 All right. Hello, David. Welcome back to the podcast. How you doing? Yeah, really good. Yeah. Thanks for having me again. Yeah. Super glad that you're back here to talk about your brand new book. And I had the opportunity to read an early copy and loved it. So it's called the expectation effect. Can you let us know what it's about and kind of like what inspired you to dive into this topic? Yeah, sure. So the expectation effect is about all of these kind of self-fulfilling prophecies that we create in our lives where our beliefs about an event or what's going to happen actually become true. Now, that sounds a bit like kind of pseudo science. It could sound a bit like the secret or that kind of book, you know, on kind of a positive thinking. But actually, this is completely grounded in real science. You know, I cite something like 470 papers at least in the to back this up. And it's really like these expectation effects are all based on like kind of known plausible physiological and behavioral mechanisms. So, you know, I'm not claiming that this is like, that you can just think yourself rich and money will come to you. But I'm talking about things like the placebo effect in medicine, which is very well known. But we now know that actually similar responses can be seen in our kind of everyday health and well being from our responses to exercise to our responses to a new diet, even to how we age, they can all be influenced quite powerfully by our beliefs. Yeah, yeah, a while back, I think I mentioned this in my review of the book, I had Eric Vanson to talk about suggestible you and I'm like, I'm like, okay, how much more is David going to go into and like you mentioned, you have so many studies and research on like I was learning even more. And one of the first things I wanted to ask you to like, when you're when you do this much research learning about it, right? Does it, do you think like that type of stuff affects the expectation effect, right? Like since you know about like you talk a little bit about how you've adopted it, you know, certain aspects of your life, but how does that affect that aspect by knowing? You know, I think it's actually really powerful and that is actually what I love about all of this research is that when we're talking about expectation effects, we're not talking about kind of deceiving people, but it's actually just kind of explaining the science behind these effects and kind of getting people to open their mind to the possibility that their current beliefs might not be totally objective, and then they might be able to shift them in a different direction to bring about some benefits that that knowledge in itself can be really powerful. And so that's what I found just reading all of this research is like, I don't have to kind of say some kind of mantra to kind of, you know, force myself to believe something that isn't true. Like I've seen the studies, I know that if I, I know that my perceptions of my fitness are going to shape how well I do, and that actually some of those responses can be more powerful than the effects of my actual genes. And then by knowing that I can just kind of start to question some previous assumptions. So for example, you know, in gym classes at school, I, you know, I found them quite difficult, like I was very small for my age, all of that kind of thing. So I kind of had built up all of these underlying assumptions about my fitness, and then seeing this body of scientific research showing that those assumptions are actually shaping my fitness now, well, then I can just reappraise those assumptions and wonder if I could take a bit more of an objective view. And that in itself is then really powerful. So it's all about almost looking at ourselves and our abilities more like a scientist and trying to abandon assumptions and then try to reframe them in a way that could be potently useful. And so yeah, I think that kind of understanding the science there actually kind of creates the ability to kind of change those beliefs. Yeah, yeah, one of the things you talk about in there, like you have a whole section on like stress and anxiety. And I think that's one place where you and I connect, like I've dealt with anxiety my entire life. And I remember, you know, a few years ago, I think that's when I first kind of learned about, you know, this, this type of research and everything like that. But you discuss a little bit of like reframing, right, that, that like anxiety, like going into a situation, whether it's like a job interview or doing a presentation and, you know, and how, you know, the science shows that if we just change it from like, I'm worried, I'm nervous, I'm stressed to like this kind of excitedness, like, have you, have you been able to use that since like researching this book? Have you like brought that into different situations and has it worked out for you with your kind of anxiety or nervousness? Yeah, all the time. I mean, I think the most obvious example for me would be in public speaking, which say for my first book, like I managed to get through that without, you know, any problems. But like I wouldn't say it was an easy experience. But then I think researching this book, I kind of came to realise that, like you said, that there are kind of two views of anxiety that you could have. So one is that it's kind of debilitating and that if you're feeling nervous, that in itself is like a sign of weakness. And you have to suppress that feeling if you're going to perform well. And if you fail to suppress that feeling, which is really likely, then you're going to perform badly. Reading the research, I realised that actually, that can be true. But a lot of those effects aren't inevitable from the feelings themselves, they're created by the expectations. And what you can see from the research is that actually, there's a whole other group of people who still feel anxious before they perform, but they see that anxiety as a kind of energy, you know, it kind of gives them a little bit of an edge to their performance. And by viewing it like that, that in itself then becomes a self-fulfilling prophecy. And they do perform better. And they feel less, they feel that anxiety is kind of less unpleasant. It's just a bit more, they're more comfortable in that anxiety. And so I applied that. I didn't even take much effort because like I said, once you've read the research, it kind of becomes a no-brainer almost. And yeah, I found it really worked. And I think like, also my experience really showed me something important about the expectation effect, which is like, you don't expect miracles to emerge immediately with this. It's like anything you're kind of learning to think in a different way. So it helped a little bit in my first talk that I gave, and then helped a bit more in the next one. And over time, it kind of developed so that now I actually quite enjoy giving presentations. But that didn't happen overnight. It was something that, you know, I had to practice. Yeah. So I think that's, you know, something interesting to touch on, right? Because like we were talking about like what inspired the book. And so you have like, you have books like The Secret and it's kind of like, you know, manifestation and, you know, this idea that, you know, if we just think it, it'll come true and all this. So how do we separate that? Because in the book, you talk about some other kind of like self-affirmations. And there's a, you know, there's a whole section on like intelligence, right? And, you know, you had your, you know, your last book talking about intelligence as well. But what, what do you see as a difference between kind of this like, like, though, like kind of pseudo-scientific-y, just self-affirmation type thing that doesn't really do anything. And then like, you know, reframing our stress into excitement or having like that growth mindset rather than the fixed mindset. How do we separate those two? So say a listener is like, okay, what's the good stuff versus the bad stuff? You know what I mean? I mean, I think like, primarily I'd say the difference is whether you actually have like a study showing that it's possible or not. But I mean, that is kind of, you know, what I base the whole, my whole premise was like, you know, I wouldn't say anything that's not supported by studies. So I guess that's the one thing, but I would say more generally, like, I think what the researchers and what I have been careful with is just to try to explore the limits of our kind of, of what this can achieve. And, you know, actually, we do find that it all depends on kind of context and kind of, you know, like plausibility in a way. So like, you know, one of the things that I think is really toxic is this idea that like positive thinking can cure you of something like cancer. And it can't because there's no, there's no biological mechanism by which your brain could shrink a tumor, like we just don't know of any mechanism and there's no evidence that that can happen, you know, when you look at controlled trials, like it can't. But that doesn't mean that actually your brain isn't having any effect on your physiology, it's having loads of effects. It's just that some, you know, that particular thing is too bad, it's too big and too difficult to achieve. But say we do know, you know, all like this is so well established that like the way you appraise animation will change like your hormonal response, for instance, or the kind of changes to your circulation, you know, whether your blood flow is kind of reaching your limbs and kind of helping to power your muscles or whether it's kind of concentrated in your core because you're scared that you're going to get injured. And so, you know, that can help change your short term performance actually in something like a sports event or, you know, even something like public speaking. But so that is, you know, that's not like miraculous. That's just the way the brain and body evolved to function. So, yeah, I think that's the distinction really. It's like, we're not asking for like something that's magical here, we're just like looking at things that we already know that there's this interaction between the brain and the body. And then it's just like looking at kind of practical ways that we can make the most of that for our own benefit. Yeah, yeah, absolutely. I think what's helped me out the most like since I really just got into like reading and learning and all these other things is just like the evolutionary reasons behind things, right? Like evolutionary psychology, evolutionary biology. Like when I understand why our brains and bodies kind of developed in these ways, then like I'm geared more towards the more science-y stuff, right? Like, you know, like stuff like The Secret and they talk about like a vision board and like putting like a mansion and money in a car. It's like, okay, well, we didn't evolve for us to like look at a vision board. But can you kind of break that down? You discussed it a little bit early on in the book to like build a foundation on this. Why did our brains evolve as this sort of like prediction machine to kind of get our bodies ready or in a certain state and kind of have like physiological changes within us? Yeah, I mean it's all about adaptability and actually like, you know, I think like our prediction machines are especially advanced but actually, you know, like most creatures, like especially most mammals, I'm sure birds as well, have to be able to preempt what's going to happen. You know, like if they see a predator coming, their body has to like respond instantly to that threat. That's a form of kind of predictive processing. Similarly, you know, if they, if an animal is, you know, like expecting not to have enough food or whatever, then it has to be able to slow its metabolism. Otherwise, it's going to starve more quickly before it can actually get food. You know, so this is like essential for our survival. I think what makes humans special is that we have all of these tools like language. You know, we're more socially perceptive to like the kind of context of the people around us, you know, what they're communicating to us. That means that actually like our, the brain's predictions can be shaped by a huge number of factors and also we have more detailed memories that might be feeding into this prediction machine. So, but essentially, yeah, the brain just has to be able to like form predictions to, for instance, to be able to like allow us to kind of adapt to like a threat or to adapt to like a more positive challenge. So, you know, running away from a predator compared to like running towards the kind of deer that you're trying to hunt, you know, like, yeah, it's quite similar responses in the body, but also subtly different because one is protecting you from injury and the other is trying to maximize your physical performance, you know. So, yeah, I just think like it, it's, we evolved to do this to be able to adapt to any situation that's in front of us. And with all of these tools like language, we are now able to kind of just shape those predictions and feed into them in ways that can be helpful for us. Yeah, yeah. And, you know, part of that too, we talk, you talk about like, you know, the fight-of-flight response and like the fear mechanisms. And, you know, this is very relatable to me right now, because you discuss a little bit about like kind of how something like exposure therapy might help. So, so quick little story for the reader or the listeners who are up to date. So, I've been dealing with a rat problem and I'm recording this in a hotel room, right? But the first sign, the first sign of a rat, I noticed that my anxiety was through the roof. Like afterwards, after we got renovated, went out over our balcony, we managed to get it outside. But I noticed that my, my anxiety was just like up just for like an hour afterwards. And I'm sitting there thinking like, why is this happening? Like, why am I so anxious about this? And, you know, there's evolutionary reasons. Like there's certain things like if we even think that we saw a snake out of the corner of our eyes, we like jump them, you know, and all that. But anyways, anyways, since I've been dealing with this problem for so long, now, like I saw rat, you know, before moving in here and like I'm fine with it, right? So, it's kind of like getting used to it. So, anyways, what I'm getting at is, how does our brain kind of adapt and turn, you know, fear into something that's a little bit more normalized? Like why does exposure therapy help changing this sort of prediction machine that we have in our brain, in our head? Yeah, I mean, I think it's like, so I think that that's another sign of adaptability in a way, because I think like, you know, we have all of these connotations of rats that like they're dangerous, they're carrying, I mean, like I think they can actually be physically dangerous. Yeah, I'm not playing with it definitely. Exactly. But also, you know, that they carry disease, so we have this kind of disgust response. But what exposure therapy is doing is over, you know, each time you see one and you emerge unscathed, it's kind of just adapting that prediction machine, recalibrating it. So, you know, that actually, you still have to be cautious, but you don't have to be as scared as you would have been before. Maybe you don't have to pump so much adrenaline into your body because you know that it's maybe not as bad as you saw. In a way, that is just like kind of exposure therapy is a very basic way of reframing the feeling of threat that you had. And I guess, then when we're talking about like the benefits of reframing our stress, our abuse of stress or whatever, that's almost like even a more sophisticated way of doing that for situations that are maybe more, less kind of, how could I put it like, you know, like I think the thing around is quite, you have got a primitive response to but whereas like maybe talking public speaking is something that's more kind of socially nuanced maybe. So yeah, so I guess that's, they're all on a continuum, but I think what each thing is doing, each step that you take in either case, it's just like recalibrating like the brain's predictions of what threat it's facing or what challenge it's facing and what it can do to kind of adapt the body to responding the best, most efficient and most efficacious way possible. Yeah, yeah, for sure. And yeah, it's really been interesting, you know, because I've tried to be very mindful of that kind of stuff. I'm just like, for example, public speaking was something terrible for, you know, for me as well. And I used to work at a rehab and, you know, they toss me in there, they're like, Oh, yeah, by the way, you're going to be doing groups in front of like anywhere from like 50 to 100 people. And I'm like, wait, what? Right. And at first, it was terrible. And then I started getting used to it. I started getting excited for it. And all that just as I started doing it more and more and more. And I try to challenge myself and do new things and all that. But one thing I was really interested in talking with you about, and we could spend the whole time talking about this is medications, right? Like the placebo effect and all this. So something that I read about and started really diving into was the placebo effects of medications and specifically antidepressants. And then I started learning more and more about it, right? So, you know, with antidepressants, I started learning that, you know, with a lot of the studies they've been doing, it's hard to account for how much the medications working versus the actual placebo effect, right? But, you know, as a recovering opioid addict, like I was addicted to pain medications, it's been really interesting learning about how pain medications and since our brain naturally creates certain chemicals that help alleviate pain, like that can help as well. So there's a lot of, like, ethical questions around, you know, medications. And do we tell people or do we not? And you touch on this a bit in the book. So can you kind of discuss that and what they're researching as far as placebo effects and some of the ethical questions because there's like informed consent, right? Like how much does this medication actually work and all that and all that stuff. It's just really, it seems really tricky and nuanced for me. Yeah, no, it is. And I think what you touch on is really important, which is the fact that in the past, like we associated placebos with deception. And it seemed like the only way we could benefit from the placebo effect was if we kind of fooled people into thinking they were receiving a real medication when they weren't. But actually like what they knew in really cutting edge research is doing is showing that deception isn't necessary. So one thing that I find really promising is this idea of open label placebos. And what the researchers did was that they kind of gave people these, well, first of all, they educated people about the mind, body connection. And they told them things that have been proven scientifically, such as the fact that when you receive a placebo pill, believing it's a pain medication, that that can cause the brain to produce its own endogenous pain killers. So you're actually having a physiological effect from your expectation. And then they gave, so they told people about that, and then they gave people a jar of pills that were very clearly labeled placebo pills. So no deception there at all. What they found was that actually just taking those placebo pills actually produced a clinically significant improvement in their pain. And what was amazing was that this didn't just last during the weeks of the trial, but then they followed up those patients five years later. And they found that actually this understanding of the mind, body connection was still improving their levels of pain five years later. It wasn't a short lived effect. And so what I think that shows us is that actually, we can create this kind of healing response ourselves by understanding the mind, body connection. It's like, I think like the ritual sometimes of taking a tablet is really important, even if it's a placebo pill, because you feel like you're being cared for, and that might be one reason for it. But I think actually just having this positive expectation that your pain relief is controllable, that that could also be quite powerful in producing these benefits. And then subsequent studies have kind of asked, well, you know, it works with open label placebo, but we just get rid of the pills altogether, just by like talking to patients and explaining to them like how their expectations might heal recovery and getting them to set realistic, but kind of optimistic expectation. And they found that that was really powerful, even with people's recovery from kind of serious heart surgery, that they recovered more quickly. And they also showed kind of changes in their physiology, such as reduced and levels of inflammatory cytokines as a result of that intervention. So I mean, it's really powerful. And I think this is how medicine needs to use the placebo effect now, not by kind of lying to patients like that's not ethical, but just by actually helping to incorporate the expectation effect into each treatment. Yeah, it's, you know, it's interesting because something that I think about a lot I write about, you know, on my sub stack and everything, it's just the the American healthcare system, because something that I've realized is, you know, and I think a lot of Americans do is that this is just get people in, get people out, right? It's all just like boom, boom, boom, boom, boom, right. And I have been very fortunate to find a primary care doctor. Like the last probably had it for like five years where she actually sits down and takes the time with me, right? Like I whenever I'm like, you know, singing my doctor's praises, I always talk about how when I go there for an appointment, she's always late. But I'm never mad because I know that she's probably talking to people at length the way she talks with me. And that's so beneficial and kind of like with what you're talking about with if we just explain it to people, right? And reading books like yours is very helpful. I've realized that with myself. The more I understand about just the world in general has helped me in a variety of different ways, whether it's, you know, this stuff or psychology, mental health, whatever it is. And one thing I love about the book, and it's, you know, because I do a lot of advocacy work for, you know, addiction, everything is you talk about how placebo's might actually be able to help with like the opioid crisis. And you touch on something there like this idea of just like being cared for and things like that. And when I first started learning about just the body responses and like dopamine and everything, it clicked for me. And you know, one of the things as a drug addict, when I was in my addiction and I ran out of drugs, right? I call my dealer and he'd be like, Oh, be there in five minutes, he takes like two hours. But as soon as I knew he was getting close, boom, my body started to calm down, right? I started to get a little euphoria before I even took the damn thing, right? So when it comes to pain management, the opioid epidemic, because you know, a lot of this started in the United States with that direct to consumer marketing saying like oxy cotton isn't that addictive and all that. How do you see, you know, the placebo effect and pain management helping to decrease the amount of like addictive medications that we're giving to people? Yeah, I mean, there's a lot of promise here and I've seen a few studies. I mentioned one of them in my book, but they have been, you know, it's moving so fast that they've been more, they've been published since the show that actually open label placebos can help to wean people off of addictive kind of painkillers. So what they did actually was a bit like this study I described previously, so they were, you know, open label, the participants knew exactly what they were taking, but they'd also boosted this effect by using this process called conditioning. So what happened was for a few days at the start of the trial, the patients took their regular painkillers along with the open label placebo, along with a kind of, they just sniffed like a kind of swab of that like absorbed, I guess cotton wool that had absorbed like a strong scent of cardamom. Then after a few days, they were encouraged, they weren't forced, but they're encouraged to just ditch the actual original pills and to just take the open label placebos along with the smell. And what they found was that that kind of conditioning the association of the strong smell with the painkillers that actually amplified the benefits of the open label placebo. So it's really, it really did help them to reduce the amount of pain medication they were using, you know, because now they were just relying on the brain zone endogenous opioids. And so that actually helped them through rehab for their injuries. And the hope is that if you could do that quite quickly, people won't get addicted to the pills in the first place. So I think there's a lot of promise there. We do need bigger trials, but I do think those are happening like all the time. And, you know, I haven't seen any negative results here, actually. So I really think that there's, they might have to refine the techniques, but I really think like this is such a promising direction for the research to take. Yeah, yeah, absolutely. It's, it's something that, you know, I think about a lot because when, when I was, I was personally in my addiction, like, you know, I was, I was mainly taking them to get high, but after a while, like they weren't even doing anything for pain, like when I would actually have pain, they weren't even doing anything. But then I started realizing like these pain medications, they were mainly just, you know, giving me a sense of euphoria, but they weren't attacking the cause of the pain, right? Like if I have a back injury, it's not going to fix my back. It's not going to fix my muscles. It's not going to fix my spine. Like there are medications that are like muscle relaxers, but like an actual opioid isn't getting to the root of that problem, you know? So, so it's, it's, it's this strange thing because so many people get hooked from getting these medications for pain, but it's not even tackling that specific problem. So if we can create that effect, getting the medications, but you know, speaking of pain and these placebos, one ethical question I'm always thinking about was, I can't remember if you touched on this in the book, but there was a surgeon, I think he, he worked on like basketball players, knees or whatever, but they were doing like, you know, like torn ligaments, like that kind of like invasive kind of surgery, but he started wondering like, how effective is this? So he started going in and not actually doing the surgery, but he would like drill the holes in their knee where it looked like they did, and they were covered just as well. So that's the ethical question I'm always thinking of, because you have like these open label placebos and all that. It's like, okay, cool, but this involves actually like puncturing skin, you know? So I'm curious your thoughts around like, you know, that like the pills sort of placebo, and then like a placebo surgery. What, what are the conversations around that type of stuff? Yeah, I mean, there's loads of research showing that actually, like placebo surgery is really potent. And one of the reasons for that is that in general, like, you know, it's good, you know, like when you take a pill, you feel like you're getting kind of the care you need. And you can kind of have this idea that the chemicals are kind of changing your body in some way. But actually, it's really easy to visualize what surgery is doing to kind of relieve a mechanical problem, you know, so that ease of understanding and visualization actually does mean that often surgery is an incredibly potent placebo. Now in the past, actually, unlike drugs, surgical procedures didn't need to go through controlled clinical trials, part of because of the ethical questions that you raised, you know, like, it's difficult to justify giving someone a kind of sham procedure where you're actually puncturing the skin and maybe, you know, raising the slight risk of like a complication or an infection. The problem I actually now think that the evidence shows that that is unethical, that to not have the placebo is unethical, because what's happened is that we've now found that lots of surgical procedures probably don't have any benefits on the placebo effect. And so we were actually rather than just having a small clinical trial where you're trying to compare the two to find the result, what's actually happening now is that worldwide, you know, millions of people are undergoing surgery, there isn't really having any direct physical benefit to them that it's all coming from a placebo effect. And you know, one of the most controversial, but I think it is a solid result though we do need more research is that actually the installing stents to relieve angina now it seems that most if not all of the pain relief that people get from that and the benefits for their kind of exercise and lifestyle comes from a placebo effect, not from the surgery itself. And you know, that is such a common procedure. So, you know, I really think actually this is something that needs to be explored in detail with like really rigorous research to make sure that people aren't undergoing surgery unnecessarily because there are other ways than rather than undergoing surgery that doctors could try to like use an expectation effect to achieve the same results. Yeah. Yeah, it's interesting. I just started a new book, I think it's called for the common good. It's more of an academic book. I think it was like released to Oxford University, or whatever, but it's all about these ethical questions around like medicine, right? And as I'm reading it, I'm thinking about, you know, the COVID vaccines and all that kind of stuff because you talk about like the no-cebo effect and maybe that'd be interesting to touch on, right? So, we have a lot of people who don't want to get the vaccine and you have people talking about, you know, the side effects, spooky side effects. There's been stuff, I don't know if you ever saw this like on TikTok, there were like, people were like, oh, look, I'm helping like a seizure after I got it and everything. But the no-cebo effect does the exact opposite. And you have a whole section on like mass hysteria and all that kind of stuff. So with, you know, specifically to like the COVID vaccine and the people who are, you know, anti-vax or vaccine hesitant, do you see the no-cebo effect by taking place? How does that happen? How does, you know, just thinking about it and how our inner circles are talking about these types of things, how's that affecting us physiologically? And could that be making worse outcomes that then make people like more afraid to get things that could be helpful? Yeah. So, I mean, the no-cebo effect is super common. And like you say, it's when, you know, it's the opposite of the no-cebo effect in a way. It's when we expect to experience some kind of illness or side effect from a drug, then we do experience it. And like the no-cebo effect and like the other expectation effects I mentioned, you know, it's coming from this mind-body connection where like we might be kind of increasing inflammation in the body, but with these negative expectations because, you know, maybe if you're expecting to be injured, then it's good to have a bit of inflammation that can help to kind of attack pathogens before they manage to take hold. You know, it can cause things like headaches. Like I've experienced that myself with my antidepressant medications that, you know, like I had read the side effects, it said like you might have quite a good chance of having headaches. And I did. They were really bad migraines. And then just as a coincidence, I was reading a paper on the no-cebo effect and, you know, specifically about antidepressants. And I kind of saw that this was coming from my expectations. And that realization kind of cured me of the headaches. But, you know, I know that those headaches were like totally real. They're not imagined symptoms. Like the pain was just as real as anything else I've experienced. And we now actually know from the studies that that's caused by the release of different chemicals in the brain that can change the dilation of your blood vessels, just like a normal headache. It's just the causes, the root cause of what's leading to those changes is your expectations rather than say the actual chemical effect. But yeah, so they're really common. You know, I've had them myself. This isn't something that we should ever like dismiss as just not being a real kind of sickness because like the symptoms are real. It's just the causes like psychogenic. But I think like in terms of the COVID vaccines actually, if you compare the kind of two arms of the trials of the placebo arm and the people receiving the active vaccines, what you find is that there is a higher rate of side effects in the people receiving the active vaccines. So there is something there, you know, when the vaccine is stimulating the immune system, it can cause you to get fever, to get headaches, to feel fatigue, like no question about that. But you do also see a lower rate but still really significant about 20% of patients in the placebo arm also experience those side effects too. So I think the figures are roughly 20% compared to 40%. So half of the people reporting side effects like headaches or fatigue, you know, like they may be caused by their expectations. And I do think that possibly like our discussion of these in the on social media, you know, like it's been really common for people to be tweeting about how wiped out they are by their side effects, you know, that could over time kind of amplify the likelihood because if you know that everyone else is experiencing this, you're more likely to experience it too. Yeah, yeah, it's it's really interesting because another we're talking about it like I was, you know, I was fortunate enough to be in some of the early groups of getting the vaccine here in the States. So when I first got it, there wasn't really much stuff out there about side effects, right? Like when I got it, like the first dose, like my arm was like sore the next day, like that was it, second dose, absolutely nothing, still need to go get my booster and all that. But there wasn't anybody talking about it because I was really early on. So that's kind of interesting to think about because I'm wondering like, if that affected anything, but you know, one of the last things I want to ask about this kind of no CBOE and all that is we live in a time where way too many people go to like WebMD and like look up stuff, right? But you can also look up medications, like I personally have to look up medications before I take anything, because I got to make sure it doesn't have any kind of like narcotics or anything like that in it. But like, if you had a if you had a friend, right, if you had a friend and you know all about the expectation effect because you've been researching this book, like, well, how much would you tell them to like look into this stuff, right? Because we want to be informed about what we're putting in our body. But it also might cause like you were talking about like getting a migraine, you know, and while kind of reading about the side effects and everything like that. So should people be doing these deep dives and all the terrible things that might happen from taking a medication? Or should they kind of only look into it a little and not go like down some crazy rabbit hole? Yeah, I mean, so doctors actually do they're kind of developing some procedures where like, you know, even in your consultation, that they can be like, they could give you the option, they'll be like, do you want to know about the side effects or do you not? I think they always have to tell you about the really rare but or serious potentially serious side effects that you have to know about some risks, you know, because you have to know the warning signs to look out for. And there's no way around that. But I do think of stuff like headaches, which often are caused by nasibar effects, maybe, you know, like, you could just choose like not to look into that too deeply. And just kind of, you know, if you start to experience anything unusual, then you can start looking to see if it's a problem to go to your doctors. So I'd say, you know, if you're happy with that kind of level of uncertainty, then I would say, you know, don't look into it too much. If you do kind of want to stay informed, and I think I generally do want to be as informed as possible, I still think, again, that just kind of a knowledge of the nasibar effect can be really helpful, like it was for me when I was experiencing these migraines, actually just opening my mind to the possibility that something was awful wasn't happening to my brain. But it was just my beliefs that in itself actually proved to be incredibly effective, but like, I'm neutralizing the nasibar effect. And there have been studies showing that that like, just educating people about it can be really helpful. Also, I'd like just look at the probabilities and kind of try to reframe them. So if you've read that like 10% of people get headaches, or get migraines, that sounds like quite a lot you can really focus on that as like sounds like quite high probability. You can present exactly the same information in a different way and say 90% of people a side effect free. Now again, you know, like that it's the same information, but actually that positive framing just helps to emphasize to you and reassure you that like the chances are you're going to be fine. And just that kind of thinking can be quite effective too. So yeah, I'd almost say like just be a little bit analytical about kind of what you're reading and don't catastrophize. So you know, like don't kind of just look at the what's potentially like a small risk and then look for signs of that in, you know, your experience and then kind of go on from there to kind of start kind of going into these spirals of like catastrophic thinking like maybe just pull back a bit and get reassurance from your doctor if you can just like ask for their advice and hopefully they'll be able to tell you a little bit more about kind of the potential causes of what you're feeling. Yeah, yeah, I think that's I think there's a certain level of like self-awareness and knowing like, you know, what what type of thinking that you have and like, are you somebody who can cataclysmize and all that because, you know, I think a lot of the listeners and people like you and I like when we look into something like we'll go and we'll like look at the probabilities and look into a little bit more information but even with like the spread of misinformation, like people just read headlines and freak out and but me, if it's something that I'm not willing to dive into too deeply, I don't hold a strong belief on it, right? But if it is something that I'm going to go research a ton and help educate myself on it, then, you know, it changes my views and the probabilities. For example, like when they're talking about vaccine side effects or like severe vaccine side effects, like I was just listening to that recent Joe Rogan podcast with Peter Nicola where he's like really like all over the place with that stuff and talking about it but, you know, I was like, okay, well, let me do some additional research on this stuff and and even still with vaccine severe side effects or potential like fatal things, it's like one out of like hundreds of thousands of millions of people, you know, and I'm willing to look into that be like, how afraid or worried should I be of this and if the probability is extremely low, then I try to flip it like you're saying and look at the opposite side of that. But one thing I did want to make sure that we were able to touch on because I listened, I was listening to the book because even though you sent me a PDF copy, I have this app that changes it to audio. I was listening on my morning walk. So you talk about food, you talk about exercise and that's where I was like, oh man, there's so much new great stuff that I've never even heard of. So one thing, one thing that I thought was absolutely insane was I've heard of that dude that you talk about like, what's his name, Malaysian, where he had like amnesia, amnesia where you can only remember like for a very small amount of time. But he was like perpetually like able to eat or not eat and all that. So anyways, I'm explaining that terribly. Can you talk about how like I've been doing the trick that you mentioned like remembering what I ate to kind of lower my hunger and my appetite. So can you kind of talk about how our memory affects our appetite and that research? Yeah, sure. So I mean, I still feel like this is very much an expectation effect, even if it doesn't immediately sound like it and I'll explain why. But yeah, so the first signs that like our brain is kind of influencing our feelings of hunger quite significantly came from this amnesic patient who's, he's Henry Malaysian or HM in the literature. And you know, so he suffered from this form of amnesia where he couldn't form new memories. So he could remember bits and pieces of his past. But he couldn't like a minute to minute he couldn't remember anything that was, you know, that just happened to him. It's like, you know, he was stuck in the research to say like a permanent present tense from when he had his operation to to the day he died, like there were no new experiences kind of being stored in his brain. And you know, this included his meals. And what they found was well, what they kind of were asking was like, does our stomach and we have senses in our stomach that can kind of tell us if the muscles are being stretched, you know, if the lining is being stretched, that can kind of roughly tell us if we've got food in our stomach or not. But how powerful is that in actually shaping our appetite? And HM's experience suggested like it's not very powerful at all. And that a lot of our appetite comes from our memories of when we've eaten and our expectations of hunger. Because what they found was they gave him a meal, he ate it, then they took the plate away, and they gave him another meal. And, you know, if he was like, had this feeling coming from his belly, that he was full, he just wouldn't have really eaten it. Like, you know, he would have been like, I don't know why, but I feel really full, I'm going to go now. But he ate it. And then they took that plate away, and they gave him a third. And he was about to kind of tuck into that too. But the researchers decided like three meals in one hour was maybe a bit much. So I took it away and didn't let him have all of that plate too. But yeah, so that really showed that actually like our brains, like there's a huge cognitive influence in interpreting the signals from our stomach and forming this kind of feeling of appetite. So, you know, memories were important for, or the lack of memories was really important for HM and other amnesic patients. For what we find actually is that it's very much true for normal people as well. So if when people are encouraged to like actively remember what they've just eaten, then they tend to have like lower appetites later in the day. So they're like snack less than people who haven't been prompted to kind of think about that specific memory. And I just see this as like being another form of the expectation effect, because the memory of the meal is increasing your expectation of being satisfied, and then that's shaping your behavior. And we actually find that things like food labeling can you know have similar effects. So if foods are labeled as being like very filling and satisfying, then we actually do experience less hunger later in the day, compared to if exactly the same food is presented to people, where it's labeled as this kind of low calorie health snack. And what's even more amazing is that's not just subjective, but it actually then seems to have this knock on effect to people's hormonal response and kind of how quickly the food passes through their gut. If you don't think you've eaten very much, the food actually just passes through you much more quickly. And that in itself is then going to shape your kind of feelings of hunger a little bit. So, you know, it's mind-body again. And it actually shows that, you know, our expectations are super important in maintaining a healthy weight. Yeah, yeah, you discussed that in the book, like, you know, there's a difference between, you know, like mindlessly like snacking on like chips or whatever while you're watching TV, because you're not thinking about it and actively remembering it. But when I first got into like mindfulness meditation, one of the things that I learned was like mindful eating, right, like really slowing down noticing like all the sensations, you know, the feel, the texture, the taste and all these other things and slowing down and how that kind of helped control my appetite. So when you were talking about some of the science behind that, I'm like, uh-huh, that kind of, you know, makes sense because I'm paying more attention to what I'm actually sitting down and eating. But one of the other things you touched on in that section, which I would love if you could like break down a little bit, was how poverty kind of affects expectation and food, right? So how does that work? If you're low income, if you're living, you know, paycheck to paycheck or even worse and struggling to put food on your table, keep the lights on, keep a roof over your head, how is that affecting like our weight and, you know, what we're eating and how hungry we are and all that? So yeah, I mean, so this really relates to this kind of expectation of scarcity. So what research from about 10 years ago had looked at was, you know, if you give people kind of a milkshake and you tell them it's like low calorie, you know, quite insipid, but it's, you know, going to make you lose weight, that that creates this kind of sense of deprivation that then changes the expression of the hunger hormone, ghrelin. So the more ghrelin you have, the hunger, the more hungry you feel and what they found was that actually people who had been led to have this sense of deprivation had higher levels of ghrelin. Ghrelin is also important because it seems to kind of adjust our metabolism. It's not just hunger, but it's actually more like changing our energy balance so that if you feel kind of that you're going to be deprived of foods, it seems to slow down your metabolism and like you're kind of spring fat, basically, because you don't want to waste like your energy if you're not sure that you're going to get enough. Now, what later researchers did in a studying career was that they actually tried to manipulate people's sense of their kind of social status within the society. So they, I can't remember exactly how they manipulated this, but they kind of made people feel like they were lower, they occupied a lower rung on a kind of the social ladder and got them to kind of really like ruminate on that fact and like the consequences it was going to have for them and their prospects and their kind of wealth later on. Then they gave these participants a milkshake and measured their ghrelin levels and what they found was that actually after that manipulation when people felt kind of poor and vulnerable and like that they might face deprivation that they also had higher levels of ghrelin, even though like the manipulation of their expectations wasn't specifically about food, it was more about social vulnerability. It had the same effect as like with the kind of insipid and low calorie milkshake. And I think that's really important but also ties with loads of studies of animals that showed that actually this is quite an old response that your perception of like where you are in like the group's pecking order actually does change like your things like your metabolism, the lower and your eating, like the lower that people are on or animals are even, you know, primates or even some birds are in their kind of social rankings, like the more likely they are to eat when food is available and the more likely they are to put on weight and that's because like if you're in a vulnerable situation and you don't know like if you're going to be able to get resources in the future you might have to make the most of what you have now. And so I think in our obesogenic society that's really important because you know like all of these signals that we're getting about like our value to society or whatever could be prompting this kind of response. I think what's interesting about that is kind of like the self-fulfilling prophecy of it too like if you feel like oh I don't know where my next meal is going to come from so I'm going to overeat right now right but then again food costs money or resources or whatever it is so then you're spending more of what you barely have and then you like stay down there because you're constantly buying more and you know because then your fridge is always going to be empty if you're living like lower status or at least feel like you do so that's that's something else that's kind of interesting to think about but you know with just a few more minutes of your time one last day I want to ask there's so much in the book that we didn't even get to touch on which is why everybody needs to go get it but people like you and I right I say here I'm like I am a scientifically thinking rational human being and people who do rituals or believe in superstitions they are just bonkers crazy like that is ridiculous you need to you need to find things based in science but you have a whole section in there about the expectation and these like rituals and superstitions so then I'm like okay maybe these people are actually acting a little bit smarter than I am and maybe I need some rituals so how how can you know a ritual or superstition actually help somebody yeah so I mean there's two kind of mechanisms that work together so I think but I think it all depends on this sense of the kind of resources you have around you and like in a way like a superstitious belief or ritual kind of just gives you this feeling that like you have more resources at your disposal even if it's like from a paranormal source you know if you believe that fine but I think what what we're looking at here is again like how the prediction machine is like looking at its kind of mental resources and like you know and also how it can deal with stress and in both cases it's like if you feel like you've got a lot of your disposal like the the brain is kind of allowing the body and even like kind of controlling the energy supply to back to the brain itself it's allowing you to have kind of more glucose to be released into the bloodstream you know it's allowing you to kind of devote more to the task because like it's it's not so worried about kind of reaching exhaustion if you've got like help if help is at hand you know what I mean so like so these these superstitions are kind of just helping you to feel a bit more prepared they're kind of increasing your sense of discipline they're increasing the kind of flow of glucose within your blood they're doing all of this good stuff and they're helping you to reappraise your stress as well because what might have seemed threatening if you've got like a kind of magic spell behind you is actually like not so threatening it's more of a kind of positive challenge that you feel that you can achieve and so that actually then increases and improves performance in all kinds of fields so on cognitive tests but also on you know sports like basketball free throws they are like more accurate when people perform their pre-performance rituals you know they there was one study looking at karaoke singing and if people performed a ritual before that they were more accurate with their singing because they had more mental focus you know like all powerful changes across the board now what I love about this research is that it's like what they actually found is that a bit like the open label placebo is like you don't have to kind of believe in something that's not true for rituals to have an effect it's almost like just knowing that something is a ritual kind of just gives you the sense that you've got kind of more resources at your disposal so with the karaoke study for example you know they perform this crazy ritual but no one really believes this like it's going to produce any kind of magic effect it was like draw a picture of yourself sprinkle salt on that picture screw it up throw it in the trash and then sing and the people did it and they scored like about 13 percent higher on the kind of karaoke machines like measurements of their singing you know like it and you know like considering like you know their performances weren't pitch perfect to start with it was it was like a significant change you know so yeah I feel like for me personally like this is just showing that actually like you should we can actually all incorporate rituals into our life without believing in magic you know Beyonce like does a series of specific stretches before each performance and I feel like that's something that we could all do you know before a presentation or something just like have like a certain warm-up that you practice like in a specific schedule and routine so it feels kind of it feels regimented and it feels meaningful you know just that kind of thing could be really helpful in our lives yeah yeah it makes me think there's so many because I read a lot of books I'm like defuncting like that science and I was thinking about like the power pose thing where that like I forgot what her name was she's not really famous hopefully you know the power pose makes you more confident I'm like well based on what I know about the expectation effect it seems like hey maybe doing that before you go and do a presentation it'll make you more confident and you go out there yeah you know you do your thing so yeah some of these rituals could definitely help and yeah David like I said there's so much in this book I absolutely loved it so for we're recording this mid-December so for everybody who wants to get their hands on this book there's two separate release dates one in the UK one in the US you let everybody know when the expectation effect is coming up yeah so if you're in the UK or Australia or any kind of Commonwealth country then it's coming out in on the 6th of January 2022 um if you're in the US or Canada it's coming out on the 15th of February 2022 and will it be available in audio format as well for all my audio listeners out there or is that going to be later down the line uh no it should be I think that's already recorded yeah very cool and and for everybody who wants to follow you because you also you know you publish articles and things like that where's the best place to find you oh yeah so my website is um davidrobson.me and that's regularly updated with my kind of portfolio but also on twitter d underscore a underscore robson beautiful awesome David it was a pleasure having you on again and yeah I hope this book gets as much love and praise as it deserves thank you