects of stress mindset on affective and cognitive responses to stress. Individuals homozygous for rs4680 low-activity allele (met/met) were responsive to the stress-is-enhancing mindset manipulation as indicated by greater increases in positive affect, improved cognitive functioning, and happiness bias in response to stress. Conversely, individuals homozygous for the high-activity allele (val/val) were not as responsive to the stress mindset manipulation. These results suggest that responses to stress mindset intervention may vary with COMT genotype. These findings contribute to the understanding of gene by environment interactions for mindset interventions and stress reactivity and therefore warrant further investigations.
View details for PubMedID 29677196
Mindsets Matter: A New Framework for Harnessing the Placebo Effect in Modern Medicine.
International review of neurobiology
2018; 138: 137–60
The clinical utility of the placebo effect has long hinged on physicians deceptively administering an objective placebo treatment to their patients. However, the power of the placebo does not reside in the sham treatment itself; rather, it comes from the psychosocial forces that surround the patient and the treatment. To this end, we propose a new framework for understanding and leveraging the placebo effect in clinical care. In outlining this framework, we first present the placebo effect as a neurobiological effect that is evoked by psychological processes. Next, we argue that along with implicit learning and expectation formation, mindsets are a key psychological process involved in the placebo effect. Finally, we illustrate the critical role of the social environment and treatment context in shaping these psychological processes. In doing so, we offer a guide for how the placebo effect can be understood, harnessed, and leveraged in the practice of modern medicine.
View details for PubMedID 29681322
Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus
PSYCHOTHERAPY AND PSYCHOSOMATICS
2018; 87 (4): 204–10
Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching interdisciplinary field that is unravelling the neurobiological, behavioural and clinical underpinnings of these phenomena in a broad variety of medical conditions. As a consequence, there is an increasing demand from health professionals to develop expert recommendations about evidence-based and ethical use of placebo and nocebo effects for clinical practice.A survey and interdisciplinary expert meeting by invitation was organized as part of the 1st Society for Interdisciplinary Placebo Studies (SIPS) conference in 2017. Twenty-nine internationally recognized placebo researchers participated.There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects. Experts particularly agreed on the importance of informing patients about placebo and nocebo effects and training health professionals in patient-clinician communication to maximize placebo and minimize nocebo effects.The current paper forms a first step towards developing evidence-based and ethical recommendations about the implications of placebo and nocebo research for medical practice, based on the current state of evidence and the consensus of experts. Future research might focus on how to implement these recommendations, including how to optimize conditions for educating patients about placebo and nocebo effects and providing training for the implementation in clinical practice.
View details for PubMedID 29895014
Optimizing stress responses with reappraisal and mindset interventions: an integrated model
ANXIETY STRESS AND COPING
2018; 31 (3): 245–61
The dominant perspective in society is that stress has negative consequences, and not surprisingly, the vast majority of interventions for coping with stress focus on reducing the frequency or severity of stressors. However, the effectiveness of stress attenuation is limited because it is often not possible to avoid stressors, and avoiding or minimizing stress can lead individuals to miss opportunities for performance and growth. Thus, during stressful situations, a more efficacious approach is to optimize stress responses (i.e., promote adaptive, approach-motivated responses). Objectives and Conclusions: In this review, we demonstrate how stress appraisals (e.g., [Jamieson, J. P., Nock, M. K., & Mendes, W. B. (2012). Mind over matter: reappraising arousal improves cardiovascular and cognitive responses to stress. Journal of Experimental Psychology: General, 141(3), 417-422. doi: 10.1037/a0025719 ]) and stress mindsets (e.g., [Crum, A. J., Salovey, P., & Achor, S. (2013). Rethinking stress: The role of mindsets in determining the stress response. Journal of Personality and Social Psychology, 104(4), 716-733. doi: 10.1037/a0031201 ]) can be used as regulatory tools to optimize stress responses, facilitate performance, and promote active coping. Respectively, these interventions invite individuals to (a) perceive stress responses as functional and adaptive, and (b) see the opportunity inherent in stress. We then propose a novel integration of reappraisal and mindset models to maximize the utility and effectiveness of stress optimization. Additionally, we discuss future directions with regard to how stress responses unfold over time and between people to impact outcomes in the domains of education, organizations, and clinical science.
View details for PubMedID 29471669
- Selection Does Not Equate Consumption Reply JAMA INTERNAL MEDICINE 2017; 177 (12): 1875–76
- Making mindset matter. BMJ (Clinical research ed.) 2017; 356: j674-?
The role of stress mindset in shaping cognitive, emotional, and physiological responses to challenging and threatening stress.
Anxiety, stress, and coping
Prior research suggests that altering situation-specific evaluations of stress as challenging versus threatening can improve responses to stress. The aim of the current study was to explore whether cognitive, physiological and affective stress responses can be altered independent of situation-specific evaluations by changing individuals' mindsets about the nature of stress in general.Using a 2 × 2 design, we experimentally manipulated stress mindset using multi-media film clips orienting participants (N = 113) to either the enhancing or debilitating nature of stress. We also manipulated challenge and threat evaluations by providing positive or negative feedback to participants during a social stress test.Results revealed that under both threat and challenge stress evaluations, a stress-is-enhancing mindset produced sharper increases in anabolic ("growth") hormones relative to a stress-is-debilitating mindset. Furthermore, when the stress was evaluated as a challenge, a stress-is-enhancing mindset produced sharper increases in positive affect, heightened attentional bias towards positive stimuli, and greater cognitive flexibility, whereas a stress-is-debilitating mindset produced worse cognitive and affective outcomes.These findings advance stress management theory and practice by demonstrating that a short manipulation designed to generate a stress-is-enhancing mindset can improve responses to both challenging and threatening stress.
View details for DOI 10.1080/10615806.2016.1275585
View details for PubMedID 28120622
Reading Between the Menu Lines: Are Restaurants' Descriptions of "Healthy" Foods Unappealing?
Health psychology : official journal of the Division of Health Psychology, American Psychological Association
As obesity rates continue to climb in America, much of the blame has fallen on the high-calorie meals at popular chain restaurants. Many restaurants have responded by offering "healthy" menu options. Yet menus' descriptions of healthy options may be less attractive than their descriptions of less healthy, standard options. This study examined the hypothesis that the words describing items in healthy menu sections are less appealing than the words describing items in standard menu sections.Menus from the top-selling American casual-dining chain restaurants with dedicated healthy submenus (N = 26) were examined, and the library of words from health-labeled items (N = 5,873) was compared to that from standard menu items (N = 38,343) across 22 qualitative themes (e.g., taste, texture).Log-likelihood ratios revealed that restaurants described healthy items with significantly less appealing themes and significantly more health-related themes. Specifically, healthy items were described as less exciting, fun, traditional, American regional, textured, provocative, spicy hot, artisanal, tasty, and indulgent than standard menu items, but were described with significantly more foreign, fresh, simple, macronutrient, deprivation, thinness, and nutritious words.Describing the most nutritious menu options in less appealing terms may perpetuate beliefs that healthy foods are not flavorful or indulgent, and may undermine customers' choice of healthier dining options. From a public health perspective, incorporating more appealing descriptive language to boost the appeal of nutritious foods may be one avenue to improve dietary health. (PsycINFO Database Record
View details for PubMedID 28541069
Harnessing the placebo effect: Exploring the influence of physician characteristics on placebo response.
Health psychology : official journal of the Division of Health Psychology, American Psychological Association
2017; 36 (11): 1074–82
Research on placebo/nocebo effects suggests that expectations can influence treatment outcomes, but placebo/nocebo effects are not always evident. This research demonstrates that a provider's social behavior moderates the effect of expectations on physiological outcomes.After inducing an allergic reaction in participants through a histamine skin prick test, a health care provider administered a cream with no active ingredients and set either positive expectations (cream will reduce reaction) or negative expectations (cream will increase reaction). The provider demonstrated either high or low warmth, or either high or low competence.The impact of expectations on allergic response was enhanced when the provider acted both warmer and more competent and negated when the provider acted colder and less competent.This study suggests that placebo effects should be construed not as a nuisance variable with mysterious impact but instead as a psychological phenomenon that can be understood and harnessed to improve treatment outcomes. (PsycINFO Database Record
View details for PubMedID 28277699
Changing Mindsets to Enhance Treatment Effectiveness.
2017; 317 (20): 2063–64
View details for PubMedID 28418538
Perceived physical activity and mortality: Evidence from three nationally representative U.S. samples.
Health psychology : official journal of the Division of Health Psychology, American Psychological Association
2017; 36 (11): 1017–25
This research sought to examine the relationship of individuals' perceptions about their level of physical activity with mortality outcomes at the population level.This study used 3 nationally representative samples with a total sample size of 61,141 U.S. adults (weighted N = 476 million). Data from the 1990 National Health Interview Survey (NHIS) and the 1999-2002/2003-2006 National Health and Nutrition Examination Survey (NHANES) were linked to prospective National Death Index mortality data through 2011, yielding follow-up periods of up to 21 years. Cox proportional hazards models were used to determine the association between respondents' perceptions of their relative level of physical activity (compared with other people their age) and all-cause mortality, adjusting for actual levels of physical activity, health status and behavior, and sociodemographic variables.Perceived physical activity relative to peers was associated with mortality risk. Individuals who perceived themselves as less active than others were up to 71% more likely to die in the follow-up period than those who perceived themselves as more active. This finding held across 3 samples and after adjusting for actual levels of physical activity and other covariates.Individuals' perceptions about their level of physical activity strongly predicted mortality, even after accounting for the effects of actual physical activity and other known determinants of mortality. This suggests that perceptions about health behaviors may play an important role in shaping health outcomes. (PsycINFO Database Record
View details for PubMedID 28726475
Association Between Indulgent Descriptions and Vegetable Consumption: Twisted Carrots and Dynamite Beets.
JAMA internal medicine
View details for PubMedID 28604924
Adaptive Appraisals of Anxiety Moderate the Association between Cortisol Reactivity and Performance in Salary Negotiations
2016; 11 (12)
Prior research suggests that stress can be harmful in high-stakes contexts such as negotiations. However, few studies actually measure stress physiologically during negotiations, nor do studies offer interventions to combat the potential negative effects of heightened physiological responses in negotiation contexts. In the current research, we offer evidence that the negative effects of cortisol increases on negotiation performance can be reduced through a reappraisal of anxiety manipulation. We experimentally induced adaptive appraisals by randomly assigning 97 male and female participants to receive either instructions to appraise their anxiety as beneficial to the negotiation or no specific instructions on how to appraise the situation. We also measured participants' cortisol responses prior to and following the negotiation. Results revealed that cortisol increases were positively related to negotiation performance for participants who were told to view anxiety as beneficial, and not detrimental, for negotiation performance (appraisal condition). In contrast, cortisol increases were negatively related to negotiation performance for participants given no instructions on appraising their anxiety (control condition). These findings offer a means through which to combat the potentially deleterious effects of heightened cortisol reactivity on negotiation outcomes.
View details for DOI 10.1371/journal.pone.0167977
View details for Web of Science ID 000392758000019
View details for PubMedID 27992484
View details for PubMedCentralID PMC5161466
Transforming Water: Social Influence Moderates Psychological, Physiological, and Functional Response to a Placebo Product
2016; 11 (11)
This paper investigates how social influence can alter physiological, psychological, and functional responses to a placebo product and how such responses influence the ultimate endorsement of the product. Participants consumed a product, "AquaCharge Energy Water," falsely-labeled as containing 200 mg of caffeine but which was actually plain spring water, in one of three conditions: a no social influence condition, a disconfirming social influence condition, and a confirming social influence condition. Results demonstrated that the effect of the product labeling on physiological alertness (systolic blood pressure), psychological alertness (self-reported alertness), functional alertness (cognitive interference), and product endorsement was moderated by social influence: participants experienced more subjective, physiological and functional alertness and stronger product endorsement when they consumed the product in the confirming social influence condition than when they consumed the product in the disconfirming social influence condition. These results suggest that social influence can alter subjective, physiological, and functional responses to a faux product, in this case transforming the effects of plain water.
View details for DOI 10.1371/journal.pone.0167121
View details for Web of Science ID 000388886000052
View details for PubMedID 27875567
View details for PubMedCentralID PMC5119827
- Self-Fulfilling Prophesies, Placebo Effects, and the Social-Psychological Creation of Reality Emerging Trends in the Social and Behavioral Sciences John Wiley & Sons, Inc. 2015
Rethinking Stress: The Role of Mindsets in Determining the Stress Response
JOURNAL OF PERSONALITY AND SOCIAL PSYCHOLOGY
2013; 104 (4): 716-733
This article describes 3 studies that explore the role of mindsets in the context of stress. In Study 1, we present data supporting the reliability and validity of an 8-item instrument, the Stress Mindset Measure (SMM), designed to assess the extent to which an individual believes that the effects of stress are either enhancing or debilitating. In Study 2, we demonstrate that stress mindsets can be altered by watching short, multimedia film clips presenting factual information biased toward defining the nature of stress in 1 of 2 ways (stress-is-enhancing vs. stress-is-debilitating). In Study 3, we demonstrate the effect of stress mindset on physiological and behavioral outcomes, showing that a stress-is-enhancing mindset is associated with moderate cortisol reactivity and high desire for feedback under stress. Together, these 3 studies suggest that stress mindset is a distinct and meaningful variable in determining the stress response.
View details for DOI 10.1037/a0031201
View details for Web of Science ID 000316620300007
View details for PubMedID 23437923
Mind Over Milkshakes: Mindsets, Not Just Nutrients, Determine Ghrelin Response
2011; 30 (4): 424-429
To test whether physiological satiation as measured by the gut peptide ghrelin may vary depending on the mindset in which one approaches consumption of food.On 2 separate occasions, participants (n = 46) consumed a 380-calorie milkshake under the pretense that it was either a 620-calorie "indulgent" shake or a 140-calorie "sensible" shake. Ghrelin was measured via intravenous blood samples at 3 time points: baseline (20 min), anticipatory (60 min), and postconsumption (90 min). During the first interval (between 20 and 60 min) participants were asked to view and rate the (misleading) label of the shake. During the second interval (between 60 and 90 min) participants were asked to drink and rate the milkshake.The mindset of indulgence produced a dramatically steeper decline in ghrelin after consuming the shake, whereas the mindset of sensibility produced a relatively flat ghrelin response. Participants' satiety was consistent with what they believed they were consuming rather than the actual nutritional value of what they consumed.The effect of food consumption on ghrelin may be psychologically mediated, and mindset meaningfully affects physiological responses to food.
View details for DOI 10.1037/a0023467
View details for Web of Science ID 000292809100006
View details for PubMedID 21574706
Mind-set matters: Exercise and the placebo effect
2007; 18 (2): 165-171
In a study testing whether the relationship between exercise and health is moderated by one's mind-set, 84 female room attendants working in seven different hotels were measured on physiological health variables affected by exercise. Those in the informed condition were told that the work they do (cleaning hotel rooms) is good exercise and satisfies the Surgeon General's recommendations for an active lifestyle. Examples of how their work was exercise were provided. Subjects in the control group were not given this information. Although actual behavior did not change, 4 weeks after the intervention, the informed group perceived themselves to be getting significantly more exercise than before. As a result, compared with the control group, they showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index. These results support the hypothesis that exercise affects health in part or in whole via the placebo effect.
View details for Web of Science ID 000245157900014
View details for PubMedID 17425538