PDF Summary:The Expectation Effect, by David Robson

What if you could think yourself to better health and a happier life—using the power of your brain and your body, not by asking the universe to do it for you? Science writer David Robson argues in The Expectation Effect that your brain’s predictions about your body, your health, your intellect, and your emotions are so powerful that they create your reality. By changing what your brain predicts, you can change the reality your brain creates for you and the limits it sets for you.

Drawing on extensive scientific research, the book explores the expectation effects that shape your health, determine how well you age and how long you live, and influence how you respond to stress. Throughout the guide, we’ll look at the strategies Robson recommends for stopping the negative outcomes of expectation effects and creating positive outcomes, and we’ll connect his ideas to what other experts say about how you can use these effects to improve your health and happiness.

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See a Healthcare Provider You Trust

Next, when you can choose which doctor to see, select someone you trust. If you feel reassured after seeing your doctor, that sense of care might act as a placebo and speed up your recovery. (Shortform note: Experts agree that having a doctor you trust has benefits for your health. A recent review of almost 1,000 studies found a strong correlation between physician empathy and patient satisfaction. The researchers also noted that empathy on the part of healthcare providers seems to lower patients' levels of anxiety and lead to better outcomes.)

Try an Open-Label Placebo

Finally, Robson advises considering a sugar pill: A placebo can work even if you know it’s a placebo, as researchers find in tests of “open-label placebos,” pills that patients know won’t directly affect their symptoms. An open-label placebo could supplement your active treatment.

(Shortform note: You can buy open-label placebo pills on Amazon, and while not everyone agrees that they work, some experts argue that it makes sense to give it a try. Still, some people have a strong response to an open-label placebo and some have none at all. Critics say that the recent enthusiasm for the use of placebos should be tempered by caution: Reviews find that placebos typically have modest effects, and the best results are found for self-reported subjective symptoms such as pain and nausea. They say that the science on open-label placebos, in particular, is shaky and constitutes a weak evidence base for clinical practice.)

Nocebo Effect

The brain’s predictive processing also produces an expectation effect that is in many ways the reverse of the placebo effect: the nocebo effect. This effect occurs when we expect to experience a symptom or illness and then develop it. According to Robson, this isn’t a result of hypochondria and it’s not all “in your head”: An expectation of getting sick signals the brain to enact the same physiological changes brought on by a real pathogen. Scientists have even observed extreme cases where the nocebo effect increases our risk of death.

(Shortform note: Though the placebo effect is well-researched, experts say that the nocebo effect is still poorly understood. That’s in part because researching the nocebo effect comes with some complicated ethical issues: Studying people who are experiencing the nocebo effect would require researchers to induce negative outcomes, which is considered unethical.)

To avoid the nocebo effect and reduce your pain or side effects, Robson recommends a few strategies:

Put Side Effects Into Perspective

When you first hear about the side effects of a treatment, try to gauge the likelihood that you’ll experience them. Robson recommends looking up clinical trials where one group receives the treatment and another receives a placebo to see whether side effects reported with the treatment were also reported with the placebo. If the same side effects occurred in both, it might be a nocebo effect, so you don’t have to worry about experiencing them.

(Shortform note: Learning about a treatment’s side effects is difficult when the average drug lists 70 potential reactions or side effects. Most of us don't have the bandwidth to consider, let alone research, each of those side effects. But it may help to know why those warnings are there: It's less about the prevalence of a given side effect than it is about protection against potential lawsuits. Knowing why the warnings appear might help you guard against nocebo effects.)

Reframe Your Symptoms

Next, if you do experience side effects, practice reframing your symptoms. If you perceive them as a signal that the treatment is doing its job, you’ll be better able to tolerate the symptoms, less likely to worry about them, and perhaps even increase your chances that the treatment will be effective for you. (Shortform note: The right mindset can help you manage any side effects you do experience with a treatment. Researchers have found that when healthcare providers reframe unpleasant symptoms as a part of the healing process, patients' anxiety and fear of the unknown are reduced. That makes the treatment and its side effects easier to tolerate, as Robson predicts.)

Don’t Let Your Thoughts Make the Pain Worse

Finally, Robson advises that if you’re coping with pain, try to avoid “catastrophizing” thoughts about how the pain will never end. These thought patterns can create a nocebo effect and make your symptoms worse. It can help to remind yourself that the pain won’t last forever. Acknowledge negative thoughts and consider whether there’s evidence for them. If there’s not, try to change your focus to a more positive interpretation.

(Shortform note: Experts explain catastrophizing as a kind of cognitive distortion where you fixate on the pain, feel that it will never end, or think that it's only going to get worse. They recommend becoming aware of these thought patterns and working to change them. Meditation, breathing exercises, psychotherapy, and mindfulness exercises can help you stop catastrophic thinking, as can seeking treatment for any underlying mental health and pain conditions.)

Psychogenic Illness

Nocebo responses can be contagious, and people can transmit expectations of illness via social contagion. Robson reports that occasionally, this manifests as an outbreak of a psychogenic illness, a mass illness with a psychological origin. Psychogenic illnesses result when expectations about a disease spread. It starts with one person, who experiences symptoms and talks about them. Then it spreads, affecting people who weren’t exposed to the actual or assumed environmental origin, like when Tourette-like tics spread across TikTok.

(Shortform note: Experts note that it’s hard to prevent psychogenic illness, and there’s no official treatment. But they do recommend treating underlying anxiety with therapy and distancing yourself from the outbreak.)

To reduce your susceptibility to mass psychogenic illness, you can keep these strategies in mind:

Be Aware of Your Vulnerability to Social Contagion

First, stay aware that your brain makes your body take on the physical or mental states of others. Robson notes that if you have the capacity for empathy, then you have the capacity to experience a psychogenic illness. (Shortform note: Our capacity to take on others’ physical or mental states isn’t always bad. Scientists find that just as psychogenic illnesses spread through social networks, mental states like happiness also spread. For instance, having a happy friend who lives within a mile of you increases the likelihood that you'll feel happy as well.)

Read Critically

Next, when you read about a health scare or a symptom that might be spreading via social contagion, think carefully about the story and see if you can spot any coincidences in the chain of events. Remember that one person’s story isn’t a substitute for data.

(Shortform note: When we get caught up in the vivid details of a news story about a health scare, it's hard to focus on the information that would help us assess the actual level of risk. In The Art of Thinking Clearly, Rolf Dobelli identifies a few reasons that we tend to pay attention to the wrong things. The salience effect, the story bias, and the survivorship bias all divert our attention to the flashiest pieces of information, which prevents us from seeing the bigger picture. Dobelli recommends picking apart the story and questioning its premises or conclusions.)

Be Open to a Psychogenic Cause for Your Symptoms

Finally, Robson recommends that if you develop symptoms, contact a healthcare provider you trust. While acknowledging that you’re experiencing real symptoms, stay open to the possibility of a psychogenic origin. (Shortform note: Experts say that even when you suspect your symptoms are attributable to a psychogenic cause, it's still important to take your symptoms seriously to see if an underlying illness or environmental toxin is responsible. Psychogenic illnesses are mostly identified in retrospect, which means that it can be difficult to identify in the moment when your symptoms are caused by this kind of social phenomenon.)

Physical Limits in Sports and Exercise

Another place that expectation effects manifest is in your body’s regulation of what you can do in a workout or practice session. In fact, Robson reports that your limits in sports or exercise might be more psychological than physical. Your brain predicts how much effort you can expend and at what intensity and limits your performance accordingly. It makes sense for the brain to tend toward conservative estimates of our physical capabilities, which can help us to conserve energy and control the risk for injury.

(Shortform note: Though Robson emphasizes that your physical limits are psychological, experts note that you need to consider the brain and body together. In Endure, Alex Hutchinson explains that your limits aren’t all in your head but that changing your brain’s interpretation of your body’s signals can increase your endurance. Still, you need to be physically and mentally capable of pushing past your limits: Without working on both, you can’t perform at your best.)

To get around the physical limits your brain sets for you, try these tactics:

Think About Your Everyday Physical Activity

First, Robson recommends that if you don’t consider yourself fit or athletic, think about the physical activity you engage in by working or doing chores. Researchers (who call this “invisible exercise”) find that you’re much more likely to experience physical benefits if you recognize these activities as exercise. This can also boost your opinion of your fitness, which can make workouts feel less exhausting.

(Shortform note: What Robson calls "invisible exercise" often appears in studies as "Non-Exercise Activity Thermogenesis," which scientists define as the energy you expend on spontaneous physical activity. While social and environmental factors tend to determine how much of this activity you get in a given day, experts agree that you can work more movement into your day (for example, by cleaning or playing with a pet) to reap the benefits of physical activity without having to go to the gym.)

Use Visualization to Improve Your Performance

Next, it may help to visualize yourself completing your workout to the best of your ability. Because your performance depends on your brain’s predictions, you can use visualization to teach your brain what your body can achieve and get around the limits it’s created. (Shortform note: Experts say that to use visualization to improve your performance, you need to make it a multisensory experience. Imagine how it feels to perform a routine or achieve a particular outcome from start to finish, focusing not just on the goal but on the process of achieving it.)

Reframe Discomfort and Fatigue

Finally, Robson advises that when you start to feel discomfort during your workout, reframe the sensation. Instead of interpreting it as a signal that you need to stop, see it as confirmation that you’re working your muscles, improving your stamina, and having a positive effect on your body. (Shortform note: To push through workout fatigue, it helps to have specific strategies in mind rather than trying to ignore exhaustion. Experts recommend trying to smile, repeating positive statements when you feel tired, practicing pushing through the difficult part of your workout, and even consuming caffeine before your workout.)

Responses to Food

Expectation effects also play a role in how your body responds to food. Robson explains that your feelings about food determine whether you enjoy your meals, feel full after eating, and maintain a healthy weight over time. That’s because your mindset about food influences your physiological response. A feeling of enjoying your food rather than depriving yourself for the sake of health makes a difference. If you eat a healthy meal and expect that it won’t fill or nourish you, that prediction comes true: Your body may not absorb the nutrients, and you may feel hungry again soon after eating.

(Shortform note: There are many reasons to think that the specific foods you’re eating aren’t the only important factor in your diet. In Fast. Feast. Repeat., Gin Stephens contends that there’s no such thing as an optimal diet for everyone because we all respond differently to the same foods. By acknowledging that there’s no perfect diet, you can stop punishing yourself for eating “bad” foods—one way that you might adopt a more positive mindset toward food.)

To improve your attitude toward food, Robson recommends making the following changes:

Choose Meals That Feel Satisfying

First, even when you’re focused on eating a healthy diet, make a point of eating meals that feel decadent and satisfying, even when they’re healthy so that you’ll feel full longer and your brain increases your metabolism. If you eat meals that you perceive as having fewer calories or being less satisfying, your body reacts accordingly and burns less energy, as if you really are depriving yourself of needed nutrients.

(Shortform note: Researchers have found that we tend to overeat not when our food is delicious, but when it’s not delicious enough. After you eat a meal that tastes fine, but not amazing, you’re probably still thinking about the food you wish you’d eaten instead. But if you eat something indulgent and delicious, you’re more likely to feel satisfied with a smaller meal and less likely to feel hungry soon after. Scientists say that your body can adjust its metabolic rate and adapt how it spends the calories you consume, so it follows that how you perceive your food could affect how your body responds to it.)

Eat Mindfully

Next, Robson recommends that you put distractions aside at meals. Researchers have found that if you’re distracted while eating, you’re less likely to feel full and more likely to overeat: When you don’t pay attention to your food, you don’t signal to your brain that you should feel full after eating.

(Shortform note: In In Defense of Food, Michael Pollan explains that when you allow senses beyond taste to guide what you eat and how much you eat, you're more likely to consume healthy portions. For example, when you eat a French ham and cheese sandwich, you might notice the sound of the baguette crunching, the smell of the ham and Gruyère cheese, and the color of the butter against the bread. Eating slowly can also give your brain time to register that your stomach is full: It takes about 20 minutes for that signal to be transmitted.)

Anticipate Your Meals

Finally, savor the anticipation of food. Scientists have found that people who imagine the taste, smell, and texture of a dessert before eating tend to choose smaller portions. By anticipating the food, they realize that they only need a few bites to enjoy the dessert. (Shortform note: In addition to helping you control what you eat, anticipation can help you enjoy things more. Psychologists say that anticipating the good things in your future also makes you feel good in the present and can help you feel more motivated, optimistic, and patient.)

Aging

Expectation effects can even influence how you age and how long you live—that’s how powerful your beliefs about aging are. Robson reports that your expectations about aging might be just as important as your actual age in determining your well-being. People with negative attitudes toward aging—like expecting to experience illness and frailty with age—are more likely to develop heart problems and stroke. Conversely, people with positive attitudes about aging—like higher expectations for the energy level and usefulness they’ll feel as they age—seem to have a lower risk for some types of dementia.

(Shortform note: Researchers have long thought that your subjective age—the age you feel you are—plays an important role in your well-being as you get older because an optimistic outlook can help you experience age-related changes more positively. Some experts think we should focus on aging better rather than living longer, as not everyone agrees with Robson that it’s possible to extend our lifespans. For instance, In Why We Get Sick, Randolph Nesse and George Williams explain that many biological forces—like the wear and tear on our bodies and the declining effectiveness of our repair systems—work against the goal of increasing our lifespans. So they think that delaying aging and staying healthy longer are more realistic goals.)

To age better and live longer, Robson recommends adopting a few strategies:

Focus on the Benefits of Getting Older

First, Robson advises against fixating on what you’ll lose by leaving your youth behind; instead, focus on all you’ll gain by living a long life. Studies show that maintaining a healthy lifestyle as you age can help your body to stay resilient, and your mindset is an integral part of that.

(Shortform note: Robson isn't the first to suggest that your focus should change as you age. Researchers have found that over our lifetimes, we tend to shift from a “promotion motivation”—seeing our goals in terms of what we want to gain or how we can improve the status quo—to a “prevention motivation”—seeing our goals in terms of avoiding loss and keeping things moving smoothly. That means that "happiness" looks different as you get older: Younger people might want to feel excited while older people want to feel peaceful. Experts say that both are valid and reflect how our focus can and should change if we're lucky enough to live a long life.)

Don’t Let Others Tell You That You Can’t Do Something

Next, reject messages that tell you you’re too old to do something. Robson advises questioning the factual evidence for these messages. While negative stereotypes about aging are everywhere, you can think critically about them and counteract them by seeking out positive role models who didn’t slow down when society told them to.

(Shortform note: Though stereotypes position aging as an inevitable loss of health and vitality, experts say that the aging process—like the brain—is plastic. You have control over how you age: Choices like alcohol and tobacco use, physical activity, and cognitive engagement account for as much as 70% of the variance in age-related changes to cognition. You don’t have to accept that you’re “too old” to do something just because someone else says so.)

Diversify Your Friend Group

Finally, Robson recommends cultivating friendships with people of different ages. This can improve your expectations of what life will be like as you get older. (Shortform note: Experts have identified many great reasons to start cultivating friendships outside of your current circle. Researchers explain that intergenerational friendships can make you smarter, more resilient, and more open-minded. Plus, in Who Will Cry When You Die?, Robin Sharma notes that building new friendships not only helps you feel supported but also adds new sources of joy to your life.)

How to Handle Expectation Effects That Influence Your Mental Well-Being

Next, we’ll look at expectation effects that influence your mental and emotional health and explain how you can take control of them.

Stress Response

Expectation effects play a role in our response to many feelings, including stress. Robson thinks stress may hurt us not because it’s inherently harmful but because we believe it’s bad for us. This means that we experience negative physiological effects from stress when we encounter it because we expect them. (Shortform note: Some experts agree with Robson that we can think of stress as neutral. In Spark, psychiatrist John Ratey defines stress as any stimulus that initiates activity at the level of our cells. In this view, stress isn’t inherently good or bad, but a fundamental biological process. Ratey thinks that it’s when the body can’t keep up with the effects of the stress that we feel negative effects from it.)

To improve your response to stress, try the following tactics:

Accept That You’re Feeling Stressed

First, Robson points out that by trying not to experience an unpleasant feeling like stress, you can create a nocebo effect out of a normal emotional experience. Instead, cultivate an attitude of acceptance toward stress. (Shortform note: Accepting negative feelings is an important step in many frameworks for changing your mindset. In Untamed, Glennon Doyle writes that embracing strong emotions and looking at them with curiosity rather than avoiding them enables you to learn something new from them.)

Put the Physical Symptoms Into Perspective

Next, Robson recommends reframing the physical effects of stress (like an elevated heart rate or a sense of jitters) as cues that your body is doing everything it needs to do. By letting your body respond to the stress, you can focus on the mental tasks at hand. (Shortform note: Whether you can use the physical symptoms of your anxiety to help your focus likely depends on the severity of those symptoms. Anxiety before an exam can prompt you to study more and perform better, but symptoms like an increased heart rate, hyperventilation, or gastrointestinal issues can sidetrack you. With minor symptoms, experts recommend distracting yourself, trying breathing or relaxation exercises, and remembering that your symptoms will pass.)

Choose a Different Word for “Stress”

When the situation is right, try changing the words you use for your stress or anxiety. The physical experience of “anxiety” is similar to that of “excitement”: If you can find a positive label for what you’re feeling, you can respond more productively to the sensation. (Shortform note: Experts say that anxiety and excitement are different emotions, but that you can learn to turn your anxiety into excitement with the right strategy. To do this, think about the situation and why you should feel excited instead of anxious. Tell yourself that you feel excited, focus on your optimism, and channel your energy into productive action.)

Insomnia

Just as an expectation effect worsens our experience with stress via a negative psychological response, a similarly negative response makes insomnia worse than it needs to be, according to Robson. When we lie awake at night, wishing we were asleep, we fall into ruminative patterns of thought that keep us awake longer. Worrying about sleep causes more sleep loss, and experts think that worrying about not getting enough sleep is worse for your health than actually getting inadequate sleep.

(Shortform note: Psychologists identify rumination as a major cause of insomnia. This kind of thinking keeps your brain alert, and it’s hard to switch off. But two methods of reducing rumination seem to work: Set aside 15 minutes of your day to think through your worries. Or, practice “constructive worrying,” in which you find actionable steps to address your worries so you can feel like you have a plan.)

To cultivate a healthier attitude toward sleep, you can keep a couple of strategies in mind:

Gather Objective Data on Your Sleep

First, Robson recommends that if you think you’re not sleeping well, use a device or app to gather data. Because expectation effects exert a powerful influence over how rested we feel, it can help to have an objective view of how much and how well you’re sleeping. (Shortform note: Experts say that sleep-tracking apps don’t offer objectively accurate sleep data analysis. But because they do enable you to watch for patterns over time, they can still help you improve your sleep. If you’re looking for clues to how you’re sleeping and how you could sleep better, apps are an inexpensive and accessible way to track how much and how well you’re sleeping, set goals for how much you’d like to sleep, and get advice on how to reach your sleep goals.)

Don’t Stress About Sleeplessness

Next, when you find yourself lying awake at night, accept that you’re feeling restless without worrying about how the loss of sleep might affect you in the morning. (Shortform note: Accepting sleeplessness isn’t easy, but in Why We Sleep, Matthew Walker offers some strategies you can try. He recommends against keeping a clock near your bed since you might watch the clock and get anxious. You can also get out of bed and only return when you feel sleepy, or try to confront any thoughts that are making you anxious before you go to bed.)

Limits of Self-Control and Mental Focus

Expectation effects also curtail your mental ability. Robson explains that we tend to assume that we have a limited amount of self-control and mental focus, but research shows that we place these limitations on ourselves. Whether you believe that your mental resources are limited or unlimited matters: The power of this belief means that expecting mental effort to feel energizing or anticipating that you can improve your concentration with effort can make these things true.

(Shortform note: Experts think that our motivation—including self-control and focus—is subjective and can improve with practice. Atomic Habits author James Clear explains that to concentrate on accomplishing a task, you need to ignore a lot of other things. He thinks that our struggles with mental focus come from a lack of clarity about priorities. So he advises that measuring what you get done can help you maintain your focus, and focusing on the process can help you exercise the self-control and focus needed to get your most important tasks done.)

To increase your willpower and mental focus, Robson recommends these steps:

Create Your Own Rituals

First, Robson recommends building rituals—like a routine of stretches to complete or a mantra to repeat—that help you feel in control of your self-control and concentration. These practices can boost your confidence in your ability, which may be all you need. (Shortform note: Several experts say that rituals can help you focus. In Deep Work, Cal Newport advises that you ritualize deep work, the kind of cognitively taxing work that requires intense concentration. One way to do this is to schedule time for these tasks, which can signal to your brain that it’s time to focus and put aside distractions. Newport also recommends creating an environment that you use specifically for deep work as another way to build rituals for yourself.)

Expect Your Skills to Improve

Next, adopt the view that willpower and focus are skills that you can practice and improve. In cultures where such attitudes are prevalent, people can improve these skills with effort. (Shortform note: Finding something interesting about the work you need to focus on might help you stay on task. Experts say that because positive expectations increase levels of dopamine in the brain, we’re better able to focus when we’re interested in a task or motivated to get it done.)

Remember Past Successes

Finally, reappraise your ability to exercise self-control and maintain your concentration by recalling a time when you were energized by mental effort. Robson explains that remembering how it felt to be absorbed in a task can help you exercise and improve these skills. (Shortform note: Recalling past successes could not only reinforce that you’re capable of difficult tasks but might also help counter the effects of stress—and tasks that test your focus or willpower can be stressful. Researchers find that recalling positive memories is an effective strategy for coping with stress and can improve your mood and make you feel more resilient.)

Intelligence and Creativity

Finally, expectation effects also influence the quality of the intelligence or creativity you can bring to a specific task. Robson points out that your expectations about your abilities often come from people around you. When you face a challenging task and think you are (or aren’t) up to the task, your expectations will likely come true. Memory, problem-solving, intellectual stamina, and resilience are influenced by what we believe about ourselves. (Shortform note: Many experts say that intelligence isn’t fixed. In Make It Stick, Peter C. Brown, Henry Roediger III, and Mark A. McDaniel explain that one way you can increase your abilities is by adopting a “growth mindset,” acknowledging that it takes effort and discipline to learn.)

To let go of expectations that limit your intellectual performance, apply these strategies:

Take an Objective Look at Your Skills

First, Robson recommends that you assess your intellectual skills and your creativity as objectively as possible. You might feel out of your depth in a specific task, but that might be a result of expectations more than evidence. (Shortform note: Researchers say that underconfidence can motivate you to work harder but can also prevent you from even trying if you assume that other people are more skilled or better qualified than you. Getting a more objective view of how you compare to others can help you feel more confident in your skills.)

Recognize Frustration as Something Useful

Next, when you’re learning something new or practicing a difficult skill, reframe frustration as a sign that you’re learning so that you can reallocate mental resources to learning and improving. (Shortform note: Experts say that making mistakes and experiencing frustration are key parts of learning. Some even think that to take full advantage of the plasticity of your brain, you have to make mistakes. Mistakes signal to your brain that something needs to change, and its response makes it possible for you to channel your frustration and make new connections.)

Try Self-Affirmation

Finally, Robson recommends that when you’re feeling anxious about how you’re perceived or feel that you’re at risk of conforming to negative stereotypes about a group you belong to, try a process that psychologists call “self-affirmation.” Make a mental list of some of your best characteristics. Then, pick one and think about why you value it, calling on a memory of a time when you demonstrated that characteristic.

(Shortform note: Psychologists think that self-affirmation is useful because it helps us protect our self-esteem. In addition to engaging in the self-affirmation exercise that Robson outlines, we can self-affirm by engaging in activities that remind us of who we are. Spending time with friends or family, doing volunteer work, or finding meaning in art or religion or other activities that are important to us can help us stay resilient in the face of challenges to our self-esteem.)