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L i s te n to T h e A B M P Po d c a s t a t a b m m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 89 your brain depolarized, so that had to be neurophysiology. That did get us thinking! TL: You're saying that the thought itself is a neurophysiological, that is physical, phenomenon. MB: Absolutely. If something is happening in the cortex, that's as neurophysiological as anything that we were measuring as far as nerve function or reflexes. TL: You're describing a shift from being focused on the body to including what was happening in the brain. MB: Yes, but what we were actually interested in is what the person was telling us about pain. For example, in the context of expectation, if I talk about an expectation that something bad might happen, maybe this treatment will hurt, the gain in the system gets elevated because of anxiety or fear and you're more likely to tell me that it hurts. Now, if I give you that stimulus again at a different time and your anxiety about it has gone down, your response will likely be different, even though the stimulus did not change. TL: So, my brain gets predisposed by my expectations. If I think it's going to hurt, I'm more likely to experience or report that as pain. MB: Yes, and the opposite is true. If you're expecting something to be good, you're more likely to report either less pain or to benefit from it. People can have expectations to benefit from the treatment in general, and more specific expectations of the technique that you're about to apply. Each of those expectations can influence what people are thinking about what is happening to them. Let's say Til comes in with neck pain. He's expecting the clinic to look a certain way. That meets his expectations. He's generally expecting benefit from treatment for his neck. Then, he receives a technique that he has high expectations is going to help him. Chances are that he is going to report feeling better than someone who comes to see the provider and they don't like the place or the provider. They're not expecting much from treatment, and then I do an intervention that is not what they expect to help them. Even if it's the same intervention for the same condition, they often report worse outcomes, compared to the person with high expectations. Whitney Lowe: In one of your papers, you said this made you consider these neurological and psychological factors to be far more prominent than we may have originally thought, in terms of beneficial physical outcomes. 2 Is that correct? What the client or patient thinks about you, your practice, or your techniques— even before they come to you— has a stronger correlation to how they're doing six months later than the treatment you actually did. MB: It is, which made us think we'd all gone through the rigorous training to master our particular area of manual therapy, but since it turns out that different providers are treating the same condition differently and yet getting similar outcomes, there has to be something else that is contributing to the outcomes. So, we were looking at what might explain how we can have so many varied approaches with similar outcomes for the same conditions. Some of our work suggests that the expectation someone has before we start is a stronger predictor of what they'll tell you six months later, than which treatment they actually received. 3 TL: What the client or patient thinks about you, your practice, or your techniques—even before they come to you—has a stronger correlation to how they're doing six months later than the treatment you actually did. MB: Yes. We asked people before they started treatment about their general expectation on full recovery. The people who said, before we did anything, that they would be completely recovered in six months were the ones who had the largest change in outcome. Mark Bishop, PhD

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