How you feel- Could it be all in your head?

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The placebo effect- Its all in your head

In medicine, the sugar pill represents an inactive or inert treatment defined as the placebo. But the placebo effect is far from inactive. It is indeed, 'all in your head'

The placebo effect is a measured change after an inactive treatment (sometimes referred to as a ‘sugar pill’) is given to a person who ‘thinks’ the treatment is real. The placebo is an important part of research designed to determine the true effect of a drug, surgery or other treatment. By comparing the effect of the placebo treatment to real treatment, researchers can determine if the results are truly related to the treatment itself or some other factor unrelated to treatment called the placebo effect.

The placebo effect is a very important concept to understand when evaluating integrative and holistic therapies especially since many of these therapies are not studied in ways to control for this effect. A positive or negative effect could simply be due to placebo and not the real treatment.  In traditional medicine, research is designed to control for and subtract the effect of the placebo effect to determine the true effect of a treatment or surgery.  The randomized placebo controlled research trial is designed with this intention. In a randomized trial, participants are randomly divided into a group that gets the treatment under study or a second group that gets placebo ‘treatment’ (i.e. sugar pill, sham surgery).  Ideally both research participant and researcher are not aware of the group that participants are assigned. This avoids any bias in measurement, observation or interaction that researchers can bring to the study.  In this way, the placebo effect (i.e. results obtained from the group that unknowingly received inactive treatment) can be statistically compared to the active treatment effect.  If there is no difference between these two groups, the treatment is not considered effective even if benefits were measured.

So what causes the placebo effect and how can you use this to your advantage? Psychological factors are associated with the strength of the placebo (or nocebo) effect. These factors include:

  • Prior treatment experience or conditioned learning. You will have a greater placebo effect with a treatment if you had a good experience with a similar treatment in the past. Each of us has our own past experiences, good and bad, and these experiences influence our future treatments. A positive experience will lead to a larger placebo effect and a negative experience (side effect or no improvement) will lead to a larger nocebo (negative) effect. Psychologists call this response conditioned learning since what we have learned from prior experiences conditions or influences are future experiences.
  • Expectations for treatment. The placebo effect will change with your expectation. If you believe or expect a treatment will have dramatic results the placebo will be greater. If you believe a treatment will not work then the nocebo effect will be stronger. This may be why studies show a greater placebo with a larger pill v. smaller pill, brand name v. generic medicine, invasive surgery v. medicine, pill v. injection.
  • Treatment value and meaning. Placebo effect is influenced by the degree of value or personal meaning attached to a treatment. This could include a treatment like stem cell that carries high hope and value or a treatment such as a natural therapy or supplement that aligns with a personal philosophy of cultural belief.

 

The fact that your experiences, expectations, ideals and values can change the placebo effect is especially important to holistic medicine. The following examples illustrate how these factors can influence treatment.

- Prior medicine side effects can influence your odds of having future side effects with a different medicine.

-Frustrations with changes and de-personalization often experienced in the rush of modern day healthcare or large institutions can have a negative impact on treatment results.

-People that are more likely to seek out nature based or holistic therapies often have a philosophical belief that natural therapies are safer or more effective in promoting a greater placebo effect.

-Treatment received is a calm, relaxing, soothing and empathic environment will have more positive benefits than one administered in an uncomfortable, rushed setting.

-Treatment results will vary based on how much you trust the person giving treatment, their show of compassion, perceptions of experience etc. 

Researchers spend time and effort to minimize the placebo response in experiments.  As a person seeking treatment of a chronic condition, however, you are interested in the ultimate outcome in how you feel with any treatment.  This outcome can include the combined effect of real treatment and placebo. You can enhance the benefit gained from any treatment (or reduce negative effects) by matching your behavior to the factors that contribute to the placebo effect. Once again the power of the mind and spirit play a strong role. The following behaviors can help you harness your placebo effect.

  • Increase your level of expectation for therapy. Understand the benefits, believe in the possible and reinforce the positive.
  • Be aware of how your prior experience can effect current treatments. Discuss your experience with your healthcare provider if you had a negative reaction to a treatment in the past. It is helpful to understand why you had a problem, ways that this can be altered going forth with new treatment, and how a new treatment is different. In this way you will be expecting a different response than your prior experience.
  • Actively participate. A treatment has a greater chance of working if you are motivated to actively participate and work with your healthcare provider to make decisions for treatment.  Aim to learn and understand what treatments can and cannot do and make a concerted effort to concentrate on the former and not the later. 
  • Include others in care. Including your loved ones, family and friends in your decisions about care can help in many ways. The positive reinforcement and wellbeing you get from sharing, compassion, encouragement and hope as you begin your treatment can go a long way towards successful outcomes.
  • Align with your beliefs. Choose therapy that is in line with your values and beliefs.  If you believe in the power of nutrition and supplements, ask your healthcare provider about treatments in this area.
  • Combine treatments you believe in or that have special meaning to you with your traditional medical treatment. For instances, it may be helpful to combine practices that are important to you to improve the benefit of a treatment.  Examples include prayer, massage, meditation, nature and animals to aid the benefits of other treatment.
  • Reinforce positive learning. Chose healthcare providers that you trust, actively listen to you, educate, engage you in the decision making, and can demonstrate the benefits of a treatment.
  • Treat depression and anxiety as these conditions affect your motivation, expectation and perception that change can occur for the better.
  • Capitalize on the power of a good therapeutic relationship between you and your doctor or healthcare provider. You are more apt to trust a provider that listens, understands, is empathic and is open to your needs, values and ideas about your healthcare.
  • Use ceremony and imagery to achieve results. A particular routine, imagery of cure or even simply wearing ‘your lucky shirt’ creates a routine that is associated with healing or positive thoughts.

 

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