Alia Crum, PhD, is an assistant professor at Stanford University and is the principle investigator of its Mind & Body Lab. She has won the National Institutes of Health New Innovator Award, a mention in the The New York Times Magazine’s “Year in Ideas,” and was a speaker at TEDMED 2016. Dr. Crum has also worked as a clinical psychologist for the VA healthcare system and as an organizational trainer and consultant. Read more about her work here.
Reprinted with permission from the Robert Wood Johnson Foundation’s Culture of Health Blog.
Three days before my regional gymnastics meet in Arkansas I landed awkwardly on a practice vault, clashing my inner ankle bones. The pain was excruciating – as was the prospect of an injury crushing my dream of competing nationally. I was determined to go on, so I decided to adopt the mindset that I could mentally overcome my physical injury. I diligently iced, taped and tended to it while visualizing myself making it to nationals in spite of the setback.
I competed and placed high enough to qualify, and was elated as well as surprised by how little the pain had affected me. Another surprise: An x-ray the next day showed that my ankle had been broken.
My experience at age 10 shows the power of mindset – the frame of mind through which we perceive, interpret and organize an inherently complex world. The ability to make sense of the world through our mindsets is a natural part of being human. But the mindsets we hold are not inconsequential. In fact they change reality by influencing our attention, affect, motivation, and physiology. I had decided my injury wasn’t going to influence my performance, and almost impossibly, it didn’t.
Experiencing the powerful effects of mindset as an athlete inspired my career as an academic health psychologist. It led me on a journey to find out: just how important are mindsets? Where do they matter most? How can we leverage them to improve health and wellbeing?
The resulting past ten years of research by my colleagues and I has revealed that mindsets are in fact powerful and are often overlooked. Here are some insights from our work.
Your beliefs about stress influence how it affects you.
Stress is a great example of how mindsets can be self-fulfilling. Stressful situations are unavoidable. And yet we’ve found that most people perceive stress as negative – even debilitating. Media or public education campaigns warn us about its harmful effects. However, ample evidence suggests that stress can enhance how our minds and bodies function. It’s how a person thinks about stress that can determine its effects, according to our research.
For example, in one study we told participants – employees in a financial company that was downsizing – that stress can help rather than hurt them. As a result, they reported fewer symptoms of depression and anxiety, higher levels of optimism, and improved work performance versus the control group. In another study we showed that adopting a “stress is enhancing” mindset leads to optimal physiological stress responses, marked by moderate levels of cortisol and high levels of the growth hormone DHEA.
These beliefs about stress tend to be self-reinforcing. So if stress helps you succeed, it reinforces a mindset that stress is helpful. This is particularly important to model for children. Parents can help in explaining that experiencing stress or even failure is a natural part of life that helps us learn and grow stronger.
Mindset magnifies the benefits of exercise.
Another area in which mindsets matter is exercise. In 2007 Ellen Langer and I studied hotel room attendants whose work involved strenuous physical activity. Two-thirds of our study participants had the mindset that they were not exercising enough, that their physical labor was “just work” and not “good exercise.” Once my colleagues and I pointed out that pushing heavy carts, vacuuming, and lifting heavy mattresses qualified as sufficient exercise, they showed improvements in weight, blood pressure, and body fat over the course of four weeks. A control group had no changes. For these room attendants, a small change in mindset measurably impacted their physiological heath. This means that acknowledging the physical nature of our active jobs, or of everyday activities such as housework, grocery shopping, and playing with our kids can help us reap more health benefits from them.
More recently, graduate student Octavia Zahrt and I found that people who perceived themselves as less active than others had up to a 72% higher mortality risk 21 years later than those who perceived themselves as more active, controlling for actual levels of physical activity.
A mindset shift can help you crave healthier foods.
Having trouble sticking to your healthy-eating resolutions? Our research suggests that shifting your mindset can help. On two separate occasions, participants in one of our studies were given a 380-calorie milkshake under the pretense that it was either a 620-calorie “indulgent” shake or a 140-calorie “sensible” shake. When participants drank what they believed was an indulgent shake, they had a significantly steeper decline in ghrelin, a hunger-inducing hormone that regulates metabolism, than when they drank what they thought was a “sensible” shake. Their bodies responded as if they had actually consumed more calories.
Brad Turnwald and I have found that many restaurants describe healthy-menu items using plain language that doesn’t suggest they are exciting and tasty. Yet as we learned in another study, describing vegetables using enticing adjectives traditionally reserved for unhealthy foods – “rich buttery roasted sweet corn,” “slow roasted caramelized zucchini bites” – increased vegetable consumption by 41% compared to the standard approach of touting their health properties.
The moral is that if you want to feel deeply satisfied with healthier foods, eat in a mindset of indulgence! Viewing healthy foods as decadent versus depriving can transform your food choices and your health. Building on these findings, my lab is now designing interventions to help children and adults adopt the mindset that healthy eating is indulgent and fun.
The placebo effect is part of good medicine.
Much of the medical community views the placebo effect as a mysterious, irrelevant, response. Our research instead reveals that it comprises measureable psychological and social components that we can harness to improve health and healthcare: the body’s natural ability to heal, the patient’s mindset, and the physician’s bedside manner.
My lab and others (including the Program in Placebo Studies at Harvard) are studying which mindsets are at play, how they interact with and activate patients’ physiology, and what health care providers can do to shape mindsets that boost the body’s natural healing abilities.
In one study, Lauren Howe, Parker Goyer and I found that when a provider showed competence – such as familiarity with a treatment – and warmth, such as understanding a patient’s needs, values and goals – patients had a stronger response to an inert cream they believed would treat an allergic reaction. This shows that providers can enhance the effect of a drug or treatment with their actions and words. A social context embedded with warmth and competence is especially important in disadvantaged communities where trust in providers may be lacking.
Healthy thinking supports a Culture of Health.
Expanding our definition of health is essential to achieving a Culture of Health. “Health” has traditionally meant an absence of disease. More recently, the definition includes behaviors as well as social demographics and the environment.
Our research adds one more dimension: the critical role of healthy thoughts.
And the role of healthy thoughts is more than just positive thinking. As the studies I described illustrate, mindsets must be specific to have impact: “My work is good exercise.” “Stress helps me thrive.” “This doctor understands me.”
These specific beliefs yield tangible physiological and behavioral consequences. They are further shaped by culture, parenting, healthcare policies and public health messages, and by organizational dynamics, marketing and media.
We can now also see that many current approaches to motivating healthy behavior may, in fact, be counterproductive. For example: constantly warning against the negative effects of stress can reinforce an unhelpful mindset that stress is debilitating. Touting a food’s health properties over its flavor also reinforces the counterproductive mindset that healthy eating is depriving.
I hope these findings will motivate schools, community organizations, health care professionals and others to promote education and awareness of the impact mindsets have on our lives and work to more effectively leverage mindsets to improve health and healthcare.
Mindsets are just one piece in the larger puzzle of factors that influence health. But as I learned at age 10 and continue to learn in my research as an adult, mindsets have a measurable affect on health, and real implications for healing.