Have you ever wondered just how powerful your mind is?
The placebo and nocebo effects
have had scientists
asking this question for years, and a wide range
of theories and case studies exist to supplement evidence in
this field.
Today we're going to be taking you through a case
study to help you better
understand what exactly these responses are, and why we should
pay attention to them.
Before we dive into the
case study, let's become more familiar with what exactly these
terms mean.
The NIH defines the placebo effect as
a beneficial health outcome
resulting from a person's anticipation that an intervention will help.
What is means is that it is a person's expectation of
the intervention working that creates the beneficial effect rather than the
intervention itself. In contrast,
Planes et al.
defined the nocebo effect as the induction,
or the worsening of symptoms induced by sham or active
therapies.
In this case,
we are saying that a person's expectation of a negative
outcome
resulting from an intervention is what creates that outcome rather
than the intervention itself.
Let's move on to our case study.
Meet Sam. Sam was recently enrolled as a human
participant in a randomized
controlled trial
looking at a potential treatment for wobbly legs, and is
placed in a group receiving sugar pill as a placebo drug
while the other group receives
the real, or the active, drug.
He doesn't know that he's receiving a placebo,
and both groups were told
there's a slight risk of getting a very dry mouth
as a side
effect of the active drug. While
Sam is not getting the active drug, his legs
become much less wobbly
and he ends up
experiencing a dry mouth.
Knowing that he's only receiving a sugar pill, why would
these effects
still be seen? There are two key psychological theories
that scientists have debated over as to why
the placebo and nocebo effects occur. Expectancy Theory
describes that having a positive expectation of a certain outcome,
through direct or explicit instruction, leads to the body inducing
its own responses to fulfill that expectation.
It's important to note that expectancy theory is forward-looking, meaning
that is focused on how we respond to the potential
for certain events to occur in the future.
In contrast,
classical conditioning is more of a backward-looking theory because it
describes how the body uses certain neutral cues that
have been associated with a particular effect in the past
to enact the same effect
when these cues are present, not in the active intervention.
For example,
if someone were to take a medication with a very
distinctive appearance and taste,
and if that medication was eventually replaced by sugar pill
with the same appearance
and the same taste,
the body might still associate
the sugar pill with the response elicited by the original
medication, and elicit
some response along these lines. In both theories.
it is important to note that the psychological responses that
end up getting evoked are done
so
from within the body,
rather than due to an active intervention.
According to Wager
and Atlas in 2015,
the placebo and nocebo effects can be broken down into
external and internal contexts.
The external context refers to factors outside
the body that can be used to cue a placebo
or nocebo response, while the internal context refers to
what these cues mean to the individual, and what the
probable psychological
and neurological outcomes
may be. The main categories of external cues include verbal
suggestions,
place cues,
social cues and treatment cues.
These can result in changes to the internal context,
such as helping to reduce stress and other emotions,
resulting in the individual feeling cared for as well as
eliciting
memories and other associations.
There are some limitations to be aware of where there's
back to conducting research regarding the placebo and nocebo effects,
which is largely due to concerns regarding informed consent
in a research context.
Shah and colleagues defined informed consent
as a process in which a healthcare provider educates.
a patient about the risks, benefits and alternatives of a
given procedure or intervention.
However,
the placebo and nocebo responses are only elicited
when an individual believes they can expect a certain outcome
that may not be associated with the intervention being given.
Figuring out how to inform them of the realistic
outcomes of the intervention becomes much trickier.
Furthermore, failing to sufficiently inform individuals of the probable
outcomes of getting involved in a study can even
lead to them becoming even more distressed,
thereby confounding the ultimate goal of evaluating a placebo or
nocebo response from a sole intervention. To combat
this, some studies suggest that informing individuals of the possible
positive and negative side effects that can still result from
placebos can help to resolve some of these misconceptions.
However,
there is still widespread debate
the next steps to address these limitations.
One of the most common myths related to the placebo
And nocebo effects that still, in part,
persists to date is that these responses are not real.
This claim is not true.
And there is a plethora of research evidence supporting the
neurobiological basis of the placebo
and nocebo effects. Numerous neuroimaging studies have demonstrated
notable changes at various sites,
across the brain when placebo or nocebo responses are elicited,
as well as changes in physical symptoms.
that get elicited from Individual to individual,
such as heart rate
variability,
as well as changes in secretion of endorphins and other
neurotransmitters and hormones.
While this topic has been of some interest in the
scientific community in recent years,
there are many other areas that we need to spend
more time learning about in order to better understand how
exactly these phenomena work.
These can include: what are the exact biological processes involved?
How does a placebo or nocebo differ from non-specific changes
in state following an intervention?
and how can the findings
help improve the quality of life and safety of individuals
in the future
receiving psychiatric and medical treatments?
In conclusion,
we can apply what
we've learned to Sam's case.
We can see that getting reduced wobbly legs,
even after taking a sugar pill, can be attributed to
the placebo effect, while getting a dry mouth,
will be indicative
of a nocebo response as an adverse side effect.
Why might this have occurred? Some key theories include expectancy
and classical conditioning,
regarding why Sam is experiencing this
now.
Some ways in which researchers can induce these effects
for future
reference include verbal, place,
social and treatment cues.
Overall,
we hope that this video was able to help you
gain a better
appreciation of just how powerful your mind is, in the
context of the placebo and nocebo effects.
If you want to learn more about these subjects,
make sure to check out the links in the description.
Thanks for watching!