February 18

Surprise!! A surprise birthday party is a “touchy” subject during a global pandemic

I open the door to my apartment and switch on the light, and  at first I cannot see anything, because I’m coming in from a dimly lit hallway. But I also don’t have to see anything, because all I hear is a loud “SURPRISE” synchronously shouted from at least 20 people. My heart jumps, my eyes have now already adjusted to the light, and I see all of my close friends standing there. My best friend pulls me into a bear hug which leaves me with goosebumps on my skin and that warm, fuzzy feeling overall. My cheeks start to burn, I am smiling ear to ear and I am just feeling so happy to have all of  them around me…

It’s actually my birthday today and since the Covid-19 pandemic still has us in its grip, a birthday party like this with all my friends and family is out of the question. So, what’s left in the basket is to imagine one…




Surprises have a surprising effect on our brain

Some people like to be surprised. Some like to surprise others, but don’t like to be surprised themselves. I equally like to surprise others and to be surprised. Surprises draw our attention into the moment and our mind focuses completely on the surprising event. Our brain likes surprises for several reasons. Do you remember the last time when someone really surprised you? You probably have a very vivid memory of this moment and a surprise party will stay in your mind for a very long time. 

Unexpected events are supposedly more likely to be remembered than others. In 2010, a group of researchers explored this phenomenon more closely (1). They had a quite unique possibility to measure their participants brain activity during open brain surgery via EEG. Before they started their experiment, the researchers hypothesized that two brain areas were responsible for these “sticky” memories – the hippocampus, which is generally responsible for long-term memory, and the nucleus accumbens, which is our reward and pleasure center (see figure 1). In their experiment, they showed their study subjects pictures of faces on a red background while electrodes measured their brain activity were inserted in the above described regions. Every once in a while, these pictures were interrupted by a picture of a house on a green background. These unexpected pictures indeed triggered the activation of the hippocampus, followed by the activation of the nucleus accumbens which was associated with a much better memory of the unexpected objects.

Figure 1: (A) Location of the nucleus accumbens and the hippocampus. (B) Experimental design used in (1). (C) Unexpected pictures activated the hippocampus stronger than expected ones (picture on the far left) and also the memory of the unexpected pictures evoked a stronger activity in this region (far right picture). Pictures adapted from reference (1).

Also, another study tested the brain’s response to expected versus unexpected events by giving participants squirts of juice or water in regular time intervals. When the squirts were unpredictable, they could also measure a significant change in the activity of the nucleus accumbens in their participant’s brain with functional magnetic resonance imaging (fMRI) which is a brain imaging technique that allows to visualize active areas in the brain (2). The coupling of brain activity in the hippocampus with our reward center is thought to be important for learning, because only relevant information receives a ‘memory boost’ by the reward system. The reason is simple. People are more inclined to remember incidents from which they might learn something new.

What would a surprise party be without hugs?

A hypothetical birthday party combines a lot of things that are important for our wellbeing that we feel deprived of during these times of a global pandemic, especially the physical interaction with friends and family.

When people were asked which type of touch they are missing most, their prevailing answer was “hugs”. Social relationships are extremely important for our overall well being. These social relationships often include physical contact, such as hugs. Just thinking of my hypothetical birthday party, the thing I would be looking forward to the most are the bear hugs I am sure to receive from my friends. 

What happens to people if they are cut off from physical interaction? Even before the Covid-19 crisis, researchers like Dr. Tiffany Field concluded that our society is suffering from a shortage of touch, something that she describes as “touch hunger”.

Interpersonal touch has widely been reported as an important form of communication, to convey emotions, and reduce stress and pain (3, 4), which supports positive therapeutic effects. Interpersonal touch has psychological and physiological impacts on your body. When someone touches you, pressure receptors within your skin are activated which are directly connected to our vagus nerve. This nerve connects our central nervous system (thus our brain) to the peripheral organs such as heart, lung and intestines. The activation of the vagus nerve is involved in many vital functions of our body, including the regulation of digestion, breathing rate, heart beat, and therefore also blood pressure. Thus, when we are hugged our systolic blood pressure drops and our breathing slows down a bit which makes us feel more relaxed. No wonder weighted blankets are increasingly popular as they supposedly have a similar effect.

But there is more to hugging than that. Hugging increases serotonin and dopamine – both neurotransmitters known to have profound effects on our mood. Hugging also reduces the stress hormone cortisol and activates the release of the “cuddling” hormone oxytocin (4). Those hormones and neurotransmitters also have an immediate effect on our reward center in the brain which leaves us happier, calmer and generally feeling good.

Oxytocin is extremely important for us to form all kinds of social bonds, especially between mother and child. But also later in life oxytocin is involved in maintaining social bonds and associated with protective effects for our psychological and also physiological well-being (5). 

There is more to oxytocin than you think

An interesting aspect of oxytocin is that it could actually be used as a drug against a Covid infection itself (6). Because oxytocin mobilizes the immune defense potential and reduces inflammation in the body, it could help fight against the cytokine storm that is associated with a severe Covid-19 infection. Also, it can have cardiovascular protective functions (7) and reduce stress and anxiety in COVID-19 patients which might also produce better outcomes for affected patients. Studies are on the way to test these hypotheses (8). While this should not encourage people to cuddle more and risk getting infected, there could be more to the healing side of touch that we anticipated (9). Something that we should also keep in mind as we move forward in this pandemic.

“Lost touch” – What are the alternatives?

Since interpersonal touch is hard to come by these days, what are the alternatives? Do we have to rely on “hugging” devices like the Hugvie that was invented by a research group in 2013 (10)? Their results showed that the use of these huggable pillows indeed reduced cortisol levels to a higher extent than remote communication alone and also encouraged listening (11). 

Hugvie, the huggable communication device, described in (10)

Or do we all need to get a “Hug-Shirt” that was invented 2002 which conveys the sensation of a hug remotely? The shirt contains electrodes that activate the sensation of a hug which can be controlled via the connected app. This allows hugs to be sent between “Hug-Shirt” users. With a price of 250 British pounds (about $340) such a hug doesn’t come cheap. Also, scientists at MIT developed a huggable robot teddy bear to  assist in healthcare, education, and social communication applications (http://robotic.media.mit.edu/portfolio/huggable/). Since you can also have conversation with it, could it serve as a companion during times of isolation? 

While technical devices might aid therapeutic approaches and help overcome reduced physical contact for a while, in my opinion, none of these tools can substitute “real” physical interaction. And a surprise party with a “Hug-Shirt” on Zoom isn’t the thing most people are looking forward to.

These and many other reasons make us crave this part of normalcy that Covid-19 has stolen from us. However, one can hope that next year’s birthday will be exactly that – a joyful day spent with family and friends with lots of hugs and laughter. A good reason to have some positive anticipation (which by the way also contributes to our wellbeing) that soon we can catch up on all those missed social interactions.

In the meanwhile, I leave you with my motto for the upcoming months: “The more you expect, the less you are surprised and the more that you just let things go, the more life might surprise you!”

And surprises are good for us 😊!


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  2. Pagnoni G, Zink CF, Montague PR, Berns GS. Activity in human ventral striatum locked to errors of reward prediction. Nat Neurosci. 2002 Feb;5(2):97-8. doi: 10.1038/nn802. PMID: 11802175
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  6. Soumier A, Sirigu A.Oxytocin as a potential defence against Covid-19?  Med Hypotheses. 2020 Jul;140:109785. doi: 10.1016/j.mehy.2020.109785. Epub 2020 Apr 23. PMID: 32344303
  7. Wang SC, Wang YF.Cardiovascular protective properties of oxytocin against COVID-19. Life Sci. 2021 Jan 26;270:119130. doi: 10.1016/j.lfs.2021.119130. Online ahead of print. PMID: 33513400
  8. Thakur P, Shrivastava R, Shrivastava VK. Oxytocin as a Potential Adjuvant against COVID-19 Infection. Endocr Metab Immune Disord Drug Targets. 2020 Sep 10. doi: 10.2174/1871530320666200910114259. Online ahead of print. PMID: 32914732
  9. Thomas PA, Kim S. Lost Touch? Implications of Physical Touch for Physical Health. J Gerontol B Psychol Sci Soc Sci. 2020 Aug 26:gbaa134. doi: 10.1093/geronb/gbaa134. Online ahead of print. PMID: 32845008
  10.  Sumioka H, Nakae A, Kanai R, Ishiguro H. Huggable communication medium decreases cortisol levels.  Sci Rep. 2013 Oct 23;3:3034. doi: 10.1038/srep03034. PMID: 24150186
  11.  Nakanishi J, Sumioka H, Ishiguro H.Impact of Mediated Intimate Interaction on Education: A Huggable Communication Medium that Encourages Listening. Front Psychol. 2016 Apr 19;7:510. doi: 10.3389/fpsyg.2016.00510. eCollection 2016. PMID: 27148119