Can't Make a Decision? 20 Common Cognitive Biases

Throughout the day, we make thousands of rational decisions. They can be as small as what we'll eat for breakfast to as big as whether to make a career move. However, while these rational decisions may come to mind, research suggests that there are a number of cognitive stumbling blocks that have an effect on our behavior, preventing us from acting in our own best interests. The chart below examines the most common biases that can affect our decision-making. Take a look:

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Stroke Survivor Walks Again After Doctors Inject Stem Cells Directly into Brain

Researchers  were “stunned” at the positive results they obtained after injecting stem cells directly into stroke patients’ brains. The discovery has created a talking point in the neuroscience community, causing researchers to re-visit and re-evaluate the notion that brain damage is permanent and irreversible.

Surgical Procedure

18 stroke patients that were at the six-month mark—the ‘plateau stages’ of their recovery, which is where, typically, no foreseeable improvements in their conditions can occur—were selected for the study.

Patients at this stage are impaired when it comes to moving their arms and legs. As such, they are usually taken out of therapy, as their brain circuits are believed to be damaged beyond repair.

Surgeons drilled holes into several locations of each patient’s skull and injected the stem cells into them. The procedure required patients to be operated on while they were conscious. Despite the seemingly bluntness of the procedure, surgeons say that the method is the simplest as far as brain surgery is concerned. 

Patients were even sent home on the same day as the surgery.

Stunning Results

Headaches, nausea, and vomiting were some of the side-effects experienced by the patients after the procedure. Tests that measured each of the patients’ speech, vision, and motor ability were then conducted one, six, and twelve months after the surgery.

The lead author and chairperson of Neurosurgery, was surprised to see that seven out of the 18 patients that underwent the treatment showed great improvement. Recovery for these seven patients, he says, was not minimal. He mentions a 71-year-old wheelchair-bound patient that was able to walk again.

Despite the positive results of the procedure,  a professor of Neurosurgery, notes that much more has to be done in order to confirm the results of the surgery. Further research is necessary in order to fully determine the true effect of the stem cells in stimulating the changes, and he notes that it is possible that the procedure induced a placebo effect.

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Your brain tells if a placebo can treat pain

The placebo effect, a fake treatment with real therapeutic outcomes often confounds the merit of successful drug trials. This questionable clinical response is often attributed to the psychological expectation of a positive outcome. This response translates to release of warm and fuzzy neurotransmitters like dopamine and endorphins in cortical structures responsible for moods, emotions, and awareness. Even knowing that you are getting a placebo does not change the outcome specifically for migraine pain treatment as shown by researchers in 2014. The placebo was 50% as effective as the real drug in reducing the pain and this result was attributed to the positive effect of ritual pill taking in general.

But is it beyond just positive thinking? What happens in the brain that leads to the placebo effect?

These questions drove the researchers to investigate placebo effects in clinical settings. Their recent publication identified specific psychological factors, anatomical features and functional connectivity between selective regions that could predispose a subset of patients response to placebo.

This study expands on the previously identified predictors based on brain functional connectivity for the treatment of pain and addresses the inherent variability of cortical activity before and after treatment. To that end, they also cross-validated an algorithm that successfully predicted the response magnitude to placebo pain treatment.

After screening 129 chronic back pain patients and excluding all subjects that did not meet the study requirements, a total of 63 patients divided into 3 groups of 20, were studied to compare responses between the no treatment group to randomized placebo treatment group. In the 6 visits that spread over 8 weeks, the placebo response was tracked through psychological questionnaires and neuroimaging scans (MRI: Magnetic Resonance Imaging and DTI: Diffusion tensor imaging). Additionally, an interactive phone application, specifically designed for the study was also used to track the patient’s pain over time rather than just during their visits.

Three characterization approaches were used to understand the predisposed response to placebo administration. Firstly, pain scores received via the smartphone app showed the analgesic effects of placebo when compared to no treatment patient cohort. Moreover, the pain reduced further in the responders over time reaching a stable value for both treatment and washout periods. Second, anatomical characteristics including subcortical limbic volume asymmetry, sensorimotor cortical thickness, and functional coupling of prefrontal regions, anterior cingulate and periaqueductal gray were the natural traits that were selectively present in the placebo effect observed population. However, studying the brain structures that are associated with the emotional state, chronic pain and placebo response in healthy individual risk factors like the amygdala, hippocampus and nucleus accumbens did not reveal anything. Lastly, 15 psychological questionnaires with 38 subscales revealed that subjects with interoceptive awareness and openness were predisposed to the placebo effect. 

The observed psychological traits and functional connectivity patterns prior to placebo treatment when put through machine learning also predicted the magnitude of the placebo effect independently.  A nested leave-one-out cross-validation method was used to predict each patient response using independent training samples. The training was done with one data set at a time. The classifier was first trained with the questionnaire data and then the functional connectivity maps were fed through. An interesting observation made was that prediction accuracy did not differ significantly when trained with questionnaires alone vs in combination with brain maps.

The systematic study design and execution with novel cross-validated predictive analysis sheds light on understanding and preparing for the complex placebo effect in the perspective of chronic pain treatment. Moreover, the authors also suggest that the questionnaire based easy pre-study patient survey might be enough to predict the positive placebo response population.

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What You Need to Know About the Birth Control Pill

Did you know that 9% of women of reproductive age take the pill worldwide? What most of them don't know, however, is that the seven placebo pills taken in the final week of the four-week cycle are unnecessary. While it is always a good idea to check in with your health provider first, with the pill it is possible that you do not even have to have your period at all. Instead, you can take it continuously for as long as you like. 

A medical professional says, “It’s not actually necessary to take a break from the contraceptive pill for a withdrawal bleed, it doesn’t do any harm to skip this break or take the combined oral contraceptive pill continually. In fact, many women already do this when they go on holiday or if they tricycle packs.”


"Providing it is safe for women to take the combined oral contraceptive pill and there are no medical contraindications then it is safe for women to use any of the pill taking regimes," she says, whether it is traditional (with regular breaks), tricycling (a break every three packs), extended (no breaks), or flexible (taking breaks but not falling into one of the previous categories). However, it appears that there is no biological evidence that 'giving your body a break' makes any difference. There is no build-up of hormones and when you stop taking the pill, the effects are immediately reversible. 

So, to make things clear, the period that you get when you are on the pill is not really a period at all. Rather, it is a withdrawal bleed. It is the body's response to the sudden drop in hormones that occurs when you stop taking the active pills and switch to the placebo pills. But what is the difference between the withdrawal bleed and a regular period? When on the pill, the uterine lining (endometrium) doesn't have the chance to build up. It remains thin which makes the bleed lighter than a regular period and less necessary.

A medical professional says “I sometimes describe that as the difference between shag rugs, and a normal period to indoor-outdoor rugs when you’re on the Pill.” 

If you decide to take the Pill continuously you may experience what is called break-through bleeding. This is a bleeding or spotting between periods. It isn't harmful, but some people may choose to take a break, then resume the Pill again after a few days - the flexible regimen. If you decide to persevere, these symptoms may dissipate with time. 
According to the experts, breakthrough bleeding typically decreases over time, as your body adjusts to the new regimen. If breakthrough bleeding becomes heavy or lasts for more than seven days in a row, it is vital that you contact your doctor. 

With regard to the placebo pills found in the monthly pack, if they are unnecessary, why do we have them and where did the idea stem from in the first place? Well, it's generally due to a complicated blend of social, economic, political and even religious factors that hark back to the 1960s when the Pill first became available for reproductive purposes. Today, affordable and easy-to-use pregnancy tests are a quick hop and a skip away at your local store. Consequently, a pregnancy scare can be confirmed within an hour of noticing a late period. Furthermore, there are ultrasounds that can date a pregnancy to the week it was conceived. This wasn't the case 50 years ago. Later, the idea of the break and the placebo pills were added to trigger a withdrawal bleed, reassuring the user that she was not pregnant in the absence of instant pregnancy tests and ultrasounds. 

Another expert says "There was a practical reason for designing the pill three weeks on, one week off but there really wasn’t a biological necessity for it from the perspective of birth control pill.” Adding that, “The myth is that you must have bleeding when you’re taking oral contraception when in fact that was just engineered into the pill for these other reasons.”

Furthermore, it was decided by the makers of the Pill that the addition of the withdrawal bleed would help a woman accept their product as a form of contraceptive, primarily because it would feel more 'natural'. They also felt that women wanted to have periods and they'd likely feel uncomfortable with a birth control method that stopped them. 
“Studies have consistently shown that when women are told there are no harmful effects from not having a period while on the Pill, especially with regards to fertility, they choose to have less frequent periods or eliminate them entirely,”says an expert.

In addition, it wasn't just the women who needed convincing women how to manage their fertility cycle depending on whether or not they wanted to have children, performing hysterectomies and talking openly to their parents about sex, including unmarried women. This was quite surprisingly progressive at that time.

Over the past five decades, there have been developments in technology and progress on the sexual freedom front that would make the placebo pills irrelevant. Furthermore, the majority of gynecological professionals agree that it is not only perfectly safe to take the active pills continuously, but it is preferable to do so, especially in women who suffer from health conditions like endometriosis or dysmenorrhea. Also, a woman with milder menstrual symptoms might benefit from skipping her period altogether. 

One of the repercussions of taking the Pill is the financial toll. “If you’re using four weeks of the pill instead of three weeks of the pill, at the end of the year you’re down two packs,” the expert says. “It’s an economic issue.” Adding that, "It’s not generally going to be offered as a first choice. The first choice is going to be whatever an insurance company and national health service etcetera are going to pay for."

But it's not just the placebo pill myth that won't disappear. Contrary to popular belief, a study earlier this year revealed that the Pill does not affect a woman's preference in male partners. You may, however, want to take an occasional break from the Pill if that's what you feel is right for you, however, you do not need to. It goes without saying that if you are thinking about making a change to your medication it is a good idea to speak to your health provider first and make sure you are taking the right pill for you. 

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Nocebo effect: Study claims expensive medicines causes its own side effects

Expensive medicines may make you feel worse, according to a study which found that people are more likely to experience stronger side effects when a treatment seems to be costly. 

While the placebo effect means that some people feel better when they have unknowingly been given a sham or control treatment, the nocebo works the opposite way. Researchers  studied if price might also affect the strength of the nocebo effect.

The team created two packages for fake creams and told volunteers that they are used to treat itchy skin. One package looked like an expensive pharmaceutical brand name, while the other looked like a cheaper, generic medication.

The participants were shown one of the two creams and told that it was believed to increase a person's sensitivity to pain as a side effect, 'New Scientist' reported. Researchers then applied creams to participants' arms, and exposed their limbs to increasing levels of heat. Each person was asked to rank the discomfort they felt.

The study, noted that participants given the more expensive-looking cream reported more pain than those given the cheaper-looking cream. Relative to a control cream that was described as having no active ingredients, the generic-looking cream raised pain on average by around three per cent, while the expensive- looking cream increased pain by nearly 30 percent, researchers said.

The finding confirms that the price of a treatment effects not only placebo strength, but nocebo power too, they said.
  
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Knowing your doctor may help reduce the injection pain!

Are you scared of getting a injection? Well, a new study suggests that knowing your doctor may help reduce your pain.

Elizabeth Losin, assistant professor at the University of Miami in the US said, "When someone believes that something is going to help relieve their pain, their brain naturally releases pain- relieving chemicals."

Losin said, ''Our hypothesis, based on what we are seeing, is that trusting and feeling similar to the doctor who is performing the painful procedure is creating that same kind of placebo pain relief."

For the findings, participants were given a questionnaire that asked about their political ideology, religious and gender role beliefs and practises.

They were then separated into two groups and told that they were assigned to the groups based on their questionnaire answers.

Researchers said that the goal was to make people from the same group think they had something in common, which might then manifest itself as more positive feelings, like trust, towards participants playing the role of the doctor or the patient from their own group.

The participants who played the patients interacted with one doctor from their own group and one doctor from the other group, both of their own gender.

During the simulated clinical interaction, the doctors performed a pain-induction procedure on the patients by applying heat to their inner forearm, meant to simulate a painful medical procedure like a shot.

After the interaction, both the doctors and the patients were asked how similar they felt to each other and how much they trusted each other.

Researchers found that the more patients reported trusting their doctor and feeling similar to them, the less pain they reported feeling from the heat on their arm.

The study also suggests that participants who experience higher levels of anxiety on a day-to-day basis experienced greater reductions in pain from feeling close to their doctor.

The findings was published in the Journal of Pain.

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