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de Leeuw M, Laager M, Gaab J, Ruppen W, Schneider T. Boosting open-label placebo effects in acute induced pain in healthy adults (BOLPAP-study): study protocol of a randomized controlled trial. Front Med (Lausanne) 2024; 11:1238878. [PMID: 38420356 PMCID: PMC10900763 DOI: 10.3389/fmed.2024.1238878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Pain is a highly prevalent symptom in the hospital setting, but treatment options remain limited. Harnessing the placebo effect in an ethical manner could provide a new possibility to reduce pain in clinical practice. So called open-label placebos (OLP) have been shown to elicit significant effects in reducing acute pain. But, before implementation, more knowledge concerning the properties of OLPs is needed. This study aims to assess the duration of analgesic effects from OLP and to determine the possibility of boosting such effects. Methods and analysis This is the protocol of an ongoing (first patient enrolled in March 2023) single-site randomized trial investigating OLPs in two parts (i.e., substudies). In both parts, pain will be induced in healthy adults using an intradermal electrical stimulation model. Participants in Part 1 will have two study visits: An interventional visit with one OLP injection accompanied by an evidence-based treatment rationale and a control visit with no treatment. For Part 2, participants will be randomized into three groups: (1) A fixed-time "Booster" group including one single repetition of the OLP injection at a fixed time point, (2) an on-demand "Booster" group including one single repetition of the OLP injection on-demand, and (3) a control group who will receive just one OLP injection. Differences in pain ratings over time (using the Numeric Rating Scale) will be analyzed with several two-sample t-tests. The time point for a fixed-time "Booster" in Part 2 will be derived from Part 1 with additional statistical tools such as a broken-stick mixed-effect model. Discussion This study aims to further characterize the analgesic effects of OLPs. In doing so, it will provide valuable information needed for later implementation of OLPs in clinical practice, where they could play a role in multimodal analgesic concepts. Ethics and dissemination The "Ethikkommission Nordwest- und Zentralschweiz" (BASEC 2023-00296) approved the study protocol. Results of the analysis will be submitted for publication in a peer-reviewed journal. Clinical Trial Registration This study is registered at ClinicalTrials.gov (NCT05819476) and is listed in the Swiss National Registry at kofam.ch (SNCTP000005470).
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Affiliation(s)
- Matthijs de Leeuw
- Pain Unit, Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Mirjam Laager
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Wilhelm Ruppen
- Pain Unit, Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Tobias Schneider
- Pain Unit, Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
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2
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Żegleń M, Kryst Ł, Bąbel P. Want to be fit? Start with your mind! The role of the placebo effect in physical fitness in children: a preliminary systematic review and meta-analysis. Int J Obes (Lond) 2024; 48:177-187. [PMID: 38081926 PMCID: PMC10824660 DOI: 10.1038/s41366-023-01413-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 01/31/2024]
Abstract
Physical activity is crucial to prevent and reduce excess body mass. The placebo effect can influence the outcomes of fitness-related interventions; however, this topic has not yet been extensively investigated in children. Summarising the data on placebo effects in fitness-related interventions is essential to understand this problem better. A systematic review of PubMed, Cochrane, PsycINFO, PsycARTICLES, TripDatabase and Embase was carried out. A meta-analysis of the results of studies with comparable research plans was performed. There were significant differences, favouring the placebo intervention. At the final follow-up, the children in placebo groups had higher maximal heart rates, shorter recovery times, longer ergometry phases, running time and lower peak and average perceived exertion than the control. The placebo effect is present in fitness-related parameters in children, regardless of the Body Mass Index status. It is crucial, as for youth with excess body mass, it is difficult to be active, especially to show appropriate levels of motivation and involvement. Importantly, the benefits of the placebo were the strongest in the motivation/ engagement-related parameters and self-assessed exertion. Notably, the nocebo effect was not observed, which is advantageous when considering placebo interventions in practice.
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Affiliation(s)
- Magdalena Żegleń
- Jagiellonian University, Institute of Psychology, Pain Research Group, Kraków, Poland.
| | - Łukasz Kryst
- University of Physical Education in Kraków, Faculty of Physical Education and Sport, Department of Anthropology, Kraków, Poland
| | - Przemysław Bąbel
- Jagiellonian University, Institute of Psychology, Pain Research Group, Kraków, Poland
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3
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McLoughlin S, Roche BT. ACT: A Process-Based Therapy in Search of a Process. Behav Ther 2023; 54:939-955. [PMID: 37863586 DOI: 10.1016/j.beth.2022.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/28/2022] [Accepted: 07/28/2022] [Indexed: 11/02/2022]
Abstract
A large array of randomized controlled trials and meta-analyses have determined the efficacy of Acceptance and Commitment Therapy (ACT). However, determining that ACT works does not tell us how it works. This is especially important to understand given the current emphasis on Process-Based Therapy, the promise of which is to identify manipulable causal mediators of change in psychotherapy, and how their effectiveness is moderated by individual contexts. This paper outlines four key areas of concern regarding ACT's status as a Process-Based Therapy. First, the relationship between ACT and Relational Frame Theory has been widely asserted but not yet properly substantiated. Second, most of the studies on ACT's core process of change, psychological flexibility, have used invalid measures. Third, while lots of research indicates means by which individuals can be helped to behave consistently with their values, there is virtually no research on how to help people effectively clarify their values in the first instance, or indeed, on an iterative basis. Finally, the philosophy underlying ACT permits a-moral instrumentalism, presenting several ethical challenges. We end by making several recommendations for coherent methodological, conceptual, and practical progress within ACT research and therapy.
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Muschalla B, Müller J, Grocholewski A, Linden M. Talking about Side Effects in Psychotherapy Did Not Impair the Therapeutic Alliance in an Experimental Study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:360-362. [PMID: 35413707 DOI: 10.1159/000524278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Beate Muschalla
- Department of Psychotherapy and Diagnostics, Technische Universität Braunschweig, Braunschweig, Germany
| | - Julia Müller
- Department of Psychotherapy and Diagnostics, Technische Universität Braunschweig, Braunschweig, Germany
| | - Anja Grocholewski
- Department of Psychotherapy and Diagnostics, Technische Universität Braunschweig, Braunschweig, Germany
| | - Michael Linden
- Department of Psychosomatic Medicine, Charité - University Medicine Berlin, Berlin, Germany
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5
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Herzog P, Barth C, Rief W, Brakemeier EL, Kube T. How Expectations Shape the Formation of Intrusive Memories: An Experimental Study Using the Trauma Film Paradigm. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10290-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Background
Although intrusions are the hallmark symptom of posttraumatic stress disorder, there is still limited knowledge about the processes that contribute to the development of intrusions. Here, we used the well-established trauma film paradigm (TFP) to investigate how expectations about the intensity and controllability of intrusions influence their occurrence.
Methods
90 healthy participants underwent the TFP before they were randomized to one of three conditions manipulating their expectations about intrusions: positive expectations group; negative expectations group; control group. The primary outcome was the frequency and severity of intrusive memories as assessed with an intrusion diary over seven days.
Results
The TFP was well implemented, as indicated by significant post-film anxiety and a substantial number of intrusions reported for the subsequent week. The three groups did not differ in their expectations about intrusions and, relatedly, in their experience of intrusions. A mediation analysis revealed that the influence of post-film anxiety on intrusive memories was fully mediated by expectations.
Conclusions
Despite the failure of the expectation manipulation, the results of the mediation analysis support the hypothesis that post-film expectations influence the formation of intrusive memories, suggesting that intrusions may result from maladaptive dynamics between emotional and cognitive processes following trauma(like) experiences.
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6
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Evers AWM, Colloca L, Blease C, Gaab J, Jensen KB, Atlas LY, Beedie CJ, Benedetti F, Bingel U, Büchel C, Bussemaker J, Colagiuri B, Crum AJ, Finniss DG, Geers AL, Howick J, Klinger R, Meeuwis SH, Meissner K, Napadow V, Petrie KJ, Rief W, Smeets I, Wager TD, Wanigasekera V, Vase L, Kelley JM, Kirsch I. What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:49-56. [PMID: 33075796 DOI: 10.1159/000510738] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments. OBJECTIVE There is an increasing need for up-to-date recommendations on how to inform patients about placebo and nocebo effects in clinical practice and train clinicians how to disclose this information. METHODS Based on previous clinical recommendations concerning placebo and nocebo effects, a 3-step, invitation-only Delphi study was conducted among an interdisciplinary group of internationally recognized experts. The study consisted of open- and closed-ended survey questions followed by a final expert meeting. The surveys were subdivided into 3 parts: (1) informing patients about placebo effects, (2) informing patients about nocebo effects, and (3) training clinicians how to communicate this information to the patients. RESULTS There was consensus that communicating general information about placebo and nocebo effects to patients (e.g., explaining their role in treatment) could be beneficial, but that such information needs to be adjusted to match the specific clinical context (e.g., condition and treatment). Experts also agreed that training clinicians to communicate about placebo and nocebo effects should be a regular and integrated part of medical education that makes use of multiple formats, including face-to-face and online modalities. CONCLUSIONS The current 3-step Delphi study provides consensus-based recommendations and practical considerations for disclosures about placebo and nocebo effects in clinical practice. Future research is needed on how to optimally tailor information to specific clinical conditions and patients' needs, and on developing standardized disclosure training modules for clinicians.
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Affiliation(s)
- Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands, .,Erasmus University Rotterdam & Delft University of Technology, Rotterdam/Delft, The Netherlands,
| | - Luana Colloca
- Departments of Pain Translational Symptoms Science and Anesthesiology, School of Nursing and Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jens Gaab
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Karin B Jensen
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Lauren Y Atlas
- National Center for Complementary and Integrative Health, National Institute of Mental Health, and National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
| | - Chris J Beedie
- School of Psychology, University of Kent, Canterbury, United Kingdom
| | - Fabrizio Benedetti
- Physiology and Neuroscience, University of Turin Medical School, Turin, Italy
| | - Ulrike Bingel
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jet Bussemaker
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Ben Colagiuri
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, California, USA
| | | | - Andrew L Geers
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Jeremy Howick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Regine Klinger
- Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie H Meeuwis
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Karin Meissner
- Division of Health Promotion, University of Applied Sciences, Coburg, Germany
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Ionica Smeets
- Science Communication and Society, Institute of Biology, Leiden University, Leiden, The Netherlands
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | | | - Lene Vase
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - John M Kelley
- Beth Israel Deaconess Medical Center, Harvard Medical School, Program in Placebo Studies, Boston, Massachusetts, USA
| | - Irving Kirsch
- Beth Israel Deaconess Medical Center, Harvard Medical School, Program in Placebo Studies, Boston, Massachusetts, USA
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Gruber J, Prinstein MJ, Clark LA, Rottenberg J, Abramowitz JS, Albano AM, Aldao A, Borelli JL, Chung T, Davila J, Forbes EE, Gee DG, Hall GCN, Hallion LS, Hinshaw SP, Hofmann SG, Hollon SD, Joormann J, Kazdin AE, Klein DN, La Greca AM, Levenson RW, MacDonald AW, McKay D, McLaughlin KA, Mendle J, Miller AB, Neblett EW, Nock M, Olatunji BO, Persons JB, Rozek DC, Schleider JL, Slavich GM, Teachman BA, Vine V, Weinstock LM. Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action. AMERICAN PSYCHOLOGIST 2021; 76:409-426. [PMID: 32772538 PMCID: PMC7873160 DOI: 10.1037/amp0000707] [Citation(s) in RCA: 282] [Impact Index Per Article: 94.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- June Gruber
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Mitchell J Prinstein
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | | | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | | | - Jessica L Borelli
- Department of Psychological Science, University of California, Irvine
| | - Tammy Chung
- Institute for Health, Healthcare Policy and Aging Research, Rutgers, The State University of New Jersey
| | | | | | | | | | | | | | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University
| | | | | | | | | | | | | | | | - Dean McKay
- Department of Psychology, Fordham University
| | | | - Jane Mendle
- Department of Human Development, Cornell University
| | - Adam Bryant Miller
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | | | | | | | | | | | - George M Slavich
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles
| | | | - Vera Vine
- Department of Psychiatry, University of Pittsburgh
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8
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Gruber J, Prinstein MJ, Clark LA, Rottenberg J, Abramowitz JS, Albano AM, Aldao A, Borelli JL, Chung T, Davila J, Forbes EE, Gee DG, Hall GCN, Hallion LS, Hinshaw SP, Hofmann SG, Hollon SD, Joormann J, Kazdin AE, Klein DN, La Greca AM, Levenson RW, MacDonald AW, McKay D, McLaughlin KA, Mendle J, Miller AB, Neblett EW, Nock M, Olatunji BO, Persons JB, Rozek DC, Schleider JL, Slavich GM, Teachman BA, Vine V, Weinstock LM. Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action. AMERICAN PSYCHOLOGIST 2021; 76:409-426. [PMID: 32772538 DOI: 10.31234/osf.io/desg9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- June Gruber
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Mitchell J Prinstein
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | | | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | | | - Jessica L Borelli
- Department of Psychological Science, University of California, Irvine
| | - Tammy Chung
- Institute for Health, Healthcare Policy and Aging Research, Rutgers, The State University of New Jersey
| | | | | | | | | | | | | | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University
| | | | | | | | | | | | | | | | - Dean McKay
- Department of Psychology, Fordham University
| | | | - Jane Mendle
- Department of Human Development, Cornell University
| | - Adam Bryant Miller
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | | | | | | | | | | | - George M Slavich
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles
| | | | - Vera Vine
- Department of Psychiatry, University of Pittsburgh
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9
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Lorenz TK. Predictors and impact of psychotherapy side effects in young adults. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tierney K. Lorenz
- Department of Psychology University of Nebraska‐Lincoln Center for Brain, Biology and Behavior, University of Nebraska‐Lincoln Lincoln Nebraska
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10
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Fanti‐Oren S, Birenbaum‐Carmeli D, Nemet D, Pantanowitz M, Eliakim A. Significant effect of information placebo on exercise test results in children with normal weight, overweight and obesity. Acta Paediatr 2020; 109:381-387. [PMID: 31373036 DOI: 10.1111/apa.14959] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/05/2019] [Accepted: 07/31/2019] [Indexed: 12/22/2022]
Abstract
AIM The aim of the study was to examine the effect of information placebo on fitness test results in normal weight, overweight and obese children. METHODS Twenty-four pre-pubertal children with overweight or obesity and 24 age and maturity-matched normal weight children performed a progressive treadmill exercise test twice. Different types of information were randomly provided regarding a water drink consumed prior to testing; standard (water) vs deliberate positive (presumed energy drink, placebo) information. RESULTS Following the placebo drink, both groups demonstrated significantly higher peak heart rate (overweight 165.8 ± 16.7 vs 174.2 ± 14.8 bpm and normal weight 177.9 ± 13.6 vs 189.8 ± 12.2 bpm) and longer time to exhaustion (overweight 396.9 ± 161.9 vs 521.5 ± 182.5 seconds; normal weight: 700.1 ± 155.2 vs 893.3 ± 150.1 seconds). Despite longer exercise duration and higher peak heart rate, average and peak rate of perceived exertion were significantly lower after the placebo drink (overweight 14.1 ± 2.5 vs 12.5 ± 2.5; normal weight 12.1 ± 1.4 vs 10.7 ± 1.5), with significantly shorter recovery time (overweight 132.2 ± 28.5 vs 118.4 ± 31.6; normal weight: 106.7 ± 18.6 vs 96.7 ± 17.8 seconds). CONCLUSION Our results demonstrate a significant effect of information placebo on fitness test results that is unrelated to body weight. Children with obesity may enhance their physical activity levels and energy expenditure if properly encouraged.
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Affiliation(s)
- Shira Fanti‐Oren
- Cheryl Spencer Department of Nursing University of Haifa Haifa Israel
| | | | - Dan Nemet
- Pediatric Department, Child Health and Sports Center, Meir Medical Center, Sackler School of Medicine Tel Aviv University Kfar‐Saba Israel
| | - Michal Pantanowitz
- Pediatric Department, Child Health and Sports Center, Meir Medical Center, Sackler School of Medicine Tel Aviv University Kfar‐Saba Israel
- Zinman College of Physical Education and Sports Sciences Wingate Institute Netanya Israel
| | - Alon Eliakim
- Pediatric Department, Child Health and Sports Center, Meir Medical Center, Sackler School of Medicine Tel Aviv University Kfar‐Saba Israel
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11
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Fanti-Oren S, Birenbaum-Carmeli D, Eliakim A, Pantanowitz M, Nemet D. The placebo effect on aerobic fitness test results is preserved following a multidisciplinary intervention program for treating childhood obesity. Scand J Med Sci Sports 2019; 30:725-731. [PMID: 31876029 DOI: 10.1111/sms.13621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/14/2019] [Accepted: 12/18/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of the study was to examine the placebo effect on fitness test results in trained and untrained overweight and obese children. METHODS Twenty pre-pubertal overweight children performed two pairs of progressive treadmill exercise tests before and 12 weeks into a multidisciplinary program for the treatment of childhood obesity. In each test pair, at random order, participants received different types of information regarding a water drink consumed prior to testing-standard information (water) vs deliberate positive information (presumed energy drink, placebo). RESULTS The intervention led to a significant change (P < .05) in BMI%ile (95.6 ± 4.4 vs 93.6 ± 6.9), % fat (35.4 ± 6.0 vs 31.6 ± 5.8), baseline heart rate (104.2 ± 11.6 vs 94.0 ± 7.0 bpm), total leisure activity score-Godin (9.3 ± 8.8 vs 41.5 ± 15.2), total screen time (6.9 ± 5.8 vs 3.1 ± 1.4 h/d), and a significant improvement in fitness. Following the placebo drink, both groups achieved a significantly higher peak heart rate (untrained: 176.1 ± 13.7 vs 167.5 ± 16.8; trained: 170.7 ± 11.6 vs 166.2 ± 11.4 bpm) and longer running time (untrained: 559.9 ± 151.0 vs 434.4 ± 140.3 seconds; trained: 728.3 ± 177.3 vs 667.1 ± 176.1 seconds). Despite longer exercise duration and higher peak exercise heart rate, average, and peak RPE were lower after the placebo drink (untrained: 12.1 ± 2.3 vs 13.6 ± 2.1; trained:10.0 ± 1.8 vs 11.6 ± 2.1), recovery time was shorter (untrained: 119.2 ± 25.3 vs 133.2 ± 23.7 seconds; trained: 92.6 ± 18.9 vs 102.7 ± 18.3 seconds). The placebo-induced change in running time and peak RPE were significantly greater prior to training. CONCLUSION The significant information placebo effect is preserved in trained overweight children. Information, as well as other motivating aids and fatigue distractors may be useful in enhancing physical performance in obese children.
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Affiliation(s)
- Shira Fanti-Oren
- Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | | | - Alon Eliakim
- Pediatric Department, Child Health Sport Center, Meir Medical Center, Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
| | - Michal Pantanowitz
- Pediatric Department, Child Health Sport Center, Meir Medical Center, Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel.,Zinman College of Physical Education and Sports Sciences, Wingate Institute, Netanya, Israel
| | - Dan Nemet
- Pediatric Department, Child Health Sport Center, Meir Medical Center, Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
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12
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Herzog P, Lauff S, Rief W, Brakemeier EL. Assessing the unwanted: A systematic review of instruments used to assess negative effects of psychotherapy. Brain Behav 2019; 9:e01447. [PMID: 31647202 PMCID: PMC6908878 DOI: 10.1002/brb3.1447] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/04/2019] [Accepted: 09/14/2019] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE While the efficacy of psychotherapy in the treatment of mental disorders is well examined, systematic research into negative effects of psychotherapy seems comparatively rare. Therefore, this review evaluates instruments for assessing negative effects of psychotherapy in order to create a consensus framework and make recommendations for their assessment. METHODS The study selection procedure follows current best-practice guidelines for conducting systematic reviews, with 10 included studies in three databases (PsycINFO, PubMed, and Web of Science). The nine instruments identified were each critically reviewed concerning the theoretical orientation, including the assessed domains of negative effects, psychometric properties, and diagnostic characteristics. RESULTS Seventeen domains of negative effects of psychotherapy were identified but inconsistently assessed by the nine instruments. Most instruments provide some initial data on their psychometric properties. Regarding diagnostic characteristics, different item-response formats are used but often with reference to "attribution to therapy." CONCLUSION This review indicates that the existing instruments for assessing negative effects of psychotherapy cover a wide range of relevant domains without any consensus on the most important ones and their psychometric properties are usually unsatisfactory. A framework for consensus, building on the definition and conceptualization of negative effects, is synthesized, and recommendations for improving the assessment are derived.
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Affiliation(s)
- Philipp Herzog
- Department of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Sören Lauff
- Department of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany.,Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
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Amanzio M, Palermo S. Pain Anticipation and Nocebo-Related Responses: A Descriptive Mini-Review of Functional Neuroimaging Studies in Normal Subjects and Precious Hints on Pain Processing in the Context of Neurodegenerative Disorders. Front Pharmacol 2019; 10:969. [PMID: 31551779 PMCID: PMC6734013 DOI: 10.3389/fphar.2019.00969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/29/2019] [Indexed: 11/13/2022] Open
Abstract
The exacerbation of a clinical condition or the occurrence of negative symptoms after an inert substance dispensation or a sham treatment is known as “nocebo effect.” Nocebo is the psychobiological effect due to the negative psychosocial context that accompanies a therapy, and it is a direct consequence of negative expectations by the patients and their own personal characteristics. Although the clinical relevance of the phenomenon is now recognized, a small number of studies have tried to ascertain its neural underpinnings (that it means nocebo responses). Moreover, there is no consensus on the brain networks involved in nocebo processes in humans. In particular, nocebo hyperalgesia has attracted almost no research attention. We conducted a mini-review on the few experimental pain functional magnetic resonance imaging (fMRI) studies of nocebo responses to discuss how negative expectancies and conditioning effects engage brain networks to modulate pain experiences. Moreover, we present possible clinical implications considering Alzheimer’s disease and behavioral frontotemporal dementia, in which the existence of a hypothetically disrupted neurocognitive anticipatory network—secondary to an endogenous pain modulatory system damage—may be responsible for pain processing alterations.
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Affiliation(s)
- Martina Amanzio
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing, Bruxelles, Belgium
| | - Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing, Bruxelles, Belgium
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Tormoen M. Gaslighting: How Pathological Labels Can Harm Psychotherapy Clients. JOURNAL OF HUMANISTIC PSYCHOLOGY 2019. [DOI: 10.1177/0022167819864258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gaslighting is a conscious or unconscious form of psychological abuse that occurs when a perpetrator distorts information to confuse a victim, triggering the victim to doubt their memory and sanity. Gaslighting can contaminate a psychotherapy relationship when clinicians rely on pathological labels to direct the therapeutic process. When psychotherapists use pathological labels, the treatment focus is often directed toward problems that lie within the client, which can be counterproductive, particularly when the client is recovering from interpersonal abuse. This article summarizes how the application of pathological labels in combination with the principles of social constructivism influenced a group of mental health professionals to gaslight the author. Illustrative narrative that depicts the author’s experience of having been gaslit by her psychology professor and then by her psychotherapist is included. The author describes how these harmful relationships caused the author to endure double-binds and betrayal during her healing process. Last, a brief discussion about posttraumatic growth and recommendations related to potential alternatives to the current diagnostic process are offered. This article was written to raise awareness of how the use of pathological labels can result in harm to psychotherapy clients.
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Fanti-Oren S, Birenbaum-Carmeli D, Eliakim A, Pantanowitz M, Nemet D. The effect of placebo on endurance capacity in normal weight children - a randomized trial. BMC Pediatr 2019; 19:15. [PMID: 30630461 PMCID: PMC6327389 DOI: 10.1186/s12887-019-1394-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to examine the influence of the placebo effect on the endurance capacity results in normal weight children. METHODS Twenty-four pre-pubertal normal-weight children aged 6-13 years participated in the study. Subjects underwent anthropometric measurements (weight, height, BMI percentile, and fat percentage), a progressive treadmill exercise test to evaluate endurance capacity, and filled habitual activity questionnaire. The participants were examined twice, in a random order, with each child being compared to him/herself. Different types of information were provided regarding a water drink consumed prior to testing- standard information (water) vs. deliberate positive information (presumed energy drink, placebo). RESULTS Following the placebo drink, children demonstrated significantly higher peak pulse (177.9 ± 13.6 vs. 189.8 ± 12.2 bpm), higher stage achieved and longer time of exercise to exhaustion (700.1 ± 155.2 vs. 893.3 ± 150.1 s). Although the exercise duration was longer, stage and heart rate achieved were higher, the reported average, and peak rate of perceived exertion (RPE) were significantly lower for the placebo (18.3 ± 1.4 vs 16.2 ± 1.5). Although the effort was higher while drinking placebo (longer run, higher exercise phase, higher heart rate), recovery time was significantly shorter. The reported differences were not associated with order of tests, age, gender or child activity level. CONCLUSION Our results demonstrate a significant information placebo effect on children's endurance capacity test results. This highlights the possible role of positive information (placebo) in trying to encourage physical activity in children. Whether this effect could be applied to longer-term interventions has yet to be tested. TRIAL REGISTRATION ClinicalTrial.gov identifier: NCT03165604 , Registered May 24, 2017.
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Affiliation(s)
- Shira Fanti-Oren
- Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | | | - Alon Eliakim
- Pediatric Department, Child Health Sport Center, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Pantanowitz
- Pediatric Department, Child Health Sport Center, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Nemet
- Pediatric Department, Child Health Sport Center, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Kristensen LE, Alten R, Puig L, Philipp S, Kvien TK, Mangues MA, van den Hoogen F, Pavelka K, Vulto AG. Non-pharmacological Effects in Switching Medication: The Nocebo Effect in Switching from Originator to Biosimilar Agent. BioDrugs 2018; 32:397-404. [PMID: 30269270 PMCID: PMC6182448 DOI: 10.1007/s40259-018-0306-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The nocebo effect is defined as the incitement or the worsening of symptoms induced by any negative attitude from non-pharmacological therapeutic intervention, sham, or active therapies. When a patient anticipates a negative effect associated with an intervention, medication or change in medication, they may then experience either an increase in this effect or experience it de novo. Although less is known about the nocebo effect compared with the placebo effect, widespread interest in the nocebo effect observed with statin therapy and a literature review highlighting the nocebo effect across at least ten different disease areas strongly suggests this is a common phenomenon. This effect has also recently been shown to play a role when introducing a medication or changing an established medication, for example, when switching patients from a reference biologic to a biosimilar. Given the important role biosimilars play in providing cost-effective alternatives to reference biologics, increasing physician treatment options and patient access to effective biologic treatment, it is important that we understand this phenomenon and aim to reduce this effect when possible. In this paper, we propose three key strategies to help mitigate the nocebo effect in clinical practice when switching patients from reference biologic to biosimilar: positive framing, increasing patient and healthcare professionals' understanding of biosimilars and utilising a managed switching programme.
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Affiliation(s)
- Lars Erik Kristensen
- Parker Institute, University of Copenhagen, Bispebjerg og Frederiksberg, Frederiksberg, Denmark
- Department of Internal Medicine, Rheumatology, Lund University, Lund, Sweden
| | - Rieke Alten
- Department of Internal Medicine, Rheumatology, Schlosspark Klinik, University Medicine Berlin, Berlin, Germany
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Sandra Philipp
- Department of Dermatology, Venereology and Allergy, Charité Universitätsmedizin, Berlin, Germany
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Frank van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek and Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Arnold G Vulto
- Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
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Attias S, Schiff E, Arnon Z, Ben-Arye E, Keshet Y, Sroka G, Matter I, Boker LK. Development and validation of a tool to evaluate Inpatient Beliefs, Expectations and Attitudes toward Reflexology (IBEAR-16). Complement Ther Med 2018; 37:69-76. [PMID: 29609941 DOI: 10.1016/j.ctim.2018.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/19/2018] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The integration of manual therapies, including reflexology, into conventional care settings is growing extensively. Patients' beliefs, attitudes and expectations toward these therapies interact with their outcomes, but currently there are no validated tools to evaluate these factors. We aimed to design and to validate such a tool specifically targeted into reflexology. METHODS Following input of a multidisciplinary team of experts, the self-administered Inpatient Beliefs, Expectations and Attitudes toward Reflexology (IBEAR) questionnaire was constructed, containing 25 items, 8 referring to demographics and 17 specifically addressing reflexology. Cronbach's alpha was computed to evaluate the questionnaire's internal reliability, and factor analysis was used for further validation (232 patients). Pearson coefficient and Kappa tests were used to test and retest (within 48 hours) the questionnaire on a group of 199 patients, to assure clarity and reliability. RESULTS For the 232 questionnaires collected, the computed Cronbach's alpha coefficient was 0.716 (acceptable reliability). Factor analysis pointed to two content areas separated into four items addressing attitudes and expectations and five items focusing on beliefs and attitudes. In the test-retest stage, 199 participants filled in the questionnaire for a second time. The Pearson coefficient for all questions ranged between 0.73 and 0.94 (good to excellent correlation) and Kappa scores ranged between 0.66 and 1.0 (moderate to high reliability). Consequently, one of the questions was removed from the IBEAR. CONCLUSIONS The present study provides evidence that the proposed IBEAR questionnaire with 16 items is a valid and reliable tool for evaluation of inpatients' beliefs, expectations and attitudes toward reflexology.
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Affiliation(s)
- Samuel Attias
- Complementary & Integrative Surgery Service, Bnai-Zion Medical Center, 47 Golomb Street, Haifa 31048, Israel; School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa 3498838, Israel.
| | - Elad Schiff
- Complementary & Integrative Surgery Service, Bnai-Zion Medical Center, 47 Golomb Street, Haifa 31048, Israel; Internal Medicine Department, Bnai Zion Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel; Bnai Zion Medical Center, 47 Golomb Street, Haifa 31048, Israel.
| | - Zahi Arnon
- Complementary & Integrative Surgery Service, Bnai-Zion Medical Center, 47 Golomb Street, Haifa 31048, Israel; Yezreel Valley Academic College, Emek Yezreel, Israel.
| | - Eran Ben-Arye
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel; Integrative Oncology Program, the Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel.
| | - Yael Keshet
- Department of Sociology and Anthropology, Western Galilee Academic College, Acre, Israel.
| | - Gideon Sroka
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel; Department of General Surgery, Bnai-Zion Medical Center, 47 Golomb Street, Haifa 31048, Israel.
| | - Ibrahim Matter
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel; Department of General Surgery, Bnai-Zion Medical Center, 47 Golomb Street, Haifa 31048, Israel.
| | - Lital Keinan Boker
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa 3498838, Israel; Israel Center for Disease Control, Ministry of Health, Israel.
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Prause N. Evaluate Models of High-Frequency Sexual Behaviors Already. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:2269-2274. [PMID: 28940038 DOI: 10.1007/s10508-017-1078-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/06/2017] [Indexed: 06/07/2023]
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Joseph AP, Mason PH, Warren N, Atley I. Recognizing the Nocebo Benefits Patient Care, But Demands Greater Cultural Competency in the Clinic. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:54-56. [PMID: 28537836 DOI: 10.1080/15265161.2017.1314044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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20
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The placebo effect and its determinants in fibromyalgia: meta-analysis of randomised controlled trials. Clin Rheumatol 2017; 36:1623-1630. [PMID: 28299460 PMCID: PMC5486479 DOI: 10.1007/s10067-017-3595-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/14/2017] [Accepted: 02/07/2017] [Indexed: 12/31/2022]
Abstract
The aims of this study were to determine whether placebo treatment in randomised controlled trials (RCTs) is effective for fibromyalgia and to identify possible determinants of the magnitude of any such placebo effect. A systematic literature search was undertaken for RCTs in people with fibromyalgia that included a placebo and/or a no-treatment (observation only or waiting list) control group. Placebo effect size (ES) for pain and other outcomes was measured as the improvement of each outcome from baseline divided by the standard deviation of the change from baseline. This effect was compared with changes in the no-treatment control groups. Meta-analysis was undertaken to combine data from different studies. Subgroup analysis was conducted to identify possible determinants of the placebo ES. A total of 3912 studies were identified from the literature search. After scrutiny, 229 trials met the inclusion criteria. Participants who received placebo in the RCTs experienced significantly better improvements in pain, fatigue, sleep quality, physical function, and other main outcomes than those receiving no treatment. The ES of placebo for pain relief was clinically moderate (0.53, 95%CI 0.48 to 0.57). The ES increased with increasing strength of the active treatment, increasing participant age and higher baseline pain severity, but decreased in RCTS with more women and with longer duration of fibromyalgia. In addition, placebo treatment in RCTs is effective in fibromyalgia. A number of factors (expected strength of treatment, age, gender, disease duration) appear to influence the magnitude of the placebo effect in this condition.
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Abstract
Prior research has consistently found disproportionate rates of traumatization and psychopathology in criminal justice-involved women. The current study aimed to characterize rates of traumatization, psychopathology, and diagnostic comorbidity in women involved with the justice system. Furthermore, this study examined the role of posttraumatic stress symptoms in the association between traumatic events and levels of self-esteem. Participants were 185 women from the Chicagoland area with current or previous (past 2 years) involvement with the criminal justice system. Results confirmed disproportionate rates of trauma experiences and psychopathology in this population, and logistic regression analyses indicated that rates of traumatization predicted diagnostic comorbidity. Analyses indicated an indirect effect of posttraumatic stress in the association between traumatic experiences and self-esteem. Findings highlight the importance of assessing and targeting both trauma experiences and posttraumatic stress in justice-involved women to optimize prevention and intervention efforts.
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Affiliation(s)
| | - Caleb Figge
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Daphna Ram
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Leonard A. Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
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Blasini M, Corsi N, Klinger R, Colloca L. Nocebo and pain: An overview of the psychoneurobiological mechanisms. Pain Rep 2017; 2:e585. [PMID: 28971165 PMCID: PMC5621640 DOI: 10.1097/pr9.0000000000000585] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/13/2016] [Accepted: 12/17/2016] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Maxie Blasini
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Nicole Corsi
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, USA
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Regine Klinger
- Center for Anesthesiology and Intensive Care Medicine, Department of Anesthesiology, Pain Therapy and Pain Psychology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Luana Colloca
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, USA
- Departments of Anesthesiology and
- Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, USA
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, USA
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Abstract
The microaggression concept has recently galvanized public discussion and spread to numerous college campuses and businesses. I argue that the microaggression research program (MRP) rests on five core premises, namely, that microaggressions (1) are operationalized with sufficient clarity and consensus to afford rigorous scientific investigation; (2) are interpreted negatively by most or all minority group members; (3) reflect implicitly prejudicial and implicitly aggressive motives; (4) can be validly assessed using only respondents’ subjective reports; and (5) exert an adverse impact on recipients’ mental health. A review of the literature reveals negligible support for all five suppositions. More broadly, the MRP has been marked by an absence of connectivity to key domains of psychological science, including psychometrics, social cognition, cognitive-behavioral therapy, behavior genetics, and personality, health, and industrial-organizational psychology. Although the MRP has been fruitful in drawing the field’s attention to subtle forms of prejudice, it is far too underdeveloped on the conceptual and methodological fronts to warrant real-world application. I conclude with 18 suggestions for advancing the scientific status of the MRP, recommend abandonment of the term “microaggression,” and call for a moratorium on microaggression training programs and publicly distributed microaggression lists pending research to address the MRP’s scientific limitations.
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Diagnosis Threat and Injury Beliefs After Mild Traumatic Brain Injury. Arch Clin Neuropsychol 2016; 31:727-737. [DOI: 10.1093/arclin/acw062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2016] [Indexed: 11/14/2022] Open
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Koithan M, Bell IR, Caspi O, Ferro L, Brown V. Patients' Experiences and Perceptions of a Consultative Model Integrative Medicine Clinic: A Qualitative Study. Integr Cancer Ther 2016; 6:174-84. [PMID: 17548796 DOI: 10.1177/1534735407301992] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: A common theme in integrative medicine (IM) is patient-centered partnering in care between patients and providers. Despite the stated ideals, few studies have assessed patients' perspectives on their actual experience in the context of a specific care model. The purpose of the present study was to retrospectively explore and compare experiences of cancer and noncancer patients under care in a consultative IM outpatient teaching clinic in the south-western United States. Design: Qualitative study using inductive content analysis of focus group interview transcripts (2 groups of adult patients with cancers of various types and 1 group of chronically ill noncancer patients with mixed diagnoses). Method: Participants were recruited by random selection from a pool of eligible patients. Groups were conducted with patients who had completed their initial conventional cancer treatment and were at least 6 months postconsultation with an IM clinic physician. Transcripts of the audiotaped focus groups were analyzed. Results: Cancer patients (n = 15) and noncancer patients (n = 6) (mean age, 60 years; 77% women) expressed overall satisfaction with IM, emphasizing (1) expansion of treatment options with lower perceived toxicity than conventional therapies, (2) positive experiences of the IM physician as caring and taking time to listen, and (3) improved self-care skills and sense of empowerment. Cancer patients noted positive relationships with their conventional MDs more than did noncancer patients, although both groups appreciated the IM physicians' communication styles. Conclusion: Patients experience a consultative integrative clinic model overall as favorable. The impact on outcomes, costs, and long-term quality of life requires additional study.
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Affiliation(s)
- Mary Koithan
- Department of Medicine (Program in Integrative Medicine) at The University of Arizona Health Sciences Center, Tucson, AZ 85724-5153, USA.
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Davidson J, Jonas W. Individualized Homeopathy: A Consideration of Its Relationship to Psychotherapy. J Altern Complement Med 2016; 22:594-8. [PMID: 27285053 DOI: 10.1089/acm.2015.0365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The benefit and potential mechanisms of action of homeopathy have long been debated. Almost entirely neglected has been the study of individualized homeopathy (IH) as a form of psychotherapy, which incorporates factors that are common to most therapies while using processes that are specific to IH. METHODS Recent research into the therapeutic components of IH is reviewed; similarities and differences between IH and other forms of psychotherapy are also described. RESULTS IH includes elements found in humanistic therapy and narrative medicine and additionally incorporates idiographic material in treatment selection. It is structured in a manner that takes maximum advantage of the components of the placebo effect, which could further expand its effectiveness beyond those conditions thought usually amenable to psychotherapy. CONCLUSIONS It is possible that IH entails specific psychotherapeutic processes in addition to possible therapeutic action of the homeopathic remedy, but the relative contributions of each remain to be determined. Suggestions are given for future research.
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Affiliation(s)
- Jonathan Davidson
- 1 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center , Durham, NC
| | - Wayne Jonas
- 2 Samueli Institute, Georgetown School of Medicine and Uniformed Services University , Alexandria, VA
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Planès S, Villier C, Mallaret M. The nocebo effect of drugs. Pharmacol Res Perspect 2016; 4:e00208. [PMID: 27069627 PMCID: PMC4804316 DOI: 10.1002/prp2.208] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 11/09/2015] [Accepted: 11/20/2015] [Indexed: 12/17/2022] Open
Abstract
While the placebo effect has been studied for a long time, much less is known about its negative counterpart, named the nocebo effect. However, it may be of particular importance because of its impact on the treatment outcomes and public health. We conducted a review on the nocebo effect using PubMed and other databases up to July 2014. The nocebo effect refers by definition to the induction or the worsening of symptoms induced by sham or active therapies. Examples are numerous and concerns both clinical trials and daily practice. The underlying mechanisms are, on one hand, psychological (conditioning and negative expectations) and, on the other hand, neurobiological (role of cholecystokinin, endogenous opioids and dopamine). Nocebo effects can modulate the outcome of a given therapy in a negative way, as do placebo effects in a positive way. The verbal and nonverbal communications of physicians contain numerous unintentional negative suggestions that may trigger a nocebo response. This raises the important issue of how physicians can at the same time obtain informed consent and minimize nocebo-related risks. Every physician has to deal with this apparent contradiction between primum non nocere and to deliver truthful information about risks. Meticulous identification of patients at risk, information techniques such as positive framing, contextualized informed consent, and even noninformation, is valuable.
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Affiliation(s)
- Sara Planès
- Centre Régional de Pharmacovigilance Grenoble University Hospital Grenoble France
| | - Céline Villier
- Centre Régional de Pharmacovigilance Grenoble University Hospital Grenoble France
| | - Michel Mallaret
- Centre Régional de Pharmacovigilance Grenoble University Hospital Grenoble France
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Conn VS, Chan KC. How Much, How Often, How Long? Addressing Dosage in Intervention Studies. West J Nurs Res 2015; 38:3-4. [DOI: 10.1177/0193945915605067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lilienfeld SO, Ritschel LA, Lynn SJ, Cautin RL, Latzman RD. Why Ineffective Psychotherapies Appear to Work: A Taxonomy of Causes of Spurious Therapeutic Effectiveness. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2015; 9:355-87. [PMID: 26173271 DOI: 10.1177/1745691614535216] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The past 40 years have generated numerous insights regarding errors in human reasoning. Arguably, clinical practice is the domain of applied psychology in which acknowledging and mitigating these errors is most crucial. We address one such set of errors here, namely, the tendency of some psychologists and other mental health professionals to assume that they can rely on informal clinical observations to infer whether treatments are effective. We delineate four broad, underlying cognitive impediments to accurately evaluating improvement in psychotherapy-naive realism, confirmation bias, illusory causation, and the illusion of control. We then describe 26 causes of spurious therapeutic effectiveness (CSTEs), organized into a taxonomy of three overarching categories: (a) the perception of client change in its actual absence, (b) misinterpretations of actual client change stemming from extratherapeutic factors, and (c) misinterpretations of actual client change stemming from nonspecific treatment factors. These inferential errors can lead clinicians, clients, and researchers to misperceive useless or even harmful psychotherapies as effective. We (a) examine how methodological safeguards help to control for different CSTEs, (b) delineate fruitful directions for research on CSTEs, and (c) consider the implications of CSTEs for everyday clinical practice. An enhanced appreciation of the inferential problems posed by CSTEs may narrow the science-practice gap and foster a heightened appreciation of the need for the methodological safeguards afforded by evidence-based practice.
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Affiliation(s)
| | - Lorie A Ritschel
- Department of Psychiatry, University of North Carolina at Chapel Hill 3C Institute, Cary, NC
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Abstract
The phrase primum non nocere ("first, do no harm") is a well-accepted credo of the medical and mental health professions. Although emerging data indicate that several psychological treatments may produce harm in significant numbers of individuals, psychologists have until recently paid little attention to the problem of hazardous treatments. I critically evaluate and update earlier conclusions regarding deterioration effects in psychotherapy, outline methodological obstacles standing in the way of identifying potentially harmful therapies (PHTs), provide a provisional list of PHTs, discuss the implications of PHTs for clinical science and practice, and delineate fruitful areas for further research on PHTs. A heightened emphasis on PHTs should narrow the scientist-practitioner gap and safeguard mental health consumers against harm. Moreover, the literature on PHTs may provide insight into underlying mechanisms of change that cut across many domains of psychotherapy. The field of psychology should prioritize its efforts toward identifying PHTs and place greater emphasis on potentially dangerous than on empirically supported therapies.
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Symon A, Williams B, Adelasoye QA, Cheyne H. Nocebo and the potential harm of ‘high risk’ labelling: a scoping review. J Adv Nurs 2015; 71:1518-29. [DOI: 10.1111/jan.12637] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit; University of Dundee; UK
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Jakovljevic M. The placebo-nocebo response: controversies and challenges from clinical and research perspective. Eur Neuropsychopharmacol 2014; 24:333-41. [PMID: 24393653 DOI: 10.1016/j.euroneuro.2013.11.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/25/2013] [Accepted: 11/28/2013] [Indexed: 01/28/2023]
Abstract
Placebo and nocebo responses fascinate, confuse, mystify and challenge. They are genuine social, cultural and psychobiological phenomena which can significantly modify the overall treatment outcome. The placebo-nocebo phenomenon represents a very good model for our better understanding the role of treatment context and how the words, indices, symbols and icons act on our brains. Placebo response is associated with reward expectancy and relief of anticipatory anxiety, while nocebo response is related to lack of reward/positive expectancy and to increase of anticipatory anxiety. Placebo-nocebo responses are mediated through changes in various cortico-subcortical networks and psychophysiological systems. In spite of many existing complementary theories and still growing research on placebo and nocebo response, the implementation of our current knowledge to benefit basic research, clinical trials and routine clinical practice is still so scarce.
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Affiliation(s)
- Miro Jakovljevic
- Department of Psychiatry, University Hospital Center, Kispaticeva 12, 10000 Zagreb, Croatia.
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Kim YJ, Lee IS, Kim HS, Lee H, Park HJ, Lee H, Mao JJ, Chae Y. Validation of the Korean Version of the Acupuncture Expectancy Scale. Acupunct Med 2014; 32:51-5. [DOI: 10.1136/acupmed-2013-010412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives Expectancy has been shown to affect patients’ responses to acupuncture therapy. However, no validated measure of expectancy for acupuncture is available in the Korean language. The Acupuncture Expectancy Scale (AES), a 4-item self-reporting questionnaire, is the validated instrument for measuring expectancies regarding acupuncture therapy. We translated the AES into Korean and examined its test–retest reliability and construct validity. Methods The AES was translated using a forward and backward translation procedure. Internal consistency was assessed in 275 participants with item-total correlations. Construct validity was also assessed by performing principal component analysis and correlating scores on the scale with the participants’ intention to receive acupuncture therapy. Test–retest reliability was assessed in 33 participants by calculating Cronbach's α and Spearman rank correlation coefficients. Results Internal consistency was high (Cronbach's α=0.910). Principal component analysis showed that expectancy of acupuncture treatment accounted for 79.2% of the variance. The AES was positively correlated with participants’ intention to receive acupuncture treatment (r=0.695, p<0.001). Test–retest reliability in 33 of the 275 participants was adequate, with the Spearman rank correlation coefficient ranging from 0.500 to 0.737 (p<0.001). Conclusions The Korean version of the AES is a valid and reliable instrument for measuring patients’ expectancies regarding acupuncture treatment in the Korean population.
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Affiliation(s)
- Yun-Ji Kim
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - In-Seon Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ho-Sun Kim
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyejung Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hi-Joon Park
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyangsook Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jun J Mao
- Department of Family Medicine and Community Health, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, USA
| | - Younbyoung Chae
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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Bolinger E, Reese C, Suhr J, Larrabee GJ. Susceptibility of the MMPI-2-RF Neurological Complaints and Cognitive Complaints Scales to Over-reporting in Simulated Head Injury. Arch Clin Neuropsychol 2013; 29:7-15. [DOI: 10.1093/arclin/act082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Expectation of treatment side effects is consistently linked with those symptoms being realised. Patient expectations, including those generated by the informed consent process, can have a large influence on the side effects that patients feel after starting a new medical treatment. Such symptoms may be the result of the nocebo effect, whereby the expectation of side effects leads to them being experienced. Side effects may also be due to the misattribution of pre-existing or unrelated symptoms to the new medication. Medical professionals' own negative beliefs about a treatment, especially generic drugs, may further enhance patients' expectations of adverse effects. The news media may also influence expectations, particularly when media attention is directed towards a health or medication scare. This field of research has ethical and clinical implications for both medical professionals and the news media with respect to the level and type of information about treatment side effects that is provided to patients or members of the public.
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Affiliation(s)
- Kate Faasse
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Köteles F, Tóth A, Bárdos G. Expectations of medicine adverse effects: Perceptual characteristics of tablets and personality background. ACTA ACUST UNITED AC 2011. [DOI: 10.1556/cemed.5.2011.4.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Köteles F, Bárdos G. What makes us sicker? An experimental study on non-specific adverse drug effects. ACTA ACUST UNITED AC 2011. [DOI: 10.1556/cemed.5.2011.4.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Johnson M. A randomized study of a novel Zen dialogue method for producing spiritual and well-being enhancement: implications for end-of-life care. J Holist Nurs 2010; 29:201-10. [PMID: 21177528 DOI: 10.1177/0898010110391265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To test the hypothesis that a novel Zen dialogue-based method can bring about significant improvements in spiritual, meditation, and well-being parameters. DESIGN A pretest-posttest design was used with participants being randomly assigned to either treatment or no treatment group at the Zen Center. The participants were 14 females and 2 males within each group with no prior formal Zen or meditation training. Those participants in the treatment group received intensive interaction for 1 day with an experienced Zen teacher using a dialogue method to induce a deep meditative state without instruction in formal meditation sitting practice. The outcome was measured with multiple previously standardized instruments designed to assess meditation states, well-being, and spirituality. RESULTS A repeated-measures analysis of variance showed statistically significant differences between the treatment and control groups for all parameters measured. In addition, the meditative state measure suggested qualities consistent with deep meditation experiences. The results justify further investigation of the technique as a rapid spiritual intervention tool particularly for clients facing end-of-life issues.
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Affiliation(s)
- Michael Johnson
- University of Utah Health Sciences Center MEG Lab & College of Nursing, 729 Arapeen Dr., Salt Lake City, UT 84108, USA.
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Interview Versus Questionnaire Symptom Reporting in People With the Postconcussion Syndrome. J Head Trauma Rehabil 2010; 25:23-30. [DOI: 10.1097/htr.0b013e3181b4b6ab] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Eyles C, Walker J, Brien S. Homeopathic Practitioner's Experiences of the Homeopathic Consultation: A Protocol of a Grounded Theory Study. J Altern Complement Med 2009; 15:347-52. [DOI: 10.1089/acm.2008.0105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Caroline Eyles
- Department of Primary Care, Complementary Medicine Research Unit, The University of Southampton, Southampton, UK
| | - Jan Walker
- School of Nursing and Midwifery, University of Southampton, Southampton, UK
| | - Sarah Brien
- Department of Primary Care, University of Southampton, Southampton, UK
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Abstract
This paper considers how the full range of human experience may catalyze a placebo response. The placebo effect has been characterized as something to control in clinical research, something to cultivate in clinical practice and something present in all healing encounters. We examine domains in which the term 'placebo' is used in discourse: clinical research, clinical practice, media representations of treatment efficacy and lay interpretations of placebo--an underresearched topic. We briefly review major theoretical frameworks proposed to explain the placebo effect: classical conditioning, expectancy, the therapeutic relationship and sociocultural 'meaning.' As a corrective to what we see as an overemphasis on conscious cognitive approaches to understanding placebo, we reorient the discussion to argue that direct embodied experience may take precedence over meaning-making in the healing encounter. As an example, we examine the neurobiology of rehearsing or visualizing wellness as a mode of directly (performatively) producing an outcome often dismissed as a 'placebo response.' Given body/mind/emotional resonance, we suggest that the placebo response is an evolutionarily adaptive trait and part of healing mechanisms operating across many levels--from genetic and cellular to social and cultural.
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Köteles F, Bárdos G. Expectations of side effects evoked by perceptual characteristics of curatives and their psychological background. ACTA ACUST UNITED AC 2009. [DOI: 10.1556/mental.10.2009.1.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Novella S, Roy R, Marcus D, Bell IR, Davidovitch N, Saine A. A debate: homeopathy--quackery or a key to the future of medicine? J Altern Complement Med 2008; 14:9-15. [PMID: 18199017 DOI: 10.1089/acm.2007.0770] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bogaerts S, Daalder AL, Van Der Knaap LM, Kunst MJ, Buschman J. CRITICAL INCIDENT, ADULT ATTACHMENT STYLE, AND POSTTRAUMATIC STRESS DISORDER: A COMPARISON OF THREE GROUPS OF SECURITY WORKERS. SOCIAL BEHAVIOR AND PERSONALITY 2008. [DOI: 10.2224/sbp.2008.36.8.1063] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this paper the authors render the results of research investigating adult attachment and posttraumatic stress disorder (PTSD) in a sample of Belgian security workers. The sample contained 3 subsamples: 68 individuals who had directly experienced a critical incident, 67 individuals
who indirectly went through a critical incident, and 77 individuals who had not experienced a critical incident in the last six months. The analysis of the research results shows that the secure attachment style and the three PTSD trauma symptom clusters in DSM-IV - intrusion, avoidance/numbing,
and hyperarousal - discriminate between the three subsamples. In other words, security workers who were directly and actively confronted with a critical incident were significantly more insecurely attached and suffered significantly more from PTSD symptoms than the groups who had no or indirect
experience of a critical incident. Furthermore, trauma-focused cognitive-behavioral therapy is widely and quite efficiently used in the treatment of PTSD. Interest has been expressed in medical approaches.
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America A, Milling LS. The efficacy of vitamins for reducing or preventing depression symptoms in healthy individuals: natural remedy or placebo? J Behav Med 2007; 31:157-67. [DOI: 10.1007/s10865-007-9134-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Accepted: 09/27/2007] [Indexed: 11/28/2022]
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Weise C, Heinecke K, Rief W. Biofeedback bei chronischem Tinnitus – Behandlungsleitfaden und vorläufige Ergebnisse zu Wirksamkeit und Akzeptanz. VERHALTENSTHERAPIE 2007. [DOI: 10.1159/000111462] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Mao JJ, Armstrong K, Farrar JT, Bowman MA. Acupuncture expectancy scale: development and preliminary validation in China. Explore (NY) 2007; 3:372-7. [PMID: 17681257 PMCID: PMC2696198 DOI: 10.1016/j.explore.2006.12.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Accepted: 12/12/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Expectancy has been shown to affect the response to psychological and medical interventions; however, the lack of validated measure of expectancy in the setting of acupuncture limits the quantitative evaluation of the effects of expectancy on clinical response to acupuncture therapy. We seek to develop and validate an instrument that measures patients' expected response from acupuncture. SETTING/DESIGN We developed the acupuncture expectancy scale by eliciting items from patients and then conducted a survey study in two phases to test the reliability and validity of the instrument among 200 subjects at six outpatient acupuncture clinics in Beijing, China. RESULTS Our final scale consisted of four items measuring the expectation of improvement of illness, enhanced coping, increased vitality, and symptom alleviation as a result of acupuncture therapy. Scores of acupuncture expectancy scales ranged from four to 20, with a median of 17, and 21% at the maximum score. No item had over 5% missing data. Internal consistency (Cronbach's alpha coefficient) was .82. Principal components analysis revealed one general component accounting for 64% of the variance. Expectancy of response was positively correlated with selected questions of perceived efficacy (0.44), satisfaction (0.49), and confidence in prescribed acupuncture therapy (0.51), all with P < .001. CONCLUSION We developed a simple four-item instrument with valid and reliable score that measures expectancy about acupuncture therapy and correlates to subject reported response. The reliability and validity of acupuncture expectancy scale score needs to be tested in other types of populations. Incorporating this instrument in clinical trials can evaluate the role of expectancy as part of the complex social-behavioral component of acupuncture therapy.
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Affiliation(s)
- Jun J Mao
- Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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Hoyer J, Helbig S, Wittchen HU. Experiences with psychotherapy for depression in routine care: a naturalistic patient survey in Germany. Clin Psychol Psychother 2006. [DOI: 10.1002/cpp.504] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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