By Umiemah Farrukh (Class of 2023)
A placebo is a beneficial effect produced by a treatment that cannot be attributed to its physiological properties but rather to its intent of healing (Miller et al., 2010). It is a powerful tool used within the field of healthcare and specifically the subfield of Psychology. When utilized properly, placebos can have major impacts, positive and/or negative, on an individual’s mental and physical health. That is why it is important to learn about what a placebo is and how it works, so we can effectively maximize (or in relevant cases, minimize) its effects on the human body.
This type of research is exactly what scientists have been doing for the past couple of decades after this concept was first introduced by John Haygaarth in 1799. Haygaarth pitted actual rods used in medical treatment against “sham” rods and found that the effect was the same in both cases (Mestel, 2017). Eventually, as scientists researched it more and this led to the understanding of the two psychological mechanisms behind the effectiveness of placebos. The first of these is classical conditioning, and it’s when two stimuli (a neutral one and one that naturally produces a response in the body) are linked together to produce a new learned response. Eventually, the conditioned stimulus alone will elicit a response. For example, needle + morphine = pain relief, until eventually just needle = pain relief. The second mechanism at play is related to the mentalistic theory; your expectations about the treatment determine the outcome. Placebos work best when both classical conditioning and the mentalistic theory work together, according to Enck and Hauser (2012).
There is some neuroscience related to the way placebos work which is essential to note here, as it works in conjunction with the two psychological mechanisms mentioned above. The first of these is the neurotransmitter release in the brain. The second is the hormone release in the brain in response to a placebo (Lidstone 2014).
An important phenomenon to understand when talking about placebos is the nocebo effect. This is best understood as the opposite of a placebo effect and is a situation where a negative outcome occurs due to a belief that the sham intervention or treatment will cause harm. The interesting thing about nocebos is that they work in the same way as placebos when we look at the neuroscience of it, and the effect is just as powerful (Planès et al., 2016). However, the only factor that is different between the two, is beliefs about the sham treatment or intervention. Having preconceived negative notions about the placebo treatment being administered changes the results. Physicians also play a huge part in communicating consciously or subconsciously these verbal triggers or negative assumptions, that lead to the nocebo effect, as the article cited above states (Planès et al., 2016). For example, when physicians tell patients about possible side effects, the probability that the patient will feel these side effects increases, and lack of emotion and warmth when talking to the patient increases the likelihood that the patient will feel negative symptoms (Enck and Hauser, 2012).
So, in order to maximize the effects of placebos, we need to make sure that the way sham treatment or placebo is introduced is positive and warm. This adds to the effectiveness of placebos, as do things like whether or not it is administered in a medical setting, the way it is administered, cost of medication, and even the color of the pill.
In conclusion, understanding placebos and the current research about them is essential to understanding health psychology and becoming more knowledgeable about public health as a topic. In doing so, we can also understand how to apply it in real life, and use the powerful effect of placebos to effectively treat mental illnesses like anxiety and depression and also physical illnesses. Lastly, future directions for this research are wide because of how applicable this topic is to real-life scenarios, and could include developing interventions for illnesses that solely rely on placebos and maximizing the potential of the placebo effect in medical settings, such as successfully using a placebo pill to treat patients with anxiety.
References
Enck, P., Winfried Häuser. (2012). Beware the Nocebo Effect. The New York Times. https://www.nytimes.com/2012/08/12/opinion/sunday/beware-the-nocebo-effect.html
Harvard Health, (2019). The power of the placebo effect.
Kirsch I. (2019). Placebo Effect in the Treatment of Depression and Anxiety. Frontiers in psychiatry, 10, 407. https://doi.org/10.3389/fpsyt.2019.00407
Lidstone S. C. (2014). Great expectations: the placebo effect in Parkinson's disease. Handbook of experimental pharmacology, 225, 139–147. https://doi.org/10.1007/978-3-662-44519-8_8
Mestel, Rosie. (2017). The imagination effect: A history of placebo power. Knowable Magazine.
Miller, F. G., Colloca, L., & Kaptchuk, T. J. (2009). The placebo effect: illness and interpersonal healing. Perspectives in biology and medicine, 52(4), 518–539. https://doi.org/10.1353/pbm.0.0115
Planès, S., Villier, C., & Mallaret, M. (2016). The nocebo effect of drugs. Pharmacology research & perspectives, 4(2), e00208. https://doi.org/10.1002/prp2.208
This type of research is exactly what scientists have been doing for the past couple of decades after this concept was first introduced by John Haygaarth in 1799. Haygaarth pitted actual rods used in medical treatment against “sham” rods and found that the effect was the same in both cases (Mestel, 2017). Eventually, as scientists researched it more and this led to the understanding of the two psychological mechanisms behind the effectiveness of placebos. The first of these is classical conditioning, and it’s when two stimuli (a neutral one and one that naturally produces a response in the body) are linked together to produce a new learned response. Eventually, the conditioned stimulus alone will elicit a response. For example, needle + morphine = pain relief, until eventually just needle = pain relief. The second mechanism at play is related to the mentalistic theory; your expectations about the treatment determine the outcome. Placebos work best when both classical conditioning and the mentalistic theory work together, according to Enck and Hauser (2012).
There is some neuroscience related to the way placebos work which is essential to note here, as it works in conjunction with the two psychological mechanisms mentioned above. The first of these is the neurotransmitter release in the brain. The second is the hormone release in the brain in response to a placebo (Lidstone 2014).
An important phenomenon to understand when talking about placebos is the nocebo effect. This is best understood as the opposite of a placebo effect and is a situation where a negative outcome occurs due to a belief that the sham intervention or treatment will cause harm. The interesting thing about nocebos is that they work in the same way as placebos when we look at the neuroscience of it, and the effect is just as powerful (Planès et al., 2016). However, the only factor that is different between the two, is beliefs about the sham treatment or intervention. Having preconceived negative notions about the placebo treatment being administered changes the results. Physicians also play a huge part in communicating consciously or subconsciously these verbal triggers or negative assumptions, that lead to the nocebo effect, as the article cited above states (Planès et al., 2016). For example, when physicians tell patients about possible side effects, the probability that the patient will feel these side effects increases, and lack of emotion and warmth when talking to the patient increases the likelihood that the patient will feel negative symptoms (Enck and Hauser, 2012).
So, in order to maximize the effects of placebos, we need to make sure that the way sham treatment or placebo is introduced is positive and warm. This adds to the effectiveness of placebos, as do things like whether or not it is administered in a medical setting, the way it is administered, cost of medication, and even the color of the pill.
In conclusion, understanding placebos and the current research about them is essential to understanding health psychology and becoming more knowledgeable about public health as a topic. In doing so, we can also understand how to apply it in real life, and use the powerful effect of placebos to effectively treat mental illnesses like anxiety and depression and also physical illnesses. Lastly, future directions for this research are wide because of how applicable this topic is to real-life scenarios, and could include developing interventions for illnesses that solely rely on placebos and maximizing the potential of the placebo effect in medical settings, such as successfully using a placebo pill to treat patients with anxiety.
References
Enck, P., Winfried Häuser. (2012). Beware the Nocebo Effect. The New York Times. https://www.nytimes.com/2012/08/12/opinion/sunday/beware-the-nocebo-effect.html
Harvard Health, (2019). The power of the placebo effect.
Kirsch I. (2019). Placebo Effect in the Treatment of Depression and Anxiety. Frontiers in psychiatry, 10, 407. https://doi.org/10.3389/fpsyt.2019.00407
Lidstone S. C. (2014). Great expectations: the placebo effect in Parkinson's disease. Handbook of experimental pharmacology, 225, 139–147. https://doi.org/10.1007/978-3-662-44519-8_8
Mestel, Rosie. (2017). The imagination effect: A history of placebo power. Knowable Magazine.
Miller, F. G., Colloca, L., & Kaptchuk, T. J. (2009). The placebo effect: illness and interpersonal healing. Perspectives in biology and medicine, 52(4), 518–539. https://doi.org/10.1353/pbm.0.0115
Planès, S., Villier, C., & Mallaret, M. (2016). The nocebo effect of drugs. Pharmacology research & perspectives, 4(2), e00208. https://doi.org/10.1002/prp2.208
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