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May A, Carvalho GF, Schwarz A, Basedau H. Influence of Role Expectancy on Patient-Reported Outcomes Among Patients With Migraine: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e243223. [PMID: 38656579 PMCID: PMC11043898 DOI: 10.1001/jamanetworkopen.2024.3223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/27/2024] [Indexed: 04/26/2024] Open
Abstract
Importance It is usually assumed that an individual's classification as a patient or a healthy person is determined by the presence or absence of disease, but little is known about whether the mere awareness of being a patient or a healthy control can play an important role for reporting outcomes. Objective To investigate whether assignment to the role of a patient or a healthy control has an effect on patient-reported outcomes. Design, Setting, and Participants This single center, double-blind, 3-group randomized clinical trial included consecutive patients from a tertiary headache clinic based at a single center in Germany who were invited to participate between October 2019 and June 2023. Statistical analysis was performed from January to March 2024. Intervention Patients with migraine were randomized into 2 groups. The first group was told that this study was centered on migraine symptoms, whereas the second group was told that healthy controls were being sought for a study about patients with vertigo. A third group of age- and sex-matched headache-free participants served as controls. All participants viewed 2 standardized roller coaster videos and provided ratings of their perceived levels of motion sickness and dizziness. Main Outcomes and Measures The primary outcome was self-reported vestibular symptoms. Secondary outcomes included differences in motion sickness, headache burden, and migraine disability. Outcomes were assessed using standardized questionnaires. Results The final sample included 366 participants: 122 patients with migraine assigned the role of patient (MP) (migraine as patient): mean [SD] age, 37.56 [12.93] years; 105 [86.1%] female), 122 patients with migraine assigned the role of healthy participant (MH) (migraine as healthy): mean [SD] age, 37.03 [13.10] years; 107 [87.7%] female), and 122 headache-free controls (HC): mean [SD] age, 37.55 [11.56] years; 100 [82.0%] female). The assigned role of the individuals with migraine (MP vs MH) had a significant effect on self-disclosure of (1) estimation that symptoms (dizziness) will occur under specific conditions (self-reported vestibular symptoms: 79 MP [64.8%]; 29 MH [23.8%]; 9 HC [7.4%]; P < .001), (2) the increase of such symptoms (dizziness) after viewing the roller coaster video, and (3) the reported frequency (median [IQR] self-reported monthly headache days for MP: 7 [4-15] days; for MH: 5 [2-10] days; P = .008) and severity (median [IQR] migraine disability assessment score for MP: 35 [20-64] points; for MH: 25 [11-47] points; P = .005) of migraine symptoms. Statistically significant changes were also found for self-reported headache frequency and disability caused by migraine. Conclusions and Relevance This randomized clinical trial found an effect of expectations regarding the role of a patient with respect to clinical and study outcomes. These findings suggest that role expectations should be taken into account when, for example, invasive treatments are discussed. Trial Registration ClinicalTrials.gov Identifier: NCT06322550.
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Affiliation(s)
- Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriela F. Carvalho
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Now with Department of Physiotherapy, Faculty of Health, Safety and Society, Furtwangen University, Furtwangen, Germany
| | - Annika Schwarz
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Now with Faculty of Social Sciences, University of Applied Sciences Bremen, Bremen, Germany
| | - Hauke Basedau
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Coane JH, Cipollini J, Beaulieu C, Song J, Umanath S. The influence of general knowledge test performance on self-ratings of and perceived relationships between intelligence, knowledge, and memory. Sci Rep 2023; 13:15723. [PMID: 37735179 PMCID: PMC10514288 DOI: 10.1038/s41598-023-42205-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023] Open
Abstract
The present study examined how taking a general knowledge (GK) test affects perceptions of one's intelligence, memory, and knowledge and the relationship between these three constructs. Participants rated their abilities on each construct and the strength of the relationships between them before and after completing an easy or hard GK test or control task. In Experiment 1, participants were (mis)informed that GK questions were correctly answered by 50% of the population; in Experiment 2, no such information was provided. Regardless of (mis)information about others' performance, participants in the Hard condition believed they had a worse memory, were less knowledgeable, and were less intelligent post-task. However, the strength of the perceived relationship between GK and intelligence decreased only when participants were misled. Judgments of one's intelligence, memory, and knowledge can be manipulated by taking a GK test, and individuals engage in self-protective behavior to reduce the potential threat to one's self-concept.
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Affiliation(s)
- Jennifer H Coane
- Department of Psychology, Colby College, Waterville, ME, 04901, USA.
| | - John Cipollini
- Department of Psychology, Colby College, Waterville, ME, 04901, USA
| | | | - Julianna Song
- Department of Psychology, Colby College, Waterville, ME, 04901, USA
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Kang H, Miksche MS, Ellingsen DM. Association between personality traits and placebo effects: a preregistered systematic review and meta-analysis. Pain 2023; 164:494-508. [PMID: 35947877 DOI: 10.1097/j.pain.0000000000002753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Placebo effects are ubiquitous yet highly variable between individuals and therefore strongly affect clinical trial outcomes such as pain relief. It is unclear whether dispositional psychological traits influence responsiveness to placebo. This preregistered meta-analysis and systematic review synthesized the literature investigating the association between personality traits and placebo effects. Based on 21 studies with 798 participants, we performed formal meta-analyses for 10 different personality traits, including behavioral inhibition, fun seeking, goal-drive persistence, reward responsiveness, empathic concern, empathic fantasy, perspective-taking, personal distress, optimism, and anxiety. We did not find evidence of associations between any of these traits and magnitude of placebo effects, which was supported by equivalence tests. Furthermore, we did not find evidence for moderating factors such as placebo manipulation type (conditioning or nonconditioning) or condition (pain or nonpain). These findings challenge the notion that personality influences responsiveness to placebos and contradict its utility for identifying placebo "responders" and "nonresponders."
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Affiliation(s)
- Heemin Kang
- Department of Psychology, University of Oslo, Norway
- Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Dan-Mikael Ellingsen
- Department of Psychology, University of Oslo, Norway
- Division of Radiology and Nuclear Medicine, Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
- School of Health Sciences, Kristiania University College, Oslo, Norway
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Vickhoff B. Why art? The role of arts in arts and health. Front Psychol 2023; 14:765019. [PMID: 37034911 PMCID: PMC10075207 DOI: 10.3389/fpsyg.2023.765019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/23/2023] [Indexed: 04/11/2023] Open
Abstract
This article is an answer to a report called "What is the evidence on the role of the arts in improving health and well-being?" The authors conclude that the arts have an impact on mental and physical health. Yet, the question of the role of the arts remains unanswered. What is and what is not an art effect? Recently, embodied theory has inspired articles on the perception of art. These articles have not yet received attention in the field of Arts and Health. Scholars in psychosomatic medicine have argued for an approach based on recent work in enactive embodied theory to investigate the connection between the body and the mind. The present article examines how key concepts in this theory relate to art. This leads to a discussion of art in terms of empathy-the relation between the internal state of the artist and the internal state of the beholder. I exemplify with a conceptual framework of musical empathy. Implications for health are addressed.
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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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Sansevere KS, Wooten T, McWilliams T, Peach S, Hussey EK, Brunyé TT, Ward N. Self-reported Outcome Expectations of Non-invasive Brain Stimulation Are Malleable: a Registered Report that Replicates and Extends Rabipour et al. (2017). JOURNAL OF COGNITIVE ENHANCEMENT 2022. [DOI: 10.1007/s41465-022-00250-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The Relation of Patient Expectations, Satisfaction, and Outcome in Surgery of the Cervical Spine: A Prospective Study. Spine (Phila Pa 1976) 2022; 47:849-858. [PMID: 35752895 DOI: 10.1097/brs.0000000000004351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN We performed a prospective nonblinded single center observational study. OBJECTIVE To investigate the relationship between expectations, outcome, and satisfaction with the outcome in patients undergoing cervical spine stabilization surgery. SUMMARY OF BACKGROUND DATA In modern healthcare, patient-reported outcome measures and patient satisfaction have become an important aspect of quality control. Therefore, outcome benchmarks for specific diseases are highly desired. Numerous studies have investigated patient-reported outcome measures and what constitutes satisfaction in degenerative lumbar spine disease. In cervical spine surgery, it is less clear what drives the postoperative symptom burden and patient satisfaction and how this depends on the primary diagnosis and other patient factors. METHODS This was a prospective, single center, observational study on patients undergoing cervical spine stabilization surgery for degenerative disease, trauma, infection, or tumor. Using the visual analogue scale for neck and arm pain, the neck disability index (NDI), the modified Japanese Orthopedic Association Score (mJOA) and patient-reported satisfaction, patient status and expectations before surgery, at discharge, 6 and 12 months after surgery were evaluated. RESULTS One hundred five patients were included. Score-based outcome correlated well with satisfaction at 6 and 12 months. Except for low NDI expectations (≥15 points) that correlated with dissatisfaction, expectations in no other score were correlated with satisfaction. Expectations did influence the outcome in some subgroups and meeting expectations resulted in higher rates of satisfaction. Pain reduction plays an important role for satisfaction, independently from the predominant symptom or pathology. CONCLUSION Satisfaction correlates well with outcome. Meeting expectations did influence satisfaction with the outcome. The NDI seems to be a valuable preoperative screening tool for poor satisfaction at 12 months. In degenerative pathology, pain is the predominant variable influencing satisfaction independently from the predominant symptom (including myelopathy). LEVEL OF EVIDENCE 5.
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Coenen M, Bingel U, Zunhammer M, Berdaguer MS, Fuhrmann C, Fimmers R, Rengelshausen J, Hartmann G, Schedlowski M, Coch C. Influence on study outcomes of an inpatient study by the behavior of the study staff (PINgPOng): study protocol for a randomized clinical trial. Trials 2022; 23:488. [PMID: 35698101 PMCID: PMC9195319 DOI: 10.1186/s13063-022-06436-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 05/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background The placebo effect as the symptom improvement following inert treatments is a fixed component of RCTs to differentiate between specific effects of the tested pharmacological substance from other unspecific effects. The PINgPOng study was set up to analyze the influence of a study team trained to either minimize the placebo response and optimize drug-placebo differences or to maximize the placebo response to increase drug efficacy by unspecific factors on the study results of a RCT in a classical early clinical trial setting. Methods/design PINgPOng is a single-center, prospective, randomized, double-blind, placebo-controlled study in a 3-group, 2-sequence, 2-period cross-over design. The study is conducted according to the principles of ICH-GCP and the Declaration of Helsinki on the Phase I-Unit of the University Hospital Bonn. The primary endpoint is the pain intensity in the cold pressor test before and after the administration of 15 mg oxycodone or placebo. The pain intensity is compared between three study conditions: 32 healthy volunteers in each study arm will be treated either by an untrained study team (arm A), by a study team trained to maximize (arm B), or to minimize placebo responses (arm C). Neuroendocrine factors (alpha-amylase activity, salivary cortisol), characteristic traits (anxiety, depression, stress), and somatic reactions are analyzed as covariates of the pain perception. Discussion The PINgPOng study will allow to answer the question whether and to what extent the behavior of a trained study team (neutral vs. maximize vs. minimize placebo responses) will differentially affect placebo responses in a setting of a highly standardized early clinical trial. The results will help to control the placebo effects by education of the clinical study team and to avoid unnecessary high placebo effects in clinical development. Trial registration German Clinical Trials Register DRKS00013586. Registered on December 22, 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06436-0.
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Affiliation(s)
- Martin Coenen
- Clinical Study Core Unit, Study Center Bonn (SZB), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. .,Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Ulrike Bingel
- Department of Neurology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Matthias Zunhammer
- Department of Neurology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Maria Soledad Berdaguer
- Clinical Study Core Unit, Study Center Bonn (SZB), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Christine Fuhrmann
- Clinical Study Core Unit, Study Center Bonn (SZB), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Rolf Fimmers
- Institute of Medical Biometrics, Informatics and Epidemiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Jens Rengelshausen
- Clinical Science, Grünenthal GmbH, Zieglerstr. 6, 52078, Aachen, Germany
| | - Gunther Hartmann
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.,Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Christoph Coch
- Clinical Study Core Unit, Study Center Bonn (SZB), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,nextevidence GmbH, Balanstraße 71a, 81541, Munich, Germany
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Do patients’ pre-treatment expectations about acupuncture effectiveness predict treatment outcome in patients with chronic low back pain? A secondary analysis of data from a randomised controlled clinical trial. PLoS One 2022; 17:e0268646. [PMID: 35594274 PMCID: PMC9122231 DOI: 10.1371/journal.pone.0268646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/14/2022] [Indexed: 12/05/2022] Open
Abstract
Objective This secondary analysis of a randomised controlled patient-blinded trial comparing effectiveness and side effect briefings in patients with chronic low back pain (CLBP) investigated the association between patients’ pre-treatment expectations about minimal acupuncture treatment and pain intensity as outcome during and after the end of the treatment. Methods Chronic low back pain patients with a pain intensity of at least 4 on a numeric rating scale from 0 to 10 received eight sessions of minimal acupuncture treatment over 4 weeks. The primary outcome was change in pain intensity rated on a Numerical Rating Scale (NRS 0–10) from inclusion visit to treatment session 4 and to the end of the treatment. Patients’ expectations about the effectiveness of acupuncture were assessed using the Expectation for Treatment Scale (ETS) before randomization. Linear regression was applied to investigate whether patients’ pre-treatment expectations predicted changes in pain intensity during and after treatment. Results A total of 142 CLBP patients (40.1 ± 12.5 years; 65.5% female) were included in our analysis. Patients’ pre-treatment expectations about acupuncture treatment were associated with changes in pain intensity after four sessions of minimal acupuncture treatment (b = -0.264, p = 0.002), but not after the end of the treatment. This association was found in females and males. Conclusions Our results imply that higher pre-treatment expectations only lead to larger reductions in pain intensity in the initial phase of a treatment, with a similar magnitude for both females and males. As the treatment progresses in the second half of the treatment, adapted expectations or other non-specific effects might play a more important role in predicting treatment outcome.
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Hackett K, Sabat SR, Giovannetti T. A person-centered framework for designing music-based therapeutic studies in dementia: current barriers and a path forward. Aging Ment Health 2022; 26:940-949. [PMID: 34139133 PMCID: PMC8678363 DOI: 10.1080/13607863.2021.1931029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: Music-based interventions have received growing attention to improve quality of life for people diagnosed with dementia. Results of randomized controlled trials and meta-analytic reviews to date, however, reveal a lack of conclusive evidence for or against the effectiveness of such interventions. Herein, we critically review the basic assumptions and methodological issues ingrained in the cultures of research and care as they relate to evaluating music-based treatments for people with dementia, and propose a shift in the methodology by which music interventions are empirically evaluated.Method: We begin by reviewing existing barriers to achieving clarity on the effectiveness of music interventions, and we highlight methodological and sociocultural constraints that have limited our ability to reach concrete conclusions in research studies to-date. We then consider several key factors that have demonstrated relevance in matching people to specific music-based interventions. Based on these key factors, we developed a person-centered framework integrating elements from precision-medicine methodology to guide intervention studies.Results: Our organizing framework systematically integrates the following factors to inform the design of intervention studies: 1) person-centered goals and desired outcomes; 2) differences among individuals in clinical, cognitive, and historical attributes; and 3) the context of intervention and access to resources.Conclusion: Integration of the proposed framework into empirical investigations of music interventions for people living with dementia will inform precise and tailored interventions that will bring clarity to this growing body of research. Another aim of this framework is to foster a more humane, person-centered approach to our culture of care.
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Affiliation(s)
| | - Steven R. Sabat
- Department of Psychology, Georgetown University, Washington, DC, USA
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The effects of being informed about chemotherapy-related cognitive symptoms with and without self-affirmation on perceived cognitive symptoms of breast cancer patients: a randomized prospective, longitudinal study. Clin Breast Cancer 2022; 22:439-454. [DOI: 10.1016/j.clbc.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/22/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
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Salunkhe G, Böge K, Wilker T, Zieger A, Jena S, Mungee A, Ta TMT, Bajbouj M, Schomerus G, Hahn E. Perceived Course of Illness on the Desire for Social Distance From People Suffering From Symptoms of Schizophrenia in India. Front Psychiatry 2022; 13:891409. [PMID: 35722581 PMCID: PMC9204028 DOI: 10.3389/fpsyt.2022.891409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stigmatization of people with schizophrenia remains a highly relevant topic worldwide, particularly in low- and middle-income countries like India. It is crucial to identify the determinants of the desire for social distance as a proxy for discriminatory behavior in a socio-cultural context to indicate ways to reduce stigma. This study aims to explore whether the public perception of the perceived course of an illness concerning people with symptoms of schizophrenia has an impact on the desire for social distance. SUBJECTS AND METHODS Data collection took place in five cities in India. The sample (N = 447) was stratified for gender, age, and religion. Desire for social distance was sampled based on a self-reported questionnaire using unlabelled vignettes for schizophrenia. First, factor analysis was conducted to identify the main factors underlying the perception of the perceived course of the illness. Subsequently, a regression analysis was conducted to examine the impact of the perception of those prognostic factors on the desire for social distance. RESULTS Factor analysis revealed two independent factors of the perceived course of an illness: (1) life-long dependency on others and loss of social integration and functioning and (2) positive expectations toward treatment outcome. This second factor was significantly associated with a less desire for social distance toward persons with schizophrenia. CONCLUSION The desire for social distance toward people with schizophrenia reduces with the expectation of positive treatment outcomes which underlines the need to raise public mental health awareness and provide psychoeducation for affected people and their family members in India. Help-seeking behaviors can be promoted by directing those needing treatment toward locally available, affordable and credible community-based services rather than facility-based care. Strikingly, lifelong dependency and the inability to socially integrate do not increase the desire for social distance, reflecting the Indian nation's socio-relational values and insufficiency of public mental health services. This indicates the suitability of systemic therapy approaches in public mental healthcare services to support the family's involvement and family-based interventions in caregiving for mentally ill people across the lifespan.
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Affiliation(s)
- Gayatri Salunkhe
- Centre of Medicine and Society, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kerem Böge
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Tanja Wilker
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Aron Zieger
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Sunita Jena
- Public Health Department, Asian Institute of Public Health, Utkal University, Bhubhaneshwar, India
| | - Aditya Mungee
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Universitätsklinikum Leipzig, University of Leipzig, Leipzig, Germany
| | - Eric Hahn
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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Braun-Koch K, Rief W. Maintenance vs. Change of Negative Therapy Expectation: An Experimental Investigation Using Video Samples. Front Psychiatry 2022; 13:836227. [PMID: 35444567 PMCID: PMC9013760 DOI: 10.3389/fpsyt.2022.836227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/25/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Therapy expectations contribute substantially to the outcome of psychotherapy. In contrast, psychotherapy expectations are rarely addressed and systematically optimised in studies on psychotherapy. MATERIALS AND METHODS A total of 142 mostly healthy participants with critical attitudes towards psychotherapy were randomised into two groups: (1) a control group that watched a video with patients who gave information about their symptoms or (2) an experimental group that watched an expectation-optimised video with the same patients giving additional information about their mostly positive therapy outcomes. The primary outcome was the Milwaukee Psychotherapy Expectation Questionnaire (MPEQ), which was filled in before and after watching the video. RESULTS Both groups showed a significant improvement of their process expectations and attitudes towards psychotherapy after watching the video. Participants in the experimental group changed their therapy outcome expectation while there was no change in the control group [F(1,140) = 9.72, p = 0.002, η2 = 0.065]. CONCLUSION A video intervention with patients presenting their positive therapy experiences improves therapy expectations in persons with critical attitudes. Expectation-optimised videos could be used for prevention programmes and when starting therapy. TRIAL REGISTRATION Trial was registered at clinicaltrials.gov (NCT03594903) on November 2018.
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Affiliation(s)
- Kristina Braun-Koch
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
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The Role of Expectation and Beliefs on the Effects of Non-Invasive Brain Stimulation. Brain Sci 2021; 11:brainsci11111526. [PMID: 34827526 PMCID: PMC8615662 DOI: 10.3390/brainsci11111526] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022] Open
Abstract
Non-invasive brain stimulation (NIBS) techniques are used in clinical and cognitive neuroscience to induce a mild magnetic or electric field in the brain to modulate behavior and cortical activation. Despite the great body of literature demonstrating promising results, unexpected or even paradoxical outcomes are sometimes observed. This might be due either to technical and methodological issues (e.g., stimulation parameters, stimulated brain area), or to participants’ expectations and beliefs before and during the stimulation sessions. In this narrative review, we present some studies showing that placebo and nocebo effects, associated with positive and negative expectations, respectively, could be present in NIBS trials, both in experimental and in clinical settings. The lack of systematic evaluation of subjective expectations and beliefs before and after stimulation could represent a caveat that overshadows the potential contribution of placebo and nocebo effects in the outcome of NIBS trials.
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Wols A, Hollenstein T, Lichtwarck-Aschoff A, Granic I. The Effect of Expectations on Experiences and Engagement with an Applied Game for Mental Health. Games Health J 2021; 10:207-219. [PMID: 33945326 PMCID: PMC8380792 DOI: 10.1089/g4h.2020.0115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: Applied games are considered a promising approach to deliver mental health interventions. Nonspecific factors such as expectations and motivation may be crucial to optimize effectiveness yet have not been examined so far. The current study examined the effect of expectations for improvement on (1) experienced fun and positive affect, and (2) in-game play behaviors while playing MindLight, an applied game shown to reduce anxiety. The secondary aim was to examine the moderating role of symptom severity and motivation to change. Materials and Methods: Fifty-seven participants (47 females; 17–21 years old) preselected on anxiety symptoms viewed a trailer in which MindLight was promoted as either a mental health or an entertainment game. These trailers were used to induce different expectations in participants. Participants subsequently played the game for 60 minutes. Before playing, participants filled out questionnaires about their general anxiety symptoms, motivation to change, state anxiety, affect, and arousal. While playing, in-game behaviors and galvanic skin response (GSR) were recorded continuously. After playing, state anxiety, affect, and arousal were measured again as well as experienced fun. Results: Participants in both trailer conditions showed increases in state anxiety, arousal, and GSR. Expectations did not influence experienced fun and positive affect, nor in-game behaviors. In addition, no moderation effects of motivation to change and symptom severity were found. Conclusion: Experiences and engagement with MindLight were not influenced by expectations, motivation to change, and symptom severity. For future research, it is recommended to examine individual differences in these effects, and long-term and more distal outcomes and processes.
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Affiliation(s)
- Aniek Wols
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Tom Hollenstein
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | | | - Isabela Granic
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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16
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Munk A, Reme SE, Jacobsen HB. What Does CATS Have to Do With Cancer? The Cognitive Activation Theory of Stress (CATS) Forms the SURGE Model of Chronic Post-surgical Pain in Women With Breast Cancer. Front Psychol 2021; 12:630422. [PMID: 33833718 PMCID: PMC8023326 DOI: 10.3389/fpsyg.2021.630422] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/01/2021] [Indexed: 01/25/2023] Open
Abstract
Chronic post-surgical pain (CPSP) represents a highly prevalent and significant clinical problem. Both major and minor surgeries entail risks of developing CPSP, and cancer-related surgery is no exception. As an example, more than 40% of women undergoing breast cancer surgery struggle with CPSP years after surgery. While we do not fully understand the pathophysiology of CPSP, we know it is multifaceted with biological, social, and psychological factors contributing. The aim of this review is to advocate for the role of response outcome expectancies in the development of CPSP following breast cancer surgery. We propose the Cognitive Activation Theory of Stress (CATS) as an applicable theoretical framework detailing the potential role of cortisol regulation, inflammation, and inflammatory-induced sickness behavior in CPSP. Drawing on learning theory and activation theory, CATS offers psychobiological explanations for the relationship between stress and health, where acquired expectancies are crucial in determining the stress response and health outcomes. Based on existing knowledge about risk factors for CPSP, and in line with the CATS position, we propose the SURGEry outcome expectancy (SURGE) model of CPSP. According to SURGE, expectancies impact stress physiology, inflammation, and fear-based learning influencing the development and persistence of CPSP. SURGE further proposes that generalized response outcome expectancies drive adaptive or maladaptive stress responses in the time around surgery, where coping dampens the stress response, while helplessness and hopelessness sustains it. A sustained stress response may contribute to central sensitization, alterations in functional brain networks and excessive fear-based learning. This sets the stage for a prolonged state of inflammatory-induced sickness behavior - potentially driving and maintaining CPSP. Finally, as psychological factors are modifiable, robust and potent predictors of CPSP, we suggest hypnosis as an effective intervention strategy targeting response outcome expectancies. We here argue that presurgical clinical hypnosis has the potential of preventing CPSP in women with breast cancer.
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Affiliation(s)
- Alice Munk
- The Mind-Body Lab, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Silje Endresen Reme
- The Mind-Body Lab, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Henrik Børsting Jacobsen
- The Mind-Body Lab, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
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17
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Denkinger S, Spano L, Bingel U, Witt CM, Bavelier D, Green CS. Assessing the Impact of Expectations in Cognitive Training and Beyond. JOURNAL OF COGNITIVE ENHANCEMENT 2021. [DOI: 10.1007/s41465-021-00206-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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18
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Effects of open-label placebos on test performance and psychological well-being in healthy medical students: a randomized controlled trial. Sci Rep 2021; 11:2130. [PMID: 33483552 PMCID: PMC7822842 DOI: 10.1038/s41598-021-81502-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/07/2021] [Indexed: 01/30/2023] Open
Abstract
Psychological distress is prevalent in students and can predispose to psychiatric disorders. Recent findings indicate that distress might be linked to impaired cognitive performance in students. Experimental findings in healthy participants suggest that placebo interventions can improve cognition. However, whether non-deceptive (i.e., open-label, OLP) placebos can enhance cognitive function and emotional well-being is unclear. Using a randomized-controlled design we demonstrate a positive impact of OLP on subjective well-being (i.e., stress, fatigue, and confusion) after a 21-day OLP application in healthy students during midterm exams. OLP did not improve test performance, but, within the OLP group, test performance was positively correlated with measures of general belief in the benefit of medication. These results show that OLP can counteract negative effects of acute stress on psychological well-being and might improve cognitive performance if supported by positive treatment expectations. Additionally, our findings in healthy volunteers warrant further investigation in exploring the potential of OLP in reducing stress-related psychological effects in patients. The trial was preregistered at the German Clinical Trials Register on December 20, 2017 (DRKS00013557).
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19
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Rütgen M, Wirth EM, Riečanský I, Hummer A, Windischberger C, Petrovic P, Silani G, Lamm C. Beyond Sharing Unpleasant Affect-Evidence for Pain-Specific Opioidergic Modulation of Empathy for Pain. Cereb Cortex 2021; 31:2773-2786. [PMID: 33454739 PMCID: PMC8107785 DOI: 10.1093/cercor/bhaa385] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/23/2020] [Indexed: 12/11/2022] Open
Abstract
It is not known how specific the neural mechanisms underpinning empathy for different domains are. In the present study, we set out to test whether shared neural representations between first-hand pain and empathy for pain are pain-specific or extend to empathy for unpleasant affective touch as well. Using functional magnetic resonance imaging and psychopharmacological experiments, we investigated if placebo analgesia reduces first-hand and empathic experiences of affective touch, and compared them with the effects on pain. Placebo analgesia also affected the first-hand and empathic experience of unpleasant touch, implicating domain-general effects. However, and in contrast to pain and pain empathy, administering an opioid antagonist did not block these effects. Moreover, placebo analgesia reduced neural activity related to both modalities in the bilateral insular cortex, while it specifically modulated activity in the anterior midcingulate cortex for pain and pain empathy. These findings provide causal evidence that one of the major neurochemical systems for pain regulation is involved in pain empathy, and crucially substantiates the role of shared representations in empathy.
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Affiliation(s)
- Markus Rütgen
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
| | - Eva-Maria Wirth
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
| | - Igor Riečanský
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria.,Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, 813 71 Bratislava, Slovakia
| | - Allan Hummer
- MR Center of Excellence, Medical University of Vienna, 1090 Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
| | - Christian Windischberger
- MR Center of Excellence, Medical University of Vienna, 1090 Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
| | - Predrag Petrovic
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden
| | - Giorgia Silani
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
| | - Claus Lamm
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
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20
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Mit den Augen der Psychoanalyse. FORUM DER PSYCHOANALYSE 2021. [DOI: 10.1007/s00451-020-00418-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Olson JA, Lifshitz M, Raz A, Veissière SPL. Super Placebos: A Feasibility Study Combining Contextual Factors to Promote Placebo Effects. Front Psychiatry 2021; 12:644825. [PMID: 33746801 PMCID: PMC7970115 DOI: 10.3389/fpsyt.2021.644825] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/08/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Ample evidence demonstrates that placebo effects are modulated by contextual factors. Few interventions, however, attempt to combine a broad range of these factors. Here, we explore the therapeutic power of placebos by leveraging factors including social proof, positive suggestion, and social learning. This study aimed to test the feasibility of an elaborate "super placebo" intervention to reduce symptoms of various disorders in a pediatric population. Methods: In a single-arm qualitative study, participants entered an inactive MRI scanner which they were told could help their brain heal itself through the power of suggestion. The sample included 11 children (6-13 years old) diagnosed with disorders known to be receptive to placebos and suggestion (Attention Deficit Hyperactivity Disorder, Tourette Syndrome, chronic skin picking, and migraines). The children were given positive suggestions during 2-4 placebo machine sessions over the span of approximately 1 month. We assessed open-ended treatment outcomes via recorded interviews and home visits. Results: The procedure was feasible and no adverse events occurred. Ten of the 11 parents reported improvements in their children after the intervention, ranging from minor transient changes to long-term reductions in subjective and objective symptoms (e.g., migraines and skin lesions). Discussion: These preliminary findings demonstrate the feasibility and promise of combining a broad range of contextual factors in placebo studies. Future research is needed to assess the causal effects of such interventions.
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Affiliation(s)
- Jay A Olson
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Michael Lifshitz
- Department of Anthropology, Stanford University, Palo Alto, CA, United States
| | - Amir Raz
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Institute for Interdisciplinary Behavioral and Brain Sciences, Chapman University, Irvine, CA, United States
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22
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Patient-Reported Expectations, Outcome and Satisfaction in Thoracic and Lumbar Spine Stabilization Surgery: A Prospective Study. SURGERIES 2020. [DOI: 10.3390/surgeries1020008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Patient-reported outcome measures (PROMs) have become an important aspect of quality control in modern healthcare. In this prospective observational study on 199 patients undergoing thoracolumbar stabilization surgery, we quantified preoperative expectations and PROMs at six and twelve months after surgery, and we investigated what constitutes patient satisfaction with the outcome. We used the visual analogue scale (VAS) for pain and the Oswestry Disability Index (ODI). Preoperative expectations were high (expected ODI: 9 ± 13%; leg pain: 1.0 ± 1.4; back pain: 1.3 ± 1.5). Pain and disability improved substantially, but expectations were mostly unrealistic (ODI expectation fulfilled after six months: 28% of patients; back pain: 48%). However, satisfaction was high (70% at six months after surgery). Satisfied patients had significantly better pain and disability outcomes and higher rates of expectation fulfillment than non-satisfied patients. Patients undergoing revision stabilization had worse outcomes than all other diagnosis groups. Prior stabilization surgery was identified as an independent risk factor for dissatisfaction. There were no preoperative pain or disability levels that predicted dissatisfaction. The data presented in this study can provide benchmarks for diagnosis-specific PROM targets in thoracolumbar stabilization surgery. Future studies should investigate whether satisfaction can be influenced, e.g., by discussing realistic outcome targets with patients ahead of surgery.
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23
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Díaz-Gutiérrez P, Arco JE, Alguacil S, González-García C, Ruz M. Neural representations of social valence bias economic interpersonal choices. Neuropsychologia 2020; 147:107584. [PMID: 32783954 DOI: 10.1016/j.neuropsychologia.2020.107584] [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: 02/10/2020] [Revised: 06/30/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
Prior personal information is highly relevant during social interactions. Such knowledge aids in the prediction of others, and it affects choices even when it is unrelated to actual behaviour. In this investigation, we aimed to study the neural representation of positive and negative personal expectations, how these impact subsequent choices, and the effect of mismatches between expectations and encountered behaviour. We employed functional Magnetic Resonance Imaging in combination with a version of the Ultimatum Game (UG) where participants were provided with information about their partners' moral traits previous to receiving their fair or unfair offers. Univariate and multivariate analyses revealed the implication of the supplementary motor area (SMA) and inferior frontal gyrus (IFG) in the representation of expectations about the partners in the game. Further, these regions also represented the valence of these expectations, together with the ventromedial prefrontal cortex (vmPFC). Importantly, the performance of multivariate classifiers in these clusters correlated with a behavioural choice bias to accept more offers following positive descriptions, highlighting the impact of the valence of the expectations on participants' economic decisions. Altogether, our results suggest that expectations based on social information guide future interpersonal decisions and that the neural representation of such expectations in the vmPFC is related to their influence on behaviour.
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Affiliation(s)
| | - Juan E Arco
- Mind, Brain and Behavior Research Center, University of Granada, Spain
| | | | | | - María Ruz
- Mind, Brain and Behavior Research Center, University of Granada, Spain
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24
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Leptourgos P, Corlett PR. Embodied Predictions, Agency, and Psychosis. Front Big Data 2020; 3:27. [PMID: 33693400 PMCID: PMC7931869 DOI: 10.3389/fdata.2020.00027] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/14/2020] [Indexed: 01/11/2023] Open
Abstract
Psychotic symptoms, i.e., hallucinations and delusions, involve gross departures from conscious apprehension of consensual reality; respectively, perceiving and believing things that, according to same culture peers, do not obtain. In schizophrenia, those experiences are often related to abnormal sense of control over one's own actions, often expressed as a distorted sense of agency (i.e., passivity symptoms). Cognitive and computational neuroscience have furnished an account of these experiences and beliefs in terms of the brain's generative model of the world, which underwrites inferences to the best explanation of current and future states, in order to behave adaptively. Inference then involves a reliability-based trade off of predictions and prediction errors, and psychotic symptoms may arise as departures from this inference process, either an over- or under-weighting of priors relative to prediction errors. Surprisingly, there is empirical evidence in favor of both positions. Relatedly, there is evidence for both an enhanced and a diminished sense of agency in schizophrenia. How can this be? We argue that there is more than one generative model in the brain, and that ego- and allo-centric models operate in tandem. In brief, ego-centric models implement corollary discharge signals that cancel out the effects of self-generated actions while allo-centric models compare several hypothesis regarding the causes of sensory inputs (including the self among the potential causes). The two parallel hierarchies give rise to different levels of agency, with ego-centric models subserving "feelings of agency" and allo-centric predictions giving rise to "judgements of agency." Those two components are weighted according to their reliability and combined, generating a higher-level "sense of agency." We suggest that in schizophrenia a failure of corollary discharges to suppress self-generated inputs results in the absence of a "feeling of agency" and in a compensatory enhancement of allo-centric priors, which might underlie hallucinations, delusions of control but also, under certain circumstances, the enhancement of "judgments of agency." We discuss the consequences of such a model, and potential courses of action that could lead to its falsification.
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Affiliation(s)
| | - Philip R. Corlett
- Department of Psychiatry, Connecticut Mental Health Center, Yale University, New Haven, CT, United States
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25
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Cognitive and Emotional Aspects of Cupping Therapy. Brain Sci 2020; 10:brainsci10030144. [PMID: 32143284 PMCID: PMC7139758 DOI: 10.3390/brainsci10030144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 11/17/2022] Open
Abstract
Cupping therapy has recently gained public attention and is widely used in many regions. Some patients are resistant to being treated with cupping therapy, as visually unpleasant marks on the skin may elicit negative reactions. This study aimed to identify the cognitive and emotional components of cupping therapy. Twenty-five healthy volunteers were presented with emotionally evocative visual stimuli representing fear, disgust, happiness, neutral emotion, and cupping, along with control images. Participants evaluated the valence and arousal level of each stimulus. Before the experiment, they completed the Fear of Pain Questionnaire-III. In two-dimensional affective space, emotional arousal increases as hedonic valence ratings become increasingly pleasant or unpleasant. Cupping therapy images were more unpleasant and more arousing than the control images. Cluster analysis showed that the response to cupping therapy images had emotional characteristics similar to those for fear images. Individuals with a greater fear of pain rated cupping therapy images as more unpleasant and more arousing. Psychophysical analysis showed that individuals experienced unpleasant and aroused emotional states in response to the cupping therapy images. Our findings suggest that cupping therapy might be associated with unpleasant-defensive motivation and motivational activation. Determining the emotional components of cupping therapy would help clinicians and researchers to understand the intrinsic effects of cupping therapy.
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26
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Scarna H. Genesis of the Heroin-Induced Addictive Process: Articulation Between Psychodynamic and Neurobiological Theories. Front Psychiatry 2020; 11:524764. [PMID: 33362589 PMCID: PMC7755881 DOI: 10.3389/fpsyt.2020.524764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 11/18/2020] [Indexed: 11/24/2022] Open
Abstract
Psychotherapeutic consultations of drug addict's patients in a Care, Support and Prevention Center in Addictology led us to propose several hypotheses on the genesis of addiction and its articulation with currently available neurobiological data. This care center dispenses both pharmacological maintenance medications for heroin dependence, such as methadone or buprenorphine, and psychological support. Our first hypothesis posits that the addictive process is driven by the narcissistic vulnerability of these patients, its neurobiological foundations being mainly mediated by the activation of endogenous opioid systems. Drug use/abuse could be a way to make arise the "True Self," therefore overcoming the defensive system's set up to protect oneself from early traumas. The neurobiological impact of traumas is also developed and articulated with psychodynamic concepts, particularly those of Winnicott. Additionally, functions of addiction such as defensive, anti-depressant roles and emotional regulation are discussed in relationship with their currently known neuroscientific bases. Although the experience in the psychodynamic clinic is at a level of complexity much higher than what is currently accessible to the neurosciences, most of the research in this domain stays in line with our psychological understanding of the addictive process. Finally, we outline some critically sensitive points regarding the therapeutic support.
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Affiliation(s)
- Hélène Scarna
- Centre de Recherche en Psychopathologie et Psychologie Clinique, Université Lumière Lyon 2, Bron, France.,Laboratoire de Psychologie EA 3188, Université de Bourgogne Franche-Comté, Besançon, France.,Univ Lyon, Université Claude Bernard Lyon 1, Inserm, Stem Cell and Brain Research Institute U1208, Bron, France.,Centre de Soin, d'Accompagnement et de Prévention en Addictologie, Hôpital de la Croix-Rousse, Lyon, France
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27
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Chentsova-Dutton Y, Maercker A. Cultural Scripts of Traumatic Stress: Outline, Illustrations, and Research Opportunities. Front Psychol 2019; 10:2528. [PMID: 31803094 PMCID: PMC6872530 DOI: 10.3389/fpsyg.2019.02528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/25/2019] [Indexed: 11/13/2022] Open
Abstract
As clinical-psychological scientists and practitioners increasingly work with diverse populations of traumatized people, it becomes increasingly important to attend to cultural models that influence the ways in which people understand and describe their responses to trauma. This paper focuses on potential uses of the concept of cultural script in this domain. Originally described by cognitive psychologists in the 1980s, scripts refer to specific behavioral and experiential sequences of elements such as thoughts, memories, attention patterns, bodily sensations, sleep abnormalities, emotions and affective expressions, motivation, coping attempts, and ritualized behaviors that are relevant to posttraumatic adjustment. We differentiate between experiences of traumatic stress that are scripted (e.g., cultural explanations are available) versus unscripted. Further characteristics such as script tracks, the effect of script interruptions, and contextual fit of scripts with other cultural models are also described. We consider examples of traumatic stress associated with war and organized, sexualized violence from "Western" and "non-Western" world regions. The concluding part of this review describes a number of possibilities for methodological approaches to assessment of cultural scripts. Capturing central elements of the script(s) of trauma would aid psychological researchers and clinicians in understanding the experiences of trauma in cultural context, which could ultimately lead to better clinical service opportunities worldwide.
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Affiliation(s)
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland.,Institute of Advanced Study Berlin, Berlin, Germany
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29
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Lee YS, Jung WM, Bingel U, Chae Y. The Context of Values in Pain Control: Understanding the Price Effect in Placebo Analgesia. THE JOURNAL OF PAIN 2019; 21:781-789. [PMID: 31733362 DOI: 10.1016/j.jpain.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/30/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Abstract
The experience of pain relief arises from physiological and psychological factors, and attributes such as the commercial features of analgesic treatments have been shown to influence placebo analgesia by affecting treatment expectations. Therefore, treatment valuation from price information should influence the placebo analgesic effect. This hypothesis was tested in a functional magnetic resonance imaging study in which healthy subjects were enrolled in a 2-day experiment. On day 1, the participants (n = 19) had treatment experiences with 2 different placebo creams during a conditioning session without receiving information on treatment price. On day 2, placebo analgesia was tested after providing price information (high vs low) while functional magnetic resonance imaging was performed. The results showed that the higher priced placebo treatment leads to enhanced pain relief. Placebo analgesia in response to the higher priced treatment was associated with activity in the ventral striatum, ventromedial prefrontal cortex, and ventral tegmental area. The behavioral results indicate that the experience of pain was influenced by treatment valuation from price. Our findings reveal that the context of values in pain control is associated with activity in expectation- and reward-related circuitry. PERSPECTIVE: Treatment with higher price was associated with enhanced placebo analgesia, and this effect was influenced by activities in expectation and reward processing brain areas. The context of value such as medical cost influences cognitive evaluation processes to modulate pain. Our study may help evaluate a patient's preference toward high-priced drugs.
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Affiliation(s)
- Ye-Seul Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, South Korea; Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University, Seongnam, South Korea
| | - Won-Mo Jung
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Ulrike Bingel
- Department of Neurology, Essen University Hospital, Essen, Germany
| | - Younbyoung Chae
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, South Korea; Department of Neurology, Essen University Hospital, Essen, Germany.
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30
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Abstract
Recently, a deep impact of psychosocial effects on the outcomes of neurofeedback training was suggested. Previous findings point out an association between locus of control in dealing with technology and the individual ability to up-regulate the sensorimotor rhythm (12–15 Hz) in the EEG. Since the antecedents of locus of control in dealing with technology differ between males and females, we have investigated the effect of sex of participant and experimenter on the outcomes of neurofeedback training. Mindfulness and SMR baseline power also were assessed as possible confounding variables. Undergraduate psychology students (n = 142) took part in a single session of neurofeedback training conducted by either male or female experimenters. Male participants as well as those female participants instructed by male experimenters were able to upregulate SMR, while female participants trained by female experimenters were not. A strong positive correlation between training outcomes and locus of control in dealing with technology was observed only in the female participants trained by female experimenters. These results are suggestive about the impact of psychosocial factors—particularly gender-related effects—on neurofeedback training outcomes and the urgent need to document it in neurofeedback studies.
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Affiliation(s)
- Guilherme Wood
- Institute of Psychology, Karl-Franzens-University of Graz, Universitaetsplatz 2, 8010, Graz, Austria. .,BioTechMed, Graz, Austria.
| | - Silvia Erika Kober
- Institute of Psychology, Karl-Franzens-University of Graz, Universitaetsplatz 2, 8010, Graz, Austria.,BioTechMed, Graz, Austria
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31
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The Neuroscience of Pain: Biobehavioral, Developmental, and Psychosocial Mechanisms Relevant to Intervention Targets. Psychosom Med 2019; 80:788-790. [PMID: 30395102 DOI: 10.1097/psy.0000000000000642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic pain is a major problem in clinical medicine and public health, affecting approximately one in five adults, and is associated with significant societal and familial burden. Early-life adversities, psychological, and biobehavioral factors are associated with an elevated risk of the subsequent development of chronic pain. In this special issue of Psychosomatic Medicine, articles address the neuroscientific, psychological, and biobehavioral processes involved in acute and chronic pain. We focus on the following themes that emerged in this special issue: (a) risk factors and early adversity as related to chronic pain; (b) the role of expectations in shaping pain perception; and (c) mechanisms of interventions targeting pain modulation. This article concludes by outlining important new targets for research, including the neurobiology of pain, important methodological challenges, and targets for personalized pain interventions.
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Yin XS, Yang JY, Cao S, Wang Y. Failure of Placebo Analgesia Model in Rats with Inflammatory Pain. Neurosci Bull 2019; 36:121-133. [PMID: 31435837 DOI: 10.1007/s12264-019-00420-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 05/21/2019] [Indexed: 12/15/2022] Open
Abstract
With the shifting role of placebos, there is a need to develop animal models of placebo analgesia and elucidate the mechanisms underlying the effect. In the present study, male Sprague-Dawley rats with chronic inflammatory pain caused by complete Freund's adjuvant (CFA) underwent a series of conditioning procedures, in which morphine was associated with different cues, but they failed to induce placebo analgesia. Then, conditioning with the conditioned place preference apparatus successfully induced analgesic expectancy and placebo analgesia in naïve rats but only induced analgesic expectancy and no analgesic effect in CFA rats. Subsequently, we found enhanced c-fos expression in the nucleus accumbens and reduced expression in the anterior cingulate cortex in naïve rats while c-fos expression in the anterior cingulate cortex in CFA rats was not altered. In summary, the behavioral conditioning model demonstrated the difficulty of establishing a placebo analgesia model in rats with a pathological condition.
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Affiliation(s)
- Xiang-Sha Yin
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Key Laboratory for Neuroscience, Ministry of Education of China, and National Health Commission, State key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100083, China
| | - Jin-Yu Yang
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Key Laboratory for Neuroscience, Ministry of Education of China, and National Health Commission, State key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100083, China
| | - Shuai Cao
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Key Laboratory for Neuroscience, Ministry of Education of China, and National Health Commission, State key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100083, China
| | - Yun Wang
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Key Laboratory for Neuroscience, Ministry of Education of China, and National Health Commission, State key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100083, China.
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100871, China.
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Using Different Expectation Mechanisms to Optimize Treatment of Patients With Medical Conditions: A Systematic Review. Psychosom Med 2019; 80:535-543. [PMID: 29697530 DOI: 10.1097/psy.0000000000000596] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Patients' expectations have been shown to predict the course and treatment success of a variety of medical conditions. Therefore, expectation-focused psychological interventions (EFPIs) have been developed to use these expectation effects clinically. Importantly, EFPI differ with regard to the particular expectation mechanism being addressed, i.e., expectation optimization or expectation violation. The aims of this systematic review were to give an overview of the application of these expectation interventions and to evaluate their effectiveness. METHODS Several databases were searched to identify clinical trials or experimental studies that conducted EFPI among participants with various medical conditions. Risk of bias was evaluated using the Cochrane Risk of Bias tool. RESULTS Eleven studies (N = 944) investigating different medical conditions (coronary heart disease, cancer, chronic pain) were included. Qualitative synthesis revealed positive effects of EFPI on clinical outcome variables in all studies. Expectation optimization approaches yielded particularly promising results. Because of the large heterogeneity of outcome measures, quantitative synthesis was not possible. CONCLUSION This review highlights the potential of EFPI for optimizing treatment of patients with medical conditions. However, it seems that different expectation mechanisms might have different application possibilities. Therefore, we provide suggestions for further developing EFPI to tailor treatment and develop personalized psychological interventions. We argue that for this purpose, it is important to consider both disease-specific aspects and patients' personality traits. In addition, we discuss future challenges such as implementing EFPI into routine medical care.
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Schwarz KA, Sprenger C, Hidalgo P, Pfister R, Diekhof EK, Büchel C. How Stereotypes Affect Pain. Sci Rep 2019; 9:8626. [PMID: 31197222 PMCID: PMC6565709 DOI: 10.1038/s41598-019-45044-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 05/30/2019] [Indexed: 01/25/2023] Open
Abstract
Stereotypes are abundant in everyday life – and whereas their influence on cognitive and motor performance is well documented, a causal role in pain processing is still elusive. Nevertheless, previous studies have implicated gender-related stereotype effects in pain perception as potential mediators partly accounting for sex effects on pain. An influence of stereotypes on pain seems indeed likely as pain measures have proven especially susceptible to expectancy effects such as placebo effects. However, so far empirical approaches to stereotype effects on pain are correlational rather than experimental. In this study, we aimed at documenting gender-related stereotypes on pain perception and processing by actively manipulating the participants’ awareness of common stereotypical expectations. We discovered that gender-related stereotypes can significantly modulate pain perception which was mirrored by activity levels in pain-associated brain areas.
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Affiliation(s)
- Katharina A Schwarz
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Institute of Psychology, University of Würzburg, Würzburg, Germany.
| | - Christian Sprenger
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pablo Hidalgo
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Pfister
- Institute of Psychology, University of Würzburg, Würzburg, Germany
| | - Esther K Diekhof
- Institute of Human Biology, University of Hamburg, Hamburg, Germany
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Jacobs W, Schagen SB, Thijssen M, Das E. Preventing adverse information effects on health outcomes: A self-affirmation intervention reduced information-induced cognitive decline in gastrointestinal cancer patients. Soc Sci Med 2019; 226:47-55. [PMID: 30844672 DOI: 10.1016/j.socscimed.2019.02.013] [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: 05/19/2018] [Revised: 02/03/2019] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
RATIONALE Nocebo studies show that informing patients about treatment side effects can adversely impact expectancies and symptom reporting. OBJECTIVE The current study examined how to inform patients fully about treatment side effects without increasing their occurrence. Extending theoretical assumptions about self-affirmation from the social-psychological to the medical domain, we tested whether allowing cancer patients to self-affirm prior to informing them about potential cognitive decline reduced the occurrence of Adverse Information Effects (AIE) on cognitive problem reporting (CPR) and verbal memory performance. METHOD Participants were 90 Dutch and Belgian gastrointestinal cancer patients with and without chemotherapy experience. Patients were randomized across three experimental conditions (information about chemotherapy-related cognitive problems with or without self-affirmation; no-information control) before completing an online questionnaire. Data were collected from May until August 2015. Main dependent variables were CPR and verbal memory performance. Stigma consciousness was included as a moderator. RESULTS Informing patients about chemotherapy-related cognitive problems increased CPR and decreased scores on two out of three memory measures. Self-affirmation reduced these AIE. Stigma conscious patients reported more problems in the information than the self-affirmation group. CONCLUSIONS Nocebo effects may be reduced by allowing patients the opportunity to restore their self-integrity at the implicit level. Self-affirmation has the potential to reduce AIE in patient populations without withholding relevant information about potential treatment side effects.
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Affiliation(s)
- Wendy Jacobs
- Radboud University Nijmegen, Centre for Language Studies, Erasmusplein 1, 6525 HT, Nijmegen, the Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; University of Amsterdam, Faculty of Social and Behavioural Sciences, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, the Netherlands.
| | - Mart Thijssen
- Radboud University Nijmegen, Centre for Language Studies, Erasmusplein 1, 6525 HT, Nijmegen, the Netherlands.
| | - Enny Das
- Radboud University Nijmegen, Centre for Language Studies, Erasmusplein 1, 6525 HT, Nijmegen, the Netherlands.
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Rabipour S, Vidjen PS, Remaud A, Davidson PSR, Tremblay F. Examining the Interactions Between Expectations and tDCS Effects on Motor and Cognitive Performance. Front Neurosci 2019; 12:999. [PMID: 30666182 PMCID: PMC6330301 DOI: 10.3389/fnins.2018.00999] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/11/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Despite a growing literature and commercial market, the effectiveness of transcranial direct current stimulation (tDCS) remains questionable. Notably, studies rarely examine factors such as expectations of outcomes, which may influence tDCS response through placebo-like effects. Here we sought to determine whether expectations could influence the behavioral outcomes of a tDCS intervention. Methods: Through an initial study and self-replication, we recruited 121 naïve young adults 18-34 years of age (M = 21.14, SD = 3.58; 88 women). We evaluated expectations of tDCS and of motor and cognitive performance at three times: (i) at baseline; (ii) after being primed to have High or Low expectations of outcomes; and (iii) after a single session of sham-controlled anodal tDCS over the left or right motor cortex. Before and after stimulation, participants performed the Grooved Pegboard Test and a choice reaction time task as measures of motor dexterity, response time, and response inhibition. Results: Repeated measures ANOVA revealed that participants had varying, largely uncertain, expectations regarding tDCS effectiveness at baseline. Expectation ratings significantly increased or decreased in response to High or Low priming, respectively, and decreased following the intervention. Response times and accuracy on motor and cognitive measures were largely unaffected by expectation or stimulation conditions. Overall, our analysis revealed no effect attributable to baseline expectations, belief of group assignment, or experimental condition on behavioral outcomes. Subjective experience did not differ based on expectation or stimulation condition. Conclusions: Our results suggest no clear effects of tDCS or of expectations on our performance measures, highlighting the need for further investigations of such stimulation methods.
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Affiliation(s)
- Sheida Rabipour
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | | | - Anthony Remaud
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa, ON, Canada
| | - Patrick S. R. Davidson
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa, ON, Canada
| | - François Tremblay
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa, ON, Canada
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Petrie KJ, Rief W. Psychobiological Mechanisms of Placebo and Nocebo Effects: Pathways to Improve Treatments and Reduce Side Effects. Annu Rev Psychol 2019; 70:599-625. [PMID: 30110575 DOI: 10.1146/annurev-psych-010418-102907] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Placebo effects constitute a major part of treatment success in medical interventions. The nocebo effect also has a major impact, as it accounts for a significant proportion of the reported side effects for many treatments. Historically, clinical trials have aimed to reduce placebo effects; however, currently, there is interest in optimizing placebo effects to improve existing treatments and in examining ways to minimize nocebo effects to improve clinical outcome. To achieve these aims, a better understanding of the psychological and neurobiological mechanisms of the placebo and nocebo response is required. This review discusses the impact of the placebo and nocebo response in health care. We also examine the mechanisms involved in the placebo and nocebo effects, including the central mechanism of expectations. Finally, we examine ways to enhance placebo effects and reduce the impact of the nocebo response in clinical practice and suggest areas for future research.
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Affiliation(s)
- Keith J Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand;
| | - Winfried Rief
- Division of Clinical Psychology, University of Marburg, 35032 Marburg, Germany;
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Belcher AM, Ferré S, Martinez PE, Colloca L. Role of placebo effects in pain and neuropsychiatric disorders. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:298-306. [PMID: 28595945 PMCID: PMC5722709 DOI: 10.1016/j.pnpbp.2017.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/01/2017] [Accepted: 06/03/2017] [Indexed: 02/06/2023]
Abstract
The placebo (and the nocebo) effect is a powerful determinant of health outcomes in clinical disease treatment and management. Efforts to completely eradicate placebo effects have shifted dynamically, as increasingly more researchers are tuned to the potentially beneficial effects of incorporating those uncontrollable placebo effects into clinical therapeutic strategies. In this review, we highlight the major findings from placebo research, elucidating the main neurobiological systems and candidate determinants of the placebo phenomenon, and illustrate a perspective that can effectively frame future research on the topic. Finally, we issue a call for increased research on the efficacy of therapeutic strategies that incorporate placebo "tools," and argue that clinical trials of the placebo response in neuropsychiatric diseases and disorders has important and far-reaching translational and clinical relevance.
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Affiliation(s)
- Annabelle M Belcher
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, USA
| | - Sergi Ferré
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, USA
| | - Pedro E Martinez
- National Institute of Mental Health, National Institutes of Health, Bethesda, USA
| | - Luana Colloca
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, USA; Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA; Department of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, USA; Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA.
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Turi Z, Bjørkedal E, Gunkel L, Antal A, Paulus W, Mittner M. Evidence for Cognitive Placebo and Nocebo Effects in Healthy Individuals. Sci Rep 2018; 8:17443. [PMID: 30487547 PMCID: PMC6261963 DOI: 10.1038/s41598-018-35124-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 10/31/2018] [Indexed: 12/19/2022] Open
Abstract
Inactive interventions can have significant effects on cognitive performance. Understanding the generation of these cognitive placebo/nocebo effects is crucial for evaluating the cognitive impacts of interventional methods, such as non-invasive brain stimulation (NIBS). We report both cognitive placebo and nocebo effects on reward-based learning performance induced using an active sham NIBS protocol, verbal suggestions and conditioning in 80 healthy participants. Whereas our placebo manipulation increased both expected and perceived cognitive performance, nocebo had a detrimental effect on both. Model-based analysis suggests manipulation-specific strategic adjustments in learning-rates: Participants in the placebo group showed stronger learning from losses and reduced behavioral noise, participants in the nocebo group showed stronger learning from gains and increased behavioral noise. We conclude that experimentally induced expectancy can impact cognitive functions of healthy adult participants. This has important implications for the use of double-blind study designs that can effectively maintain blinding in NIBS studies.
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Affiliation(s)
- Zsolt Turi
- Department of Clinical Neurophysiology, University Medical Center Goettingen, Goettingen, Germany
| | - Espen Bjørkedal
- Institute for Psychology, University of Tromsø, Tromsø, Norway
| | - Luisa Gunkel
- Department of Clinical Neurophysiology, University Medical Center Goettingen, Goettingen, Germany
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center Goettingen, Goettingen, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center Goettingen, Goettingen, Germany
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Rabipour S, Wu AD, Davidson PS, Iacoboni M. Expectations may influence the effects of transcranial direct current stimulation. Neuropsychologia 2018; 119:524-534. [DOI: 10.1016/j.neuropsychologia.2018.09.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 09/14/2018] [Accepted: 09/14/2018] [Indexed: 01/05/2023]
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Hein G, Engelmann JB, Tobler PN. Pain relief provided by an outgroup member enhances analgesia. Proc Biol Sci 2018; 285:rspb.2018.0501. [PMID: 30257910 DOI: 10.1098/rspb.2018.0501] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 09/03/2018] [Indexed: 12/15/2022] Open
Abstract
Pain feels different in different social contexts, yet the mechanisms behind social pain modulation remain poorly understood. To elucidate the impact of social context on pain processing, we investigated how group membership, one of the most important social context factors, shapes pain relief behaviourally and neurally in humans undergoing functional neuroimaging. Participants repeatedly received pain relief from a member of their own group (ingroup treatment) or a member of a disliked outgroup (outgroup treatment). We observed a decrease in pain ratings and anterior insula (AI) pain responses after outgroup treatment, but not after ingroup treatment. Moreover, path analyses revealed that the outgroup treatment induced a stronger relief learning in the AI, which in turn altered pain processing, in particular if the participant entered the treatment with a negative impression toward the outgroup individual. The finding of enhanced analgesia after outgroup treatment is relevant for intergroup clinical settings. More generally, we found that group membership affects pain responses through neural learning and we thus elucidate one possible mechanism through which social context impacts pain processing.
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Affiliation(s)
- Grit Hein
- Department of Psychiatry, Psychosomatic and Psychotherapy, Translational Social Neuroscience Unit, University of Wurzburg, Wurzburg 97080, Germany
| | - Jan B Engelmann
- Center for Research in Experimental Economics and Political Decision Making (CREED), Amsterdam School of Economics, and Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam 1001, The Netherlands
| | - Philippe N Tobler
- Department of Economics, Laboratory for Social and Neural Systems Research, University of Zurich, Zurich 8006, Switzerland
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Damien J, Colloca L, Bellei-Rodriguez CÉ, Marchand S. Pain Modulation: From Conditioned Pain Modulation to Placebo and Nocebo Effects in Experimental and Clinical Pain. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 139:255-296. [PMID: 30146050 DOI: 10.1016/bs.irn.2018.07.024] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Accumulating evidence reveal important applications of endogenous pain modulation assessment in healthy controls and in patients in clinical settings, as dysregulations in the balance of pain modulatory circuits may facilitate pain and promote chronification of pain. This article reviews data on pain modulation, focusing on the mechanisms and translational aspects of pain modulation from conditioned pain modulation (CPM) to placebo and nocebo effects in experimental and clinical pain. The specific roles of expectations, learning, neural and neurophysiological mechanisms of the central nervous system are briefly reviewed herein. The interaction between CPM and placebo systems in pain inhibitory pathways is highly relevant in the clinic and in randomized controlled trials yet remains to be clarified. Examples of clinical implications of CPM and its relationship to placebo and nocebo effects are provided. A greater understanding of the role of pain modulation in various pain states can help characterize the manifestation and development of chronic pain and assist in predicting the response to pain-relieving treatments. Placebo and nocebo effects, intrinsic to every treatment, can be used to develop personalized therapeutic approaches that improve clinical outcomes while limiting unwanted effects.
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Affiliation(s)
- Janie Damien
- Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), Department of Surgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Luana Colloca
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, United States; Departments of Psychiatry and Anesthesiology, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Carmen-Édith Bellei-Rodriguez
- Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), Department of Surgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Serge Marchand
- Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), Department of Surgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Fonds de Recherche du Québec-Santé (FRQS), Montréal, QC, Canada.
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Jung WM, Ryu Y, Park HJ, Lee H, Chae Y. Brain activation during the expectations of sensory experience for cutaneous electrical stimulation. NEUROIMAGE-CLINICAL 2018; 19:982-989. [PMID: 30003035 PMCID: PMC6039842 DOI: 10.1016/j.nicl.2018.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 06/03/2018] [Accepted: 06/17/2018] [Indexed: 12/30/2022]
Abstract
The brain actively interprets sensory inputs by integrating top-down and bottom-up information. Humans can make inferences on somatosensation based on prior experiences and expectations even without the actual stimulation. We used functional magnetic resonance imaging to investigate the neural substrates of the expectations of the sensory experience of cutaneous electrical stimulation on acupoint without actual stimuli. This study included 22 participants who wore sticker-type electrodes attached on three different acupoints on different body regions: CV17 (chest), CV23 (chin), and left PC6 (arm). Participants evaluated de qi sensations after they expected electrical stimulation on those points in random order without actual stimulation. All stimuli were presented with corresponding visual information of the stimulation sites. The control condition included the same visual information but outside the body. The expectations of cutaneous electrical stimuli without actual stimulation on three acupoints resulted in greater de qi sensation compared to the control condition. Cognitive components of cutaneous electrical stimulation exhibited greater brain activation in the anterior insula, pre-supplementary motor area, and secondary somatosensory area. The expectations of acupuncture stimulation exhibited a distinct experience of somatosensation as well as brain activations in insula and pre-supplementary motor area. Our findings suggest that the sensory experience of the pseudo-cutaneous stimulation may be derived from the predictive role of the salience network in monitoring internal and external body states. The pseudo-cutaneous stimulation can elicit remarkable somatic sensations. Insula and pre-SMA are involved in the expectations of sensory experience. Somatic sensation from pseudo-stimulation is influenced by top-down information.
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Affiliation(s)
- Won-Mo Jung
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yeonhee Ryu
- KM Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Hi-Joon Park
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyejung Lee
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Younbyoung Chae
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Abstract
AbstractIndividual-specific predispositions may precede the cultural evolution of shamanism and may be linked to it via principles of predictive coding. We have used these principles to identify commonalities between clinical and shaman-like non-clinical voice-hearers. The author may find this approach helpful in relating the experiences of shamans to those of their clients.
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Bissell DA, Ziadni MS, Sturgeon JA. Perceived injustice in chronic pain: an examination through the lens of predictive processing. Pain Manag 2018; 8:129-138. [PMID: 29451429 DOI: 10.2217/pmt-2017-0051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic pain conditions have been shown to be exacerbated by psychological factors, and a better understanding of these factors can inform clinical practice and improve the efficacy of interventions. The current paper investigates perceived injustice, a novel psychosocial construct, within a framework influenced by the tenets of predictive processing. The proposed conceptual model derived from tenets of predictive processing yields a single hierarchical self-reconfiguring system driven by prediction, which accounts for a wide range of human experiences such as perception, behavior, learning and emotion. This conceptualization can inform the development and implementation of more targeted therapeutic interventions for chronic pain.
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Affiliation(s)
- Daniel A Bissell
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Maisa S Ziadni
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - John A Sturgeon
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA 98105, USA
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Peiris N, Blasini M, Wright T, Colloca L. The Placebo Phenomenon: A Narrow Focus on Psychological Models. PERSPECTIVES IN BIOLOGY AND MEDICINE 2018; 61:388-400. [PMID: 30293977 PMCID: PMC6195310 DOI: 10.1353/pbm.2018.0051] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The placebo effect is a complex phenomenon that can be described from neurobiological, psychosocial, and epistemological perspectives. Different leaders in the field have proposed multiple theories and models that attempt to describe both the nature and the mechanisms of action underlying placebo effects. This article focuses on the most relevant psychological models that have been suggested for characterizing the different mechanisms underlying the placebo effect. We outline how the dynamic psychoneurobiological aspects of the placebo phenomenon can be a potential reliable and useful tool in daily clinical practice for illness and symptom management within a wide variety of specialties and health-care practices.
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Affiliation(s)
- Nathalie Peiris
- Department of Anesthesiology School of Medicine, University
of Maryland, Baltimore
| | - Maxie Blasini
- Department of Pain Translational Symptom Science,
School of Nursing, University of Maryland, Baltimore
| | - Thelma Wright
- Department of Anesthesiology School of Medicine, University
of Maryland, Baltimore
| | - Luana Colloca
- Departments of Anesthesiology and Psychiatry, School
of Medicine; Department of Pain Translational Symptom Science, School of Nursing;
and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore
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Prochazkova L, Lippelt DP, Colzato LS, Kuchar M, Sjoerds Z, Hommel B. Exploring the effect of microdosing psychedelics on creativity in an open-label natural setting. Psychopharmacology (Berl) 2018; 235:3401-3413. [PMID: 30357434 PMCID: PMC6267140 DOI: 10.1007/s00213-018-5049-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 09/20/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Taking microdoses (a mere fraction of normal doses) of psychedelic substances, such as truffles, recently gained popularity, as it allegedly has multiple beneficial effects including creativity and problem-solving performance, potentially through targeting serotonergic 5-HT2A receptors and promoting cognitive flexibility, crucial to creative thinking. Nevertheless, enhancing effects of microdosing remain anecdotal, and in the absence of quantitative research on microdosing psychedelics, it is impossible to draw definitive conclusions on that matter. Here, our main aim was to quantitatively explore the cognitive-enhancing potential of microdosing psychedelics in healthy adults. METHODS During a microdosing event organized by the Dutch Psychedelic Society, we examined the effects of psychedelic truffles (which were later analyzed to quantify active psychedelic alkaloids) on two creativity-related problem-solving tasks: the Picture Concept Task assessing convergent thinking and the Alternative Uses Task assessing divergent thinking. A short version of the Ravens Progressive Matrices task assessed potential changes in fluid intelligence. We tested once before taking a microdose and once while the effects were expected to be manifested. RESULTS We found that both convergent and divergent thinking performance was improved after a non-blinded microdose, whereas fluid intelligence was unaffected. CONCLUSION While this study provides quantitative support for the cognitive-enhancing properties of microdosing psychedelics, future research has to confirm these preliminary findings in more rigorous placebo-controlled study designs. Based on these preliminary results, we speculate that psychedelics might affect cognitive metacontrol policies by optimizing the balance between cognitive persistence and flexibility. We hope this study will motivate future microdosing studies with more controlled designs to test this hypothesis.
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Affiliation(s)
- Luisa Prochazkova
- Cognitive Psychology Unit & Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands.
| | - Dominique P. Lippelt
- Cognitive Psychology Unit & Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Lorenza S. Colzato
- Cognitive Psychology Unit & Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands ,Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany ,Institute for Sports and Sport Science, University of Kassel, Kassel, Germany
| | - Martin Kuchar
- Forensic Laboratory of Biologically Active Substances, Department of Chemistry of Natural Compounds, University of Chemistry and Technology Prague, Prague, Czech Republic ,Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic
| | - Zsuzsika Sjoerds
- Cognitive Psychology Unit & Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Bernhard Hommel
- Cognitive Psychology Unit & Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
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48
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Oberste M, Hartig P, Bloch W, Elsner B, Predel HG, Ernst B, Zimmer P. Control Group Paradigms in Studies Investigating Acute Effects of Exercise on Cognitive Performance-An Experiment on Expectation-Driven Placebo Effects. Front Hum Neurosci 2017; 11:600. [PMID: 29276483 PMCID: PMC5727042 DOI: 10.3389/fnhum.2017.00600] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/27/2017] [Indexed: 12/29/2022] Open
Abstract
Introduction: Many studies report improvements in cognitive performance following acute endurance exercise compared to control group treatment. These cognitive benefits are interpreted as a result of a physiological response to exercise. However, it was also hypothesized that expectation-driven placebo effects account for these positive effects. The purpose of this study was to investigate the differences between expectations for cognitive benefits toward acute endurance exercise and multiple control group treatments. Methods: Healthy individuals (N = 247, 24.26 ± 3.88 years) were randomized to eight different groups watching videos of a moderate, a vigorous exercise treatment or one control group treatment (waiting, reading, video-watching, stretching, myofascial release workout, and very light exercise). Then, they were introduced to three commonly used cognitive test procedures in acute exercise-cognition research (Stroop-test, Trail-Making-test, Free-recall-task). Participants rated the effect they would expect on their performance in those tasks, if they had received the treatment shortly before the task, on an 11-point Likert scale. Results: No significantly different expectations for cognitive benefits toward acute moderate exercise and control group treatments could be revealed. Participants expected significantly worse performance following vigorous exercise compared to following waiting and stretching for all cognitive tests. Significantly worse performance after vigorous exercise compared to after very light exercise was expected for Stroop and Free-recall. For Free-recall, participants expected worse performance after vigorous exercise compared to myofascial release training as well. Conclusion: Our results indicate that expectation-driven placebo effects are unlikely to cause the reported greater cognitive improvements following acute moderate and vigorous endurance exercise compared to following common control group treatments.
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Affiliation(s)
- Max Oberste
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Philipp Hartig
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Benjamin Elsner
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Hans-Georg Predel
- Department of Circulation Research and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Bernhard Ernst
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Philipp Zimmer
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany.,National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany
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49
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Rabipour S, Andringa R, Boot WR, Davidson PSR. What Do People Expect of Cognitive Enhancement? JOURNAL OF COGNITIVE ENHANCEMENT 2017; 2:70-77. [DOI: 10.1007/s41465-017-0050-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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50
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Falling upward with Parkinson's disease. NPJ PARKINSONS DISEASE 2017; 3:29. [PMID: 28920076 PMCID: PMC5597627 DOI: 10.1038/s41531-017-0031-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 11/18/2022]
Abstract
Falls can injure, even kill. No one with Parkinson’s disease (PD) wants to fall by accident. However, the potential nastiness of falls does not preclude a more nuanced understanding of the personal meaning that falls can have. Rather than view falls as a problem to fear and manage solely by preventing and repairing harm, people with PD and those who care for them may recast falls as a mixed blessing. Falls may be a resource, skill, and catalyst for personal growth. We discuss how falls may give rise to opportunities in interrelated domains: capabilities, credo, character, creativity, chronemics, and connectedness. Clinicians could incorporate a positive focus across these domains to help people with PD to ‘fall upward’ in the sense of flourish.
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