Can Tylenol Dissolve Feelings of Dread?

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Thinking about death, fearing the unknown and worrying about the future aren’t traditionally considered sources of physical pain, but they may be susceptible to the same pain-killing treatments.  

Tylenol (acetaminophen) isn’t the most obvious remedy for dread— unlike, say, heroin or a stiff drink, it isn’t known to provide the emotional escape that fear of dying might require. But recent research suggests a strong connection between the pathways responsible for physical and social pain, that hints the same treatments might work for both. One study, for example, revealed an intriguing connection between the over-the-counter medication and its ability to lessen the sting of social rejection.

So Daniel Randles, a PhD candidate at the University of British Columbia and his colleagues decided to see if the interaction ran deeper. Perhaps, they thought, the pain-processing region in the brain reacts to many types of unexpected, potentially negative events. After all, both pain and social rejection involve unpredictable and distressing events that could lead to behavioral changes to avoid those situations in the future. Uncertainty also tends to increase both types of pain.

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“Our research focuses on a particular region of the brain, the dorsal anterior cingulate cortex (DACC),” says Randles, the lead author of the study, published in Psychological Science. “This region is known to process physical pain and manage social pain as well.”

But to recreate the same uncertain, distressing feeling among participants in a study setting, Randles and his team had to get creative. They assigned more than 120 college students to take either a 1,000mg dose of Tylenol or a placebo, and asked half of each group to write about what would happen to their body after they died, and the other half to discuss dental pain, which doesn’t (at least for most people) trigger the same deep, existential dread or anxiety.

To see how the pain killer affected their sense of unease, the volunteers were then asked to consider setting bail for a woman arrested for prostitution. Prior studies showed that thinking about death or facing strange and unexpected situations or circumstances tends to make people seek certainty and meaning as a way of compensating for their anxiety over the unknown and unfamiliar. One way to do this is by upholding moral norms. So after people consider their own death, for example, they tend to be more punitive when asked to make sentencing decisions regarding crime. If thinking about death had provoked unsettling uncertainty, setting a higher bail could re-affirm a moral certainty, reducing the ambiguity.  “Focusing on things that still make sense makes them feel better,” explains Randles, suggesting that reinforcing conventional morality “downregulates this anxiety.”

And, in fact, those who thought about dental pain showed no difference in the bail values they set for the prostitute, whether they took placebo or Tylenol.  They faced no uncertainty or anxiety. But for those who had contemplated their own death, the Tylenol seemed to make a difference. Those who took the pain-killer set a bail of $313 while those given placebo went up to $443.  The Tylenol somehow reduced anxious compensation.

“I think it’s a very interesting idea and I find it to be plausible,” says Tor Wager, director of the cognitive and affective control lab at the University of Colorado in Boulder, who was not associated with the research. He adds that the results need to be repeated: “The more surprising something is, the more evidence we need before we can take it to the bank.”

To extend their findings, the researchers then asked some students to watch a short segment from the David Lynch film, Rabbits, and other participants to view a clip from The Simpsons. The Lynch clip, which included human characters with rabbit heads who made non sequitur statements, random laughter and applause as well as ominous music, was meant to induce unease and discomfort among the viewers.

Since the participants all lived in Vancouver, they were well aware of the riots that occurred in 2011 after the Canucks lost the Stanley Cup hockey game. So following their video session, they were asked about what punishment they thought those who had committed vandalism following the event that shamed the city deserved. Those who watched the Simpsons clip were the most lenient, regardless of whether they took Tylenol or the placebo, while the group that took the sugar pill and viewed the Rabbits segment called for the heaviest punishment. The students who took Tylenol before watching the Rabbits, however, were as lenient as those who watched the Simpsons.

Randles cautions that these results don’t prove that Tylenol can treat existential despair — even significant effects observed in such laboratory settings often don’t translate into real relief, particularly when attempting to extrapolate from normal students, such as those recruited for the study, to those with anxiety or depression.  “It’s not clear if this would have useful therapeutic benefits,” he says, “You would have to run a clinical study.”

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However, the research does suggest that on some level, our brains process many types of negative experiences similarly— which means they might even be treated similarly, by something as common as a single dose of an over-the-counter medication. “All these experiences of  pain and existential dread might involve [some of] the same circuits and for that reason, they might interact with one another,” says Wager, adding that it could suggest a systems-level reason “for emotional trauma to later translate into physical pain or vice versa.”

And what about people who are more comfortable with the unease of the unknown, and fans of surreal art a la Lynch?  If the research had been done with David Lynch fans, says Randles, “It’s entirely possible that we would have had a null result.”