You ever just have one of those days where everything seems like it’s going wrong?
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Maybe you wake up with that gut feeling it’s going to be a bad day. You trip over something in the dark and stub your toe. Then, on your way to work, you bump into someone and they spill their coffee all over your shirt. That incident puts you behind, causing you to miss a meeting with your boss — an important meeting you forgot to put on your calendar a week ago.
Slowly, each subtle inconvenience starts piling up. Is it you? Or is it something else?
Whatever the reasoning, your experiences make you feel a sense of impending doom that the rest of the week is going to be just as bad as today. Before you know it, you’re caught up in a self-fulfilling prophecy, where bad things continue to happen to you because you’re only focusing on the negative things that are happening.
Psychologist Susan Albers, PsyD, explains the psychology behind self-fulfilling prophecies and how they play a more critical role in your medical care.
What is a self-fulfilling prophecy?
Self-fulfilling prophecies occur when a prediction brings about its own fulfillment. In layman’s terms, that means that if you believe something to be true, you’ll act as if it were true. And your actions double down on your prediction to make it a reality. It’s kind of a vicious cycle.
Perhaps the simplest example of a self-fulfilling prophecy, says Dr. Albers, is that gut feeling you’re going to have a bad day. If you predict you’re going to have a bad day, maybe you start dragging your feet and regret getting out of bed. You’re already in a bad mood, but when you stub your toe, you see that as confirmation: Yep, it’s definitely going to be a bad day.
“As you’re walking down the street, it’s a nice day outside and one or two people smile at you, but then a third person bumps into you and they spill their coffee on your clothes,” poses Dr. Albers. “This could cause you to discount the pleasant experiences you’ve had in order to confirm the negative expectation you’ve been building.”
And just like that, you’re in a bad mood for the rest of the day. Those negative emotions can impact how you act toward yourself and others. This could lead to potentially harmful outcomes when other people develop certain expectations and assumptions about who you are, especially if you’re acting negatively toward them. Those outcomes then retroactively confirm you were right all along — that the day was indeed bad. But in the end, you were a victim of a self-fulfilling prophecy.
“The term ‘self-fulfilling prophecy’ originated in social psychology and it refers to how expectations can impact behavior,” says Dr. Albers. “A prediction about an outcome becomes true simply because the person acts in a way to align with their belief.”
We see this play out often in the way we uphold stereotypes about people and places. For example, if a teacher holds internal bias toward a student of a certain sex, race, social class or physical ability, that teacher may give that student (intentionally or unintentionally) less attention or act more aggressively toward the student.
In response, the student may underperform in class and get worse grades than if they had worked with a teacher who was more supportive. And the student’s low performance will act as confirmation of the teacher’s upheld stereotype. This common self-fulfilling prophecy in education has been a subject of several research studies.
“A self-fulfilling prophecy also occurs when the expectations you have for yourself affect your own well-being,” notes Dr. Albers.
The psychology behind self-fulfilling prophecies
So, what’s going on when you’re caught up in a self-fulfilling prophecy?
Well, the cycle actually starts in your head.
“Self-fulfilling prophecies are a complex phenomenon that involves multiple psychological layers,” states Dr. Albers. “When you set certain expectations, those expectations can lead you to notice certain things but not pay attention to others. Your mind focuses on details that confirm what you expect.”
This is especially true when it comes to your medical care. One easy example of this is the placebo effect. This phenomenon occurs when a person participating in a clinical trial experiences improvement in their condition even though they received sugar pills or saline and water injections instead of an actual treatment.
Although the exact mechanism that causes the placebo effect is not known, doctors believe the physical changes in your body occur as a result of your brain releasing a series of certain hormones in response to your belief that you’re receiving real treatment.
“It shows the power of the mind and belief. Your body doesn’t distinguish between what is true and false. It only needs to believe something is true to respond as if it is,” explains Dr. Albers. “The saying ‘It’s all in your head,’ has some merit. If you tell yourself, ‘I’m not doing well,’ your body is listening. Your mind will send signals to your body and release chemicals that support this notion, like stress chemicals and an immune response.”
Self-fulfilling prophecies play out in medical outcomes, patient satisfaction and your overall health and well-being, too.
How fast you walk is often used as a long-term meaningful marker of physical function as you age. In fact, a 2015 study discovered that participants experienced a slower walking speed after two years of examination if they had negative perceptions about getting older. Those negative perceptions about aging likely led to a decline in physical and social activity, which then had an effect on their ability to walk.
“However, sometimes you have this chicken-and-an-egg effect, where it’s hard to say which one comes first,” notes Dr. Albers. “Did you have a negative thought that made you slow down or did you have a negative thought because you noticed signs of slowing down?”
A 2021 study suggested internalized ableism and preconceptions about head trauma and coma survivability can result in a person’s premature withdrawal from life support. The idea is that inherent bias from all parties — including doctors, patients and patient family members — can even have lasting effects on another person’s health and the way we approach medical care as a whole.
For example, if the doctor had a negative impression about coma patient survival outcomes, they could prematurely suggest removing a patient from life support because of those negative impressions instead of giving them enough time to recover. That action then results in the patient’s death, essentially confirming the doctor’s notion that surviving the coma state is unlikely.
The same could happen with family members who may also prematurely remove their loved one from life support out of fear they may not fully recover.
These inherent biases, and the actions we take or don’t take that fuel those inherent biases, are what drive a self-fulfilling prophecy.
“When people are recovering from something like a surgery or a chemotherapy series, there’s a period where a patient is only focused on what they can no longer do, even if they know that’s temporary,” says Dr. Albers. “That doesn’t feel good.”
If someone withdraws from activities they love or people they used to socialize with, they could become more depressed or experience an increase in anxiety. If someone believes they may not survive their experience, they may not participate as often or as fully in day-to-day activities, and this could have an impact on their diet, physical activities and more.
“Your mindset is only one part of the equation in healing and recovery, but it is not one to be underestimated,” stresses Dr. Albers. “Recovery isn’t entirely based on your thoughts, but your thoughts can help or hinder the situation significantly. They can also impact your mood.”
Essentially, our thoughts don’t happen in an air-tight vacuum. How we feel about ourselves, the world around us, our doctors and our medical care all have an immediate impact on our health, our wellness and our ability to heal.
“Your head is a real place and your body follows the path set out by your mind,” says Dr. Albers. “We can never promise someone they won’t have complications, like an infection, or that something won’t go wrong during surgery. But by defining your own expectations, you can guide your body to having as comfortable an experience as possible so that natural healing processes, which may include the placebo effect, can occur.”
In other words, telling your body, You can heal, can help to lead yourself in that direction.
Tips for avoiding harmful self-fulfilling prophecies
Self-fulfilling prophecies don’t have to be negative. You can start taking your fate into your own hands by doing the following:
Be mindful of your thoughts and beliefs
Express your feelings verbally to others and nonverbally in writing or journaling. Talking or writing out your thoughts and emotions can expose your true feelings, which might be guiding you more than you realize or are even aware of.
“Take note of any ways in which your thoughts may be holding you back or impacting your behavior,” says Dr. Albers.
For example, you might think, If I don’t believe I will get better, why bother taking my medication. Instead, reframe these thoughts with empowering language like, I can try; I will give it my best shot.
“Take note of the language you use. Avoid absolute or limiting terms and phrases like ‘never,’ ‘always,’ ‘I must’ or ‘I can’t,’” says Dr. Albers.
Use coping statements
Like using positive affirmations, you’ll want to rely on statements and phrases that set conditions for a good outcome in a real and true way.
“Something that is not necessarily real and true is the phrase ‘You’re going to be fine.’ No one can promise that and people kind of instinctively know that. It’s usually not reassuring and doesn’t feel genuine or authentic,” says Dr. Albers.
“Instead, say something like, ‘I’m in good hands.’ That’s an active use of the placebo effect. By feeling that your team is competent and has your best interests in mind and that they’re doing everything they can, that helps set a condition towards that body-mind effect.”
Activate your sense of autonomy
Sometimes, we have to do things we don’t want to do or experience things we’re afraid of, like undergoing certain treatments or surgeries, or participating in an activity we’re dreading. Those experiences are easier if you take ownership of them. To do this, find small ways to make the experience your own. What is the activity or treatment doing for you? How is it in service of your well-being? Thinking of positive reasons why you may want to experience something may shift your perspective so that you show up for yourself when you need it most.
“Doing this activates your autonomy and gets your mind and body all pointed in the same direction,” encourages Dr. Albers. “Try empowering statements like, ‘I am taking care of myself. I am choosing to do this treatment for my own well-being.’”
And if you get stuck in negative beliefs, try playing devil’s advocate and look at the situation from a different perspective. Ask yourself, What if I’m able to recover?
Gather resources and set up a support system
In the simplest example of having a bad day, you could bolster your support by telling your friends, family or coworkers that you’re feeling off and may need additional assistance. Maybe you could take time out for yourself if you’re able to and rest. In more serious examples involving health conditions, treatment and surgery, you could set up meal plans, rely on help from your social relationships and plan distractions that will keep you entertained while you heal.
“Support is key and tightly connected to a positive mindset,” says Dr. Albers. “You want to talk about short- and long-term goals. Come up with short-term strategies to move through your immediate stressors. If you’ve been dealing with these feelings for a long time, you may want to think about therapy after the immediate physical crisis has passed when you can talk about these things in more depth.”
Think about difficult things you didn’t think you could do in the past and remind yourself how you overcame them. Looking at past proof can strengthen the belief that you can do this.
Be kind to yourself
Give yourself the grace, time and energy to process what’s happening in your own time. Your feelings are valid, and you shouldn’t feel forced to always stay positive. Instead, you’ll want to be wary of toxic positivity and allow yourself to feel things in real time and process your feelings as you experience them.
“We hear people talk about the power of positive thinking all the time and this happens a lot in cancer. You see people tell patients, ‘Just be positive,’ as if that were going to be enough to keep their cancer from recurring,” says Dr. Albers.
Mindfulness includes the notion of acceptance. Accepting rather than fighting what’s happening reduces stress in your body and helps give you an inner sense of peace. For many, it’s a more realistic mindset than trying to convince yourself something isn’t happening.
By getting in the right headspace, you can make sure your actions empower you to tackle whatever you’re facing without bottling up those negative feelings. And you can essentially bring about your own positive self-fulfilling prophecy by giving positive attention to the real feelings you’re having and by setting yourself up for success.
“You can take any feeling, including anger or sadness, and give it positive attention from yourself. It’s about having compassion toward any feeling you encounter,” says Dr. Albers.
“If you have a small child who’s angry or upset, the instinct is to slow down, go to their level and listen to them and help them accept that feeling. Having compassion and accepting an emotion rather than trying to fight it off is sometimes the antidote to the self-fulfilling prophecy.”