Labs worldwide report converging evidence that undermines the low-sugar theory of depleted willpower

One of the main findings in willpower research is that it's a limited resource. Use self-control up in one situation and you have less left over afterwards - an effect known as "ego-depletion". This discovery led to a search for the underlying physiological mechanism. In 2007, Roy Baumeister, a pioneer in the field, and his colleagues reported that the physiological correlate of ego-depletion is low glucose. Self-control leads the brain to metabolise more glucose, so the theory goes, and when glucose gets too low, we're left with less willpower.

The breakthrough 2007 study showed that ego-depleted participants had low blood glucose levels, but those who subsequently consumed a glucose drink were able to sustain their self-control on a second task. In the intervening years the finding has been replicated and the glucose-willpower link has come to be stated as fact.

"No glucose, no willpower," wrote Baumeister and his journalist co-author John Tierney in their best-selling popular psychology book Willpower: Rediscovering Our Greatest Strength (Allen Lane, 2012). The claim was also endorsed in a guide to willpower published by the American Psychological Association earlier this year. "Maintaining steady blood-glucose levels, such as by eating regular healthy meals and snacks, may help prevent the effects of willpower depletion," the report claims.

But now two studies have come along at once (following another published earlier in the year) that together cast doubt on the idea that depleted willpower is caused by a lack of glucose availability in the brain. In the first, Matthew Sanders and his colleagues in the US report what they call the "Gargle effect". They had dozens of students look through a stats book and cross out just the Es, a tiresome task designed to tax their self-control levels. Next, they completed the famous Stroop task - naming the ink colour of words while ignoring their meaning. Crucially, half the participants completed the Stroop challenge while gargling sugary lemonade, the others while gargling lemonade sweetened artificially with Splenda. The participants who gargled, but did not swallow, the sugary (i.e. glucose-containing) lemonade performed much better on the Stroop task.

The participants in the glucose condition didn't consume the glucose and even if they had, there was no time for it to be metabolised. So this effect can't be about restoring low glucose levels. Rather, Sanders' team think glucose binds to receptors in the mouth, which has the effect of activating brain regions involved in reward and self-control - the anterior cingulate cortex and striatum.

The other study that's just come out was conducted by Martin Hagger and Nikos Chatzisarantis based in Australia and the UK. Their approach was similar to Sanders' except that participants gargled and spat out a glucose or artificially sweetened solution prior to performing a second taxing task, rather than during. Also, this research involved a series of 5 experiments involving many different ways of testing people's self-control, including: resisting delicious cookies; reading boring text in an expressive style; unsolvable puzzles; and squeezing hand-grips. But the take-home finding was the same - participants who gargled, but did not swallow, a glucose drink performed better on a subsequent test of their willpower; participants who gargled an artificially sweetened drink did not. So again, willpower was restored without topping up glucose levels. Moreover, the benefit of gargling glucose was displayed only by participants who'd had their self-control taxed in an initial task. It made no difference to participants who were already in an untaxed state.

Hagger and Chatzisarantis agree with the interpretation of the Sanders' group, except they make a distinction. The effect of glucose binding to receptors in the mouth could either stimulate activity in brain regions like the anterior cingulate that tend to show fatigue after a taxing task. Or they say that glucose in the mouth could trigger reward-related activity that prompts participants to interpret a task as more rewarding, thus boosting their motivation. The explanations are complementary and need not be mutually exclusive.

The key point is the new results suggest depleted willpower is about motivation and the allocation of glucose resources, not about a lack of glucose. These findings don't prove that consuming glucose has no benefit for restoring willpower, but they suggest strongly that it's not the principle mechanism. It's notable that the new findings complement previous research in the sports science literature showing that gargling (without ingesting) glucose can boost cycling performance.

"While our findings are consistent with the predictions of the resource-depletion account, they also contribute to an increasing literature that glucose may not be a candidate physiological analog for self-control resources," write Hagger and Chatzisarantis. "Instead ego-depletion may be due to problems of self-control resource allocation rather than availability." An important next step is to conduct brain-imaging and related studies to observe the physiological effects of gargling glucose on the brain, and on motivational beliefs. There are also tantalising applications from the new research - for example, could the gargle effect (perhaps in the form of glucose-infused chewing gum) be used as a willpower aid for dieters and people trying to give up smoking?

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Hagger, M., and Chatzisarantis, N. (2012). The Sweet Taste of Success: The Presence of Glucose in the Oral Cavity Moderates the Depletion of Self-Control Resources. Personality and Social Psychology Bulletin DOI: 10.1177/0146167212459912

Sanders, M., Shirk, S., Burgin, C., and Martin, L. (2012). The Gargle Effect: Rinsing the Mouth With Glucose Enhances Self-Control. Psychological Science DOI: 10.1177/0956797612450034

--Further reading--
From The Psychologist: Roy F. Baumeister outlines intriguing and important research into willpower and ego depletion.

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Cope with pain by changing how you picture it

Most people who suffer from serious pain have one or more mental images that they associate with the discomfort and what it represents to them. A new study by Clare Philips and Debbie Samsom has shown that these pain-sufferers can be taught to re-imagine this pain imagery in a more positive light, bringing them instant relief and emotional comfort.

Of 73 volunteers at an occupational rehab centre in Vancouver, 57 had pain and said they experienced imagery associated with that pain, and so they were recruited into the study (there were 24 men, the average age was 45).

After being interviewed about their baseline pain and their psychological state - including feelings of mental defeat, anxiety and depression - the participants were asked to select their most powerful and distressing pain-related mental image. "I see myself on all fours - like a dog but unable to move," said one. All participants spent time forming this "index image" in their mind before answering more questions about how they were feeling. Focusing on the unpleasant image increased pain and emotional distress. Remember, this is an image that the participants experienced spontaneously in their everyday lives (for nearly half of them, it came to mind several times a day).

Next, after a six-minute gap talking about where they grew up (as a distraction), 26 of the participants were taught to re-picture their pain. They were asked to think "how would you rather see the image?" and to describe in detail what this would entail. They then focused on this new image - for example, the participant above who'd previously described the dog-image now imagined: "I am at the start of a race….the gun goes off and the crowd cheers as I take off." The remaining participants acted as controls and spent the same time focused on their original, unpleasant index image.

After picturing a "re-scripted" pain image, the participants in that group experienced a dramatic drop in their pain levels. In fact, 49 per cent of them said they felt no pain at that time, compared with 11 per cent of them feeling no pain after imagining their index image. "The pain decrements were fast, easily produced and dramatically large," the researchers said. The re-script group also exhibited improvements in anxiety, sadness, mental defeat and beliefs about their own fragility. The control participants, by contrast, experienced none of these improvements.

There was another six-minute gap and the re-script group again pictured their positively re-imagined pain image. The controls were now also taught how to re-imagine their pain image - the local research ethics committee had insisted on this. The original re-script group continued to enjoy reduced pain and psychological benefits, which counts against the idea that the novel image had merely served as a temporary distraction. The controls now also enjoyed the benefits of re-picturing their pain.

Philips and Samsom said that the participants found it easy and pleasurable to re-script their pain images. Of course there is a need now for research to see whether these benefits of re-picturing pain can last into the long term. It would also help to have a different kind of control group - for example, one that merely visualised random positive images, to see if the effects of specifically re-picturing pain are more powerful. Where this study focused on the sensory detail of pain images, future work could also look into the re-writing the images' cognitive meaning.

The findings add to a broader literature showing that our experience of pain is affected by many psychological factors, such as our beliefs about our ability to cope. This doesn't mean the pain isn't real, but it does mean that psychological techniques can be incredibly effective at bringing relief and improvements to people's quality of life.

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Philips C, and Samson D (2012). The rescripting of pain images. Behavioural and cognitive psychotherapy, 40 (5), 558-76 PMID: 22950868

-Further reading-
Psychologist magazine special issue on the psychology of pain
Acceptance, not distraction, is the way to deal with pain (Digest item)
Verbal reassurance can dull the effect of pain, but only if it's from someone we identify with (Digest item)

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Self-licensing: when you indulge through reason, not lack of willpower

We usually think of over-indulgence in terms of a lack of willpower. I scoff the doughnut because I can't marshal the necessary self-control to resist it. A great deal of psychology research has pursued this particular line, demonstrating, for example, that willpower seems to be a finite resource. Expend it in one situation and you'll have less left over for another.

A new study by Jessie de Witt Huberts and her colleagues at Utrecht University takes a different perspective. They point out that we often over-indulge, not because we can't help it, but because we reason that it's okay to do so. After that half-hour run, we tell ourselves, we deserve the doughnut! de Witt Huberts' team call this self-licensing and they say it's surprisingly under-researched.

Previous studies have shown how self-licensing affects our choices. For example, after working harder, people are more likely to choose a cake over a fruit-salad. But before now, no-one's looked to see how self-licensing might affect actual indulgent consumption.

Before they got started, de Witt Huberts and her team had to confront a complication with researching this topic - the need to separate out the effects of low energy from self-licensing. If someone's been working hard, not only might this encourage them to think they deserve a naughty snack, their lack of energy might also deplete their willpower (indeed, studies have suggested that low sugar levels reduce willpower).

To get around this problem, de Witt Huberts and her colleagues needed a way to trick people into thinking they'd worked hard (inviting self licensing) without actually diminishing their willpower levels. They did this by having participants test-out what they were told was a new screening tool for dyslexia. It involved looking at 200 words on a computer screen, one at a time, and pressing the key on the keyboard that corresponded to the first letter of each word. Crucially, one group of participants did this for five minutes, and were then told they had to do it all over again for another five minutes to check the reliability of the screening tool. The other participants simply had a one-minute break between two 5-minute sessions.

In a pilot study with 106 women, the group who thought they'd had to test the screening tool twice, felt like they'd worked harder than the other group, who thought they'd done it just once (even though both groups had worked for the same length of time). Next, both groups completed the Stroop test, a classic measure of self control that requires people to read colour words (e.g. blue), whilst ignoring the ink colour they're written in. This test confirmed that both groups had the same levels of self control even though one group felt like they'd worked harder than the other.

When it came to the study proper, 39 women were split into two groups - one did the dyslexia screening tool in two phases, to make them feel like they'd worked harder, and the other group did it in one bash. Next, ostensibly as part of a separate consumer research study, all the women taste-tested some crisps, M&Ms, Wine gums and Chocolate chip cookies.

The take-home finding? Both groups said their willpower levels felt the same, but the women who thought they'd worked harder tended to eat more of the naughty food. In the ten minutes available, they consumed an average of 26 grammes of more snack-food, which equated to 130 more calories. As well as feeling like they'd worked harder, they also said they felt more hungry, but this wasn't correlated with the amount they ate. The researchers speculated that the feelings of hunger could have been a further form of self-licensing - "I've worked hard and I'm hungry".

This study is one of the first steps towards uncovering the part that self-licensing plays in giving in to temptation. It's limited in that the sample only included women and the self-licensing was implicit. The women who thought they'd worked harder were more indulgent, but we don't know anything about the way they reasoned with themselves, or if the effect was conscious at all. "Nevertheless," the researchers concluded, "although many questions about self-licensing require further investigation, the current studies demonstrate that sometimes people strategically choose to indulge and that gratification of our desires is not inevitably governed by our impulses."
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ESSIE C. DE WITT HUBERTS, CATHARINE EVERS, and DENISE T. D. DE RIDDER (2012). License to sin: Self-licensing as a mechanism underlying hedonic consumption. European Journal of Social Psychology DOI: 10.1002/ejsp.861

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Smile your way to a vegetable-loving child

Maybe you've tried giving them names - Sally Sprout or Brian the Broccoli. Or perhaps you've made noises of gastronomic delight, "hmm, yummy!" Yet still your young child refuses to eat their greens. Maybe it's because of that slight, but all too visible, sneer on your face. After all, you're not wild about veggies either. Well, it's time for you to become a better actor. A new study suggests that young children are particularly sensitive to the emotional expressions of other eaters, and that these emotions are likely to affect their eating habits.

Laetitia Barthomeuf and her team presented 43 5-year-olds, 38 8-year-olds and 42 adults with photographs of two women eating various foods. As they ate, the women either looked happy, disgusted or just had a neutral expression. There were six different foods - three that the participants had earlier said they liked (chocolate, bread and cream cake) and three that they said they disliked (kidney, black pudding, cooked sausage with vegetables). Twenty-seven additional participants had been excluded earlier because their preferences didn't fit this pattern.

As they looked at each photo, the child and adult participants were asked to say how much, on a scale of 1 to 10, they desired to eat the food that the woman in the photo was eating. The take home finding - the children, especially the five-year-olds, were influenced much more by the facial expressions of the women, than were the adults.

If the woman in the photo had a look of disgust, this reduced the children's, and to a lesser extent, the adults', desire to eat foods that they liked. In contrast, if the woman had a look of pleasure on her face, this  increased the children's, and to a lesser extent, the adults', desire to eat foods they didn't like (for five-year-olds only, it also increased their desire to eat foods they liked). Even a neutral facial expression in the eating women made a difference - increasing and decreasing the participants' desire for liked and disliked foods, respectively, especially in the children.

The researchers speculated that the influence of the women's facial expressions occurred because seeing their expressions led to simulations of those same emotions in the minds of the participants. They further suggested that this process is accentuated in younger children because of the immaturity of their prefrontal cortex.

The study has some obvious weaknesses, acknowledged by the researchers - they didn't measure actual eating behaviour, and the stimuli were photos, as opposed to a real-life dining situation. Nonetheless, they predicted the effects of other people's emotional expressions might be even larger in a more realistic situation and that the results therefore have important implications for the encouragement of children's healthy eating habits. "Adults may unconsciously influence children's food preferences via their facial expressions of pleasure or disgust," they said.

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Barthomeuf, L., Droit-Volet, S., and Rousset, S. (2012). How emotions expressed by adults’ faces affect the desire to eat liked and disliked foods in children compared to adults. British Journal of Developmental Psychology, 30 (2), 253-266 DOI: 10.1111/j.2044-835X.2011.02033.x

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Strong reassurances about vaccines can backfire

Unwarranted public anxiety about vaccinations can have deadly consequences. Unfortunately, the challenge of communicating health risks is full of psychological complexity. A new German study brings this home, showing how messages that deny vaccination health risks in unequivocal terms can backfire, actually increasing concern among parents.

Cornelia Betsch and Katharina Sachse recruited 115 participants online (mean age 34; 34 per cent were male; 43 per cent had one or more children). The participants were asked to imagine they were a parent of an 8-month-old and to read an account of a fictitious illness Phyxolitis pulmonis. They were further told that their paediatrician had advised vaccinating their child against this condition. Next, the participants were presented with anti-vaccine statements that they'd ostensibly found on the internet (e.g. "Multiple vaccines overwhelm the infant's immune system"). Finally, they read statements of reassurance about the vaccine, which claimed any risks were low - half the participants read weak versions (e.g. "There is only sporadic evidence that repeated vaccinations overwhelm the immune system") and half read strong versions of these statements (e.g. "there is no evidence that repeated vaccinations overwhelm the immune system").

The key finding here was that participants who read the strong statements of reassurance actually reported greater perceptions of risk afterwards, and lower intentions to vaccinate their child. This effect was heightened among participants who had a preference for complementary medicine. Results didn't vary according to whether participants were a parent in real life or not.

A second study with a further 119 participants was similar but this time the source of the reassuring statements was varied, either being from a pharmaceutical company (untrusted) or from a government health department (a trusted source). Again, strong statements of reassurance backfired, increasing risk perception and reducing vaccination intentions, but only if those statements came from an untrusted source. Again, this paradoxical effect was stronger among participants who favoured complementary medicine.

This study can't reveal why the paradoxical effect occurs. However, one possibility proposed by Betsch and Sachse is that an extreme statement of no risk is more attention-grabbing, which only serves to highlight the possibility that risk is an issue. Another potential explanation is that people look for ways to combat claims they disagree with, and if those claims are stated more strongly then that encourages people to marshal even stronger counter-claims of their own.

The results have obvious implications for real-life risk communication. "Especially when organisations lack complete knowledge about how much trust the public puts in them, optimal risk negation is likely to profit from moderate rather than extreme formulations," the researchers said.
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Betsch, C., and Sachse, K. (2012). Debunking Vaccination Myths: Strong Risk Negations Can Increase Perceived Vaccination Risks. Health Psychology DOI: 10.1037/a0027387


Previously on the Research Digest:
How to promote the MMR vaccine.
The psychological barriers facing MMR promotion campaigns.


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Mental health problems worsen after cosmetic surgery

Are people who opt for medically unnecessary, cosmetic surgery psychologically vulnerable? Does having such surgery bring them psychological relief?

These are tricky questions. There's actually evidence of increased mental health problems among people who've undergone cosmetic surgery. But whether that's a harmful side-effect of the surgery, or a hangover from pre-operative problems, it's difficult to say.

Randomly controlled trials would help, but of course that's not possible in this situation for ethical reasons. What's needed is a large-scale prospective study that follows thousands of people up over many years. Hopefully a sub-set will opt for cosmetic surgery during that time and then it should be possible to look for any psychological vulnerabilities preceding the surgery and any changes post-surgery.

That's exactly what a team of Norwegian researchers have done. Tilmann von Soest and his colleagues began in 1992 with a sample of over 12,000 school students aged 12 to 19 years, and then surveyed them periodically for several years. Attrition of the sample left 2,890 participants at the final survey in 2005 (many participants were lost early in the study, in 1994, because they changed schools). By 2005, 106 of the participants had had at least one cosmetic surgery procedure. This included 78 women - that's 4.9 per cent of women in the sample; and 28 men - 2.2 per cent of the men in the sample.

Because of the lack of men, the researchers focused only on the women. The majority of their operations were for breast augmentation (26.8 per cent) or reduction (19.5 per cent), with other procedures including liposuctions, ear and nose modifications.

There was strong evidence that women with psychological problems were more likely to opt for surgery. The female participants who went on to have cosmetic surgery were more likely to have a history of poorer mental health, including more depression and anxiety, more illicit drug use, self-harm and suicide attempts. Unsurprisingly, the women who had breast surgery more often had a history of less satisfaction with that part of their body (although general appearance satisfaction wasn't related to undertaking surgery). By contrast, sociodemographic factors were not related to who had surgery and who didn't.

Did the surgeon's scalpel benefit the psychological health of these women? With one specific exception, it seems the answer is a categorical "no". Breast surgery was associated with increased satisfaction with that part of the body, but having cosmetic surgery of any kind was associated with increases in anxiety and depression, eating disorders, more alcohol use and more suicide attempts. Surgery didn't boost general appearance satisfaction.

The study isn't without its shortcomings, as the authors acknowledge. For instance, the apparent adverse effects of cosmetic surgery may not be specific to cosmetic procedures but could apply to having surgery of any kind. The study also relied on participants reporting their own mental health.

This study provides "no evidence that cosmetic surgery should be used to alleviate mental health problems in women dissatisfied with their appearance," the researchers concluded. "Nor do the results support the notion that cosmetic operations in exceptional cases should be covered by the public health-care system due to a potential psychotherapeutic effect for the patient."
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  von Soest, T., Kvalem, I., and Wichstrøm, L. (2012). Predictors of cosmetic surgery and its effects on psychological factors and mental health: a population-based follow-up study among Norwegian females. Psychological Medicine, 42 (03), 617-626 DOI: 10.1017/S0033291711001267

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Want to eat less? Try using your non-dominant hand

Much of our eating behaviour is habitual. Many of us eat biscuits with tea, nibbles before dinner, popcorn at the cinema and so on. A new study by David Neal and his colleagues has put these habits under the microscope and shown just how entrenched they can become and how they can be broken.

One hundred and fifty-eight participants were recruited to either watch movie trailers at a cinema or music videos in a university department meeting room. In both settings they were given popcorn to eat, which was either stale or fresh. Now, some of the participants were habitual popcorn eaters at the movies, others weren't. The notable finding was that in the cinema setting the habitual popcorn eaters ate just as much of the popcorn when it was stale as when it was fresh. This they did even though they said they liked it less (just as the non-habitual popcorn eaters did), and regardless of whether they were hungry or not. Neal's team said this highlights how habits are driven by context (the cinema) and are immune to attitudes (i.e. liking) and motivation (i.e. hunger). By contrast, when in the department meeting room (not the usual setting for eating popcorn), the habitual popcorn eaters ate less of the stale popcorn and their consumption was influenced by hunger. This shows that if you escape the context that usually drives a habit then its power weakens and motives and intentions can take over.

A second study was similar to the first except this time half the participants were told to eat the popcorn with their non-dominant hand (i.e. right-handers had to eat with their left). This manipulation, which obstructs the automatic execution of a habit, had a similar effect to changing the environmental context. Habitual popcorn eaters allowed to use their dominant hand again ate just as much stale popcorn as fresh, in spite of liking it less, and regardless of their hunger levels. But those instructed to use their non-dominant hand were freed of their usual habit - they ate less of the stale popcorn and their consumption was driven more by hunger and liking.

"Habit change may ... require impeding habit activation [by contexts] or interrupting fluid habit execution," the researchers said. "Although our findings suggest that both avenues are effective, it is not always possible for dieters to avoid or alter the environments in which they typically overeat. More feasible, perhaps, is for dieters to actively disrupt the execution of the activated eating sequence by simple manipulations such as eating with the non-dominant hand and, in so doing, bring their eating under their personal control."
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Neal, D., Wood, W., Wu, M., and Kurlander, D. (2011). The Pull of the Past: When Do Habits Persist Despite Conflict With Motives? Personality and Social Psychology Bulletin DOI: 10.1177/0146167211419863

Further reading: How to form a habit.
Seven ways to be good.

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The woman misdiagnosed with Alzheimer's, and how we can all be affected by the suggestion that we have psychological problems

Psychologists in the Netherlands have documented the case of a 58-year-old woman who was misdiagnosed with Alzheimer's Disease. The would-be patient consulted a neurologist at a stressful time in her life, in the knowledge that her mother had had the illness. A brain scan indicated reduced activity at the front of her brain ("hypofrontality"), and the neurologist also estimated her performance on a test of cognitive impairment as poor (though no formal test was conducted). On this basis he diagnosed Alzheimer's*.

The woman was devastated and thereafter her condition deteriorated significantly, to the point that she was permanently confused and, at one point, suicidal. Some months later, after receiving advice from an Alzheimer's helpline, the woman consulted a different neurologist for a second opinion. She completed comprehensive memory tests and undertook a further brain scan. All results were normal. This neurologist surmised that her earlier hypofrontality was associated with depression. He also went to great lengths to explain the good news about her results and the misinterpretation of her earlier scan, but it proved extremely difficult to assuage her concerns.

Years later, Harald Merckelbach and his team have interviewed the woman and they report that she continues to experience intrusive thoughts about the misdiagnosis and to catastrophise her memory lapses. Merckelbach's group believe the effect of a misdiagnosis has parallels with the implantation of false memories. Just as false memories are difficult to reverse, so too are mistaken diagnoses. "Conferring a diagnostic label is far from a neutral act," they said. "Many diagnostic labels have strong stereotypical connotations and sometimes, these will automatically shape the experiences and behaviour of patients, a phenomenon called 'diagnoses threat'."

To test these ideas further, Merckelbach, with colleagues Marko Jelicic and Maarten Pieters, gave 78 undergrads a psychological symptoms questionnaire to complete. Afterwards the students performed Suduko puzzles as a distraction. Next, the researchers went through some of the students' answers with them. During this review, the researchers inflated two of the answers they'd given to anxiety items. For example, imagine a student had originally indicated that she never had trouble concentrating. The researcher would inflate that answer by two points on the scale, as if she'd said that she sometimes had trouble concentrating, and they then asked the student to explain why she'd given that answer. Remarkably, 63 per cent of the participants failed to notice that their answers had been altered, and they proceeded to describe their experience of the symptoms (readers may notice parallels here with a phenomenon known as "choice blindness", in which people seem to have little insight into a recent choice they made).

Ten minutes later, and again after one week, all the students re-took the psychological symptoms questionnaire. At both time points, students who'd earlier failed to notice that two of their answers had been altered, now gave higher ratings to those two items, as if they considered themselves to have those symptoms. Such an effect was not observed among the minority of students who'd earlier noticed that their answers had been altered. An analysis of all the students' original baseline answers uncovered higher average baseline symptoms among those who would fail to notice the inflation of their answers. "Apparently a non-zero symptom intensity level introduces ambiguity; thereby raising the probability that misinformation is accepted," the researchers said. However, it's not the case that the influenced participants were simply more keen to give answers that the researchers wanted - they scored just the same on a test of social desirability.

The results from this study are consistent with past research showing how misinformation about physical symptoms can shape how people feel: for example, false feedback about asthmatic wheezing can trigger breathlessness in children with asthma.

Harald Merckelbach and his colleagues said their findings had particular significance for the way medical professionals interact with patients with unexplained symptoms, including those labelled with chronic fatigue, fibromyalgia, irritable bowel syndrome, and chronic pain. "... Expressing concern about the possibility of an underlying illness and, related to this, excessive investigation and attending patient support groups may all contribute to symptom escalation. What these interventions have in common is that they convey the message to the patient that his or her symptoms might be more intense and severe than he/she thinks they are. Our study suggests that blindness to unintended misinformation about the severity of the symptoms may underlie escalation of symptoms."

The researchers recommend that medics avoid mentioning the whole spectrum of possible symptoms when interviewing patients with medically unexplained symptoms. They also pointed to interesting avenues for future research. For example, notwithstanding the ethical issues involved, could patients benefit from receiving misinformation that lowered their symptom ratings? Also, is the inflated self-reporting of symptoms observed here based purely on exaggerated report, or is it grounded in an altered experience of symptoms?
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Merckelbach, H., Jelicic, M., and Jonker, C. (2011). Planting a misdiagnosis of Alzheimer's disease in a person's mind. Acta Neuropsychiatrica DOI: 10.1111/j.1601-5215.2011.00586.x

Harald Merckelbach, Marko Jelicic and Maarten Pieters (In Press). Misinformation increases symptom reporting – a test – retest experiment. J R Soc Med Sh Rep.

*Many years later, the neurologist was found guilty of having misdiagnosed several patients with Alzheimer's and 26 malpractice suits were filed against him (the woman featured in this case study was not part of that litigation).

This post was written by Christian Jarrett for the BPS Research Digest.

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