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Wilhelm M, Fischer SM, Rief W, Fiorio M, Barbiani D. Generalization and enhancement of the effects of an active placebo nasal spray on sadness. J Affect Disord 2024; 369:S0165-0327(24)01706-3. [PMID: 39413882 DOI: 10.1016/j.jad.2024.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 09/03/2024] [Accepted: 10/11/2024] [Indexed: 10/18/2024]
Abstract
INTRODUCTION The placebo effect, i.e., the psychobiological response arising from administering an inert treatment, influences various domains, such as pain perception and emotional regulation. Positive framing might enhance this effect. This study tested whether the effect of an active placebo (mimicking drug side effects to enhance treatment credibility) on is generalized between two different contexts of sadness induction and if positive framing of side effects enhances this effect. METHODS Ninety-six healthy participants were randomly assigned to one of three groups: Placebo+positive framing (PPF), Placebo+standard information (PSI), or no treatment control (NTC). Participants underwent a sadness induction protocol during an in-person lab session and a 20-min online follow-up at home six hours later. Primary outcome was self-reported sadness, secondary outcome was self-reported side effects. RESULTS Both the PPF and PSI groups showed a significant decrease in sadness compared to the NTC group after placebo administration during the lab session (p < 0.001) and at follow-up (p < 0.05). At follow-up, only the PPF group did not experience a significant increase in sadness. Positive framing did not improve side effect tolerability. LIMITATIONS Self-reported measures introduce subjective bias. The sample restriction to healthy volunteers limits generalizability. The six-hour period may not capture clinically relevant long-term effects. CONCLUSIONS The active placebo nasal spray effectively reduced sadness, with effects persisting for six hours and across different contexts. Positive framing did not enhance side effect tolerability but may have helped maintain effectiveness at follow-up. Further research is needed in clinical populations and to explore long-term effects.
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Affiliation(s)
- Marcel Wilhelm
- Department of Clinical Psychology, Philipps-University Marburg, Marburg, Germany.
| | - Sarah Mae Fischer
- Department of Clinical Psychology, Philipps-University Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology, Philipps-University Marburg, Marburg, Germany
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Diletta Barbiani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Department of Psychology, Università Cattolica del Sacro Cuoro, Milan, Italy
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Huneke NTM, Cross C, Fagan HA, Molteni L, Phillips N, Garner M, Baldwin DS. Placebo Effects Are Small on Average in the 7.5% CO2 Inhalational Model of Generalized Anxiety. Int J Neuropsychopharmacol 2024; 27:pyae019. [PMID: 38577951 PMCID: PMC11059817 DOI: 10.1093/ijnp/pyae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/10/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Anxiety disorders are highly prevalent and socio-economically costly. Novel pharmacological treatments for these disorders are needed because many patients do not respond to current agents or experience unwanted side effects. However, a barrier to treatment development is the variable and large placebo response rate seen in trials of novel anxiolytics. Despite this, the mechanisms that drive placebo responses in anxiety disorders have been little investigated, possibly due to low availability of convenient experimental paradigms. We aimed to develop and test a novel protocol for inducing placebo anxiolysis in the 7.5% CO2 inhalational model of generalized anxiety in healthy volunteers. METHODS Following a baseline 20-minute CO2 challenge, 32 healthy volunteers were administered a placebo intranasal spray labelled as either the anxiolytic "lorazepam" or "saline." Following this, participants surreptitiously underwent a 20-minute inhalation of normal air. Post-conditioning, a second dose of the placebo was administered, after which participants completed another CO2 challenge. RESULTS Participants administered sham "lorazepam" reported significant positive expectations of reduced anxiety (P = .001), but there was no group-level placebo effect on anxiety following CO2 challenge post-conditioning (Ps > .350). Surprisingly, we found many participants exhibited unexpected worsening of anxiety, despite positive expectations. CONCLUSIONS Contrary to our hypothesis, our novel paradigm did not induce a placebo response, on average. It is possible that effects of 7.5% CO2 inhalation on prefrontal cortex function or behavior in line with a Bayesian predictive coding framework attenuated the effect of expectations on subsequent placebo response. Future studies are needed to explore these possibilities.
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Affiliation(s)
- Nathan T M Huneke
- Southern Health National Health Service Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
- University Department of Psychiatry, Academic Centre, College Keep, Southampton, UK
| | - Cosmina Cross
- Southern Health National Health Service Foundation Trust, Southampton, UK
| | - Harry A Fagan
- Southern Health National Health Service Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
- University Department of Psychiatry, Academic Centre, College Keep, Southampton, UK
| | - Laura Molteni
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
- University Department of Psychiatry, Academic Centre, College Keep, Southampton, UK
| | | | - Matthew Garner
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK
- University Department of Psychiatry, Academic Centre, College Keep, Southampton, UK
| | - David S Baldwin
- University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Southern Health National Health Service Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
- University Department of Psychiatry, Academic Centre, College Keep, Southampton, UK
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Barnes K, Babbage E, Barker J, Jain N, Faasse K. The role of positive information provision in open-label placebo effects. Appl Psychol Health Well Being 2023; 15:1406-1426. [PMID: 36932997 DOI: 10.1111/aphw.12444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/06/2023] [Indexed: 03/19/2023]
Abstract
Open label placebos (OLPs) appear generally efficacious among clinical samples, but the empirical evidence regarding their use in non-clinical and sub-clinical samples, as well as when administered independent of a convincing rationale, is mixed. Healthy participants (N = 102) were randomised to either a 6-day course of OLP pills with information provision (OLP-plus: N = 35), without information provision (OLP-only: N = 35), or no-treatment control group (N = 32). OLP pills were described as enhancing physical (symptoms and sleep) and psychological (positive and negative emotional) well-being. Well-being was assessed at baseline and on Day 6. Expectancies and adherence were measured. OLP administration interacted with baseline well-being. The OLP-plus group demonstrated increased well-being on all outcomes other than positive emotions, but only when they reported decreased baseline well-being. OLP-only and control groups did not differ. The OLP-plus group demonstrated elevated expectancies, that mediated the OLP effect on physical symptoms relative to control, but only when well-being was lower than average at baseline (i.e. moderated-mediation). Results demonstrate the importance of information provided with OLPs. The moderating effect of baseline outcomes may reconcile inconsistent results regarding clinical and non-clinical samples. Accounting for baseline symptoms in non-clinical and sub-clinical samples is likely to enhance our understanding of when OLPs are effective.
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Affiliation(s)
- Kirsten Barnes
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Emily Babbage
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jessica Barker
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Natasha Jain
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate Faasse
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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Winkler A, Hahn A, Hermann C. The impact of pharmaceutical form and simulated side effects in an open-label-placebo RCT for improving psychological distress in highly stressed students. Sci Rep 2023; 13:6367. [PMID: 37076557 PMCID: PMC10113726 DOI: 10.1038/s41598-023-32942-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/05/2023] [Indexed: 04/21/2023] Open
Abstract
Open-label placebo (OLP) may be utilized to reduce psychological distress. Yet, potential contextual effects have not been explored. We investigated the impact of pharmaceutical form and the simulation of side effects in a parallel group RCT (DRKS00030987). A sample of 177 highly stressed university students at risk of depression were randomly assigned by computer generated tables to a 1-week intervention with active or passive OLP nasal spray or passive OLP capsule or a no-treatment control group. After the intervention, groups differed significantly in depressive symptoms but not regarding other outcomes of psychological distress (stress, anxiety, sleep quality, somatization), well-being or treatment expectation. OLP groups benefitted significantly more compared to the no-treatment control group (d = .40), OLP nasal spray groups significantly more than the OLP capsule group (d = .40) and the active OLP group significantly more than the passive OLP groups (d = .42). Interestingly, before intervention, most participants, regardless of group assignment, believed that the OLP capsule would be most beneficial. The effectiveness of OLP treatments seems to be highly influenced by the symptom focus conveyed by the OLP rationale. Moreover, pharmaceutical form and simulation of side effects may modulate efficacy, while explicit treatment expectation seems to play a minor role.
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Affiliation(s)
- Alexander Winkler
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University Giessen, Otto-Behaghel-Str. 10F, 35394, Giessen, Germany.
| | - Alannah Hahn
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University Giessen, Otto-Behaghel-Str. 10F, 35394, Giessen, Germany
| | - Christiane Hermann
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University Giessen, Otto-Behaghel-Str. 10F, 35394, Giessen, Germany
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Dong Y, Weir NM. Antidepressants: A content analysis of healthcare providers' tweets. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100232. [PMID: 36876146 PMCID: PMC9976573 DOI: 10.1016/j.rcsop.2023.100232] [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: 09/29/2022] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 02/12/2023] Open
Abstract
Background Antidepressants are the primary treatment for depression, and social support from social media may offer another support route. Whilst Twitter has become an interactive platform for healthcare providers and their patients, previous studies found low engagement of healthcare providers when discussing antidepressants on Twitter. This study aims to analyse the Twitter posts of healthcare providers related to antidepressants and to explore the healthcare providers' engagement and their areas of interest. Method Tweets within a 10-day period were collected through multiple searches with a list of keywords within Twitter. The results were filtered against several inclusion criteria, including a manual screening to identify healthcare providers. A content analysis was conducted on eligible tweets where correlative themes and subthemes were identified. Key findings Healthcare providers contributed 5.9% of the antidepressant-related tweets (n = 770/13,005). The major clinical topics referred to in the tweets were side effects, antidepressants for the treatment of COVID-19, and antidepressant studies of psychedelics. Nurses posted more tweets sharing personal experiences with commonly negative attitudes, in contrast to physicians. Links to external webpages were commonly used among healthcare providers, especially users representing healthcare organisations. Conclusions A relatively low proportion of healthcare providers' engagement on Twitter regarding antidepressants (5.9%) was identified, with a minimal increase throughout the COVID-19 pandemic when compared to previous studies. The major clinical topics referred to in the tweets were side effects, antidepressants for the treatment of COVID-19 and antidepressant studies of psychedelics, which have been made publicly available. In general, the findings confirmed that social media platforms are a mechanism by which healthcare providers, organisations and students support patients, share information about adverse drug effects, communicate personal experiences, and share research. It is plausible that this could impact the belief and behaviours of people with lived experience of depression who may see these tweets.
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Affiliation(s)
| | - Natalie M. Weir
- Corresponding author at: 161 Cathedral Street, Glasgow G4 0NR, United Kingdom.
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Sezer D, Locher C, Gaab J. Deceptive and open-label placebo effects in experimentally induced guilt: a randomized controlled trial in healthy subjects. Sci Rep 2022; 12:21219. [PMID: 36481801 PMCID: PMC9731964 DOI: 10.1038/s41598-022-25446-1] [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: 05/06/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Placebos are known to yield significant effects in many conditions. We examined deceptive and open-label placebo effects on guilt, which is important for self-regulation and a symptom of mental disorders. Following an experimental induction of guilt, healthy subjects were randomized to deceptive placebo (DP; n = 35), open-label placebo (OLP; n = 35), or no treatment (NT; n = 39). The primary outcome was guilt responses assessed in area under the curve (AUC). Secondary outcomes were shame, guilt, and affect. We hypothesized that DP and OLP would reduce guilt compared to NT. Guilt responses were higher in the NT group than in the placebo groups (estimate = 2.03, 95% CI = 0.24-3.82, d = 0.53), whereas AUC guilt did not differ significantly between the placebo groups (estimate = -0.38, 95% CI = -2.52-1.76, d = -0.09). Placebos are efficacious in reducing acute guilt responses, regardless of the placebo administration (i.e., open vs. deceptive). Furthermore, we observed narrative-specific effects with significant changes of guilt but not shame, pride, or affect. These results indicate not only that guilt is amenable to placebos but also that placebos can be administered in an ethical and potentially emotion-specific manner.
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Affiliation(s)
- Dilan Sezer
- grid.6612.30000 0004 1937 0642Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Missionsstrasse 62, 4055 Basel, Switzerland
| | - Cosima Locher
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland ,grid.11201.330000 0001 2219 0747Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jens Gaab
- grid.6612.30000 0004 1937 0642Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Missionsstrasse 62, 4055 Basel, Switzerland
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Can placebos reduce intrusive memories? Behav Res Ther 2022; 158:104197. [PMID: 36122440 DOI: 10.1016/j.brat.2022.104197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/29/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022]
Abstract
After traumatic experiences, intrusive memories can flash back and evoke significant distress. Here, we investigated whether the frequency and severity of intrusions can be reduced by the provision of placebo. After the (online) exposure to the trauma-film paradigm, healthy participants (N = 112) received deceptive placebo (DP), open-label placebo (OLP), or no treatment. In the DP group, participants were led to believe to receive a dopamine-modulating drug, which was supposed to disrupt the consolidation of traumatic memories, although they in fact received the same placebo tablets as the OLP group for one week. The results show that the groups did not differ in the frequency of intrusive memories after one week. However, participants receiving OLP reported a significantly reduced intensity of intrusions as compared to DP. Across groups, negative expectations about the intensity and controllability of intrusions were associated with a higher frequency of intrusions, higher distress, higher burden, and more negative appraisal. The results suggest that expectations play an important role in the emergence of intrusive memories and that some of the disabling aspects of intrusive memories can be reduced by placebo. This may carry clinical potential because placebos are an accessible, cost-effective intervention to reduce the risk of intrusive memories.
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Hahn A, Göhler AC, Hermann C, Winkler A. Even when you know it is a placebo, you experience less sadness: First evidence from an experimental open-label placebo investigation. J Affect Disord 2022; 304:159-166. [PMID: 35181385 DOI: 10.1016/j.jad.2022.02.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Recent studies demonstrate substantial effects of deceptive placebo on experimentally induced sadness, even on autonomic activity. Whether deception is necessary, remains to be elucidated. We investigated the effect of an open-label placebo (OLP) treatment, i.e. an openly administered placebo delivered with a convincing rationale for its sadness-protecting effect. METHODS Eighty-four healthy females were randomized to an OLP group or a no-treatment control group. All participants received the same detailed information about the OLP effect, only the OLP group received an OLP nasal spray. Before and after the OLP intervention, participants underwent a sad mood induction procedure combining self-deprecating statements (Velten's method) and sad music. Sadness was assessed by the Positive and Negative Affect Schedule (PANAS-X). Autonomic activity was measured continuously. RESULTS Participants in the OLP group reported a significantly attenuated increase in sadness upon mood induction and less sadness after induction compared to the control group (d = 0.79). Regardless of intervention, heart rate decreased during mood inductions with a more pronounced deceleration in the second mood induction. LIMITATIONS Generalizability is limited due to the selective sample and the reliance on an experimentally controlled mood induction. CONCLUSION OLP treatment had a beneficial effect on perceived sadness, at least at the subjective level. Hence, deception may not necessarily be required for placebos to modulate experienced sad mood. Investigating the beneficial effects of OLP in (sub-)clinical samples would seem a promising and required next step towards a clinical use of placebo-associated positive treatment expectations.
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Affiliation(s)
- Alannah Hahn
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University, Giessen, Germany
| | - Annelie C Göhler
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University, Giessen, Germany
| | - Christiane Hermann
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University, Giessen, Germany.
| | - Alexander Winkler
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University, Giessen, Germany.
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Baker J, Gamer M, Rauh J, Brassen S. Placebo induced expectations of mood enhancement generate a positivity effect in emotional processing. Sci Rep 2022; 12:5345. [PMID: 35351936 PMCID: PMC8964732 DOI: 10.1038/s41598-022-09342-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Abstract
A perceptual bias towards negative emotions is a consistent finding in mood disorders and a major target of therapeutic interventions. Placebo responses in antidepressant treatment are substantial, but it is unclear whether and how underlying expectancy effects can modulate response biases to emotional inputs. In a first attempt to approach this question, we investigated how placebo induced expectation can shape the perception of specific emotional stimuli in healthy individuals. In a controlled cross-over design, positive treatment expectations were induced by verbal instructions and a hidden training manipulation combined with an alleged oxytocin nasal spray before participants performed an emotion classification task on happy and fearful facial expressions with varying intensity. Analyses of response criterion and discrimination ability as derived from emotion-specific psychometric functions demonstrate that expectation specifically lowered participants’ threshold for identifying happy emotions in general, while they became less sensitive to subtle differences in emotional expressions. These indications of a positivity bias were directly correlated with participants’ treatment expectations as well as subjective experiences of treatment effects and went along with a significant mood enhancement. Our findings show that expectations can induce a perceptual positivity effect in healthy individuals which is probably modulated by top-down emotion regulation and which may be able to improve mood state. Clinical implications of these promising results now need to be explored in studies of expectation manipulation in patients with mood disorders.
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