A growing body of research has shown that people's mindsets have measurable physical results.
People's expectations to heal and the social context surrounding them, including their relationships with doctors, drive these placebo responses – where a patient's health changes without being treated.
Despite this research, the benefits of these psychological and social forces are still receiving much less attention than drug and device treatments in healthcare.
In a recently published report in the BMJ titled "Making mindset matter," a group of Stanford experts call for more healthcare professionals to place emphasis on the importance of individual mindsets and social context in healing.
The experts also urge researchers to develop more studies that measure the physical effects of these psychosocial elements in order to understand and quantify patients' subjective experiences of expectations, connection and trust.
"We have long been mystified by the placebo effect," said Alia Crum, an assistant professor of psychology and the lead author of the report. "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 healthcare."
Harnessing power of mindsets
A healthcare professional's bedside manner is important and what patients think and expect about treatments can influence health outcomes, Crum said.
But the healthcare and education systems in the U.S. generally do not emphasize psychosocial training. As a result, new doctors and healthcare workers take few courses on how to effectively form meaningful relationships with patients and how best to help them adopt useful mindsets.
Crum, together with co-authors Dr. Abraham Verghese, professor of medicine, and psychology doctoral candidate Kari Leibowitz, argues that the healthcare and education systems need to prioritize the role of psychological and social forces in healing.
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," Leibowitz said. "So it's not just mentioned in one or two classes or taught for one semester and then forgotten about."
The experts also called for a reform of standard randomized trials in the healthcare system. When examining the effects of a new drug, researchers should include 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 rigorous 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 a 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," Verghese said. "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 healthcare."
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 had a heightened pain response after they were 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, her 2011 study showed that the physical effects of food depend on how caloric or indulgent it is in a person's mind. Crum's 2013 study 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 at Stanford has partnered with Verghese's Presence center.
But more work remains to be done, according to Crum and other experts.
Scientific research needs to move beyond merely comparing drug treatments to placebos and focus on exploring what mechanisms drive placebo responses and what patients and doctors can do to effectively leverage these effects to improve healthcare, the experts 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."
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Alia J Crum et al. Making mindset matter, BMJ (2017). DOI: 10.1136/bmj.j674