How Mindsets Shape Reality w/ Dr. Alia Crum

Introduction to Racetrack

0:00When you've got a one-track mind, you go where the cravings take you. Welcome to Racetrack. Breakfast that satisfies. Snacks that sing. Drinks that refresh.

0:14It's a stop that pulls you in. We don't blame you for having a one-track mind. Because once you stop at Racetrack, no other stop will do. Same time tomorrow? You know it. Racetrack. Whatever gets you going.

Meditation and Mindsets

0:30I think that what meditation does, what mindfulness does, is it helps you realize that you have mindsets. That the world, your beliefs aren't just sort of a reflection of reality as it is. That like could be this way or could be that way. And you kind of like sit back and you sort of see the kind of absurdity of it all. So that's part of it. But then what? Then you need to go live your life. Then you need to get back in the game. And so it's, you know, it's stepping back in and say, now I'm going to live my life and I'm going to choose to view stress as enhancing.

Introduction to Psychology Podcast

1:05Hello and welcome to the Psychology Podcast, where we explore the depths of human potential. I'm your host, Dr. Scott Barry Kaufman, a cognitive scientist and Columbia professor. On this episode, we have my dear friend, Dr. Ali Crum, whose research focuses on how changes in subjective mindsets, the lenses through which information is perceived, organized, and interpreted, can alter objective reality through behavioral, psychological, and physiological mechanisms.

1:37Her work is, in part, inspired by research on the placebo effect, a remarkable and consistent demonstration of the ability of the mindset to elicit healing properties in the body. She is interested in understanding how mindsets affect important outcomes outside the realm of medicine in the domains of behavioral health and organizational behavior. More specifically, she aims to understand how mindsets can be consciously and deliberately changed through intervention to affect organizational and individual performance, physiological and psychological well-being,

2:08and interpersonal effectiveness.

Personal Connection

2:10This chat was very sentimental to me personally. I met Dr. Crum in graduate school at Yale, and we connected immediately. I remember fondly our deep chats, and I'm so proud to see her become such a superstar in the field. I hope you find this chat just as informative as I did. So without further ado, I bring you Dr. Ali Crum. Oh my God, Ali, how do you look exactly the same? I mean, you look exactly the same. It's so good to see you. It's so good to see you, too. I mean, like, you're exactly like, you know, Yale dance.

2:45What was that? I don't know. Some party. Gypsy bar? I think it must be something. Yeah. The memory I have of you in my mind is like exactly the same. Anyway, congratulations on keeping your health and vitality in youth, and for your amazing, amazing ascendancy in the field of psychology, successes and research and everything. It's been such a delight and honor to watch you soar. Oh my gosh. Well, I feel the same about you, Scott.

3:16Seeing you brings me right back to New Haven. You know, I remember going to your dissertation. I remember meeting your mom right outside of the Hall of Graduate Studies. And, you know, just to, we were just, you know, we were so, such kids then. But at the same time, you know, I think both of us, I was drawn to you because I got a sense that this was your passion, right? This was your calling and you weren't doing it to get some credentials. You were doing it because you knew it mattered.

3:48So it's been fun to watch from afar and listen to all your work. And likewise.

Undergraduate Experience

3:53Thanks. Thanks. Well, let's back up before we even met. Let's back up to your undergraduate at Harvard. You were a TA for a very special and popular course on happiness by Tal. Is that correct? Yes. Tal Ben-Shahar. Changed my life. Can you tell me a little bit about that experience? And how it influenced you for the research you've continued to do? For sure.

Childhood Influence

4:23I mean, I think in order to understand the effect that that class had on me, it's important to share a little bit about my childhood. So I grew up in a household. My father was a teacher of transcendental meditation. He was a master of the art of Aikido. He started a foundation called Windstar Foundation with John Denver, the singer-songwriter, where they would host speakers, retreats where people would come basically to study in the mind-body arts.

4:55And so I grew up going to all these retreats. You know, my summers were filled going to meditation and Aikido seminars and retreats. And so when I got to Harvard, I realized, you know, fairly quickly that that was not a normal upbringing, that that wasn't the status quo for the other students there. And, you know, for a while I was a little bit lost. I was feeling, you know, a sense of imposter syndrome, a sense of like, you know, I've learned a lot, but I haven't learned all they know in terms of, you know, the academics.

5:31But it wasn't until I met Tal Ben-Shahar, Ellen Langer, Anne Harrington, that I realized that, you know, even though my childhood was unique, it was actually being researched at the time from a neuroscientific standpoint. You know, the rise of positive psychology was happening. The neuroscience of meditation was just beginning. And people were starting to take this work really seriously from a scientific standpoint.

6:03So that class, you know, it didn't necessarily like open my mind to things that I hadn't learned or heard of before, but it made me feel at home. It made me feel like I belong.

Seminal Research

6:16So you did some, you contributed to some seminal research, even as an undergrad in Harvard, which I think paved the way for a career on mindsets and stress. So can you talk about some of that seminal research? Yeah. So the original research that I did, you know, I mentioned I had sort of been, I had experienced the power of the mind to affect the body, both through watching my dad teach meditation, teach Aikido and the martial arts. Also as an athlete, I was an elite gymnast for a number of years.

6:49And then I was a division one athlete at Harvard. I was an ice hockey player. And I was taking a class actually with Ellen Langer at the time. And she said, you know, you know, I think I came back all sweaty from a practice to lab or class or something. And she was like, oh, you know, exercise. That's just a placebo. And I was sort of like, wait, what? Really? What are you talking about? And, you know, but it caught my attention. And, you know, I think at the time I was really struggling with this sense, this question of like, what is enough exercise?

7:27Like I was training two to three hours a day and then I would like go work out after practice even further. And it kind of got my attention. I was like, what if it's all in my head, the benefits of what I'm doing? And so I started researching placebo effects actually sequentially. Anne Harrington was teaching a class on the history of medicine. And she made a comment one day in class that said she said, you know, something like, you know, in many ways, studying the history of medicine is like studying the history of the placebo effect.

8:01And so these two things kind of got in my head, wow, you know, what is the placebo effect? How strong is it? And I did a lot of research looking into that. And then the study that Ellen and I did was looking at hotel housekeepers. We found that they were getting a lot of exercise but weren't aware of it. And what we found was if we could make them aware of that, help them to see not only are they getting above and beyond the surgeon general's requirements, they are, you know, they're probably getting more exercise than most people in the United States.

8:38That that shift in mindset didn't just change how they felt, but also had measurable changes on their blood pressure, their body fat, their weight, and so forth. So that really kicked it off for me. Yeah, that's pretty revolutionary research. Pretty revolutionary foundation. Thank you. So, yeah, I think what it did was it brought two fields together that hadn't been integrated before. There was all this work on behavioral health being, you know, the modern medicine, right?

9:10We need to eat well. We need to exercise. We need to stop stressing. We need to stop smoking. And it brought the research on placebo response into that and said, well, yeah, we do need to do all those things, but also we need to pay attention to our beliefs, to our mindsets, to how we're thinking about these things.

Yale Research

9:29Yeah, for sure. And then when you got to Yale, you worked on – you continued this research. You published this paper in 2011 called Mind Over Milkshakes, a classic, classic in the field. Mind Over Milkshakes, not just nutrients, determine ghrelin, is that how you say it? Response. So can you just tell us what is ghrelin, you know? And I know it's related to hunger, but give me a little more technical description. And, you know, how does our mindset affect that?

10:00Yeah, well, first of all, do you remember – I think I asked you to read a draft of this paper back in New Haven. Maybe it hadn't made such an impact yet, but I remember – It was in 2009. Something like that. We were sitting at a restaurant somewhere in New Haven, and I had given it to you to read because I was struggling with how to frame it. But you were really helpful. Oh, yeah. Isn't that funny? It is funny. It's all full circle. But, yeah, so this study, quite frankly, this is my favorite study I've ever done.

10:36It's mostly because of how profoundly it changed my life as a result. So ghrelin is a hunger hormone. Medical experts call it the hunger hormone. Yeah. It helps regulate hunger and metabolism. So, you know, I don't know what time it is. I think you're in New York, so maybe you've already eaten lunch. But I haven't yet. So my ghrelin levels are slowly rising. And the purpose of that is to send signals to my brain and body that I need to seek out food.

11:11So rising levels of ghrelin signal hunger. It also – rising ghrelin slows metabolism just in case we don't get the food that we need. And then theoretically, or at least, you know, prior to the study, it had been assumed that in proportion to the amount of calories you consume, ghrelin levels will drop. So say I go out after we chat and I have a giant hamburger and a milkshake, then my ghrelin levels will plummet, telling my brain,

11:43okay, you can stop feeling hungry, stop searching out food, and I'm going to rev up the metabolism to consume the food that you just ingested. So, you know, actually these gut peptides, these hunger hormones hadn't really been fully discovered until the late 1990s. And we're still just now figuring out what they do and how they work in concert. But what we were interested in in this study was does our body's physiological response, and in particular our body's ghrelin response,

12:15does that differ, might that differ if we have different beliefs about the food that we're eating? Amazing. So in that study, we worked with the Yale New Haven Hospital, and we gave people the exact same milkshake. So it was about a 350-calorie milkshake. Yeah. And we either told them that it was 620 calories, high-fat, high-sugar, or 120 calories, 140 calories, low-fat, sort of sensible diet shake.

12:48And we had them hooked up to an IV. We were measuring ghrelin levels through their bloodstream. And what we found was that even though the shakes were exactly the same, when people thought they were consuming an indulgent shake, their body responded as if they had had more food. So the drop in ghrelin was about three times as great compared to when they thought they were consuming a sensible kind of low-fat diet shake. That sounds like a big effect, statistically.

13:18Can you, like, subjectively describe what that difference is? Does that make sense? Totally. So, well, first of all, the findings were significant, important in the sense that no one had ever documented just any physiological change based on the belief. So that was one thing that was important. But the second reason why this study was important was realizing, actually, the direction in which the belief had an effect.

13:50So I went into this, remember, like, thinking, okay, placebo effects are basically, you know, if you think you're going to be healthy, you'll have a healthy response. So I assumed that the sensible shake, if, you know, if it made any difference at all, that would be the better mindset to be in. And what we found was exactly the exact opposite, right? Assuming you want to maintain or lose weight, when, if you're consuming something in the mindset that you're eating sensibly, healthy, it conveys to the brain a sense of scarcity or restraint.

14:29And what that does is it perpetuates ghrelin, perpetuates the hunger signals, slows metabolism and so forth. So the mindset of sensibility or restraint or scarcity actually counteracts the hard work that you might be doing, actually reducing your caloric intake. Does that make sense? It does. But the effect you found of three times less, is that the equivalent of, of literally going from signaling that it's time to eat versus like, I don't feel any hunger at all?

15:09Or, or is it like, just not as strong? Or I guess I'm trying to like quantify, qualify it, not quantify it. Yeah, I, I don't know. It was three fold greater compared to the sense of scarcity. It's definitely an important effect. It's definitely an important effect. But how much did that affect their subjective sense? And honestly, I, the subjective sense is less important than the physiological sense. Well, that's a good point.

15:39Yeah. In that, in this case. And I think everybody's different. And I think, you know, I've, I've, since that time wanted to do my sort of dream study is, you know, cause I was just, they were sitting in there for two hours, right? We're measuring their response to the shake. So it's like, okay, how much does this really matter? Um, but you know, what if we could take somebody over the course of a month, right? And not only change their diet, but change their beliefs about what they're eating.

16:10So maybe they're starting a low carb diet or low fat diet or whatever it is. But if they believe that it's enough, will that actually change weight, change their body composition and so forth? But we haven't been able to do that because as you can imagine, it's hard to, um, deceive people for a long period of time. And we wouldn't want to deceive them for a long period of time. Hi, all.

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17:50That's centerforhumanpotential.com slash S-A-C. Okay, now back to the show. Oh, no, that's cool. That's really cool. Well, you've done some really great extensions of this work.

Stress Mindset Measure

18:03In 2013, you teamed up with Peter Salovey, who was he head of the Yale Graduate School at that time, I think? Yeah, he was, I think, dean when we started working together and then provost when I left. Yeah, great. And this guy called Sean Aker was a co-author in this paper as well. But you are the lead author, I want to state, for the record. You're amazing, Ali Krum. And this paper is Rethinking Stress, the Role of Mindsets in Deterring the Stress Response.

18:34And so what I want to talk about in this paper is you developed a measure called the Stress Mindset Measure. Can you give me, I hate to put you on the spot, but can you give me one or two items? Like, how do I know if I score high on this measure? Yeah, of course. And you love self-report. I'm a nerd.

18:54I love psychometrics. I do, too. So we have that in common. So this, the Stress Mindset Measure, the SMM, asks questions like, experiencing stress enhances my performance and productivity. So do you strongly, you know, do you disagree with that, agree with that, strongly agree with that?

19:19Experiencing stress depletes my health and vitality. That one is reverse scored.

19:28Experiencing stress. I think we had a health and performance, vitality. Oh, it enhances my learning and growth. So we wanted to cover these sort of three dimensions, health and vitality, learning and growth, performance and productivity. And for the record, these items are, you know, if you score high in this, it's not the majority of participants who tend to think this way, correct? I mean, most of us don't think, when I say stress to every person on the street, they don't think, oh, that's going to improve my performance.

20:03So what were percentages and things? Yeah, I think, you know, we've studied this now in many different populations. It's been translated in many different languages. And the average score is always, almost always, below the midpoint. So, you know, categorically, you would put that into the belief that stress is debilitating. The only group, at least that I've sampled in my life so far, that is, on average, in the enhancing side of the scale, over the midpoint, are Navy SEALs.

20:46So, and it makes sense, right? You know, these are people who are literally choosing to go into some of the most stressful experiences you could dream up. In part, because they know they can handle it, and they know they'll thrive under that pressure. Makes sense. I mean, I'm sure that, like, the whole West Point cadet, you know, vibe is that, you know, when they come in. And so you found, this is so cool, you found that those who score higher on this scale showed moderate cortisol reactivity and high desire for feedback under stress.

21:27Now, that's not, this is not the norm. This is not the norm. So, explain the really important implications of this kind of, these changes to cortisol and your desire for feedback under stress. Yeah. Well, first of all, it's important to kind of take a step back and understand what this measure is, right? So, you know, the truth about stress is that it is a paradox, right? Like, there's lots of research showing that stress can have damaging effects on our health, on our learning, on our growth, on our well-being, and so forth.

22:05But if you actually dive deeper into the literature, you realize that, you know, it's not all bad. And, in fact, the body's stress response was not designed to kill us. Like, it was not designed to hold us back. It was designed to help us rise to the occasion to meet the demands we're faced with. In fact, Hans Selye, who sort of, you know, humorously called the father of stress, when he first wrote about stress, he wrote about the stress responses non-specific, right?

22:35It's just the body's reaction to the challenges that it faces. And he also talked about, you know, not just stress as only bad, but stress as being both distress when it causes negative effects and eustress when it actually helps the brain, body, system grow, learn, perform. So, we want to distinguish between kind of what is the true nature of stress, which is, like most things in life, a paradox. Many types of outcomes are possible.

23:07And what we're interested in, which is our belief or mindset, the core assumption that we have about the nature of stress. Now, if you probe somebody further, they might say, well, I get that it could be good here and da-da-da-da. They can get all nuanced in their thinking. But, you know, when we operate, when we act in the world, we are acting based on these default assumptions, right? Our first inclination is going to be based on where on that scale did we stake our claim on average. Yeah.

23:38And so, there's variability in that. Even though, on average, most people are on the stress and debilitating side, there's variability in people's beliefs. And what we find is that that variability matters. So, people who believe, hold the mindset that stress can be enhancing, they show more adaptive cortisol response. And I'll talk about that in a second. And they also show more willingness for feedback. And it makes sense, right?

24:08It does. If you think that stress is bad for you, and then you're faced with something stressful in your life, how do you feel, right? Now, not only are you stressed because, like, something just happened, but now you're stressed about the stress. And you're upset that you're stressed. And you're a little depressed that you have to deal with the stress. And you're worried about, you know, the cardiovascular ramifications of the stress. So, the mindset itself just made the stress worse.

24:39So, emotionally, it changes. Motivationally, we also are influenced by our mindset. So, if you believe that stress is debilitating, that it's bad for you, that it's going to kill you, what are you motivated to do? You're motivated to either, yeah, to, like, get the hell out of there. Like, either pretend that this problem isn't there, you know, that your boyfriend or girlfriend didn't just give you negative feedback. Or to overcompensate, to overreact, to, like, make sure this problem goes away.

25:13So, those two responses, either hyperactivity around the stress or, you know, avoid and hypoactivity, show up physiologically. So, either people freak out or they check out. And what we found is people who believe that stress can be enhancing, they're somewhere in the middle. They're like, okay, I didn't want to be dealing with this stress, but it's here, and the stress response is designed to serve me. So, what do I have to learn from this? How can I engage with this in an appropriate, thoughtful, useful way?

25:49What feedback do I actually need to hear? And that shows up physiologically in, you know, moderate levels of cortisol, which is important because most people get this wrong and they think cortisol is all bad. But, but actually, you know, cortisol is linked with attention, focus, engagement, right? So, you want to be somewhere in the middle with respect to cortisol. You know, there's a, there's an old saying that goes, when you worry, you suffer twice. And you had me thinking that it's, you know, you have the stress, but the whole avoidance, and we should use the word fear.

26:24Is it, that enhances these reactions and this, these, and these, these physiological responses that cause damage to your body, quite frankly, and your mind. So, in some ways, it's like a double whammy, you know, it's, you have the stress itself, and then you also have the avoidance response. So, it just seems like the more you can have this stress-enhancing mindset, the more you're kind of like avoiding a double whammy.

26:54Does that make any sense? Totally. You know, in some of the work that I did with Peter Salovey, he coined the term emotional intelligence back before Dan Goldman rolled with that. Peter Caruso. Yes, yes. Yeah, and David Caruso. David Caruso. But one of the things I remember Peter talking about, and later Mark Brackett and others, is this idea of dirty discomfort. So, you have clean discomfort, which is like the stress, or the fear, or the sadness, and then you have dirty discomfort, which are your judgments and concerns about the discomfort.

27:33Like, I can't believe I'm feeling this way, I shouldn't be feeling this way, this is going to be harmful for me, and so forth. And so, you know, it's, it's nuanced, right? Like, the goal is not to, you know, get rid of all negative feelings, right? It's to feel them, but not make them doubly damaging, as you say, not make them worse, right? There's enough to learn from them. And that's important, I think, you know, to say with respect to the stress-enhancing mindset is, you know, sometimes people misunderstand that.

28:07They think, oh, that means that, you know, you should seek out more stress in your life. And it's like, well, no, like, if you care about anything in life, you're going to experience stress surrounding it. In fact, you know, the definition of stress, at least that I use, is stress is the experience or anticipation of encountering challenges in your goal-related efforts. That's super jargony, but like, you know, for all intents and purposes, what matters is that you only experience stress in domains that you care about, right?

28:44If I told you that Johnny was failing school, you wouldn't really be stressed about that, unless you were Johnny, or your son was Johnny, or you cared about the Johnnies of the world passing school. So we're going to have stress in our life. You don't need to seek it out. A stress-enhancing mindset also doesn't mean that the stressor is a good thing. And I think, you know, you know this with all your work on trauma and your great book that you just wrote recently.

29:15Like, you know, when you say you can rise above, right, trauma, it doesn't mean that, like, the trauma was a good thing. Like, stress, the stressor is not a good thing, but going through it can lead to enhancing outcomes. And that mindset makes those outcomes more likely. Yeah, it seems like a bedfellow of a Carol Dweck's growth mindset, but applied to a different domain.

29:46Exactly. Yeah, no, Carol's work has been very inspirational. I think her use of the term mindset to kind of define a core belief that we have about the nature of intelligence as fixed or malleable is just so profound and important. And what we're doing here is we're trying to, you know, expand that, but it's different, right? Now the topic is stress and the modifiers are, you know, is stress enhancing or debilitating, not necessarily growth or fixed, right?

30:20So it's, we have mindsets about all sorts of things, and it turns out they matter.

30:31They do matter, and we can, you know, get even nerdier. You proposed a metacognitive approach to mindset change. If, just when you thought it didn't get nerdy enough, you create your stress mindset scale, what is the metacognitive approach that you published in 2023, where you evaluate your rethink stress mindset intervention from 2013?

Metacognitive Approach

31:01Yeah, anyway. Yeah, let's go. Let's go. I'm so glad we get to nerd out together, Scott. Yeah, me too. It's been too long. We need a better term for this, but it's so crucial, right? So we, the truth of stress is a paradox. Our mindsets matter. If we know the goal is to get people to adopt more of a stress is enhancing mindset, because we know that's useful for them. How do we do that, right? So one approach could be to just try to convince them that that's the true mindset, right?

31:37Like, that's the right way to think about stress. And in fact, we did that in that early study with Peter Salovey and Sean Aker. We worked with UBS bankers who were going through layoffs after the 2008 financial recession. And what we did was we gave them three minute video clips that shared the science, science of stress, anecdotes, etc. But they were oriented towards one or the other of these truths.

32:08So, you know, one group in the study saw all the information that kind of reaffirmed how bad stress is for you. And the other group saw all the information that showed that stress, you know, actually wasn't designed to be that way. It was designed to support your immune system and narrow your attention in ways that can support you. And what we found is over the course of the week, just watching those videos did change their mindset and it did have effects on their health and performance.

32:38But I left that study feeling like, you know, that wasn't really ideal because it's not fully true. Like we're not lying to people. Everything that we put in those films were, you know, was based on evidence or it was a true anecdote. But it wasn't the full picture, right? So then I was left with this question of how do we get people into the mindset that stress can be enhancing?

33:07Not by kind of, you know, you know, trying to teach them or getting them to see that that's the true nature of stress, but by getting them to see that that mindset is useful. And so what we decided to do was to create an intervention where people learned the true nature of stress. They learned all the whole messy story of stress. It can be the worst thing for you, right? And some people really thrive and grow from stress. All of these things are true.

33:39And your mindset about it matters. It can shape your attention. It can shape your feelings. It can shape your motivation. It can even change your body. So you choose, right? Like how do you want to choose to view stress, right? Do you want to view it as debilitating or do you want to view it as enhancing? So by meta mindset, what we mean by that is we inspire people to adopt the mindset, a particular mindset, such as the mindset that stress can be enhancing.

34:11Not because they're manipulated into it, but because they choose consciously that that mindset is a more useful one to have. Well, so it's just like a flexible stress mindset. Yeah. Strategically flexible. Yeah, it's sort of like, you know, I think that what meditation does, what mindfulness does is it helps you realize that you have mindsets, that the world, your beliefs aren't just sort of a reflection of reality as it is, that like could be this way or could be that way.

34:48And you kind of like sit back and you sort of see the kind of absurdity of it all. So that's part of it. But then what, right? Then you need to go live your life. Like then you need to get back in the game. And so it's, you know, it's stepping back in and say, now I'm going to live my life and I'm going to choose to view stress as enhancing. It's my life. Now I'm going to live forever.

35:20Okay. Where's your piano? I don't know, but I can beatbox. No. So, I mean, this is, there's a whole, there's so many extensions, so many offshoots of this. I mean, there's some fascinating stuff found that you can change cancer mindsets, you know? Um, a brief mindset focused digital intervention was effective at improving physical, social, emotional, and functional HRQOL.

35:50Okay. What does that mean? You got to love jargon. Yeah. Um, yeah. So, you know, we did the stress mindset stuff. That stuff's still ongoing. So important. Um, as you know, sadly, well, we can come back to this, but I thought, you know, we would do this. And then everybody would learn about it. And then everybody would have a stress is enhancing mindset. I think, sadly. You need to write that book. Um, I'm working on it. I'm working on it.

36:20Yeah. Um, but sadly, I feel like our culture has even taken a step back in, you know, having this belief that stress is bad. All stress should be avoided. We should protect everyone from stress and so forth. Um, but we can talk about that. The cancer work is really near and dear to my heart. This is work that I've done with Sean Zion, a former grad student in the lab, Lydia Shapira and others, Jonathan Barrick. And we wanted to understand what our mindsets that people have about cancer.

36:56Yeah. And, you know, what we learned is that, you know, like stress, there's, you know, cancer is complicated. It doesn't just have one effect on people's lives, but people have mindsets about it. Three of the mindsets that we know people hold are, you know, either you view it as kind of an unmitigated catastrophe. My life as I knew it was over. Um, nothing will ever be the same. Why me? Poor me. You know, uh, yeah. The cancer is a catastrophe.

37:27But people can also view it more as something that's manageable, right? They have a mindset that, yeah, I'm diagnosed with cancer. This is not what I would have hoped for. This is not what I wanted, but I can manage this. I can handle this. And there's a third mindset that we see actually, um, quite frequently in people with cancer. And that is that cancer can be an opportunity. So, again, that doesn't mean you wanted it. It doesn't mean it's a good thing in and of itself.

37:59Post-traumatic growth. Potential for post-traumatic growth. Exactly. The experience of going through cancer can, yeah, help you reorganize your priorities, help you, you know, deepen your values, help you self-actualize, help deepen your relationships. Um, and, you know, unlike stress, actually, in the normal population, when you look at people with cancer, this is actually pretty strong, right? And I think when you're really faced with tough things, you kind of are forced to see the light in it, to see the silver linings.

38:32Yeah. But here, again, there's lots of variability. And what we find is that, interestingly, these mindsets aren't correlated with the severity of cancer. So, you have people who have stage four metastasized cancer who believe it's an opportunity, feel like it's manageable. And you have people with stage one, you know, no big deal kind of cancers that feel like their whole life's over. And here, again, these mindsets matter in shaping how people feel, how they're motivated to engage with treatment, how their bodies are responding physiologically, and what they pay attention to in treatment.

39:15And the intervention that we designed is also a metacognitive strategy to changing people's mindsets. So, you can imagine, you know, we didn't want to go in and say, hey, you who just was diagnosed with cancer, you should think this way, or this is the right way. We don't do that. So, what we do is we showcase stories from former, you know, people who have been formerly diagnosed, they're cancer survivors, talk about the role of their mindsets in the cancer journey.

39:46And they're not just the people who had great mindsets for the start. They're people who initially felt like this was a catastrophe, and then realized the impact of their mindsets, chose more useful mindsets, and reaped the benefit of doing that. So, the intervention is watching others talk about their mindset, and what we show in that study is that, you know, that intervention, which is a total of about an hour long of documentary-style films, changes mindset, and that confers the benefit on health-related quality of life.

40:22So, health-related quality of life is, you know, basically how well are you functioning? Are you getting up and doing the things that you want to do? Are you, you know, do you feel good about your relationships? Are you physiologically, in terms of symptoms, sort of managing okay? That's cool. There's another category of people that you might want to consider in your further studies on the topic. There was a woman who got a lot of press for the way she handled her cancer diagnosis. She was told that she had stage 4 cancer and maybe had two years left to live, and she decided she was going to completely surrender to it, actually.

40:59She said, I'm not going to fight a battle with cancer. I'm going to enjoy my life for two years and accept it, accept that I only have two years left. And I just don't feel like you don't hear about that option often enough. You find, like, you're almost, like, feeling pressure to fight it, to, you know, oh, yeah, what are you doing to fight it? What are you doing to, you know, fight the battle with cancer? She's like, I don't want to fight the battle with cancer. I want to enjoy my life. And so that's just, it might be an interesting, if you can get a large enough sample of people like that.

41:32A hundred percent. I'm so glad you brought that up because I think it's another place where people misinterpret the work, you know. And, you know, having the mindset that cancer is an opportunity or cancer is manageable doesn't mean you're kind of happy about cancer. It also doesn't mean you're sort of denying it. It also doesn't mean you're a hundred percent going to beat it, right? It's just to get there, the first step is really to acknowledge and accept the reality of your diagnosis.

42:06And it's only when you do that that then you can choose how you're going to handle that, how you're going to approach it. And that might mean going all in and getting the treat, every single, you know, treatment that you can. Or it might mean, you know, I don't want to do that. I want to live out the rest of my days, you know, doing something else. But you can only get there through acknowledging it and through having a mindset that is useful. Yeah.

42:37I want to shift a little bit to what happens when you get information about yourself and how that changes those actual things without you trying to change them.

Genetic Risk and Physiology

42:49So that's a long-winded way of talking about a study that you were a co-author on with Chernwald and colleagues in 2019. Learning one's genetic risk changes physiology independent of actual genetic risk. I mean, that's mind-blowing. I mean, it's just so mind-blowing to me, okay? Because so many of us are able with 23andMe, right? We're able to find out all this information about our genetic risk estimates for this and that, Alzheimer's, cancer, obesity, all sorts of diseases.

43:25What did the study find about just merely learning about that? Yeah, this was such an interesting and fun study to run. We got people into the study under the study guise that we were looking at how, you know, personalized medicine, how we could create sort of personalized fitness plans. And this was very believable in the Stanford area. Lots of stuff on genome mapping and personalized medicine were happening at the time.

43:55And we, in particular, we're interested in one gene called the CREB1 gene. And that gene had been linked with obesity and weight through exercise capacity pathways. So people with the risk allele of the CREB1 gene were essentially associated with less cardiovascular efficiency when they exercise.

44:27So you would run, you feel like not very good at it, you know, it's sort of painful to run. And the theory was that was linked with part of the reason why these people had higher rates of obesity. What we were interested in in the study was, what do your beliefs about your genetic risk influence the physiological effects of that gene?

44:56So not just, you know, well, first of all, you know, 23andMe was big, lots of this genetic, you know, genotyping was getting more and more, you know, common. And the theory was, I think, that if you got information about your risk for certain things, that that would motivate you to, you know, compensate and engage in behaviors that would make you healthy. And a meta-analysis had been done to show basically that that just wasn't true at all.

45:28Like people would be told they were at risk for all these things and it just didn't motivate them to be any healthier. So that was interesting. But what we were interested in was even more kind of fundamental, which was, if you believe that your genes make you bad at exercise, will that actually, will that just the belief? Will it change the genes? Change, yeah, change the expression of the genes. And so what we did was we, this was also a within-subject study, like the milkshake study.

46:02So it was the same people did the same VO2 max test. It was a cardiovascular efficiency test. This was done at the human performance lab run under Scott Delft. And so we hooked them up. We were literally measuring the amount of oxygen they were intaking and how efficiently they were able to convert it to carbon dioxide through their lungs. And we did one exercise test, very stringent. It's sort of like a stress test, if you've ever done one, or a VO2 max test.

46:37And then we had them do the exact same test one week later. But before they did it, we gave them their genetic result. So we gave that on this very official looking pamphlet. And we said, you know, we just want to give you some important information that we got from your genotype. Right. And they looked at it and half were told they were, they had the risk allele, that they were the people who were likely to have lower exercise efficiency.

47:08Or they were told they had the protective allele, that they had the good gene, right? Like this, they had the type of gene that made them good at exercise, basically.

47:17And then we had them run again, the exact same test. Now, what was interesting about this is we had their actual genotype, too. And so we had their actual genotype, and then we randomized them to getting the information. So the information they got was randomly determined, right? So therefore, we can separate the effect of the actual gene on the outcome and the perceived genetic risk on the outcome. And essentially, what we found was the perceived genetic risk mattered.

47:53When people thought they had the risk allele, they converted oxygen into CO2 in a far less efficient rate. They also, you know, felt hotter, more pain, less motivation, you know, a lot of other effects as well. But the physiological results were really interesting. And it was fully shaped by belief, not their genetic risk.

48:25Just to clarify, I'm understanding this methodology correctly. They were given accurate information about their genetic risk, right? You didn't have a condition where people were given, because that'd be interesting, too. A condition where people were given the complete opposite of... Yeah. Sorry, I didn't explain that. So people... That's why I'm just going to clarify. Yeah, no, this is good. So we had their actual genetic risk, which is actually three types. You're either the risk allele, the protective allele, or the heterozygote, which is sort of right in the middle.

49:00And what we did was we took each of those three groups, and we randomized them to being told they're either protected or at risk. So it wasn't actually accurate for everyone. Some were, right? Some were, but some were. So people who were actually protected, half were being told they were protected, and half were being told the exact opposite. Gotcha. Yeah. And so then we can look at, if you just compare the people who were told they were at risk versus told they were protected, regardless of what their actual genetic risk was.

49:37Just that information changed their exchange rate of carbon dioxide and oxygen and carbon dioxide. Changed it in a direction consistent with what they were told? Is that the idea? Yeah. Exactly. So the belief that you are, you know, your genes make you less efficient when you exercise. Less protected. Created that reality. I mean, that's... I mean, that's... I just can't express enough how my mind was...

50:12When I read that paper. Yeah, it's amazing. And it's tied me thinking of studies that I want to conduct, you know, because there's... The GWAS approach is now starting to show not great predictability, but that there's something there with, like, predicting IQ, for instance, and academic achievement potential, you know. You know, and it's... You're getting statistically significant effects. It's explaining maybe, what, like, 2% to 15% of the variance of the outcome.

50:47I mean, that's something. And so it makes me wonder, what if you start... What if you tell people their risk for, like, IQ, for instance, like, higher will IQ? Does it actually alter the expression of the genes that the GWAS studies are starting to show are relevant? I just think that would be such an interesting study and potentially controversial, I understand, but I'm just very curious. Yeah, and I love that idea. And how far does it go, right? Again, this was another one of those studies where our effects were very temporary, right?

51:23In part because it was an experimental manipulation. We were deceiving them, many of them, about their genetics risk. And that was important to do for the science, right? We wouldn't know otherwise. But, you know, if you want to do sort of a long-term study of, like, oh, how does learning that you're, you know, all the aggregate of your genes lead you to have high IQ, and how might that affect you over decades, right? Like, that would be really interesting, but we got to be careful in how we, you know, glean that information.

51:57As you know, you know, these messages matter. That's why I would want to do the studies is the way my mind was thinking about it is that it can help show. I mean, in a way, this is a modern-day version of the Pygmalion effect. You know, this is like a modern-day fancy genetics update on that. You know, is it a self-fulfilling prophecy, our genetic, is our genetic expression the way we think a self-fulfilling prophecy on our genetic expression? But, you know, to me, it's still along the similar lines, you know.

52:32Totally. I had that same thought as you were sharing your ideas. And I think, you know, some of the reviewers on our paper had a similar question, which is like, you know, how important is it that this is genetic information? Like, you know, what if it was just like family history? Or, you know, in the Pygmalion study, it was the Harvard aptitude test. Like, you know, at that time, that was really important information that you believed. And in the day of age we're living in, or at least, you know, we were, I think we're changing slowly, but genes are like every, you know, there's something that's like, oh, that's just hardwired, right?

53:11If your genes, you know, predispose you to something, that's meaningful, that's real. But at the end of the day, that's just information, just like some test or, you know, your family history or otherwise. That's exactly right. I want to end this interview by discussing a very fruitful collaboration you've got going with Jarrett Clifton at University of Pennsylvania.

53:42You guys are quite the duo. So, him looking at beliefs about the world at large, and you obviously having a very illustrious career looking at beliefs and how it can affect physiology. So, what does that mind meld look like? I saw that you recently published a paper in the American Psychologist. Is that right? In Greece this year. That's right. Yeah. I mean, that's like a dream for a psychologist to publish in the American Psychologist. So, congratulations. It's probably not your first time.

54:12Probably not international psychologist, but. That's a good point. That was very American-centric of me to say that. Thank you for pointing that out. But have you been in the American Psychologist before? Tell me about this paper a little bit. No, that was the first time. Yeah, and thank you for that. I do, you know, I remember reading, you know, you know, the American Psychologist. It has like the picture of the psychologist. I remember reading articles from some of my heroes in that. But yeah, I'm really excited about the partnership that I've started with Jer Clifton.

54:46I know you know him from Penn. Penn days. They're similar. Penn roots.

54:53Jer is doing really critical work, I think, looking at the beliefs that we hold, the mindsets we hold about the nature of the world as one big place. And, you know, just as I've extended Carol Dweck's work from looking at your core beliefs about intelligence to looking at our core beliefs about other domains like stress or cancer or exercise or diet or our genes, right? What Jer's doing is looking at what are our core beliefs about the world, right?

55:28Like, do you believe the world is dangerous or safe? Do you believe the world is abundant or scarce? Do you believe the world needs you, Scott Barry Kaufman, or could it just live without you, right? These are, again, neither true or false, right or wrong. There's lots of evidence to support either side of these spectrums. Really? There's a lot of evidence? No, sorry, go on. The world needs you, Scott.

56:01You're saying there's evidence for the world don't need me? Yeah, right. Well, the world, I believe the world needs you. I believe the world needs me, right? I believe that's actually objectively true, though. That's where I'm disagreeing. That's where I'm disagreeing with you. My meta mindset knows that it's not objectively true, but it is a mindset that serves me and keeps me motivated to do what I can to actually have that be true. But anyways, we got off on a tangent there, but, you know, so Jer's work was really methodologically advanced because instead of just, like, coming up with, you know, the beliefs that he thought mattered about the world, he decided to take a systematic approach to uncovering what are all the possible beliefs that people could hold about the nature of the world.

56:52He looked at, you know, he looked at, you know, many thousand tweets, he looked at all the great religious texts, philosophical texts, you know, surveys in different countries and so forth. And, you know, I think my contribution to that work has been to kind of help define the type of belief we're talking about here. So these aren't, you know, nuanced kind of, you know, takes on the world that could be falsified, like the world is flat or, you know, the world was made by God, right?

57:29These are simple, adjectival and evaluative beliefs about the nature of the world. And they tend to have these modifiers, like it's fixed or malleable, it's enhancing or debilitating, it's abundant or scarce, these adjectives that characterize the essence of what the world is. And in that paper, what was fun to write about with Jare is, you know, when it comes to the world, our beliefs are omnipresent, right?

58:05Why? Because we never leave the world. At least you and I haven't yet left the world. And so personality psychologists and social psychologists used to get in these epic debates about like, is it the person? Like, is it their personality that's shaping their behavior? Or is it the situation, right? And obviously, like, the situation matters, you know, your level of introversion and quietness is going to differ if you're in a movie theater or a party. But on the whole, you know, whether you're more extroverted is going to shape how talkative you are.

58:39But what Jare and I talk about in this paper is that personality, as defined as this is who you are on average across many different situations, is not, is here too also about a belief about a situation, right? It's in this case, it's a belief about the situation of the world, this place that you never leave. So that's a little philosophical, but we're doing lots of fun work, kind of trying to codify what are these beliefs?

59:12How do they matter? Like, what are the mechanisms and what's the role that they play in shaping not just, you know, our health and performance, which has been my focus, but who we are, how we show up in the world? It's such deep, deep, profound and important work. Ali, I started off saying I'm so proud of seeing your journey. I just want to conclude by reiterating that and really view you as, you know, one of the brightest lights in our field in this generation, at this time, in human history.

59:46And I'm honored to be in the world with you at this time. Thanks so much, Scott. Yeah. And I really, you know, when I look back at my days in grad school, which were stressful and uncertain, and, you know, in many ways, research was me-search. I started the stress research during that time. And I, you know, having people like you in my life made it possible, made it doable, made it fun.

1:00:19And most importantly, people like you reminded me of why we're doing this, right? We're not doing it for ourselves. We are doing it for the world. So thank you for the work that you do and all the sincerity and the, you know, really just the kind of joy that you bring to it. Thank you. Thanks for letting, having me remind myself about all that as well is really important as well. So, boy, thank you so much. And yeah, talk soon.

1:00:50To be continued. To be continued. To be continued. To be continued. To be continued.