Placebo Effects in Psychiatry and Psychotherapy

2013 ◽  
Author(s):  
David A. Jopling
Keyword(s):  
Placebo Effect ◽  
Placebo Effects ◽  
Open Label ◽  
Evolutionary Origins ◽  
Talk Therapy ◽  
Psychoactive Medication ◽  
New Directions ◽  
Made In

This chapter begins by debunking some of the myths and misconceptions surrounding placebo effects, through a survey of some of the discoveries that have been made in the last fifty years about the range, frequency, and potency of placebo effects in medicine and psychiatry. It then looks at how placebo effects make an appearance in psychiatry and psychotherapy, particularly in the case of treatments of depression that involve psychoactive medication and/or talk therapy. Following this is a survey of some of the leading definitions of the placebo effect, as well as a survey of some of the leading explanatory theories. The chapter concludes with a discussion of some new directions in placebo research: namely, open-label placebos and the evolutionary origins of placebo effects.

scholarly journals Open-label dose-extending placebos for opioid use disorder: a protocol for a randomised controlled clinical trial with methadone treatment

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026604 ◽  
Author(s):  
Annabelle M Belcher ◽  
Thomas O Cole ◽  
Aaron D Greenblatt ◽  
Stephen W Hoag ◽  
David H Epstein ◽  
...  
Keyword(s):  
Placebo Effect ◽  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
Treatment Seeking ◽  
Personality Factors ◽  
Placebo Effects ◽  
Opioid Use ◽  
Open Label ◽  
University Of Maryland ◽  
Study Results

IntroductionMore than 2 million individuals in the USA have an opioid use disorder (OUD). Methadone maintenance treatment is the gold standard of medication-based treatment for OUD, but high-dose methadone is associated with cardiotoxicity and respiratory complications, among other side effects. These adverse effects make enhancing the effectiveness of lower doses of methadone an attractive therapeutic goal. Long recognised for its capacity to enhance treatment outcomes for a wide range of neuropsychiatric disorders including pain, the placebo effect offers an as-yet untested avenue to such an enhancement. This approach is particularly compelling given that individuals with substance use disorder tend to have higher salience attribution and may thereby be more sensitive to placebo effects. Our study combines two promising clinical methodologies—conditioning/dose-extension and open-label placebo—to investigate whether placebo effects can increase the effective potency of methadone in treatment-seeking OUD patients.Methods and analysisA total of 120 newly enrolled treatment-seeking OUD patients will be randomly assigned to one of two different groups: either methadone plus daily placebo dose-extension (PDE; treatment group) or methadone/treatment as usual (control). Participants will meet with study team members five times over the course of 3 months of treatment with methadone (baseline, 2 weeks, and 1, 2 and 3 months postbaseline). Throughout this study time period, methadone dosages will be adjusted by an addiction clinician blind to patient assignment, per standard clinical methods. The primary outcome is methadone dose at 3 months. Secondary outcomes include self-report of drug use; 3-month urine toxicology screen results; and treatment retention. Exploratory outcomes include several environmental as well as personality factors associated with OUD and with propensity to demonstrate a placebo effect.Ethics and disseminationHuman subjects oversight for this study is provided by the University of Maryland, Baltimore and University of Maryland, College Park Institutional Review Boards. Additionally, the study protocol is reviewed annually by an independent Data and Safety Monitoring Board. Study results will be disseminated via research conference presentations and peer-reviewed publications.Trial registration numberNCT02941809.

scholarly journals 3523 Innovative Approaches to Clinical Research on Placebo Effects: A Regulatory Science Perspective

2019 ◽  
Vol 3 (s1) ◽  
pp. 118-118
Author(s):  
Kimberly Uweh
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Placebo Effect ◽  
Controlled Trial ◽  
Placebo Response ◽  
Current Treatment ◽  
Low Back ◽  
Placebo Effects ◽  
Open Label ◽  
Double Blind

OBJECTIVES/SPECIFIC AIMS: To analyze contemporary study design methods and clinical trial approaches in placebo research. METHODS/STUDY POPULATION: An analysis was conducted on the following studies: I. “Managing” the Placebo Effect: The Single-Blind Placebo Lead-in Response in Two Pain Models by RN Haden, et al. The objective of the study was to consider elements of the placebo response in the context of two pain models using a “single-blind placebo lead-in” design (SBPLI) by engaging the “placebo response” prior to randomization to active drug and placebo-controlled conditions. The methods of the study included two pilot drug trials using knee osteoarthritis (KOA) and non-radicular low back pain (LBP) subjects, SBPLI protocols were conducted. In the first study, 36 subjects with non-radicular CLBP were enrolled in a double-blind, randomized, placebo-controlled trial of hydromorphone ER. In the second study, a total of 42 subjects with chronic KOA pain were enrolled in a double-blind, randomized, placebo-controlled study of milnacipran. Gender and/or diagnosis affected placebo responses as observed in changes in patient self-reported pain, depressive and pain anxiety symptoms were examined. Additionally, the placebo response on performance-based tests (stair climbing, range of motion (ROM), sit to stand repetitions, and 6-minute treadmill distance) was evaluated. II. Randomized Placebo-Controlled Placebo Trial to Determine the Placebo Effect Size by L. Gerdesmeyer, et al. The objective of the study was to analyze the pure placebo effect on clinical, chronic pain through a blinded RCT. The methods of the study included 182 patients suffering from chronic plantar heel pain for over 6 months, who failed to respond to conservative treatments, were screened and 106 of these patients were enrolled into this study. The patients were randomly assigned to receive either a blinded placebo shockwave treatment or an unblinded placebo shockwave treatment. The primary outcome measure was the differences in percentage change of visual analogue scale (VAS) scores 6 weeks after the intervention. The secondary outcome measure was the differences in Roles and Maudsley pain score (RMS) 6 weeks after intervention. III. Open-label placebo treatment in chronic low back pain: a randomized controlled trial by C. Carvalho, et al. The objective of the study was to investigate whether placebo effects in chronic low back pain could be harnessed ethically by adding open-label placebo (OLP) treatment to treatment as usual (TAU) for 3 weeks. The methods of the study included 97 randomized participants in a 3-week randomized control trial comparing current treatment plus OLP to current treatment alone (TAU). RESULTS/ANTICIPATED RESULTS: N/a DISCUSSION/SIGNIFICANCE OF IMPACT: The aforementioned studies provide placebo researchers with contemporary and reliable methodologies to examine placebo effects on participants. These methodologies provide scientists with clinical translational research methodology styles based on the foundation of regulatory science.

scholarly journals Harnessing the placebo effect: the need for translational research

2011 ◽  
Vol 366 (1572) ◽  
pp. 1922-1930 ◽  
Author(s):  
Luana Colloca ◽  
Franklin G. Miller
Keyword(s):  
Clinical Practice ◽  
Translational Research ◽  
Placebo Effect ◽  
Clinical Setting ◽  
Routine Clinical Practice ◽  
Laboratory Research ◽  
Placebo Effects ◽  
Brain Areas ◽  
Nocebo Effects ◽  
Made In

Laboratory research recently has greatly enhanced the understanding of placebo and nocebo effects by identifying specific neuromodulators and brain areas associated with them. However, little progress has been made in translating this knowledge into improved patient care. Here, we discuss the limitations in our knowledge about placebo (and nocebo) effects and the need for translational research with the aim of guiding physicians in maximizing placebo effects and minimizing nocebo effects in their routine clinical practice. We suggest some strategies for how, when and why interventions to promote beneficial placebo responses might be administered in the clinical setting.

Placebos and Movies: What Do They Have in Common?

2021 ◽  
pp. 096372142110038
Author(s):  
Fabrizio Benedetti
Keyword(s):  
Everyday Life ◽  
Common Sense ◽  
Placebo Effect ◽  
Psychological Factors ◽  
General Framework ◽  
Physiological Responses ◽  
Therapeutic Effects ◽  
Physiological Effects ◽  
Placebo Effects ◽  
What Matters

Placebos are fake therapies that can induce real therapeutic effects, called placebo effects. It goes without saying that what matters for inducing a placebo effect is not so much the fake treatment itself, but rather the therapeutic ritual that is carried out, which is capable of triggering psychobiological mechanisms in the patient’s brain. Both laypersons and scientists often accept the phenomenon of the placebo effect with reluctance, as fiction-induced clinical improvements are at odds with common sense. However, it should be emphasized that placebo effects are not surprising after all if one considers that fiction-induced physiological effects occur in everyday life. Movies provide one of the best examples of how fictitious reality can induce psychological and physiological responses, such as fear, love, and tears. In the same way that a horror movie induces fear-related physiological responses, even though the viewer knows everything is fake, so the sight of a syringe may trigger the release of pain-relieving chemicals in the patient’s brain, even if the patient knows there is a fake painkiller inside. From this perspective, placebos can be better conceptualized as rituals, actions, and fictions within a more general framework that emphasizes the power of psychological factors in everyday life, including the healing context.

scholarly journals Reactivity in social scientific experiments: what is it and how is it different (and worse) than a Placebo effect?

2021 ◽  
Vol 11 (2) ◽  
Author(s):  
María Jiménez-Buedo
Keyword(s):  
Experimental Data ◽  
Conceptual Framework ◽  
Placebo Effect ◽  
Placebo Effects ◽  
Causal Inferences ◽  
Scientific Experiments ◽  
Social Scientific ◽  
The Many ◽  
Definition Of ◽  
In Virtue Of

AbstractReactivity, or the phenomenon by which subjects tend to modify their behavior in virtue of their being studied upon, is often cited as one of the most important difficulties involved in social scientific experiments, and yet, there is to date a persistent conceptual muddle when dealing with the many dimensions of reactivity. This paper offers a conceptual framework for reactivity that draws on an interventionist approach to causality. The framework allows us to offer an unambiguous definition of reactivity and distinguishes it from placebo effects. Further, it allows us to distinguish between benign and malignant forms of the phenomenon, depending on whether reactivity constitutes a danger to the validity of the causal inferences drawn from experimental data.

Choice and the Placebo Effect: A Meta-analysis

2022 ◽  
Author(s):  
Biya Tang ◽  
Kirsten Barnes ◽  
Andrew Geers ◽  
Evan Livesey ◽  
Ben Colagiuri
Keyword(s):  
Placebo Effect ◽  
Effect Size ◽  
Meta Analysis ◽  
Placebo Treatment ◽  
Placebo Effects ◽  
Sleep Difficulty ◽  
Clinical Scenarios ◽  
Health Related ◽  
Choice Frequency ◽  
Improve Patient

Abstract Background Choice has been proposed as a method of enhancing placebo effects. However, there have been no attempts to systematically evaluate the magnitude, reliability, and moderators of the influence of choice on the placebo effect. Purpose To estimate the effect size of choice on the placebo effect and identify any moderators of this effect. Methods Web of Science, PsycINFO, EMBASE, and PubMed were systematically searched from inception to May 2021 for studies comparing placebo treatment with any form of choice over its administration (e.g., type, timing) to placebo treatment without choice, on any health-related outcome. Random-effects meta-analysis was then used to estimate the effect size associated with the influence of choice on the placebo effect. Meta-regression was subsequently employed to determine the moderating effect of factors such as type of choice, frequency of choice, and size of the placebo effect without choice. Results Fifteen independent studies (N = 1,506) assessing a range of conditions, including pain, discomfort, sleep difficulty, and anxiety, met inclusion criteria. Meta-analysis revealed that choice did significantly enhance the placebo effect (Hedges’ g = 0.298). Size of the placebo effect without choice was the only reliable moderator of this effect, whereby a greater effect of choice was associated with smaller placebo effects without choice. Conclusions Treatment choice can effectively facilitate the placebo effect, but this effect appears more pronounced in contexts where the placebo effect without choice is weaker. Because most evidence to date is experimental, translational studies are needed to test whether providing choice in clinical scenarios where placebo effects are weaker may help boost the placebo effect and thereby improve patient outcomes.

Placebos in chronic pain: evidence, theory, ethics, and use in clinical practice

BMJ ◽  
2020 ◽  
pp. m1668 ◽  
Author(s):  
Ted J Kaptchuk ◽  
Christopher C Hemond ◽  
Franklin G Miller
Keyword(s):  
Chronic Pain ◽  
Clinical Practice ◽  
Predictive Coding ◽  
Evidence Theory ◽  
Placebo Treatment ◽  
Placebo Effects ◽  
Unified Framework ◽  
Open Label ◽  
Double Blind ◽  
Bayesian Brain

ABSTRACTDespite their ubiquitous presence, placebos and placebo effects retain an ambiguous and unsettling presence in biomedicine. Specifically focused on chronic pain, this review examines the effect of placebo treatment under three distinct frameworks: double blind, deception, and open label honestly prescribed. These specific conditions do not necessarily differentially modify placebo outcomes. Psychological, clinical, and neurological theories of placebo effects are scrutinized. In chronic pain, conscious expectation does not reliably predict placebo effects. A supportive patient-physician relationship may enhance placebo effects. This review highlights “predictive coding” and “bayesian brain” as emerging models derived from computational neurobiology that offer a unified framework to explain the heterogeneous evidence on placebos. These models invert the dogma of the brain as a stimulus driven organ to one in which perception relies heavily on learnt, top down, cortical predictions to infer the source of incoming sensory data. In predictive coding/bayesian brain, both chronic pain (significantly modulated by central sensitization) and its alleviation with placebo treatment are explicated as centrally encoded, mostly non-conscious, bayesian biases. The review then evaluates seven ways in which placebos are used in clinical practice and research and their bioethical implications. In this way, it shows that placebo effects are evidence based, clinically relevant, and potentially ethical tools for relieving chronic pain.

Some Pain, Some Gain: Reflections on the Past Two Decades of Neonatal Pain Research and Treatment

2002 ◽  
Vol 21 (5) ◽  
pp. 37-41 ◽  
Author(s):  
Linda Franck
Keyword(s):  
Health Professionals ◽  
Future Research ◽  
Pain Research ◽  
Attitudes And Practices ◽  
Neonatal Pain ◽  
The Past ◽  
New Directions ◽  
Infant Pain ◽  
Made In

This review reflects back on the progress that has been made in infant pain research over the past 20 years and how the research has influenced (or has failed to influence) the attitudes and practices of health professionals about infant pain. Progress in understanding of infant pain neurobiology, treatment, and measurement are discussed, and new directions for future research are proposed.

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