Rethinking Explicit Expectations: Connecting Placebos, Social Cognition, and Contextual Perception

Cognitive flexibility in neurological disorders: Cognitive components and event-related potentials

Performance deficits on the Wisconsin Card Sorting Test (WCST) in patients with prefrontal cortex (PFC) lesions are traditionally interpreted as evidence for a role of the PFC in cognitive flexibility. However, WCST deficits do not occur exclusively after PFC lesions, but also in various neurological and psychiatric disorders. We propose a multi-component approach that can accommodate this pattern of omnipresent WCST deficits: the WCST is not a pure test of cognitive flexibility, but relies on the effective functioning of multiple dissociable cognitive components. Our review of recent efforts to decompose WCST performance deficits supports this view by revealing that WCST deficits in different neurological disorders can be attributed to alterations in different components. Frontoparietal changes underlying impaired set shifting seem to give rise to WCST deficits in patients with amyotrophic lateral sclerosis, whereas the WCST deficits associated with primary dystonia and Parkinson's disease are rather related to frontostriatal changes underlying deficient rule inference. Clinical implications of these findings and of a multi-component view of WCST performance are discussed.

The trickle-down effect of predictability: Secondary task performance benefits from predictability in the primary task

Predictions optimize processing by reducing attentional resources allocation to expected or predictable sensory data. Our study demonstrates that these saved processing resources can be then used on concurrent stimuli, and in consequence improve their processing and encoding. We illustrate this "trickle-down" effect with a dual task, where the primary task varied in terms of predictability. The primary task involved detection of a pre-specified symbol that appeared at some point of a short video of a dot moving along a random, semi-predictable or predictable trajectory. The concurrent secondary task involved memorization of photographs representing either emotionally neutral or non-neutral (social or threatening) content. Performance in the secondary task was measured by a memory test. We found that participants allocated more attention to unpredictable (random and semi-predictable) stimuli than to predictable stimuli. Additionally, when the stimuli in the primary task were more predictable, participants performed better in the secondary task, as evidenced by higher sensitivity in the memory test. Finally, social or threatening stimuli were allocated more "looking time" and a larger number of saccades than neutral stimuli. This effect was stronger for the threatening stimuli than social stimuli. Thus, predictability of environmental input is used in optimizing the allocation of attentional resources, which trickles-down and benefits the processing of concurrent stimuli.

Nocebo and pain: An overview of the psychoneurobiological mechanisms

INTRODUCTION

Nocebo effects are defined as adverse events related to negative expectations and learning processes that are involved in the modulation of the descending pain pathways. Research over the last couple of decades has illustrated that behavioral, psychoneurobiological and functional changes occur during nocebo-induced pain processing.

OBJECTIVES

We aimed to review published human and non-human research on algesia and hyperalgesia resulting from negative expectations and nocebo effects.

METHODS

Herein, we searched and comprehensively reviewed scientific literature providing informative knowledge about the psychoneurobiological bases of the nocebo effect in the field of pain with an emphasis on how pain processes are shaped by both cognitive and non-cognitive factors.

RESULTS

Negative expectations are formed through verbal suggestions of heightened pain, prior nociceptive and painful experiences and observation of pain in others. Susceptibility to the nocebo effect can be also influenced by genetic variants, conscious and nonconscious learning processes, personality traits and psychological factors. Moreover, providers' behaviors, environmental cues and the appearance of medical devices can induce negative expectations that dramatically influence pain perception and processing in a variety of pain modalities and patient populations.

CONCLUSION

Importantly, we concluded that nocebo studies outline how individual expectations may lead to physiological changes underpinning the central integration and processing of magnified pain signaling. Further research is needed to develop strategies that can identify nocebo-vulnerable pain patients in order to optimize the psychosocial and therapeutic context in which the clinical encounter occurs, with the ultimate purpose of improving clinical outcomes.

On the Maintenance of Expectations in Major Depression - Investigating a Neglected Phenomenon

In this perspective paper, we suggest that among patients suffering from major depressive disorder (MDD), dysfunctional expectations are maintained despite experiences that are contrary to these expectations. Surprisingly, this persistence of expectations in MDD has not yet been addressed by empirical studies. We argue that it is worthwhile to investigate this phenomenon with the aim of improving the treatment of MDD, and we provide a theoretical framework for understanding it. It is hypothesized that the persistence of expectations is primarily due to a process called immunization. That is, people experiencing depressive symptoms may cognitively reappraise the contradictory experience such that expectations do not need to be changed. There may be two mechanisms underlying this immunization: (1) the experience in the expectation-violating situation is considered to be an exception; or (2) the credibility of the information gained from the experience is called into question. Moreover, the maintenance of expectations may be particularly persistent if a person’s expectations reflect his or her self-concept, as self-concept has been shown to be associated with future expectations. To empirically examine the hypothesized maintenance of expectations in MDD, we propose an experimental approach which could provide important implications for the treatment of MDD within cognitive behavioral therapy. We suggest that psychological interventions such as behavioral experiments should more rigorously focus on patients’ appraisal of expectation-violating experiences in order to prevent immunization processes. Therapists should continuously examine whether patients’ expectations were modified and should address the reasons for the maintenance of expectations.

Can Psychological Expectation Models Be Adapted for Placebo Research?

Placebo responses contribute substantially to the effect and clinical outcome of medical treatments. Patients' expectations have been identified as one of the major mechanisms contributing to placebo effects. However, to date a general theoretical framework to better understand how patient expectations interact with features of medical treatment has not been developed. In this paper we outline an expectation model that can be used as framework for experimental studies on both placebo and nocebo mechanisms. This model is based on psychological concepts of expectation development, expectation maintenance, and expectation change within the typical paradigms used in placebo research. This theoretical framework reflects the dynamic aspects of the interaction between expectations and medical treatment, and offers a platform to combine psychological and neurophysiological research activities. Moreover, this model can be used to identify important future research questions. For example, we argue that the dynamic processes of expectation maintenance vs. expectation changes are not sufficiently addressed in current research on placebo mechanisms. Therefore, the question about how to change and optimize patients' expectations prior to treatment should be a special focus of future clinical research.

Scientific Psychology in the 18th Century

As early as 1783, the almost forgotten philosopher, metaphysicist, and psychologist Ferdinand Ueberwasser (1752–1812) designated himself “ Professor für empirische Psychologie und Logik” (professor of empirical psychology and logic) at the University of Münster, Germany. His position was initiated and supported by the minister and educational reformer Franz von Fürstenberg (1729–1810), who considered psychology a core scientific discipline that should be taught at each school and university. At the end of the 18th century, then, psychology seems to have been on the verge of becoming an independent academic discipline, about 100 years before Wilhelm Wundt founded the discipline’s first official laboratory. It seems surprising that Ueberwasser’s writings—including a seminal textbook on empirical psychology—have been almost entirely overlooked in most historical accounts. We focus on this important founding moment of psychological science and on the circumstances that eventually brought this seminal development to a halt.