There's pessimism. There's optimism. Then there's another, lesser explored but deeply significant state — expectation. That feeling of knowing, or believing we know, what's going to happen. And while wishing doesn't make things so and doomsday predictions don't bring about bad luck, there's no denying that our mindsets can profoundly impact our outcomes.
UK science writer David Robson's "The Expectation Effect: How Your Mindset Can Transform Your Life" is a fascinating exploration of the ways in which our brains can sabotage or save us in our most challenging moments. Robson, who previously wrote "The Intelligence Trap," draws on meticulously researched and reviewed scientific data to show the power of our minds to quantifiably affect our physical and mental health. In the process, he proposes that harnessing its resources can help us sleep better, eat better, and even age more slowly.
Doing so is not about miracles or magical thinking. It's about making the best of what we're dealt, and training our brains to recognize, as Robson says, the difference between what's "dangerous" and merely "unfamiliar."
Salon talked to the author via Zoom recently about the impact of expectation, and how little shifts can make big differences in our lives.
This conversation has been lightly edited and condensed for clarity.
Let's start with what we mean when we say "expectation." You say early on that it's different from typical big-picture optimism and pessimism.
The expectation effect is about how we can create self-fulfilling prophecies, in which our beliefs shape our behavior, our perception, and our physiology. In general, the positive thinking movement has been very vague. It's been this idea of the law of attraction. You feel good, you think good things, good things will come to you. This is very different from that, because I'm talking about our specific expectations about specific events or situations or phenomena.
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Traditionally with positive thinking, you might have been told to imagine that you're not stressed. "Tell yourself you're relaxed. Say a mantra, visualize." But what we're saying here with the expectation effect is, don't try to change the way you're feeling, because often that's impossible. You can change the way that you interpret your stress — whether you see it as this wholly negative thing, or whether you accept that it's unpleasant but can also serve a useful purpose. By having that mental shift, which I think is much more manageable for most people, that that can have profound effects on your lives and can improve your mental and physical health.
Let's talk about the evidence for these expectation effects, because it's compelling. It's not, "If I think about things differently, then I'll have different outcomes."
The evidence base is so big now that we almost need to stop thinking about the mind-body connection as this magical, mystical thing, and accept it and think more carefully about how we can use that and apply it practically. We're really at that point of the research. The foundation of all of this comes from the research on the placebo effect, which scientists have been studying seriously for about 70 years now. That's a huge body of evidence. I would be surprised if any scientists now denied that the placebo effect exists — that it's important and that it can produce real physiological change in patients.
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What's happened really in the last 10 years is that people have taken this out of the clinical settings. We've started to realize that placebo-like responses and nocebo-like responses — the negative, opposite of the placebo effect, they're not just happening when you're in hospital or when you go to a doctor's surgery. They're affecting you in every area of your life — exercise, diet, sleep, even how we age. We're seeing the same physiological mechanisms are affecting us in all of these areas.
What are the limitations? When we talk about these placebo effects, in terms particularly of pain relief or antidepressants, what is and is not possible?
What I find really frustrating with a lot of this previous conversation about the mind-body connection, is that it's often treated as if it's an alternative to scientifically proved, evidence-based medicine. It's not. It should never be considered that. It's another important tool that doctors and patients can use to improve the outcomes of surgery, or of taking antidepressant pills, taking any kind of medication. Changing our expectations about side effects could even reduce some of the side effects you have from the COVID vaccine. That's what I really see it as, something that we need to be considering to make the most of the effects of all of these other measures that we know have been proven.
That's why the book is really based on such solid scientific evidence. I have more than 450 citations of peer-reviewed papers. I've been really careful to only mention the things that have been proven with good scientific studies and that form this larger body of research. I've tried to pick apart what works, and ignore all of those grander claims that haven't been proven. All of the things that I cover have a plausible physiological mechanism.
A lot of it is about how the brain is altering the expression of hormones. For example, when you feel stressed or when you feel anxious about surgery, we know that these things are happening to patients already, whether or not you try to apply the expectation effect. The expectation effect is teaching us how to do that systematically for our own good, rather than maybe suffering from the negative expectation effects that have been ignored previously.
It's a tricky line to walk. We want to acknowledge and respect people's pain and experiences, while also setting them up for success. How do we do that in a way that is sensitive?
A lot of the positive expectation effects that doctors and healthcare providers can create, come from explaining the science behind the treatments. Knowledge is power in that way. There's a study that I absolutely love of these kids who had bad peanut allergies. They were going through this immunotherapy program where you increase the dose of the protein from very small to a whole peanut by the end of the six months. The idea is training the immune system to learn to deal with this protein without having a full on allergic reaction.
Along the way, a lot of these children do suffer some side effects. Their body is responding to the protein with some kind of moderate allergic reaction. They still might get hives, or they might get a kind of funny sensation in their mouth. They might feel a little bit unwell as they're building up their strength against the protein. What they researchers did was tell them to reinterpret those sensations. They told them that in the same way that when we exercise, our muscles start aching as we build strength, all of the things they were feeling are a sign that their body is responding to the protein, and that the treatment is working essentially. That it's building up the strength of the immune system.
They weren't trying to get the patients to deny what was happening. They were telling them an objective truth, that is what was happening in the body. But by understanding that and changing the interpretations, the children stopped seeing those side effects as being so scary and saw them as something that could be quite positive. That not only improved their comfort and reduced their anxiety, but it also improved the efficacy of the treatment itself. You could measure that in their biological reaction, that by the end of the trial, they had higher levels of these good antibodies that were helping to prevent the full allergic reaction to the peanut.
That's really where I'm come coming from here, presenting facts and making sure that people understand the facts. You can remove all of the negative catastrophic thinking, and that's enough to have a real noticeable difference for people's wellbeing.
It's not about the glass being half-full or half-empty. It's about it being both at the same. We do create expectations. We need to, to survive. We need to feel stress. It's not about fighting that. So what can we do, then?
The best example here would be about anxiety. If you're entering a new unfamiliar situation, like doing public speaking for the first time, it's really natural that you're going to feel anxious about that. Because you care, you want to perform your best. When people have tried to suppress that anxiety, that only backfires. It's much worse for you to try to tell yourself you're not feeling it, or to distract yourself, which often isn't possible. What you have to ask yourself there is, well, what is the purpose of this anxiety?
We developed all of these stress responses because they're evolutionarily beneficial to us. When your heart is racing, it's pumping blood around your body. It's making sure your limbs are oxygenated, but also your brain. So it sharpens your thinking.
What the research has shown, really strongly, is to shift your mindset from thinking that the anxiety is debilitating. That's certainly how I felt before public speaking. I felt like if I'm anxious, I won't perform well. That only increases your anxiety and is not helpful at all. But you can think, "This anxiety is here because it's helping me to deal with a big mental challenge and physical challenge to maintain my poise and to project my voice." Realizing that the anxiety can be beneficial has been shown to improve performance in all kinds of different areas.
It also changes the physiological response. It moderates it. What happens is that you still have cortisol, the stress hormone, which can be helpful for sharpening your thinking, making sure you're really on the ball. But you also see higher levels of anabolic hormones — things like DHEAS and testosterone that are important for cellular growth and repair. What that means is that afterwards, you recover from the situation a lot better. The high level of cortisol isn't causing so much wear and tear on your tissues because you also have this natural antidote within your system too.
That was obviously beneficial for us in the past. Whenever we were facing these scary challenges, you've got this inbuilt mechanism to make sure you perform well in the moment but you don't cause damage afterwards. We are trying to make sure that you have that response, rather than if you see anxiety as fully debilitating and you are more likely to get into this situation where you see a real threat to yourself. If that's prolonged over a long period of time, that's when you're going to have the damage to your body.
We're also living now in a time when we can see the danger of a Dunning-Kruger effect — I'm right, I know I'm right, I know exactly what's going to happen. It feels like we are in an epidemic of overconfident expectation.
Overconfidence is a really interesting one, because I think people are overconfident about what they know, and maybe about things like intelligence. The Dunning-Kruger effect has been shown in so many different areas. We do have overinflated expectations there. In other situations, we often do have this negativity bias. I think it really depends on the context. With something like intelligence or creativity, there is some good evidence that when people have higher perceptions of what they can achieve, that that can be quite beneficial to their performance. I'm not saying that we should all tell ourselves we're right, everyone else is wrong. What we can do is if you find yourself being overly negative about your abilities in some area — like say you're a kid at school and you tell yourself, I can't do math — you can start questioning yourself. You don't have to think you're a brilliant mathematician, but you can start questioning, is that really objectively true? Or is it possible that I could make improvements to my performance? That's what's really important, is to push yourself out of your comfort zone, incrementally. Rather than creating an overly optimistic expectation, it's more to question whether your negative expectations are as true and objective as you think they are.
When you face things like frustration — like if you're learning math, or if you are facing writer's block if you're a writer — rather than interpreting that frustration as a sign that you are not capable of doing it, you could think of that as a sign that your brain is working hard. You are dealing with a lot of complexity. It's a really important point for you for growth, for learning, for improving yourself. Avoiding the extremes k is what we need to do. We need to keep an open mind about what we can achieve and then test our assumptions.
When you were writing this book, was there something in particular that really jumped out at you in all of the research?
The research on the effects of our expectations on dieting were really spectacular for me. I like that example because it's so far removed from this idea of positive thinking. You might have been told in the past, visualize yourself as being thin and toned and that's going to happen to you. This is much more specifically about your expectations of the food that you're eating.
People unrealistically expect that healthy foods have fewer calories and are going to be less satisfying. That in turn means that then they feel a greater hunger later on, and that's also reflected in the hormonal response. What you need there is to think about what your body really needs and what this food is providing, to try to make any food that you eat a kind of celebration and cultivate those feelings of indulgence. I found that incredibly helpful.
I would also say the work on sleep was really useful for me. We know that chronic insomnia is bad for your health, but a lot of us are overly pessimistic about the effects of moderate sleep loss. We assume that the day after we've had a disturbed night, we're going to have poor concentration and great fatigue and we're going to be grumpy. Well, it turns out that is an expectation effect. In the lab, you can give people sham feedback about their sleep. Whether it's positive or negative feedback explains all of those symptoms. That was totally revealing to me.
Finally, the work on aging. Our beliefs about what we associate with old age can then affect not our risk of things like Alzheimer's, but also our longevity by as much as seven and a half years. I found that incredible. What I loved about that research was that when I was looking into this, it sounds incredible, but then you find the behavioral and physiological mechanisms, and they're so solid. What researchers have done is now joined all those dots. It shows that things that ageism can be a real threat to our health and that we need to fight that. This is bigger than the individual. It's something that we should be thinking about for the whole of society.
I love that you end the book by talking about how we're always a work in progress.
That is exactly what we need to learn.
What does that mean in terms of our neurological systems, when we say we're always a work in progress?
We've known for a long time now that our brains have neuroplasticity. I think 75 years ago, 100 years ago, there was this assumption that you get to adulthood and you're fully formed. We've now come to realize that development continues long after childhood and adolescence. There's some research showing that some cognitive skills don't peak until your 70s. You're constantly evolving and changing, and your brain is rewiring, becoming more efficient at the things that you're more practiced at.
In terms of the expectation effect, we need to remember this point of view. One of the big barriers for people applying the expectation effect is they might realize that they've got certain mindsets that aren't helpful to them, but they might also feel like it's impossible for them to change those mindsets. What we know from neuroplasticity, from the science of personality, from all of these things, is that you can change. You can make quite big changes to your psychology. It needs a bit of work. You can't change it overnight, I'm not suggesting that. But with small steps, day after day, you might find that over the course of a few months or a year, that you achieve something quite spectacular that you never realized beforehand.
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