Research supports the observation that mindsets shape health outcomes and providers shape mindsets. Here is a sample of the evidence we used while developing this training.
Mindsets Shape Health Outcomes
The placebo effect, which can be attributed in part to the mindset that one will heal or receive benefit from a treatment, leads to clinically significant outcomes in most conditions. These include pain, anxiety, depression, asthma, allergy, hypertension, immune deficiencies, endocrine deficiencies, Parkinson’s disease, some cancers, and recovery from surgery (e.g., Price et al., 2008; Finniss et al., 2010).
Mindsets about how much exercise we’re getting influence the benefits we receive from that exercise. For example, female hotel room attendants who were informed that their work is good exercise experienced significant decreases in weight, body fat, body mass index, and a 10 point drop in systolic blood pressure, despite not increasing their workload or engaging in additional exercise (e.g., Crum et al, 2007).
Active medications are not as powerful when delivered without the mindset that the medication is going to work. For example, patients experienced significantly greater pain relief from morphine when they were aware of receiving the morphine than when the morphine was administered without patient knowledge. Similar effects been shown in treatment for anxiety, Parkinson’s, and hypertension (e.g., Benedetti et al., 2003).
Mindsets about the food we eat influence the way our bodies digest that food. Study participants consumed the same milkshake at two different times, described as either a “sensible,” low-calorie milkshake or an “indulgent,” high-calorie milkshake. Participants saw a threefold greater decrease in ghrelin, a gut peptide associated with satiety, when drinking the milkshake described as “indulgent” than when drinking the “sensible” milkshake. In other words, when participants thought they were eating indulgently, their bodies responded as if they had consumed more calories (e.g., Crum et al., 2011).
Specific treatment mindsets trigger distinct brain regions and physiological responses. For example, the expectation of pain relief from placebo anesthesia activates endogenous opioid systems. The expectation of anxiety relief from anti-anxiety placebos activates the anterior cingulate and orbito frontal cortices as well as autonomic nervous system processes such as heart rate and blood pressure (Price et al., 2008; Finniss et al., 2010).
Mindsets about illness and the body influence health and wellbeing in patients with chronic illness. For example, in a study of patients with chronic illness, those who viewed their illness as manageable and their body as capable had better life satisfaction, perceived health, and functioning than patients who saw their illness as a catastrophe or their body as to blame for their illness (Zion, Dweck, & Crum, 2021).
Providers Shape Mindsets
A positive patient-provider relationship can improve not only patient satisfaction, but also patients’ physiological health. For example, studies have demonstrated that a warm and trusting patient-provider relationship leads to better outcomes for diabetes patients, reduced cold severity and duration, and can even improve surgical outcomes and reduce the need for painkillers after surgery (e.g., Levinson, 1994; Hojat et al., 2011; Rakel et al., 2011; Pereira et al., 2016).
The patient-provider relationship can shape patient health outcomes to an equal or greater degree than other significant health behaviors. For example, a meta-analysis examining the power of the patient-provider relationship found that the effect size of the influence of the patient-provider relationship on health outcomes was greater than the effect size of the influence of smoking on male mortality over eight years (e.g., Kelley et al., 2014).
Warmth and Competence
Providers who display both warmth and competence – demonstrating to patients that they understand both medicine broadly and the patient specifically – are more effective in setting expectations for patients. For example, when physician warmth and competence were manipulated in a laboratory study of allergic skin response, allergic reactions improved or worsened based on physician suggestion only when the physician was high in both warmth and competence. When the physician did not display warmth and competence, what she said about the treatment in question – whether it would make the allergic reaction better or worse – made no difference (e.g., Howe, Goyer, & Crum, 2017).
Patient interactions with providers can be therapeutic in and of themselves, even in cases where no medical or pharmacological treatment is prescribed. For example, a recent study found that a one-sentence assurance from a healthcare provider was enough to significantly reduce itch from an allergic reaction, even absent any medical treatment (e.g., Leibowitz et al., 2018).