Psychology Now

THE POWER OF FRIENDSHIP

LET IT
FIZZLE

OUT

that feeds your dog or a customer at work. you free from the unwanted pressure of Ending a friendship is never
Friendships of pleasure form when someone trying to juggle your time between too many an easy task, but if you have
shares the same interests as you. Finally, people. Pause for a moment and think about identified a friendship that is no
friendships of virtue are based on mutual how you feel. Do you feel as though you are longer serving you, then it’s one
respect and compassion, and usually form spreading yourself too thin? Do you want to that needs to be accomplished.
over a long period of time. These friendships invest more energy and time into people that One way of cutting someone out
are based on the idea that you share similar matter to you? Then it’s time to have a reshuffle of your life is by slowly reducing
values and aspirations, and they can develop within your friendship circle and direct your contact and the amount of time
from as early as school years. But how are attention to the people who actually benefit you are spending with that
we meant to lead a balanced lifestyle with so your life. person. Start by not organising
many friendship circles? And is it possible to to meet up as frequently, and
have too many friends? The numbers game avoid texting back as often.
When considering Dunbar’s stance that we It might not be easy and you
Too often we hold on to friendships that no have 150 meaningful connections, 50 friends, will inevitably miss that person
longer serve us, which is why it is important 15 close friends and five loved ones, your true from time to time, but just keep
to take a step back every now and again to friends who are there for you through thick reminding yourself of why you’ve
re-evaluate and ask yourself whether that and thin are those you would include in this
friendship is of benefit to you. You have magic number five. decided to let go.
to ask yourself some key questions: Is this
friendship making me happy? Is this person Take a moment and think about these five friends make you happy and concentrate
worthy of my precious time? ultimate best friends, and ask yourself on building stronger bonds. Focus on these
whether you are spending enough time with small, intimate groups of friends and be
Time to let go them. Dunbar believes that one of the main confident when you decide to walk away
Maybe you can identify a relationship that is reasons we should declutter and refine our from the relationships that are no longer
not making you happy and you frequently friendships is so that we can ensure our time working. You will find you will become
leave their company feeling sad. Perhaps you is being shared in an effective and manageable happier, more energised and better at
have a toxic friendship that leads to way. Having a small, intimate group of friends managing your time.
arguments and constant negativity. We hold means that you can hone in on why these
on to certain friends for a number of reasons,
but a common one is because of time. If AVOID TOXIC PEOPLE
we have invested significant time into a
relationship, we stick with it. But whether At some stage in our lives, we will inevitably meet someone toxic. © Getty Images / cienpies
you’ve been friends for one month or ten Toxic people are draining and negative, and often the kinds of people
years, if that relationship isn’t adding anything
to your life, why waste any more time trying who require too much energy and time. They are easy to identify
to fix it? Maybe you make an effort with because they can leave you feeling anxious and sad. These are
someone and this isn’t reciprocated – these the friends that we need to step away from. You can tell them your
one-sided friendships can leave you feeling intentions by simply explaining to them face to face your reasons and
exhausted. Like unnecessary objects in your walking away with your head held high. Be clear in the direction you
home, it is possible and even recommended to are going in and walk away from people who don’t make you happy.
cull your friends.

Less is more
Focusing on the people that matter the most
is a step in the right direction. We need to free
ourselves of the stress that is caused by
trying to people-please, and instead focus on
those people who make us happy. Choosing
to have fewer, more valuable friends leaves

PSYCHOLOGY NOW 101

THE PLACEBO EFFECT

102 PSYCHOLOGY NOW

THE PLACEBO EFFECT

THE

EFFECT

How do sugar pills and saltwater injections
trick the mind into healing the body?

WORDS LAURA MEARS

S ugar pills ease depression, instance, if the staff reassured them that the
colourful creams numb the skin, new cream would work, it did. But if staff told
and saline injections make pain them that the cream would increase their
melt away. The placebo effect is a pain, it actually made things worse.
powerful healer, but how does it
actually work? The appearance of medicines can also shift
our expectations. We associate bold colours
In the 1890s, Ivan Pavlov discovered like red, orange and yellow with a stimulant
classical conditioning. His famous effect, and blues and greens with sedation.
experiments taught dogs to associate the Change the colour of a tablet and it’ll change
sound of a bell with the arrival of food. When what people expect it to do. Similarly, if a pill
they heard the noise, they started to dribble costs more or comes in a branded box, we
in anticipation. The same thing can happen expect it to outperform its cheaper or generic
to us with medicine. We make associations counterparts. Even the name of the treatment
based on our experiences. If people take has an impact. One study found that putting
aspirin for a headache, they start to associate the word ‘placebo’ on a migraine medicine
the shape and taste of the tablets with pain called rizatriptan reduced its impact. Calling
relief. Replace the pills with a placebo and a placebo ‘rizatriptan’ made it work better. Not
the pain will still be lessened. surprisingly, calling the real medicine by its
proper name worked best of all.
Placebos, also known as ‘dummy’ or
‘inactive’ treatments, are made from inert The placebo effect even works with
substances like saline, starch or sugar. They surgery. The process of cutting the skin open
look and feel like the real thing but without and stitching it back together can help people
any of the chemical effects. with knee pain, and fake operations can even

Great expectations Replace the
The whole experience of receiving treatment pills with a
can help us to feel better. One study gave placebo and
people a painkilling cream for two days the pain will
and then replaced it with a placebo. The be lessened
participants had experienced the cream
working, so they expected it to continue
helping. Also, the tone of voice of medical
staff and the information they give people
about what to expect during treatment can
change the way people respond. In this

PSYCHOLOGY NOW 103

THE PLACEBO EFFECT

ALL IN THE MIND

Despite its complexities, the human brain is surprisingly easy to fool

Parkinson’s disease disrupts the brain’s ability to produce dopamine. One study in
2010 found that the placebo treatment for Parkinson’s could provide results almost
identical to those achieved with the conventional medication, the drug L-dopa. The

illustrations below represent a patient’s brain scans from this trial.

More
dopamine

UNTREATED MEDICATION PLACEBO

Less
dopamine

Absence of dopamine Almost normal levels Almost normal levels
of dopamine of dopamine

ease heart pain caused by angina. Nothing the prefrontal cortex. This region handles can even make non-painful touching hurt, a
actually needs to happen inside the body; complex behaviours and planning. When we phenomenon known as allodynia. Reading
the sights and smells of the hospital and the expect to feel better, it boosts activity in nerve about side-effects or looking diseases up on
procedure of an operation can trick the brain. pathways that extend into the spinal cord. the internet can shape what we expect to
MRI scans have shown that the placebo effect happen, and this affects the brain.
The first neurobiological evidence for how decreases blood flow in the parts of the spinal
the placebo effect works came in the 1970s. A cord that let pain signals through. Endorphins Change the
study published in 1978 in The Lancet looked triggered by taking placebo tablets help to colour of a
at what happened when people received stop pain signals from reaching the brain. tablet and it’ll
a placebo painkiller after having a tooth change what
removed. To find out how the placebo effect Does it ever not work? people expect
worked, half the participants were also given it to do
the drug naloxone, which blocks the activity The placebo effect works less well on people
of natural painkillers called endorphins. with Alzheimer’s disease, who often have
damage to the nerve cells in their prefrontal
In this study, naloxone stopped the placebo cortex. The effect can also be blocked by
tablets from working, but only when people placing magnets over the scalp, interfering
expected the placebo to help with their pain. with nerve signals in the front of the brain.
When we expect a tablet to kill pain, the brain
makes its own painkillers. Anxiety can also block placebo pain relief.
Studies have found that simply telling people
Current evidence now suggests that this their pain will get worse can make it worse. It
effect starts in a part of the brain called

104 PSYCHOLOGY NOW

THE PLACEBO EFFECT

PLACEBO PATHWAYS CEREBRAL CORTEX

The placebo effect depends on two The cerebral cortex is responsible for
separate sets of signals in the brain intelligence, memory and consciousness. It
sends signals to the periaqueductal gray.
PAIN REDUCTION
VENTRAL
Brain scans have revealed that the TEGMENTAL
cingulate cortex, insula and AREA
thalamus – which are involved
with the brain’s pain This structure in the
circuitry – show reduced midbrain is part
activity during the of the dopamine
placebo effect. reward system.
It sends signals
CINGULATE CORTEX to the nucleus
accumbens.
INSULA THALAMUS

NUCLEUS PERIAQUEDUCTAL
ACCUMBENS GRAY MATTER

Dopamine is released in the The periaqueductal gray controls
nucleus accumbens, helping to pain by making a natural painkiller called
dampen feelings of pain. enkephalin, which sends pain-blocking
signals towards the spinal cord.
AMYGDALA

Images of the brain experiencing the
placebo effect show that activity in the
amygdala (which is involved in fear and
emotional responses) is decreased.

PLACEBO IN THE BRAIN

The science behind what really goes on inside our brain when we take a placebo

The placebo effect is all in the mind, and it’s controlled by the parts of the brain that are responsible for managing
anxiety, reward and pain. The cerebral cortex controls the highest brain processes, like consciousness and intelligence.
The region at the front, known as the prefrontal cortex, handles complex behaviour, including our response to a placebo.
When we take a sugar pill believing it will help with pain, the prefrontal cortex passes messages to pain control neurons
called the periaqueductal gray. These send natural, morphine-like painkillers into the brainstem, triggering the release of
serotonin. More painkillers, known as enkephalins, then flood the spinal cord, where they block pain signals before they
are able to reach the brain. At the same time, dopamine streams into the brain’s reward system, helping to reduce the

perception of pain.

PSYCHOLOGY NOW 105

The second part of the brain’s placebo THE PLACEBO EFFECT
system is a chemical messenger called
cholecystokinin (CCK). It is produced when THE NOCEBO EFFECT
we are anxious. Blocking its activity with
a drug called proglumide enhances the While placebos can be incredibly helpful, they can also
placebo effect, as does calming anxiety with result in some unwanted side-effects
the medicine diazepam.
The nocebo effect is like the placebo effect but in reverse. If we think
Other observations that sugar pills are the real thing, then they can cause side-effects
Most of the work to understand the placebo just like real medicines. It’s hard to study the nocebo effect, but in
effect has focused on pain, but dummy pills 2014 Sara Planès and her colleagues at the Grenoble University
can affect other aspects of health and disease Hospital in southeastern France gathered 86 studies together and
too. People with Parkinson’s disease suffer reviewed the evidence.
damage to nerve cells in a part of the brain They found that symptoms of the nocebo effect tend to be non-
called the substantia nigra. These damaged specific, like nausea, dizziness and headache. They also discovered
nerve cells stop producing dopamine, and that it affects women more than men, and people with depression
this leads to problems with movement that and anxiety are particularly vulnerable. The team were also able to
worsen with time.
confirm that, just as with the placebo effect itself, the nocebo effect is
Placebo medicines can increase the partly psychological and partly neurobiological.
amount of dopamine in the brains of people
with Parkinson’s disease. If they expect to Conditioning can make us expect side-effects, and while chemical
receive real treatment and think that they will changes in our brains can make pain feel better, they also have the
improve, dopamine levels rise on their own.
potential to make it worse.
The immune system can also respond
to a placebo. In 2002, the Goebel research PSYCHOLOGY NOW
group at the University of Duisburg-Essen
in western Germany trained the immune
system using a flavoured drink. They
repeatedly dampened immune activity using
an immunosuppressant called cyclosporin A.
Each time they accompanied the treatment
with the drink. After the conditioning was
complete, they didn’t need the drug any
more. The drink was able to suppress the
immune system on its own.

In 2008, they repeated the experiment with
allergies. This time they gave antihistamines
with the flavoured drink. Incredibly, not only
did the drink make people feel better even

Reading
about side-
effects
or looking
diseases up on
the internet
can shape what
we expect to
happen, and
this affects
the brain

106

THE PLACEBO EFFECT

when the antihistamines had been removed, Every time we receive
but it also reduced the activity of allergy- medical treatment, part of the
inducing immune cells called basophils. experience is psychological

We still don’t fully understand the placebo PLACEBOS IN TRIALS
effect, but there’s no escaping it. Every
time we receive medical treatment, part The placebo effect is powerful in its own right, but to date it’s been
of the experience is psychological, and most useful as a way of testing new treatments. Studies of the
medical professionals are already using this
knowledge to help us get better. placebo effect have shown that receiving a tablet and expecting it
to work can be enough to make you feel better. So how do we know
There are two types of placebo. Pure if a new treatment is actually working? The answer is to give half the
placebos do nothing chemical to the body, patients the real thing and give the other half a sugar pill that looks
like sugar pills or saline injections. Impure
placebos are treatments that do have exactly the same, then compare the two.
chemical effects but not for the condition for This works best if neither the patients nor the doctors know which
which they are being used. Antibiotics are an treatment they are getting, a technique called ‘double blinding’. This
example; they treat bacterial infections but way no one can be quite sure what to expect. If the people receiving
are often prescribed for flu even though it’s the real treatment do better than the ones on the sugar pills, you can
caused by a virus.
be sure that it’s not just the placebo effect at work.
A recent survey of UK GPs found that,
though few use pure placebos, three-quarters
prescribe impure placebos to patients at least
once a week. Examples can include giving
people nutritional supplements, probiotics,
antibiotics and alternative medicines.
Alternatively, it can entail booking patients
in for non-essential tests. The most simple
option is just using the power of positive
suggestion. There is an ongoing debate about
whether this is ethical, but similar studies in
other countries have found that placebo use
is widespread. The more we
understand how it works, the
better we will be
able to harness
its power.

© Getty Images / DrAfter123

PSYCHOLOGY NOW 107

WHEN EATING BECOMES AN ISSUE

WHEN

BECOMES AN

ISSUE

With 1.25 million people in the UK estimated to
have one, and hospital admissions on the rise,

we look at the issue of eating disorders

WORDS SARA NIVEN

F ood and the act of eating can recognise if someone has one; it’s possible SARA NIVEN
represent different things to to have a serious eating disorder and be a THERAPIST AND
different people. Some may normal weight. Although girls and young WELLBEING JOURNALIST
view it as simply fuelling them women aged between 12 and 20 are most
through the day. For others, at risk, up to 25% of cases could be boys Sara has experience counselling young
preparing and enjoying a meal is one of and men, estimates Beat, an eating people over issues including eating
life’s pleasures. But what if the normal disorders charity.
urge to eat became something to fight, and disorders, in addition to writing on the
food is seen as the enemy? Or if there is a “Eating disorders can affect people of subject for a range of publications.
compulsion to down large amounts at a any age or gender, any social or cultural
time, but the guilt and regret that follows background,” confirms Tom Quinn, director seeking attention, people with eating
consumes you for far longer than it took to of external affairs at Beat. “Stereotypes disorders will often do all they can to hide
consume the food? about who can get them mean it can be their illness, and it’s common for them to
even harder for everyone who needs feel guilty and ashamed about what’s
The mindset of someone with an eating treatment to access it. While eating happening. If you recognise the symptoms
disorder can be hard to understand for those disorders can be a way of coping with of an eating disorder in yourself or anyone
who have never experienced this type of feelings or situations that are making the you know, you should seek help as soon
mental illness. And that is exactly what it is, person unhappy, depressed or anxious, they as possible.”
as opposed to a fad or an attention-seeking are not the fault of the person suffering, and
ploy, as some believe. Neither is it easy to no one chooses to have one. Far from

108 PSYCHOLOGY NOW

WHEN EATING BECOMES AN ISSUE 019

Complex causes
Hospital admissions for eating disorders
have risen by more than a third across all
age groups in the last two years, according to
latest figures from NHS Digital.

Although social media is often seen as
placing an increased emphasis on physical
appearance and portraying unrealistic body
ideals, experts agree it would be a mistake
to lay the blame on that. In reality, eating
disorders were around long before the
internet, with anorexia first observed and
recorded back in the 17th century.

“Eating disorders are extremely complex
mental illnesses and their causes are not
fully understood,” adds Tom Quinn. “What
is known is that people can be at risk when
they’re exposed to a number of factors,
including a genetic predisposition to
developing the illness, and environmental
factors that act as triggers, such as peer
pressure, stress or trauma.

“Social media is never the sole and direct
cause of an eating disorder. However, so-
called ‘pro-ana’ and ‘pro-mia’ content helps
perpetuate the illnesses for people already
suffering, and is easily accessible online.
It’s important to note that most of this
content is created and shared by
people who are unwell themselves,
so is not deliberately malicious.”

Certain personality traits have
been linked to eating disorders.
Researchers at King’s College
London identified five
obsessive-compulsive
traits including
perfectionism, inflexibility
and cautiousness. They
found women with anorexia
or bulimia were significantly
more likely to have shown
these traits as children.
Someone with all five was
seen as being 35 times more
likely to develop an eating
disorder compared to someone
who had none of the traits.
Sufferers of anorexia are also
more likely to suffer from
obsessive compulsive disorder

PSYCHOLOGY NOW

WHEN EATING BECOMES AN ISSUE

MY SIX-YEAR BATTLE
WITH BULIMIA

Eating Ruby Harris* tells her story of developing and
disorders overcoming an eating disorder
are complex
mental “I was plump as a young child and clearly remember a teacher’s tactless
illnesses comment about my size leaving me feeling self-conscious. Although I

(22% compared to a general population rate had slimmed down by the age of 14, life at home was difficult; my parents
of 8%), while bulimia has been linked to high divorced and my mother remarried a man I didn’t like, which caused
levels of impulsivity and anxiety. conflict. During that summer holiday, I drastically cut down on what I

Types of eating disorders was eating and, when I went back to school, friends commented on how
When eating disorders are discussed, people skinny I was. I didn’t believe them and decided I had to lose more weight
tend to picture someone very thin and frail. before everyone realised I was actually fat. My thinking and body image
In reality, anorexia nervosa, where someone became completely distorted. Not giving in to hunger, exercising as much
tries to keep their weight as low as possible as possible, and a hollow, empty feeling felt like an achievement and a
by restricting food, over exercising or a
combination of both, is the least common comfort, as well as a form of control.
eating disorder, accounting for around 8% of After months of seriously restricting my food intake, that gave way to
cases, show statistics from Beat. The others binge eating. My body was crying out for calories, but I was disgusted
include bulimia, which makes up 19%, binge with the fact I was putting weight back on and hated myself. Cycles of
eating disorder (BED) at 22%, and other not eating for a day or more were followed by eating large quantities,
specified feeding or eating disorder (OSFED), then making myself sick or taking laxatives. During binges, I’d even eat
which accounts for 47%. frozen food or bizarre combinations like cornflakes and custard. It wasn’t
about taste or enjoyment, more an overwhelming compulsion to cram
Bulimia involves binge eating followed by food down, without the ability to stop. I now wonder if it was related to
the sufferer deliberately making themselves
sick, using laxatives, exercise or restricting stuffing down anger and upset I didn’t feel able to express.
food intake to try to avoid gaining weight. I didn’t know I’d developed bulimia, only that it wasn’t normal behaviour,
Binge eating disorder is similar, with upset and eventually went to my GP to ask for help. This was back in the 1980s
and guilt experienced after consuming large
amounts of food, but minus the purging. and he didn’t seem to know what to suggest for a 16-year-old with an
eating disorder, other than an art therapy group for adults with various
110 mental health problems, which I declined. Now the area where I still live

has a specialist eating disorders unit, there is online advice and most
schools offer counselling services. I did find a book on bulimia, which was
helpful, and started counselling at college. One of the things that helped
me stop making myself sick was finding out stomach acid is really bad for
your teeth and erodes the enamel. Obviously bulimia was damaging my
body in lots of ways, but I’d always been proud of my teeth and thinking

of that was more effective when I was tempted.
It took time, but around six years after my eating disorder began, I
finally managed to break free from bulimia. Unlike unhealthy habits or
addictions, you can’t just give up or avoid food. Recovering involved
working on changing the damaging relationship I’d developed with it and

finding other ways to cope with difficult feelings and situations.
Today I am a normal weight for my height, I exercise in moderation and
eat normally, but tests have shown my eating disorder has contributed to
a higher risk of developing osteoporosis. I regret the years I wasted and

long-term effects, but I’m just grateful I was able to stop when I did.
*Name has been changed

PSYCHOLOGY NOW

WHEN EATING BECOMES AN ISSUE If you recognise that you or someone you © Getty Images
know is showing signs of an eating disorder,
FIVE STEPS TO it is important to get help as soon as possible.
ADDRESSING AN ISSUE The earlier treatment is sought, the better
chance of recovery there is.
PICK THE RIGHT TIME AND PLACE
Expert advice
If you suspect a friend or family member has, or is at risk of developing, Professor Janet Treasure is a leading
an eating disorder, educate yourself on the signs and symptoms psychiatrist specialising in the field of eating
disorders. She has co-worked with patients
beforehand. Choose a calm time to talk privately, avoiding mealtimes. and their friends and family to provide
strategies to help support recovery.
CHOOSE YOUR WORDS CAREFULLY
Research published over the last two
Focus on how they’re feeling rather than what they are (or are not) decades has flagged up several important
eating and their weight. If they get angry or defensive, don’t be put off factors for carers to be aware of:

or react similarly. Be well informed
It can be difficult to know
TRUST YOUR INSTINCT whether you’re sourcing reliable
information. “Research in scientific
If someone denies they have a problem, keep an eye on them without journals is carefully scrutinised
making it obvious. It can feel hard to take another approach, but it’s although occasionally there can
be false trails,” she explains.
important to if you suspect something is wrong. “Organisations such as Beat (www.
beateatingdisorders.org.uk) and
OFFER HELP TO GET HELP FEAST (www.feast-ed.org) are helpful
and may signpost local workshops or
If they admit to a problem, encourage them to see their GP as soon
as possible, offering to go with them or, in the case of a child or young training sessions.”
person you are responsible for, make an appointment and take them.  -

SEEK SUPPORT Avoid extremes
It can be tempting to get frustrated
If you think it would be easier for them to talk more anonymously,
or you need support yourself, contact the Beat Helpline on or angry with someone stuck in a
0808 801 0677. There is also a Youthline on 0808 801 0711. destructive cycle; we may wonder
why they can’t just stop behaviour
The most common eating disorder, that is harming them and affecting
however, is OSFED, where symptoms don’t
fit neatly into one of the other categories. those who care about them.
Examples can include someone who has all Alternatively, we may tip-toe around
the symptoms of anorexia, but their weight
remains within a ‘normal’ range, or has them, inadvertently ending up
symptoms of bulimia but the binge/purge accommodating or normalising
cycles don’t happen as often as would be their behaviour. Professor Treasure
typically expected.
111
A pre-occupation with and/or secretive
behaviour around food and noticeable
self consciousness when eating in front of
others are just two signs that could indicate
someone may have a problem.

PSYCHOLOGY NOW

© Getty Images / Malte Mueller advises guarding against veering WHEN EATING BECOMES AN ISSUE
between being too critical or
overly protective and instead A PARENT’S STORY

providing a calm, consistent and Georgina Norris’s daughter, Elizabeth, died at the age of 39,
gentle approach. after a 20-year battle with anorexia that started when she was
  -
at university and involved more than a dozen hospital stays.
Positive role models Describing her as a highly intelligent, witty and strong-willed
girl, Georgina says Elizabeth was offended by the idea that her
Researchers, including Professor
Treasure, identified three role models illness was the result of misguided vanity.
“Although she became conscious of her weight as a teenager
for carers in terms of developing and decided to go on a diet, as an adult, she was adamant
helpful behaviour. These are called that the illness had nothing to do with her appearance and
‘dolphin’, ‘St Bernard’ and ‘herd of was almost insulted anyone would think that. Instead, she often

elephants’, as she explains: talked about feeling like she ‘took up too much space’.
“The dolphin is used to portray a “I’ve often wondered what made her vulnerable – she was
wise, hands-off, but gently nudging a lovely, very sunny child, much-loved and highly thought of.
approach, and the dolphin’s smile But she did find it hard adjusting to the single-sex school she
is also significant. As part of this transferred to at the age of 16, where some of the girls could be

model, caregivers are taught quite catty and make personal comments.
motivational interviewing techniques. “She was also a perfectionist who set herself high standards,
and nothing she did was ever good enough for her. When she
This uses a guiding style to elicit started playing the piano and taking grades, she immediately set
reasons, and plans to support change her sights on grade 8. When she achieved a first-class honours
degree at university, she would say that it wasn’t a ‘good’ first.”
from the individual themselves. Georgina says she first realised something was wrong when
The St Bernard mode represents
staying close to the individual to Elizabeth wore a poncho to walk to a swimming pool on a
provide warmth and nurture for hot summer’s day and only took it off as she lowered herself
someone lost in the frozen waste and in. Although Georgina admits that as the years went by, they
isolation of an eating disorder and eventually gave up hope of a recovery being possible, she
promote the idea of hope for change. and her husband did all they could to provide support to their
The head to tail connection of daughter during her long illness, including attending a workshop
elephant herds is used to show how
important it is to work as a team, for the relatives of people with anorexia.
both within the family and with “I learned not to get pulled into the anorexia agenda. Elizabeth
health professionals. In a herd of would often ask me if she was fatter than when I last saw her,
elephants, leadership is not related and I had to start telling her I would not get involved in those
to dominance, all in the group show conversations because whatever I said wasn’t helpful either way.
respect for others and their collective
If someone told her she looked ‘well’ or ‘better’, it translated
ability to solve problems.” for her as ‘fat’. If you said she looked thinner, she would be
happy for a few minutes before returning to the mindset
it’s of needing to lose weight.
“As a parent, an eating disorder can leave you
important feeling totally helpless, and Elizabeth’s death
feels so needless. Of course when I see the
to get help children of friends having worthwhile jobs,
getting married and having children I
as soon as am happy for them. But it also grieves
me that my darling daughter didn’t
possible experience these ordinary, normal
things and never will.”

1 1 2 PSYCHOLOGY NOW

UNDERSTANDING NIGHTMARES

UNDERSTANDING

Why do we have bad dreams and
what can we do to stop them?

WORDS LAURA MEARS

N ightmares are the scourge health affects their dreams. This is most but your own interpretation is likely to be © Getty Images / Natty Blissful
of the sleepy, but scientists pronounced in post-traumatic stress disorder, more valuable.
think that they’re just a where the brain reruns past events during the
natural part of healthy night, but everyday stresses can also bleed Use a weekly tracker to record your
rest. Experts aren’t sure into our sleep. sleep, including any bad dreams you have,
exactly why we have them, but it might because recording your nightmares could
have something to do with developing Keeping a regular bedtime and taking the help you to manage them more effectively.
connections inside our brains. Dreams and time to wind down before bed can really One technique used in the treatment of
nightmares may help with memory storage, help to get you into the right mindset for nightmares associated with PTSD is ‘image
emotional processing or training for real- restful sleep. You can reduce stress and rehearsal’. The idea is to practise visualising
life fight or flight situations. All three can anxiety by exercising during the day and different endings to your nightmares during
be stressful, so it’s no wonder that dreams avoiding stimulants such as caffeine and the day. This gives your brain a bank of new
sometimes turn into nightmares. This nicotine in the run-up to bedtime, but one ideas to call on when you experience the
happens most frequently between the ages of the best things you can do to manage nightmare for real. It works best for recurring
of three and six, but nightmares often persist nightmares is to record and analyse them. nightmares, because they often end in the
into adulthood, especially in those of us who If your mind is trying to work through same way.
are naturally anxious. memories, emotions and stressful situations
in your dreams, it’s possible that there’s Many people are able to work through their
Nightmares, like dreams, happen during something to learn from them. You could nightmares on their own, and some even
REM. When in the REM phase of sleep, our look up a generic dream meaning online, learn to enjoy them, but if you’re struggling,
bodies switch on a protective mechanism it’s important to reach out for help.
called sleep paralysis. The brainstem sends
muscle-relaxing signals to the body, which
stop us acting out our dreams with our arms
and legs. This is why we sometimes wake up
from a bad dream unable to move. Known
as ‘old hag syndrome’, waking suddenly
from a bad dream can leave you feeling like
someone is pressing you into the bed. Luckily,
the effect soon subsides as the brainstem
wakes up.

For some, foods that alter body
temperature or brain chemistry, such as
chillies, sugar and alcohol, can contribute to
bad dreams. For others, it can be something
as simple as sleeping in an uncomfortable
position. Physical health problems, such
as a fever or a migraine, can also cause
nightmares, as can certain medications.
Many people also find that their mental

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1 1 4 PSYCHOLOGY NOW

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IS

DIFFICULT

How people make their minds up is
one of the most interesting, and best

funded, areas in psychology

WORDS EDOARDO ALBERT

I t’s a big choice: buy the hybrid that people were rational actors when it came
eco-friendly BMW i8 sports coupé, to assessing and deciding their economic
which costs from £114,000 new, or behaviour. Remember, in the days before
go for the Mercedes Benz S class social security, these could easily be life
four-door saloon, starting at £76,000, or death decisions: for a medieval peasant
the preferred car of diplomats and high- farmer, judging when to plant his crops could
powered gangsters the world over. It’s the mean the difference between a rich harvest
sort of choice that, sadly, not many of us are and starvation. In Victorian times, people
likely to face – and certainly not writers of often had little choice but to accept difficult,
articles about psychology – but for BMW hard work in dangerous conditions as the
and Mercedes Benz, knowing what factors only alternative was the work house.
govern the decision making of their potential
customers is an important consideration in Faced with these choices, economists
their billion-dollar businesses, and one that assumed that people acted for their best
they, and other corporations, are willing to interests, and that they decided these
invest serious time, money and effort into interests by a rational inquiry as to the costs
investigating. This explains why the psychology and benefits of their actions. So, when faced
of decision making, in modern-day study, is with the choice between luxury cars that
often subsumed into business schools. In that would move them equally well from A to B,
respect, it is merely returning to its roots, for they would naturally choose the cheaper,
the inquiry into why human beings make the and genuinely four seated (with space
decisions that we make arose originally as part for five), Mercedes Benz S class over the
of economics theory. significantly more expensive BMW i8, which
can shoehorn two short people into the back
Economic roots of decision-making theory seats if they don’t mind having their knees
As economists, beginning with Adam Smith, up to their chins for the journey. However,
started to investigate the mechanisms of wealth we know perfectly well that some people
creation and transfer in societies, it quickly would choose the BMW over the Mercedes
became an axiom of the nascent field of study for a whole host of reasons, few of which have
anything to do with a cost benefit analysis.

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How much you earn matters normal course of events, this is not a problem, How a
Part of the explanation for this apparently as the money flows in and out of the bank at a decision is
obstinate refusal by people to follow their fairly constant rate. But suppose all the bank’s framed is crucial
own material best interests was first provided depositors, suddenly fearing that the bank in influencing
by the mathematician and physicist Daniel might go bust, all simultaneously demand what decisions
Bernoulli (if the name rings a bell, Bernoulli’s the return of their money. No bank, ever, are made
principle is one of the foundations of could pay out to all its depositors at once:
aerodynamics and is often demonstrated they simply don’t have the reserves. Amid will throw the dice, as there is no downside.
in classrooms by a physics teacher holding the panic of the banking crash, depositors, all But suppose the rules of the game change.
two sheets of paper a few inches apart looking to save their own nest eggs, ended up Now the person holding that bundle of crisp
and blowing between them, causing them making the bank fail and, as a consequence, £10 notes says that you will win £100 if you
to move together). A genuine polymath, they lost their money. A rational actor, throw a three, four, five or six, but if you throw
Bernoulli made groundbreaking discoveries knowing that this was the inevitable outcome, a one or a two then you have to pay them
in mathematics and statistics, including his would have waited. But people panicked. £100. Would you still be willing to take the
development of the idea of expected utility There have been many similar irrational gamble? What about if you only lost your
in decision making. Bernoulli pointed out booms and busts through history, from tulip money through throwing a one? Are the odds
that the sorts of decisions householders mania, when a single tulip bulb went for 12 good enough then?
made were not purely based on maximising acres of land, through the South Sea Bubble
income, but rather depended on how much in the 18th century, and right up to recent ?
risk the decision maker was prepared to take times and the Dot-com Bubble that occurred
with his money and how much they were in the 1990s.
looking to make depending on their income.
For someone earning the average wage for Psychologists look at decision making
a writer, £10,000 per annum, an additional When faced with all this evidence of human
£500 would be a very significant windfall. beings as irrational actors, the time was ripe
But for a footballer in the Premier League, in the 20th century for a fresh, psychological
who makes on average £50,000 per week, an approach to decision making. This new
additional £500 would barely be noticeable. analysis was provided in seminal work
by psychologists Daniel Kahneman and
Booms and busts Amos Tversky. Kahneman and Tversky
So with this addition from Daniel Bernoulli, demonstrated that people were far from
economists continued on their gloomy way, rational actors when it came to making
predicting – or more often not – depressions economic decisions, with their judgement
and booms while assuming that people affected by a whole host of considerations
basically acted in their own best interests beyond simple costs and benefits. In
for rational reasons. The problem with this, particular, Kahneman and Tversky argued
of course, is that people are not entirely that people are averse to making a loss when
rational, indeed far from it. A classic example compared to making a gain. Thus, according
was provided by the banking crashes that to this argument, winning £100 on the throw
triggered the Great Depression of the 1930s. of a dice suddenly becomes much, much less
Although people might think their money is attractive if there is a significant chance of
safe with a bank, the truth is that banks use losing £100 if the throw goes against you. The
the money deposited with them to lend to idea runs like this. Suppose you will win £100
people who want to take out loans. In the if you throw a six with a dice. Naturally, you

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How we frame a problem often about a possibility affect their decisions as to no connection to the outcome. So when
decides its solution its riskiness. Thus people tend to feel more estimating the price of a house, if people are
Kahneman and Tversky found that potential frightened about taking a plane ride than given a random price and asked to estimate
losses weigh more heavily when making they do when getting into their car, although how much more or less the real price is, they
decisions than potential gains. a car journey actually carries a greater degree will tend to stay closer to this random figure
of risk than a plane journey. than when people are asked to simply make
The other major discovery they made was an estimate without a random starting price.
that how a decision is framed is crucial in Anchoring is the tendency that people
influencing what decisions are made. In one have to stay near a starting point, even Availability is an effect of how well we
of their experiments, Kahneman and Tversky when that starting point is random and has remember certain things. For instance, if you
put the problem in terms of a medical
dilemma. One group of people were told that WHY TEENAGERS
600 people with a very serious, ultimately TAKE RISKS
fatal, medical condition could be given two
possible treatments. With the first treatment, Teenagers are notoriously bad at risk assessment, from driving too
200 people would be cured. If they chose the Vfast through to drinking too much and experimenting with drugs. In
second, experimental treatment, there was one study, psychologists asked people a series of questions including
a one in three chance that all 600 people whether it was a good idea to set your hair on fire and whether it was
would be cured, but there was also a two in a good idea to drink bleach. The answer to these and other questions
three chance that none of the 600 would be was supposed to be ‘No’, and teenagers did indeed say ‘No’, but it
saved. The second group of people had the took them significantly longer to make that decision than adults. It’s
same choice but it was framed differently. not entirely their fault. These sorts of judgements are based on the
They were told that the first treatment meant experience-based systems in our brains that mature later than other
that 400 people would definitely die while parts of the brain: the ventromedial and dorsolateral areas of the
with the second, experimental treatment, frontal lobe aren’t fully developed in young people. So next time you
there was a one in three chance that no one see a teenager setting their hair on fire, reach for the fire extinguisher
would die and a two in three chance that
all the patients would die. With the choices but remember: their brain is still developing.
framed in terms of saving lives in the first
instance, and losing lives in the second
instance, most people in the first group chose
the first treatment, thus definitely saving 200
people, but in the second group, where the
choice was framed as an option between
400 people dying and having a one in three
chance of saving everyone, then the majority
chose the second, experimental treatment.

Blink and decide
Thus how a choice is presented will affect,
quite fundamentally, the choices people
make. In the real world, decisions are not
usually presented in such a clear-cut,
quantifiable way, and they often require quick
decisions, sometimes before it is possible
to evaluate all the possible factors affecting
the decision. Not surprisingly, we as human
beings are wired to make decisions quickly,
and the more urgent the decision the more
the choice is taken from conscious control.
So, touching something hot triggers the
autonomic nervous system to pull your hand
away without any conscious decision on
your part. Back in our days on the African
savannah, the decision on whether to fight or
run had to be made quickly, based on a swift
evaluation of threat and risk. To help us make
these quick decisions, the mind makes use
of shortcuts, which are called heuristics by
researchers in the field.

The shortcuts of decision making
Among these mental shortcuts are the
affect heuristic, anchoring, availability and
representativeness. To start with the affect
heuristic, this is the way people’s feelings

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have witnessed a car sliding off the road at
a local bend once, when seeing other cars
approaching the same spot you are likely to
overestimate the chance of them skidding off
the road too: a vivid memory of a particular
event makes us think that a repeat of such an
outcome is more likely than it actually is.

Representativeness is a nice word
for stereotypes. We’re all told to avoid
stereotyping and yet we all do it: in the
real world, it is very difficult to make the
sort of quick judgements often needed
without employing them. So suppose you
are interviewing Gary for the position of
university librarian and he walks in with a
copy of The Sun newspaper rolled up under
his arm. Gary would probably have to work
very hard to overcome the stereotyping
associated with reading The Sun and being a
university librarian.

Fast and slow decision making HELP IN A WORLD OF CHOICE
Back in our African savannah days, the fast,
experience-driven decision-making systems We are bombarded by choices. In a supermarket aisle, a shopper might
that we share with our primate cousins were see well over a hundred choices of breakfast cereal. Making the choice
vital in helping us to escape predators. But
as human society and human beings have can be simplified by deciding that the decision will be based on one
evolved, a second form of decision making feature alone, such as price, so in that case you might go for the own-
has become necessary, one that is slower, brand cornflakes. For buying something like a car, it might be better to
more deliberative and less instinctual than use an evaluative method, where you list all the desired features you
our ancestry would allow. This new (in want the car to have, with ratings from +5 to -5, and you then look at the
evolutionary terms but it would be tens of potential cars and rate them according to these desired features. The
thousands of years old), evaluative system
of decision making is not at all helpful when choice will then fall on the car that accumulates the highest score.
deciding which way to run from a tiger, but it
comes into its own with the sorts of decisions the top branches to laugh out loud at the Greater experience leads to swifter and better
that hunter gatherers and, later, pastoralists sight of a porcupine bumbling along, minding intuitive decision making.
and agriculturalists had to make: where to its own business.
go to find the new crop of jackfruit; how Decision making overall can be improved
long to leave the cattle pastured on the hills It takes time to decide by becoming aware of the different factors
before the weather turns; when to plant the However, recent studies have shown how affecting our choices, from the mental
new crop of barley. These are decisions that our maturing brains, in particular the shortcuts we use to make things manageable
require thought and evaluation. This newer ventromedial and dorsolateral sections of the but that also cut out otherwise viable options
mode of decision making can also be used, frontal lobe, can allow even snap judgements (in the case of Gary, the would-be university
after the fact, to assess how good our snap to be informed by previous learning and librarian, further questioning might have
judgements, made using the older neural experience. For example, an experienced revealed that he found the newspaper thrown
pathways, were. Having run and climbed a doctor will often base his or her decision on the floor and picked it up because, being
tree because of the crack of a twig, one of our on the seriousness of a patient’s condition tidy, he did not want litter in the library);
ancestors might well have looked down from on fewer factors than a less-experienced to a greater appreciation of the value of
doctor, but their judgement will be made properly evaluative decision making. After
Greater more quickly and will be more accurate all, it enabled our ancestors to find food, and
experience leads than that of the less-experienced doctor. kickstarted that greatest of all changes in
to swifter and human history, the agricultural revolution.
better intuitive
decision
making

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HOW MUCH CAN YOU
TRUST YOUR BRAIN?

Our decisions are not always our own thanks to the
unconscious biases buried in our brains

BANDWAGON EFFECT CONSERVATISM BIAS CONFIRMATION BIAS CHOICE-SUPPORTIVE BIAS

People follow the crowd, meaning Have you ever heard someone say, When you believe something to be When you make a choice, it is
you might be more likely to vote “There’s nothing that will change my true, you see evidence that supports probable you will look back on it
for someone because they have mind”? That is conservatism bias. We positively to rationalise your decision,
have a tendency to not update our views it, like when you think someone even if you see afterwards that there
more supporters even if they doesn’t like you, you are more likely to
don’t align with your views. when faced with new evidence. were better options.
notice when they’re ‘off’ with you.

EMPATHY GAP NEGATIVITY BIAS

When we are being logical (cold), we Negativity bias is when our minds react
don’t understand how our decisions more strongly to negative experiences
would differ if we were emotional (hot). rather than positive ones. It makes us
Conversely, when we are emotional, we more likely to turn down opportunities
don’t realise how much our decisions are because we can see the threats within the

being influenced by emotion. choice rather than the advantages.

FREQUENCY ILLUSION RESTRAINT BIAS

Have you noticed that when you learn a We overestimate our ability to resist
new word you start seeing it everywhere? temptation. This means we think we won’t
eat a slice of cake at a party when we’re
Our brains have a habit of trying to see trying to eat healthily, but many of us will
patterns, so we notice things more if they
have overestimated our own willpower.
are interesting to us – like a new word.

OSTRICH EFFECT GALATEA EFFECT

Humans often (metaphorically) bury their This describes the power of self-
head in the sand. We choose to ignore expectation. If you believe you will
the bad things that are happening, like succeed, you are more likely to be
not checking our bank accounts, rather successful, compared to if you believe
than tackle the problem.
you can’t do something.

OVERCONFIDENCE BIAS PROCRASTINATION BIAS

Some people may be overconfident in We tend to accept short-term reward
their abilities because of this bias and rather than wait for a better reward. We
know our coursework will be more worth
as a result take greater risks in it in the long run, but we are still tempted
decision-making, which may end
by the funny cat videos.
positively or negatively.

SCOPE INSENSITIVITY REACTANCE BIAS © Getty Images / smalvik / Nadine_C / katflare / Irina_Strelnikova / Dmi+T

Our brains are not very good at If we are forbidden to do something, we
understanding scale. If we hear a disaster may have the desire to do that exact thing
in order to prove our freedom of choice,
has impacted 200, 2,000 or 200,000 like being asked not to walk on the grass
people, we react the same because we
can’t comprehend the larger numbers. or touch a piece of art.

ANCHORING BIAS SURVIVORSHIP BIAS

We make our decisions from the first You see so many books every day, you
piece of information that we learn about a might think it is easy to publish. This is an
subject. This is why we are more inclined example of survivorship bias, as you have
to buy something when we see the original not seen the many more that didn’t make

price placed next to the reduced price. it to the publishing stage.

SELECTIVE ATTENTION FUNDAMENTAL ZERO-RISK BIAS STATUS QUO BIAS
ATTRIBUTION ERROR
Our attention is a limited resource, and We prefer the elimination of all risk over The status quo bias is our preference
we have to direct it on things specifically This is when we attribute the behaviour of a greater reduction in a larger risk for things to stay the same. You might
someone to a character flaw rather than (overall), like choosing to clean up a revisit the same restaurant or purchase
for it to work. Our brains filter just an uncharacteristic moment. Someone the same brands just because that’s
information in our environment to focus who snapped at you once is probably not small oil spill completely, rather than
on what is useful and ignores the rest. an angry person, but we think they are. using the same money to clean up a what you have done in the past.

giant oil spill significantly.

PSYCHOLOGY NOW 119

FIGHT OR FLIGHT FLIGHT

FIGHT

120 PSYCHOLOGY NOW

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FIGHT
OR

The brain’s ancient threat-detection
system gets us out of danger at

lightning speed, but at what cost?

WORDS LAURA MEARS

T he fight or flight response is The hypothalamus sits in the middle of the
all-consuming. Your heart beats brain, monitoring and adjusting everything
faster, your breathing gets quick from temperature and thirst to appetite and
and deep, your palms sweat, sleep cycles. It wires into the autonomic
and your mouth goes dry. With nervous system, which sends electrical
fractions of seconds to react in the face of impulses down through the spinal cord and
danger, this is what gets you out of harm’s out into the body. It also has a direct line to
way before you’ve even had time to think. the pituitary gland, a long-range hormone
It’s an ancient self-defence mechanism that’s signaller that pumps chemical messages into
hard-wired into the nervous system – your the blood.
body’s way of getting you ready for battle.
The autonomic nervous system has
The body’s panic button is a walnut-sized two parts, which provide opposing sets of
piece of brain tissue called the amygdala, instructions to the organs. The sympathetic
and its job is to monitor incoming sensory nervous system revs the body up, whereas
signals for signs of threat. It is connected the parasympathetic nervous system calms
to a larger brain area called the thalamus, it down.
which acts as the brain’s sensory relay. The
thalamus gathers inputs from the brain’s Nerve signals move faster than hormones,
sensory processing areas and from the so the first part of fight or flight kicks this
internal organs, and the amygdala listens in. system into action. When the hypothalamus
When something doesn’t look quite right, receives a danger signal from the amygdala,
the amygdala has just seconds to get the it switches the sympathetic nervous
body ready to fight or flee, and this involves system on, which then sets off a cascade
synchronising all the organ systems to divert of electrical messages that result in the
resources to the muscles. The fastest way to release of a neurotransmitter that’s called
do this is to talk to the master controller of noradrenaline. The muscles and organs
the body, the hypothalamus. are on constant alert for this signal – they
have adrenergic receptors that can detect

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TOO MUCH OF A
GOOD THING

What happens if the fight or flight system won’t turn off?

The fight or flight response evolved to get us out of sticky
situations fast. But it’s only supposed to work on short timescales.
To boost muscle power in a time of crisis, the body has to borrow

resources from other areas; when the crisis is over, those areas
need their blood supply back. But what happens when the threat

doesn’t go away?
The fight or flight response gives way to the stress response. The
sympathetic nervous system calms down and adrenaline production
stops, allowing heart rate and blood flow to return to normal. In its
place, cortisol kicks in. Known as the stress hormone, cortisol can talk
to almost every cell in the body. Its main job is to change metabolism
and dampen lower-priority activities like growth, reproduction and
immunity. It does this by altering the release of reproductive
hormones, interfering with molecules used to fight infection
and changing the way that cells respond to growth
factors. This helps to make sure that there’s energy
available to deal with the stressful situation, but it
can cause side-effects, changing digestion, sleep
patterns and mental health. Only when the stress

subsides will the body return to normal.

when noradrenaline is released from nearby for extra fuel. The pupils widen to allow as The adrenal glands get some of the best
nerves. When the signal finally arrives, the much light in as possible, sharpening central blood supply in the body, helping to get the
organs start to respond. vision, and the hands and feet become adrenaline out into the system at lightning
sweaty, improving grip. For a few moments speed. Messages pass through so fast that by
The heart beats faster and the blood you become superhuman. To allow all of the time adrenaline production starts, the
vessels constrict, boosting blood supply this to happen, non-essential systems have brain’s cortex might not even have clocked
to the muscles and brain. The airways to slow down. Blood vessels to the digestive the threat.
relax, letting more oxygen pass into the system, skin and kidneys narrow, diverting
bloodstream, and the liver releases glucose vital nutrients away. Saliva dries up, appetite When we need to get out of the way
disappears and the stomach stops churning. of a speeding car, we don’t have time for
Do we stand conscious thought. It takes about two
a chance if we Noradrenaline is powerful, but the body minutes for full adrenaline production to
stay and fight, has a second chemical message that takes the switch on, and by this time the cortex has
or would it fight or flight response to the next level, and caught up. Conscious processing comes back
be better for that’s adrenaline. on line and the powerful, problem-solving
us to turn parts of the brain can help with decisions
and run? The sympathetic nervous system sends about what to do next.
danger signals to the adrenal glands.
Positioned just above the kidneys, these small Do we stand a chance if we stay and fight,
organs are hormone factories, and their job or would it be better for us to turn and run?
is to flood the blood with adrenaline. Deep Whichever conscious choice we make, the
in the centre of each one, in a part of the fight or flight response has already made sure
gland called the adrenal medulla, chromaffin that the body is ready.
cells start adrenaline production. These cells
connect to their neighbours via tiny holes Sometimes, the answer is neither fight
called gap junctions, so when one receives a nor flight, and the body’s built-in defence
danger signal, the others respond as well. system has a solution for that too. If a
predator is nearby but hasn’t seen you yet,

122 PSYCHOLOGY NOW

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it can be better to freeze to avoid detection. The heart beats faster and
The prefrontal cortex and the anterior the blood vessels constrict,
cingulate cortex talk back to the amygdala boosting blood supply to the
and hypothalamus. They can override muscles and brain
the sympathetic nervous system with
parasympathetic signals, slowing the heart parasympathetic nervous systems started to called Adrenoceptor Alpha 2C (ADRA2C),
rate and calming the body down in the hope work as a pair to control heart rate and divert which sits inside the cortex of the brain
that the danger will pass. blood away from the gut, and we all use listening for fight or flight signals. In lab
cortisol to manage stress. experiments, mice born without the gene
There’s only so long that the body can startle more easily and are quicker to attack,
maintain a full-blown fight or flight response. Although the fight or flight response seems revealing that its normal job is to dampen
We can’t divert blood away from the to be ancient, there are some unique things the fight or flight response.
digestive system all day, so there’s a second about the way in which humans react to
phase of the response that kicks in later if danger. We are one of only two species in the A look at the gene in humans and
the danger still hasn’t subsided. This is the entire animal kingdom that engages in war – chimpanzees showed up a natural change
stress response. bands of humans, and bands of in ADRA2C that means our brains make
chimpanzees, come together to kill other less of it. If we are anything like mice, there
Stress signals come through the same members of their own species in large- is a chance that this change might make
pathway, beginning in the hypothalamus scale conflicts. It seems that this might have us more volatile in response to fight or
and ending in the adrenal glands, but they something to do with how our specific fight flight signals.
travel by a different route. This time, the or flight systems evolved.
hypothalamus talks to the pituitary gland, However, our fight or flight response seems
telling it to release the adrenocorticotropic, When researchers looked at one of the to come at a cost. It might have originally
or ATCH, hormone, into the blood. This then fight or flight genes in our brains, they evolved to get us out of danger, but it can just
travels to the outer part of the adrenal glands, found something different. There’s a protein as easily get us into danger too.
the adrenal cortex, which then switches on
production of the stress hormone, cortisol. © Getty Images / treety

Cortisol backs up the fight or flight
responses for more long-term survival by
changing the body’s metabolism. It releases
sugar into the blood for fuel and dampens
non-essential systems like reproduction, the
immune response, growth and digestion.

The fight or flight response has helped our
species to flourish in the face of some of the
most dangerous situations on the planet, but
it’s not unique to humans. The ability to adapt
to dangers in the environment, or to escape
if adaptation isn’t possible, is a fundamental
part of animal survival.

Some fight or fight responses are incredibly
simple. Bacteria, for example, can sense
danger in their environment and respond by
switching genes on and off (fight) or moving
away (flight). But as organisms get larger, the
responses become more complex.

A fight or flight system for a complex body
like ours depends on a nervous system. We
need to be able to speed the heart up or
slow it down on demand to give our muscles
the boost they need when we’re in danger.
Invertebrates can do this to some extent,
but for the full experience it seems you need
a backbone.

Lampreys are some of the most ancient
living vertebrates, closely related to the
ancestors that gave rise to all modern fish,
amphibians, reptiles, birds and mammals.
Their nervous systems are simpler than ours,
but they still have the components that are
needed to build the fight or flight response.

A look at the evolutionary tree reveals
that simpler vertebrates rely more on
adrenaline for their fight or flight responses,
and as vertebrates became more complex,
changes to the nervous system gave their
brains finer control. The sympathetic and

PSYCHOLOGY NOW 123

MEDITATION AND THE BRAIN

THE BRAIN

Training the brain to remain in the
present moment can ease stress, reduce
anxiety and even lower blood pressure.

But how does it work?

WORDS LAURA MEARS

T he English word ‘meditation’ study participants can be variable, as can the
comes from the Latin meditari, length and duration of the practices they’re
which means to think or to asked to perform as part of each trial.
ponder. But the practice has its
roots much further east than The absolute gold standard in medical
Rome. It originated in India as early as 4,000 research are randomised controlled trials.
years ago, before spreading eastwards to In these studies, participants are randomly
China and Japan, and westwards along the separated into two groups: one receives the
Silk Roads into Europe. Now, as brain scans experimental treatment, while the other
begin to pinpoint the neurophysiology of receives a different treatment or placebo as
meditative experiences, and research trials a ‘control’. This enables researchers to really
explore the effects meditation practices can measure the difference that the experimental
have on our wellbeing, what began as a step treatment makes. But designing a control for
on a spiritual path towards enlightenment is meditation trials is tricky.
fast gaining a reputation as a panacea.
When researchers at Johns Hopkins
Neural rewiring for health University trawled through more than 18,500
and wellbeing meditation research studies in 2014, they
There are hundreds of different ways to found only 47 that met their strict criteria for
practice meditation, but at their core, most proper study design and control. But within
use a form of focused awareness to calm and those 47 high-quality research papers, there
balance the mind. Though research is still were some clear psychological benefits: an
in its early stages, trials are starting to reveal eight-week meditation practice showed to
the difference that even a short meditation improve symptoms of anxiety, depression,
practice can make to health problems like stress and pain.
depression, anxiety and insomnia.
This pattern of improvement in mental
It’s important to note at this stage some health problems is mirrored elsewhere in the
of the challenges inherent in unpicking meditation literature. Separate studies have
the effects of meditation on the mind. It is found that meditation helps to boost lifespan,
notoriously hard to design studies that truly improve quality of life, lift mood and decrease
measure subjective effects on mood and anxiety for people with cancer. It helps to
wellbeing, and due to the sheer number prevent relapse in people experiencing
of different meditation practices, it’s often repeated bouts of depression. And, it can
difficult to compare the results from one trial help people to cope with the symptoms of
to the next. The meditation experience of menopause and irritable bowel syndrome.

Meditation also has positive effects on
wellbeing in people without underlying

124 PSYCHOLOGY NOW

MEDITATION AND THE BRAIN

PSYCHOLOGY NOW meditation
helps to
boost lifespan,
and decrease
anxiety

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MEDITATION AND THE BRAIN

LEARNING TO LET GO

©Sarah Wilks-Harrison Steve Harrison dedicated his life to the practice and teaching of yoga after a
transformational experience with a yoga master. We asked him why learning to meditate

is so hard, and what we can do to make it easier.
“I think for me the first thing to understand is that meditation is a state, rather than a
practice. It’s convenient to say ‘I practice meditation’, but it’s not really the case. We can
create an internal environment that is conducive to slip into a meditative state, but you
can’t actually do meditation because meditation is where doing ceases to happen.”

WHY IS IT SO HARD TO LEARN TO GET INTO A MEDITATIVE STATE?

“In a modern world, it can be unrealistic to ask a mind to be able to focus. The obstacle that most people
encounter almost straight away is their own bodies. Physical discomfort is, for a lot of people, a distraction

from letting go into meditation. Sore knees, sore hips, backache… the body just keeps interfering.
Focus techniques are an incredibly subtle device that require an immense amount of willpower. It can turn

into a fight with ourselves to try to calm the mind when the body is not agreeing.”

WHAT CAN WE DO TO MAKE IT EASIER?

“The ancients spent thousands of years devising ways to help people manoeuvre into a
meditative state. It wasn’t only the mind that was worked on. If you can do simple things to
work with your body and your breathing, it will do a lot of work on the mind without the fight.
But the biggest thing for me, and I think the least spoken about, is our own psychology. Most

of us are incredibly identified with our thoughts and our sense of individuality. In order to
not constantly be pulled back into a thought stream about ourselves, we need to have a
genuine interest in finding a space or an experience that’s beyond our usual constructs of

who we think ourselves to be.

“Ask yourself, how would it be if I just let go of myself for a moment? We don’t disappear as a
result of slipping into meditation, we expand.”

health problems. It seems to improve working train us to draw our attention away from
memory, focused attention and emotional the parts of the brain involved in reasoning
regulation. In one study, participants listened and judging, and towards the more ancient
to either a guided meditation or a language structures that are involved in awareness of
lesson. Then they were challenged with the present moment.
disturbing images. Those who had meditated
were much quicker to recover from the The brain constantly monitors incoming
emotional hit. signals from the outside world, passing
them through a structure just above the
A quiet space and a comfortable seat brainstem called the thalamus. It works like
So how does meditation change the way a comms relay, taking in sensory signals and
our minds work? Many other tools that help forwarding them on to other parts of the
us with emotional control usually work on brain for processing. Filtering this stream
the parts of the brain involved in conscious, of information is an active process; we
rational thought. But meditation practices constantly and consciously have to choose
work differently. Rather than actively trying to what to focus on.
control our thinking, meditation techniques
Our focus decisions are complicated by
an additional stream of information, the

126 PSYCHOLOGY NOW

meditation MEDITATION AND THE BRAIN
techniques
draw attention TRY THIS AT HOME
away from
reasoning Yoga teacher Steve Harrison shares a simple four-step meditation
and judging practice for beginners. This is an indirect method to do a lot of

sensations from inside our bodies. These are work on the mind without actually having to fight with the mind. Sit
detected by the insula, the part of the brain down, get comfortable, take some long, deep breaths, and create
responsible for interoception, or internal an environment inside in which the mind can actually start to focus.
self-awareness. It responds to feelings like
pain, hunger and thirst, but also has a role in BRING THE BODY INTO A
emotional awareness, and links in with other COMFORTABLE SPACE
parts of the brain involved in attention.
The one key is to be comfortable. Any form of physical movement
Deciding what sensation to focus on or intuitive stretch can make sure that the body is as fluid as
falls to a wide circuit of connected brain
regions called the ‘salience network’. It uses possible. Then ensure that the body is in the most conducive state
the anterior insula (the internal sensor), to relax, without falling asleep. Sit on a chair, or in an armchair, but
the anterior cingulate cortex (the attention always ensure you have a straight spine in order to keep the brain-
allocator) and the amygdala (the fear
centre), to listen in on external and internal body connection alert.
sensations, before then working out where
we should put our focus. And it changes SORT OUT YOUR BREATHING
when we meditate.
If you’re looking for the quickest way to create an equilibrium in
Meditation practices almost always begin your system, the breathing is the key. The state of the breathing
by taking a comfortable seat in a quiet space. reflects the state of the mind. If the breathing is agitated, the mind
This helps to minimise the internal and is agitated. If the breathing is calm, the mind will also become
external sensations fighting for our attention
and, over time, starts to change the way the calm. Just gently start to control and deepen and steady the
salience network operates. breathing in order to calm the mind without directly trying to

During meditation, the thalamus remains control the mind.
active, still passing signals into the brain.
But, with fewer distractions, the mind has FOCUS ON DEEP BREATHS
room to focus in on sensations that often go
unnoticed, like the feeling of the breath. It’s unrealistic to sit down and try to just watch your natural breath.
Don’t go too subtle too quickly – you will last seconds and then
In experienced meditators, the connections
in the internal-sensing insula change and you’ll be off. You’ll have this constant ping-pong inside of returning
strengthen, improving internal awareness, to focus on your breath and then getting pulled back out again. So,
and grey matter in the attention-allocating deepen your breathing, because deep breathing is much easier to
anterior cingulate cortex increases, aiding
focus and flexible thinking. Meanwhile, the focus upon.
prefrontal cortex, which makes decisions,
weakens its connection to the fear-inducing KEEP PRACTICING
amygdala. One study found that after just
eight weeks of meditation, the amygdala even You can slip into a meditative state by accident, but to slip into
started to shrink in size. it at will requires lots of training. The mind that’s not trained will
generally be quite dissipated and unable to hold attention. But it’s
On a whole-brain scale, imaging studies not necessary for the health benefits and the wellbeing to achieve
have discovered even more widespread the meditative state. Commit to regular, patient practice and just
changes. Measures of white matter reach towards the point of meditation; there are a whole host of
thickness show that meditation can boost
connections in the front of the brain, which benefits that come with the journey.
contains areas involved in attention and
emotional regulation. Simultaneously, 127
regular meditation practice seems to prune
connections towards the back of the brain, in
areas that are involved in self-referencing and
egocentric processing.

PSYCHOLOGY NOW

MEDITATION AND THE BRAIN

Cutting out external interruptions and meditations activate the motor cortex and responsible for our sense of self. The network
turning inwards during meditation rewires cerebellum. And visual-focus meditations lights up when we daydream, when we think
and reshapes the mind. activate the visual cortex. But studies on about others, when we ruminate on the past,
blood flow in the brain have shown that, and when we project into the future. It tends
Focused attention in a wandering mind rather than direct the attention outside of the to become active when we withdraw from
Minimising distraction and internalising the body, this kind of activity in a meditative state the world into a resting state, but meditation
mind is just one part of a meditation practice. actually helps us to look inside. practice changes how it operates.
The other major component is attention
training. Many practices have a particular Focusing on a single external sense, like Inexperienced meditators often notice that
point of focus upon which to fix the attention; sight, can activate the areas of the brain the mind tends to wander during meditation:
the breath, a word or maybe a sensation. involved in internal sensing and, while this that’s the default mode network activating.
is happening, a part of the brain called the It’s the brain’s way of planning, processing
Depending on the focal point, different medial prefrontal cortex slows down. and thinking about itself, and it can run away
parts of the brain light up. Mantra meditations with us when our senses are internalised. But,
activate the auditory cortex. Moving The medial prefrontal cortex is part of the with practise, people seem to become better
brain’s ‘default mode network’, the circuits

THE MEDITATING BRAIN

47 3 2

9 7 ANTERIOR CINGULATE CORTEX
18
Meditation increases grey matter in the part of
56 the brain that handles attention allocation. This
may aid focus and flexible thinking.
1 PREFRONTAL CORTEX 5 AMYGDALA
8 INSULA
This part of the default mode network is Activity in the brain’s fear centre
responsible for decision making and decreases. With prolonged meditation Repeated meditation practice increases the
self-referencing. Alpha wave activity practice, this part of the brain may even connections inside the brain’s internal
(representing a relaxed brain state) shrink in size. sensation monitor, strengthening the brain’s
increases here during meditation. awareness of the body.
6 HIPPOCAMPUS
2 PARIETAL LOBE 9 THOUGHT-FEAR CONNECTION
The part of the brain responsible for
The parietal lobes process sensory memory storage rewires in long-term The link between the prefrontal cortex and the
information, spatial orientation and meditators. The right hippocampus amygdala weakens with meditation practice,
awareness of the body in 3D space. increases in size, affecting spatial memory helping to stop fear and emotion interfering
Changes in activity here are linked to and planning. with attention and concentration
spiritual meditative experiences.
PSYCHOLOGY NOW
3 THALAMUS

The brain’s sensory relay lights up during
meditation as attention turns to specific
sensations, like the feeling of the breath
in the lungs.

4 FRONTAL LOBE

Activity in the large lobes at the front of
the brain will increase as the meditator
starts to consciously control the focus of
their attention.

128

MEDITATION AND THE BRAIN

at noticing when the mind starts to wander, Studies examining meditation in people meditation © Getty Images / Lisitsa / Pikovit44
and can learn to gently bring it back into with anxiety, anger and high blood pressure makes people
focus. And, with experience, the default mode have found that meditation not only makes feel better,
network actually starts to slow down. people feel better, but it also reduces physical reducing
markers of stress. Stress hormones drop, physical stress
A study of the brains of experienced inflammation markers fall, heart rate lowers, markers
versus novice meditators at Yale University breathing slows down, and blood pressure
found that repeated meditation practice decreases. For some, a single meditation and physical impact of a regular practice is to
re-tunes the default mode network. But session was enough to see a positive change. experience it for yourself.
rather than switch off, the network rewires.
The connections in the network that control Molecular studies suggest that the effects It can be difficult to know where to
self-referencing and emotion weaken, while of meditation go deep into our physiology. In begin, but although there are hundreds of
those involved in awareness of the present a small study at Harvard University, scientists techniques, they can all lead to the same
moment get stronger. This could explain why, found that 15 minutes of meditation every tranquil state. It’s just a case of finding the
in a meditative state, we are able to witness day for eight weeks could change patterns methods that work for you. A good place to
sensations, noticing the breath, the body or of gene expression. Our cells each carry an start is guided meditation. Allowing someone
the thoughts without trying to interfere. entire copy of the human genome, but they else to take you through your practice –
only need to use a handful of genes at any whether at a class, or via an app, video or
Losing your self in the moment one time. So, they turn sets of genes on and podcast – can help to keep you focused when
The yogic scholar Patanjali described off depending on what’s happening around your mind starts to wander. And you don’t
meditation more as a state of mind than them. A regular meditation practice flipped have to commit to a long session. Research
an activity. The practices of removing the switch on 172 genes linked to the body suggests that just a short period of regular
distraction, internalising the thoughts and clock, sugar metabolism and inflammation. training is enough for noticeable effects. Be
focusing the attention all serve to bring consistent, start small, and build slowly.
the mind to a place where it can enter an Beginning your own practice
effortless meditative state. In this state, known Meditation is an active area of research and
in Sanskrit as dhyana, the sense of self debate in the scientific community, and there
dissolves, and the senses of space and time is still much work to be done to understand
also fall away. how it affects the brain and how best to use it
to improve health and wellbeing. But one of
This type of experience is one of the most the best ways to learn more about the mental
challenging to study because it is hard to
conjure up on demand, but scans of Tibetan
Buddhist meditators revealed that it might
be associated with a decrease in activity
in the parietal lobes. These brain regions
handle the processing involved in picturing
the body in 3D space, working out what’s
you and what isn’t, and keeping track of time.
Changes here seem to have the power to alter
our perception of ourselves, not only during
meditation, but also following other powerful
out-of-body or loss-of-self experiences. In
another study, which asked nuns to relive
past spiritual experiences, the parietal lobes
also showed shifting patterns of activity.

Body-mind connection and your
physical health
Meditation has obvious effects on the
mind, but can also induce changes to the
body. Our psychology is powerfully linked
to our physiology. Mental stress floods the
body with a trio of fight or flight hormones:
adrenaline, noradrenaline and cortisol. Their
role is to prepare us to fight, freeze or flee.
They raise the heart rate, quicken breathing
and alter the metabolism.

Addressing feelings of stress using
meditation can change the state of the body
by transitioning the mind out of its ‘fight or
flight’ mode and into its opposite ‘rest and
digest’. It flips off the sympathetic nervous
system, which governs the stress response,
and flips on the parasympathetic nervous
system, thereby easing the strain placed on
the heart and lungs.

PSYCHOLOGY NOW 129

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Psychology
Now
TAKE CONTROL OF YOUR MIND
FOR A HAPPIER, HEALTHIER LIFE

Human nature is a fascinating concept. From
the way we think to the way we behave, the
mind is a powerful yet delicate tool, and must
be nurtured in the same way we take care of
our bodies. Gaining a greater understanding
of human behaviour and mental processes
will ultimately lead to a better understanding
of ourselves. And once we realise why we
and others behave in certain ways – whether
alone or in group settings – it becomes much
easier to avoid stressful situations, reduce
anxiety, make better decisions, and live a
more fulfilled life.

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