How Placebo Effects Work to Change Our Biology & Psychology

Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life.

欢迎来到休伯曼实验室播客，我们在这里讨论科学和基于科学的日常生活工具。

I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.

我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。

Today, we are discussing placebo effects.

今天，我们正在讨论安慰剂效应。

We will also be discussing what are called nocebo effects, as well as belief effects.

我们还将讨论所谓的反安慰剂效应以及信念效应。

All three of these, placebo, nocebo, and belief effects, are all related to our brain's incredible ability to place an expectation on what is about to happen and actually change what is about to happen, independent of the physical and chemical properties of a drug or some sort of other treatment solution for things like pain, Parkinson's disease, irritable bowel syndrome, asthma, stress, and on and on and on.

所有这三种效应，安慰剂效应、反安慰剂效应和信念效应，都与我们的大脑对即将发生的事情抱有期望并实际改变即将发生的事情的令人难以置信的能力有关，独立于药物或某种其他治疗方案的物理和化学特性，例如疼痛、帕金森病、肠易激综合症、哮喘、压力等等。

Now, one of the most incredible things about these effects is that despite the fact that it would appear that they are simply psychological or the power of the mind over matter, it's not that at all.

现在，关于这些效应最令人难以置信的事情之一是，尽管事实上它们看起来只是心理作用或心灵对物质的力量，但事实并非如此。

Placebo, nocebo, and belief effects actually change the way your biology, your physiology works.

安慰剂、反安慰剂和信念效应实际上改变了你的生物学和生理学的运作方式。

In fact, you have neural circuits within your brain that are dedicated to how your expectation of what will happen actually changes some of the most core biological functions within your brain and body, modifying, for instance, heart rate, blood pressure, the release of specific neuromodulators such as dopamine and adrenaline, and so powerfully so that these types of effects can actually work along with traditional drug treatments or behavioral treatments in order to vastly change the way that your brain and body work.

事实上，你的大脑中有神经回路，专门负责你对将要发生的事情的预期如何真正改变你的大脑和身体内一些最核心的生物功能，例如改变心率、血压、多巴胺和肾上腺素等特定神经调节剂的释放，这些改变的力度如此之大，以至于这些类型的效果实际上可以与传统的药物治疗或行为治疗一起发挥作用，从而极大地改变你的大脑和身体的工作方式。

So if you think of the word placebo as an inert substance or treatment that is merely a control, it's merely something introduced to an experiment or a clinical trial to try and figure out what's happening normally in somebody's brain or body as a comparison to some drug or other type of treatment, well, while that can be true, and placebo controls are vital for certain clinical studies, it's also the case that placebos, nocebos, and belief effects have powerful impact on our physiology entirely separate from all of that, so much so that several highly esteemed researchers in the medical community around the world believe that placebo, nocebo, and belief effects should actually be leveraged in the treatment of various diseases as their own unique treatment.

因此，如果你认为安慰剂这个词是一种惰性物质或仅仅是一种对照的治疗方法，那么它只是引入到实验或临床试验中的东西，目的是试图弄清楚某人的大脑或身体中正常发生的情况，与某些药物或其他类型的治疗进行比较，好吧，虽然这可能是真的，而且安慰剂对照对于某些临床研究至关重要，但安慰剂、反安慰剂和信念效应对我们的生理学也有强大的影响，与所有这些完全无关，以至于世界各地医学界的几位备受尊敬的研究人员认为，安慰剂、反安慰剂和信念效应实际上应该在治疗各种疾病中发挥作用，作为其独特的治疗方法。

So by the end of today's episode, you are going to have a clear understanding of what placebo, nocebo, and belief effects are, their biological underpinnings, and the way that you can leverage them toward your mental health, physical health, and performance.

因此，在今天的节目结束时，您将清楚地了解安慰剂、反安慰剂和信念效应是什么，它们的生物学基础，以及如何利用它们来促进您的心理健康、身体健康和表现。

Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.

在开始之前，我想强调一下，这个播客与我在斯坦福大学的教学和研究角色是分开的。

It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public.

然而，我的愿望和努力的一部分是向公众提供有关科学和科学相关工具的零成本消费者信息。

In keeping with that theme, I'd like to thank the sponsors of today's podcast.

为了与这个主题保持一致，我要感谢今天播客的赞助商。

Okay, let's talk about placebo effects.

好吧，我们来谈谈安慰剂效应。

I will also be talking about nocebo effects.

我还将讨论反安慰剂效应。

And let's just establish the difference between those.

让我们来确定它们之间的区别。

Placebo effects are when an inert substance or behavioral treatment, that is, a substance or behavioral treatment that is not going to have any kind of direct biological or psychological activity, it shouldn't do anything on its own, somehow does in the direction of improving symptoms or performance.

安慰剂效应是指一种惰性物质或行为治疗，即一种物质或行为治疗不会产生任何直接的生物或心理活动，它本身不应该做任何事情，但以某种方式在改善症状或表现的方向上起作用。

Now let's contrast that with nocebo.

现在让我们将其与反安慰剂进行对比。

Nocebo is when a drug or behavioral intervention which is inert, it should have no impact on symptoms or performance of any kind, but with nocebo, it turns out these substances or behavioral interventions actually worsen symptoms or performance.

反安慰剂是一种惰性药物或行为干预，它应该对任何类型的症状或表现没有影响，但对于反安慰剂，事实证明这些物质或行为干预实际上会使症状或表现恶化。

Now, oftentimes people will just say a placebo effect.

现在，人们常常只会说安慰剂效应。

It's a little bit rarer for people to distinguish between placebo and nocebo effects, but I do think it's important to know their difference.

人们很少能区分安慰剂效应和反安慰剂效应，但我确实认为了解它们的区别很重要。

Going forward, I'll mostly just refer to these as placebo effects, but I'll talk about nocebo effects a little bit later.

展望未来，我主要将这些称为安慰剂效应，但稍后我会讨论反安慰剂效应。

I'll also talk about belief effects.

我还将讨论信念效应。

So let's just establish what belief effects are.

那么让我们来确定什么是信念效应。

Belief effects are when you or somebody else learns specific knowledge that changes your expectation about what is going to happen in reference to, say, stress or consuming a given food or taking a given drug or doing a specific behavioral protocol, and the specific information you learn or assimilate actually leads to that specific outcome.

信念效应是指当你或其他人学到特定的知识，改变你对将要发生的事情的期望时，例如，压力或食用特定的食物或服用特定的药物或执行特定的行为方案，并且你学习或吸收的特定信息实际上会导致特定的结果。

So in many ways, belief effects and placebo effects are similar.

因此，在很多方面，信念效应和安慰剂效应是相似的。

It's just that the word placebo or placebo effects is commonly used to refer to drugs and behavioral interventions.

只是安慰剂或安慰剂效应这个词通常用来指药物和行为干预。

Belief effects are a more specific language used to describe when information of any kind changes the outcome of some physiological or psychological process.

信念效应是一种更具体的语言，用于描述任何类型的信息何时改变某些生理或心理过程的结果。

Now, what's common to placebo, nocebo, and belief effects is that they all work by changing expectation.

现在，安慰剂、反安慰剂和信念效应的共同点是它们都是通过改变期望来发挥作用。

And any time we talk about expectation, we're talking about the function of the nervous system, and specifically the brain, and specifically the prefrontal cortex within the brain.

任何时候我们谈论期望时，我们都在谈论神经系统的功能，特别是大脑，特别是大脑内的前额叶皮层。

The prefrontal cortex is neural real estate, which is just fancy nerd speak for the neurons and their connections that reside just behind your forehead, just in the front of your skull.

前额皮质是神经区域，用奇特的书呆子的话来说，它是指位于你前额后面、头骨前面的神经元及其连接。

Now, the prefrontal cortex has a lot of different subdivisions or regions.

现在，前额皮质有很多不同的细分或区域。

The overall function of the prefrontal cortex can be described as having the ability to either activate or suppress other neural circuits deeper in the brain.

前额叶皮层的整体功能可以描述为具有激活或抑制大脑深处其他神经回路的能力。

Some people, in fact, a previous guest on the Huberman Lab podcast, a neurosurgeon, said the prefrontal cortex can generally be described as the structure in the brain that controls other structures in the brain by saying, "Shh." Or suppressing their function.

事实上，一些人，事实上，胡伯曼实验室播客的前任嘉宾，一位神经外科医生，说前额皮质通常可以被描述为大脑中的结构，通过说“嘘”来控制大脑中的其他结构。或者抑制它们的功能。

So for instance, if you have the impulse to move or to shout, the prefrontal cortex suppresses that movement or suppresses that desire to shout or that shouting.

例如，如果你有想要移动或喊叫的冲动，前额叶皮层会抑制这种运动或抑制那种喊叫或喊叫的欲望。

If you've ever had the experience of going to the edge of a cliff or being on a high bridge and thinking, "Oh my goodness," you just have this spontaneous thought, which please don't do this in action, but one will have this thought like, "Oh my goodness, what if I just jumped off?" And people think, "Oh my goodness, do I have some sort of death wish?" Well, no. The prefrontal cortex being largely a context evaluating and prediction machine is essentially looking at that landscape and predicting what would happen, indeed how bad it would be if you were to jump off that bridge or jump off that cliff.

如果你曾经有过这样的经历：走到悬崖边缘或在一座高桥上思考，“天哪，”你只是有这种自发的想法，请不要在行动中这样做，但人们会有这样的想法，“天哪，如果我跳下去怎么办？”人们会想，“天啊，我是不是有某种求死的愿望？”嗯，不。前额叶皮层在很大程度上是一个环境评估和预测机器，本质上是观察风景并预测会发生什么，实际上，如果你从那座桥上跳下来或从那座悬崖上跳下去，情况会有多糟糕。

And then you feel that, "Oh my goodness, what's wrong with me?

然后你会觉得，“天哪，我怎么了？

Why would I think this?" But the fact that you think it even for a moment, but you don't do it, and the fact that you recognize that it's sort of a dangerous thought, certainly a dangerous action, again, please don't engage in the action, tells you that your prefrontal cortex is working properly.

我为什么会这么想？”但事实是，你哪怕只是想了一会儿，却没有这么做，而且你认识到这是一种危险的想法，当然也是一种危险的行动，再次强调，请不要采取这种行动，这告诉你，你的前额皮质工作正常。

Again, the prefrontal cortex is involved in suppressing certain types of behaviors.

同样，前额叶皮层参与抑制某些类型的行为。

And what sorts of behaviors?

以及什么样的行为？

Well, the larger theme of the prefrontal cortex that we need to consider today is that it is an expectation or prediction-making machine.

那么，我们今天需要考虑的前额皮质的更大主题是，它是一个期望或预测机器。

It is a bunch of neurons that release chemicals and have electrical activity that are speaking with and receiving information from other areas of the brain, and it's evaluating a number of things, like context.

它是一群释放化学物质并具有电活动的神经元，与大脑其他区域对话并接收来自大脑其他区域的信息，并且它正在评估许多事物，例如上下文。

Like, "What's going on in this room?

比如，“这个房间里发生了什么？

What's going on in this scene?

这一幕发生了什么？

What's supposed to happen here?

这里应该发生什么？

What might I do?

我可以做什么？

What should I do?

我该怎么办？

What should I not do?" Et cetera.

我不应该做什么？”等等。

Now, the other thing about the prefrontal cortex, given that it has all these different subdivisions, is that some of those subdivisions have a unique, what we call labeled line communication, like a unique highway that leads to specific brain areas that control specific bodily functions, including heart rate, blood pressure, et cetera.

现在，关于前额叶皮层的另一件事是，考虑到它有所有这些不同的细分，其中一些细分具有独特的，我们称之为标记线通信，就像一条独特的高速公路，通向控制特定身体功能的特定大脑区域，包括心率、血压等。

And a little bit later in the episode, I'll talk about a specific paper, it's one of my favorite papers, in which a specific prefrontal cortical region is identified as controlling very primitive aspects of our physiology, such as body temperature and heart rate, in reference to beliefs or what's happening in a social scene.

在本集中稍后，我将谈论一篇特定的论文，这是我最喜欢的论文之一，其中特定的前额皮质区域被确定为控制我们生理学的非常原始的方面，例如体温和心率，涉及信仰或社交场景中发生的事情。

And this is very different from the way that, say, getting into cold water or experiencing some other sort of stressor causes increase in heart rate or vasoconstriction.

这与进入冷水或经历其他某种压力源导致心率增加或血管收缩的方式非常不同。

What we're talking about here when we talk about placebo, nocebo, and belief effects are the way in which you learn information, or you are told information like, "Hey, this pill is going to do blank," maybe because the label says it, maybe because the scientist or the doctor tells you that this pill does blank or this injection will do blank.

当我们谈论安慰剂、反安慰剂和信念效应时，我们在这里谈论的是你学习信息的方式，或者你被告知这样的信息，“嘿，这个药丸会产生空白”，也许是因为标签上这么说，也许是因为科学家或医生告诉你这个药丸会产生空白，或者这种注射会产生空白。

Or maybe you learn some information about what some specific drug or supplement or behavioral protocol will do.

或者，您可能会了解一些有关某些特定药物、补充剂或行为方案的作用的信息。

And in that learning, you come to expect a specific set of effects.

在学习过程中，你会期待一系列特定的效果。

And certain neural circuits in the prefrontal cortex become active and start to activate certain neural circuits deeper in the brain in areas like the hypothalamus.

前额皮质中的某些神经回路变得活跃，并开始激活大脑深处下丘脑等区域的某些神经回路。

These are ancient, very well conserved across animals, areas of the brain that control very primitive functions.

这些是古老的，在动物中保存得很好，是控制非常原始功能的大脑区域。

They exist in essentially all mammals and even in reptiles.

它们基本上存在于所有哺乳动物甚至爬行动物中。

The prefrontal cortex also communicates with areas of your brain stem, controlling things like breathing, et cetera.

前额叶皮层还与脑干区域进行通信，控制呼吸等。

So the prefrontal cortex is a sophisticated area of your brain that takes into account context, both in the present as well as memories from the past.

因此，前额叶皮层是大脑中一个复杂的区域，它会考虑当前的环境以及过去的记忆。

It can take into consideration goals about the future, and then combines all of that into neural signals to areas of the brain that control basic physiological functions related to the immune system, the stress system, the reward system, the pleasure system, and on and on.

它可以考虑未来的目标，然后将所有这些结合成神经信号，发送到控制与免疫系统、压力系统、奖励系统、快乐系统等相关的基本生理功能的大脑区域。

So when we talk about placebo, nocebo, and belief effects, what we're really talking about is the ability for information and specific experiences to lead to expectations within us about what's going to happen, and then our physiology of our brain and body fundamentally changes such that those things happen.

因此，当我们谈论安慰剂、反安慰剂和信念效应时，我们真正谈论的是信息和特定经验导致我们对将要发生的事情产生预期的能力，然后我们的大脑和身体的生理机能从根本上发生变化，从而使这些事情发生。

So let's talk about some specific examples of placebo effects from the research literature.

那么让我们来谈谈研究文献中安慰剂效应的一些具体例子。

And today, we're going to cover a lot of different examples from different systems.

今天，我们将介绍来自不同系统的许多不同示例。

But as we do that, I will specifically be selecting examples that illustrate different types of placebo effects and illustrate what those different types of placebo effects are.

但当我们这样做时，我将专门选择一些例子来说明不同类型的安慰剂效应，并说明这些不同类型的安慰剂效应是什么。

Now, I should mention that if you're interested in placebo effects, there's a wonderful book that describes many, many different placebo effects and their biological underpinnings in cases where those biological underpinnings are understood.

现在，我应该提到，如果您对安慰剂效应感兴趣，有一本很棒的书描述了许多不同的安慰剂效应及其生物学基础（在这些生物学基础被理解的情况下）。

And the book I'm referring to is one that I used prominently in researching this episode.

我指的这本书是我在研究这一集时主要使用的书。

It's called none other than "Placebo Effects: Understanding the Other Side of Medical Care", and the book is by Fabrizio Benedetti.

这本书的名字正是《安慰剂效应：了解医疗保健的另一面》，这本书的作者是 Fabrizio Benedetti。

I hope I pronounced that right, Fabrizio.

我希望我说得对，法布里奇奥。

And to you Italians out there, if I didn't do it correctly, I apologize.

对于意大利人来说，如果我做得不对，我深表歉意。

It's an absolutely wonderful book.

这绝对是一本很棒的书。

I confess I've never met Fabrizio Benedetti.

我承认我从未见过法布里奇奥·贝内代蒂。

I confess I have no relation to the publisher or to the book itself, except that I absolutely love the book.

我承认我与出版商或这本书本身没有任何关系，只是我绝对喜欢这本书。

So highly recommend this book.

所以强烈推荐这本书。

I'll be pulling from a number of different examples described in this book today.

今天我将引用本书中描述的许多不同的例子。

To my mind, one of the most interesting examples of placebo effect is where placebo is given and can profoundly change levels of dopamine release in the brain.

在我看来，安慰剂效应最有趣的例子之一是给予安慰剂，它可以深刻改变大脑中多巴胺的释放水平。

Now, the study I'm about to describe was done in Parkinson's patients.

现在，我要描述的研究是在帕金森病患者中进行的。

People with Parkinson's have degeneration of neurons in an area of the brain called the substantia nigra, which is an area of the brain in the kind of bottom back part of the brain.

患有帕金森氏症的人大脑中一个称为黑质的区域存在神经元退化，该区域位于大脑的后下部分。

For you aficionados, it's the ventral tegmental area, but you don't need to know that name.

对于你的爱好者来说，它是腹侧被盖区，但你不需要知道这个名字。

These neurons contain dopamine and are essential for the generation of smooth movement patterns, including walking and reaching and moving one's hand to write, et cetera.

这些神经元含有多巴胺，对于生成平滑的运动模式至关重要，包括行走、伸手、移动手写字等。

And of course, dopamine is involved in a bunch of other things too, including motivation and reward In people with Parkinson's, depending on how severe and advanced the Parkinson's is, they suffer deficits in the ability to generate smooth movements and often deficits in motivation and reward pathways as well.

当然，多巴胺还与许多其他事情有关，包括动机和奖励。对于帕金森氏症患者，根据帕金森氏症的严重程度和进展程度，他们在产生平稳运动的能力方面存在缺陷，并且通常在动机和奖励途径方面也存在缺陷。

Now, there are many different treatments for Parkinson's, some more successful than others.

现在，帕金森病有许多不同的治疗方法，其中一些治疗方法比其他方法更成功。

Unfortunately, it's still not completely curable, at least not at this time.

不幸的是，它仍然无法完全治愈，至少目前还不能。

But most of the drugs that are successful in treating Parkinson's to some degree or another are drugs that increase levels of dopamine within the brain.

但大多数在某种程度上成功治疗帕金森病的药物都是增加大脑内多巴胺水平的药物。

For obvious reasons, as I just mentioned, Parkinson's is a degeneration of the dopaminergic, meaning dopamine-containing and releasing neurons in the brain.

出于显而易见的原因，正如我刚才提到的，帕金森病是多巴胺能神经元的退化，这意味着大脑中含有和释放多巴胺的神经元。

So people with Parkinson's will often be given L-DOPA, which is a precursor to dopamine, or other types of drugs that increase dopamine within the brain.

因此，帕金森氏症患者通常会服用左旋多巴（多巴胺的前体）或其他类型的增加大脑内多巴胺的药物。

Now, there have been a number of studies that have compared certain drugs known to increase dopamine, such as L-DOPA, things like apomorphine, bromocriptine, et cetera, to placebo control drugs.

现在，已经有许多研究将某些已知会增加多巴胺的药物（例如左旋多巴）、阿扑吗啡、溴隐亭等与安慰剂对照药物进行了比较。

And one of the interesting takeaways from those studies is that, yes, drugs like L-DOPA, bromocriptine, et cetera, increase dopamine and at least can partially or transiently improve symptoms of Parkinson's in many, not all, patients with Parkinson's.

这些研究的一个有趣的结论是，是的，左旋多巴、溴隐亭等药物会增加多巴胺，至少可以部分或暂时改善许多（不是全部）帕金森病患者的帕金森病症状。

The placebo drugs given in many of those studies, which were simply a sugar pill or some other inert pill, it doesn't contain any chemicals that are known to directly bind to or increase dopamine in the brain, and yet nonetheless, when the brains of certain patients were imaged, it was clear that not only was there an improvement in symptomology, but there were increases in dopamine release within those patients' brains, which on the face of it should make no sense.

许多研究中使用的安慰剂药物只是一种糖丸或其他一些惰性药丸，它不含有任何已知会直接结合或增加大脑中多巴胺的化学物质，然而，尽管如此，当对某些患者的大脑进行成像时，很明显不仅症状有所改善，而且这些患者大脑内的多巴胺释放也有所增加，从表面上看，这应该是没有意义的。

However, when people with Parkinson's or people who even don't have Parkinson's are told a given drug can increase dopamine, and then they put these people into a brain imaging device, it's called a PET device, it has nothing to do with animals, it's the positron emission tomography device, and these people had been injected with or consumed something called raclopride.

然而，当患有帕金森症或什至没有帕金森症的人被告知某种药物可以增加多巴胺，然后他们将这些人放入大脑成像设备中，它被称为PET设备，它与动物无关，它是正电子发射断层扫描设备，这些人被注射或服用了一种叫做雷氯必利的东西。

It sounds really weird and dangerous, but actually raclopride looks a little bit like dopamine itself chemically, and it has a little tag or label on it, and it can bind to certain receptors in the brain where dopamine would normally bind.

这听起来真的很奇怪和危险，但实际上雷氯必利在化学上看起来有点像多巴胺本身，它上面有一个小标签或标签，它可以与大脑中多巴胺通常结合的某些受体结合。

What was observed is that the placebo itself was causing reduced binding of this raclopride to areas of the brain that have dopamine receptors, which meant unequivocally that there was more dopamine released in the brain because if more dopamine is released in the brain and parks in those receptors, well, then the raclopride, which looks a lot like dopamine, can't also park or bind to those receptors.

观察到，安慰剂本身导致雷氯必利与大脑中具有多巴胺受体的区域的结合减少，这明确意味着大脑中释放了更多的多巴胺，因为如果大脑中释放更多的多巴胺并停留在这些受体上，那么雷氯必利（看起来很像多巴胺）就不能停留或结合到这些受体上。

Simply put, a placebo drug, again, a drug that has no direct action on the dopaminergic system, if it's given to somebody who has Parkinson's or who doesn't, and they are told, "This drug is going to increase levels of dopamine in your brain and potentially improve your symptoms of Parkinson's or have some other effect," well, it succeeded in increasing dopamine levels within the brain, which basically should make us all sit back and say, "Okay, what are we to think of drugs like L-DOPA and apomorphine, bromocriptine, as compared to placebo?

简而言之，安慰剂药物，又是一种对多巴胺能系统没有直接作用的药物，如果给患有帕金森病或没有帕金森病的人服用，他们被告知，“这种药物会增加你大脑中的多巴胺水平，并可能改善你的帕金森病症状或产生其他一些效果，”好吧，它成功地增加了大脑内的多巴胺水平，这基本上应该让我们大家坐下来说，“好吧，什么是与安慰剂相比，我们会想到左旋多巴、阿扑吗啡、溴隐亭等药物吗？

Why isn't everyone just taking placebo?

为什么不是每个人都只服用安慰剂？

Why aren't we just telling people, 'Hey, this sugar pill is going to increase dopamine?'" Well, two important points to answer that.

为什么我们不直接告诉人们，‘嘿，这种糖丸会增加多巴胺？’”好吧，回答这个问题有两个要点。

First of all, the increases in dopamine that are observed from placebo plus information about what that placebo ought to do for increasing dopamine are not as robust, or I should say generally not as robust as the increases in dopamine observed from an actual drug known to increase dopamine transmission or release within the brain.

首先，从安慰剂中观察到的多巴胺增加以及关于安慰剂应该如何增加多巴胺的信息并不那么强劲，或者我应该说通常不如从已知会增加大脑内多巴胺传输或释放的实际药物中观察到的多巴胺增加那么强劲。

The second point is that the structure of the information given to somebody and the belief that they form about what ought to happen, that is the expectation effect, which you'll start to realize more and more across today's episode, that expectation effect really is the underpinning of the placebo effect.

第二点是给予某人的信息结构以及他们对应该发生的事情形成的信念，这就是期望效应，在今天的节目中你会开始越来越意识到，期望效应实际上是安慰剂效应的基础。

Well, the strength of that expectation is really hard to anchor across individuals.

嗯，这种期望的强度确实很难在个人之间固定。

And in fact, if people realize they're taking a placebo, the magnitude of the dopamine increase is actually decreased.

事实上，如果人们意识到他们正在服用安慰剂，多巴胺增加的幅度实际上会降低。

So this is why we use placebo controls in clinical trials.

这就是我们在临床试验中使用安慰剂对照的原因。

We want to establish the real difference between the effect of a given drug on a biological system, in this case, increasing dopamine, from the belief or the expectation of what that drug will do.

我们想要确定某种药物对生物系统的影响（在本例中是增加多巴胺）与对该药物作用的信念或预期之间的真正差异。

So in that sense, the placebo is really a measure of expectation of what a drug treatment will do, at least in the context of a drug trial.

因此，从这个意义上说，安慰剂实际上是对药物治疗效果的预期衡量标准，至少在药物试验的背景下是如此。

So I mention this somewhat complicated example because first of all, many people are interested in dopamine.

所以我提到这个有点复杂的例子，因为首先，很多人对多巴胺感兴趣。

We all make dopamine.

我们都会产生多巴胺。

It's involved in motivation, drive, and focus, and reward, all sorts of things that we hear a lot about these days.

它涉及动机、驱动力、专注力和奖励，以及我们现在经常听到的各种事情。

Second of all, it really illustrates that placebo, that is expectation about what will happen, is impacting, of course, placebo effects.

其次，它确实说明了安慰剂，即对将要发生的事情的期望，当然正在影响安慰剂效应。

You realize that now.

你现在意识到了。

But it then also has to be the case that placebo effects are playing into any effect that we might observe from taking a given drug or supplement based on our expectation of what that drug or supplement will do.

但安慰剂效应也必须影响到我们根据对某种药物或补充剂的预期，服用某种药物或补充剂可能观察到的任何效应。

And miraculously, or at least what I find miraculous, is that placebo effects, these expectations based on knowledge and beliefs, are highly specific, which raises all sorts of questions about, for instance, if you were given a drug that increases dopamine levels, but you weren't told that it increases dopamine levels, that perhaps you were told, you were lied to and told that it increases the activity of a different neuromodulator like serotonin, would it?

神奇的是，或者至少我觉得神奇的是，安慰剂效应，这些基于知识和信仰的期望，是高度具体的，这引发了各种各样的问题，例如，如果给你一种增加多巴胺水平的药物，但你没有被告知它会增加多巴胺水平，也许你被告知，你被欺骗并被告知它会增加另一种神经调节剂如血清素的活性，不是吗？

Well, let's explore that because as wild as that seems, it turns out that what we believe about a given drug treatment or behavioral treatment actually has a high degree of specificity.

好吧，让我们来探讨一下，因为尽管这看起来很疯狂，但事实证明，我们对特定药物治疗或行为治疗的看法实际上具有高度的特异性。

So to illustrate the incredible specificity of placebo effects, I want to describe a study related to hormone function Hormones come in many different forms.

因此，为了说明安慰剂效应令人难以置信的特异性，我想描述一项与激素功能相关的研究激素有多种不同的形式。

We have testosterone, estrogen, growth hormone, cortisol, et cetera.

我们有睾酮、雌激素、生长激素、皮质醇等等。

There's a study that was carried out in humans in which subjects were informed about growth hormone release and cortisol release.

有一项针对人类的研究，受试者被告知生长激素的释放和皮质醇的释放。

Growth hormone is a hormone released from a gland in the brain called the pituitary.

生长激素是一种从大脑垂体释放的激素。

The pituitary has different parts.

垂体有不同的部分。

The anterior pituitary releases growth hormone each night when you go to sleep.

每晚入睡时，垂体前叶都会释放生长激素。

It's involved in protein synthesis, tissue repair, bodily growth, appendage growth, and many other things.

它参与蛋白质合成、组织修复、身体生长、附属物生长和许多其他事情。

Cortisol is a hormone that's released from the adrenals.

皮质醇是一种从肾上腺释放的激素。

It can also be synthesized and released a couple of other places in the brain and body, and it's involved in immune system function and anti-inflammatory action.

它也可以在大脑和身体的其他几个地方合成和释放，它参与免疫系统功能和抗炎作用。

A lot of people think cortisol is bad, but it's actually an important hormone for our daily health, our alertness, and waking up in the morning, et cetera.

很多人认为皮质醇不好，但它实际上是一种对我们日常健康、警觉性和早晨醒来等重要的激素。

In any event, subjects in this study learned about growth hormone and cortisol and their release, where they're released from, what they do, just as you did.

无论如何，这项研究的受试者了解了生长激素和皮质醇及其释放、释放的位置、作用，就像您一样。

And then their growth hormone and cortisol levels were measured, and not surprisingly, they didn't change.

然后测量了他们的生长激素和皮质醇水平，毫不奇怪，它们没有变化。

Just learning about growth hormone and cortisol did not change growth hormone or cortisol levels in these human subjects.

仅了解生长激素和皮质醇并不会改变这些人类受试者的生长激素或皮质醇水平。

Now, on days two and three of this experiment, subjects received an injection of a drug.

现在，在该实验的第二天和第三天，受试者接受了药物注射。

The drug is called sumatriptan, and sumatriptan is known to increase levels of growth hormone and reduce levels of cortisol.

这种药物称为舒马曲坦，已知舒马曲坦可以增加生长激素的水平并降低皮质醇的水平。

And indeed, that's what they observed.

事实上，这就是他们所观察到的。

When people received these injections and then their blood was drawn, growth hormone levels went up, cortisol levels went down.

当人们接受这些注射并抽血时，生长激素水平上升，皮质醇水平下降。

Now, the interesting part of the study is a separate day.

现在，这项研究的有趣部分是单独的一天。

So after the drug treatments, they come back and they are injected with saline, which has no specific biological effect.

所以药物治疗结束后，他们回来注射的是生理盐水，没有特殊的生物学作用。

It's simply salt water.

这只是盐水。

They're injected with saline, and they experience increases in growth hormone and decreases in cortisol, which on the face of it might seem like, wow, that's incredible.

他们被注射生理盐水，生长激素增加，皮质醇减少，从表面上看，这似乎是，哇，这太不可思议了。

But based on what you've learned thus far in today's episode, you could imagine that knowledge about growth hormone and cortisol somehow combined with the injection to lead to an expectation of increases in growth hormone and decreases in cortisol, which would be amazing in its own right.

但根据您在今天的节目中到目前为止所学到的知识，您可以想象有关生长激素和皮质醇的知识以某种方式与注射相结合，从而导致生长激素增加和皮质醇减少的预期，这本身就令人惊奇。

After all, saline is inert.

毕竟，盐水是惰性的。

It doesn't do anything directly and specifically to the growth hormone or cortisol system.

它不会直接且专门地对生长激素或皮质醇系统产生任何作用。

But get this, it turns out that a saline injection, which does nothing on its own, on day four or five after people have received this drug treatment, increases growth hormone and decreases cortisol independent of what people are told they are being injected with, even if they are told they are being injected with a drug that has completely different effects than sumatriptan.

但事实证明，在人们接受这种药物治疗后的第四天或第五天，生理盐水注射本身没有任何作用，它会增加生长激素并减少皮质醇，与人们被告知注射的药物无关，即使他们被告知注射的药物与舒马普坦的效果完全不同。

So why would this be?

那么为什么会这样呢？

How could this be?

怎么会这样？

In fact, there was even a condition in which subjects were told on the day they received the placebo, you're about to get an injection of something that's going to decrease growth hormone.

事实上，甚至有一种情况是，受试者在接受安慰剂的当天被告知，你将注射一些会减少生长激素的药物。

But rather, they experienced a genuine increase in growth hormone and decrease in cortisol in the exact same way they did when they received the active drug, sumatriptan.

相反，他们经历了生长激素的真正增加和皮质醇的减少，就像他们接受活性药物舒马曲坦时一样。

So this wild type of scenario has to be explained, and in order to explain it, we need to zoom out from the experiment and ask, what's the similarity between day two and three of the experiment, meaning the days in which the people received the actual active drug, sumatriptan, that increases growth hormone, reduces cortisol, and the day in which they received the placebo.

因此，这种疯狂的场景必须得到解释，为了解释它，我们需要从实验中缩小范围，并询问实验的第二天和第三天之间有什么相似之处，即人们接受实际活性药物舒马普坦（增加生长激素、减少皮质醇）的日子，以及他们接受安慰剂的日子。

And the one thing that anchors both those days together, meaning the one thing in common that can explain this effect, is that those were the days in which people received an injection.

将这两个日子联系在一起的一件事，意味着可以解释这种效应的一个共同点，就是那些日子都是人们接受注射的日子。

And in fact, through various control experiments and a few other experiments that were done subsequent to this, because this experiment has been more or less repeated in different forms in different laboratories, it became clear that the brain and body somehow came to expect that receiving an injection leads to increases in growth hormone and cortisol.

事实上，通过各种对照实验和随后进行的一些其他实验，因为这个实验在不同的实验室以不同的形式或多或少地重复了，很明显，大脑和身体以某种方式预期接受注射会导致生长激素和皮质醇的增加。

Now, this is not an indefinite effect.

现在，这并不是一个无限期的影响。

People will get injections of other things in the future, presumably active drugs, not just saline, that will change hormone levels or change neurotransmitter levels.

人们将来会注射其他东西，可能是活性药物，而不仅仅是盐水，这会改变激素水平或神经递质水平。

But in this experiment, what happened is that there was a pairing within the nervous system.

但在这个实验中，发生的是神经系统内存在配对。

There was somehow a binding of the notion of getting an injection with a syringe, which in the first case was of a drug that increases growth hormone, decreases cortisol.

在某种程度上，用注射器注射的概念有一定的约束力，在第一种情况下，注射器是一种增加生长激素、减少皮质醇的药物。

And then when subjects came back and were injected with a different syringe, presumably, I would hope so, with a different syringe filled with saline, even though the saline should do nothing, the body and brain had somehow formed a pairing, an association between syringe injection and increased growth hormone, decreased cortisol.

然后，当受试者回来并用不同的注射器注射时，想必，我希望如此，用另一个充满盐水的注射器，即使盐水应该不起任何作用，身体和大脑以某种方式形成了配对，注射器注射与生长激素增加和皮质醇减少之间存在关联。

Which is incredible given that these systems, the anterior pituitary, the adrenal glands, these are ancient systems that to our knowledge, we can't directly control with our mind.

这是令人难以置信的，因为这些系统，垂体前叶，肾上腺，这些都是古老的系统，据我们所知，我们无法直接用我们的思想控制。

I can't simply close my eyes and grit my teeth and cause the release of growth hormone.

我不能简单地闭上眼睛，咬紧牙关，导致生长激素的释放。

I can't simply decide to deploy cortisol from my adrenals.

我不能简单地决定从我的肾上腺中调配皮质醇。

Although if I thought about something very, very stressful for a long time, there'd probably be some cortisol secretion.

不过，如果我长时间思考一些非常非常有压力的事情，可能会分泌一些皮质醇。

But to our knowledge, there is no way to use thoughts, to use beliefs, to use understanding of knowledge to cause changes in our endocrine glands.

但据我们所知，没有办法用思想、用信念、用对知识的理解来引起我们内分泌腺的变化。

Our hormone glands, the pituitary, the adrenals.

我们的荷尔蒙腺、垂体、肾上腺。

But here we have a case where a drug that increases certain hormones and decreases other hormones simply by virtue of the fact that it was injected into somebody, leads to a case where subsequent injections, at least in the short run, lead to the exact same hormone changes simply because in the mind and/or body of these individuals, injection comes to equal increase in growth hormone, decrease in cortisol, independent of what's being injected.

但在这里我们有一个案例，一种药物仅仅因为注射到某人体内而增加某些激素并减少其他激素，导致随后的注射，至少在短期内，导致完全相同的激素变化，仅仅是因为在这些人的思想和/或身体中，注射会导致生长激素的同等增加，皮质醇的减少，与注射的物质无关。

Now, a key point is that had on the final day of the experiment, the subject's been injected with a different drug that, for instance, increases serotonin or reduces epinephrine.

现在，关键的一点是，在实验的最后一天，受试者被注射了另一种药物，例如，增加血清素或减少肾上腺素。

I doubt that They would have instead experienced increases in growth hormone and reductions in cortisol.

我怀疑他们是否会经历生长激素的增加和皮质醇的减少。

That's simply not the case.

事实并非如此。

The fact that there was only saline in there meant that there was an opportunity for the syringe and the injection, we don't know which, to lead to some sort of paired association in the brain and body that led to increased growth hormone, decreased cortisol, which mimicked the drug effect.

事实上，那里只有生理盐水，这意味着注射器和注射（我们不知道是哪一种）有机会在大脑和身体中产生某种配对关联，导致生长激素增加，皮质醇减少，这模仿了药物效应。

But the whole scenario here, as wild as it is, really speaks to the fact that oftentimes we think a given treatment is causing a given effect only because of the action of the drug or the action of a given behavioral protocol.

但这里的整个场景，尽管很疯狂，却确实说明了这样一个事实：我们常常认为某种特定的治疗方法之所以会产生特定的效果，只是因为药物的作用或特定的行为方案的作用。

But in fact, the drug and the protocol exist in a big context of different things that the brain and body are integrating and trying to make sense of, and that often gets lumped together.

但事实上，药物和方案存在于大脑和身体正在整合并试图理解的不同事物的大背景下，并且经常被混为一谈。

I often say that your brain is, yes, a prediction machine, but it's also trying to simplify things in those predictions.

是的，我经常说你的大脑是一台预测机器，但它也试图简化这些预测。

It's not taking into account all the information.

它没有考虑到所有信息。

It's often lumping information together and coming up with ideas about what's going to happen and why, and doing this subconsciously in a way that, as you just learned, can have profound effects on what happens within us, even at the level of something as basic as hormone release.

它通常是将信息集中在一起，并提出关于将要发生的事情和原因的想法，并以一种潜意识的方式进行，正如您刚刚了解到的那样，可以对我们体内发生的事情产生深远的影响，甚至在像激素释放这样基本的水平上也是如此。

Now, what I just described is a pretty extreme example, and it's a very experimental condition type example.

现在，我刚才描述的是一个非常极端的例子，它是一个非常实验性的条件类型的例子。

It's rare that people are undergoing these kinds of organized receival of information followed by specific drug treatments and placebo injections, et cetera.

人们很少会经历这种有组织的信息接收，然后进行特定的药物治疗和安慰剂注射等。

But you've all experienced the placebo effect in action by way of what's called classical conditioning, simply by virtue of the fact that the smells of certain foods and your past experience of certain foods can lead to the release of a hormone called insulin.

但你们都通过所谓的经典条件反射体验过安慰剂效应，仅仅因为某些食物的气味和您过去对某些食物的经历会导致一种称为胰岛素的激素的释放。

Insulin is a hormone that is involved in regulating blood glucose, blood sugar.

胰岛素是一种参与调节血糖的激素。

And typically, when insulin levels go up in the bloodstream, glucose levels are going to go down because of the way that insulin controls blood sugar levels.

通常，当血液中的胰岛素水平升高时，由于胰岛素控制血糖水平的方式，血糖水平会下降。

Now, if you've ever had the experience of walking past a bakery or a pizza shop where a delicious smell is wafting out into the environment, you may notice that it, quote, unquote, "makes you hungry." And indeed, it does make you hungry, because presumably you've had the experience of certain smells being associated with the consuming of certain foods, maybe bakery foods, maybe pizza, maybe steak, whatever it is, and the consumption of those foods actually leads to increases in insulin in your bloodstream.

现在，如果您曾经有过走过面包店或披萨店的​​经历，那里散发着美味的气味，您可能会注意到，无论引用还是不引用，它“让您感到饥饿”。事实上，它确实会让你感到饥饿，因为你可能已经体验过某些气味与食用某些食物有关，也许是烘焙食品，也许是披萨，也许是牛排，无论是什么，这些食物的食用实际上会导致你血液中胰岛素的增加。

Well, there's the so-called conditioning effect, whereby the smell of the food itself starts to lead to increases in insulin.

嗯，这就是所谓的调节效应，食物本身的气味开始导致胰岛素增加。

But the conditioning effects of different stimuli, different things in the context of eating and specific foods leading to increases in insulin, is actually highly, highly modifiable.

但不同刺激、饮食中的不同事物以及导致胰岛素增加的特定食物的调理作用实际上是高度可改变的。

So much so that experiments have been done where, for instance, somebody eats a particular food, or in some cases, it's just directly injected with insulin, but more often consumes a particular food, and just prior to consuming or during consuming that food, there's a bell ringing or a buzzer in the background going off.

以至于已经进行了一些实验，例如，某人吃某种特定的食物，或者在某些情况下，只是直接注射胰岛素，但更常见的是食用某种特定的食物，并且就在食用该食物之前或食用该食物期间，背景中会响起铃声或蜂鸣器。

And they do that a few times, and then, I'm sure you're anticipating what's coming, somebody can just hear the buzzer or the bell can simply ring, and that person will experience an increase in insulin.

他们这样做了几次，然后，我相信你已经预料到会发生什么，有人可以听到蜂鸣器或铃声，那个人就会经历胰岛素的增加。

So what I'm describing is a conditioned insulin response.

所以我所描述的是条件性胰岛素反应。

A stimulus, such as a bell or a buzzer, that on its own should have zero effect on insulin release, has been paired with a food that genuinely increases insulin within the bloodstream.

铃声或蜂鸣器等刺激本身对胰岛素释放的影响为零，但与真正增加血液中胰岛素水平的食物搭配使用。

And then even if the food isn't present, the stimulus, the buzzer, the bell, et cetera, can evoke the insulin response.

然后，即使没有食物，刺激、蜂鸣器、铃声等也可以引起胰岛素反应。

Now, this is an important example to understand because it's a common one that we've presumably all experienced and that exists within the wiring of our brain right now.

现在，这是一个需要理解的重要示例，因为这是我们想必都经历过的常见情况，并且现在存在于我们大脑的线路中。

But it's different than the smell evoking the insulin response, because delicious food which evokes an insulin response, having a particular odor, that makes sense in the context of food.

但它与引起胰岛素反应的气味不同，因为美味的食物会引起胰岛素反应，具有特殊的气味，这在食物的背景下是有意义的。

But here we're talking about something completely unrelated to the food, not the odor, not the taste, not the appearance, just something that happened to be in the environment in which you ate the food, leading to an increase in insulin.

但这里我们谈论的是与食物完全无关的东西，不是气味，不是味道，不是外观，只是恰好存在于你吃食物的环境中的东西，导致胰岛素增加。

And it just screams placebo effect.

它只是尖叫安慰剂效应。

But it also screams that the placebo effect is strongly modifiable according to context.

但它也尖叫着安慰剂效应可以根据环境进行强烈修改。

Again, the prefrontal cortex being the seat of the anticipation or placebo effect, and the prefrontal cortex taking into account lots of things in the environment, trying to understand what's here, what sounds, what smells, what colors, and then lumping all of that together, and eventually, through the activation of specific neural circuits, leading to a very basic hormonal response, in this case, the release of insulin.

同样，前额叶皮层是预期或安慰剂效应的所在地，前额叶皮层考虑到环境中的许多事物，试图了解这里是什么，什么声音，什么气味，什么颜色，然后将所有这些集中在一起，最终通过激活特定的神经回路，导致非常基本的激素反应，在这种情况下，是胰岛素的释放。

And of course, what I just described is classical conditioning a la Pavlov.

当然，我刚才描述的是巴甫洛夫的经典条件反射。

Pavlov won the Nobel Prize for his description of classical conditioning, in which dogs could be induced to salivate in anticipation of food by way of a stimulus completely unrelated to food itself.

巴甫洛夫因其对经典条件作用的描述而获得诺贝尔奖，其中通过与食物本身完全无关的刺激，可以诱导狗在期待食物时流口水。

Not the smell, not the look, not the taste.

不是气味，不是外观，不是味道。

Rather, just a bell rung before the consumption of food in a dog eventually led to a situation where the mere ringing of a bell could evoke salivation from those dogs.

相反，在狗吃食物之前敲响铃声最终会导致仅仅敲响铃声就能引起狗流口水的情况。

So are we all just like salivating dogs?

那么我们是否都像流口水的狗一样呢？

I guess we are.

我想我们是。

Okay, so given that context is a powerful modifier of the placebo effect, and in fact may be central to the placebo effect, I just want to rattle off a few of the known placebo effects that have been demonstrated which show the extent to which your brain and my brain are coming up with ideas about what given drugs or given behavioral treatments ought to do, and in that way, shaping what happens when you take a placebo.

好吧，考虑到背景是安慰剂效应的强大调节剂，而且实际上可能是安慰剂效应的核心，我只想快速列举一些已被证明的已知安慰剂效应，这些效应表明你的大脑和我的大脑在多大程度上想出关于给定药物或给定行为治疗应该做什么的想法，并以这种方式塑造当你服用安慰剂时会发生什么。

Or, and this is an idea that we'll go into in a bit more detail in a few minutes, perhaps context is also changing the way that active drugs, not placebos, but active drugs, are impacting your brain and body.

或者，我们将在几分钟内更详细地讨论这个想法，也许环境也在改变活性药物（不是安慰剂，而是活性药物）影响您的大脑和身体的方式。

The examples I'd like to give are from laboratory studies about the placebo effect, but that relate to very common at-home and normal life scenarios.

我想给出的例子来自关于安慰剂效应的实验室研究，但这与非常常见的家庭和正常生活场景有关。

Okay?

好的？

They are not unique to the laboratory, and they are the following.

它们并不是实验室独有的，它们如下。

First of all, placebo effects are strongly modifiable by the expectation of the quality of a given treatment.

首先，安慰剂效应可以通过对特定治疗质量的预期来强烈改变。

For instance, if you are given a placebo that has a brand name on it or a name of A drug, it could even be a made-up name.

例如，如果给你的安慰剂上有品牌名称或 A 药物名称，它甚至可能是一个虚构的名称。

You don't know what the drug does, but it has trademark TM there in the corner of the name, so brand name as opposed to generic placebo.

你不知道这种药物的作用是什么，但它的名称一角有商标 TM，因此是品牌名称，而不是通用安慰剂。

The brand name placebo has a stronger effect.

品牌安慰剂的效果更强。

Moreover, if a placebo is placed into a package, not just put in front of you on a little tray or in a little dish, but rather in a package where you have to push it through that little foil wrapping, or you have to take it out of a bottle, and especially if that wrapping or bottle has a label on it, or it looks as if it's a quote unquote "real drug," well, then the placebo has an even greater placebo effect.

此外，如果安慰剂被放入一个包装中，不仅仅是放在你面前的一个小托盘或一个小盘子里，而是放在一个包装中，你必须将它推过那个小铝箔包装，或者你必须将它从瓶子中取出，特别是如果包装或瓶子上有一个标签，或者它看起来好像是一个引用不引用的“真正的药物”，那么安慰剂就有更大的安慰剂效应。

The color of a given drug can even have an effect based on our association or expectation of what different colors relate to in terms of our physiology.

特定药物的颜色甚至可以根据我们对不同颜色与我们生理学相关的关联或预期而产生影响。

For instance, if subjects are given pills that they are told will help them fall and stay asleep, and some subjects are given blue pills, other subjects are given red pills, other subjects are given yellow pills.

例如，如果给受试者服用可以帮助他们入睡和保持睡眠的药丸，则一些受试者服用蓝色药丸，其他受试者服用红色药丸，其他受试者服用黄色药丸。

The subjects that take the blue pills tend to sleep better even though all the pills, regardless of color, are placebo.

服用蓝色药丸的受试者往往睡得更好，尽管所有药丸（无论颜色如何）都是安慰剂。

They contain no active substance.

它们不含活性物质。

So for some reason, most people associate the color blue with sleep, whereas, or I should say by contrast, if people are given a blue, a red, or a yellow pill and they are told it's a stimulant, the subjects taking the red pill, here I mean the actual literal red pill.

因此，出于某种原因，大多数人将蓝色与睡眠联系在一起，而，或者我应该说，相比之下，如果给人们服用蓝色、红色或黄色药丸，并告诉他们这是一种兴奋剂，那么受试者服用红色药丸，这里我指的是真正的红色药丸。

I'm not talking about any kind of cultural red pill.

我不是在谈论任何一种文化红色药丸。

I haven't seen "The Matrix" yet.

我还没看过《黑客帝国》。

People tell me I need to see it.

人们告诉我我需要看看它。

But I'm talking about taking the red pill, quote unquote.

但我说的是服用红色药丸，引用不引用。

I'm talking about taking a pill that is the color red in an experiment.

我说的是在实验中服用一种红色的药丸。

The people that take that pill experience a greater placebo-induced stimulant effect as opposed to when subjects take a blue or a yellow pill.

与服用蓝色或黄色药丸的受试者相比，服用该药丸的人会感受到更大的安慰剂引起的兴奋作用。

For some reason, the color red is associated with a quote unquote "upper effect or stimulant effect." Moreover, if subjects are given a blue, a red, or a yellow pill and they are told that the pill will have an antidepressant effect, the subjects that took the yellow placebo get the biggest antidepressant effect.

出于某种原因，红色与“上层效应或刺激效应”相关联。此外，如果给受试者服用蓝色、红色或黄色药丸，并告诉他们该药丸具有抗抑郁作用，那么服用黄色安慰剂的受试者会获得最大的抗抑郁效果。

So the color of a given pill even impacts the direction, or in this case, the magnitude of the placebo effect.

因此，给定药丸的颜色甚至会影响安慰剂效应的方向，或者在这种情况下，影响安慰剂效应的大小。

And I should mention that in every one of those studies, yes, there was information about what the given pill should do.

我应该提到的是，在每一项研究中，是的，都有关于给定药物应该做什么的信息。

It was not the case that if people took the red pill, they felt a stimulant effect, if they took a blue pill, they felt a sleepy effect, and if they took the yellow pill, they felt an antidepressant effect.

事实并非如此，如果人们服用红色药丸，他们会感到兴奋作用，如果他们服用蓝色药丸，他们会感到昏昏欲睡，如果他们服用黄色药丸，他们会感到抗抑郁作用。

These were three separate experiments, one on sleep, where subjects were given one of the three colors of pills.

这是三个独立的实验，其中一个是关于睡眠的，受试者服用三种颜色的药丸中的一种。

Blue had the strongest effect.

蓝色的效果最强。

Or a study of stimulant effects, they were told it's a study of pills that will increase alertness and attention.

或者是一项关于兴奋剂作用的研究，他们被告知这是一项可以提高警觉性和注意力的药物的研究。

They were given one of three different colors.

他们被赋予了三种不同颜色中的一种。

The red pills had the biggest effect.

红色药丸的效果最大。

And the third experiment, subjects were told this is a pill that will alleviate, to some degree, your symptoms of depression.

在第三个实验中，受试者被告知这是一种可以在一定程度上缓解抑郁症状的药丸。

The people who took the yellow pill experienced the greatest relief of depressive symptoms.

服用黄色药丸的人的抑郁症状得到最大程度的缓解。

Now that's pretty wild, but what perhaps is even wilder is the more invasive a placebo intervention is, the greater the placebo effect.

现在这相当疯狂，但也许更疯狂的是安慰剂干预的侵入性越大，安慰剂效应就越大。

So capsules have a bigger effect than tablets.

所以胶囊的作用比片剂更大。

I don't know if that's more invasive, but I guess it looks more medicinal to have a capsule versus a tablet.

我不知道这是否更具侵入性，但我想胶囊看起来比片剂更具药用价值。

Who knows why, but that's what's been observed.

谁知道为什么，但这就是观察到的情况。

An injection of a placebo has a greater effect than a consumption of a capsule or a tablet, of course.

当然，注射安慰剂比服用胶囊或片剂具有更大的效果。

And if people are placed into a medical device or machine, especially in cases where one of their limbs or both of their limbs or even their whole body is placed into a device, even though the device is doing absolutely nothing specifically to our biological system, it is inert.

如果人们被放入医疗设备或机器中，特别是当他们的一个肢体或双肢甚至整个身体被放入设备中时，即使该设备对我们的生物系统绝对没有任何作用，它也是惰性的。

A bunch of buttons and a bunch of noises and a bunch of humming as if something were happening, but nothing is happening that directly relates to any one specific biological system except, and now you know what I'm about to say, except expectation of what the machine is doing.

一堆按钮、一堆噪音和一堆嗡嗡声，好像有什么事情正在发生，但没有任何事情发生与任何一个特定的生物系统直接相关，除了，现在你知道我要说什么了，除了对机器正在做什么的期望。

Well, that has the greatest placebo effect of all.

嗯，这具有最大的安慰剂效应。

So for some reason, as the level of invasiveness or the, let's just say, the complexity of a given treatment is increased, well then the magnitude of the placebo effect is also increased.

因此，出于某种原因，随着侵入性水平或特定治疗的复杂性增加，那么安慰剂效应的程度也会增加。

And what this tells us is that the human brain has come to associate level of invasiveness, level of complexity of a given treatment or machine to equate to bigger outcomes.

这告诉我们，人类大脑已经将特定治疗或机器的侵入性水平、复杂性水平与更大的结果联系起来。

And in some sense, that's completely logical.

从某种意义上说，这是完全合乎逻辑的。

But again, we have to remember, in absolutely zero of these conditions, whether or not it's a tablet, a capsule, an injection, or a medical device, is there anything being done to these human subjects that impacts a specific biological function except one?

但我们必须再次记住，在这些条件绝对为零的情况下，无论是片剂、胶囊、注射剂还是医疗器械，除了一个以外，是否对这些人类受试者做了任何影响特定生物功能的事情？

And that one, again, is the activation of specific neural circuits in the prefrontal cortex that then are able to communicate with other areas of the brain and body through bonafide biological mechanisms of neurotransmitter release and electrical activity in neurons.

这又是前额皮质中特定神经回路的激活，然后这些神经回路能够通过神经递质释放和神经元电活动的真正生物机制与大脑和身体的其他区域进行通信。

This is what the brain does.

这就是大脑的作用。

And of course, the prefrontal cortex being part of the brain, those are the mechanisms it employs to change the activity of hormone-releasing glands, to change the activity of other neurons.

当然，前额叶皮层是大脑的一部分，它利用这些机制来改变激素释放腺的活动，从而改变其他神经元的活动。

In other words, the belief effects, the expectations are real.

换句话说，信念的影响、期望是真实的。

They are having effects through true biological circuitry.

它们通过真正的生物回路产生影响。

It's just that the pills and the treatments and the machines are not doing anything specific at all except activating expectation.

只是药丸、治疗方法和机器除了激活期望之外根本没有做任何具体的事情。

So we've been talking about the placebo effect, and I've been giving examples of strong placebo effects.

所以我们一直在谈论安慰剂效应，我也给出了强烈安慰剂效应的例子。

And while all of what I told you is substantiated by data, I do not want to give you the impression that the placebo effect is limitless, because it is not limitless.

虽然我告诉你的所有内容都有数据证实，但我不想给你留下安慰剂效应是无限的印象，因为它不是无限的。

For instance, placebos have been used to help in the treatment of cancer, but their effects within the treatment of cancer are limited to a very specific set of symptoms and contexts.

例如，安慰剂已被用来帮助治疗癌症，但它们在癌症治疗中的作用仅限于一组非常特定的症状和背景。

So for instance, people who are told a given drug will help them with their cancer by reducing their symptoms of chemotherapy or radiation therapy often experience reductions in the negative symptoms of chemotherapy or radiation therapy.

例如，如果人们被告知某种药物可以通过减轻化疗或放疗的症状来帮助他们治疗癌症，那么化疗或放疗的阴性症状通常会减轻。

Reduced pain, reduced nausea, and by consequence, improved feelings of well-being compared to people who do not receive the placebo and who are not told, "Hey, this drug," which in reality is a placebo, is going to help you with your treatment.

与未接受安慰剂且没有被告知“嘿，这种药物”（实际上是安慰剂）的人相比，疼痛减轻，恶心减少，从而改善了幸福感，这将有助于您的治疗。

It's going to make it less uncomfortable.

这会减少一些不舒服的感觉。

Okay, so in the context of cancer treatment, placebo can reduce the discomfort of various cancer treatments.

好的，在癌症治疗的背景下，安慰剂可以减少各种癌症治疗的不适。

However, placebos cannot reduce the size or eliminate tumors.

然而，安慰剂不能缩小或消除肿瘤。

If people who unfortunately have tumors, AKA cancer, are given a placebo and told, "This drug," which actually is a placebo unbeknownst to them, "is going to reduce the size of your tumors or eliminate your tumors," that placebo is not effective in reducing the size or eliminating those tumors.

如果不幸患有肿瘤（又称癌症）的人服用安慰剂，并被告知“这种药物”（实际上是他们不知道的安慰剂）“将减小肿瘤的大小或消除肿瘤”，那么安慰剂对于减小肿瘤的大小或消除这些肿瘤是无效的。

This is very important to understand because, as you recall, placebo effects are expectation effects.

理解这一点非常重要，因为正如您所记得的，安慰剂效应是期望效应。

Expectation effects are driven in large part by the prefrontal cortex and its connectivity to other areas of the brain and thereby to the body.

预期效应在很大程度上是由前额叶皮层及其与大脑其他区域乃至身体的连接性驱动的。

But the outputs of the prefrontal cortex are limited.

但前额皮质的输出是有限的。

There are a certain number of them, and indeed there are many of them, but those connections do not extend to tumors themselves or biological systems or circuitries that allow one's beliefs to reduce the size of or eliminate tumors.

它们有一定数量，而且确实有很多，但这些联系并没有延伸到肿瘤本身或生物系统或电路，使一个人的信念能够减少肿瘤的大小或消除肿瘤。

And this is very important because unfortunately, there are many sufferers of cancer, and there are many theories about accelerating the treatment of, or improving the treatment of, or even curing cancer using so-called mind-body techniques or mind-body tools.

这是非常重要的，因为不幸的是，有很多癌症患者，并且有很多关于使用所谓的身心技术或身心工具来加速治疗、改善治疗、甚至治愈癌症的理论。

And we need to be fair to the data which have conclusively shown that reductions in stress, improvements in sleep, social support, a number of things can improve cancer treatment outcomes.

我们需要公平对待数据，这些数据最终表明，减轻压力、改善睡眠、社会支持等许多因素都可以改善癌症治疗结果。

Now, those are not placebo effects.

现在，这些都不是安慰剂效应。

Those are all practices for which we know there are reductions in inflammation, reductions in stress hormones that lead to improved outcomes in the context of radiation therapy, in the context of immunotherapy, in the context of any bona fide treatments known to reduce tumor size.

我们知道这些都是可以减少炎症、减少应激激素的做法，从而在放射治疗、免疫治疗以及任何已知可以缩小肿瘤大小的真正治疗中改善结果。

So what we need to do is separate out three things here.

所以我们需要做的就是在这里分离出三件事。

Behavioral practices such as meditation, sleep, social support, known to reduce inflammation and stress, and that can improve cancer outcomes.

冥想、睡眠、社会支持等行为习惯可以减少炎症和压力，并可以改善癌症的结果。

Those are not placebo effects.

这些不是安慰剂效应。

Those are real effects.

这些都是真实的效果。

There are also drugs, radiation, chemotherapy, immunotherapy, and devices known to reduce tumor size and hopefully eliminate cancerous tumors.

还有已知的药物、放射、化疗、免疫疗法和设备可以缩小肿瘤大小并有望消除癌性肿瘤。

That would be the hope.

这就是希望。

Those are real effects.

这些都是真实的效果。

And then there are the placebo effects, the knowledge and belief and expectation about what a given treatment will do.

然后是安慰剂效应，即对特定治疗效果的了解、信念和期望。

In some cases, it's knowledge about what a given drug will do that improves the outcome achieved with that drug.

在某些情况下，了解某种药物的作用可以改善该药物所达到的效果。

In some cases, it's people being given a completely inert substance or solution like saline solution, but being told, "This is going to help with your nausea symptoms.

在某些情况下，人们会被给予完全惰性的物质或溶液，如盐水溶液，但被告知，“这将有助于缓解恶心症状。

This is going to help with your pain during your immunotherapy, radiation, etc." And those are real effects, but they can only be explained by virtue of expectation and knowledge, AKA placebo effects.

这将有助于缓解您在免疫治疗、放射治疗等过程中的疼痛。”这些都是真实的效果，但它们只能通过期望和知识来解释，也就是安慰剂效应。

And I want to emphasize that those placebo effects are not acting directly on tumors to reduce their size or eliminate them.

我想强调的是，这些安慰剂效应并不直接作用于肿瘤以缩小或消除肿瘤。

Another example of how placebo effects can be very powerful and yet still have limits to them is yet another study from Dr. Ted Kaptchuk's lab at Harvard Medical School.

哈佛医学院 Ted Kaptchuk 博士实验室的另一项研究是安慰剂效应如何非常强大但仍然有限的另一个例子。

And by the way, many, not all of the studies that I've been describing today have been done by the Kaptchuk Lab.

顺便说一句，我今天描述的许多（并非全部）研究都是由 Kaptchuk 实验室完成的。

He's done beautiful work on placebo effects for a very long time now.

很长一段时间以来，他在安慰剂效应方面做了出色的工作。

He's considered a real pioneer and a leader in the study of placebo, and he's also been a big proponent of exploring the placebo effect, not simply as a contrast to drug effects or device effects, but as their own specific effect that perhaps can be leveraged in the context of treating disease.

他被认为是安慰剂研究的真正先驱和领导者，他也是探索安慰剂效应的大力支持者，不仅仅是将其与药物效应或设备效应进行对比，而是将其视为其自身的特定效应，也许可以在治疗疾病的背景下加以利用。

So hats off, literally plural hats off because they've had so many discoveries in the context of placebo and their powerful effects and their possible uses from the Kaptchuk Lab and their colleagues there at Harvard Medical School.

所以，脱帽，实际上是复数脱帽，因为卡普特丘克实验室和哈佛医学院的同事在安慰剂及其强大的作用和可能的用途方面取得了如此多的发现。

Just incredible work.

简直是令人难以置信的工作。

And one of my favorite studies from the Kaptchuk Lab is one published in the "New England Journal of Medicine" some years ago in which they took people who had asthma.

我最喜欢的卡普特丘克实验室的一项研究是几年前发表在《新英格兰医学杂志》上的一项研究，其中他们以患有哮喘的人为对象。

So these are people diagnosed with asthma.

这些是被诊断患有哮喘的人。

These are people who have challenges breathing, and they experience a lot of discomfort in trying to breathe normally unless they are taking their asthma medication.

这些人呼吸困难，除非服用哮喘药物，否则在尝试正常呼吸时会感到很多不适。

In this study, they took people off of their asthma medication, of course, not indefinitely, but for a short period of time.

在这项研究中，他们让人们停止服用哮喘药物，当然，不是无限期地，而是短时间内。

And as expected, those people experienced challenges in breathing and discomfort associated with the challenges in breathing.

正如预期的那样，这些人经历了呼吸困难以及与呼吸困难相关的不适。

One group received no treatment.

一组未接受治疗。

They were just taken off their asthma meds and evaluated, and then of course, put back on their asthma meds.

他们刚刚停止服用哮喘药物并进行评估，然后当然又重新服用哮喘药物。

Another group received a placebo treatment, and another group received a drug known to improve the symptoms of asthma.

另一组接受安慰剂治疗，另一组接受已知可改善哮喘症状的药物。

Now, what was interesting is that the people who received the drug for the treatment of asthma, not surprisingly, had improvements in breathing and less discomfort.

现在，有趣的是，接受这种药物治疗哮喘的人，呼吸得到改善，不适感减轻，这并不奇怪。

Exactly what you'd expect.

正是您所期望的。

However, the people with placebo also experienced less discomfort in breathing, but their patterns of breathing didn't change.

然而，服用安慰剂的人呼吸不适也减轻了，但他们的呼吸模式没有改变。

So again, this really speaks to the fact that placebo effects can be very powerful, but that they're very specific.

再说一次，这确实说明了这样一个事实：安慰剂效应可能非常强大，但它们非常具体。

They are not simply wiping out a condition like asthma or completely eliminating all symptomology of a given condition like cancer.

它们并不是简单地消除哮喘等疾病或完全消除癌症等特定疾病的所有症状。

This study illustrates very clearly that placebo is effective in reducing the discomfort associated with the challenges of breathing, but not eliminating challenges with breathing per se.

这项研究非常清楚地表明，安慰剂可以有效减少与呼吸挑战相关的不适，但不能消除呼吸挑战本身。

Whereas, as I mentioned before, there are drugs, bona fide prescription drug treatments that can both restore normal patterns of breathing and relieve the discomfort.

然而，正如我之前提到的，有一些药物，真正的处方药治疗既可以恢复正常的呼吸模式，又可以缓解不适。

So what this really speaks to is the fact that the prefrontal cortex and its involvement in expectation can have powerful effects on things like pain, powerful effects on things like dopamine, powerful effects on any number of different brain and body systems, but not all of them.

所以这真正说明的是这样一个事实，即前额叶皮层及其对期望的参与可以对疼痛等事物产生强大的影响，对多巴胺等事物产生强大的影响，对许多不同的大脑和身体系统产生强大的影响，但不是所有的系统。

Our beliefs and expectations are powerful as evidenced by the placebo effect itself, but they are not what we call omnipotent.

正如安慰剂效应本身所证明的那样，我们的信念和期望是强大的，但它们并不是我们所说的万能的。

They can't do anything and everything.

他们什么也做不了。

One of my all-time favorite studies in the context of placebo is a paper that was published pretty recently, and the title of this paper is "Nicotine-Related Beliefs Induce Dose-Dependent Responses in the Human Brain." And if ever there was a paper that pointed to the fact that our belief systems can really shape the way that different drugs, different supplements, different behavioral protocols can impact the way that our physiology and our brain work, it's this paper.

我一直以来最喜欢的关于安慰剂的研究之一是最近发表的一篇论文，这篇论文的标题是“尼古丁相关信念在人脑中引起剂量依赖性反应”。如果有一篇论文指出这样一个事实，即我们的信念系统确实可以塑造不同药物、不同补充剂、不同行为方案影响我们的生理和大脑工作方式的方式，那就是这篇论文。

It's a pretty straightforward study.

这是一项非常简单的研究。

It was, of course, carried out in humans.

当然，这是在人类身上进行的。

And what they did is they had people vape nicotine.

他们所做的就是让人们吸食尼古丁。

Nicotine is a known cognitive enhancer.

尼古丁是一种已知的认知增强剂。

Nicotine, so named because it binds to nicotinic acetylcholine receptors in the brain, which is just fancy nerd speak for the receptors, the little parking spots for acetylcholine, a neuromodulator that's involved in attention, and by virtue of being involved in attention, is critical for the performance of certain focused tasks.

尼古丁之所以如此命名，是因为它与大脑中的烟碱乙酰胆碱受体结合，这只是一个奇特的书呆子所说的受体，乙酰胆碱的小停车位，一种与注意力有关的神经调节剂，并且由于参与注意力，对于执行某些集中任务至关重要。

Okay?

好吧？

So most people associate nicotine with smoking, vaping, dipping, or snuffing.

因此，大多数人将尼古丁与吸烟、吸电子烟、吸食或吸鼻子联系在一起。

Here we're talking about nicotine that's vaped.

在这里我们谈论的是电子烟中的尼古丁。

However, I want to be very clear, I am not encouraging people to vape nicotine.

不过，我想澄清的是，我并不是鼓励人们吸尼古丁。

Yes, vaping is probably healthier for you than smoking, but vaping is not good for you.

是的，吸电子烟可能比吸烟更健康，但吸电子烟对你不利。

It would be better to not vape than to vape at all.

不吸电子烟比根本不吸电子烟要好。

I did an entire episode about nicotine, so I want to leave aside the issue of whether or not you decide to use nicotine.

我做了一整集都是关于尼古丁的，所以我想把你是否决定使用尼古丁的问题放在一边。

Okay?

好吧？

That's all covered in the episode on nicotine.

这一切都在关于尼古丁的剧集中进行了介绍。

I'll provide a link to that in the show note captions.

我将在节目注释标题中提供指向该链接的链接。

There's a lot of considerations there.

这里面有很多考虑因素。

It does increase blood pressure, and it increases vasoconstriction, and on and on.

它确实会增加血压，并增加血管收缩，等等。

But as I mentioned, nicotine is a cognitive enhancer.

但正如我提到的，尼古丁是一种认知增强剂。

It can increase focus and attention, and in doing so, it can allow your brain to do certain things better, like task switching, like focusing in the context of a lot of distraction, et cetera.

它可以增加注意力和注意力，这样做可以让你的大脑更好地完成某些事情，比如任务切换，比如在很多分心的情况下集中注意力，等等。

So in this study, "Nicotine-Related Beliefs Induce Dose-Dependent Responses in the Human Brain," subjects used a vape to ingest nicotine, and they were told that they were either ingesting a low, medium, or high concentration of nicotine.

因此，在这项“与尼古丁相关的信念会引起人脑剂量依赖性反应”的研究中，受试者使用电子烟摄入尼古丁，并被告知他们摄入的是低浓度、中浓度或高浓度的尼古丁。

And a really nice thing about this study is that they actually measured how much nicotine people vaped.

这项研究的一个非常好的事情是，他们实际上测量了人们吸电子烟的尼古丁量。

So they were able to measure how much nicotine made it into the bloodstreams of these people.

因此他们能够测量进入这些人血液中的尼古丁含量。

And they were also able to evaluate brain activity in areas of the brain known to have these nicotinic receptors and to also be involved in certain cognitive tasks.

他们还能够评估已知具有这些烟碱受体并参与某些认知任务的大脑区域的大脑活动。

So just to get to the grand conclusion of the study, what they found is that people who were told that they ingested a high concentration or a medium concentration of nicotine performed better on a cognitive task that we know is dependent on or can be modified by the amount of acetylcholine transmission in a certain area of the brain than did individuals who were told that they ingested a small concentration of nicotine.

因此，为了得出这项研究的总体结论，他们发现，那些被告知摄入高浓度或中等浓度尼古丁的人在认知任务上表现得更好，我们知道这些认知任务依赖于或可以通过大脑特定区域的乙酰胆碱传输量来改变，而那些被告知摄入低浓度尼古丁的人比那些被告知摄入低浓度尼古丁的人表现更好。

Now, the interesting part of the study is that everybody consumed the same amount of nicotine.

现在，这项研究有趣的部分是每个人都消耗了相同量的尼古丁。

So here we have a situation where there is a so-called dose-dependent placebo effect.

所以这里我们遇到了所谓的剂量依赖性安慰剂效应的情况。

Everyone gets the same amount of nicotine, but people are either told, meaning they were lied to in some cases, that they got a small, medium, or high concentration of nicotine.

每个人都会摄入相同量的尼古丁，但人们要么被告知，这意味着在某些情况下他们被欺骗了，他们摄入了低浓度、中浓度或高浓度的尼古丁。

And for the group that was told that they received a medium concentration of nicotine, they performed better on a cognitive task than did the people who were told they received a smaller concentration of nicotine.

对于那些被告知接受中等浓度尼古丁的人来说，他们在认知任务上的表现比那些被告知接受较低浓度尼古丁的人要好。

Moreover, people who were told that they received a high concentration of nicotine performed better than either the individuals who were told they received a medium or small concentration of nicotine.

此外，被告知接受高浓度尼古丁的人比被告知接受中等或低浓度尼古丁的人表现更好。

But as I mentioned before, everyone received the same concentration of nicotine.

但正如我之前提到的，每个人都摄入了相同浓度的尼古丁。

So this tells us that not only are placebo effects related to expectation, but that the expectation somebody has of the degree of an effect they should experience actually creates a different level of experience.

因此，这告诉我们，安慰剂效应不仅与期望有关，而且人们对自己应该经历的效应程度的期望实际上会产生不同程度的体验。

Put differently, if you're told that you're getting a small amount of drug, a medium amount of drug, or a high amount of drug, and that the size of an effect gets bigger as you go from small, medium, to high, well, then you will experience the small, medium, or high effect, depending on which group you were in, even if you all got the same dose of drug.

换句话说，如果你被告知你正在服用少量药物、中等剂量或大量药物，并且效果的大小随着你从小、中、到高的变化而变大，那么你将体验到小、中或高的效果，具体取决于你所在的组，即使你们都服用相同剂量的药物。

Now, I need to be very clear.

现在，我需要非常清楚。

Everybody got actual nicotine.

每个人都摄入了真正的尼古丁。

The placebo effect here is related to what people believed about the dose of nicotine they got, but everyone got active nicotine.

这里的安慰剂效应与人们对尼古丁剂量的看法有关，但每个人都摄入了活性尼古丁。

Now, here's where it gets really cool.

现在，这就是它变得非常酷的地方。

As I mentioned earlier, in this study, they imaged the brains of people that were in either the group that was told they got a small or medium or high concentration of nicotine.

正如我之前提到的，在这项研究中，他们对被告知摄入低浓度、中浓度或高浓度尼古丁的一组人的大脑进行了成像。

And what they found is that in the specific area of the brain that is known to respond to nicotine and that is involved in cognitive functioning related to the task that these subjects were given, they saw increased levels of activity of the neurons in that brain region that scaled up according to whether or not people were told they got a small, medium, or high amount of nicotine.

他们发现，在已知对尼古丁有反应的大脑特定区域中，该区域涉及与这些受试者所承担的任务相关的认知功能，他们发现该大脑区域的神经元活动水平有所增加，根据人们是否被告知他们摄入了少量、中量或大量尼古丁，神经元的活动水平也会增加。

Again, everyone got the same amount of nicotine.

同样，每个人都摄入了相同量的尼古丁。

They were simply told small, medium, or high, and the brain area itself changed its level of activity, which in turn changed the outcome on the cognitive task, which basically puts everything in a really nice box, wraps it up with wrapping paper beautifully, puts it in a bow, and says, "Okay, placebo effects are real, and placebo effects scale with the degree of expectation that one has." So anytime we are told that a small dose of something is going to lead to a small effect, a medium dose of something is going to lead to a bigger effect, and a high dose will lead to an even higher effect, well Whether or not that occurs is going to depend a lot on what sorts of "effects" we are expecting.

他们只是被告知小、中或高，大脑区域本身改变了其活动水平，这反过来又改变了认知任务的结果，这基本上把所有东西都放在一个非常漂亮的盒子里，用包装纸漂亮地把它包裹起来，把它打成蝴蝶结，然后说：“好吧，安慰剂效应是真实的，安慰剂效应会随着人们的期望程度而变化。”因此，每当我们被告知小剂量的某种东西会产生较小的效果，中等剂量的某种东西会产生更大的效果，而高剂量的东西会产生更大的效果，那么这种情况是否会发生在很大程度上取决于我们期望的“效果”类型。

Again, you can't use placebo to eliminate tumors.

再次强调，你不能使用安慰剂来消除肿瘤。

There's a limit to what placebo effects can occur.

安慰剂效应的发生是有限度的。

But assuming that the effect that one is interested in is modifiable by knowledge and expectation, well, the size of that effect will scale with how big you expect the effect to be.

但假设一个人感兴趣的效应可以通过知识和期望来改变，那么，该效应的大小将随着你期望该效应的大小而变化。

And it's not purely psychological.

这并不纯粹是心理上的。

That's the point here.

这就是重点。

It's not just about your beliefs and you doing something very different in the context of a task or in a sports event.

这不仅仅是关于你的信仰以及你在任务或体育赛事中做一些非常不同的事情。

Your physiology, in this case, the activity of a specific brain region, increases its level of output according to your expectation of the level of drug you consumed.

您的生理机能（在本例中为特定大脑区域的活动）会根据您对所消耗药物水平的预期增加其输出水平。

So, in my description of that recently published study, you notice I said placebo effects, but in many ways, what I was describing were belief effects.

所以，在我对最近发表的研究的描述中，你注意到我说的是安慰剂效应，但在很多方面，我描述的是信念效应。

It's a little bit difficult to disentangle what's a placebo effect and what's a belief effect.

区分什么是安慰剂效应和什么是信念效应有点困难。

In general, belief effects have to do with acquiring a bit more information or specificity of information about what the expectation should be.

一般来说，信念效应与获取更多关于期望应该是什么的信息或信息的特异性有关。

So, I suppose the study I just described could easily fall under the category of belief effects and not just placebo effects.

因此，我认为我刚才描述的研究很容易属于信念效应的范畴，而不仅仅是安慰剂效应。

But nonetheless, belief effects are powerful, and they're especially powerful because as one starts to layer in different amounts and different types of information as to what a given drug treatment or behavioral treatment will do, one can start to see really nuanced outcomes as well as truly surprising outcomes.

但尽管如此，信念效应是强大的，而且它们尤其强大，因为当人们开始将不同数量和不同类型的信息分层，以了解某种药物治疗或行为治疗的作用时，人们可以开始看到真正微妙的结果以及真正令人惊讶的结果。

And some of my favorite studies on belief effects were done by my colleague at Stanford.

我最喜欢的一些关于信念效应的研究是由我在斯坦福大学的同事完成的。

She's in the Department of Psychology.

她在心理学系。

Her name is Dr. Alia Crum.

她的名字是阿莉亚·克拉姆博士。

She's been a guest on the Huberman Lab podcast before.

她之前曾是 Huberman Lab 播客的嘉宾。

We will also provide a link to that episode.

我们还将提供该剧集的链接。

And Alia's lab studies mindsets.

阿莉亚的实验室研究思维方式。

Mindsets, of course, incorporate a lot of things besides beliefs.

当然，除了信念之外，心态还包含很多东西。

They involve prior knowledge.

它们涉及先验知识。

They tend to have even more information woven into them than either placebo effects or belief effects.

它们往往比安慰剂效应或信念效应融入更多的信息。

But Alia's really one of the world leaders in understanding these belief effects and has done some just gorgeous work in illustrating the incredible range and extent of belief effects that exist.

但阿莉亚确实是理解这些信念效应的世界领导者之一，并且在说明信念效应存在的令人难以置信的范围和程度方面做了一些出色的工作。

One of my favorite studies in this context is the paper from Alia's lab entitled "Mind Over Milkshakes: Mindsets, Not Just Nutrients, Determine the Ghrelin Response." So here, I'll just briefly describe the study.

在这方面，我最喜欢的研究之一是 Alia 实验室的论文，题为“关注奶昔：心态，而不仅仅是营养素，决定胃饥饿素反应”。所以在这里，我将简要介绍一下这项研究。

I'll paraphrase the abstract.

我将解释一下摘要。

On two separate occasions, people consumed a 380-calorie milkshake, and they were either told that it was a 620-calorie "indulgent shake" or a 140-calorie "sensible shake." Then the hormone ghrelin was measured.

在两个不同的场合，人们喝了一杯 380 卡路里的奶昔，他们要么被告知这是 620 卡路里的“放纵奶昔”，要么是 140 卡路里的“合理奶昔”。然后测量激素生长素释放肽。

Ghrelin is a hormone associated with hunger.

生长素释放肽是一种与饥饿相关的激素。

It is released from and binds to various sites within the brain and body, but it's generally associated with the hunger response, the desire for food.

它从大脑和身体内的各个部位释放并结合，但它通常与饥饿反应，即对食物的渴望有关。

Then their subjects had their blood drawn at three different time points, so at baseline, prior to consumption of the milkshake, anticipatory, meaning just prior to consuming the milkshake, and post-consumption, 90 minutes after consuming the milkshake.

然后，他们的受试者在三个不同的时间点进行抽血，即在基线时，在饮用奶昔之前，预期时，即在饮用奶昔之前，以及在饮用后，即饮用奶昔后 90 分钟。

And then ghrelin was measured within the blood samples that the people provided.

然后在人们提供的血液样本中测量生长素释放肽。

Now, as you recall, everyone is consuming the same 380-calorie shake, but that's unbeknownst to them.

现在，正如您所记得的，每个人都在喝同样的 380 卡路里奶昔，但他们并不知道这一点。

One group thinks they're drinking an indulgent shake that has lots of calories.

一组人认为他们正在喝一种含有大量卡路里的放纵奶昔。

The other group thinks they're ingesting a "sensible shake" with fewer calories.

另一组则认为他们摄入的是热量较少的“合理奶昔”。

And it's important to note that in the study, the individuals were asked to read the labels of the shake and get information about, okay, this is an indulgent shake.

值得注意的是，在这项研究中，人们被要求阅读奶昔的标签并获取有关“好吧，这是一种放纵奶昔”的信息。

It has a lot of calories, a lot of fat, et cetera.

它含有大量的卡路里、大量的脂肪等等。

In the other case, this shake has very few calories.

在另一种情况下，这种奶昔的卡路里含量非常低。

It contains healthy ingredients, et cetera.

它含有健康成分等等。

Now, you can probably guess where this is going.

现在，您可能可以猜到这是怎么回事。

The people that consumed the milkshake but were told it was a high-calorie indulgent shake and also, by the way, consumed information about it being high calorie and indulgent, or they were reading that on the label, experienced steeper reductions in this hunger-associated hormone called ghrelin, as compared to the group that also consumed the same 380-calorie shake but thought that the shake was a sensible shake with fewer calories, that was a healthier shake.

喝了奶昔但被告知这是一种高热量放纵奶昔的人，顺便说一句，他们也消费了关于它是高热量和放纵的信息，或者他们在标签上看到了这一信息，与同样喝了同样 380 卡路里奶昔但认为该奶昔是热量较少的合理奶昔、这是一种更健康的奶昔的那组人相比，这种与饥饿相关的激素（胃饥饿素）的含量急剧减少。

Those people experienced reductions in ghrelin as well, but they were less steep.

这些人的胃饥饿素也有所减少，但幅度没那么大。

They occurred less quickly over time.

随着时间的推移，它们发生得越来越慢。

And in addition, their subjective level of satiety, of fullness, or of feeling as if they had enough food to quell off hunger was also related to whether or not they thought they had consumed the higher calorie indulgent shake or the lower calorie sensible shake.

此外，他们的主观饱腹感、饱满感或感觉好像有足够的食物来消除饥饿也与他们是否认为自己喝了较高热量的放纵奶昔或较低热量的合理奶昔有关。

There are a bunch of other interesting aspects to this study.

这项研究还有很多其他有趣的方面。

I'm just giving you a cursory overview of the major effects.

我只是向您粗略地概述一下主要影响。

But the takeaway is very straightforward.

但要点非常简单。

What we believe about the foods we are consuming strongly impacts the downstream hormonal effects of consuming those foods.

我们对所吃食物的看法强烈影响食用这些食物的下游荷尔蒙效应。

Ghrelin, after all, is a peptide hormone that is secreted from the stomach.

毕竟，胃饥饿素是一种从胃分泌的肽激素。

Okay.

好的。

Yes, the stomach has neurons, but as far as we know, the stomach doesn't have a little thinking brain in there.

是的，胃里有神经元，但据我们所知，胃里没有一点思考的大脑。

The stomach is operating in a very kind of crude language of the nervous system as compared to the thinking and analytic language of the brain, the forebrain.

与大脑（前脑）的思维和分析语言相比，胃以一种非常原始的神经系统语言运行。

But what's happening here is that knowledge, indeed specific knowledge about what more calories means as opposed to fewer calories, what the word indulgent means as opposed to sensible, all of that is being combined and then communicating with neurons and other systems of the gut to literally create a different hormonal response to food.

但这里发生的是知识，实际上是关于更多卡路里与更少卡路里意味着什么，放纵这个词与明智相对的含义的具体知识，所有这些都被结合起来，然后与神经元和肠道的其他系统进行通信，从而真正产生对食物的不同荷尔蒙反应。

And that's incredible because the hormonal response to food is a very strongly evolutionary conserved set of mechanisms, and yet this study and other studies like it, including the conditioned insulin response that we talked about earlier, Pavlov's dogs, or in this case, we are the Pavlov's dogs.

这是令人难以置信的，因为对食物的激素反应是一组非常强烈的进化保守机制，然而这项研究和其他类似的研究，包括我们之前讨论过的条件性胰岛素反应，巴甫洛夫的狗，或者在这种情况下，我们是巴甫洛夫的狗。

We're the ones that can get conditioned to a bell or the smell of a food or the sight of a sign on a bakery to get an insulin increase.

我们是那些能够习惯于听到铃声、食物的气味或看到面包店的标志来增加胰岛素的人。

All of that stuff that is Primitive hardwiring of the brain and body is also being strongly impacted by the more, let's call it, sophisticated or analytic aspects of the wiring of the brain, such as the prefrontal cortex, such that what we believe is going to happen is actually what happens.

所有大脑和身体的原始硬连线也受到大脑连线的更复杂或分析方面的强烈影响，例如前额叶皮层，这样我们相信将要发生的事情实际上就是发生的。

Now, the other study on belief effects and mindsets and how they can impact outcomes in terms of our physiology relates to exercise.

现在，另一项关于信念影响和心态以及它们如何影响我们生理学结果的研究与运动有关。

And this is a study that Dr. Krum herself described came about because she was talking to one of her academic advisors.

克鲁姆博士自己描述的这项研究是因为她正在与她的一位学术顾问交谈。

This was before she opened her own laboratory.

这是在她开设自己的实验室之前。

And Alia's an athlete.

阿莉亚是一名运动员。

She was actually a Division I athlete.

她实际上是一名一级运动员。

She's an incredibly impressive individual, by the way.

顺便说一句，她是一个令人难以置信的令人印象深刻的人。

She's a tenured professor at Stanford.

她是斯坦福大学的终身教授。

She was a Division I athlete.

她是一级运动员。

She has a degree, or rather a certification, in clinical psychology.

她拥有临床心理学学位，或者更确切地说是证书。

So she's an extremely accomplished individual.

所以她是一个非常有成就的人。

But exercise and athletics have always been a big part of her life.

但锻炼和运动一直是她生活的重要组成部分。

And one day she was talking to her advisor, and her advisor offered the possibility that, and here I'm paraphrasing from a different conversation, perhaps all the positive effects of exercise are placebo.

有一天，她正在和她的顾问交谈，她的顾问提出了一种可能性，在这里我从另一次谈话中转述，也许运动的所有积极作用都是安慰剂。

That's actually what her advisor said.

事实上她的顾问也是这么说的。

And Alia said, "No, there's no way." And we know that you exercise, you, sure, get an increase in heart rate and blood pressure during exercise, but that leads to lower levels of baseline blood pressure and heart rate afterwards, after you adapt to that exercise.

阿丽亚说：“不，没办法。”我们知道，当你锻炼时，你的心率和血压肯定会在锻炼过程中增加，但在你适应这种锻炼后，这会导致基线血压和心率水平降低。

And her advisor said, "Well, okay, that might be true, but why don't you go test it?" So she did test it.

她的导师说：“好吧，这可能是真的，但你为什么不去测试一下呢？”于是她就测试了一下。

What she did is she took hotel service workers, so these are people that clean hotel rooms for a living, and these are very active people.

她做的就是带着酒店服务人员，所以这些人是以打扫酒店房间为生的，而且是非常活跃的人。

They're vacuuming, they're changing sheets, they're going upstairs, they're folding laundry.

他们用吸尘器吸尘，换床单，上楼，叠衣服。

They're doing a bunch of different things throughout the day.

他们一整天都在做很多不同的事情。

And they divided them into two groups.

他们把他们分成两组。

One group was told that doing a great job and being diligent is very good for you.

一组人被告知，做好工作并且勤奋对你非常有好处。

They were told all sorts of things about their job and how it was important, and indeed, their job is important.

他们被告知关于他们的工作的各种各样的事情以及它的重要性，事实上，他们的工作很重要。

We need people who can perform these roles of turning over hotel rooms and doing those sorts of things so that hotel rooms can be clean and beautiful when we arrive.

我们需要能够履行这些职责的人，例如翻修酒店房间并做诸如此类的事情，以便我们到达时酒店房间干净漂亮。

The other group, however, was told that the normal daily activities that these people were partaking in, the folding of the laundry, going up and down the stairs, pushing of carts, et cetera, was exercise, and more importantly, that it was the type of movement that could, for instance, lead to reductions in blood pressure, reductions in body weight, improvements in lots of different health metrics.

然而，另一组被告知，这些人参与的正常日常活动，叠衣服、上下楼梯、推车等等，都是锻炼，更重要的是，这种运动可以降低血压、减轻体重、改善许多不同的健康指标。

Now, the incredible outcome of this study was that simply on the basis of whether or not people were told, and therefore believed, that their daily activities would lead to improvements in these different health metrics, reductions in blood pressure, reductions in basal heart rate, reductions in body weight, well, that's exactly what happened.

现在，这项研究令人难以置信的结果是，仅仅根据人们是否被告知并因此相信他们的日常活动会导致这些不同健康指标的改善，血压降低，基础心率降低，体重减轻，事实确实如此。

People who received the information about how exercise was healthy and their work mimicked exercise experienced the health metric changes.

收到有关运动如何健康的信息并且他们的工作模仿运动的人经历了健康指标的变化。

Whereas people who were simply told, "Your work is important.

而人们只是被告知：“你的工作很重要。

It's important to do a good job," et cetera, they did not experience the same health metric improvements.

做好工作很重要，”等等，他们没有经历相同的健康指标改善。

So that provides support for what Dr. Krum's advisor had suggested, that at least some of the effects of exercise are likely due to mindsets or beliefs, AKA belief effects.

因此，这为克鲁姆博士的顾问的建议提供了支持，即运动的至少一些影响可能是由于心态或信念，又称信念效应。

So throughout today's episode, I've been talking about how our expectations and beliefs and mindsets can impact these really deep layers of our physiology, things like hormone release, things like level of discomfort or pain during a given treatment, and on and on.

因此，在今天的节目中，我一直在谈论我们的期望、信念和心态如何影响我们生理学的深层，例如激素释放、特定治疗期间的不适或疼痛程度等等。

And I've talked a lot about the prefrontal cortex that's critical for understanding what's happening in a given context and for setting those expectations because the prefrontal cortex, as you recall, is a prediction machine.

我已经谈论了很多关于前额叶皮层的内容，它对于理解给定环境中发生的事情以及设定这些期望至关重要，因为正如你所记得的，前额叶皮层是一个预测机器。

And context is important for prediction, and on and on.

上下文对于预测非常重要，等等。

What I haven't yet told you is how it is that the prefrontal cortex actually does this.

我还没有告诉你的是前额叶皮层实际上是如何做到这一点的。

What are these magical output pathways of the prefrontal cortex?

前额叶皮层这些神奇的输出通路是什么？

And while I already established that they are not infinite, the prefrontal cortex can't control everything, meaning if I give you some information like just thinking about and believing that your left quadricep is going to be much stronger than your right quadricep, and if you just keep perseverating on, meaning you keep thinking about that and looping on in your mind, and I give you some examples of how thinking about strength can make muscles stronger and on and on.

虽然我已经确定它们不是无限的，但前额叶皮层无法控制一切，这意味着如果我给你一些信息，比如思考并相信你的左侧股四头肌会比右侧股四头肌强壮得多，如果你坚持下去，意味着你不断思考这一点并在你的脑海中循环，我会给你一些例子，说明思考力量如何使肌肉变得更强。

In the classic context of the placebo effect, all that expectation ought to lead to an improvement in strength and perhaps size of your left quadricep.

在安慰剂效应的经典背景下，所有这些期望都应该导致左股四头肌的力量和尺寸的改善。

But that's not what happens.

但事实并非如此。

Why?

为什么？

Or more accurately, why not?

或者更准确地说，为什么不呢？

Well, as far as we know, there isn't a direct neural circuit or hormonal pathway whereby thoughts from the prefrontal cortex can impact the growth of muscles in your left quadricep.

嗯，据我们所知，不存在直接的神经回路或激素途径，来自前额叶皮层的思想可以影响左股四头肌的肌肉生长。

However, there are output pathways from the prefrontal cortex to regions of the brain that are known to control very basic bodily and brain functions, such as the hypothalamus.

然而，从前额叶皮层到大脑区域的输出路径已知可以控制非常基本的身体和大脑功能，例如下丘脑。

And those pathways are known to be able to change certain parameters of our, for instance, stress response, so blood pressure, heart rate, vasoconstriction, even body temperature.

众所周知，这些途径能够改变我们的某些参数，例如压力反应，血压、心率、血管收缩，甚至体温。

So I just want to take a moment and describe what I consider one of the more beautiful studies illustrating a specific pathway from the prefrontal cortex to the hypothalamus that allows control of the so-called stress response in the context of very specific psychological stressors.

因此，我只想花点时间描述一下我认为最精彩的研究之一，该研究说明了从前额叶皮层到下丘脑的特定路径，该路径允许在非常特定的心理压力源背景下控制所谓的压力反应。

Now, this paper is important not just for our discussion of placebo belief and mindset effects, but also for any discussion about so-called psychosomatic effects, or the idea that our modes of thinking, whether or not they are related to calmness or to stress, can strongly impact our physical health.

现在，这篇论文不仅对于我们讨论安慰剂信念和心态影响很重要，而且对于任何关于所谓的心身影响的讨论都很重要，或者对于我们的思维模式，无论它们是否与平静或压力有关，都会强烈影响我们的身体健康的想法。

And the title of the paper is "A central master driver of psychosocial stress responses in the rat." Goodness, that's a tongue twister.

论文的标题是“大鼠心理社会压力反应的主要驱动因素”。天哪，这真是绕口令。

Psychosocial stress responses in the rat.

大鼠的心理社会应激反应。

Now, the fact that this study was performed in the rat should not cause us to lean away from it or to think that it's not relevant to humans, because the very same circuitries that are described within this study have analogous circuitries within the human brain.

现在，这项研究是在老鼠身上进行的，这一事实不应让我们放弃它或认为它与人类无关，因为这项研究中描述的电路在人脑中也有类似的电路。

I know that to be true from my work in neuroanatomy, teaching neuroanatomy, and other groups separate from the group that did this study have explored similar circuitries in the human brain.

从我在神经解剖学方面的工作、神经解剖学教学以及与进行这项研究的小组不同的其他小组已经探索了人脑中的类似电路，我知道这是事实。

Now, in this study, what they were able to do was to identify these two particular regions, which I'll just call them dpDTT for short.

现在，在这项研究中，他们能够做的是识别这两个特定区域，我将其简称为 dpDTT。

So instead of saying dorsal pontine cortex and dorsal tenia tecta, so just say dpDTT.

因此，不要说背侧桥脑皮层和背侧腱索，而是说 dpDTT。

This is this area of the prefrontal cortex.

这是前额皮质的这个区域。

Okay, don't let these acronyms and names scare you.

好吧，不要让这些缩写词和名称吓到您。

These are just names of a little subregion within the prefrontal cortex.

这些只是前额皮质内一个小分区的名称。

Send connections, little wires that we call axons, to an area of the brain called the dorsomedial hypothalamus.

将连接（我们称之为轴突的小电线）发送到大脑中称为下丘脑背内侧的区域。

The dorsomedial hypothalamus is a highly conserved structure, meaning whether or not you look in mouse or in rat or in apes or in humans or in dogs, the dorsomedial hypothalamus contains neurons that are involved in generating cardinal features of the stress response.

下丘脑背内侧是一个高度保守的结构，这意味着无论您是否观察小鼠、大鼠、猿、人类或狗，下丘脑背内侧都含有参与产生应激反应的主要特征的神经元。

Things like increased blood pressure, things like increased vasoconstriction, things like increased body temperature, things like increased brown fat thermogenesis.

比如血压升高、血管收缩增加、体温升高、棕色脂肪生热作用增加等。

Now, we can even go a step further because that's what they did in this study.

现在，我们甚至可以更进一步，因为这就是他们在这项研究中所做的。

They mapped the connections from these specific subregions of the prefrontal cortex, the dpDTT, down to the dorsomedial hypothalamus, and a very specific set of neurons within the dorsomedial hypothalamus.

他们绘制了从前额叶皮层 dpDTT 这些特定子区域到下丘脑背内侧以及下丘脑背内侧一组非常特定的神经元的连接。

But even there, we're still in the brain.

但即使在那里，我们仍然在大脑中。

We haven't yet established how activation of these specific neurons in the dorsomedial hypothalamus actually change blood pressure, how they actually cause vasoconstriction in the periphery, because that's what happens when you get very stressed, whether or not it's from social stress or from cold water.

我们还没有确定下丘脑背内侧这些特定神经元的激活实际上如何改变血压，它们实际上如何引起外周血管收缩，因为这就是当你感到非常紧张时会发生的情况，无论是来自社会压力还是来自冷水。

There's a constriction, what we call vasoconstriction, in the periphery.

周围有一种收缩，我们称之为血管收缩。

Blood is shuttled toward the core of the body to keep your core organs alive.

血液被输送到身体的核心，以保持核心器官的活力。

You're still going to get blood to the big limbs of your body so you can move, run if you need to, but your digits, your appendages are going to get far less blood flow to them because of this vasoconstriction, and that's achieved by an output from the dorsomedial hypothalamus, okay, so the second hub along this chain, to an area of the brainstem called the rostral medullary raphe.

你仍然会将血液输送到你身体的大四肢，这样你就可以移动，如果需要的话可以跑步，但是由于这种血管收缩，你的手指、你的肢体得到的血流量会少得多，这是通过下丘脑背内侧的输出来实现的，好吧，所以沿着这条链的第二个枢纽，到脑干的一个叫做延髓中缝的区域。

Okay, again, fancy name.

好吧，又是一个好听的名字。

You don't have to remember the name if you don't want to.

如果您不愿意，则不必记住该名称。

Maybe you aficionados want to.

也许您的爱好者想要。

But what we're doing here is we're moving from the prefrontal cortex to the hypothalamus, then to the brainstem, and then from the brainstem out to what we call the periphery, to the body, to the spinal cord, to the blood vessels themselves, to the organs of the body, like the gut and the heart and the lungs, all the things that we associate with the so-called stress response.

但我们在这里所做的是，从前额皮质移动到下丘脑，然后到脑干，然后从脑干到我们所说的外周，到身体，到脊髓，到血管本身，到身体的器官，比如肠道、心脏和肺，所有这些都是我们与所谓的压力反应联系在一起的。

So as we've been learning about placebo effects and belief effects and mindset effects and learning that, okay, just our knowledge about something, our anticipation, our thinking can influence levels of a hunger hormone.

因此，当我们一直在了解安慰剂效应、信念效应和心态效应时，我们了解到，好吧，仅仅我们对某事的了解、我们的预期、我们的思维就可以影响饥饿激素的水平。

Isn't that wild?

那不是狂野吗？

Or it can influence the amount of pain that we experience in response to a cancer treatment, or it can change the amount of dopamine in the brain in the context of a placebo given to people with Parkinson's.

或者它可以影响我们对癌症治疗的反应所经历的疼痛程度，或者它可以改变帕金森病患者服用安慰剂时大脑中多巴胺的含量。

Well, all of that seems very, very surprising until you look at studies of the sort that I've been describing in the last few minutes that are starting to establish the very precise neural circuitries that lead from areas of the brain, like the prefrontal cortex, that are associated with thought and context and planning and prediction, down to, I don't want to call them the deeper or more primitive layers of the brain, because these areas like the hypothalamus and the medulla, the brainstem, they're not really primitive in the sense that they do very sophisticated things.

好吧，所有这些看起来都非常非常令人惊讶，直到你看到我在过去几分钟描述的那种研究，这些研究开始建立非常精确的神经回路，这些神经回路从大脑的区域开始，比如前额皮质，与思想、背景、计划和预测相关，我不想称它们为大脑的更深或更原始的层，因为这些区域，比如下丘脑、延髓、脑干，它们在本质上并不是真正的原始区域。他们做的事情非常复杂。

It's just that they tend to be present in both mammals and reptiles.

只是它们往往存在于哺乳动物和爬行动物中。

They're present in fish, whereas the prefrontal cortex is a brain structure that has undergone fairly significant elaboration as you move from animals like, say, cats, dogs, up to great apes and to humans.

它们存在于鱼类中，而前额皮质是一种大脑结构，从猫、狗等动物，到类人猿和人类，它已经经历了相当重要的精细化。

And at least to our knowledge as a field of neuroscientists and biologists, humans have the most sophisticated or rather elaborate prefrontal cortex, the most number of different subareas of the prefrontal cortex.

至少据我们神经科学家和生物学家所知，人类拥有最复杂或相当复杂的前额叶皮层，前额叶皮层的不同分区数量最多。

And every time there's an investigation of those subareas, what they do, what their anatomies are, meaning where they connect to and who connects back to them, it's found that there is a tremendous degree of specificity.

每次对这些子区域、它们的作用、它们的解剖结构是什么、它们连接到哪里以及谁连接回它们进行调查时，我们都会发现它们存在很大程度的特异性。

All of which is to say that we shouldn't be surprised at all that these placebo belief and mindset effects occur because there's a clear biological substrate for them.

所有这些都表明，我们不应该对这些安慰剂信念和心态效应的发生感到惊讶，因为它们有明确的生物学基础。

So up until now, we've been talking about the placebo effect as these incredible set of effects that have a real biological substrate.

到目前为止，我们一直在谈论安慰剂效应，因为这些令人难以置信的效应具有真正的生物基质。

There are anatomical pathways, hormonal pathways, neurotransmitters involved, and that's all true, but what's also true is that the placebo effect can vary in size tremendously between individuals and across different studies.

涉及解剖学途径、激素途径、神经递质，这些都是事实，但同样事实是，安慰剂效应的大小在个体之间和不同研究中可能存在巨大差异。

And in fact, this was described in the first formal study of the placebo effect.

事实上，第一个关于安慰剂效应的正式研究对此进行了描述。

In that study, it was shown that approximately 30% of the individuals in the study showed a robust placebo effect, but that the other 70% showed a less robust placebo effect.

该研究表明，研究中大约 30% 的个体表现出强烈的安慰剂效应，但其他 70% 的个体表现出不太强烈的安慰剂效应。

And that result, meaning that variation in susceptibility to the placebo effect, has borne out again and again and again across different studies.

这一结果意味着对安慰剂效应的敏感性存在差异，这一结果在不同的研究中得到了一次又一次的证实。

Now, modern science has now taught us that if you look at the genomes, the genes that happen to be expressed in one individual versus the next, versus the next, versus the next, there are certain genes, not a lot of them, but there are certain genes that seem to correlate with certain types of placebo effect being greater or lesser in certain individuals.

现在，现代科学告诉我们，如果你观察基因组，即一个人与另一个人、下一个人、下一个人之间恰好表达的基因，就会发现有某些基因，但数量不是很多，但有些基因似乎与某些类型的安慰剂效应在某些个体中的大小有关。

And while there are a lot of these different genes and a lot of different placebo effects, one of the more interesting ones is the COMT gene, which encodes for something called catechol-O-methyltransferase.

虽然有很多不同的基因和很多不同的安慰剂效应，但更有趣的基因之一是 COMT 基因，它编码一种叫做儿茶酚-O-甲基转移酶的东西。

Catechol-O-methyltransferase, as the name suggests, because it has an ase in there.

儿茶酚-O-甲基转移酶，顾名思义，因为它里面有一个酶。

In the context of a discussion about biology, that almost always means you're talking about an enzyme.

在讨论生物学时，这几乎总是意味着您正在谈论酶。

Catechol-O-methyltransferase is an enzyme involved in The regulation of the so-called catecholamines.

儿茶酚-O-甲基转移酶是一种参与所谓儿茶酚胺调节的酶。

Catecholamines being dopamine, epinephrine, and norepinephrine.

儿茶酚胺是多巴胺、肾上腺素和去甲肾上腺素。

Okay, we've already talked about dopamine in the context of Parkinson's.

好的，我们已经讨论过帕金森病中的多巴胺。

I've talked about dopamine a lot, frankly, on the "Huberman Lab" podcast because it's involved in motivation, it's involved in focus, pursuit of reward.

坦率地说，我在“休伯曼实验室”播客上多次谈论多巴胺，因为它与动机、注意力、对奖励的追求有关。

It's involved in movement, as we discussed earlier.

正如我们之前讨论的，它涉及运动。

Norepinephrine and epinephrine also do many different things in the brain and body, but not the least of which is to increase activation state for heightened focus, for increasing the bias toward movement of the body, and on and on.

去甲肾上腺素和肾上腺素还在大脑和身体中发挥许多不同的作用，但其中最重要的是增加激活状态以提高注意力，增加对身体运动的偏向，等等。

In any event, this gene, COMT, catechol O-methyltransferase, seems to show strong variation in individuals that show strong variation in the placebo response to certain types of placebo conditions.

无论如何，这个基因，COMT，儿茶酚 O-甲基转移酶，似乎在个体中表现出强烈的变异，这些变异在对某些类型的安慰剂条件的安慰剂反应中表现出强烈的变异。

And I just mention it because, A, I think it's super interesting.

我只是提到它，因为，A，我认为这非常有趣。

After all, a lot of the studies that have demonstrated placebo effects have shown those effects in the context of changes in dopamine, epinephrine, and norepinephrine.

毕竟，许多证明安慰剂效应的研究都表明这些效应是在多巴胺、肾上腺素和去甲肾上腺素变化的背景下产生的。

So it's not without context that we're talking about the COMT gene.

因此，我们谈论 COMT 基因并不是没有背景的。

But also just as a general theme, the fact that there are genes that encode for specific biological substrates, in this case, regulation of dopamine, epinephrine, and norepinephrine, and those genes show up at different levels in different individuals, and the placebo effects show up at different levels in different individuals.

但也作为一个普遍的主题，事实上存在编码特定生物底物的基因，在这种情况下，多巴胺、肾上腺素和去甲肾上腺素的调节，这些基因在不同个体中以不同水平出现，安慰剂效应在不同个体中以不同水平出现。

And now there are studies that are starting to show that the levels of those genes and the degree to which one experiences the placebo effect, either elevated response or reduced response to the placebo effect, seem to be fairly strongly correlated.

现在有研究开始表明，这些基因的水平和人们体验安慰剂效应的程度（对安慰剂效应的反应升高或降低）似乎有相当强的相关性。

So this, again, is more evidence that, yes, the placebo effect is based on knowledge, belief, expectation, but that it has a real biological substrate.

因此，这再次证明，安慰剂效应是基于知识、信念、期望，但它具有真正的生物基础。

Just as there are anatomical pathways out of the prefrontal cortex to the hypothalamus down to the brainstem and out to the body, there are also genes expressed in specific cells within our brain and body that allow for our beliefs and expectations that are carried through that prefrontal cortex circuitry to have either a greater or lesser effect.

正如从前额叶皮层到下丘脑，再到脑干，再到身体的解剖通路一样，我们的大脑和身体内的特定细胞中也有表达的基因，这些基因使我们的信念和期望通过前额叶皮层电路产生或大或小的影响。

So throughout today's episode, I've been talking about how knowledge, your belief and understanding about what might happen, ought to happen, or very likely will happen, influences whether or not that thing actually happens, the so-called placebo effect or belief effect or mindset effect.

因此，在今天的节目中，我一直在谈论知识、你对可能发生、应该发生或很可能发生的事情的信念和理解如何影响该事情是否真正发生，即所谓的安慰剂效应或信念效应或心态效应。

And what I hope I've made clear during the course of our discussion is that while placebo effects arrive through our cognitive understanding of what might, ought to, or is likely to happen, the downstream effects, the effects on asthma, irritable bowel syndrome, insulin, growth hormone.

我希望在我们的讨论过程中澄清的是，虽然安慰剂效应是通过我们对可能发生、应该发生或可能发生的事情的认知理解而产生的，但下游效应，对哮喘、肠易激综合症、胰岛素、生长激素的影响。

Pick your favorite biological system.

选择你最喜欢的生物系统。

Essentially, every system within the brain and body has been shown to be susceptible to placebo effects.

从本质上讲，大脑和身体内的每个系统都被证明容易受到安慰剂效应的影响。

What I hope is becoming clear is that in every case, the placebo effect is a biological effect.

我希望越来越清楚的是，在任何情况下，安慰剂效应都是一种生物效应。

It's not just our thoughts tricking us into thinking something happened that didn't happen.

不仅仅是我们的想法欺骗我们，让我们认为某件事发生了，但实际上并没有发生。

It's our thoughts, our mind, creating real biological effects.

是我们的思想、我们的思想创造了真正的生物效应。

If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.

如果您正在学习和/或喜欢此播客，请订阅我们的 YouTube 频道。

That's a terrific zero-cost way to support us.

这是支持我们的绝佳零成本方式。

In addition, please subscribe to the podcast on both Spotify and Apple.

此外，请在 Spotify 和 Apple 上订阅该播客。

And on both Spotify and Apple, you can leave us up to a five-star review.

在 Spotify 和 Apple 上，您都可以给我们五星级的评价。

Please also check out the sponsors mentioned at the beginning and throughout today's episode.

另请查看今天节目开头和整个节目中提到的赞助商。

That's the best way to support this podcast.

这是支持这个播客的最佳方式。

If you have questions for me or comments about the podcast or topics or guests that you'd like me to include on the "Huberman Lab" podcast, please put those in the comments section on YouTube.

如果您对我有疑问，或者对您希望我在“Huberman Lab”播客中包含的播客或主题或嘉宾有意见，请将这些意见放入 YouTube 的评论部分。

I do read all the comments.

我确实阅读了所有评论。

If you're not already following me on social media, I am hubermanlab on all social media platforms.

如果您还没有在社交媒体上关注我，我是所有社交媒体平台上的 hubermanlab。

So that's Instagram, X, Threads, Facebook, and LinkedIn.

这就是 Instagram、X、Threads、Facebook 和 LinkedIn。

And on all social media platforms, I present science and science-related tools, some of which overlaps with the content of the "Huberman Lab" podcast, but much of which is distinct from the content of the "Huberman Lab" podcast.

并且在所有社交媒体平台上，我展示科学和科学相关的工具，其中一些与“Huberman Lab”播客的内容重叠，但其中很多与“Huberman Lab”播客的内容不同。

So again, it's hubermanlab on all social media platforms.

再说一遍，所有社交媒体平台上都是 hubermanlab。

If you haven't already subscribed to our "Huberman Lab" podcast Neural Network Newsletter, the Neural Network Newsletter is a zero-cost monthly newsletter that includes podcast summaries and podcast protocols, which are brief one- to two-page PDFs that explain, in bullet point fashion, things like deliberate cold exposure.

如果您还没有订阅我们的“Huberman Lab”播客神经网络通讯，神经网络通讯是一份零成本的每月通讯，其中包括播客摘要和播客协议，这些是简短的一到两页 PDF，以要点的方式解释诸如故意冷暴露之类的事情。

We have a foundational fitness protocol.

我们有一个基本的健身协议。

We have a toolkit for sleep.

我们有一个睡眠工具包。

We have a toolkit for neuroplasticity and learning, deliberate cold exposure, deliberate heat exposure, and on and on.

我们有一个用于神经可塑性和学习、有意的冷暴露、有意的热暴露等等的工具包。

All of that, as I mentioned, is completely zero cost.

正如我提到的，所有这一切都是完全零成本的。

You simply go to hubermanlab.com, go to the menu function, scroll down to Newsletter, and provide your email.

您只需访问 hubermanlab.com，转到菜单功能，向下滚动到新闻通讯，然后提供您的电子邮件即可。

I want to emphasize that we do not share your email with anybody.

我想强调的是，我们不会与任何人分享您的电子邮件。

Thank you for joining me for today's discussion all about placebo and belief effects.

感谢您参加今天有关安慰剂和信念效应的讨论。

And last but certainly not least, thank you for your interest in science.

最后但并非最不重要的一点是，感谢您对科学的兴趣。