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placebo effect

Placebo Effect belief and psychology

The placebo effect

The original meaning of ‘placebo’ comes from the latin word placer – to please (in English "placate"). Placebos were inert substances given to patients to please them so that the patient felt that they were getting some sort of treatment when nothing else was available (Moerman, 2002 p11).
The common meaning of placebo is some inert substance, or some procedure that should not have any medical benefit, but does. 
Moerman (2013) argues that the placebo lies not in the substance, but in the meaning that the receiver takes from it. "I will argue that in most of these, the results usually make more sense if we try to determine how a meaningful interaction occurred, rather than trying to understand the effectiveness of … “nothing.” Whatever form the substance takes, in the mind of the patient it represents the whole of medical knowledge, and is imbued with power."

This has been known for centuries: the King’s touch was believed to cure scrofula, a visit to the doctor makes some people feel better, Chinese Americans born in years associated with ‘earth’, years ending in 8 or 9, disproportionately die of diseases such as lumps and tumours, traditionally associated with earth in Chinese culture.

The placebo effect has been tested extensively

Moerman (2013) cites ten different studies showing the placebo effect. In one, patients got more relief from headaches when they believed the aspirin was a heavily advertised branded version, as opposed to an identical unlabeled aspirin.

In dentistry, the dentists were told that their patients were or were not getting an active drug, but the patients weren’t told. The patients whose dentists were told they were using the active drug actually reported less pain, despite having no knowledge of the experiment at all. Another dentistry study proved that belief in the placebo caused measurable physiological changes in the brain, and produced active opiates to relieve pain.

IBS patients were told that they were getting placebo pills, containing only sugar, but that had proved effective in clinical trials in the past: 97% of the patients who knowingly took the sugar pills proved to be healthier on all measures a week later. In trials of depression drugs, placebos did almost as well and produced much the same results.

The placebo effect also exists with active drugs. After surgery all patients were given Tramadol, but some were injected with it and told what it was, while others had it delivered through their IV line without being aware of it. The injected patients reported much more pain relief from identical doses

The conclusion is that people do not respond to placebos, what they respond to is their own beliefs, to the beliefs for of the carers, to their cultural background and to the words that accompany the intervention. It is the totality of the experience that matters.

Placebo Effect and the cycle of healing

Of course there may be no psychological effect at all. One possible reason is regression to the mean. Many diseases get better on their own. The common cold for example takes about a week and a half to run its course if untreated, but if you get the finest treatment that medical science can provide, it will last only about ten days.

Whatever you do for a cold has no effect, but the cold does come to an end, so you can credit whatever you did as curing it. Many diseases are cyclic: you get unwell, then you get better on your own and then you feel unwell again, but there is no cure. The episodes may well be years apart.

The placebo effect comes in because patients seek help when they are unwell, when the cycle is at or near its peak. Left on its own, the symptoms will subside back to average, and whatever is done has no effect at all because the disease is just running along its cycle. The treatment seems to work, but actually has no effect, so whatever you do the outcome is a placebo effect.

This is most likely the reason for many of the strange folk remedies that people believe in. 

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paradoxical intervention

paradoxical intervention therapy

A paradoxical intervention is a non-hypnosis way of treating people. It seems to be the opposite of what you would think is needed.

Paradoxical Intervention for Smoking

For example, the late Alan Carr wrote a book about stopping smoking. One of the first rules in the book was that the reader was not to stop smoking now, and make no attempt to give up. They have to keep smoking until they have finished the whole book. Now, I have no idea what he intended with this instruction, but the result is that the smoker starts reading the book, and then feels pressured to keep smoking. They didn't want to smoke, but must. You can't stop until you have finished the book.

That means that every time you turn a page you are reminded that you are not allowed to stop smoking yet. That increases the desire to not be forbidden to stop, which increased the desire to want to stop. Which is precisely the feeling you want the smoker to have. So paradoxically, by ordering them to not stop, you increase their desire to stop.

Paradoxical Intervention theory

The basic idea in a paradoxical intervention to reduce the resistance of the client. Normally a client wants to do the problem behavior because they have some unconscious programming or need that needs to be fulfilled. Normally the unconscious need is outside of awareness. If you give the client permission to go on doing the problem behavior, then the client is able to get some awareness of why they want to do it. By thinking about that, the client becomes aware that they actually do have some control over their own behavior.

Paradoxical Intervention examples

The interventions can be anything. For example, telling a child that they should scream some more and see where it gets them. Or telling a person threatening suicide to go ahead. There is of course a danger in this, so in practice things are usually less dramatic. A typical paradoxical intervention would be to tell a procrastinator to set aside an hour a day to do procrastination. Tell them to get really good at it. This forces the individual to think about the consequences of their action, and possibly to reconsider its usefulness.

Milton Erickson Paradoxical Intervention

Milton Erickson described many paradoxical interventions. His best known is probably the case where a couple were having sexual problems. The wife didn't want to initiate sex. He told them to go home and to not have any sex, to never have sex again. The result was that the couple lay in bed and for the first time, didn't feel any pressure to have sex. Which soon resulted in them thinking about sex more, and in actually having sex again. Together they proved the therapist wrong.

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Life coach

Life coach may not be what they say they are

Beware of the life coach 

I had a call today from someone asking if I could refer them to a life coach. I had to tell them that I did not know any life coach that I would inflict on anybody. All the ones I had ever met were losers trying to tell other people how to live their lives. There might be genuinely useful ones out there, but I have never met them.

I was once a member of the local Chamber of Commerce and it seemed to me that most of the membership was made up of Life Coaches and Personal Finance Advisors. They appeared to be there for the sole purpose of marketing to each other. It also seemed to me that not one of them knew the slightest bit about what they were talking about. When I asked those 'Life Coaches" how much money they had in the bank, or what kind of car they drove, it was immediately obvious that they were complete amateurs. In fact most them had taken up these 'professions' because they had lost their jobs in the downturn. They had to do something to make money so this seemed like a good way to make a living.

Your Life Coach and the Management Sciences Paradox

It reminds me about what is known as the Management Sciences paradox. This says that the people who go into professions are the ones who should never be in that profession. The basis of the paradox is that people are attracted to study the things they feel weakest about. For example, when I was doing my psychology degree it was clear that most of the students were secretly hoping to find out what they feared what is wrong with them. And in my estimation all of the staff had psychological issues of their own.

People who are chronically disorganized, for example, realize they have a problem and begin to search for ways to not be so disorganized. So they learn more and more about what makes people disorganized and how to be less disorganized. They end up knowing more about disorganization than anyone else, but they are still disorganized. But when it comes to selecting people to teach about disorganization, who gets the job? The person who has studied it most - the person who is in fact fundamentally disorganized.

In this way you end up with Behavioural Scientists who alienate everyone they meet, time managers who are always late, therapists who secretly believe they are no good, and life coaches who are hopeless losers.

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How to Hypnotize Coming out of Trance

Freudian slip: Calling your current partner by your ex-partner’s name

 Calling your current partner by your ex-partner's name

Today I saw a client with a Freudian slip. He called his current partner, Rachel, by his ex-partner's name, Rebecca.

A very decent man, he worries deeply about whether he is doing the right thing for his partner. He divorced his wife, Rebecca some years ago. Now he's started a relationship with a new partner, Rachel. Last week they invited a valuer to their home as the first step to setting up a financial basis for their new relationship. David inadvertently introduced his current partner as Rebecca.

Rachel was upset. However, she got over it. Until he did it again the following day. He called her Rebecca again.

Rachel got upset again. She continues to be upset. She has accused David of wanting to reignite the relationship with his ex-wife. She refuses to be consoled. Rachel is now talking about breaking up the relationship.

And to top it all, David called her Rebecca for a third time.

David is distraught. He desperately wants this relationship to work. He will do anything to make it work. But he is now terrified that he is going to use the wrong name again. The very last thing he wants is to have anything to do with his ex-wife. He just cannot understand why her name keeps coming up.

What to do about a Freudian slip?

Most people would just laugh it off. However David isn't that lucky. Rachel has also been through a messy divorce herself. She has little confidence in relationships. She desperately wants this relationship to work but is always looking out for signs that might be another disaster like the last one. So being called the wrong name just confirms this to her.

What is actually happening is the result of a simple psychological process. When David was married to Rebecca he got used to having a woman in his life. That woman was always called "Rebecca". He called her "Rebecca" thousands of times. If there was a woman there, he unconsciously identified her as Rebecca, and use that name. After thousands of repetitions it became automatic.

Getting a divorce does not wipe your mind clean. David is so used to using the word "Rebecca", that when there is a woman nearby that he feels comfortable with, his mind automatically brings up the word "Rebecca". It doesn't mean anything. It is just an unconscious shorthand process. It may actually persist for many years in certain situations. But it still doesn't mean anything, except his mind is taking a shortcut.

Both he and his partner are going to have to dig deep into their store of compassion and understanding to get over this. But it is definitely not grounds for separation.



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Earliest memory Recall

Earliest memory Recall – How old were you?

Earliest memory Recall

Can you recall your earliest memory? Research suggests that the average age of a single first memory is three and a half years old. The few memories you have from an early age are scattered and unrelated until much older. This has been known for over a century, but still is not appreciated by the general public.

Many people still believe that memory is like a streaming recording. That everything that happens to you, everything you see and hear, is permanently held somewhere in your mind. They think that with the right technique you can recall your earliest memory. This is just not true.

Clients often think their memory is deteriorating, or they worry because they don't remember anything before age six. In particular, people worry that if they don't remember anything from their early childhood, then they must be suppressing something. Something bad must have happened. I have had clients worried that they had been sexually molested. They could not think of any other reason why they had no memories of being that age.

Don't trust your earliest memory recall

The age at which memory becomes more or less continuous varies greatly. Women in general have earlier memories than men. Your chance of having an early memory depends on how startling or emotional the event was. The more dramatic, the more you are likely to recall something, although it may only be a fragment. About one in thirty of people claim to have a memory going back to age one. And about one in thirty have no memories at all before age six or seven, or even eight.

All memory is very plastic, changeable. Research suggests that many memories are in fact false. This applies in particular early memories. For most people, what you think is a genuine memory is actually the result of visualizing what relatives have told you happened, or you manufactured after seeing photographs of the time. Even the real memories that we have are being constantly revised. Almost every time you think of something, you're actually mixing it in with other incidents. You basically remanufacture your memories continuously.

All of these are normal and of no consequence.

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Boxes inside boxes

Boxes inside boxes: a metaphor therapy case

I had another very interesting client today. This client allowed me to get an insight into how the human mind works, and gave very clear metaphors of how she saw her problem.

 This client was a woman in late middle age who had suffered from anxiety most of her life. She came to see me because she is having trouble playing the card game Bridge. She is actually a good and skilled player. But whenever she has to partner with someone she does not know, her game falls apart. She is sure that her new bridge partner will be better than her. My client gets anxious at the thought of what the other person might think about her play. She then worries about this until by the time she gets to the card table she is a nervous wreck, and she plays terribly badly. This therefore fulfils her own prophecy and the whole cycle repeats with the next new player.

Metaphor therapy

 I decided to use metaphor therapy. I got her to take some deep breaths to calm herself. Then I asked her to think about the last bridge game she had when she felt she just could not deal with it. I got her to associate into the feeling. "Think about the shape of the feeling," I told her. "What shape is that feeling?"

She is one of those clients who fidgets a lot, and moves around in the chair. I began to wonder if this method was going to work. Then she surprised me by saying "it's ovalish.". So I asked, "How  big is it?" She guested with her hands to indicate that it was about the size of a dustbin lid. I asked some more clarifying questions and she told me "it's a big piece of coal."

I then started developing the metaphor of the "big piece of coal". She describes in detail has been black and shiny and heavy with lots of sharp angles. I then asked "can you make it a little bit bigger?" "Yes," she said. "And a little bit bigger still?" "Yes," she said. This told me that she actually had some control over it.

I then asked "can you make it a little smaller?" "And a little smaller still?" There was a period of silence until she said "no, it won't get any smaller. It is just getting more dense."

Changing the first mental block

She had now found her subconscious blockage. When a client says they cannot change a metaphor it means that there is something in their unconscious mind which is defending that. This is usually a fear of being unable to handle the change that might come afterwards.

So I changed my approach. I started to suggest to her ways that this thing could change. The idea was to keep suggesting things until I suggested something that her mind would accept. I tried suggesting hammers, drills, crushers, anything that would break up that "piece of coal".

Nothing seemed to work. She steadfastly refused to think of anything that could affect this "piece of coal". I was running out of ideas until remembered that it was actually a piece of coal. Coal burns! So I suggested it might go on fire. She immediately said "No. No, that can't happen."

I wasn't sure what to do next and just waited for her to say something else. And then she said "it could be heated, and give off gas." Somehow, this was acceptable to her mind. I told her to go ahead and heat it.

I then asked her "what is it like now?"

She said "it is grey and porous and quite weak."

I then went back to suggesting hammers, drills et cetera. And while I was going through the list of possible tools she said "It is all dust now."

And I thought to myself "Job done."

So I asked her to think back to the bridge game and the feeling she had about not being good enough for her partner. "How does that seem to you now?"

"Just the same," she said.

Changing the second mental block

Okay… I had seen this behaviour before. Her unconscious mind would not let me anywhere near the real problem. Instead it had offered me some minor metaphor and allowed her to work through that. Her unconscious mind knew that it was safe to change that.  But, it also means that her mind is now receptive to change, because it had experienced some change without any psychological kickback.

So I started the whole process again. I got her to associate back into the original problem, to imagine being in that situation where she was sure that she was going to disappoint the other person and feel embarrassed.

This time I had to work a lot harder to get past her defences. Eventually she told me "there is a big wooden box." Once again I got her to describe the object in detail. She told me that it was "very old, and very strong."

I then set about trying to find ways I could get her to destroy the box. Nothing seemed to work. I sensed that this time was up against a major piece of resistance. I suggested it might go transparent, that it might get wet and rot, it could get eaten by worms and fall apart. None of these produced any response.  

Boxes inside boxes

So I asked "what do you think might be in the box?"

After a long period she said "more boxes. There are more boxes inside."

"How many boxes?"

"There are five boxes", she said. I then got her to describe each of the boxes. She told me "the big one is made of cardboard. Then there's another one made of metal. And one made of glass. And another cardboard one. And a wooden one." It was now obvious from her demeanour, that she had gone deep into trance, and was actually experiencing these things directly.

And then she said "and there are papers, and files scattered around." I did not know quite what to make of that, so I decided to explore the five boxes.

"And what do you think is in those boxes?"

And one by one she began to tell me about the contents of each box. The wooden box contains soil. The glass box contained a red light. The small cardboard box contained a wooden puzzle. The metal box took a long time to uncover. It turned out to be in two sections. The top section has five compartments, and each compartment was filled with a liquid colour. Each colour was different. I asked, "what do you think the are for?" She said, "I don't know."

So I suggested, "perhaps you can make something out of those things?"

She said, "yes, I think I might."

She then said "those papers have all the things I have done wrong in my life written on them. They are all neatly organised into files."

Burning her old anxieties

I took a while to appreciate the startling development.

So I asked her "what would you like to have happen to those papers and files?"

She said "I suppose I could get rid of them?"

I asked her "what would you use to get rid of them?"

She said, " I could use the red light to burn them."

So I encouraged her, "and you can use the red light to burn them all up."

And a lovely smile came over her face. I asked "what's happening in that place now?"

She said, "they are all getting burned up, and I'm putting the ashes in the soil."

The time between her responses got longer and longer. And the smile on her face got broader and broader. She was clearly enjoying burning up all her old mistakes.

The time between responses got so long, that I went off and made a cup of tea.

When I came back she was sitting there with her eyes open, smiling.

She said, "I didn't want to come back. I was having such a good time playing with the red light and I can still feel it swirling around me."

I asked her, "And what about that old feeling of not being good enough?"

And she said, "well, actually I think it's gone."


I finished the session then. I felt that she had undergone a profound change

And on the way out she said, "I'm looking forward to finding what's in the other compartment of that metal box."


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not who you think you are

You are not who you think you are

We can all remember ourselves as children. Most of us think that we are still essentially the same as we were then. This is part of a basic belief that we all stay pretty much the same person all through life.

Not who you think you are: different beliefs

There are other beliefs which disagree with this view. Buddhists in particular, believe that the "personality is an illusion." The Buddhist philosophy believes that we all change constantly, and that our belief that things stay the same is wrong.
It is well known that our body replaces all of its cells many many times in our life time. Some cells are replaced in a matter of days, some cells survive for years before finally being replaced. Even if you stay the same weight and height, there is a constant turnover of the physical matter that makes you up.

Science is now beginning to discover that is not just your body that changes. Your mind, your thoughts, your ideas, your beliefs, – they all change too. How you think can be changed by meditation. The basic functioning of your own unconscious mind can also be changed.

The evidence

A recent study compared the personality of a set of schoolchildren measured in 1950 with those same schoolchildren 63 years later. The study found no correlation between how teachers assessed the children's personality at the time, and how close friends assess their personality now. It appears that every one of these children had changed their personality over their lifetime. Other studies have suggested that for shorter periods, tens of years, your personality stays pretty constant. But this study shows exactly the opposite.

I'm sure that we are all familiar with meeting an old school friend after many years, and being amazed at how much they had changed. Well, it seems that the same applies to you.

Harris, et al. Personality Stability From Age 14 to Age 77 Years. Psychology and Aging. 2016 Dec; 31(8): 862–874. doi: 10.1037/pag0000133


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dealing with death

How to help someone dealing with death

Most people just don't know what to do around death.

Dealing with death is difficult. You want to help, but don't know what to do. Many people feel very uncomfortable when someone they know has a close friend or relative die. It is hard to know what to do or say. You don't want to make things worse by bringing it up, and at the same time you don't want them to think you're insensitive. The trouble is that no one ever tells you how to deal with it. It's something that we just don't talk about.

The first thing to realise is that the person involved already knows. You cannot make it worse by mentioning it. You cannot help them without acknowledging their loss. What you need to do, in every case, is to let the person know that you share their loss. Empathy, not sympathy.

Let them know you care

It can be very tempting to just pretend that it didn't happen. To just not talk to the person. This is the worst thing that you can do. What the grieving person needs is for lots of people to reach out to them. You don't have to be highly skilled are particularly empathetic. You just need to let them know that the person they lost was also important to other people.

The best thing you can do is to listen. Let them talk, and just listen. Do not offer advice. Don't tell them "it will pass". Do not tell them stories about how it also happened to you. Really listen. Hear their grief and acknowledge it. Many people are too busy thinking about what they are going to say in return to really hear what's being said. Talk about your memories of the dead person, share what you have in common. And don't sanitize the dead person. Talk about their faults as well as their virtues. Let the listener know they were a real person in your life.

Do something practical

It is always better to do something than to do nothing. The second best thing you can do is to help the person in practical ways. If they are not coping well, offer to cook a meal. Or to look after the kids for a night. Ask if you can do the ironing. Maybe suggest you go out for a walk at the weekend. Show the person you care by doing something useful for them.

The third thing to do is to be there for them. Even if you feel deeply embarrassed, do not just disappear. How are you going to rebuild a friendship, if you just dropped out of sight the moment they really needed some help? Call the person, visit the person, let them know that you are there if they want to call you day or night. Let them know that you are a resource, a friend.

Invest in a long-term friendship

And be a continuing friend. If you know they're still grieving long after the event, then don't be afraid to reach out on the anniversary. Being person may feel very down at that point, and your offer of friendship and company can make a difference.

But whatever you do, just be there for them.



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Hypnosis marketing

Hypnosis marketing – packaging or contents?

I was looking at some really slick hypnosis marketing recently on the Internet. It is a hypnosis based service to stop smoking. It looks very professionally done and is franchised through many local hypnotists. The benefits to the hypnotist are obvious. A small local hypnotist is able to on-sell a professionally made stop smoking service. And presumably they get a commission from hosting the advert or recommending it to their clients.

I have no doubt that it works for some people. I have no doubt that doing it this way is much cheaper than going to a professional hypnotherapist. And it is a good thing that smokers are able to get some cut-price help.

What I do wonder about however, is whether the marketing gets more thought than the therapy. This particular service offers a ten step program. The smoker downloads ten audio hypnosis recordings and listens to them over a period of weeks.

Why a ten step program? Why not six or eleven or some other number? What is so special about ten?

It seems to me highly unlikely that purely by chance stopping smoking requires ten separate stages. Or ten separate things to address. And yet, it is very common for all sorts of therapies to be packaged in this way. I think it is much more likely that the people selling such therapy packages are looking for something catchy to use in their marketing. The number of steps has absolutely nothing to do with what is needed to produce the result.

To me, this suggests that the therapy is being twisted to fit the marketing, and not the other way round. If the therapy actually requires six steps or nine steps or some other number, then the package must contain unnecessary padding. Or the actual requirements are being thinned out and possibly are less effective.

I am always suspicious of any over-neat package of anything to do with human psychology. Human beings just don’t fit into nice square boxes.

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Smoking blindness

Smoking blindness

My local health district has proudly announced a new smoke-free effort to help people to cut down smoking. It is the result of years of planning and the combined efforts of seven area health boards. The initiative is "employing expert staff dedicated to helping people across the regions to become Smokefree".

The new service offers face-to-face coaching and 24-hour phone support. "The quick coaches will support you through a six-week program and provide free nicotine patches, lozenges and/or gum."
The service is embracing all the latest in technology. As well as weekly face-to-face meetings, they are using texting, videoing, Skyping, and emails to keep constantly in touch with the smokers. And it costs nothing. People wanting to quit get any combination of nicotine replacement therapy patches, nicotine gum, and lozenges free and unlimited.
The government has said publicly that it intends to make the whole country smoke-free by 2025. This initiative is part of that policy. And I applaud anything that is being done to help people stop smoking.

Smoking Blindness

However, this looks like another case of smoking blindness. Everything in this new initiative is based on a model of smoking which regards smoking as a purely physical or biomedical affliction. This reflects the widespread view in medicine that smoking is the result of physical addiction. If you believe that smoking is the result of addiction to tobacco then of course the correct response is to help eliminate the addiction. This is done with pharmaceuticals and encouragement. In my view this is just official smoking blindness.

It is surprising to me that this entire multimillion dollar initiative seems to give no weight at all to the psychological side of smoking. Hypnotherapy is very successful at stopping smoking. It does not use pharmaceuticals, and does not offer ongoing multiweek support. This is because you don't need them.

Smoking is at least as much about the psychology of the smoker as it is about the physical side. In fact I believe that smoking is almost entirely a psychological issue. It is rather disheartening to see yet another instance of smoking blindness by the medical profession. I wish the initiative well, but I really think that they are working on a flawed model.

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