Hero's Code

Why doesn’t Mrs Smith help herself?

Going into the amputee rehabilitation centre today I saw a number of people – minus various limbs - sitting around outside in wheelchairs smoking. 

This is not unusual I have to say.  I am not a fan of smoking but it always strikes me as sad that people who have lost limbs due to compromised blood circulation aren’t motivated enough to eliminate smoking from their diet.  But when you think about, I am passing judgement from my viewpoint and I don’t have a clue how these individuals see the world.

Now I don’t wish to debate the rights and wrongs of smoking here.  I wouldn’t like to think that we start passing judgement on others too quickly in order to control them.  There is a great tendency anyway for more and more control applied to each of us for the collective good.  I don’t really want to debate that here.  I am interested in the attitudes and beliefs of people that lead to behaviours and consequences.

One of the challenges we face in the UK at least is that medical science allows many more people today to survive the consequences of, for example, peripheral vascular disease for longer.  This is surely a good thing. 

Once upon a time a person may have had a leg amputation and even after rehabilitation with a prosthesis or a wheelchair we would realise that prospects of survival would be limited.  Today however, we have leg amputees who are surviving longer – going on to have other higher-level amputations of the leg as well as having increased likelihood of arm amputations.  When blood flow is compromised it sadly affects all of the circulatory system.  Whilst prostheses and rehabilitation are improving it is always going to be a case of “shutting the stable door after the horse has bolted.”  Prevention is what matters and one aspect of shaping that is to consider human behaviour and attitude.

What I did have the opportunity to do recently was discuss with a group of clinicians the motivation strategies that could be used with their patients.

Imagine you are a doctor - Did you ever have the feeling that you made strong recommendations to your patient, used your best possible words to “persuade” someone – and thought that he or she really got the point – only to find that your patient did not do what you recommended?  Probably a special strategy might help.

Sometimes it is very useful to find out how people are motivated.  Fundamentally, one way of thinking about this is that we all are moving towards pleasure or away from pain.  Put another way, we are

“Moving towards something“ kinds of people or “Moving away from something” kinds of people

My view – and just look around you to check what you think– is that there are many more moving away from pain kinds of people than moving towards people.   People mean to do things, say they will do things … and yet they wait and wait and wait.

There are those people who respond much more readily to running away from a threat than approaching an aim.  There are people that like to have a blank, clutter free, desk and others who simply don’t want to sink into total chaos as paper cascades from heaps piled all over the desk.

There are people who fill in their tax-forms to feel good that they have dealt with all of that in lots of time – and others who only respond at the very last moment when they realise that the pain felt by not dealing with this is now greater than the perceived pleasure that would come from doing something else.

There are people, who do sports to stay in good health – and others who do so because they would like to lose weight or have some other complaint go away.

And .. there are those who invest in pension plans to have a good time during retirement and others who are afraid of being poor and old.

So lets have a look at Mrs Smith. 

She is an “away from something” patient.  When you want to attract her with positive benefits such as “better mobility” or “improved cosmesis” it simply won’t work as well as if you came up with a different strategy that’s meaningful in her world.  For her, the new prosthesis will seem like gold if she knew that this prosthesis would help her avoid some dire consequence – like losing her other leg.  And remember that what would be a bad outcome for one person would be of no consequence to another.  It’s the individual’s perception that matters.  We have to be careful here about the ethics of scaring people I guess.

Mr Jones, who is by contrast a “towards something patient” would not be motivated by the same things as Mrs Smith.  He would be much more interested in the fact that if he had this prosthesis he would be able to join his daughter at her wedding next month or that this would keep him independent for so much longer.

For all clinicians, if you know how someone is motivated, life gets much easier.  You can avoid having to struggle with people to “get your own” way against the will of someone who simply does not and never will, see the world the way you do.  Compliance to treatment will grow once you meet the person in his or her own world rather than broadcast from the lofty position of your own.

And you know what, when you really think about this, it works not just with patients.  It works with doctors, therapists, assistants - and in the world outside. This even works with your children.

How do you find out if they are away from or towards something people?  Well, I suggest you don’t interrogate but instead use metaphor (story telling) or just get to know them by asking innocently about situations and see how they respond.  By looking for contrast we can easily see what works.

Why not start with yourself. Go back to a time in your life when you were really strongly motivated to do something and you actually took action.  Remember what it felt like? What did you see, what did you hear, what did you feel? 

Now just for contrast think of another situation where you just knew that something needed to be done – but you just procrastinated – you waited and waited until the pain of further delay just overcame your resistance to react.  Note again what you saw, what you heard and what you felt.  Notice that how we represent these situations in our physiology is completely different.  For now, all I can tell you is that with patients it gets much much easier if you are working with representations that motivate them rather than ones that lead to procrastination.

The Placebo Effect - A matter of belief

You have certainly heard of the placebo effect and you may have thought that a placebo only works because the person receiving it (medicine, a lotion or potion) doesn’t know it’s a placebo.  It actually works because of belief.

As a person involved in the design and development of medical technology I now try to incorporate knowledge of belief and expectancy into many aspects of what we do.  The "look and feel" of products, the attitude and beliefs of the prescriber and many subtle influences need to stack up for the benefit of the patient.

Back in 1931 researchers had long recognised that the placebo effect was a useful conceptual model to better understand the safety and efficacy of medicines in development.  It had been known for decades that some patients would say that they felt better just with the suggestion that they were being given a remedy.  Back then, researchers interested in measuring the effects of a drug called sanocrysin on patients with tuberculosis, wanted to discount this observable placebo effect.  Their idea was to give some patients a glass of distilled water whilst telling them they were really receiving sanocrysin.  Ever since, placebo-controlled, double-blind studies have been deployed as a way of evaluating drugs in clinical trials.  Consequently science has an awful lot of information on placebos – probably more than we have on all drugs put together.

In his book “Time for a Change”, Richard Bandler describes (tongue in cheek) how he and a graduate student had planned to market placebo pills to the general public. They made plans to publish a leaflet with an index.  A person would look up “Headaches” for example and read,

“When tested against other drugs, placebos work five out of six times – and no side effects.”

Then it would say
”Take seven when you have a headache.”

Unfortunately, the FDA complained that the effects would wear off and that the placebo would lose its efficacy. Bandler says that he knew that this could happen because some people would not have strong enough beliefs first time around.  So they revealed their back-up plan.

“New! Placebo Plus! Twice the inert ingredients! Twice as powerful as before.”

Nevertheless, the FDA wouldn’t let them offer their capsules and told them it would be illegal and couldn’t work.  Bandler’s view was “We had proved it would work. After all, we had decades of their own experimental results directly from them.”

If the basis of placebo is belief, we can recognise that we must have learned or adopted beliefs in some way and therefore we can change them.  Belief’s are nothing to do with fact and are a construct of an individual or a group of individuals.  Bandler says,

“My clients often knew a placebo when they got one.  They still do. I actually give them the ability to believe that it works because it is a placebo.  I explain that because they already know it works for a placebo, it will work forever. It does.”

We can distinguish between placebo and placebo effect.  Basically, any sort of treatment can act as a placebo but what determines if there is a placebo effect is the actual response of the patient to the intervention.

Based on the Latin for “I shall please,” placebo takes many forms but has been offered as a sugar pill, a saline injection and distilled water.  We have also seen placebo surgeries where patients are anesthetised, cut open and stitched up again to appear as if they have had surgical interventions even when they haven’t. We have often heard sceptics dismiss responses to complementary and alternative therapies as “merely” placebo effects. However, whether in the past you have considered the effect a scientific annoyance or a miracle, its power is becoming much harder to deny as we shall see.

One of the most enduring questions about the placebo effect is whether this is an effect of human physiology or of psychology; is it of the mind or of the body?  To me even if it “is in the mind” that was pretty impressive.  Research is now demonstrating that it is both.

Research at the Harvard Medical School and elsewhere is showing that a change in the mind-set or attitude of a patient alters their neuro-chemistry whether in controlled laboratory studies or in the clinic.  Patients affected by pain and debility, look to doctors and allied health professionals for the words, gestures and deeds that reinforce their belief in medicine’s power and reinforce our expectation that we will benefit from an intervention.  Research is showing that neuro-chemical changes are induced that have a catalytic effect on many body systems.

Belief, attitude and expectation – perhaps we could label these as “hope” – can be embedded and shaped by the encounter between patient and the universe of care they receive.  This hope produces an effect that can block pain by releasing endorphins and enkephalins that in turn influence fundamental processes such as respiration, circulation, elimination and motor function.  Hope is the leverage that can start a cascade of physical effects making improvement much more likely.

One of the reasonable questions we could pose is

“If we accept that placebo is real – how can we harness this power and really direct it in clinical situations to support our other strategies?”

As more people start to pose this question it becomes much more likely that research could be directed away from just demonstrating the effect exists, and more toward research and practice that can help us harnesses this power.

The placebo’s effect in treating depression was considered in a 1998 meta-analysis (bringing together related journal articles to provide a potentially stronger evidence base).  The authors suggested that the placebo effect might account for up to one third of the clinical benefit of modern antidepressants.  Some authors claim an even stronger improvement.  This level of benefit is highly significant and certainly worthy of attention.  It causes challenges for pharmaceutical companies who need to demonstrate that their formulations produce a measurable effect compared with placebo.

Pharmaceutical companies are interested in placebo because it complicates the clinical trial process.  The Wall St Journal in 2004 noted that clinical trials are finding that placebos are almost as effective as formulated antidepressants.  For example, Fluoxetine (Brand name Prozac) gave a response score of 8.30 compared with a response score of 7.34 for placebo.  The score was measured over five trials and noted the average improvement, measured in points on a standard, validated scale to assess the severity of depression.  Other formulations exhibit similar levels of performance relative to placebo.

Placebo response to antidepressants is particularly high in young people. A trial for Zoloft found improvements in 59% of children given a placebo compared with 69% who took an active medicine.

You see, clinical trials deal with statistics and typically require large numbers of participants to be of any value.  The smaller the effect that is to be detected the larger the trial needs to be.  What we do know is that some individuals respond very powerfully to placebo and others don’t – and we don’t yet know how to reliably spot who is who beforehand.  For example, to get permission to market a new drug, the manufacturer most convince a regulatory agency that its product performs better than placebo in at least two large, controlled trials.  If the makers could identify ahead of time the individuals that do well on placebo, then they could eliminate them from the trial, allowing trails to be smaller and conducted more quickly.  This is important because antidepressants represent perhaps $20 billion in world-wide sales.

Recent studies of patients with Parkinson’s disease, a condition in which one part of the brain (the striatum) stops producing enough dopamine to support normal movement and muscle control. Drugs called dopamine antagonists can provide some symptomatic relief by substituting for the missing dopamine. 

Funny thing is that placebo can bring relief too - and in ways that are more than just allowing people to ignore their symptoms.

Scientists at the University of British Columbia found that placebos improved the symptoms of Parkinson’s disease in some subjects and that in these individuals increased levels of dopamine were being generated in the striatum of their brains.

The majority of placebo-effect studies have focused on pain.  These days we have the technology to monitor brain chemistry and activity through the use of functional magnetic resonance imaging.

When we consider the placebo effect we are mapping some aspects of the mind-body connection and opening the lid on some of the pathways through which mental factors alter people’s symptoms, health, or even an underlying disease.

Some of the factors are coming to light:

The Person
Studies suggest that trial participants are more likely to experience a placebo response if they have strong belief in the treatment they are helping researchers evaluate.

The Clinician
Doctors, clinicians and the individuals involved in the care of a person may also influence outcomes.  Research has shown that when physicians are hopeful and enthusiastic about the active treatment in a study, patients are more responsive to a placebo.  The effect of medical and nursing care (the “Hawthorne” and “halo” effects) and the nature of the patient-doctor relationship is definite although some people would dispute that this is part of the placebo effect.

The Particular Condition or Illness
It is suspected that placebo will work better for some conditions than others.  Studies suggest that problems with vague causes such as aches and pains or fatigue, are more responsive than conditions where the cause is obvious and structural.  For example, it’s hard to ignore the “reality” of a broken bone or an amputated limb.  By the same token, placebos have tended to work more consistently with acute pain than chronic pain.  Maybe the issue here is the ability of the person to secure strong enough emotional leverage or hope.

The Treatment
The usual placebos used in trials have been inert pills that have no direct physical effects.  In some studies though, patients have received an active placebo that cause symptoms that the patient will notice (raised heart rate for example) but has no therapeutic effect.  Not surprisingly the active placebo produces a stronger response perhaps because it is easier for the patients to believe they are receiving an active drug.

The Three Legged Trial
Some researchers have pointed out that trials would be better conducted with three legs. One group would receive the active treatment, one the placebo and a third would receive nothing. The idea being that many patients might have got better on their own.

Nanobiomechanics

It seems pretty obvious that diseased cells are going to differ in various ways from diseased ones.  We tend to think of peering through a microscope to spot the difference between health and disease.

Medical researchers have long known that diseases can cause -- or be caused by -- physical changes in individual cells.   For instance, invading parasites can distort or degrade blood cells, and heart failure can occur as muscle cells lose their ability to contract in the wake of a heart attack.
Research at MIT is looking at mechanical effects at the cell interface to get physical about this.

Knowing the effect of forces as small as a piconewton -- a trillionth of a newton -- on a cell seems to give researchers a much finer view of the ways in which diseased cells differ from healthy ones. 

Subra Suresh has spent much of his career making nanoscale measurements of materials such as the thin films used in microelectronic components. But since 2003, Suresh's laboratory has spent more and more time applying nanomeasurement techniques to living cells.

One of Suresh's recent studies measured mechanical differences between healthy red blood cells and cells infected with malaria parasites.  Suresh and his collaborators knew that infected blood cells become more rigid, losing the ability to reduce their width from eight micrometers down to two or three micrometers, which they need to do to slip through capillaries.

Rigid cells, on the other hand, can clog capillaries and cause cerebral hemorrhages.  Though others had tried to determine exactly how rigid malarial cells become, Suresh's instruments were able to bring greater accuracy to the measurements.

Using optical tweezers, which employ intensely focused laser light to exert a tiny force on objects attached to cells, Suresh and his collaborators showed that red blood cells infected with malaria become 10 times stiffer than healthy cells -- three to four times stiffer than was previously estimated.

Eduard Arzt, director of materials research at the Max Planck Institute in Stuttgart, Germany, says that Suresh's work is important because cell flexibility is a vital characteristic not only of malarial cells but also of metastasizing cancer cells. "Many of the mechanical concepts we've been using for a long time, like strength and elasticity, are also very important in biology," says Arzt.

Based on news from MIT

Abuse of technology

A British study found that workers distracted by phone calls, e-mails and text messages suffer a greater loss of IQ than a person smoking marijuana.

The constant interruptions reduce productivity and leave people feeling tired and lethargic, according to a survey carried out by TNS Research and commissioned by Hewlett Packard.

The survey of 1,100 Britons showed:

• Almost two out three people check their electronic messages out of office hours and when on holiday
• Half of all workers respond to an e-mail within 60 minutes of receiving one
• One in five will break off from a business or social engagement to respond to a message.

Nine out of 10 people thought colleagues who answered messages during face-to-face meetings were rude, while three out of 10 believed it was not only acceptable, but a sign of diligence and efficiency.

But the mental impact of trying to balance a steady inflow of messages with getting on with normal work took its toll, the Press Association reported. In 80 clinical trials, Dr. Glenn Wilson, a psychiatrist at King's College London University, monitored the IQ of workers throughout the day.

He found the IQ of those who tried to juggle messages and work fell by 10 points -- the equivalent to missing a whole night's sleep and more than double the 4-point fall seen after smoking marijuana. This is a very real and widespread phenomenon, Wilson said.

We have found that this obsession with looking at messages, if unchecked, will damage a worker's performance by reducing their mental sharpness. Companies should encourage a more balanced and appropriate way of working. Wilson said the IQ drop was even more significant in the men who took part in the tests The research suggests that we are in danger of being caught up in a 24-hour 'always on' society, said David Smith of Hewlett Packard. This is more worrying when you consider the potential impairment on performance and concentration for workers, and the consequent impact on businesses.

How do you see beliefs?

I have written a few times about beliefs. Today I want to write about them in a fairly analytical way.  Belief systems have a number of peculiarities that set them apart from facts and set them apart from other "systems."

Belief systems are not consensual.  Different beliefs may well result in different interpretations of the same  phenomena.  For example, depending on one's beliefs, the "generation gap" results from insensitive and restrictive parents - or from ungrateful and immoral children. 

One's beliefs can influence intrepretations of relatively secure facts; for example, some smokers refuse to believe that smoking causes cancer.

Beliefs deal with conceptual entities such as the generation gap, the supernatural, extrasensory perception or karma.  Things thta you can't generally carry in a wheelbarrow.  Thus an entity that exists in one belief system may be absent in another.

Sometimes beliefs represent alternative worlds; typically "the world as it should be."  Ideologies often have implicit alternative world views.

Beliefs have an evaluative or affective component. So events tend to be good or bad, to invoke pleasure or displeasure.  We could conceive of two types of affect. One involves the world divided up into good and bad things for example.  A second aspect of affect is how it influences the operation of a system.

Beliefs may be built on subjective experiences or episodes.  Logical, rational deductions may be based on a subjective event.  For example, an elaborate theory may be constructed around an event that was believed to occur but that actually did not.  An example is the N-Ray episode I wrote about yesterday.

One does not know, a priori, what knowledge is relevant to a belief. The knowledge pertinent to a medical diagnosis of cancer, for example, can be codified fairly easily.  It is less easy to decide what is irrelevant to conceptual entities such as, for example - the sexual promiscuity of today's youth

Credibility and emotion interact when it comes to evaluation.  One may believe  something is true with real passion; or there may be no emotional investment at all in a particular belief.

These charateristics make reasoning from belief much more complicated than reasoning from facts or measurable uncertainties. No wonder it isn't easy.

Alien Beliefs

These days I play in a world of consulting and coaching where human attitudes and beliefs, whether spoken or not, are fundamental to behaviour and success. I can never infer or deduce another's thoughts from the hints in what they say or what they do. However, it is truly amazing what can happen when any of us gets to examine a crusty old, unconscious belief that has shaped and maybe limited our lives for so long. In a moment, we can be free of it and our whole life takes a different course.  Society has long been fascinated by the attitudes and beliefs that shape human behaviour - messy and challenging indeed.

In the past my world was one of academic research and scholarship.  You would think that this domain of objectivity would be immune to the vagaries of human beliefs. Not so.  Aliens would know better.  Scientist's are actually human and as prone to belief-itis as the rest of us.

Now just imagine what aliens might think.  I was watching an oldish TV show "3rd Rock from the Sun" on TV the other day. You may not have seen it but it portrays the comic attempts of a family of aliens trying to fit into our modern society.  They actually manage to get along pretty well with humans.  It's a funny programme.  The aliens are interesting and a lot more fun than the humans I have to say.

Of course, a group of aliens would be caught in five minutes in my town. Humans are far too strange and irrational.  In my town we get up really early in the morning then head off in all directions in metal machines with wheels. We drive really fast in opposite directions with just a painted line and bit of belief to keep us apart. Sometimes the lines don't make a difference.

You know, the aliens would start to learn our rules in order to fit in but they would quickly spot some flaws in human logic. When are you supposed to do X? - and when are you supposed not to? 

Everybody here seems to know. We have some expected behaviours.  But we don't understand any of it. We only do it because long ago we forgot how this all started. We aren't paying attention any more to the ideas, attitudes and beliefs that shape our behaviour.

The aliens might enjoy a conversation with a person who speaks only facts. The type of conversation you could just imagine having with an official who refuses to give a personal opinion, make a prediction of the future or offer an explanation for the past.

Instead, suppose they overheard the testimony of a couple of police officers;

"We were called to the scene at 11:57 and found the suspect holding two hostages. We overpowered the suspect without injury to any party. The suspect is now undergoing psychological evaluation"

What they do not say is that they believe the suspect is guilty, he is nuts, they believe he is a drug abusing sadist, that they were terrified whilst overpowering him, that they sincerely hope he gets the maximum sentence possible and so on.

Police officers rightly stick to the facts; at least whilst they are on duty.  Afterwards they are as full of opinion, belief, innuendo, prejudice and emotion as the rest of us.

In this example, the distinction between belief and fact is amplified to make the point that so much of human discourse and confusion lies in the beliefs, speculations, predictions and desires of all of us. Beliefs are real enough to create impact but lie beneath the surface of our communications like icebergs.

I wish I could tell you that science was more objective.  However, this has never been true and is not today.  Long ago, Sir Isaac Newton failed to report absorption lines in the prismatic solar spectrum, though they would have been clearly visible with the apparatus he was using. The most likely explanation for his failure to see them is that he held theoretically based expectations that such phenomena should not exist.  Because he believed they did not exist, he failed to see them, or at least to note their presence.

While Newton failed to see something that did exist, scientists of the early twentieth century saw something that did not exist. First reported by Rene Blondlot in 1903, "N-rays" appeared to make reflected light more intense.

During the period 1903-1906, some 120 trained scientists published almost 300 articles on the origins and characteristics of this spurious radiation, the so-called N rays. So long as they were believed to exist, the effects of N-rays were "observed" by many scientists. Of course, once it was determined that N-rays did not exist, their effects ceased to be observed.

You have all heard the expression "I will believe it when I see it."  However, Dale Purves studying the neuroscience of vision at Duke University has suggested that actually the truth is often closer to the statement "I see it because I believe it."  Vision is to some extent a reflex activity in which what we perceive is biased by our conditioned expectation of what should be.

Twenty years ago, belief systems were a serious topic of research in the field of artificial intelligence and decision theory. A quick scan of the academic literature today shows that belief systems are still a serious topic of research. Whilst some of the world seeks to understand the rest of us will do what we can.

Emotional memory shapes our results

As a business coach I am normally asked to focus on an agenda around business results.  Nevertheless working with people often brings up surprising differences in how people deal (or otherwise) with personal challenges.  We see the lesson time and time again that it is not really the situation that poses the challenge but it is the person's response to it.

Some years ago, I took part in a long distance mountain walk to raise money for charity.  Basically we were just a bunch of guys facing up to enjoying a lot of Scottish rain and a significant number of blisters.  We stayed in a variety of basic hostel accommodation as we travelled the country which invariably meant that we were all sleeping on pads in the same room. 

It was then I first learned the horror of sleep deprivation.  One of our number, George (a robust and well known local entrepreneur), had an ability to get to sleep within seconds and then keep the rest of us awake all night with thunderous snoring. 

After a couple of nights of this, one of our party, Russell, a manager at our local bank, could stand it no more and dragged his sleep pad outside just so that he could get to sleep.  When we told George about Russell having to move out, he could only laugh and hinted at a pretty keen emotional memory.  “Well that’s justice anyway – I’ve lost many a night’s sleep because of that f****** bank manager!” 

However it shows up in our lives, emotions such as fear have a very powerful effect.  Some authors refer to fear as an acronym standing for “Fantasised Experience Appearing Real” and we all probably recognise this as being pretty accurate. 

Although we all have different code words for fear and it’s maybe not always “cool” to acknowledge it, we certainly all have a deep knowledge of its effects.  In some societies openly acknowledging fear is not something we are supposed to do.  I was brought up in a society in which “Big boys don’t cry” and people keep a “Stiff upper lip”.

In order to feel fear, the fact is we are probably choosing to believe something which is not true.  We are choosing to form a mental picture that is nothing to do with current reality but everything to do with an imagined future scenario.

I was watching a documentary about Mohamed Ali recently which pointed out that despite his disability through Parkinson’s disease, he chose to believe that his God would never give him a test that he couldn’t cope with.  His mental picture of his disability as an opponent gave him the power to face his situation from a position of strength and challenge rather than weakness.

I’m a great fan of Sir Ranulph Fiennes who is one of the most remarkable human beings I’ve ever met and certainly the world’s greatest living explorer.  Ranulph didn’t succeed in his bid to trek solo and unsupported from Canada to the North Pole. 

He came back with a badly frostbitten hand that was still intensely painful five months after his return.  I’m sure that this isn’t a comment on his belief in the UK’s National Health Service, but he eventually resorted to putting his five frostbitten fingers into a workbench vice one by one and removing the blackened ends with a fretsaw. 

“If the finger bled or hurt, I just moved the saw up a little,” he said. 

Fiennes was happy that his handy-work had knocked thousands off the eventual surgery bill.  Whatever you or I might think, he saw (no pun intended) an opportunity where most of us would just see a crisis.

Scientists have now been able to determine how the brain shapes memories about significant emotional events.  This process is called the formation of emotional memory.  Many human mental disorders - including anxiety, phobia, post-traumatic stress disorder and panic attacks – are the result of problems in the brain’s ability to control fear.  Although we are not so interested in these clinical issues today, the research that is going on can give us a better understanding of how fear surfaces within you and I and what the effects are.

Classical conditioning
Most of what we know about the links between memory and emotion come from work in the field of classical fear conditioning.  In this type of research a subject, often a rat, hears a noise or sees a flashing light that is paired with a brief (and mild) electric shock.  After a few brief experiences the rat quickly learns to associate the noise or light to the shock and responds accordingly.  Most importantly the rat learns to respond in the same way even when the shock is no longer given.  In other words, behaviour has been learned.

In the language of science the noise or light is a “stimulus” and the resulting behaviour of the rat is a “conditioned response”.  The delivery of the electric shock is termed an “unconditioned stimulus”.  Now conditioning of this type happens very quickly in rats – and in humans too.  Just a single experience of pairing a shock to a stimulus brings on the conditioned response.

Significantly, once this fearful reaction is established it becomes relatively permanent!  If the light or noise is then delivered many times without the shock, the rat’s response eventually diminishes in a process termed extinction.

Research evidence suggests though that the emotional memory formed through such conditioning is not actually erased.

What happens is that the brain somehow learns to control the fear response rather than actually erasing the memory.  The memory may still lurk there waiting to be recalled once again.  The fear response is lying dormant and may pop up again some time under even unrelated conditions.

Fear conditioning appears in just about every animal group that has been studied; it’s present in fruit flies and it’s present in people even though there may be some differences in the details of how it works.

Our response to fear
One of the popular scenarios used to describe the stress response – which is basically our fear response – goes like this. 

A hiker comes across a snake on a mountain path.  The instant the snake is seen, visual stimuli are quickly routed to a part of the brain known as the thalamus which acts as a rapid switching station that passes information to the amygdala which we introduced in Chapter Four.  The amygdala has long been recognised as an important brain region with respect to the processing of emotion and especially in moderating the storage and strength of emotional memories.

The thalamus seems to act only on fairly primitive information; perhaps by comparing a “threat” pattern stored in the brain with the incoming visual stimuli.  This quick information relayed to the amygdala allows the brain to trigger a response in the body by powering up the heart and the musculoskeletal system to respond to the threat.

Meanwhile the visual cortex also receives information from the thalamus and this, given a bit more time, actually seeks to determine the nature and extent of the threat.  It’s a more considered response.  The hiker is now “aware” not just that there is a potential threat, but that there is a snake on the path.  If through this process the hiker determined however that the snake was actually harmless and there was no real threat, the cortex could signal the amygdala to quell the fear response. 

This makes sense because failing to respond to danger is potentially more costly than responding inappropriately to a benign situation.  When your life is at risk, you don’t really need to know straight away whether the snake is a python or a cobra or whether it is red or blue.  Once you are at a safe distance you can consider that question safely.

What we can see here is that we have both a fast response and a slower response within our physiology. The fast response through the thalamus is based on very basic recognition of a possible threat.  Sensory input from the eyes, ears and so on is compared with a “database of threats” – the previously stored emotional memory.

The slightly slower and more reasoned response through the cortex and the hippocampus (responsible for learning of facts about entities such as people, places, events and things) has a chance to moderate our state.  If reason shows “no real threat”, then the fear response is quelled.

Early life conditioning
Science suspects that traumatic early life events may be significant in shaping our fear responses later in life.  You see, we seem unable to remember traumatic early life events because the hippocampus has not yet matured enough to consciously form accessible memories.  The emotional memory system develops earlier in life and clearly forms and stores primitive patterns of these same events.  These patterns are then not part of our accessible memory but they ARE part of our emotional memory.  For this reason, the traumas we suffered in our early life may affect mental and behavioural functions in later life through processes that remain inaccessible to our consciousness.

Can you see that a stimulus may find a match in the amygdala, stored decades ago and perhaps even by our genetic ancestors, that triggers a fast response because that stimulus is still recognised as a threat?  The information that should allow the response to be moderated through the cortex is not available.  That moderating information was never stored.

The creation of emotional memory has been linked to a process called long-term potentiation or LTP in which the neurotransmitter glutamate and its receptors bring about strengthened neural transmission.  Once LTP is established, the same neural signals produce larger responses.  Emotional memories may involve LTP in the amygdala where fear conditioning seems to take place. 

The fact seems to be that we are emotion driven and our response to the environment that we face each day is “programmed” deep within us.

Let’s summarise this bit of science. 

From when we are babies in arms we develop and store primitive emotional programmes that are basically about ensuring our survival.  The brain is learning to recognise “patterns” that represent threats to our survival.  When we are out and about in the world the part of the brain known as the amygdala matches our current situation with the stored patterns of threats.  If a “threat” is detected, a response is initiated and it is instantaneous. 

The amygdala sends a signal to our physiological systems to power up our fight or flight mechanism and it literally disconnects us from our higher consciousness – in other words it stops us thinking!  Every cell in the body responds to the stimulus.  When someone cuts you up in traffic and you respond with what later seems like “irrational” behaviour – it’s this process at work.

Our autonomic nervous system becomes out of balance as the so-called sympathetic pathway speeds up the body for high effort.  A million years ago, the effort of running away or fighting the threat would have burned off the adrenaline which floods into our system to allow this effort.  Today, there might not be such an opportunity and when repeated often, this adrenaline overload leads to increased risk of obesity, diabetes, hypertension, cancer, heart disease, stroke and the many other consequences of imbalance.

The job of the so called parasympathetic pathway of the autonomic nervous system is to slow down the body systems and release hormones that naturally neutralise the adrenaline.  Relaxation and meditation can bring this about but only slowly and anyway we may not be able to relax when it is most needed.  It’s not just the autonomic nervous system at work – it’s the molecules of emotion we discussed earlier.  The hormonal system is slower acting but is extremely powerful and needs to be in balance too. 

We probably don’t yet know all of the hormones that flow to regulate our balance.  Two of the best known are DHEA which is associated with positive emotions, feelings of well-being and success, and cortisol which is associated with negative emotions, feelings of submission and despair.  It is no good taking DHEA pills (although they exist) because what we need is balance – both in the fast response autonomic nervous system and in the slower response of the hormonal system.

What the Institute of HeartMath in California verified scientifically is that the body has a built-in way of creating coherence and balance from chaos.

It seems that the heart is a powerful source of electromagnetic energy – much more powerful than the brain (1000 to 5000 times more powerful) and it can be used to send a signal back to the brain that quickly defuses the stress induced imbalance. 

As the heart beats it generates electromagnetic energy in a rhythmic way that can be seen as the familiar ECG waveform. The heart rate is a measure of how many heartbeats or cycles there are in a minute.  We now know that a healthy heart has a rhythm that varies smoothly.  Even when we are at rest, the heart rate speeds up for a few cycles and then slows down for a few cycles.  When we are ill or stressed this heart rate variability becomes chaotic or very uneven.

The act of putting attention to the heart in particular, and if you can manage this, generating and holding positive feelings there, causes the heart rhythm to change.  The heart rate starts to vary in a smooth fashion.   This biological rhythm is communicated to every cell in the body and literally entrains every cell and organ system to fall into step. 

As this smooth signal from the heart is communicated to the brain, the amygdala no longer seems to inhibit thinking.  Once again, we can regain access to the higher consciousness and intuitive, creative abilities of the brain.  This action of putting attention to the heart activates the slower pathway we noted earlier that allows us to access the cerebral cortex.  We actually see things in a broader perspective and miraculously this is a useful key to defusing stress, improving creativity and even personal communications.