Good day to you. you legend of a human. Welcome to the Therapy Natters podcast series, A show all about the things that make us tick, the things that make us tock and the ways to turn a tick into a tock maybe even a sick into a sock a warm fluffy sock that is, I'm Richard Nicholls, and as always, I've got my rather baffled co-presenter here. Fiona Biddle with me as well. Hi there, Fiona. Are you wearing your warm, fluffy socks today? On this autumnal day?
I, I'm not, but I have got a fluffy blanket over my legs, like an old lady sitting in my little corner. I feel very snug and cozy, but yes, baffled. Baffled. Worried to be quite frank, but.
Oh, I have that effect on many people.
for any, any listeners? Yes, this is, this is concerning and it's only 10 o'clock in the morning, so I presume we can't blame alcohol.
Oh, no. Not at all. No, I've Got a cup of Redbush tea. I can't. really blame that. I have just had some porridge and Nutella, so maybe that could
that's, it then. That's it.
Yeah, Although I'm, I'm true to type. I mean, if you've listened to me long enough, you might have heard odd ramblings. And if you're a friend of mine. Oh, you've certainly heard some rather
That was just yeah, it sort of went a bit beyond, but It was good
tick tock sick and sock. They rhyme and I wanna turn our sicks into something other than a sick and a sock rhymes with tock. So it felt right.
And I am presuming this did not have any prior thought.
Yeah, it did
It did?
Even with prior thought, I go it's fine. Tick and tock. Sick and sock. That works.
Okay. Good.
But we do
it.
We do wanna create that warm environment. You know. We can't put the heating on at the minute, unless we take out another mortgage. So we've gotta try and put on our warm and fluffy socks.
And we can't take out another mortgage cuz of the interest rates. So.
Oh, we're We, We're screwed.
need, we need socks. We need socks and blankets.
How's your week been?
Yes. Pretty good. Nothing much to report. Weather's ghastly isn't it?
Bit drizzly. It's proper.
Absolutely pouring here.
I haven't got much blue sky left. There was a little bit earlier on. um, First thing this morning. Yeah. It was just chucking it down. thought, well, at least we'll top up the reservoirs bit by bit. You know, it'll, Maybe we'll have a better spring and summer. And we won't have to have a hose pipe
back. Yeah. So reframing
It's what we do as therapists constantly trying to find the positives in a difficult situation, or at least trying to find alternative ways of thinking about things.
Yeah. Well we've talked about reframing the last couple of weeks, so that just, that did follow on,
What we do as therapists often is try to turn one situation into another one, turning the sick into a sock And well, I think we're not alone in that. Even people in general practice. Somebody, goes to them, and they're feeling sick is to try and turn it into something else, And whether they do that, with a nice bedside manner, which they, used to do.
There used to be a time when you, could spend half an hour with your GP and they would sit with you and they'd say, I'm really, sorry that you've been feeling as bad as you've been feeling. I really hope we can help you. here are some of your options. I've got this idea that might be able to help you. And they'll, you know, They'll give them something. We don't have that. anymore.
Oh, I don't yes, it is quicker. But there are still some doctors who have a better bedside manner than others. I remember a time when I, I went to the doctor, it was a very long time ago, I just said, I just don't feel well, and the GP just said something like, Oh dear. And just saying that I felt warm, I felt listened to. I felt her compassion validated. So it doesn't take very long.
Yeah.
It was an expression, the tone and just simple words. I can't remember exactly, but something like oh dear
And sometimes that's enough to get the ball rolling, to begin to feel better because we know if we are psychologically in a bad place whatever else we're experiencing could be an growing toenail. It could be a swollen lymph gland, whatever it is. If we can create a comfortable environment for ourself, especially if somebody else can validate us and make us, and not, not feel sorry for us, but understand us to get us so that we don't feel quite so alone.
And maybe it's a distracting thing, I don't know, but whatever it is, we know that the mind can make us, make us feel better, even if we are, you know, genuinely, really unwell. Uh, And I do think, although like you say there are some good GP's out there and there are, and I've, met some of them, I've even interviewed some of them from my podcast series. Some of them are amazing, and they recognize the importance of a good relationship with your patient as being part of the cure.
The treatment often is creating a good relationship with your patient. That's not a secret, but the last sort of hundred years, Things have become very, Here, take this pill. Okay, you have a symptom? Let's see if we can find a pill for that. Let's see if we can find some medication. for that. And sometimes there isn't one, but the GP still has to do something. They can't say, Cuz this is the nocebo effect. Sort of creating something negative.
If they were to say, Well there's nothing I can do, they're only gonna feel hopeless, they're only gonna feel worse. But if they say, actually I've got this medication here. To be honest, I don't fully know much about it or why it works. We just know that it does a lot of the time. Would you like to try it? Yes, Yeah, of course. Now it could just be aspirin, it could be a sugar pill, it could be nothing.
And although people won't admit it, well no, they have admitted it, I think there has been some surveys into doctors deliberately giving out a placebo.
It's not legal in the UK
uh, well that was in the States actually. the
Yeah, it is. it is not legal in the UK for GP's to prescribe, specifically placebos. Used to be. And I remember a guy who I think he's, retired maybe even beyond retirement. But he was a chemist as well as a therapist. He told a story that chemists used to, this is probably in the sixties, if not earlier. They would sometimes on the prescription form write ADT. ADT stands for Any Damn Thing.
Right.
So it was just telling the pharmacist to give something clearly for the placebo effect. Again, that's not gonna be legal these days. You can't just prescribe any damn thing.
Even though we know that the placebo will help somebody with with quite severe pain, a good 30% of the time and some research, even goes higher than that, but we know minimum 30% of the time here take this pill, you'll feel better. And it does. is it unethical to not?
Well yes. I think you could, you could definitely argue that perhaps we should define placebo before we get too much into discussing it. It's Latin for I will please.
Right.
It's rather nice isn't it?
Yeah, that's lovely. Huh? I will please. I know that the, there were people that were called the placebos. This is going back many, many, many many hundreds of years. They were fake mourners at funerals
Ah yes.
I guess. to please the family or to please somebody. please god. I don't know. But they were there just to, just to mourn if no one else would. They were called the placebos
So it is something that is designed to make something better, but without any content to make it better.
Yeah.
that's, that is the very rough definition of what a placebo is. And there is a lot of research on the placebo effect. And yeah,
it has to be. Because if you're gonna research anything, you're gonna also be researching the placebo at the same time. But there has been specific placebo research. Yeah.
specific placebo research. But yes, any research will be looking for the effect of placebo to take that out, to find out whether whatever it is that you're researching has something beyond the placebo effect. Just because doctors can't actively prescribe a placebo doesn't mean that it's not an effect that is used
Mm. in the real medication that they do prescribe, the placebo effect will be in that. That can even be the shape or size of the pill or the way that it was presented.
Yeah. There was a TV documentary, one of Michael Mosley ones a few years ago, and he was interviewing Irving Kirsch and he is an American psychologist, an academic, He is the associate director of the program in placebo studies and a lecturer in medicine at the Harvard Medical School and Beth Israel Deaconess Medical Center. And he's the leading, it says A here, but THE leading research in the field of placebo studies, I would suggest, and also does a lot on hypnosis, which is interesting.
Yeah, I recognized his name from being involved in hypnosis, Which is a Non Deceptive Mega placebo. I've heard it described as. as
Yes. In this program he talked about how some pill, so ibuprofen for example, or paracetamol, that sort of pill has a greater effect if it's red than it's white. And I know Solpadeine they're red. And I know that I think, oh, this is gonna be powerful cuz it's a red yeah. one.
Yeah. And blue is a calming color, so that tends to be for the ones to relax. Which is bizarre because Viagra, quite famously Is you know, the blue pill, and yet that's not one to relax. But we do know that despite the fact that Cialis, which is a far more potent erectile dysfunction medicine than viagra is. Viagra. Has MORE of an effect out in the real world because it's such a reputation. But Cialis is better. It's better at what it does. Far better.
Yet Viagra is the one that in the, in the public, when you put it into the real world, is the one that gets more of an effect. Because, One it's name and it's big. It's a large pill. Cialis is a tiny little pill, apparently, tiny. I say apparently there, I've not been to my GP to ask for erectile dysfunction medication.
I was zipping my lips there. I was not going to say anything. But you said it yourself.
I'm tempted cuz I, I do have Raynaud's Syndrome. And that means that the circulation doesn't reach the ends of my fingers when it's cold. And this time of year it starts to get terrible. Really bad. I'm Like my hands are 10 years older than the rest of me and I do wanna go to GP actually. And have a bit of a chat about that. I'm gonna do that. Stop talking about it, Richard. Be a man. Actually make it happen. Don't be the old version of a man and just pretend that everything's fine.
Everything's fine. No man up. Go and see your GP, Richard, see if you can get some medication. Hey, maybe they'll, gimme Viagra. I'll let you know how it all goes.
I presume that is something that you have seen as a treatment for Raynaud's Syndrome, not you've just made it up,
No, no, no. Cuz Viagra, although it has a side effect of being useful for erectile dysfunction. It's just about the circulation, It's just a way of opening up capillaries and things like that, which is what my hands do need this time of year is it starts to get nippy. Otherwise I've gotta go everywhere wearing gloves. Even in the house. The doctor said last time, just wear gloves in the house. Like, that's not the answer.
just wear gloves in the house. Yeah. That's not going back to bedside manner. That's not really it, is it? But then you were just saying about Viagra and having the, placebo effect from the name and the expectancy from the name. That also applies to things like ibuprofen. They found that buying Neurofen, people feel that Neurofen is more effective than Boots own ibuprofen. There's fairly recently been some trouble with some medications having exactly the same thing but branded differently.
So I can't remember which make it was, but probably shouldn't mention it anyway, but it was whatever it was for migraine whatever it was for period pain, whatever it was for arthritis, and it was actually the same thing. But but, but but more expensive. Because it was labeled for that particular thing. That's all placebo effect. I'm getting the one that's for migraine. Therefore, it will only go to my head.
Mm.
It won't go to my feet. But
target the pain. Can you really, Can you target a pain
But that made me think about children.
Mm-hmm.
Parents out there listening you can maximize the placebo effect with your children very easily because you tell them that it's targeted. You tell them that this will go, If it's a pill, you know, calpol or whatever, tell em it'll go straight there. But also when mine were little they loved the TV program Camberwick Green.
Wow! That was before my time.
It was new in my time, so that's when it was first out. But they were replaying it when my boys were little in the Nineties.
And so I recorded them all on VHS, off the telly. And what I would do with mine, if they were not feeling very well, obviously if it was not something serious, but I would give them a spoonful of water and say it was Dr. Mopp's magic medicine.
Now you don't do that with a 15 year old,
No.
but with a five year old or a three year old,
Yeah.
But that would often do it. They would feel better cuz they'd had Dr Mopp's magic medicine.
Yeah. Pavlov knew a hundred Plus years ago that if you stitch things together, you have a stimulus, it's just conditioning to a degree. You know, they're sitting feeling comfortable. They're watching Camberwick Green or whatever, Starting to feel a little bit, better. I'm sitting here feeling better and I've had that, that solution or that pill or whatever.
I mention this 'cos I'm thinking of how people that have had chemotherapy and it's made them very, very sick will often get triggered if they walk into a room that was painted the same color as the room was, where they used to have their chemo. Cause their brain remembers, remembers the feelings and brings that sick feeling in with them. And that's the, mind doing that not the walls. It's not the paint that's doing that. That's just a neurological If This Then That process.
Well, we'd call our anchoring, wouldn't we? Yes, but I've also got this thing up on my screen about the factors that influence the placebo effect, which is where you're going really here. And it says cognitive and behavioral factors such as acquiescence, expectancy, conditioning, suggestion, and motivation, influence the placebo effect.
Yeah.
So, I know again, when I was growing up, Doctors were supposed to know everything. We just, doctors did know everything. So that would maximize that placebo effect because, well, they're right. There is x condition equals Y treatment Doctor says so .Therefore it will work.
mm.
We don't have anywhere near that level of expectancy now. But it is still there and it can still be maximized. Couple of other places. One. You're are a father, did you, when you were having Billy, well, you didn't have him, but when Dawn was having Billy, did she try things to make him arrive? There are lots of things that you can try to make a baby come when it's just hanging around.
So they say,
Well, this is it. Is it just placebo effect? Is having a curry really going to make a baby come? Is drinking raspberry tea really gonna make a baby come? Oh, and then there's other things that you, I remember having warts on my hands when I was a teenager. The doctor actually told me, rub a piece of raw meat on it and bury the meat in the garden.
Oh, for goodness sake,
It didn't work.
What? May as well have been literally blowing smoke up your arse Fiona
Charming.
Well, They did do that.
No, no he didn't.
Oh no he didn't. No. This was, you know, early 1900's
That's old wives tales.
Yeah. But the doctors were doing it. Even when we were figuring out the moons around the solar system and stuff, We were looking up there going. Wow, there's lots going on. Science was good. Still blowing tobacco smoke up patients backside. Ridiculous.
But some old wives tales, although now as I say, I cannot think of one, have proven to be valid. What about robbing a dock leaf on a nettle sting?
I mean maybe not the authority on that, but one thing that placebos used to be called were bread pills. And of course, moldy bread. Bread mold had been used for maybe thousands of years before penicillin was completely identified as a treatment. They didn't know quite why they just thought it was the Bread maybe. And then the bread pills became the, the placebo of choice. Just take a bread pill. That wasn't that long ago
I did not know that.
Hm. Yeah. bread pills. Yeah. You learn something new every day.
Yes Nocebo, you mentioned it
Hmm.
at the beginning. I was just wondering whether that is a made up word or if that means something in Latin. Let me have a little look.
it could be a pseudo Latin
I've got Latin A level, but that was a very long time ago
The nocebo effect, is rather bizarre, I think it came about, because when people were told, Here's the medication you're gonna be taking, and these are the side effects. Those side effects might be hives, might have itching or sickness, and even if they were taking the sugar pill, they would still have the negative side effects, that they've been warned about. Physiological changes They would come out in hives if they were given the suggestion that they would, and that's a suggestion.
That's words planting a seed in somebody's mind, that they're going to have a, a reaction on their skin. and it did. That's incredible.
Nocebo does come from the Latin, meaning I will harm. So it isn't a made up phrase, but yeah. with suggestions like that, we know that can happen. I was thinking of statins as one example. There are so many stories about the side effects that are there. But not anywhere near as common as people report them to be. And they have found that to be a nocebo effect.
Clients say all that about their antidepressants, Don't they? That they're terrified of taking them because, well, they've said this to me, terrified of taking them because of all the side effects that they, read. Because If they've been given antidepressants, then they might well have a very negative mindset and that's the first place they're gonna go. They're not gonna look at the positives of taking antidepressants. They're gonna look at the negative.
Or at least they're gonna highlight those stronger than would any positive effects of taking the medication. And that's in itself a side effect of having a mental health issue.
And also there's a natural tendency for people to rather not do something which the not doing causes harm than doing something which probably will help but might cause more harm. Hence the issues with vaccinations. People are scared of the harm that might, let's just take, take a completely random set of numbers. If having a vaccination leads to a 50% reduction in the chance of having a disease, but a 1% chance of having something else. The tendency is to look at the 1%, not the 50%
Yeah. We're drawn towards a negative side of things, aren't we? And
We don't want, we don't want, to be doing something that might cause harm, so it's better to just not do anything cuz then you don't feel blame, you don't feel guilt, etc So all of that tied together, it's . Those lists of side effects can be problematic.
Hmm. And I do think this is useful for people. I mean, mean, people might be thinking, what's this gotta do with with, with therapy? Well, it just goes to show you just how powerful you are. Your brain can do all these things. Your brain can make you feel worse about something. It can make you feel better about something just because you steer it in a particular direction. Now, of course, the placebo and the placebo effect are being caused by the external world normally.
But if you understand and you recognize What the brain can do this? And I remember, oh, this goes back sort of when I, early days of being a therapist at least 15 or 20 years ago, in the early days of, I think. HIV treatment, when they'd found this incredible way of controlling RNA. Ribonucleic Acid. And this particular medication, it beat the placebo cuz the, the medication itself had something like 60% success rate at controlling RNA. And the placebo was I think 40% something like that.
And the article was all about how great this medication was. And I wanted to stop and go, No, hang on a minute. The placebo helped people slow down the production of Ribonucleic acid within their body to prevent HIV turning into full blown AIDS? We did that with our, with our, with our brain. That's phenomenal. Cause I dunno where Ribonucleic Acid is created within my system, but part of me does. And being given the suggestion, take this pill and your RNA production will slow down and it does.
That that's crazy.
That's also an interesting use of the term I, because you did then get to, Well, part of me does, Well what? What's the I? Is the I the conscious mind then?
Mm
consciously don't know where it is, but it's.
I unconsciously do.
Going back to having babies the, the body knows how to give birth
Yeah.
the mind just gets, gets in the way, messes it up. So in terms of therapy one of the things you can actually do is actively in partnership work on placebo.
Mm
Work on the belief systems. Those expectancies that we mentioned. The expectancy that, that comes from a placebo. Work on it, build it and create your own suggestions to yourself. Pain is one of the key areas for using placebo. I mean, we've discussed that with terms of the medication but expectancy around pain, you can negotiate that with your brain.
For any listeners who have issues with pain whether it's specific, whether you've, got conditions that cause pain, whether you've broken your leg. Whatever it is, or unexplained pain, whatever. This book is called The Painful Truth by Monte Lyman. It's excellent. It's very, very readable.
And it goes into stuff about the placebo effect distinctly but it also has really very valuable angle of talking about pain, and this sounds obvious, but he goes into it in great detail about pain being protective. And the dot, dot dot from that is that quite often that protection is not required. So we get pain and the the mind is thinking, Oh, I need to protect you from this. So,
Gives you a warning
yes, constant warning of don't do this, but you sort of either aren't going to do it or you're gonna do it anyway. I know that I've used the concepts in this book. If I've been walking somewhere and my back's been hurting, I'll have a little chat with my unconscious mind to say Look, I'm walking to there anyway, so there's no point in you giving me the pain. I'm just walking to there and then I'll stop. So there's no need to do it. It's pretty effective. Not a hundred.
Pain doesn't just completely go away.
It's pain. Yeah.
Yeah. Doesn't completely go. But it, it certainly can.
We don't all need to spend decades training in, in meditation like the Buddhist monks do, so we can all be kicked in the testicles and so on. You took a swig of coffee then, as I said the word testicles. Sorry about that.
It's, It's okay. It didn't somehow today that didn't shock me.
you've become desensitized to me. You spent enough time with me now.
Yep.
But, they can handle that and they just stand there and go kick me. And, they just take it and that takes decades of training to get so in touch with the mind and body connection that you can override pain like that,
that's, that does strike me as a little bit silly though, because
it's somewhat unnecessary.
the reason that that pain is there is because that part of the body needs to be protected.
Hm.
So yes,
Hmm.
not sure about that one.
No, it's not comfortable to watch for anybody. Most people will watch it and even women will be crossing their legs going, What? Stop doing that to him. It's not good, but they've trained their brain
Yep
to not feel the pain. And if somebody has a chronic pain or chronic anything, really knowing that you have a psychological trick to be able to handle this better, it just takes a bit of practice. It takes a lot to, to get in touch with your unconscious mind and give it suggestions that say, this is safe. It's, okay. I am getting treatment. It's fine. Now, of course, caveat. Get treatment. Don't ignore pain.
If somebody's having constant headaches, for example, to only use mind control techniques to try and diminish the pain and never go to your GP after four years of constant headaches, that's not a good idea.
I know of a hypnotherapist who was getting back pain and thought, Oh, I know how to deal with pain with hypnosis. And very successfully did until he collapsed because it was kidney infection.
Oosh.
So he'd masked the necessary pain that was saying something is wrong. So, yes, we don't do that.
Be sensible with it.
Yeah. Be, be sensible. And that's a thing with therapy. If you, if anybody goes to a hypnotherapist, cause that's what they'd usually do for pain. If the therapist doesn't ask for a medical referral, i.e gets a letter from your doctor or at least speaks to the doctor themselves. If they don't do that, go to somebody else because therapists should know that there's a risk of masking something and you don't take it. So always want the, the GP to say, Oh, no, it's fine. Yes, Mrs. Smith.
Yeah, we, we've, we've done all the investigations. There's nothing there. You, you go for it. Do your best. And quite often get that. But if that hasn't happened, No, no, no, I haven't done it myself, but I know of people who have, and I've been on the receiving end, is hypnosis for pain during an operation.
Yes.
So, Shaun was my hypnotherapist when I had a minor op. It was quite funny actually because I had set it up with the, surgeon, but the surgeon had completely forgotten. But he was really excited about this. And I was still expecting to have a local anesthetic as well. And it was something that if it's not that straightforward, we might have to do a general straightaway. So I was still expecting to get the little local anesthetic. They, they just didn't do it.
So I thought, Okay, I'll go along with this. And it was absolutely fine. It worked a treat. It was what we'd usually say is it's you feeling pressure rather than pain, that sort of thing. And it worked an absolute treat. And there are videos you can get them online of people having open heart surgery. Anything with hypnosis
the BBC did, did a documentary into into hypnosis actually. And. that's been, you know, quite famous in our, in our profession being talked about when it came out. It was about 15, 10, 15 years ago. It was really, really good. And this woman had some teeth removed. And she had no anesthetic at all. It was purely just practicing relaxation, practicing controlling the pain by giving it a number and. just turning the number down. Just turn the number down, down, down, down. down.
And she needed to raise her hand every now and again to give herself a few seconds to get herself back into the, the zone. And bring the number down. and she could have, I think she had two teeth removed and some implants put in. And the BBC are filming this and the presenter's watching it going. Oh my goodness, how on earth Can somebody do this? practice? I think she'd had 10 sessions. of, of therapy to practice pain management,
Well. It's practice and also it goes back to that expectation. If the mind knows that the pain isn't necessary because what's happening is a good thing and not something to be protective about, then there's no need for the pain.
And that's how powerful our mind is. And don't take it for granted, whether it's the placebo or the nocebo. And hope, maybe hope is a big part of all of this, and positive expectation and how to get out of your own way when your brain says, No, this is horrible, This is only gonna get worse, Things are going to stop cuz am I gonna make myself feel worse by planting
this
in my mind that it will be. Yes, maybe we can plant a seed in our mind that things are gonna get better and make them better and take that path. It's not an easy path to take cuz you've gotta override the fears and all that, negative, catastrophizing and obsessive thinking about the worst case scenarios. But If you catch yourself doing it, just be aware of the path you're sending yourself down. Recognize it Okay, I'm gonna practice, something new. I'm gonna practice.
something more positive and get into a a better mindset. Hopefully seven days a week, 24 hours a day, or as near as damnit as a,
as a human Well, It's the getting back to a good place. That's really crucial, isn't it? That you can have a little slump, you can have a bad day, but it's being able to pull yourself back up and say, All right, okay, that's that done. Maybe I'll spend another five minutes in this slump and then I'll pull myself back up.
Yeah. So Fiona, We'd better love them and leave them For another day as time is ticking on ticking and tocking and sicking and
and socking.
Right. Questions. If you've got some, we have had some questions sent in. We'll look at those ready for next week. cause we Haven't answered any questions today cause we wanted to talk about the placebo effect and mindset and so on. But yeah, continue to send us in some some questions. Don't, worry we haven't forgotten about you. Keep 'em coming and We'll group them all together into appropriate topics and we'll spend time talking about them.
I dunno about you, but I feel quite energized from that conversation about the power of the mind and the options that we have. Good.
I hope everybody does. That's that's a good place to be Yeah, that's that's a good thing to create. Right then you lovelies. We'll speak to you next week. Take care all.
Bye everybody.