The Psychological Power Of Expectations - David Robson

1. 0:00 – 1:26

   Intro

   1. DRDavid Robson0:00

      ... so the scientists have just, kind of, done these experiments where they gave these people foods that didn't contain any gluten or wheat, but they told them it did, and they still experienced all of the symptoms. That shows us that their symptoms aren't imagined. They really were experiencing them. But it's, like, the kind of opposite of the placebo effect. The expectation that they will become ill makes them feel the symptoms. (wind blowing)

   2. CWChris Williamson0:24

      David Robson, welcome to the show.

   3. DRDavid Robson0:26

      Yeah. Thanks so much for having me.

   4. CWChris Williamson0:28

      How did you get interested in the way that expectations can impact our lives?

   5. DRDavid Robson0:33

      Like, (clears throat) I guess, like, as a medical writer, I've kind of known about the placebo effect for ages. Um, but then I just, like, over the last five years, I'd just seen, like, such an abundance of research that had kind of moved beyond, like, you know, the effects in hospitals, but to, like, all other areas of our lives. So, you know, like, um, there is s- you know, some great research on these kind of weird psychogenic illnesses that pass between people just through expectations. But then also, like, research looking at the way our expectations shape our performance at the gym, like how we respond to sleep loss, even, like, how quickly we age. Um, and it was actually that finding, I just thought, like, "I have to write this book now." Because it's, like, it's actually cutting people's lives by, like, seven and a half years, like, if you have this negative view of aging, if you see it as this kind of period of inevitable decline. And that just seems so profound. It felt like, actually, you know, you could do a lot of good by telling this story, basically.

2. 1:26 – 7:33

   Expectation Effect & Placebo Effect

   1. DRDavid Robson1:26

   2. CWChris Williamson1:26

      What's the difference between the expectation effect and the placebo effect?

   3. DRDavid Robson1:31

      So, the placebo effect is, like, one type of expectation effect, and so that is, like, um ... I guess most people are familiar with it, but that's very much like if you have high expectations that a treatment is going to be effective, even if it's a dummy treatment, um, then you will see some kind of, um, alleviation of your symptoms. Um, so that's been researched for, like, five decades, you know. Like, there's no longer any controversy over that. Um, but the expectation effect is kind of much more general, so this is looking at how we create self-fulfilling prophecies, um, uh, from our beliefs through, like, uh, various mechanisms, so changes to our behavior, changes to our, um, perception, and changes to our physiology.

   4. CWChris Williamson2:10

      And that happens both positively and negatively, right? This isn't us just making things better. We can also make things worse.

   5. DRDavid Robson2:16

      Yeah, and I think that's how it often manifests in our lives, like day to day, is that when we have these kind of negative expectations, we're, like, needlessly hampering our performance. We're, like, kind of limiting our potential, essentially. So, um ... So yeah, a lot of what I write in the book is actually just, like, asking people to reassess those negative expectations and just kind of bring it up to something that's a bit more objective or open-minded, and even that can have a huge effect on your life.

   6. CWChris Williamson2:42

      The problem is we have a negativity bias, right? We have a, a leaning generally towards negativity. We're vigilant for whatever might be lurking in the bushes of existence. And now that the expectation effect is something that we know about, that negativity bias bleeds into a reality negativity bias, right? We become a self-fulfilling prophecy of the fears that we had previously.

   7. DRDavid Robson3:05

      Yeah, that's exactly it. So it's like the, um ... One of the researchers told me, and I totally believe this, that our expectations that we have today are kinda shaping our reality tomorrow. So, you know, like, they are actually shaping the way we perceive the world, but also kind of, uh, physically what's happening to our bodies. Um, but like you said, we have this negativity bias. I think, like, in our culture, we often see, like, being pessimistic as being inherently more rational or kind of smarter, you know, it's smart to be cynical, but often we're just needlessly negative, actually. Our kind of pessimistic expectations are no more rational than if we were, like, a kind of Pollyanna figure who was always being, like, totally optimistic about everything, you know? So yeah, that's why I think we have to find that sweet spot where we're not, like, raising our expectations to be kind of wishful thinking, but we're just kind of asking objectively, "Could I see this situation, um, kind of more positively," essentially.

   8. CWChris Williamson3:56

      You looked at the expectation effect in diet, right?

   9. DRDavid Robson4:00

      Yeah, exactly. So that's one of my favorite examples. Um, and like, this is another way I try to kind of differentiate the expectation effect from just, like, positive thinking. You know, like, well, it's like, um, The Secret where you kind of ... You're told to just imagine yourself being, like, super skinny and, like, you will just become super skinny. Um, well that's totally not gonna happen. But what the scientific research shows is that it's much more about our kind of specific expectations of the food we're eating. Um, and so when we're kind of dieting, um, we're so focused on, like, the kind of sense of deprivation and, like, you know, all the calories we're missing, that that actually kind of sets up the body for starvation. So it does things like increases the levels of the hunger hormone ghrelin that stimulates appetite. Um, and ghrelin also kind of, um, slows your metabolism, so you burn fat more slowly, essentially. So if you're on a diet, you've got this mindset of deprivation, um, you've got high levels of ghrelin that are kind of making you have hunger pangs and, like, reducing your metabolism, it's like a recipe for disaster. It's, like, gonna make your diet so much harder. Um, so yeah, that was revelatory for me to just realize that actually, you know, very simply, kind of the kind of packaging we see around our diet foods are actually changing the way our body responds to the food.

   10. CWChris Williamson5:16

       Is that language like low calorie snack and stuff like that?

   11. DRDavid Robson5:22

       Yeah, all of that kind of thing. And you know, like, they, um ... The scientists did this kind of linguistic analysis of kind of diet foods, and it's, it's not just like focusing on the low calories, it's also, like, they miss out on all of the vocabulary that might help you to get pleasure out of food. So you know, like, if you have a high fat food, it's gonna be like, um, luxurious, decadent, you know, like, um, uh, you know-

   12. CWChris Williamson5:43

       Creamy and tasty.

   13. DRDavid Robson5:44

       Yeah, creamy, tasty. They're gonna focus on all of the kind of sensory aspects. If you have a diet food, it's, like, sensible, which is like such a bland, horrible word. (laughs) And then, like, that actually changes your hormonal response to the food just by having that kind of language that sets you up to feel like you're depriving yourself.

   14. CWChris Williamson6:02

       Interesting. So there is a balance, I suppose, for marketers that are doing food marketing between...... the, I guess, the conversion in terms of whether people are going to pick it up, and then the enjoyment-

   15. DRDavid Robson6:15

       Mm-hmm.

   16. CWChris Williamson6:15

       ... or the effectiveness of whether or not it actually satiates people a bit more. What was the-

   17. DRDavid Robson6:19

       Yeah.

   18. CWChris Williamson6:20

       ... didn't you look at something to do with French people? Aren't French people supposed to be really fat and they're not?

   19. DRDavid Robson6:26

       (laughs) Yeah, right, exactly, 'cause they eat a lot of food that's kind of high in saturated fats. Um, so they should have higher levels of kind of cardiovascular disease, um, because of this. And yet they don't. They actually... you know, they, like, um, have lower BMIs, but also just lower rates of heart attacks compared to, like, America and the UK, even though we eat, like, fewer saturated fats. Um, so that's kind of this mystery. But then you look at the French kind of whole attitude to eating, and they just don't feel this kind of guilt around what they eat that we have in the UK or US. So, um, it's like there was this survey that asked, um... it was like word association and, like, "What do you associate with cream cake?" And in France it was, like, celebration, and in the UK it was guilt.

   20. CWChris Williamson7:09

       Regret, yeah.

   21. DRDavid Robson7:10

       Um, (laughs) yeah, exactly.

   22. CWChris Williamson7:11

       (laughs)

   23. DRDavid Robson7:11

       So the idea here is that, actually, if you're feeling, like, totally stressed about the food you're eating all the time, and you're missing out on all of that pleasure, that's like a major source of stress. And we know that stress itself can kind of contribute to ill health. So, like, you know, day to day, you're not gonna notice the difference. But over a lifetime, it can help to explain the differences between those cultures in terms of the kind of illnesses that they experience.

3. 7:33 – 16:19

   How the Mind Imitates Illness

   1. DRDavid Robson7:34

   2. CWChris Williamson7:34

      What was that thing that you looked at to do with gluten and gluten intolerances?

   3. DRDavid Robson7:39

      Hmm, yeah, I mean this maybe is a bit controversial. So there are some people that definitely have a gluten intolerance, like there's just no question about that. It's like their, you know, their body is responding to it. It's got a, a true allergic reaction. Um, so I'm not questioning that. But, like, I think recently we've seen a lot of media coverage where people don't have, like, uh, celiac disease, but they're just kind of gluten sensitive or wheat sensitive. So, you know, about 30% of people now report that. And it's, you know, that has kind of increased from a couple of percent to 30% in like 10 years. It's... It would be crazy if, like, our bodies were changing that quickly. Um, and then, so the scientists have just kind of done these experiments where they gave these people these foods that didn't contain any gluten or wheat, but they told them it did contain the gluten and wheat, and they still experienced all of the symptoms. So they were still having, like, the bloating or the diarrhea, like, all of this, um, stuff. So, like, that shows us that their symptoms aren't imagined. Like, they really were experiencing them, but it's through an expectation effect. It's like the kind of opposite of the placebo effect. It's like the expectation that they will become ill makes them feel the symptoms. Um, and that probably can ex- explain the rise. Like, the... Essentially all the media coverage about wheat sensitivity is kind of making a lot of people ill.

   4. CWChris Williamson8:58

      Wow. It's like a (clears throat) , a psychological contagion in a way.

   5. DRDavid Robson9:03

      Mm-hmm. Yeah.

   6. CWChris Williamson9:03

      And if you're hearing a lot of news stories about, "This is how bad gluten is for you, and this is how you're going to react, and this is how you're going to respond," and maybe you've got a friend who's got it as well, and... It doesn't surprise me that that stuff happened, but it's so hilarious. It's such an interesting intersection, right? Because people don't have a gluten intolerance, or they, they, um, might not have as severe of a gluten intolerance as their body is responding to.

   7. DRDavid Robson9:27

      Yeah.

   8. CWChris Williamson9:27

      However, they are suffering with the effects of a gluten intolerance.

   9. DRDavid Robson9:34

      Yeah.

   10. CWChris Williamson9:34

       So it is, it is not quite the same as a placebo effect, right? It's, it's... There's... It's in some sort of no man's land in between the two. They don't have the problem, but they do have the impact, but they don't have it for the reason that they thought that they did.

   11. DRDavid Robson9:49

       Yeah, that's exactly it. And I think actually, like, a lot of people find it quite offensive if you suggest it's kind of... the origin is psychological rather than, like, purely biological. But actually, like, I don't think that distinction makes sense anymore when we understand the mind-body connection, because we know that, like, our expectations can change our physiology. So, you know, loads of other experiments have shown that, like, if you're expecting to kind of have a headache, that expectation then actually changes the release of, like, different chemicals in your brain that change the vasculature of, of your brain. So it's actually like changing the pressure that causes the headache. So if you take a kind of tablet and you expect to have a headache, um, like, it's not the biological action that's gonna give you that headache, but you're still gonna feel the pain, and it's still actually caused a change, you know, within the brain itself. It's still... It's like the words are biologically active rather than the pill you're taking, essentially. And we're seeing exactly the same thing with, um, the wheat intolerance. It's like the expectation is biologically active. It's not the food that you're eating that's actually causing that problem.

   12. CWChris Williamson10:53

       I think the reason... And I could, uh, totally imagine if I had some, uh, illness or (clears throat) allergy of some kind that I've been dealing with for a long time, and then somebody comes in and, and says, "Well, this is potentially contributed to or worsened by your psychology." That makes you feel culpable. That makes you-

   13. DRDavid Robson11:15

       Mm-hmm.

   14. CWChris Williamson11:15

       ... feel like it's your fault, almost, and like you're in control. The reason that people like the idea of medicalizing, or at least it makes them feel more secure, is that by giving something a term, by branding it as something, it, it kind of makes it feel more realistic, more real, more medicalized, more scientific, and probably a little bit more like, um, it's not their fault.

   15. DRDavid Robson11:40

       Yeah, totally. Yeah. And I, I think, like, that's something that has been contribu- uh, contributed to by, like, the medical profession, in that, like, I think a lot of doctors have this kind of assumption actually, that if something's psychogenic, it's kind of not real, it's imaginary. You know, they have kind of assumed it's kind of malingering, so often, like, doctors can be quite rude when they present this diagnosis that something's psychogenic in origin. Um, what does that mean?

   16. CWChris Williamson12:04

       What does psychogenic mean?

   17. DRDavid Robson12:05

       What's going to be more upsetting. So that's just like if it's psychological in origin, essentially. So if it, um, comes from, like, the brain, not from, like, a biological... direct biological action. Um-Yeah. And that- I mean, it's so damaging. And then, like, so these people then feel very resistant to the diagnosis. They're not really gonna be very positive about, say, having, like, a cognitive behavioral therapy to try to treat this psychogenic illness. So they're, like, stuck in the slip. It's actually much harder to treat them than it would be often to treat someone with a purely biological illness.

   18. CWChris Williamson12:38

       No way. So somebody that's got a psychogenic, uh, gluten intolerance is potentially more difficult to treat than somebody who has a biologically driven gluten intolerance? That's-

   19. DRDavid Robson12:53

       Yeah.

   20. CWChris Williamson12:53

       That's so interesting.

   21. DRDavid Robson12:55

       Yeah, it's crazy. I mean, and because there's, like, loads of other psychogenic illnesses that are, like, even more severe. So some people have-

   22. CWChris Williamson13:01

       What are some good examples?

   23. DRDavid Robson13:03

       ... like, some people have psychogenic blindness, where they- their brain has kind of fooled them into thinking that their eyes can't see. And then, so they actually can't see. Like, it's actually, their brain is just blocking that sensory information from being processed consciously. Um, and again, or paralysis, even, like some people have, like, paralyzed limbs that are caused by, like, the expectation that it's been paralyzed somehow without a kind of biological damage, anatomical damage. Um, and for those people, yeah, like, it's really difficult then to try to get them to respond to treatment because it feels so insulting, and there's such stigma attached to that, even though it shouldn't be. Because actually, you know, all of us are kind of experiencing these expectation effects to a greater or lesser degree. Um, it's just like we're- you know, they're having a more extreme reaction than most people.

   24. CWChris Williamson13:51

       One of the places that I noticed this in my own life was with fasting. So (clears throat) everybody knows the experience of being hungry and not having eaten. It's 2:00 PM, and you still haven't had any food in you or whatever, and you've got those hunger pangs. But after a bunch of different episodes with longevity doctors like Dr. David Sinclair and his colleagues, I realized that maybe that hunger signal is something that I'm actually seeking. Maybe that's something that's good for me. It's a hormesis stressor. It's gonna activate telomeres and all of the other stuff that I can't remember. And that then reframed the experience of being hungry to me. I thought, "Actually, this is a signal that something's going right here." Like this is the input that I'm after. And yeah, okay, it's not wildly enjoyable, but it's not that bad. Just the sensation of being hungry without the narrative and the story around, oh my God, I need to eat. My energy is going to be low. Blah, blah, blah. I actually find that my energy goes up while I'm hungry. I find that I'm more alert. I find that my thoughts are quicker. And I think, "Oh, this is good for me. This is something that I'm supposed to be doing, and I'm gonna look forward to having my food in an hour's time or whatever."

   25. DRDavid Robson14:59

       Yeah, I mean, that's just, like, what the expectation effect is all about, is this kind of process of reframing. Um, so it's not about denying the feelings. It's not like you're telling yourself, like, "I'm not hungry," but you're just- you're reinterpreting those feelings, and you're kind of telling yourself, like, based on the science, that it's actually, like, a good thing for you. And so we see that with a lot of the upper expectation effects that I discuss, like, um, when people are working out at the gym, you know, like, um, some people really catastrophize, like, when they're kind of feeling tired, like during an endurance exercise, and they- they see it as a sign of- that their own fitness is, you know, kind of really poor, that maybe they're gonna suffer a heart attack or something. Um, and what you want to do is just kind of change that interpretation and be like, actually, like, you know, no pain, no gain. Like if it's- if I'm feeling uncomfortable, that's when I'm doing my body, like, the most good. Um, and you can see that when people do interpret that, like, it changes a bunch of things in the body, but, um, especially, like, it- it kind of helps to encourage the release of the endogenous opioids that we have in the brain. So, like, the endorphins, essentially, that give you that runner's high. Like when you reinterpret your feelings during a workout and realize that actually, like, the feeling of pain can almo- almost be like a reward, you get those, like, the release of those endorphins that makes you feel good, and it makes you want to come back to the gym afterwards. So,

4. 16:19 – 27:40

   Applying the Placebo Effect

   1. DRDavid Robson16:19

      what are- it's quite powerful.

   2. CWChris Williamson16:20

      What are some of the examples of this being used in sports?

   3. DRDavid Robson16:26

      Yeah, I mean, there's, like, loads of anecdotal evidence of, like, um, coaches kind of giving, um, telling their athletes that they're taking this kind of banned substance, but they're actually just giving them an injection of, like, glucose or whatever (laughs) like. Um, but because the athlete's gonna believe they've taken this performance enhancer, if they do, you know, like they have much greater strength or endurance. So, you know, it's being used kind of- I thi- I think that's ethically dubious, like misleading the athletes and, like, getting them to feel that they're taking a banned substance is like, you know, um, definitely, like, some questions and alarm bells there. But I think more generally, like, um, there's a lot of research just showing that you- a lot of the sports supplements that we take, like the legal ones are also kind of bes- benefiting from a placebo effect. So things like caffeine, that we might take as a muscle stimulant, um, actually the research shows that if you give people decaf, but tell them that it's like high-intensity caffeine, they, like, get a lot stronger. Um, and if you give them, like, proper, like high dose of caffeine and tell them that it's decaf, they actually get weaker because of that.

   4. CWChris Williamson17:31

      You're kidding.

   5. DRDavid Robson17:31

      So it's like... Yeah, it's crazy. So actually most of the benefits from that supplement is coming from our expectations, not from the chemical effects.

   6. CWChris Williamson17:39

      Shit the bed. So another implication here for, um, marketers and general branding is the story that you tell people around the things that they're taking largely determine their experiences of it. And I'm in Austin at the moment, and there is a strong psychedelic community here, and I had... Do you know Hamilton Morris? Uh, H- Hamilton's pharmacopeia guy who used to work for Vice?

   7. DRDavid Robson18:06

      Uh, yep. Yeah. Yeah, I do.

   8. CWChris Williamson18:08

      He's a long, stringy kind of chemist guy that goes and takes drugs all over the world.

   9. DRDavid Robson18:12

      Yeah.

   10. CWChris Williamson18:12

       Um, (clears throat) I was talking to him about, uh, Bufo alvarius, which was the toad, psychedelic toad. And people used to sort of, they'd rub it on a piece of glass, and then they scrape it off, and then they smoke the toad venom. And he is adamant that you're able to recreate that-... chemically one-to-one. It, it is the same molecular structure, uh, and yet-

   11. DRDavid Robson18:34

       Yeah.

   12. CWChris Williamson18:34

       ... people still went about using the toad. And there is a whole story around the fact that it's sacred. And he had the exact same thought of what you're mentioning now with regards to the supplements, that literally none of it is to do with the fact that it's come from a toad, and everything is to do with the fact that there's this story around the fact that the toad is sacred, and you go on a, a big walk to go and find them, and you see them and you spend time with them. And the same thing when people are talking about psychedelics, set and setting. Those are the two things that you try and control. What's your intention coming into this? What's the experience been around this? If you're going away to do an ayahuasca retreat, you're fasting for days beforehand. You make sure that you don't swear. You're in this beautiful surrounding. It... You've got, you know, indigenous music being played, and you've got a headdress on, and people are dousing you in flower petal water and stuff. Like, what is this? It's priming, it's story, it's narrative. It's creating that expectation that something magical and positive is about to happen.

   13. DRDavid Robson19:32

       Yeah, I mean, that's totally it. Like, the ritual is just so important there. That it's like, I almost find it surprising that anyone could think you could separate the two. Um, 'cause I would say, yeah, like, in those experiences, like, maybe 80% of what people are feeling is gonna be from the ritual, from the story, like you said, uh, from the setting. And like, a very small part is going to come from the drug. I mean, we see this in, in medicine with, like, um, people who are receiving morphine after an operation. Um, so they could receive that in their intravenous drip. It's just delivered automatically. Um, or you can have a doctor give you an injection and tell you, you know, "This is pain relief. You're gonna feel better." And actually, to get the same level of pain relief, um, you need twice as big a dose when it's, the morphine is administered surreptitiously without the ritual of the doctor giving you that morphine. So it's like the placebo effect alone is like, yeah, like half of the power of morphine, which is quite crazy.

   14. CWChris Williamson20:28

       I remember reading a story in one of Johann Hari's books about a guy who had a magic electric wand thing in the 1800s or the 1900s. Do you know this story? And he used to wave it over people, and then over time, they took different things away. Do you know this?

   15. DRDavid Robson20:45

       I don't, no, but it sounds interesting.

   16. CWChris Williamson20:46

       Okay, so-

   17. DRDavid Robson20:47

       Yeah.

   18. CWChris Williamson20:48

       ... these patients were catatonic for one reason or another. Maybe it was chronic pain or back pain or depression or something. And this guy said, "I've created this special new device, and I'm going to wave it over you, and it's going to make everything better." And it was all complex, and maybe it used electricity, and it was wood wrapped in metal with wires and other stuff. And he used to wave it over people, and these people that had been catatonic for years had sometimes got up and started moving around. "Oh, it's a miracle." And over time, I can't remember if it was this guy or if it was somebody else that was trying to disprove it or whatever, or, or stress test it, started... recreated their own and started taking bits away from it. So first, they unplugged the electricity, and then they removed the wires, and then they took away the metal sheet, and then they took away the wood, and then it was just someone waving their hand over people-

   19. DRDavid Robson21:34

       (laughs) .

   20. CWChris Williamson21:34

       ... and saying the same thing, and you end up with exactly the same outcome.

   21. DRDavid Robson21:40

       Yeah, I mean, it's incredible. And I... So I think a lot of... well, like part of the placebo effect, um, is just that feeling that someone is kinda caring for you. That can be quite powerful in itself. And we know that that can do things like, um, reduce the inflammation that you feel within your body. So it's almost like, um, if you're kinda feeling isolated and ill, your body's, like, sending loads of inflammatory markers, like, that can kind of... they attack pathogens by, like, brute force. Um, but when you know that you're being cared for or that you have kind of some kind of security, the body can, like, remove that inflammation and allow, like, the more specific parts of your immune system to kick into action. So, like, the production of antibodies. Um, so yeah, I feel like the healing ritual in itself is super important. And then on top of that, we have the specific expectations of what the treatment is going to kind of give us, like, what benefits we're gonna get. And then that can have more specific effects on, like, you know, whether you have, like, pain relief, whether it, like, reduces your blood pressure, like, all of that kind of stuff.

   22. CWChris Williamson22:42

       You said that our beliefs are more powerful than our genes when it comes to exercise. Why is that?

   23. DRDavid Robson22:50

       Yeah, I mean, um, so there's this experiment. It was just like a... the exper- the scientists, like, asked these people to come into the lab. They gave them a genetic test. Um, it was looking at the CREB, uh, CREB1 gene. Um, so that's just... uh, we know that that is involved in, like, um, loads of things to do with, like, endurance exercise. So kind of how efficiently your lungs kind of can, uh, exchange the carbon dioxide for oxygen. Um, your, like, body temperature as you exercise, if you have, like, the bad variant, um, you just start to feel, like, hotter and more uncomfortable, like, and a bit more sweaty as you exercise. So, you know, like, it is important. But the scientists gave sham feedback to these participants. So they... You know, regardless of what they actually had, they told some, like, "You have this amazing variant, you're gonna be brilliant." And the others were told, like, "You're really not cut out for exercise. Like, don't expect much." Um, so that changed, like, the endurance on the treadmill. Like, it did have an immediate effect on performance. But, um, but actually, then it changed the physiological measures too. So actually, if you expected to, um, have this, like, great version of the gene, it actually changed the efficiency of the gas exchange. So, you know, that's kind of incredible. Also, things like the efficiency of their movement seemed to have been different. Um, but what's even more incredible to me was that actually, they then compared the size of the expectation effect to the size of the actual genetic effect. And often, the, the expectations were having more of an effect than the genes itself. So whether you think you're cut out for exercise is probably more important than the kind of genome you were born with.

   24. CWChris Williamson24:23

       Wild. What did you... You looked at Michael Phelps for some reason?

   25. DRDavid Robson24:27

       Yeah.

   26. CWChris Williamson24:28

       What'd you learn from him?

   27. DRDavid Robson24:30

       Um, so he, um...... he'd always said, like, he didn't think, like, his secret was, like, in his body, but it was more, like, in his, um, amazing ability to visualize exercise. So, like, in addition to doing all of the physical training, he would, like, imagine every race in, like, minute detail. Like, all of the turns, like, every twist of his body, he would plan out. Um, and then he, he said it was like, his visualization was so good that when he actually got into the pool, it was almost as if he'd done, like, an extra kind of training practice. Um, and then, so that's, like, really intriguing but it's kind of anecdotal, but then actually, the scientific research shows that, um, visualizing exercise can be really powerful on its own. So there was, like, this study, um, they just got people to kind of imagine, like, lifting heavy objects every day for six weeks. Um, they weren't actually doing any weightlifting. They were just imagining it. Um, and then, like, compared to the beginning of that period, they were, like, 10% stronger, um, compared to participants who hadn't done any kind of imaginary lifting at all, and they were actually a bit weaker. Um, it sounds incredible, and, like, I think it's important to emphasize here that, like, the scientists aren't claiming that it was actually building the muscles themselves. Like, they didn't have more kind of muscle mass. But what the brain was doing was kind of recalibrating what it thought the muscles could achieve, and then that was causing it to, uh, recruit more muscle fibers. So when we exercise, actually, even if we're, like, really exerting ourselves, we only recruit about 50, like, 50% of our muscle fibers. That's to kind of stop us from exhausting ourselves and giving us, like, more energy reserves if we need it later. Um, probably when they were doing this visualization exercise, it was just persuading the brain to maybe recruit a few more of those muscle fibers, which then made them, like, physically stronger even though they didn't have bigger muscles.

   28. CWChris Williamson26:18

       A big chunk of what people are doing when they train in the gym is drilling that CNS, right? Getting the-

   29. DRDavid Robson26:23

       Yeah.

   30. CWChris Williamson26:23

       ... they're called movement engrams. Making sure that you're moving efficiently, that you're doing things right. And (clears throat) I remember hearing about... I, I, I ruptured my Achilles, uh, a year and a half ago, and my doctor had said to me, "Look, throughout the process of this, before you can get onto doing calf raises, you can restrict the atrophy that you're going to get in your calf if you imagine yourself doing calf raises." So-
5. 27:40 – 33:49

   Expectation Effect on Sleep & Ageing

   1. DRDavid Robson27:40

   2. CWChris Williamson27:40

      What did you look at to do with sleep?

   3. DRDavid Robson27:43

      Um, yeah, this was totally fascinating to me. So, um, like, scientists can just, like, get people into this, um, into their labs and get them to sleep for a night, and they can measure, like, their brain activity to see if they've actually been asleep or if it's been really disturbed. Um, and then you get people to kind of report how much sleep they had. Um, in general, people's subjective, uh, assessment of their sleep is just really poor, so, like, almost everyone, like, over- or underestimates how much they've slept. Um, so you get this group who are, like, the, uh, complaining good sleepers. So they sleep, like, eight hours a night, you know, no problem there at all, but they might... I guess, you know, they wake up, like, in the middle of the night for, like, a couple of minutes, but in their head it was like they were awake for hours, and they are totally convinced that they're gonna have insom- the effects of insomnia the next day. Um, and what you can see is that that becomes a self-fulfilling prophecy. So they suffer from, like, poor concentration, you know, fatigue, irritability, all of these things just because of their expectations, not because they've suffered any kind of sleep loss.

   4. CWChris Williamson28:49

      And the reverse presumably as well for the people who under-sleep, but convince themselves that they've probably done okay.

   5. DRDavid Robson28:56

      Yeah, the non-complaining bad sleepers are the total opposite. So they actually don't have any of the effects of insomnia, not even, like, things like, uh, high blood pressure, which often comes from bad sleep loss. Um, they're just completely immune to all of that. Um, so I, I actually kind of personally identify with that. Like, I, I do think, like, I do have disruptive sleep, but I also just, like, try to focus on the, on how much sleep I have got, because I know that, like, you know, even if it feels quite disturbed, like, if you're just kind of lying there dozing, that's better than, like, not getting any sleep at all. And yeah, so I don't get, like, uh, bad, like, effects of insomnia, whereas, like, my partner's the total opposite. Like, he will, like... He sleeps for, like, nine hours a night, but if he wakes up once, he will be, like, in a really bad mood the next day.

   6. CWChris Williamson29:42

      Did you look at people who consider themselves, or, or think that they're not going to get to sleep very easily? And people a lot... everyone's familiar with this. You've got a big event tomorrow or you're going away on holiday and the flight's early, so you get to bed a little bit earlier than usual and you end up falling asleep three hours after your usual bedtime, lying awake in bed, thinking, "I need to get to sleep." I'm gonna guess that the expectation effect must... Why... Are you expecting to go to sleep? I guess that you're fulfilling the prophecy of fearing that you won't.

   7. DRDavid Robson30:13

      Yeah, that's exactly it. It's like you're raising the anxiety that you won't, and then when you're not getting sleep, you're kind of, um, kind of catastrophizing that and focusing on all of the kind of bad effects that are gonna arise from that sleep loss. Um, so yeah, that's like... I mean, it is... You know, I've experienced that a lot and it's, like, a terrible thing, but actually, counterintuitively, the best way to avoid that is to try to stay awake.Um-

   8. CWChris Williamson30:38

      (laughs)

   9. DRDavid Robson30:38

      ... if you're- you're just like- (laughs)

   10. CWChris Williamson30:39

       (laughs)

   11. DRDavid Robson30:40

       If you're just like, "Well, I'm not gonna sleep, so I'm just gonna, like, stay awake here," and, like, you will yourself to stay awake, you kinda cut through all of that anxiety. And ironically, then you get to sleep, like, more quickly. So (laughs) yeah.

   12. CWChris Williamson30:53

       That's interesting. What about aging, then? You said at the start that the expectation effect can reduce life by seven years?

   13. DRDavid Robson31:02

       Yeah. Yeah, exactly. So, um, researchers in the US kind of looked at these huge, like, longitudinal studies, so tracking people's kinda lives from, you know, like, teen- their teenage years right to their kind of deaths in their 70s and 80s. Um, and at some point in that, you know, like in their 30s, they kind of measured, like, their expectations of what was gonna happen as they got older. So they asked them, you know, "Is it gonna be a time of decline and disability? Are you gonna kind of lose your independence? Or do you see it as this kind of time of growth, you know, time of wisdom?" Like, you know, they weren't kind of asking them, like, "Do you deny that there's any problems that come with aging?" But just some people kind of see the good as well as the bad. Um, and they found that those, um, those, uh, kind of views that people had in midlife then predicted how long they would live by, um, a difference of about seven and a half years. So, like, big difference in longevity. Um, and then later studies-

   14. CWChris Williamson31:57

       Do you know how big this study was?

   15. DRDavid Robson32:00

       Yeah, that would have been thousands of participants. Uh-

   16. CWChris Williamson32:02

       Oh, so this is a really-

   17. DRDavid Robson32:03

       ... yeah.

   18. CWChris Williamson32:03

       ... representative sample?

   19. DRDavid Robson32:05

       Yeah, yeah, exactly. And then it's been, like, repeated again and again with loads of different samples. And they've found the expectations of aging can predict things like, um, like your risk of getting Alzheimer's disease. Like, if you have th- the positive views, it cuts your risk of Alzheimer's by about 50%. Even if you have the genetic predisposition to get Alzheimer's, it still cuts it by 50%.

   20. CWChris Williamson32:29

       Mate, this is wild.

   21. DRDavid Robson32:31

       Yeah.

   22. CWChris Williamson32:31

       This is so crazy.

   23. DRDavid Robson32:33

       So I was, like, totally skeptical of that. Um, but then, you know, like we were saying, like, the studies were well-conducted and they were, like, big numbers. Um, and then they- the scientists have also kind of joined the dots to kind of find the mechanism for how that would happen. Um, and so, like, one is just kind of behavioral. Um, it's like, if you're defeatist about getting old, you're not gonna do so much exercise, you're not gonna look after your health, you know, that's gonna have an effect. Um, but there's also a kind of physiological effect here too and that's, like, if you feel vulnerable as you get old, um, every challenge in your life is going to feel, like, super stressful. So that's gonna raise, like, levels of cortisol, um, it raises levels of, like, inflammation. We know that both of those things can cause bodily wear and tear. And then you can see the effects right down to kind of differences within the cells themselves. So it kind of, um, the people with the negative effects have, like, shorter telomeres. Like, like you- I'm- I'm sure you know this, but yeah, like, those protective caps that kind of, uh, protect our DNA from kind of damage. Um, and the kind of epigenetic markers within their cells, um, it's like the cells are just ticking at, like, a quicker rate if you have the negative beliefs compared to the positive beliefs.

   24. CWChris Williamson33:48

       Why

6. 33:49 – 41:26

   Why Do These Effects Exist?

   1. CWChris Williamson33:49

      do you think that this effect exists? So there's some, uh, mechanistic elements of this, right? Like you said, the person... And this is not just for aging, but for- the- the- the whole effect-

   2. DRDavid Robson34:01

      Yeah.

   3. CWChris Williamson34:01

      ... overall. I'm trying to work out why this is adaptive. I'm trying to work out why it's so universal, why it seems to work across, like, a million different mechanisms. Why have we got this?

   4. DRDavid Robson34:14

      Yeah. I mean, it's like, um... I think it's, like, just so fundamental to how the brain works, um, and what it does is it gives us kind of flexibility. Um, so there's, like, this new idea in kind of the study of consciousness that the brain works as this kind of prediction machine. So it's always, like, building simulations of what's going on around us, um, that helps us to kind of process the sensory data. Uh, but also, just as importantly, it's kind of, um... it's allowing the brain to kind of prepare the body for the challenges that we're gonna face. Um, so, you know, just like adjusting the levels of your hormones, like, so that if you're gonna face, like, a kind of danger, like, you're kind of pumped up and, like, physically ready to attend to the threat. And, you know, your psychology is gonna change as well, so that you, um, are kind of more on the ball and, like, uh, more capable of kind of- of, like, focusing on the danger and not kind of thinking about other stuff, like, not being too dozy. Um, so it's actually this prediction machine is giving us a lot of flexibility. It's allowing us to respond, like, second by second to what's going on around us. Um, the thing is, like, those predictions, like, sometimes it's purely based on things like the context of the situation that you're in, um, or, you know, like, how much you've eaten, how much you've slept. You know, like, there's definitely, like, an objective element to that that the body is kind of getting from all of its kind of sensors, like, within the body and, like, on the skin. Um, but also it's just drawing on all of its previous experiences to kind of calibrate those predictions. Um, and that's where, like, our conscious thinking and, like, our expectations and our interpretations of the events, like, the... yeah, like, the way we kind of choose to frame them, that's shaping the predictions and then it's shaping how the body responds as well.

   5. CWChris Williamson35:59

      What do you see as the difference between creating a positive expectation and being delusional?

   6. DRDavid Robson36:07

      Mm. Yeah, I mean, that's something, like, I really wanted to get clear, um, in my book, because it's like, um, so much of the positive thinking literature is kind of about being delusional in a way. So it's like, you know, we were talking about, like, your expectations at the gym, like, if someone is, like, a real couch potato, like, going to the gym and telling themselves that they're, like, an Olympic athlete is only gonna lead to disappointment. Like, you cannot be that delusional that you're really gonna fool yourself. So I think, like, it's really important to set, like, realistic expectations. Even if you're improving your expectations, it's like...... always trying to be, kind of honest to yourself and authentic. Um, so, like, at the gym, like, I think, like, don't tell yourself you're gonna be, you know, like, a world-class athlete straight away. But, like, just reinterpret those feelings that you're having at the gym. Like, if you're being, like, overly negative about, like, the fatigue that you're feeling, and you're kinda catastrophizing that, and you're telling yourself that there's something, like, fundamentally wrong with your body, like, you just need to reappraise those feelings and actually look at it much more objectively. And, and kind of just tell yourself that actually if you're feeling fatigued, like, that is not only normal but it's desirable. It's like you with fasting, it's like, you're telling yourself that, "Yeah, like, I'm hungry, but that is why I'm doing this." It's what I'm choosing to be hungry.

   7. CWChris Williamson37:22

      It's what I'm here for. Yes. Exactly.

   8. DRDavid Robson37:23

      Yeah, exactly. So I think that's how we want to reframe our feelings is just to be ... and our expectations is just to kind of, yeah, to be honest, and to just, like, avoid catastrophizing stuff when actually we can just see it in a more positive light.

   9. CWChris Williamson37:39

      So the ... You've got the proximal zone of development for skill acquisition-

   10. DRDavid Robson37:42

       Yeah. (laughs)

   11. CWChris Williamson37:43

       ... and we've got the proximal zone of expectation for the expectation effect. Not too far-

   12. DRDavid Robson37:48

       Yeah.

   13. CWChris Williamson37:49

       ... not too little, certainly not negative.

   14. DRDavid Robson37:52

       Yeah. Yeah. Exactly. I love that. Yeah. It definitely has to be a kind of proximal zone. And actually, like, if we look at the expectation effect around, like, stress and anxiety, like, it's exactly what you're describing there, in that like, um, our culture has always been, like, really down on anxiety and seeing it as being, like, purely kind of detrimental to your performance and debilitating. Um, but actually the science shows us that, you know, those stress responses can be really useful and adaptive. Like, you know, cortisol is kinda sharpening your mind, it's a- actually helping you to release kinda glucose into your blood. When your heart is pumping, like, that ca- like, really hard, that can feel quite uncomfortable, um, but it's actually, like, getting all the oxygen around your body into your brain. So it's like preparing you for, like, a big challenge. Um, and what the scientists, like ... They kind of told some people, like, "Suppress your feelings." Like just, you know, tell yourself, "I'm calm, not anxious." And they told the other people, just like, um, "Just accept your anxiety, but recognize that it might be having these benefits and that you actually evolved to feel this for a reason." And then they got them to do things like difficult public speaking, or like, um, doing, like, a tough kinda graduate exam. And they found that actually the kind of honest reappraisal of the feelings, like, not suppressing them, but just like, reinterpreting what they meant and, like, just questioning, like, "Are they actually detrimental or could they be useful?" That that in itself was enough to improve their performance, um, you know, on the public speaking, on the exam, kind of making them more creative, like, improving their numerical skills, um, reducing their anxiety. And it also just helped their- them to kind of recover from their anxiety afterwards. So, you know, like, if you've had, like, a stressful event, like, sometimes you can just feel exhausted for, like, the whole day afterwards. Like, you're, you're still kinda charged. Um, but for these people, they weren't. They just went back to, like, their normal life, you know, like, their body started, like, digesting their food properly again, you know, their heart rate returned to normal. Um, and that's really important for, like, the long-term effects of stress, 'cause if you can- if you have, like, a momentary, like, feeling of stress but then, like, recover quickly afterwards, that's not so damaging for your body in the long term.

   15. CWChris Williamson39:58

       It's the chronic stress that we're seeing that's super, super damaging to people. I have a-

   16. DRDavid Robson40:02

       Yeah.

   17. CWChris Williamson40:02

       ... a friend, comedian Bridget Phetasy, and she still gets very, very nervous before she goes on stage. And she's got a little mantra that she says to herself, she says, "I'm not nervous, I'm excited. I'm not nervous, I'm excited. I'm not nervous, I'm excited." And I have a (laughs) I have another friend, uh, very well-known DJ who frequently throws up before he goes to do a set, because that's how much he cares, because the nerves are in there. Um, and he n- (laughs) he's now told me that if he doesn't throw up before a set, he gets concerned.

   18. DRDavid Robson40:34

       (laughs)

   19. CWChris Williamson40:34

       He's more concerned if he doesn't vomit before he goes on than he does, because he's not sure if he's in the zone.

   20. DRDavid Robson40:40

       Well, I mean, that is extreme, but I totally can identify with that. And it's like, um, like you were saying about kind of, "I'm not nervous, I'm excited." Like, 'cause the ... what's happening in your body is, like, so similar, like, they're actually indistinguishable, like excitement and anxiety.

   21. CWChris Williamson40:55

       It's very much the story that you're telling yourself that is determining whether it is nerves or excitement.

   22. DRDavid Robson41:00

       Yeah. Exactly. And I think for most people it's a kinda combination. Like, you're kind of anxious, but you're also excited, both. And you're feeling both of those things because it's important to you. And it's almost just kinda recognizing that fact, that, like, you're doing this for a purpose. Like, most often people aren't forcing you to do this. You're doing it because you're ambitious, or 'cause you love to entertain or whatever. And just recognizing that fact, that you're kinda feeling these things for a reason, that can be really powerful.

7. 41:26 – 51:38

   Does Willpower Deplete?

   1. DRDavid Robson41:26

   2. CWChris Williamson41:26

      What was that study to do with people pretending to be fighter pilots?

   3. DRDavid Robson41:31

      Ah, yeah, so this was to improve, like, vision, which is kinda crazy. Um, yeah. So they took, like, people with kind of normal vision and some people who were a bit, kinda short-sighted, um, and they just kinda told them to pretend that you're a proper fighter pilot. So they gave them a, a sight test first of all, and then put them in this, you know, hyper-realistic kind of flight simulation. Um, while they were doing that simulation they had to kind of read off some codes from the wings of the planes that they were kinda flying around. Um, and what they found was that the people who were doing that kind of hyper-realistic simulation, that they actually, like, their eyesight physically improved. So they were able to see characters that were much smaller than they had been able to see on the kind of real sight test. Um, and then they repeated this experiment in other settings that they ... And one of them was just like they took the normal sight test, but, you know, it goes from, like, big letters to small, they just reversed it. Um, and the idea there was that we have this kind of association that the further down the test you go, the harder it is to see, but at the top you should be able to see. And again, they were able to distinguish characters that they hadn't been able to see before.

   4. CWChris Williamson42:43

      You looked at willpower as well, and I'd heard this-... I'd seen a story to do with... Was it Roy Baumeister that did the original willpower deb- degradation studies?

   5. DRDavid Robson42:55

      Yeah. Yeah.

   6. CWChris Williamson42:55

      Yeah, so I remember seeing a, a... how would you say? A prelude to the expectation effect a few years ago, when I was reading about the fact that, um... What's it- it's not willpower degradation. What's it called?

   7. DRDavid Robson43:10

      Um, ego depletion.

   8. CWChris Williamson43:11

      Ego depletion, that's it. Um, ego depletion seems to be present only in the people that know about ego depletion.

   9. DRDavid Robson43:19

      (laughs) Yeah.

   10. CWChris Williamson43:20

       Uh, so tell... What's the red pill that people need to understand about willpower?

   11. DRDavid Robson43:24

       Yeah, I mean, that is totally an upper expectation effect. Um, so yeah, what's interesting is that in Western culture as a whole, we've kind of had this assumption that, like, um, when you practice kind of mental focus or kind of, um, self-control, like when you're resisting temptation, that that is tiring, and that it's gonna... The more you do it, like, the harder it's gonna be, essentially. So, you know, and that's exactly what people like Roy Baum- Baumeister heard, uh, recorded. You know, like, it's, it is like a muscle that you're kind of tiring out, and the longer you do it, like, the more likely you are to kind of lose your focus or, um, uh, give in to temptation. Um, but then they did some studies in India where people don't share that cultural belief. So, actually, in India, it's much more common for people to think that, like, willpower is self-, uh, perpetuating. Um, it's almost like they think, like, once you get into the zone, it's, like, easier to kind of continue practicing your willpower. It's... Yeah, it's like a-

   12. CWChris Williamson44:22

       Which is equally plausible.

   13. DRDavid Robson44:24

       Yeah, totally, yeah. It's just like anything, like, um, once you get into the kind of momentum going, it kind of can continue. Um, and so then they did the ego depletion experiments with those people, and they found the total opposite, actually. Like, um, they didn't experience the ego depletion at all. Their willpower did indeed crease- increase the more they practiced it. So their focus was much better on a second task compared to the first task, 'cause they'd had this time to kind of warm up. Um, so that was really strong evidence that, like, yeah, it's totally due to our underlying beliefs about what's gonna happen to the brain. It's purely an expectation effect. There's no kind of biological cause for ego depletion.

   14. CWChris Williamson45:04

       Does knowing about the expectation effect or the placebo effect change the effect of it? 'Cause I don't know if we have created an information hazard for everybody who's listening now that could have blissfully stumbled upon the expectation effect and benefited from it, but now they know the fact that it's only a blah blah.

   15. DRDavid Robson45:22

       No, yeah, I mean the great thing is it's actually the opposite. Like, um, knowing about the expectation effect can actually make it more powerful in some way, and so we know this from studies of placebos. So, like, in a typical placebo experiment, you give someone a painkiller... uh, you give someone a dummy pill, but you tell them it's a painkiller. So it's like, you have to be deceptive. Um, but then scientists started, like, wondering, "Well, what happens if we actually just give people a jar of placebo pills labeled as, like, 'Placebo Pills: Take Two a Day'? Can that actually improve their pain just as well as the, uh, kind of surreptitious placebos?" Um, and they found that actually it can. So, in this study from Portugal, they were looking at people with chronic pain. They gave them, um, these pills, and they also ga- gave them this kind of explanation of the expectation effect. So, just a kind of grounding in, like, what happens with the mind-body connection, how the brain can produce its own painkillers, you know, all of that information. And then they just gave people these pills and told them to kind of take them twice a day. And they were really clear, like, "You must take the pills, even though they're dummy pills." Um, then five days later, they had seen a reduction in their symptoms already, that was about 30%, um, on the kind of standard score of pain. So that's the clinical threshold for any new treatment. Like, if a treatment's effective, you have to have a 30% reduction. And these people were experiencing that from open-label p- placebos, and they-

   16. CWChris Williamson46:49

       Bottle it, sell it.

   17. DRDavid Robson46:51

       Yeah, exactly. We need... we need more. And actually you can buy, like, placebo pills on Amazon, so (laughs) uh, like it's already available if you want it um... But actually, like, you know, that's fine, like, and if I had chronic pain I probably would take, like, open-label placebos. But actually there's just loads of other ways you can, like, um, increase expectations without kind of the sham treatments in medicine. So, you know, just like giving people psychological therapy where you kind of explain the importance of expectations, and then... So if they've had heart surgery you kind of just help them to kind of set out a kind of framework for, like, how they hope they will improve over the next six months. That can also bring about this kind of placebo-like response. So you still see kind of improvements in, like, biological measures, like the level of inflammation that they're experiencing after the operation, how quickly they leave hospital, you know, how quickly they return to work. All of that just through honestly helping people to change their expectations.

   18. CWChris Williamson47:48

       Wasn't there something to do with medicines where, um, people began to use genuine medicines and then, uh, they were either weaned off or the dose got reduced or something? 'Cause I imagine that must be... Let's say that you have a, a drug that's got a, a f- relatively toxic side effect perhaps, or there's a reason why you wouldn't want to be on it longer term. Um, you introduce it, you taper it down, that would be... You get both sides, right? You've been introduced to the experience, you've got that, um, set and setting almost, and then you, you dial it back, and, and people still get to benefit.

   19. DRDavid Robson48:24

       Yeah, I mean that's a really big hope for, like, treating opioid addiction, essentially. So, there have been studies looking at, um, kind of people in rehab from, like, um, terrible injuries. And, like, you do start out by giving them an opioid drug, but very quickly you kind of... You give them the drug, and then you give them the placebo pill as well, so they take both together. And you can strengthen it even further by kind of...... associating both with, like, a really strong smell, so like the smell of cardamom, for example. So, so you'd have, like ... You'd sniff the cardamom and you'd take the placebo and you'd take the drug. And then after a few days, you just stop or encourage them. You don't force them, but you encourage them. Like, "You don't need to take the drug anymore. Just take the placebo pill and the smell-"

   20. CWChris Williamson49:07

       Sniff the cardedem- cardamom.

   21. DRDavid Robson49:08

       Yeah. (laughs) Yeah, exactly.

   22. CWChris Williamson49:09

       So this is like a Pavlovian, like, uh, Pavlovian weaning.

   23. DRDavid Robson49:13

       Yeah. It's exactly that. And then what happens is the brain is already responding. It's been conditioned then, um, to produce its own opioids, and at a much higher level than it would without the conditioning response. And so that can really reduce, like, the amount of the active drugs that people take. And there have been, like, case studies where people have completely weaned themselves off the opioids, like, quite quickly just by using this technique.

   24. CWChris Williamson49:36

       What was the thing to do with peanut allergies?

   25. DRDavid Robson49:40

       Oh, yeah. Yeah. I mean, that was ... That's one of my favorite studies, 'cause I think it, again, it shows just how we're like ... We're talking about honestly reframing stuff rather than, like, being delusional. Um, so like, when kids have peanut allergies, you can actually train their immune system to stop responding, uh, to the peanut protein. And it's just like exposure therapy. So you start off with, like, a tiny dose of the protein, and then you build up over six months to a whole peanut. So by the end, you know, if a kid is at a party and they accidentally eat, like, a Snickers bar or whatever, they're not gonna be in danger having eaten that, because they've trained their body to deal with that. Um, but when, when the kids do this therapy, it's like really uncomfortable, you know, 'cause the body is starting to have like a mild allergic reaction as they increase the doses. So they get hives, you know, uncomfortable feelings in their mouths. They might feel sick. You know, all of these things that are frightening and kind of seem to be putting them in danger. And the researchers, like, just tried to get them to reinterpret how they saw those, uh, that discomfort. So they just said, "This is ... Rather than being dangerous, this is actually a sign that the treatment is being effective." It's like, in the same way when you're doing strength training, your muscles are gonna start aching. Like, you know, your ... This is a sign that you're stimulating the immune system and it's kind of learning and responding. Um, so at the end of the trial, those, uh, patients who had had that kind of training and reframing, they just reported fewer side effects, um, overall. So it had reduced their discomfort. But like, even more impressively, like it had also changed the, uh, efficacy of the treatment. So those kids were actually showing high levels of this, like, friendly antibody that can protect them from the l- overall, like, noxious, um, allergic reaction. It kind of just stops the immune system from overreacting. And they had much higher levels than the kids who, who hadn't learned to reframe these symptoms in that way.

8. 51:38 – 58:44

   Contagious Expectations

   1. DRDavid Robson51:38

   2. CWChris Williamson51:38

      Have you considered whether or not this, in part, accounts for some of the side effects we've seen with the recent vaccine rollout and the fact that people have ... I mean, has there ever been as widespread of a medication with as many, uh, disputed, disputable side effects, and then people reporting them and all sorts of stuff?

   3. DRDavid Robson52:00

      Yeah. Yeah. Yeah. I mean, totally. It definitely has had an effect. Like, um ... And you know, like, I think on social media you could see everyone kind of sharing their kind of war stories about having the vaccine and then, like, being knocked out for a couple of days or, you know, having a bad headache or whatever. So it was very much, like, contagious, these expectations. Um, so the studies so far showed that actually, you know, these vaccines are quite ... They s- definitely stimulate the immune system. So they do cause, like, for some people, about 25% of people, they do lead to those kinds of, um, uh, mild side effects. So things like fatigue, maybe having a bit of a fever, having a headache. You know, that's all kind of to be expected for like half ... uh, for 25% of the people t- having the vaccines. But actually, in the, um, in the trials, you saw that the people receiving the placebo injections were also (laughs) , um, quite likely to have those side effects too. So about half as many people had those side effects in the placebo trials. So we know from that, that yeah, like, the vaccines themselves were causing some of these, like, um, slightly uncomfortable side effects, but the expectations were causing it for a, a large number of people too.

   4. CWChris Williamson53:12

      And there was that thing at Gatwick Airport, which I remember from a few years ago, where it was all over the press and the entire airport was shut down and people were saying that there was drones absolutely everywhere. But you reckon that might be an expectation effect as well?

   5. DRDavid Robson53:26

      Yeah. (laughs) I mean, that was ... So yeah, like in 2018, you know, I think just one person reported a drone, and then, like, within a couple of days, like, hundreds of people said they'd seen them. Um, but like, the police and the army were using like, you know, radar. (laughs) Like, they were, you know, using all their technology to kind of detect where these drones were, and like, they couldn't find a single one, and no one took a photo of a drone that could be verified.

   6. CWChris Williamson53:51

      That's it? There was no footage. It didn't-

   7. DRDavid Robson53:53

      Yeah.

   8. CWChris Williamson53:53

      ... appear on any radar. It wasn't on any of the equipment, and yet you had this cascade of reports coming in.

   9. DRDavid Robson54:00

      Yeah. So it just seems like it was ... Yeah. Like a contagious expectation effect. And so we know that the expectations can shape perceptions and that ... It's like it was priming people to see a drone when, like, there was nothing in the sky.

   10. CWChris Williamson54:14

       This would be interesting to look at if there was a similar sort of event happening again. What you would presumably expect in terms of the number of reports would be like a normal distribution curve.

   11. DRDavid Robson54:26

       Mm-hmm. Yeah.

   12. CWChris Williamson54:27

       So you would have one, a few, a few more, a few more, a few more, a peak-

   13. DRDavid Robson54:31

       Yeah.

   14. CWChris Williamson54:31

       ... and then it would begin to tail off. I wonder if you mapped those onto a distribution-

   15. DRDavid Robson54:37

       Yeah.

   16. CWChris Williamson54:37

       ... about whether or not it would come back like that. That would be interesting.

   17. DRDavid Robson54:40

       Yeah. I mean, I think anecdotally from what the police had reported, it did seem like that with Gatwick, in that you did start out with just one, and then within a couple of hours there was ... might be another person had seen it. But then as it kind of got into the media, you know, and was spread around the airport, like, yeah, you saw a rapid increase. And like, there can't have been that many drones around. Like, it would've just been impossible. So I mean-... you can never rule out the possibility that maybe the first report was genuine. But definitely, like, the airport didn't need to be closed for, like, three days and, like, disrupt all of those holidays. Like, yeah.

   18. CWChris Williamson55:14

       One thing that you said earlier is something I've been thinking about a lot recently, which is this sort of culture of generalized cynicism that we've got at the moment.

   19. DRDavid Robson55:21

       Yeah.

   20. CWChris Williamson55:21

       And when you realize... Y- y- you are right. There's something... People think of it as more rational, more cool almost, to be cynical and, and sort of blunt about most things. You see this m- like, in its extreme on the internet. No one is excitable on the internet. Everyone's-

   21. DRDavid Robson55:46

       Right. (laughs)

   22. CWChris Williamson55:46

       ... playing, like, a Louis Theroux persona. Um, and, yeah, when you think about the fact that that cynicism and the sort of public messaging that we have, and then the social me- like, top-down public messaging and then the bottom-up social messaging that people see, literally could be making people more sick, more fat, less healthy, stupider, with side effects from... Uh, you know, it's everything. Cynicism, cynicism genuinely is kind of like a disease or a virus.

   23. DRDavid Robson56:18

       Yeah, it totally is. And like, what really annoys me is it's like, um, if you're being like, like people think it's, like, super smart to be skeptical. But actually being reflexively skeptical and just not believing anything good, like, to me, that is, like, just as bad as being-

   24. CWChris Williamson56:33

       Oh, it's just as stupid, yeah.

   25. DRDavid Robson56:35

       Yeah, exactly, as being totally gullible. It's like you're doing exactly the same thing. It's just you're taking the opposite viewpoint. Um, so yeah, that drives me crazy and especially, like I say it a lot with like, um, you know, like as a science writer, like, amongst my colleagues actually, it's kind of quite fashionable to always be, like, super skeptical of any new and exciting result. But it's like, that's not, that's not being, like, a better journalist or like a more skeptical thinker. That's actually just, like, kind of virtue signaling almost, or yeah, like trying to prove your intelligence without applying your intelligence.

   26. CWChris Williamson57:09

       The programming is just as simplistic. It's just moving in the opposite direction. You haven't thought about it either. You haven't considered it either. You're just-

   27. DRDavid Robson57:17

       Yeah.

   28. CWChris Williamson57:17

       ... taking a heterodox position in the hopes that this makes you seem cool. And so, let... What about the ethics then? Do you think that there's an ethical concern around deceiving somebody or deceiving other people, even if it's in the service of making their outcomes in life better?

   29. DRDavid Robson57:35

       Yeah, no, I do see it as, like, a big ethical issue to like, um, deceive people. Um, and I think, like, in medicine, you know, like, um, it's why these open-label placebos, like the honest placebos are so important because I think if you start deceiving patients, um, and then they find out they've been deceived, um, then they're going to lose, like, a lot of faith in the medical profession, and then that's gonna cause, like, problems further down the line. So, I think we have to... like, you just have to be honest for like the ethical reasons. But then I actually think, like, when we know that you can apply the expectation effect honestly without any kind of problems anyway, like, there's no need to be deceptive really. Like, you... it is enough often just, like in l- so many of these studies, it's enough just to kind of, like, tell people about the science. Like, you just give them, like, a kind of, you know, popular science article that kind of explains how, like, stress can be beneficial to you, or you know, how you can reframe the feelings of, uh, exercise and that that can improve your performance. Like, you know, very kind of plain, like, not deceptive at all. Just that information is enough. Like, the knowledge is power in these cases. So yeah, I don't think we need to worry about deception anymore.

9. 58:44 – 1:04:41

   Applying the Expectation Effect

   1. DRDavid Robson58:44

   2. CWChris Williamson58:44

      Are there any effects that run counter to the expectation effect? Are there any things that you found... I think you mentioned something to do with, uh, constantly following happiness as a, uh, uh, actually can make people less happy, which seems to kind of run in the opposite direction. Were there any others?

   3. DRDavid Robson59:02

      Yeah, I mean, that's, uh, that's the main one, I think. And yet it's kind of like, it makes sense. I mean, so it's like counterintuitive, but it's like if you're, um, always trying to be happy, like, the kind of converse of that is that you're actually then, like, demonizing the negative feelings you might be having or the uncomfortable feelings you might be having. So it kind of is like, um, an expectation effect in that it's like, if you want to be so happy, but you think that anytime you feel frustration or anxiety it's a disaster, you're kind of then setting yourself up to, like, experience those emotions, um, a lot more negatively and to kind of, for them to have a bigger impact on your life. Um, but yeah, it is... I think, like, the simplistic view of the expectation effect would just be it's like, tell yourself to be happy and you will be happy. But yeah, that doesn't happen. Um, so yeah, I think we have to be careful to ha- kind of have the, to kind of outline the limits of the expectation effect and the nuances. It's, it's not always as simple as just kind of hoping for the best, you know? Um, I also just think we have to be honest about the fact that like, say in medicine, like say you've got, like a terminal illness or you know, like, just improving your expectations isn't gonna help you to get better. For- like, sometimes the expectation effect just... there's no physiological mechanism by which it could help you to, to kind of benefit from the expectation effect, essentially. So we, we just have to be careful to be honest about kind of when it does work and when like, you're not gonna expect to see, like, the full benefit.

   4. CWChris Williamson1:00:35

      Is one of the most important things here, um, information or people's understanding or knowledge around whatever the experience is that they're going through? So for instance, um, talking about going to the gym, the understanding that one of the byproducts of going to the gym is going to be you sweating and you lifting, you, you feeling aches in your muscles and stuff like that. That knowledge enables the reframing, right? My point is, is there a-... the, i- it seems like one of the first steps to becoming effective at the expectation effect is an, a degree of understanding or knowledge around the specifics of whatever it is that you're trying to get the effect to work on. Is that right?

   5. DRDavid Robson1:01:20

      Yeah, it totally is. Yeah, exactly. So, it's like, yeah, with, like, exercise, it helps for you to understand, like, the exercise physiology that are, and to understand why you're feeling these things. 'Cause otherwise, it's really easy for you to be, like, um, to catastrophize those feelings if you don't understand the science of, kind of, why they might be beneficial to you. The same with stress, like, you feel the discomfort and if you don't understand, like, some of the basics of the science of, like, why we have the cortisol s- uh, spike at all, um, then yeah, all you're gonna focus on is the negative feelings and not necessarily on h- why it might be useful. So, yeah, I, I really do think actually it's, like, just a bit of scientific literacy in all of these areas can go a long way to helping you to reframe your expectations.

   6. CWChris Williamson1:02:03

      That's one part of it, right?

   7. DRDavid Robson1:02:05

      Yeah.

   8. CWChris Williamson1:02:05

      What I, what I want to try and get out of you is, what are the common strategies, if people want to effectively apply the expectation effect, which aren't contingent on specific knowledge about the thing that they're trying to, to use it on? You know-

   9. DRDavid Robson1:02:22

      Mm-hmm.

   10. CWChris Williamson1:02:22

       ... reframing and all of that stuff, what are your, uh, what's the, the best framework that you've come up with that people can take away?

   11. DRDavid Robson1:02:29

       Hmm. Yeah, I mean, there's definitely some things that I think you can do that, like, whatever challenge you're facing, it's, they're gonna help you to form better or more objective expectations. Um, and my favorite one is really this process called, like, self-distancing. And so th- it was developed by Ethan Kross at the University of Michigan, kind of, independently from the expectation effect. But, what he had noticed is that if you, the way you talk to yourself is often really different from the way you would talk to a friend. So, you're much more self-critical and much more negative when you talk to yourself, compared to if you're advising someone who's in exactly the same position. Um, and so his solution to that is just to imagine that you're advising your friend, like, when you're talking to yourself. And you can even use, like, the third-person, kind of, language. So, you can be, like, I could be like, uh, you know, it sounds stupid, it sounds like Elmo from Sesame Street or whatever, but it could be like, um, uh, you know, like, (laughs) "David's worried about," I don't know, like, um, getting older, David feels that hi- (laughs) he's gonna be, like, vulnerable and, uh, you know, get, suffer from decline. You know, all of that. Um, but the fact is, like, if you were talking to yourself, you might be like, looking in the mirror, see some wrinkles and be like, "Oh, God, I look hideous. This is awful." Like, "It's only gonna get worse." If you were talking to a friend, li- you would be like, "No, you're still fine." Like, um, "There's still lots to look forward to." Like, you know, "Don't be so defeatist," like, "You can still grow. You can still..." like, "There's still stuff that you can do and achieve," like, "as you're getting older." Um, and so yeah, I think that's just something that I've found super helpful, like, whenever I am, kind of, wrestling with, like, needlessly negative expectations, it's just to kind of shift perspective and think, like, would I actually talk to other people and, and, like, tell them the things that I'm telling myself?

   12. CWChris Williamson1:04:20

       And that's use the third person with an, in a monologue-

   13. DRDavid Robson1:04:24

       Yeah.

   14. CWChris Williamson1:04:24

       ... and also imagine that you were saying it to somebody else?

   15. DRDavid Robson1:04:27

       Yeah, exactly. And treat yourself with the, kind of, compassion that you would treat someone else, basically, so.

   16. CWChris Williamson1:04:34

       David, this is great. Now this is a really, really cool effect. I'm very, very glad that you've written the book. If people want to see what you do, where

10. 1:04:41 – 1:05:20

    Where to Find David

    1. CWChris Williamson1:04:41

       should they go online?

    2. DRDavid Robson1:04:42

       Uh, so my website is davidrobson.me. Um, I'm d_a_robson on Twitter. Um, I'm on LinkedIn. Yeah, but I mean, basically Twitter or my website are the best place.

    3. CWChris Williamson1:04:57

       Dude, I really appreciate you coming on today. Thank you.

    4. DRDavid Robson1:04:59

       Cool. Yeah, it's been my pleasure. Thanks.

    5. CWChris Williamson1:05:01

       What's happening, people? Thank you very much for tuning in. If you enjoyed that episode, then press here for a selection of the best clips from the podcast over the last few weeks. And don't forget to subscribe. Peace.

Episode duration: 1:05:20