Can Mindset Improve Your Health?

What Is Neuroplasticity and How Does it Work?

Ever since “brain training” became popular, there has been a lot of confusion about what the intervention is and how it works. Many people believe that brain training—neuroplasticity-based practice in particular—is a purely psychological intervention and those who advocate for it are dismissive of the biomedical reality of serious chronic complex diseases.

Patients who suffer from debilitating biomedical conditions are outraged by the perception that their lived experience is being reduced to a psychological problem that they could “think their way out of.” These conditions include myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), environmental sensitivities (ES), and long COVID—to name only a few. Add in postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), chronic Lyme disease, and cranio-cervical instability (CCI), and you have quite a lobby against neuroplasticity-based approaches.

I have been among these skeptics. As a scientist who relies on research-based evidence to mold my views, I didn’t think what I believed could change my biological reality. I remember thinking: “Show me the evidence.” When I first started hearing about people improving using neuroplasticity-based interventions almost 15 years ago, it didn’t make sense to me. I thought, how could changing thoughts and behavior change long-standing, disabling medical symptoms? I wondered whether these people were really as ill as I was or as they claimed they had been. Could these strategies help people with bonafide biomedical conditions?

Luckily, when I don’t understand something, I’m motivated to learn more. This often involves trying it for myself. So, I attended a program, and very quickly, some of my life-long sensitivity symptoms decreased. They have remained in remission for 10 years. My curiosity to learn more increased. My long-standing beliefs had just been disproved, and I wanted to know why. So, I embarked on a deep dive into the field, attending other programs, reading dozens of scientific articles and books, attending conferences, and talking to people who had lived experience with neuroplasticity-based programs.

Principles of Neuroplasticity

The first turning point for me was understanding how the brain works:

• New neural connections are continually being created and destroyed based on lived experience
• The brain treats all experiences the same, whether they are thoughts, feelings, or actions.
• We have the capacity to direct changes in our own brain.

A window of understanding started opening for me once I understood these two things:

(a) substantive changes to the brain structure and function are possible, and
(b) we can influence those changes in a goal-directed manner.

But there is more . . .

Why Doesn’t Neuroplasticity-Based Practice Work for Everyone?

Just because changing the brain is possible doesn’t mean it is easy or straightforward. As a medical doctor, I work with thousands of people and they don’t all respond in the same way. I’m always interested in why interventions work better for some people than for others, for some symptoms than for others, and in some circumstances than in others. It was this important question that motivated me to keep learning: Could something be getting in the way of progress for some people, and if so, what was it?

Neuroplasticity and Mindset

Mindsets are mostly unconscious ways of viewing our world that shape what we expect to happen. They’re the mental tapes running in the background of our brains. They consist of our beliefs about virtually everything, including what outcomes we think are possible with respect to health, finances, relationships, happiness, and so on. Although I understood how changing my thoughts, feelings, and behaviors could rewire my brain, I didn’t yet grasp how beliefs I wasn’t even aware of might be affecting my health and life.

In this blog, I share a few of the studies that convinced me that mindset is real and impacts our health and happiness on a daily basis. If it’s true that mindset can impact biology, then negative beliefs can cause negative consequences and positive beliefs can cause positive consequences. Therefore, if I want to be healthy and happy, l need to:

• be aware of the power of mindset;
• learn how to observe my own mindset;
• evaluate whether my mindset is aligned with my life goals; and
• learn to change my mindset so that it can be my ally.

Examples of the Power of Mindset

I will share with you some striking studies demonstrating the impact of mindset on aspects of biology beyond conscious control. Be prepared to be amazed.

1.  The Smokers’ Study
This innovative study measured the impact of perceived nicotine dose on the brain function of smokers. A group of smokers were given an electronic cigarette and told that it either contained a low, medium, or high level of nicotine. In reality, the nicotine dose was the same for all the participants. After vaping the e-cigarette, the participants were asked to perform a decision-making task known to activate a part of the brain called the thalamus, which has a lot of nicotine receptors. The smokers who believed they were getting higher levels of nicotine had more activation in this part of the brain as measured on functional MRI. The thalamus is a deep brain structure over which we have no conscious control. It influences incoming information, including signals that can trigger pain responses by the brain. The results showed that the brain activity correlated with the perceived dose of nicotine given rather than the actual dose. To sum up, people who thought they’d inhaled higher doses of nicotine had higher levels of brain activation in a part of the brain known to be activated by nicotine.

2. The Housekeeper’s Study

What about aspects of function that are especially relevant to people with chronic complex diseases such as myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), environmental sensitivities (ES), and long COVID? For many of us, the ability to be active and the impact of our activity, or the lack thereof, on our health are central to our quality of life. This study measured the impact of mindset about exercise on health. The researchers noted that hotel housekeepers are physically active during their workdays vacuuming, lifting bags of laundry, cleaning, and so on. Despite this, many housekeepers believed that they weren’t very active or that their activity wasn’t beneficial because they didn’t have enough energy at the end of the day to work out at a gym.

A group of hotel housekeepers (mostly Latina women) was divided into two groups. One group was given information about:

• the number of calories burned by their typical work activities;
• the amount of activity they did each day being above the recommendation of the United States Surgeon General; and
• their activity levels being considered “good exercise.”

The control group was not given the information that their daily work qualified as exercise.

Four weeks later, all of the housekeepers were

• asked how much exercise they got during their workday; and
• measured for weight, body fat, blood pressure, waist-hip ratio, and body mass index (BMI).

Neither group of housekeepers changed the amount of exercise they did. Nevertheless, the housekeepers who were told their physical activity level was beneficial perceived they were getting more exercise (change of mindset). When measured, they had lost weight, had lower blood pressure, and decreased body fat. In this experiment, the only thing that differentiated the two groups was the information about the benefits of their workday exercise. This information affected their mindset of perceived exercise and changed several important health indices even though neither group changed their activity levels

3. The Sleep Study
What about sleep? Refreshing sleep or the lack thereof is central to all chronic complex diseases. We’re constantly bombarded with “helpful” public health messages telling us that every aspect of our health suffers without sufficient sleep. We are told insufficient sleep causes problems wthinking clearly, weight gain, and risk of diabetes, heart attack, and even dementia. Are there any unintended consequences of being told the negative outcomes of insufficient sleep when one has a serious, difficult-to-solve sleep problem? Through many decades of illness, I had a strong belief that my poor sleep significantly impaired my ability to function. Unfortunately, I passed this belief on to many, many patients. Is this belief true? And if it is, generally speaking, is it always true on an individual, daily basis? 

In a clever study, the impact of people’s beliefs about how much sleep they got was measured. Subjects were asked to rate how well they slept the night before they attended the research lab. Then they were hooked up to a fancy machine. They were told the machine could accurately measure how much rapid eye movement (REM) sleep they had gotten the night before. In fact, the machine was a sham and didn’t measure anything. After the “testing,” the subjects observed the experimenters making complex calculations to determine their percentage of REM sleep. The subjects were then randomly told either that they had gotten more than average or less than average REM sleep the night before. The “assigned” REM amount was sometimes similar to how participants rated their own sleep and sometimes different. The subjects were told that getting enough REM sleep was important to be able to think quickly and clearly. After being provided with this information, all of the subjects were given difficult tests of concentration and memory.

The subjects who were told they had gotten more than average REM sleep the night before performed better on the cognitive tests than those who were told they had gotten less than average REM sleep. The performance of the people who were told they had an above-average REM sleep was in the normal range for healthy adults. The performance of the people who were told they had had less REM sleep than average performed as if they were sleep-deprived.

The ratings of sleep quality that participants had given themselves had no impact on the cognitive tests. These results suggest that information from an authoritative source —with a show of fancy machinery and complicated calculations — impacted the mindset of the participants.

Is Stress Always Bad for Us?

Generally, stress is talked about in negative terms. We are told that stress increases the risk of death and disease and causes mental illness and relationship problems. All of these negative impacts are research-based. An emerging field of research, however, suggests that having a mindset of stress being harmful may actually contribute to its negative impacts. If true, this is unfortunate because, just like death and taxes, none of us can avoid stress. Could there be another way to think about stress? One that could lead to a better outcome?

In its simplest form, stress is the body’s reaction to changes in food intake, temperature, activity, or danger. These stress responses ensure our survival. When we perceive a threat, our stress response increases our arousal and enables us to focus on the problem to find a solution. Although rarely talked about in the mainstream media, in the short term, stress improves our cognitive function and can increase mental toughness and a sense of mastery, deepen relationships, and lead to a greater appreciation for life.

How to Make Stress Work for Us Rather than Against Us

So, given these different research findings, what determines whether stress will be harmful or helpful? We all know of situations, such as childhood neglect or abuse, where the outcomes are very dire. Is there some threshold above which stress is just too much for most people? Some authors suggest that there are no absolutes when it comes to stress. They also suggest that the outcome may depend on the balance between the amount and type of stress and the person’s resilience and ability to cope with a particular stressor.

Mindset about stress has a big impact on our behavior. For example, if we believe that stress is harmful, we’re likely to take measures to avoid it. This is universally found to be ineffective, especially since none of us can avoid all stressors. Stress is a part of life. On the other hand, if we have the mindset that stress could challenge us to rise to the occasion and increase our knowledge and skill level, we’re more likely to accept stress when it happens and look for opportunities for growth and learning.

It has been shown that people who view stress negatively have a less optimal biological response. They either become over-aroused — such as becoming frantic or scared — or they freeze and fail to act in a way that might be beneficial. Conversely, people who realize the opportunities that stress may afford them are more likely to have a moderate arousal level providing enough energy and focus to problem-solve and, if necessary, protect themselves.

The Good News: Our Mindset about Stress Can Be Modified

If our mindset about stress influences outcomes, can we change it for the better to help people have better outcomes when faced with stressors? Dr. Alia Crum, a Stanford psychology researcher, assessed whether people’s mindsets about stress could be altered through short video presentations. Participants in the study were shown three videos in a week talking about the effects of stress on health performance, learning, and growth. Half the subjects were shown videos explaining the general belief that stress is debilitating. The other half were shown videos that stress can be enhancing. She found that the subjects’ mindset was easily changed. The people who were shown the videos explaining the benefits of stress changed their beliefs. In addition, they reported feeling better psychologically and having better performance at work after the intervention.

Dr. Crum then designed a study to measure the cortisol levels in people who were exposed to the artificial stress of being asked to give a presentation in which they were going to receive (potentially critical) feedback. A mindset that stress could be beneficial moderated cortisol responses to the experimental stress. People with a pre-existing positive mindset about stress had a moderate cortisol response to the experimental stress. Taken together, the two studies show that stress mindset influences how stress is experienced psychologically and biologically, and that a relatively simple intervention can change people’s mindset about whether stress is harmful or helpful.

Can a “Stress Is Enhancing” Mindset Improve Health? 

This information is extremely helpful to those of us who suffer from chronic health conditions and who experience many stressors outside of our control. I’ve worked with many patients who dreaded stress and felt that it was preventing them from moving ahead with their health and their lives. Alternatively, others, appearing from the outside to have equally challenging life circumstances, didn’t dread or avoid stress but rather seemed to meet it head-on and look for solutions. Looking back, it’s this second group who did better overall. At the very least, they seemed more content and more accepting of their circumstances, in less psychological distress. Just because stress can be an opportunity for people to increase resilience and skills, it doesn’t mean we should seek stress. Rather it suggests that we may not need to use so much energy trying to avoid stress.

Could Mindset Be Helping People with  ME/CFS Recover?

Could research on mindset provide clues about why more people with ME/CFS and related diseases seem to be recovering? For years and decades, the only messages I received from researchers, healthcare professionals, and others with ME/CFS and related conditions were that ME/CFS and related disorders were incurable chronic conditions and that there was nothing I could do to get better. I wonder now what impact that pessimistic mindset had on my health. I wonder whether I could have recovered sooner if I had believed that recovery was possible. We don’t yet have effective, evidence-based treatments for ME/CFS, FM, ES, or long COVID.

So, we can’t attribute the recovery trend to biomedical advances. Listening to recovery stories, I hear a common thread. Many people who recover come to believe — often through listening to other recovery stories or taking courses teaching that recovery is possible — that even if they are severely ill, there is hope. We’re now told that if we think and respond differently to our symptoms, we can shift them. Could this shift to a more hopeful mindset explain the increase in people who are recovering? Understanding the science of mindset makes this idea scientifically plausible.

Since my health has improved, my mindset has changed. I have increasingly communicated a recovery mindset to my patients and followers, and I have observed many more of them
achieving improved health since I have been able to support their hopefulness.

Biology and Mindset Work Together

For clarity, none of us became ill because of our mindset. We became ill because of biological triggers like infection, accident, surgery, pregnancy, trauma, sleep deprivation, and more. It is disrespectful of our lived experience and just plain incorrect to reduce anybody’s experience to one caused by or perpetuated by mindset alone.

However as described by Dr. Alia Crum, one of the leading experts in the field, mindset and biology are not mutually exclusive. Both are true, and they work synergistically. People want and need to learn more about the biomedical abnormalities they experience. And, of course, they should avail themselves of all appropriate medical interventions that might help improve their health. Sadly, there are far too few effective interventions, and many exciting discoveries are years away from being available to the average patient. The studies I shared in this blog showed that mindset affects biology. A mindset that improvement is possible can strengthen the outcomes of biomedical and self-management strategies we may try. We don’t yet know exactly how mindset impacts biology, but we know it does.

4 Steps to Make Mindset Work for You

Given this new information, I suggest a mindset practice.

1. Become aware of your mindset without judgment. What are your beliefs about the activities or experiences you are having? Do you believe the experience is positive or negative? Do you perceive an experience as a stress or a challenge?
2. Why do you care so much about this experience? Once you have identified the underlying issue, how could you address it proactively?
3. What can you do to improve your ability to cope with, learn from, and get stronger from this experience?
4. If you have negative beliefs about your health and your future, are they true? Are there any alternative possibilities? For example, if you have a bad night’s sleep, is it possible you could still function the next day? Are there others with similar histories as yours who have improved or recovered? Could you rehearse a more optimistic belief to create new neural pathways, new beliefs, and new habits aligned with the life you want to create?

References

Crum, A. J., & Langer, E. J. (2007). Mind-Set Matters: Exercise and the Placebo Effect. Psychological Science, 18(2).

Crum, A. J., Salovey, P., & Achor, S. (2013). Rethinking stress: the role of mindsets in determining the stress response. Journal of Personality & Social Psychology, 104(4), 716-733.

Draganich, C., & Erdal, K. (2014). Placebo sleep affects cognitive functioning. Journal of Experimental Psychology: Learning, Memory, & Cognition, 40(3), 857-864.

Ofer, P., Anastasia, S., Matthew, H., Soojung, N., Ambereen, K., Natalie, B., . . . Xiaosi, G. (2023). A thalamic circuit represents dose-like responses induced by nicotine-related beliefs in human smokers. bioRxiv, 2022.2007.2015.500226.

Alia Crum podcast https://www.gsb.stanford.edu/insights/mindset-matters-how-embrace-benefits-stress