Dr. Alia Crum

Great to be here.

We define mindsets as core beliefs or assumptions that we have about a domain or category of things that orient us to a particular set of expectations, explanations, and goals.

I can distill it down for you.

So mindsets are an assumption that you make about a domain.

So take stress, for example, the nature of stress.

What's your sort of core belief about that?

Do you view stress as enhancing, good for you, or do you view it as debilitating and bad for you?

Those mindsets, those core beliefs orient our thinking.

They change what we expect will happen to us when we're stressed, how we explain the occurrences that happen or unfold when we're stressed, and also change our motivation for what we engage in when we're stressed.

Sort of distilling down those core assumptions that really shape and orient our thinking and action.

Yeah, sure.

Sure.

So I think it's important with Carol Dweck's work, a lot of people kind of get focused on growth motivation and all these things, but her work really originated from thinking about what she called those implicit theories or core beliefs about the nature of intelligence or ability, right?

So do you believe that your baseline levels of intelligence are fixed?

static, set throughout the rest of your life?

Or do you believe that they can grow and change?

The reality is, as it always is, complex, and it's a bit of both, and it's all these things.

But as humans, we need these simplifying systems to help us understand a complex reality.

But they're not inconsequential, right?

They matter in shaping our motivation.

And as she has shown, if you have the mindset that intelligence is malleable,

you're motivated to work harder to grow your intelligence.

If you have the mindset that it's fixed, why work harder at math if you don't think you're good at it?

What our work has aimed to do is to expand the range of mindsets that we are studying, focused on, and also understand and expand the range of effects that they have.

So I mentioned mindsets about stress.

We've also looked at mindsets about food and healthy eating.

So do you have the mindset that foods that are good for you, healthy foods, are disgusting and depriving?

Or do you have the mindset that healthy foods are indulgent and delicious?

Generally, people, at least in our culture in the West, have this view that stress is debilitating, healthy foods are disgusting and depriving.

And those mindsets, whether or not they're true or false, right or wrong, they have an impact.

And they have an impact not just through the motivational mechanisms that Dweck and others have studied, but as our lab has started to reveal, they also shape physiological mechanisms by changing what our bodies prioritize and prepare to do.

We've looked at mindsets about exercise.

Do you feel like you're getting enough or do you feel like you're getting an insufficient amount to get the health benefits you're seeking?

Mindsets about illness.

Do you view cancer as an unmitigated catastrophe or?

Or do you view cancer as manageable?

We've looked at mindsets about symptoms and side effects.

Do you view side effects as a sign that the treatment is harmful?

Or do you view side effects as a sign that the treatment is working?

Again, these are sort of core beliefs or assumptions you have about these domains or categories.

But they matter because they're shaping, they're synthesizing and simplifying the way we're thinking.

But they're also shaping what we're paying attention to, what we're motivated to do and potentially even how our bodies respond.

Certainly.

Yeah, this was a study that I ran as a graduate student at Yale University.

I was working with Kelly Brownell and Peter Salovey.

Peter Salovey had done a lot of work on really coining the term emotional intelligence.

He's now the president of Yale, right?

I had come in doing some previous work on mindsets about exercise and placebo effects and exercise.

And it really occurred to me that there was a very simple question that hadn't been probed yet.

And that was, do our beliefs about what we're eating change our body's physiological response to that food, holding constant the objective nutrients of that thing?

So that question might sound outrageous at first, but it's really not outrageous if you're coming from a place of having studied in depth placebo effects.

Placebo effects are this robust demonstration in which simply taking a sugar pill, taking nothing, under the impression that it's a real medication that might result

relieve your asthma, reduce your blood pressure, boost your immune system, can lead to those physiological effects even though there's no objective nutrients.

And we have more evidence on placebo effects than we have for any other drug because of the clinical trial process in which all new drugs and medications are required to outperform a placebo effect.

So we have a lot of data on the placebo effect.

But anyways, going back to this question, it was like, all right, we've moved from, you know, medications solving our health crises to behavioral medicine solving our health crises, increase people's exercise, get them to eat better.

To what degree are these things influenced by our mindsets or beliefs about them?

So to test this question, we ran a seemingly simple study.

This was done at the Yale Center for Clinical and Translational Research.

And we brought people into our lab under the impression that we were designing different milkshakes with vastly different metabolic concentrations, nutrient concentrations, that were designed to meet different metabolic needs of the patrons of the hospital.

So you're going to come in, you're going to taste these milkshakes,

And we're going to measure your body's physiological response to them.

This was a within subjects design.

So it was the same people consuming two different milkshakes, two different time points separated by a week.

And at one time point, they were told that they were consuming this really high fat, high caloric milkshake.

indulgent milkshake it was like a 620 calorie super high fat and sugar the other time point they were told that it was a low fat low calorie sensible sort of diet shake in reality it was the exact same shake it was right in the middle it was like 300 calories moderate amount of fats and sugars

And we were measuring their body's gut peptide response to this shake.

And in particular, we were looking at the hormone ghrelin.

Medical experts call it the hunger hormone, rises in ghrelin, signal, you know, seek out food.

And then theoretically, in proportion to the amount of calories you consume, ghrelin levels drop, signaling to the brain, okay, you don't need to eat so much anymore.

You can stop eating and also revving up the metabolism to burn the nutrients that were just ingested.

What we found in this study was that when people thought they were consuming the high-fat, high-calorie indulgent milkshake, their ghrelin levels dropped at a three-fold rate stronger than when they thought they were consuming the sensible shake.

So essentially their bodies responded as if they had consumed more food, even though it was the exact same shake at both time points.

It was, to my knowledge, one of the first studies to show any effects of just believing that you're eating something different on your physiology.

The second piece was really important as well.

And especially for me, this was one study that really transformed the way I think about how I approach eating.

And that was the manner in which it affected our physiology was somewhat counterintuitive.

So I had gone in thinking.

The better mindset to be in when you eat is that you're eating healthy, right?

Like, you know, it just makes sense.

Like, placebo effects, think you're healthy, you'll be healthy, you know?

But that was a far too simplistic way of thinking about it.

And in fact, it was the exact opposite.

When these participants thought they were eating sensibly, their bodies left them still feeling physiologically hungry, right?

Not satiated, which could potentially be corresponding to slower metabolism and so forth.

So if you're in the interest of maintaining or losing weight, what's the best mindset to be in?

It's to be in a mindset that you're eating indulgently, that you're having enough food, that you're getting enough.

And at least in that study, we showed that has a more adaptive effect on ghrelin responses.

It does matter what it is, and it matters what you think about that diet and what others around you and in our culture think about that diet because those social contexts inform our mindsets.

Our mindsets...

interact with our physiology in ways that produce outcomes that are really important so let's not get dualistic and say you know it's either all in the mind or not in the mind let's also not be unnecessarily combative and say oh it should be all plant-based or you know keto or whatever it's all of those things are a combined product of what you're actually doing and

And what you're thinking about, if you believe in it, if you don't, if you're skeptical or, you know, in some cases you think you should be eating a certain way and then you don't live up to that.

It might have an adverse effect because of the stress and the anxiety associated with that.

Well, it's also, and I would just say that, you know, the term that we use in our field is nocebo effect for that, which is sort of the placebo's ugly stepsister.

You know, it's when negative beliefs cause negative consequences.

So you are told you will have, you know, it's very well demonstrated that when people are told about certain side effects, they're far more likely to experience those side effects later.

Yeah, no, I think that this is a really good example of this phenomenon, right?

That the total effect of anything is a combined product of what you're doing and what you think about what you're doing.

And we found a group of people who were getting a lot of exercise.

but weren't aware of it, a group of hotel housekeepers.

So these are women working in hotels who were on their feet all day long, pushing carts.

It was clear that they were getting above and beyond at least the Surgeon General's requirements at that time, which were to accumulate 30 minutes of moderate physical activity per day.

But what was interesting was when we went in and surveyed them and asked them, hey, how much exercise do you think you're getting?

A third of them said zero.

And the average response was like a three on a scale of zero to 10.

So it's clear that even though these women were active, they didn't have that mindset, right?

They had the mindset that their work was successful.

just work, hard, maybe thankless work that led them to feel tired and in pain at the end of the day, but not that it was good for them, that it was good exercise.

So what we did was we took these women and we randomized them into two groups, and we told half of them that their work was good exercise.

In this case, it was true, factual information.

We oriented them to the Surgeon General's guidelines.

We oriented them to the benefits that they should be receiving.

And then we had measured them previously on their physiological metrics like weight and body fat and blood pressure.

And we came back four weeks later and we tested them again.

And what we found was that these women, even though they hadn't changed anything in their behavior, they had benefits to their health.

So they lost weight.

They decreased their systolic blood pressure by about 10 points on average.

What this reveals is that we have to be more thoughtful in how we go about motivating people to exercise or teaching people about the benefits.

Our current approach is just to basically tell people writ large, you know, here's what you need to get.

The intention with that is to motivate them.

Because public health officials think, well, if I just tell people you need to get more exercise because it's good for you, they'll do it.

We know now that that doesn't work, that these guidelines are not motivational.

They don't change our behavior.

And what our work adds to that is that not only is it not motivational, it also creates potentially a mindset that...

you know, makes people worse off than they were without knowing about the guidelines.

Great.

Yeah.

So I had, you know, I'd come off the heels of doing some research in exercise and diet.

The obvious next thing to think about was stress.

Right.

The public health message was very clear.

Right.

That stress was bad.

Right.

Unmitigated and harmful.

Right.

on our health, our productivity, our relationships, our fertility, our cognition, you name it, right?

The messages that were out there, by and large, oversimplified messages focused on the damaging consequences of stress.

But as you know, if you actually dive deeper into the literature on stress and the origins of stress, what you find is that, you know, the literature, like most literature, is not so clear cut.

And in fact, there's a large amount of evidence to support the fact that the experience of stress, meaning encountering adversity or challenge in one's goal related efforts, uh,

It does not have to be debilitating.

And in many cases, the body's response was designed to enhance our ability to manage at those moments.

Right.

So some research showing that stress narrows our focus, increases our attention, speeds up the rate at which we're able to process information faster.

There was some research out there showing this phenomenon of physiological toughening, the process by which the release of catabolic hormones and the stress response recruit or activate anabolic hormones, which help, as you know, build our muscles, build our neurons to help us grow and learn.

And there was a whole body of emerging research on post-traumatic growth or this phenomenon in which even the experience of the most traumatic stressors, the most chronic and enduring stressors, could lead not to destruction, but in fact to the exact opposite, to an enhanced sense of connection with our values, connection to others, sense of joy and passion for living there.

My work since then has been not to try to argue that stress is enhancing and not debilitating, but try to point out that the true nature of stress is a paradox.

The true nature of stress is manifold and complex and lots of things can happen.

But to question, what's the role of our mindset about stress in shaping our response to stress?

So some work had already been done looking at your perception of the stressor, right?

So do you view a stressor like a challenging exam or a health diagnosis as a challenge or a threat?

And that had shown pretty convincingly that when you view stressors more as a challenge, less as a threat, that your brain and body responds more adaptively.

What our question was was to take the sort of psychological construal one step higher in abstraction.

So not just the stressor, but the nature of stress, right?

Do you, you know, at that core level, do you view stress as something that's bad, is going to kill us and therefore should be avoided?

Or do you view stress as natural and something that's going to enhance us?

And so we set out to design a series of studies to test the extent to which these mindsets about stress mattered.

And we found in a number of correlational studies that that more enhancing stress mindset was linked to better health outcomes, better well-being, and higher performance.

So then we set out to see if we could change people's mindsets

And in our first test of this, we decided to do so by creating these multimedia films that showcased research, anecdotes, facts about stress, all true, but oriented towards one mindset or the other.

So you can imagine one set of films showed basically the messages that were out there in the public health context.

The other showed, hey, you know, stress has been linked to these things.

But in fact, the body stress response was designed to do this.

Did you know it could do that?

And we had empowering images like LeBron James making the free throw in the final minute versus missing it.

Exactly.

And our question was, does orienting people to different mindsets change how they respond to stress?

So this study was done in the wake of the 2008 financial crisis.

We worked with

UBS, a company, a financial service company that was undergoing pretty massive amounts of layoffs.

So these employees were stressed about being laid off.

They were taking on more pressure.

It was just a tough time.

And we randomized them into three conditions.

And this was all pre-work before getting a training on stress.

But the three different conditions, some watched no videos, some watched the

stress will crush you videos and some watched the stress could enhance you videos.

And what we found was that just, you know, it was a total of nine minutes of videos over the course of the week led to changes in their mindsets about stress, which led to changes in their physiological symptoms associated with stress.

So people who watch the enhancing films

had fewer back aches, muscle tension, insomnia, racing heart, and so forth.

And they also reported performing better at work compared to those who watched the debilitating videos.

Now, interestingly, we didn't make anyone worse with the debilitating videos, which was good.

We had told the IRB we didn't expect that because that message was already out there.

That's what they were already seeing.

That wasn't new to them.

It was more this enhancing message.

a perspective that turned out to be inspiring.

People get this wrong sometimes.

They think that I'm saying that a stress-enhancing mindset means you should like stress.

That's not what we're saying, right?

Having a stress-enhancing mindset doesn't mean the stressor is a good thing, right?

It doesn't mean that getting a cancer diagnosis is a good thing or being in abject poverty is a good thing.

These are not good things.

But the experience of the stress associated with that, the challenge, the adversity, that experience can lead to enhancing outcomes with respect to not just our cognition, but our health, our performance and our well-being.

How does that work?

Right.

Well, it works through a number of different pathways.

One is that it changes fundamentally what we're motivated to do.

So if you, you know, just imagine we're stressed about something and you think that stress is bad.

then what's your motivation, right?

Your motivation is to, well, first you get worried about the stress, right?

And second is your reaction is typically to do one of two things.

It's either to freak out and do everything you can to make sure that this doesn't affect you negatively or to check out.

And say, oh, it's not a big deal.

I'm not going to deal with it.

You know, you're basically in denial.

So people who have a stress is debilitating mindset, and we've shown this in our research, tend to go to one or the other of those extremes.

They freak out or they check out.

Why?

Because if stress is bad, you need to either...

get rid of it and deal with it or it needs to not exist, right?

If you have a stress-enhancing mindset, the motivation changes, right?

Then the motivation is how do I utilize the stress to realize the enhancing outcomes?

What can we do here, right, to learn from this experience to make us stronger, fitter, you know, have better science and treatments for the future, right?

deepen my relationships with others, improve my priorities and so forth.

So the motivation changes.

The affect around it changes.

It doesn't make it easy to deal with.

But what we've shown in our research is that people who have a stress-enhancing mindset have more positive affect, not necessarily less negative affect.

And it potentially changes physiology.

We have a few studies that show that people who are, you know, inspired to adopt more enhancing mindsets have more moderate cortisol response and they have higher levels of DHEA levels in response to stress.

The way I think about mindset is that mindsets are kind of a portal between conscious and subconscious processes.

They operate as a default setting of the mind, right?

So if sort of programmed in there, you have stress equals bad.

That's been programmed in through our upbringing, through public health messages, and through media and other things.

And it kind of sits there as an assumption in the brain.

And the brain is then...

figuring out how should it respond to this situation.

And if the assumption, the default, the programming is stress is bad, that's going to, through our subconscious, trigger all the things that's like, okay, well, I need to like, you know, rev up the things that protect me versus rev up the things that help me grow.

Just talking about this, right, for your listeners, they're now invited to...

bring their stress mindsets up to the consciousness and say, what is my stress mindset?

How am I thinking about stress?

Can I reprogram that?

Can I start to think about it as more enhancing?

That takes a little bit of a conscious work potentially, but then once you do that, it can, that can kind of operate in the background, influencing how your body responds and you don't have to say, okay, I'm stressed.

I better tell my

you know, anabolic hormones.

That doesn't work that way.

But these mindsets can help with the translational process.

Yeah, and that's an important, important nuance in your language, which is people have, by and large, come from a place of how do you manage stress?

How do you cope with it?

Which implies how do you fight against it?

And yeah, the real challenge is how do we leverage it?

How do we utilize it?

How do we work with it?

And I have a lot of thoughts on this.

The first and most important thing is to clarify our definition of stress.

The negative stress mindset is so insidious that now people define stress with its negative consequences.

So the first step is to decouple that and to realize that stress is a neutral, yet to be determined effect of experiencing or anticipating adversity in your goal-related efforts.

So let me unpack that a little more.

You can be in the midst of it, or you could just be worried about something happening.

That's one aspect.

Second is adversity or challenge, so something that's working against you.

But the third piece is critical, and that is in your goal-related efforts.

What that means is that we only stress about things we care about, and we don't stress about things we don't care about.

So then the question becomes, okay, if that's true, how can I better utilize or leverage or respond to the inevitable stresses that we're going to experience?

We've developed a three-step approach to adopting a stress-enhancing mindset.

And briefly, the first step is to just acknowledge that you're stressed.

The second step is to welcome it because inherently in that stress is something you care about.

And then the third step is to utilize the stress response to achieve the thing you care about.

Not spend your time, money, effort, energy trying to get rid of the stress.

Does that make sense?

Right.

Treat yourself like a scientist.

Look at your life.

Look at your mindsets.

See what's serving you.

See what isn't.

Find more useful, adaptive, and empowering mindsets and live by those.

The guiding light for me has been

an undercurrent of understanding that our mindsets matter.

I think I got that very clearly and deeply as a child, both through my experiences as an athlete.

You know, I know many of your listeners are athletes.

Any athlete knows that you can be the same physical being from one day to the next, one moment to the next, and perform completely differently just depending on what you're thinking.

I was a gymnast growing up.

And if you can't visualize, if you can't see something in your mind, you have no chance when you get up there on the balance beam, right?

And I also, my father was a martial artist, a teacher of meditation.

So this kind of mind-body work was baked into me from an early age.

And I think what I've done recently is to try to understand it scientifically and more importantly, to figure out

How can we how can we do better with this?

Right.

How can we you know, we're all talking about AI taking over the world and technology, this and personalized medicine, that.

And it's like we have done so little, relatively so little with the human resource, our human brains.

That the, you know, the potential for which is so great and we've done almost nothing, you know, take the placebo effect.

We know a lot about what it is.

We've done almost nothing to leverage that in medicine consciously and deliberately.

So my, what keeps me going, what gets me through the hard times is just that burning question of what is going on here and what more can I do with the power of my mind?

Yeah, all our papers and materials and interventions are housed on our website.

mbl.stanford.edu we also have a link there too that takes you to stanford spark which stands for social psychological answers to real world questions we have a lot of toolkits on that website including a toolkit for this rethink stress approach of acknowledging welcoming and utilizing your stress and

Yeah.

Thank you.

And I guess I just want to end by saying, I think this work is really the tip of the iceberg of what can and should be done.

And so I really invite your, you, your listeners and all, you know, anybody who's inspired by this work, if they want to share stories or want to partner on a collaboration to please reach out.

Great.

Thank you.