What if I told you there was a treatment out there that could reduce stress or depression, ease nausea, improve sleep, relieve pain, and help with nearly any illness you can think up? You’d probably assume it’s a scam. Something like this is just too good to be true. Oh, and don’t forget – there are no negative side effects; it’s free; and it’s available anywhere.
This treatment is nothing new or high-tech; it’s something we call the placebo effect, a mind-body phenomenon that was thrown out decades ago. However, recent studies and contemporary science are starting to see its promising potential.
Placebo Effect Percentage
The placebo effect – or the placebo response – is what happens when a fake treatment, such as sham acupuncture or a sugar pill, has a positive effect on one’s condition. US physician Henry Beecher was the first to utilize it in 1955 when he collected data from 15 studies with 1082 patients suffering varying degrees of pain. He illustrated that an average of 35.2% of cases responded effectively to the placebo painkiller, and since then, many researchers have only validated his findings.
Often, researchers doing studies will use a placebo treatment to separate how much benefit comes from the so-called active treatment from what is just a result of the placebo response. Usually, it’s still around 30%.
Shifting the Stigma
In the last few decades, however, placebos have gotten a bad name, many labeling it a “fake treatment.” You’ll even find doctors using them to see who is actually ill and who is reporting fake symptoms or had psychosomatic symptoms. Associate Professor Ben Colagiuri from the School of Psychology at the University of Sydney says, “Historically, people who responded to placebos were thought to be gullible or thought to be making up their symptoms, or they didn’t have a real medical problem.”
Fortunately, the stereotype is beginning to fade away, and attitudes are changing as a result of recent research. “I think we’ve moved on from that view now,” Colagiuri says. “It’s becoming more widely accepted that placebos can have genuine beneficial effects in at least some patients for at least some conditions.”
Dr Kate Faasse from the School of Psychology at the University of New South Wales, agrees. She reports that there has been no tie of personality traits, such as gullibility, to the placebo effect. “People who respond to placebos are just normal people for whom that treatment context is particularly effective. It’s absolutely nothing to do with being any of those negative stereotypes,” she says.
Social & Cultural Factors
As the stigma shifts, fewer doctors readily dismiss the placebo effect as ineffective or mystical. In contrast, pioneering thinkers are finding ways to harness the potential healing powers the placebo effect holds.
For instance, one of the factors to consider with the placebo effect is the social context. Researchers at Stanford University pin-pricked participants arms to elicit an allergic response. One group received a placebo antihistamine cream from a doctor at a spotless desk with a badge indicating seniority, exuding warmth and confidence. The others received the same cream from the same doctor except he had a student doctor badge, a bumbling demeanor, and a cluttered desk. In the end, the first group responded much more positively to the antihistamine cream than the second.
Another factor is that of cultural context. Think of how different Western medicine is from traditional Chinese medicine (TCM). “You give them [both] a pill and say, ‘This is a powerful painkiller; it will help you get better”, but it’s actually a sugar pill. Or you give [them both] acupuncture but it’s actually sham acupuncture,” says Colagiuri.
“You can pretty reasonably expect that you’ll get a much larger placebo effect in the Western medicine-exposed person who gets the pill, and a larger one in the TCM-exposed person who gets the acupuncture,” he says. “We can’t say that one is a placebo responder and one is not. We need to understand the whole treatment context including the individual’s prior experiences in order to predict whether they’ll have a placebo effect or not.”
The fact is, within all of us is the ability to trigger our mind-body healing mechanisms that form the placebo effect. As Faasse notes, “Most of us can heal from a cold or a cut. It’s those same processes that we’re activating, we think, with the placebo effect.”
Your Inbuilt Pharmacy
Science has yet to get to the bottom of how our healing capacity works, but what is most certainly true of human nature is that positive expectations and prior experience play a key role. Faasse explains, “Those two go hand in hand. If you have positive previous experience you also tend to have [a] positive expectation.”
In a way that’s “much more complicated than we initially thought,” according to Faasse, our positive expectations affect our inner pharmacy. “It seems like just thinking about something can activate the neural networks in your brain associated with that outcome and perhaps that’s what’s triggering these endogenous (built-in) mechanisms.”
How the placebo effect works
If you understand how the human mind and body work, this really doesn’t come much as a surprise. Our bodies are daily manufacturing and regulating medications to care for our body functions and maintain good health, things like painkillers, antibiotics, antidepressants, anti-inflammatories, immune stimulants, cancer-fighting drugs, blood pressure stabilizers, stimulants, and many more.
Our bodies being wired the way they are, the placebo effect then works through all the various systems the brain already uses to heal the body. For example, when you are experiencing pain, it influences the body to produce more endogenous opioids, natural painkillers. In Parkinson’s disease, it can cause the brain to produce more dopamine, the neurotransmitter that is deficient in this condition.
Placebo in Practice
Researchers have studied the placebo effect most in-depth in relation to pain treatment, and it’s been significantly proven how powerfully the mind influences the body. Faasse describes a study conducted by Italian researchers on the placebo effect in post-surgical pain where the first group was given a painkiller by a doctor while the second group was given the same painkiller but by a machine so that they didn’t know when they were receiving the drug. The painkiller was one-third to one-half less effective in the second group.
Placebo Effect Psychology
Colagiuri has tested the placebo effect in his own lab by giving electrical shocks to healthy volunteers. He found that when he gave them a placebo pill and told them it was a powerful painkiller, the volunteers tended to have a significantly milder response to the shock.
He applied some of his research to people with clinical insomnia, as well. “By the end of the placebo treatment, that group was below the cut-off for clinically significant insomnia. We’re not talking about just a statistically significant difference, but one that’s actually changing where, on average, this group is landing on the insomnia scale,” he says.
At the end, the participants are informed that they were only receiving placebos. “The effects are so strong in some individuals that when you say, ‘We were actually giving you placebos’, they say, ‘No, you weren’t. I got better so you must have been giving me a real drug.’”
What’s even more novel is that researchers are also finding that people who know they are receiving a placebo benefit too. They’ve designated this “open label” placebo research, and Faasse says that treating people with an open-label placebo while telling them “how powerful the placebo effect is and how it triggers all these different psychophysiological mechanisms that can improve health” is just as effective.
“We’ve seen it across a range of health conditions: irritable bowel syndrome, chronic pain, allergic rhinitis, depression.” Faasse has even given open label placebos to healthy participants, telling them that because of the mind-body connection, it can improve their well-being. As the study concludes, participants are asked to comment on their experience. One of them said, “I’d been really struggling … This week I had more energy. I felt like this great weight had lifted off me. I couldn’t tell you for sure that it was the placebo, but damn it was a good week!”
Faasse believes that the placebo effect is potentially an effective tool in therapy, considering how it’s been effectively proven through research. “It’s this interesting blurry line of — can we call placebo an evidence-based therapy? I think we have enough data now to say as long as it’s ethically delivered … that we really do have quite substantial evidence that it can be beneficial.”
Whether it’s conventional medicine or alternative therapy, Faasse notes that the placebo effect is vital in just about any medical treatment. Alternative health practitioners, in particular, are great at utilizing placebo effects. Alternative therapists allow for longer consultations and usually portray more warmth, empathy, and a better communication of the expected benefits, in contrast to the time-pressured nature of Western medicine. All of this taps into the placebo effect.
Tapping into Its Healing
Simply visiting a healthcare practitioner can effectively harness the placebo effect. “Having interactions with a clinician and getting care can actually facilitate this mind-body healing process that your body’s totally geared up to do, anyway,” says Faasse.
Experiencing warmth and empathy from the medical practitioners you encounter further enhances the power of the placebo effect. One study showed that patients with irritable bowel syndrome given placebo acupuncture with intentional warmth and attention had significantly better outcomes than those who received it coldly.
Faasse has realized that how information is portrayed can radically change its effect. For instance, hearing there’s a 76% chance you won’t get a headache as a side-effect of your medication is so much more positive than hearing there’s 24% chance you could. Communication affects treatment outcomes.
“It’s logically identical information but emotionally quite different,” says Faasse. As a result of these realizations, Faasse and her team are working to inform other practitioners how to frame necessary information to be more positive and to exude warmth, empathy, and competence. It all ties in with the placebo effect.
Colagiuri advises thoughtfulness in health professionals’ communication with patients. “They obviously have an ethical and moral obligation to patients to be honest about what they’re administering, the possibility of improvement and the possibility of side-effects. But the way in which they communicate that information could be having quite a profound effect,” he says. “Try to take into consideration what the patients’ expectancies are and how they want to be informed about different components of the treatment.”
For patients, on the other hand, he notes that researching the positive side-effects on Google for hours on end is not helpful. It’s always better to maintain a positive expectation than to dwell on possible negative effects. He also recommends that patients voice concerns of negative effects to their doctors because “often the risk can be lower than what seems to be presented online.”
Power of Choice
Faasse and her team have also discovered in their research that when patients are given a choice of which pill to take, the placebo effect is influenced – even though the choices were all the same medicine and dosage.
This could be potentially radical within clinical practices where some conditions could be treated by various options. When the patient is given the opportunity to choose, the likelihood of it working is higher than if it is chosen for him.
Research continues to discover to what extent people can harness placebo outcomes themselves and how effective a positive attitude is on health. Colagiuri says. “That’s still being found out. I’d be a little bit reluctant to recommend that too strongly because it also suggests that you’ll only get better if you believe those things. It puts too much emphasis on the patient.”
Colagiuri does not advise choosing a treatment simply because your expectations about it our positive. A positive outlook can’t solve anything, and he is aware that much misinformation is being circulated to take advantage of the sick and vulnerable, resulting in expensive treatments that don’t work. “You don’t want to give up a proven treatment just because you think another one’s more effective,” he says.
The fact is that people have died while believing that their current treatment is the best thing for them. The placebo effect does have limits. However, harnessing the placebo-effect certainly does no harm and has the potential to do much good through mind-body medicine.
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