By Jackoline Costantino, PharmD, PGY-1 Pharmacy Practice
Resident, University of Maryland Medical Center
TEDx talk, available on YouTube, from Dr. Alia Crum, https://www.youtube.com/watch?v=0tqq66zwa7g&t=380s
This talk was particularly impactful for me because when
teaching students and even learning, the
power of our mindset can override our
aches, pains, daily dread, dead dog tired, bad moods and in the life of a
resident/teacher/mentor I can attest that there are days where it’s mind over
matter to get through to tomorrow. Our mind is so powerful. Throughout this
read, I want each of you to think of how you can implement this into your day
to day learning and teaching activities.
What is a mindset?
She describes a mindset as simply a lens or frame of mind
which orients an individual to a particular set of associations and
expectations. These mindsets are not
inconsequential, but rather they play a huge role in our health, wellness,
capacity to learn, motivate our self, and others, and to comprehend our day to
day inputs. Many people are currently working on research to tap into our
mindset to shift our perspectives and make substantial changes in our outcomes.
To tie this to teaching and learning, Carol Dweck, 2012, demonstrates that if
we can shift our mindset about intelligence, talent and something that’s fixed
to something that’s moldable over time, it can drastically change our academic
and professional success. Students that believe that intellectual abilities are
qualities that can be developed (as opposed to qualities that are fixed) tend
to show higher achievement across challenging school transitions, and greater
course completion rates in challenging math courses. Also, new research has demonstrated
that believing (or being taught) that social attributes can be developed can
lower aggression and stress in response to peer victimization or exclusion and
result in enhanced school performance.
Ability to Heal
Dr. Alia Crum, Mindset researcher and professor at Stanford
University, begins her talk with a story about a group of researchers,
Benedetti and colleagues, 2003, studied patients that were undergoing thoracic
surgery. Following this procedure the sedation would ware off and the patients
would require pain medications. The research was designed to see if patients
felt better from medication delivered by a provider or medications delivered
from a pre-programmed pump (PCA). What this study found was that patients had a
better response to pain relief to provider delivered medications despite the
dose of medication given. The study went to further test this hypothesis on
other treatments like anxiety and hypertension. When the providers informed the
patients of the results of their intervention vs not informing the patient, the
effects were consistently profound. Regardless of the medication, dose or
procedure, the patients who were not informed had a markedly blunted response
and in some cases no affect was demonstrated while the patients that were
informed showed dramatic responses to their treatment. You could associate this with what we
frequently call the placebo effect. But, what is the placebo effect? The
placebo affect is a powerful, robust, consistent demonstration of the ability
of our mindset, in this case the expectation, to heal and recruit healing
properties in the body.
The Athlete
She then goes on to talk about working with Ellen Langer, a
professor and Psychologist at Harvard Medical School. Crum, a Division 1
athlete spent hours in the gym daily to prepare her body for the challenges her
sport would require of her. Dr. Langer, upon finding out she was an athlete,
said “you know, exercise is just a placebo, right?” So this got her thinking,
was she getting fitter and stronger because of the time and energy put into
working out daily, or was it because of believing in this process that helped
her get fit and strong?
To test this theory, she found a group of housekeepers that
were normally very active daily, on their feet > 30 minutes completing at
least moderate activity. However, when asked if they workout regularly, 2/3 of
them said no. When asked on a scale of 0-10 (0 being no exercise and 10 being
at least daily), how much exercise do you get daily, 1/3 said they got no
exercise at all. What if you change that mind set? She then split the women
into two groups, measured them on a variety of elements: weight, blood
pressure, body fat, job satisfaction and gave one half a 15 minute
presentation. The presentation consisted of explaining to them that their job
satisfied the Surgeon General’s description of daily physical activity. She
explained the benefits to a daily active lifestyle. She then re-measured the previously
determined elements described above 4 weeks later. The group that didn’t
receive the information had no changes in their clinical characteristics.
However, the treatment arm lost weight, reduced their blood pressure, dropped
body fat, and had a better job satisfaction. This is presumably without
changing behavior, their health and wellness changed by a 15 minute
presentation.
Shake It Off
After digesting the
results from the previous trial, she describes her next challenge of setting
out to determine if mindset has a direct effect on diet. She sets up a study
(Crum, 2011) to determine if our mindset controls our physiologic response to
eating. She made shakes with the same ingredients except she put two different
labels on the shakes. One shake,
Sensi-Shake, depicts a rather boring picture, ingredient list and low calories.
The other shake, Indulgence , had a picture of a decadent delight with whipped
cream to top it all off and triple the calories. Blood samples were taken to
measure ghrelin, a peptide made in the stomach, also known as the hunger
hormone. When we are hungry, ghrelin starts to rise and signals to the brain we
are ready to eat. It also slows the metabolism down in case we don’t find food.
When we consume food, ghrelin decreases and
our metabolism speeds up to breakdown the food we consumed. In response to
eating the Sensi-Shake the ghrelin dropped 20 points. A week later the same
patients came back to try the other shake. After consuming the Indulgence
shake, the ghrelin dropped by 70 points. This would make sense if the shakes
consumed were actually different caloric intake, however, the shakes were the
exact same undenounced to the patient. Here, mindset matters. It might not be
just calories in, and calories out, but rather what we believe and what we
expect has an objective impact on our outcomes and our body’s response.
Stress and Mindset
Lastly, to drive the point home, she set up a study (Crum,
2013) about stress and the interpretation of stress from employees that just
found out they lost 10% of the workforce in an already labor tight setting.
Half the employees watched a 3 minute video prior to starting their shift called
“stress is debilitating” and the other half watched a video called “stress is
enhancing.” Both videos presented the same information, except each video was
either directed to the negative effects of stress or it was directed to the
positive effects of stress. Over the course of 3 weeks, the “stress is
enhancing” group reported less negative health symptoms (less back pain, less
muscle tension, less insomnia), and higher level of engagement and performance
at work. Whereas the “stress is debilitating” group had little to no change
from baseline in health symptoms or work performance.
Application to
Pharmacy Learning:
Students in competitive programs such as medicine,
engineering, and architecture all have one thing in common: a seemingly
unending amount of exams and an often constant state of stress. These frequent,
high stakes exams can take a significant toll on a student who lacks mental
stamina or a strong support network. However, based on the experiences
mentioned above there are some efforts we can explore to potentially improve
student performance by changing their mindset.
We often hear of the value of finding quick, easy wins to
build confidence and momentum personally, or within an organization. I believe
these same tenants have the potential to lessen test anxiety, and improve
performance on exams without sacrificing academic rigor. For example, what if
we were to design an exam in which one question was given to students ahead of
time and it was made clear that this question would be representative of all
future questions. This would give the instructor the opportunity to demonstrate
the structure of their questions and allow them to show that their questions
were drawn from the terminal learning objectives presented at the beginning of
the lecture. Furthermore, if this
question was positioned at the beginning of the exam it would give the student
confidence that would hopefully shift their mindset, and build their
self-esteem to face the rest of the exam. Thinking back through my pharmacy school
experience I definitely felt more confident when I knew the first several
questions on an exam versus starting the exam with a challenging or difficult
question. By simply understanding the mindset of our students we can empower
and assist them to perform and learn at their highest levels rather than be
bogged down or inhibited by stress.
Conclusion:
In these four studies, Dr. Crum demonstrates the power of
mindset on medicine, exercise, diet, and stress. While I think it’s important
to construct a classroom representative of intellect and rigor, I am also a
believer that these simple adjustments could make a large impact in the life of
a learner. Coupling a quick “stress is beneficial” video close to the start of
the course, as well as designing the test to reflect “easier” questions at the
beginning are simple technique to empower students, build their confidence and
change their mindset not only about the course, but also learning.
References:
·
Crum AJ. (2014, Oct). Change your mindset,
change the game. [Video File]. Retrieved from https://www.youtube.com/watch?v=0tqq66zwa7g&t=380s
·
Benedetti F, Maggi G, Lopiano L, Lanotte M,
Rainero I, Vighetti S. Open Versus Hidden Medical Treatments: The Patient's
Knowledge About a Therapy Affects the Therapy Outcome. Prevention &
Treatment. 2003;6 Article 1
·
Crum AJ, Langer EJ. Mind-set matters: Exercise
and the placebo effect. Psychol Sci. 2007;18(2):165-71
·
Crum AJ, Corbin WR, Brownell KD, Salovey P. Mind
over milkshakes: mindsets, not just nutrients, determine ghrelin response.
Health Psychol. 2011;30(4):424-9
·
Finniss DG, Kaptchuck TJ, Miller F, Benedetti F.
Placebo Effects: Biological, Clinical and Ethical Advances. Lancet.
2010;375-(9715):686-695
·
Yeager DS, Dweck CS. Mindsets that promote
resilience: When students believe that personal characteristics can be
developed. Educational Psychol. 2012;47(2):302-314
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