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Thinking About Thinking

About (Thinking?)

Adam Haar Horowitz

Fluid Interfaces Lab

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4 months old

(Csibra, 2001)

BANANA!

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Psychogenic Pseudocoma (Baxter, 2003)

Arm/Face Drop Test for Paralysis

Vomiting

Seizures

Slow Speech

Deafness

Vertigo

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Belief is Powerful

25%-72% of patient visits to primary care physicians are primarily the result of psychosocial distress presenting as somatic complaints (Edwards, 2010)

Disease consists of biological dysfunction of the human organism—the primary focus of diagnosis and treatment within biomedicine. Illness is the experience of detriments to health, including the symptomatic manifestation of disease

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Belief is Powerful

Experience is statistical combination of prior information (past experience plus current expectation) with incoming sensory data (the stimulus), following Bayes’ law

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Expectancy Effects

A treatment of no intended therapeutic value, inert tablets etc. And every active drug and intervention ALSO contains placebo.

“Subjective” constructs like expectation and value have identifiable physiological bases, so we can modulate physical and mental health by modulating belief and value.

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Placebo and Nocebo Effect

For depression, placebo response rate is close to 50%, often indistinguishable from the response rate to antidepressants. It’s not chemically addictive, toxic or expensive.

“The results of our analysis indicated that the placebo response was 82% of the response to these antidepressants. “ Kirsch, 2014 (Irving hates SSRI’s)

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Placebo Overdose!

Tylenol/Acetaminophen no better than placebo for lower back pain

Lower back pain is the leading cause of disability worldwide, and Tylenol is damaging to your liver

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Neuroscience of Placebo

Feeling/Reporting: fMRI studies show placebo analgesia is related to decreased brain activity in pain-reporting regions of the brain, including the thalamus, amygdala, insula, and anterior cingulate, (Wager et al., 2004).

A misconception about the placebo response is that only „imagined‟ symptoms can be alleviated by a placebo. In fact, placebos work by engaging the body‟s own biochemical healing systems. In placebo analgesia, incoming sensory information combines with expectation in the brain to shape the experience of pain (Koyama et al., 2005). fMRI studies show that placebo analgesia is related to decreased brain activity in pain-reporting regions of the brain, including the thalamus, insula, and anterior cingulate, as well as increased activity in the prefrontal cortex, implying that the experience of pain is being altered (Wager et al., 2004). Many of the body‟s hormones and neurotransmitters affect healing and may be implicated in placebo responses. It is known that placebo analgesia is mediated at least in part by endorphins effect on the µ-opioid system, a pain and stress inhibitory neurotransmitter system. As another example, a recent paper by Benedetti and Colloca reviews how anxiety may increase pain-related nocebo effects by the activation of the cholecystokininergic (CCK) system, which facilitates pain transmission (Colloca & Benedetti, 2007). In this manner, placebo effects reflect a fascinating interplay between the psychological and the neurological. Other placebo effects (non-analgesia related) work through different neural mechanisms (Fricchione & Stefano, 2005) (Pacheco-Lopez, Engler, Niemi, & Schedlowski, 2006) (de la Fuente-Fernandez et al., 2001) but the current discussion will focus only on pain.

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Neuroscience of Placebo: BUMSS

Anticipating/Motivating Behavior: the rACC and lateral OFC participate in a generalized expectancy modulatory network that mediates placebo effects.

BRAINS! SO WHAT!?

Well, now we can tell if our intervention is effecting feeling, reward, anticipation or report

A misconception about the placebo response is that only „imagined‟ symptoms can be alleviated by a placebo. In fact, placebos work by engaging the body‟s own biochemical healing systems. In placebo analgesia, incoming sensory information combines with expectation in the brain to shape the experience of pain (Koyama et al., 2005). fMRI studies show that placebo analgesia is related to decreased brain activity in pain-reporting regions of the brain, including the thalamus, insula, and anterior cingulate, as well as increased activity in the prefrontal cortex, implying that the experience of pain is being altered (Wager et al., 2004). Many of the body‟s hormones and neurotransmitters affect healing and may be implicated in placebo responses. It is known that placebo analgesia is mediated at least in part by endorphins effect on the µ-opioid system, a pain and stress inhibitory neurotransmitter system. As another example, a recent paper by Benedetti and Colloca reviews how anxiety may increase pain-related nocebo effects by the activation of the cholecystokininergic (CCK) system, which facilitates pain transmission (Colloca & Benedetti, 2007). In this manner, placebo effects reflect a fascinating interplay between the psychological and the neurological. Other placebo effects (non-analgesia related) work through different neural mechanisms (Fricchione & Stefano, 2005) (Pacheco-Lopez, Engler, Niemi, & Schedlowski, 2006) (de la Fuente-Fernandez et al., 2001) but the current discussion will focus only on pain.

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Neuroscience of Placebo

We know the endogenous opioid system (endorphins, enkephalins, and dynorphin which all affect dopamine release) is implicated in modulating pain in placebo because we can stop it with naloxone.

SO WHAT!? Functions range from the regulation of central stress responses and pain, hypothalamic-pituitary regulation of reproductive and stress hormones (e.g. cortisol), and the adaptation and response to novel and emotionally salient stimuli

Heredity of placebo

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Understanding the effects of belief enables a powerful new way to conceive interventions. We cannot intervene with specificity at the chemical or electrical level.

By modulating belief about an intervention, we can work specifically at the level of shared semantics, targeting something which is not targetable (and may not even exist as unitary) at the level of implementation or processing.

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Belief has effects at many time scales!

Short term--Analgesia, preference, depression,

Medium Term--bias, empathy, behavior change

Long term--Mindset, self-concept, learning style

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compared with the control group, they showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index.

Crum, Alia J., and Ellen J. Langer. "Mind-set matters: Exercise and the placebo effect." Psychological Science 18.2 (2007): 165-171.

APA

Mindset: Ellen Langer

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Carol Dweck

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post hoc, ergo propter hoc

Program the Body to Program the Mind

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Fixed and Growth Mindset

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These Are Tools

Changing the focus of attention explicitly and implicitly

Memory Reactivation

Classical conditioning

Meditation

�Changing expectations/motivation

Priming/Negative Priming

Manipulating post-hoc evaluation

Changing long term mindset

Changing self-concept

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Classical conditioning, changing expectations, changing post-hoc evaluation, changing attention, changing long term mindset and self-concept

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