Can positive thinking provide an improved outcome for an illness?

Question

Sometimes you hear that a gravely ill patient "just gave up" and subsequently died. Many people put great value in the healing power of positive thinking, with the more cynical ones blaming a bad progression of disease onto a "lack of will". Especially with cancer there are many people saying they survived it, because they fought the cancer.

Is there any evidence that the state of mind, the attitude of the patient has a real effect on the course of illnesses? I can imagine a positive attitude improving the quality of life, but I'm not so sure about having a real, physical effect on the illness.

Answer 1

Yes, both placebo and nocebo effects are real phenomena (although they are often exaggerated in popular media).

Google Scholar shows a lot of scientific papers on those, some of them provide a very detailed insight into those mechanisms:

The nocebo phenomenon, in which placebos produce adverse side effects, offers some insight into nonspecific side effect reporting. We performed a focused review of the literature, which identified several factors that appear to be associated with the nocebo phenomenon and/or reporting of nonspecific side effects while taking active medication: the patient's expectations of adverse effects at the outset of treatment; a process of conditioning in which the patient learns from prior experiences to associate medication-taking with somatic symptoms; certain psychological characteristics such as anxiety, depression, and the tendency to somatize; and situational and contextual factors.

—Nonspecific Medication Side Effects and the Nocebo Phenomenon, by Arthur J. Barsky, MD; Ralph Saintfort, MD; Malcolm P. Rogers, MD; Jonathan F. Borus, MD

The latest scientific evidence has demonstrated, however, that the placebo effect and the nocebo effect, the negative effects of placebo, stem from highly active processes in the brain that are mediated by psychological mechanisms such as expectation and conditioning.

—New Insights into the Placebo and Nocebo Responses, by Paul Enck, Fabrizio Benedetti, Manfred Schedlowski, Neuron - 31 July 2008 (Vol. 59, Issue 2, pp. 195-206)

Answer 2

To add to Krzysztof's answer. There were also studies suggesting that people can control somewhat the date of their death around major events.

This study, that won the 2001 Ig Novel for economics suggests that death rates changed around a change at the inheritance tax rate people.

This paper examines data from U.S. federal tax returns to shed light on whether the timing of death is responsive to its tax consequences. We investigate the temporal pattern of deaths around the time of changes in the estate tax system - periods when living longer, or dying sooner, could significantly affect estate tax liability. We find some evidence that there is a small death elasticity, although we cannot rule out that what we have uncovered is ex post doctoring of the reported date of death.

This study, that suggests the same with asian male Cancer patients around Chineese Harvest Moon Festival.

RESULTS: There were significantly fewer deaths overall in men before the holidays than after (p-value equals 0.0081), with most of the difference being due to cancer deaths, particularly among men over 75 years of age. For women, there were actually more deaths before than after the holidays. The data, stratified according to age, gender, disease and holiday, yielded only five out of 48 variables with a p-value of less than 0.05, which was slightly above chance, considering the large number of comparisons made. In four of the five situations, there were significantly fewer deaths before than after the holidays; but after Bonferroni correction, only the finding of fewer cancer deaths for men aged over 75 years before HMF was significant.

CONCLUSION: Other than cancer deaths in males, we found little evidence in this dataset of death postponement until after important holidays in the Hong Kong Chinese population.

While the studies are not conclusive, they do suggest that if a person really wants to live through some important occasion (like a major holiday) he or she may be able to postpone their death by a few days.

Answer 3

Thoughts clearly have an effect on your body. But maybe not thoughts themselves, but rather moods and emotions that thoughts are capable of inducing which in turn can have physiological effects on different body systems.

Ruminative response to negative mood and other depressive symptoms are thoughts and behaviors that repetitively focus the individual's attention on his or her negative feelings and the nature and implications of those feelings. Although many people feel compelled to ruminate about themselves and their problems when experiencing dysphoria and depression, converging empirical evidence suggests that such a coping style is associated with numerous deleterious outcomes.

Negative emotions such as anger, fear, anxiety, even sadness and crying, arouse people's autonomic nervous systems, producing increases in heart rate, vasoconstriction, and blood pressure, as well as other changes.

On the other hand, positive thinking will often produce positive emotions which can be beneficial to your body.

Positive emotions, positive moods, and positive sentiments carry multiple, inter-related benefits. <...> Second, good feelings alter people's bodily systems. Experiments have shown that induced positive affect, not only speeds the recovery from cardiovascular accidents following the effects of a negative effect, but also alters frontal brain asymmetry, and increases immune function. Third, good feelings predict salubrious mental and physical health outcomes. Prospective studies have shown that frequent positive affects predict (a) resilience to adversity, (b) increased happiness, (c) psychological growth, (d) lower levels of cortisol, (e) reduced inflammatory responses to stress, (f) reductions in subsequent-day physical pain, (g) resistance to rhinoviruses, and (h) reductions in stroke, and fourth, perhaps due to reflecting these effects in combination, good feelings may predict people's longevity. Several well-controlled longitudinal studies document a clear link between frequent positive affect and longevity, which is at least partially mediated by positive emotions, downregulating the effect of excessive or inappropriate sympathetic activation (stress, anxiety, or anger).

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278874/

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Thinking and imagination have a medical application as well. One of the techniques that rely on them is autogenic training.

Autogenic training refers to a series of mental exercises involving relaxation and autosuggestion practice regularly. The aim is to teach individuals to switch off the 'fith/flight/fight' stress response at will. The resulting passive state is believed to allow the brain and body to tap into its own spontaneous self-regulatory mechanisms, which, in turn can encourage an awareness of the origin of certain mental and physical disorders. In the US, the term 'autogenic' often refers to any method that involves patients using their own resources to help themselves, usually involving relaxation, visualisation or autosuggestion.

During a 'classical' autogenic session, the patient should

think about heaviness and warmth in the limbs. These constitute the first two exercises of atogenic training. Four other instructions, relating to heart rate, breathing, warmth in the abdomen and coolness of the forehead, were added to form the six standard exercises.

Later Sshultz and Thomas developed the personal and motivational formulae (at first known as 'intentional formulae'), which are tailored to the individual experience, and involve repitition of therapeutic suggestions, designed, for example, to correct negative patterns of thought.

CLINICAL EVIDENCE

Recent RCTs or systematic reviews suggest that autogenic training can alleviate headaches in a variety of clinical situations. A meta-analysis of all controlled trials reached positive conclusions for some conditions (hypertension, asthma, intestinal diseases, glaucoma and eczema) but made no assessment of the quality of the studies. One RCT (n=18) suggested that autogenic training may be a useful adjunctive therapy for complex regional pain syndrome. A systematic review of CCTs suggested that autogenic training is equally effective in controlling chronic pain as hypnotherapy.

Complementary Therapies for Pain Management: An Evidence-based Approach, Elsevier Health Sciences, 2007 p.106-108