While researching the book Cure, science writer Jo Marchant wanted to understand how distraction could be used to nullify pain, so she participated in a virtual reality experiment.
During the first part of the experiment, Marchant sat, without distraction, with her foot in a box of unbearably hot water. "It felt like a very intense burning pain on my foot when I just experienced it on its own," Marchant tells Fresh Air's Terry Gross.
But then Marchant put on noise-canceling headphones and began to play a snow-and-ice-themed immersive video game that had been developed specifically for burn patients. This time, when the researcher applied the same burning pain to her foot, she barely noticed it.
"The researchers explained it as our brains only have a certain capacity for attention," Marchant says. "If you've got something that's really commanding your attention, there's less attention left over for experiencing the pain."
During the course of her research, Marchant also investigated the science behind the placebo effect, hypnosis, meditation, prayer and conditioning. She says that the healing power of the brain could offer a powerful complement to modern medicine. "That's a whole different approach to pain that I think tells us that drugs aren't the only answer," she says.
On harnessing the placebo effect to feel better
One thing that people often don't realize about the placebo effect is there isn't just one placebo effect. There are many, depending on what we think a treatment is going to do for us. So, for example, if you take a fake painkiller, that actually reduces pain-related activity in the brain and the spinal cord and it causes the release of natural painkillers in the brain called endorphins. And these are actually the painkillers that opioid painkillers are designed to mimic, so it's working through the same biochemical pathway that a painkiller would work through. But if a patient with Parkinson's takes a placebo that they think is their Parkinson's drug, they get a flood of dopamine in the brain, which is exactly what you would see with the real drug.
Even with altitude sickness, for example, if somebody at altitude takes fake oxygen, you see a reduction in ... prostaglandins. ... These actually work to dilate blood vessels and they cause many of the symptoms of altitude sickness.
So what you see in all these different conditions is that taking a placebo, or, to be more accurate about it, our response to that placebo, can cause biological changes in the brain that actually ease our symptoms, and that's not something that's imaginary; that's something that's underpinned by these biological changes that are very similar to the biological changes you get when we take drugs.
On possible explanations for why the placebo effect sometimes works
Some of it seems to have to do with stress and anxiety — if we feel that we are in danger or under threat, the brain raises its sensitivity to symptoms like pain. ... Whereas, on the other hand, if we feel that we are safe and cared for and things are going to get better soon, we can kind of relax, we don't need to be so alert to these symptoms. So that's one thing that might be at play.
There are also physiological mechanisms for example, conditioning. ... If listeners are familiar with Pavlov's dogs, so this is the idea that a physiologist called Ivan Pavlov conditions dogs so that whenever he gave them their food he would make a noise, like ring a bell for example, and eventually they came to associate the bell with their food and they would salivate just to the sound of the bell. He didn't need the food anymore. We can all be conditioned to have different physiological responses to a stimulus like that, and that works not just for salivation, but for things like immune responses. So, for example, if you take a pill that suppresses your immune system, later on, if you take a similar looking placebo pill, even if there's no actual active drug in there, your body will mimic that same response. Your body has learned that response and that just happens automatically; it doesn't matter what you believe about the pill.
On making sense of placebo responses
I don't think we should be giving people fake pills. I think, first of all, there is some evidence that honest placebos still work, so there are studies in various conditions, for example — irritable bowel syndrome, headaches, hyperactivity disorder — where patients have received placebos but they knew they were placebos and still got a benefit from that. And that's probably all down to things like just being in a trial, the feeling that you're being helped can have those effects on the brain. So you don't necessarily have to lie to people, but beyond that, I think what we need to do is try and understand what are the active ingredients of placebo responses — whether that's expectation, which is then influenced by all different things, such as your previous experiences with treatment, what you're told about a treatment, how sympathetic your physician is. There's all sorts of things that are feeding into how you'll respond to that treatment. So I think we need to try and understand those things and think how we can incorporate those elements into medical care routinely, rather than, for example, relying on fake pills.
The basic idea [of mindful meditation] is that you try to focus on the present moment rather than worrying about the past or the future. ... There have been hundreds of studies on mindfulness now, and there's very good evidence that it reduces stress and anxiety, and that it reduces symptoms such as chronic pain and fatigue. So that's very well shown now in the analysis of lots of different studies, and that's in healthy people but also in people with depression or people with serious illness. What there's less research on is whether that feeds through into benefits for the immune system and sort of more physical health benefits, if you like.
There is some evidence suggesting that mindfulness meditation can make us more resistant to infection and that's everything from winter colds to slowing the progression of HIV and that it gives people a better response, for example, than flu vaccine. There was another study suggesting that people with psoriasis responded better to their medication when they also had mindfulness training. ... But the studies so far are quite small, so it would be great to see more research on that.
On why slow, measured breathing helps with stress
With a stress response, the brain and the body are influencing each other in both directions, so if we see a danger then that's going to make us feel stressed and one of the follow-ons from that is that our breathing is going to speed up. If you were to speed up your breathing on your own, you'd probably start to feel a bit more aroused and on edge. And, equally, if you calm the breathing down, you're kind of forcing your body into a more relaxed state and you will then experience probably fewer negative thoughts as a result. When we're stressed, our brains almost come up with negative thoughts to try and explain why we're stressed, if you like, if you're kind of anxious or worried about something, all sorts of negative thoughts are going to pop into your head, but if you can just calm that down, then that's going to have a beneficial effect on your mental state as well.
On how how stress can rewire the brain — and creates more stress
Your brain reflects the way that you think throughout your life. You kind of shape it by your thoughts and your behaviors. If you play violin for eight hours a day, then the parts of the brain responsible for helping you to play the violin will get larger. If you're thinking stressful thoughts for the whole day then those parts of the brain are going to get larger and other parts of the brain will deteriorate. It's kind of an irony because then the very brain circuits that we would need to try and counter that are no longer working as well as they should, so that's why something like meditation can be helpful because just simply saying, "Oh, I'm going to change how I think now. I'm not going to be as stressed now," doesn't really work; you have to change your brain over a long period of time.
TERRY GROSS, HOST:
This is FRESH AIR. I'm Terry Gross. You hear a lot of claims about the healing power of the mind. And, sure, some of those claims are based on pseudoscience and wishful thinking. But it's undeniable that the mind influences the body, and some scientists are trying to better understand that relationship so that it can be harnessed in the treatment of pain, inflammatory and autoimmune diseases, heart disease, depression and other problems. My guest, Jo Marchant, is a British science journalist who's written a new book reporting on what scientists are learning about what the mind can do to promote healing and why it can do it. She also examines what the mind cannot do and what claims made by alternative medicine go too far. Her new book is called "Cure: A Journey Into The Science Of Mind Over Body." She's traveled around the world talking to researchers investigating the placebo effect, hypnosis, meditation, distraction, prayer, conditioning and other approaches to helping the mind heal the body. She has a PhD in genetics and medical microbiology and has written for New Scientist, Nature and Smithsonian. Jo Marchant, welcome to FRESH AIR. Let's start with the placebo effect. In a lot of research studies when people improve but they've just been given, like, a sugar pill as opposed to the real medicine, it's dismissed as the placebo effect. Like, it was just a sugar pill. It didn't do anything, so the fact that you improved - we're just going to dismiss that and write it off to the placebo effect. But now some researchers are trying to harness the placebo effect, figuring, like, if a sugar pill could make some people feel better, what's going on and how can we use that to help them feel better? So can you describe a little bit what this effect is - like, how researchers are trying to harness the placebo effect as something we can use to heal ourselves?
JO MARCHANT: Sure, so it's true that in some cases, people would have got better anyway, so there isn't, you know, very much that we can harness there. But what neuroscientists are finding is that taking a fake medicine, something that we believe to be something that's going to help us, really also has measurable biological effects on the brain and the body. And those can ease our symptoms and have therapeutic benefits. One thing that people often don't realize about the placebo effect is there isn't just one placebo effect. There are many depending on what we think a treatment is going to do for us. So for example, if you take a fake painkiller, that actually reduces pain-related activity in the brain and the spinal cord and it causes the lease of natural painkillers in the brain called endorphins. And these are actually the chemicals that opioid painkillers are designed to mimic. So it's working through the same biochemical pathway that a painkiller would work through. But if a patient with Parkinson's takes a placebo that they think is their Parkinson's drug, they get a flood of dopamine in the brain, which is exactly what you would see with the real drug. And even with altitude sickness, for example, if somebody at altitude takes fake oxygen, you see a reduction in neurotransmitters called prostaglandins. And these actually work to dilate blood vessels and they cause many of the symptoms of altitude sickness. So what you see in all these different conditions is that taking a placebo - or to be more accurate about it, our response to that placebo can cause biological changes in the brain that actually ease our symptoms. And that's not something that's imaginary. That's something that's underpinned by these biological changes that are very similar to the biological changes you get when we take drugs.
GROSS: So that's a kind of remarkable thing. Like, what explains that the proper hormones are released when people take a placebo depending on what their needs are and what they think the placebo's going to do?
MARCHANT: There are lots of different things that are feeding into it. Just as there are different mechanisms of placebo, there are probably different factors that play in all of them. And the research is really only beginning to understand that. Some of it seems to have to do with stress and anxiety. You know, if we feel that we are in danger or under threat, the brain raises its sensitivity to symptoms like pain. If we see a lot of people around us who are getting sick, we're more likely to feel sick ourselves. And there's a good evolutionary reason for that because if people around us are getting sick, perhaps we've also eaten something that might make us sick and we need to be sensitive to that, whereas on the other hand, if we feel that we are safe and cared for and things are going to get better soon, we can kind of relax. We don't need to be so alert to these symptoms. So that's one thing that might be at play. There are also physiological mechanisms - for example, conditioning. So I don't know if listeners would be familiar with Pavlov's dogs. So this is the idea that - a physiologist called Ivan Pavlov conditions dogs so that whenever he gave them their food, he would make a noise, like ring a bell for example. And eventually, they came to associate the bell with their food, and they would salivate just to the sound of the bell. He didn't need the food anymore. And we can all be conditioned to have different physiological responses to a stimulus like that. And that works not just for salivation, but for things like immune responses. So for example, if you take a pill that suppresses your immune system, then later on if you take a similar-looking placebo pill, even if there's no actual active drug in there, your body will mimic that same response. It's like you - your body has learned that response. And that just happens automatically. It doesn't matter what you believe about the pill. So those are just two examples of different mechanisms that can be going on.
GROSS: So placebo effect is telling us, apparently, is that we have some power to heal ourselves of some things - that the brain has some remarkable healing powers. But with the placebo effect, the brain is being tricked. You know, the body is taking in medication that the brain is being told is real medication. And so the brain is being tricked into secreting the right hormone or doing the right thing with the immune system. So that raises some ethical questions. I mean, how do you harness the placebo effect? Do you give people fake pills and lie to them and tell them it's real? That's not ethical.
MARCHANT: No yeah, so I don't think we should be giving people fake pills. I think - first of all, there is some evidence that honest placebos still work. So you can - there are studies in various conditions - for example, irritable bowel syndrome, headaches, hyperactivity disorder where patients have received placebos but they knew they were placebos and still got a benefit from that. And that's probably all down to things like, you know, just being in a trial, feeling that you're being helped, can have those effects on the brain. So you don't necessarily have to lie to people. But beyond that, what I think we need to do is try and understand what are the sort of active ingredients of placebo responses, if you like. So whether that's expectation, which is then influenced by all different things such as your previous experiences with treatment, what you're told about a treatment, how sympathetic your physician is - there's all sorts of things that are feeding into how you'll respond to that treatment. I think we need to try and understand those things and think how can we incorporate those elements into medical care routinely rather than, for example, relying on fake pills.
GROSS: So you're saying a good relationship with a doctor - instilling some kind of comfort and confidence in the patient - is helpful?
MARCHANT: Yes, definitely. I mean, there's a lot of research on social supports reducing stress and anxiety, for example, which in turn can reduce pain. And if that reduces the amount of painkillers that we need, for example, when we're undergoing surgery, that can in turn reduce complication rates. So that's very important from that perspective. There's also some quite interesting research looking at placebo effects. So one study, for example, looked at acupuncture, but sham acupuncture. This is, like, fake or placebo acupuncture, if you like. So the needles are placed in the wrong places and they don't fully penetrate the skin, but the people think it's real acupuncture. And this was given to people with irritable bowel syndrome. And in a group where that was given by a sort of polite but cold practitioner, 44 percent of them said they had adequate relief from the symptoms. But in a group where the practitioner was sort of extra empathic and friendly and supportive, 62 percent of them had adequate relief from their symptoms. So just that element of the care that you're getting from the practitioner, just their sort of change in attitude, had a big benefit for the people that were going through that treatment. That's nothing to do with the sort of physical effect of the treatment itself, just the way that that care is delivered. And that's the kind of research that I think could help us to deliver medical care in a more effective way for people.
GROSS: There are certain conditions that the placebo effect - or to put it in a different way, just like harnessing the mind's healing powers might be very effective, and other conditions where it's probably not going to be very helpful. What are some of the conditions in each of those categories?
MARCHANT: I think this is where it's really important that we have the scientific research rather than just sort of saying a blanket, oh, the mind can heal you, because it really does depend on what condition you're talking about. So placebo effects, and psychological approaches to treatment in general, are very effective for symptoms such as pain, depression, fatigue, nausea - so all those things that affect sort of how we feel. And you might say, oh, well, you know, those aren't real problems. You know, those are just subjective things. But, you know, for a lot of people those are really serious conditions that blight their lives. And an awful lot of medicine and the drugs that are prescribed are aimed at, specifically, easing those symptoms - all the painkillers and the antidepressant that we take. So I think that that, you know, is a very significant part of medicine. If we can influence that through mind-body approaches, not necessarily to replace drugs, but in other cases perhaps to maximize the effectiveness of the drugs that we take so we can take lower doses. Also, in some cases, immune responses can be influenced. So there's some really interesting research looking at using conditioning to reduce the drug doses that are required in kidney transplant patients, for example, or patients with autoimmune disease. If we then look at things where perhaps the mind isn't going to play a large role, physiological processes that we're not sort of consciously aware of often - so things like blood sugar levels or cholesterol levels in the blood. You know, if you've got a serious infection, you probably wouldn't want to rely on a placebo. You're going to want the antibiotics. So it's complicated. But it's definitely depends on the condition. Sometimes the mind can have a dramatic, immediate effect. Other times it's kind of one subtle effect among many. And other times, it has no effect at all.
GROSS: If you're just joining us, my guest is science writer Jo Marchant. Her new book is called "Cure: A Journey Into The Science Of Mind Over Body." Let's take a short break and then we'll talk some more. This is FRESH AIR.
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GROSS: This is FRESH AIR. And if you're just joining us, my guest is science writer Jo Marchant. She's the author of the new book "Cure: A Journey Into The Science Of Mind Over Body." So as a lot of people know, one of the problems with our body's stress response is that it's trained for the flight-or-fight situation where, you know, our caveman ancestors had to run from various animals. So when you're under stress, like, your heart beats faster, you're prepared to, like, run and flee. But when you're sitting at a desk and you have a deadline you have to meet, your body is often behaving as if you have to run from a beast, when what you're really doing is having to think and write or sort papers or do math. And all that adrenaline isn't necessarily going to be very helpful. And then if you're under stress a lot, you're constantly in that state of your body telling you that it has to flee. So why is that bad for your body?
MARCHANT: Well, from an evolutionary point-of-view, the fight-or-flight response is a great thing. It helps us to survive. If you're in a situation that requires an immediate emergency response, as the name says, you know, if you need to run as fast as you can, if you need to fight with an attacker, we need this response. You know, it helps us. But the problem is that when we get into a situation where we're worrying about things all the time, that response is switched on long-term. And that can be very damaging. So, for example, the raised blood pressure - that's useful in the moment if you need to respond to a physical threat. But if that's raised all the time, then that can damage arteries and that can contribute to heart disease, atherosclerosis, that kind of thing. If sugar is released into the bloodstream, over time that can contribute to obesity and diabetes. And one of the most damaging things that fight-or-flight does is it triggers a branch of the immune system called inflammation. This is like the body's first line of defense against infection and injury. So again, in a sort of emergency situation, that's quite a useful thing to have switched on. And what should happen is that it just gets switched off again after quite a short period of time. But if we're stressed all the time, inflammation stays high. And then it can start kind of eating away at the body's tissues, if you like, because it's quite nonspecific. And so that can increase our risk of autoimmune disease, for example - anything from eczema and psoriasis to multiple sclerosis and it can also contribute to sort of chronic disease of aging - anything from atherosclerosis to dementia.
GROSS: Autoimmune diseases are diseases in which the immune system attacks healthy tissue and the body turns against itself.
MARCHANT: Yes, that's right. So a lot of these conditions like arthritis or multiple sclerosis, it's - inflammation is what's driving that. It's the body's inflammation attacking your own tissues. And if we are chronically stressed, that makes us more susceptible to those conditions.
GROSS: OK, so let's get back to the mind-body thing. What are researchers learning now about how we can control the mind's response so that the body isn't triggered to be in this persistent flight-or-fight response when we're under stress all the time but we don't need to be running or fighting? Where would we like to start with that? Do you want to start with meditation? That's something that a lot of people are familiar with, a lot of people have tried. What's the premise there in terms of how meditation might address the kind of stress - chronic stress - that we're talking about?
MARCHANT: Well, there are many hundreds, probably, of different kinds of meditation. And one of the best-studied is mindfulness meditation, which has just become so popular. We hear so much about it. And the basic idea there is that you try to focus on the present moment rather than worrying about the past or about the future. And by focusing on the present moment, we become more aware of our thoughts, and just to see those as fleeting thoughts rather than getting carried away in ruminations about, oh, wish I hadn't said that the other day, or how am I going to prepare for this meeting tomorrow or, you know, even thoughts such as oh, you know, I'm no good at this, or, you know, I haven't got any friends, or, you know, negative thoughts like that and worrying about them. We just see those thoughts that we can let go. And there have been hundreds of studies on mindfulness now. And there's very good evidence that it reduces stress and anxiety and that it reduces symptoms such as chronic pain and fatigue. And that's in healthy people but also in people with depression or people with serious illness. What there's less research on is whether that feeds through into benefits for the immune system and sort of more physical health benefits, if you like. So there is some evidence suggesting that mindfulness meditation can make us more resistant to infection. And that's everything from winter colds to slowing the progression of HIV, and that it gives people a better response, for example, to flu vaccine. There was another study suggesting that people with psoriasis responded better to their medication when they also had mindfulness training. But there's some interesting evidence, but the studies so far are quite small, so it would be great to see more research on that.
GROSS: So the premise, then, with the mind-body response to meditation is that you're basically training your body, you're training your brain, to stop reacting in stressful ways to various things in the world. You're trying to teach the mind to stay in the moment and not panic, not worry, not obsess.
MARCHANT: Yeah, so one of the people that I interviewed on this topic was a guy here the UK. He's a police officer, and he was diagnosed a few years ago with multiple sclerosis around the same time that his first son was born. He now has two boys. And as you can imagine, that was a horrifically stressful thing for him to be diagnosed with this terrible progressive disease at the same time as he's just becoming a new father. He had to take sick leave from the job that he loved. He'd never really heard of mindfulness meditation, but he read about it and tried it just to cope with the stress of his condition. And the way he explained it to me was that when you have multiple sclerosis or a condition like that, a lot of the agony comes from worries about the past. You know, he was thinking, oh, I used to love walking in the hills and I'll never be able to do that again. I'll never be able to do my job properly again. And worries about the future - he worried that he was going to go blind and then he wouldn't see his kids grow up. He worried that he was going to have to suffer unbearable pain - I mean, really terrible concerns that he had. And what mindfulness meditation did for him was to help him to not follow those chains of thought and focus on each moment as it came and even enjoy each moment as it came. You know, when he was playing with his kids, to just really enjoy that for what it was rather than letting it be ruined by all these thoughts about, oh I won't be a good father further down the line. Or, if he had a physical challenge, like trying to climb the stairs, rather than letting that become overwhelming and then thinking, oh, will I be able to do this next week or next month or next year, just taking those stairs one step at a time - just accepting each moment along the way. And he said that through doing that, he believes that his well-being now is better than it's ever been in his life, including before he was diagnosed. He says he's happier now. And for me, that was quite a powerful demonstration because if he can cope with those stresses using mindfulness meditation, I think it must be quite a powerful thing.
GROSS: And there are also forms of biofeedback in which a person hooks themselves up to various gizmos that are measuring various body functions that are supposed to help you train yourself to be in a more calm state. Would you explain the premise of biofeedback and some of the different mechanisms for practicing it?
MARCHANT: Yeah, so the idea with biofeedback is that you have some sort of display where you're hooked up to a monitor, and you can see your body's physical functions - whether it's your breathing rate or your heart rate or your skin temperature. And so it's just meant as an aid to try and get yourself into to whichever physiological state you're trying to get into. And so if you're trying to relax, then being able to see your heart rate and your breathing rate can perhaps be an aid to doing that.
GROSS: Because you know if you've accomplished it. Like, you have evidence, like, my blood vessels are dilated and my fingertips are warmer, so the meditation or the breathing or whatever I'm doing to try to get to a calmer state is working. And it helps you understand what that state is that you're striving for.
MARCHANT: Yes, exactly. I mean, if you've been chronically stressed for years, you might not know what it feels like to be relaxed. So just having a visual indication can be helpful for some people. Whether that's more effective than, say, meditation or simply just sitting still and slowing down your breathing - because just slowing down your breathing, perhaps five seconds in, five seconds out, is a very effective, quick way of just calming the body down and reducing the stress response. And it's not really a coincidence that a lot of forms of meditation involve focusing on the breathing.
GROSS: My guest is science journalist Jo Marchant, author of the new book "Cure: A Journey Into The Science Of Mind Over Body." We'll talk about an experiment using virtual reality to distract burn victims from pain, and why stress wires your brain to experience more stress, after we take a short break. I'm Terry Gross, and this is FRESH AIR.
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GROSS: This is FRESH AIR. I'm Terry Gross, back with science journalist Jo Marchant, author of the new book "Cure: A Journey Into The Science Of Mind." It's called "A Journey Into The Science Of Mind Over Body." It's about what scientists are learning about the mind's ability to help heal the body. When we left off, we were talking about how biofeedback and meditation can reduce stress, thereby helping limit the damaging physiological effects of stress. Why is that kind of slow, measured breathing and various forms of - part of various forms of meditation - why does that work physiologically? Like, what do researchers know about why that has a calming effect?
MARCHANT: Well, with the stress response, the brain and the body are influencing each other in both directions. So if we see a danger, then that's going to make us feel stressed and one of the follow-ons from that is that our breathing is going to speed up. If you were to speed up your breathing on your own, you'd probably start to feel a bit more kind of aroused and on edge. And equally, if you calm the breathing down, you're kind of forcing your body into a more relaxed state. And you will then experience probably fewer negative thoughts as a result. When we're stressed, our brains almost come up with negative thoughts to try to explain why we're stressed, if you like. If you're kind of anxious or worried about something, all sorts of negative thoughts are going to pop into your head. But if you can just calm that down, then that's going to have a beneficial effect on your mental state as well.
GROSS: You say that scientists are finding that stress can rewire the brain. How?
MARCHANT: Yes, that's right. If we're chronically stressed over a long period of time, then that changes what the brain looks like in scans. So there were certain areas of the brain - the amygdala, for example, which is involved in sort of fear and our kind of initial sort of emotional response to a threat. And that is larger in people who have been chronically stressed. It's hard to do kind of experiments in people. But in animals, you can actually see that where if you take a group of rats, say, and subject them to stress, you will see the amygdala grow over time. So it does seem to be a sort of cause-and-effect thing rather than just people with larger amygdalas get more stressed. And then there are other areas of the brain, such as the hippocampus and the prefrontal cortex, that are more to do with sort of rational thought and planning that get smaller over time. And then if you take people who meditate, you see those changes in reverse. So there are studies showing that if a group of people meditates, the amygdala then becomes a smaller and the hippocampus and prefrontal cortex become larger. And that's probably not anything specific to meditation, but it's just that reducing stress and changing patterns of thinking over a period of time then is reflected in the structure of the brain.
GROSS: So the message I'm hearing from you is that stress leads to stress unless you do something to try to stop it (laughter) that you become...
GROSS: ...Wired to just be stressed all the time.
MARCHANT: Yes, absolutely. I mean, if - your brain reflects the way that you think throughout your life. You kind of shape it by your thoughts and your behaviors. If you play violin for eight hours a day, then the parts of the brain responsible for helping you to play the violin get larger. If you were thinking stressful thoughts for the whole day, then those parts of the brain are going to get larger and other parts of the brain will deteriorate. It's kind of an irony because then the very brain circuits that we would need to try and counter that are no longer working as well as they should. So that's why something like meditation can be helpful because just simply saying oh, I'm going to change how I think now, I'm not going to be as stressed now doesn't really work. You have to change your brain over a long period of time. It's like thinking oh, I'm going to be physically fit. I'm going to go running once and then I'm going to be physically fit. It doesn't work that way. You know, you're going to have to exercise regularly over a long period of time to see that change in your body. And it's exactly the same with the brain.
GROSS: That's why meditation and biofeedback and things like that, they're a practice. They're not just - they're not just something you do once or twice.
MARCHANT: Yes, exactly. And they're all different roots of the same thing, really. But if you really want to change the way that you think, you need to put in the hours, basically.
GROSS: I think one of the real hopeful aspects of mind-body therapies have to do with dealing with chronic pain. And there's a lot of painkillers on the market. Many of them are addictive. Many of them make the people who take them feel kind of foggy. And as wonderful as painkillers can be, a lot of people really hate taking them. And not just because many of them are addictive, but also because people often don't like how they feel with the painkiller. I've heard a lot of people say they'd rather be in pain. Have you heard that, too?
MARCHANT: Yes, absolutely. There's all sorts of problems with taking painkillers, yes. As you say, the way they make people feel, addiction. You know, around 16,000 people die in America every year through overdoses of prescription painkillers. So there's a huge problem there with the drugs. And there are several lines of research that are telling us that there are so many other factors that feed into pain. It's not just the kind of chemical pharmacological issue if you like that can be dealt with with drugs. There are - as well as sort of the physical side of pain, there are psychological factors that feed in - social factors, cultural factors even. So, for example, if you look at placebo research, that's showing us that placebo responses are very strong in pain. If someone does feels cared for in a trial and feels that they're doing something that is going to make them feel better that is incredibly good at relieving pain. And placebo responses are so strong now in pain that the drug companies are actually finding it very difficult to beat those effects with new painkillers. But there are also other areas. So, for example, there's a line of research using virtual reality to deal with pain in serious burns patients. So they've designed in this sort of snow world that you can be immersed in. And burn patients can be inside the snow world as they're having their wounds treated and, you know, the dressings changed and things, which can be incredibly painful. And trials show that that reduces their pain by 15 to 40 percent on top of what they're getting with drugs because often the pain is such in these patients that even though they're on the maximum safe amount of drugs, they're still in terrible pain. And the distraction of being immersed in this virtual reality world reduces that pain further...
GROSS: Now, let me stop you right there 'cause that's a very interesting thing that distraction from the pain helps ease the pain. And you tried this. You tried the virtual reality snow world (laughter).
MARCHANT: I did, yes.
GROSS: They simulated paint in your foot. You had some kind of, what, electric probe on your foot that was...
MARCHANT: It's a box that fills with water and they heat the water. So it feels like a burning pain. It wasn't bad enough to actually create a permanent burn on my foot, fortunately. But it was pretty painful. Luckily, the day I went, the electric shock equipment wasn't workings, so I didn't get the electric shocks. But this is something that felt like a very intense burning pain on my foot when I just experienced it on its own. And then you put on the goggles and the noise-canceling headphones and you're in this ice canyon floating through it. It's this beautiful world with mammoths and penguins and snowmen. And you've got a little mouse where you can fire snowballs at them. And you've got Paul Simon's music playing through the headphones. And it's this really cool world, and you feel completely immersed in it. And the researcher then applied the same burning pain to my foot, and I barely noticed it. It was - I could kind of tell it was there, but I just wasn't really interested in attending to it is the only way I can describe it. It seemed very distant and not something that needed to concern me at that time. And the researchers explained it as our brains only have a certain capacity for attention. And if you've got something that's really commanding your attention, there's less attention left over for experiencing the pain. And it does seem that the more that you're immersed in that world, the better it works. So just playing a normal videogame would probably help a bit, but it's not as good as this immersive experience. So that's a whole different approach to pain. That I think tells us that drugs aren't the only answer. Yes, we need better drugs for dealing with pain. But we should also be taking more seriously these other approaches.
GROSS: You know, what you're describing, this immersive virtual reality being such a potent distraction from pain, and in that sense it minimizes the pain, it reminds me of things that a lot of people have experienced, perhaps not to that extent. But, like, when you're engrossed in something, you probably don't feel your pain as much. Actors always talk about, you know, when they do the whole show must go on thing that when they're on stage they're not feeling the pain. It's when they come back off stage when the show's over that they feel it again. So can you apply what you learned from virtual reality as a distraction from pain into the real world?
MARCHANT: Yes, absolutely. I think a lot of people with chronic pain get caught in this cycle where because you're in pain, you don't go out and do things and enjoy activities because you're worried about the pain. You end up staying at home and not doing as much. And then you've got nothing else to do really but then worry about the pain, which in turn makes it worse because you're focusing on it. So you need a way of breaking that cycle. And this is something that's coming through from placebo research as well, researchers doing brain scans on people who are experiencing placebo responses to painkillers. And you do see very similar changes in the brain to what you'd see if someone was taking a painkiller. But you also see changes that the drugs aren't causing directly. So you see changes in the prefrontal cortex, parts of the brain that were involved in decision-making and sort of attitudes. And their conclusion is that just feeling that you're doing something about the pain and having a placebo actually makes people less afraid of the pain and more willing to go out and do things and live life and enjoy it. And that's not - you know, that's not something that you get directly from the painkillers. That's just something that's coming from the people themselves. And if we can understand the power of that - because then you can get that cycle, then you can get out and start doing more and have other things to distract you. So if we can understand the power of that - again, that gives us a whole other approach to improving people's lives when they're in pain.
GROSS: If you're just joining us, my guest is science writer Jo Marchant. She is the author of the new book "Cure: A Journey Into The Science Of Mind Over Body." Let's take a short break here, then we'll talk some more. This is FRESH AIR.
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GROSS: This is FRESH AIR. And if you're just joining us, my guest is science writer Jo Marchant. She's the author of the new book "Cure: A Journey Into The Science Of Mind Over Body." Are there ways that you have been applying what you've learned about the mind-body connection and how we can use our minds to help feel less pain or to help heal, things that you've been applying in your own life?
MARCHANT: I think there's three main ways that I've applied it in my own life. So one is that it's changed my attitude to any symptoms that I do experience. So obviously, I still want to be aware of any problems that might indicate serious illness that - where I need to get that checked out. But, you know, if I have a headache or a tummy bug or I, you know, feel like I've got flu and I'm fatigued, it kind of makes me perhaps not get as anxious and worried about that. Instead of thinking oh no, I've got a headache, there's nothing I can do about it, this is going to take up my day, I feel as though I have a certain amount of control over how that affects me, so I can kind of imagine those endorphins flooding into my brain. I don't take placebo pills, but I might go for a run or distract myself or do something else, and just imagine that sort of improvement that I want to see. And, you know, it's - that's not a miracle cure, but I feel like that enables me to continue with the life - my life and have some control over those symptoms.
Another one is with my children. I'm very aware of how they can pick up on suggestions from me, positive and negative, about how they might be feeling. For example, if I say oh, are you not feeling well? You know, do you have a headache, or do you have a tummy ache? Just asking questions, I'm aware of how that actually sort of might plant the suggestion of that with them. Or if I'm, you know, giving them medicine or putting cream on, or even just giving them a hug or kissing something better, I really try and make a big fuss of that and tell them how that's going to make them feel better. And, you know, even if I'm just - if my son's grazed his knee and I'm kissing that better, I kind of see that as actually having a real therapeutic effect for him. I see that as - actually much more literally now. You are kissing him better because if he feels comforted and cared for and that it's OK, that it's being dealt with, there are going to be those endorphins released into his brain, and he is going to feel less pain. It's not just an imaginary thing. That's a real biological effect. So I kind of do feel like I have a role to play in how they experience these symptoms.
And then in terms of stress as well, researching this book has really made me see that stress isn't just something that affects us mentally, but it's having feed-through effects into our physical health as well. So I'm trying really hard to stay on top of that, and I feel like the research has kind of given me some of the tools to do that in terms of focusing on the people around me. I know that I can choose to focus on sort of positive things in my life rather than getting caught up in sort of negative worries and ruminations, and in terms of the importance of trying to find time for things that I enjoy and find meaningful as well.
GROSS: So are you practicing any kind of mindfulness or meditation techniques?
MARCHANT: I don't do formal sitting meditation. Maybe that appeals to some people, but it's not something that - you know, I've tried it in the past, but it's not something I do regularly. But in terms of trying to be mindful and just find times throughout the day, whether it's when I'm going for a run or doing housework, or even if I'm just playing with my children, just making sure that I'm in the moment and focusing entirely on them and not, in the back of my mind, running through what am I going to do later? What do I need to prepare for tomorrow? You know, just being present with them at that time I find very helpful. And, you know, in terms of individual experience, I can't say what that's done for my health, but it's certainly made me happier.
GROSS: So you live in England, where there's a national health service. In the United States, there's - you know, we now have Obamacare, there's private health insurance and there's, you know, insurance a lot of people get if they're full-time employees from their employer, which they usually have to pay a lot for in addition. But the way medical care is going in the United States right now, I think a lot of doctors are feeling pressure to spend less time with patients and to see more patients. And that is counter to the kind of care you talk about in the book, where comforting words, positive feedback, encouragement can lead to a more calm, positive attitude that can promote healing, at least in many conditions. And so I'm wondering, like, in England, is that kind of issue - is there that kind of issue, too, that doctors don't necessarily have the time to provide that kind of reassurance and comforting care to patients?
MARCHANT: Yeah, absolutely. So I don't think we spend quite as much on health care as you do in the States. It's nearly $3 trillion a year in the U.S. - that's more than 17 percent of GDP - and that's overwhelmingly going on the cost of drugs and surgery, those kinds of interventions. But I think the average - if you're going to see your primary care physician, the average appointment time in the U.S. is 20 minutes, I think. In the U.K., the standard appointment is 10 minutes. It's even more squeezed. So there's not a great deal you can do in 10 minutes apart from write a prescription, and there is - I do think that there's - that might likely be counterproductive.
There is a study in acid reflux disease, for example - it's just a small study, there isn't that much research on this so far, but it was comparing appointment times. So patients who got 18-minute apartments versus 44-minute appointments, and showing that the ones with the longer appointments, that their symptoms were relieved dramatically more those with the short-term appointments, even though they were all receiving either a placebo or a homeopathic medication. So just studies like that, I think we need more of. We need to be applying this evidence-based approach not just to drugs and whether they work, but to all the other elements of care. So appointment times and attitude of doctors, the words that doctors use when they are telling us about the treatments. I mean, all of these things matter to our care, and we should be taking those just as seriously as we do the drugs and their effects.
GROSS: Joe Marchant, thank you so much for talking with us.
MARCHANT: Thank you.
GROSS: Jo Marchant is the author of the new book "Cure: A Journey Into The Science Of Mind Over Body." Maureen Corrigan will review the new novel by Elizabeth McKenzie about a couple engaged to be married and the family baggage they're bringing to the union after we take a short break. This is FRESH AIR. Transcript provided by NPR, Copyright NPR.