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Cummins J, Faasse K, Helfer SG, Geers AL. The development of an implicit measure of treatment expectations. THE JOURNAL OF SOCIAL PSYCHOLOGY 2024:1-17. [PMID: 39172046 DOI: 10.1080/00224545.2024.2376538] [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: 01/30/2024] [Accepted: 06/23/2024] [Indexed: 08/23/2024]
Abstract
In three preregistered studies, we investigated whether implicit treatment expectations, using a relational implicit measure (the MT-PEP), vary between participants provided opposing information about novel medical treatments (Studies 1 and 2) or who responded based on normative beliefs toward common over-the-counter drugs (Study 3). The studies revealed large Cohen's d effect sizes of both novel and well-known treatment information within the implicit measure. The studies also provide evidence of convergent validity, with MT-PEP scores associated with explicit beliefs about medicine and over-the-counter drug familiarity. Implicit treatment expectations can be assessed and offer a novel tool for the intersection of social psychology and medicine.
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2
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Friehs T, Milde C, Glombiewski JA, Kube T. Change in pain expectations but no open-label placebo analgesia: An experimental study using the heat pain paradigm. Eur J Pain 2024; 28:769-785. [PMID: 38108636 DOI: 10.1002/ejp.2216] [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: 05/10/2023] [Revised: 09/24/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Open-label placebos (OLP) prescribed without deception and with a convincing rationale have been shown to evoke powerful treatment effects. Patients' treatment expectations seem to influence the magnitude of the effect. OBJECTIVE We examined if two different OLP rationales increased pain tolerance and reduced pain intensity and unpleasantness in a standardized heat pain experiment. METHODS Participants (N = 71) who self-reported reoccurring pain for at least the last 3 months were randomly assigned to one of three groups. We compared a personal-emotional and a scientific-matter-of-fact rationale with a control group (CG) that received the same placebo without any rationale. The rationale suggested a desensitizing effect on pain perception and improved pain coping of the placebo, whereas in the CG it was introduced as an ointment for measurement. The primary outcomes were pre-post changes in pain tolerance, expected and experienced pain intensity and unpleasantness. RESULTS Participants showed a decrease in expected pain intensity, but not expected pain unpleasantness for both rationales. There were no differences in pain tolerance and experienced pain intensity and unpleasantness. CONCLUSIONS Our study suggests that evoking positive treatment expectations is not sufficient to elicit an OLP response. Possibly, the magnitude of expectations change in this study was not powerful enough to evoke an OLP effect. Additionally, it is possible that OLP effects in pain are unrelated to positive treatment expectations. The failure of OLP in our study is in contrast to a number of previous studies examining the effects of OLP in experimental and clinical pain. SIGNIFICANCE This study provides evidence that positive treatment expectations are not sufficient to evoke an open-label placebo effect in a standardized heat pain experiment. We showed that two different rationales improved participants treatment expectations, but failed to evoke a placebo effect in comparison to a control group that received the same placebo, labelled as an ointment to improve measurement quality.
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Affiliation(s)
- Thilo Friehs
- Pain and Psychotherapy Research Lab, Department for Adult Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau (RPTU), Landau, Germany
| | - Christopher Milde
- Pain and Psychotherapy Research Lab, Department for Adult Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau (RPTU), Landau, Germany
| | - Julia Anna Glombiewski
- Pain and Psychotherapy Research Lab, Department for Adult Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau (RPTU), Landau, Germany
| | - Tobias Kube
- Pain and Psychotherapy Research Lab, Department for Adult Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau (RPTU), Landau, Germany
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3
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Friehs T, Kube T. Erwartungen als Kernmechanismus des Placeboeffekts: Implikationen für die psychotherapeutische Praxis. PSYCHOTHERAPEUT 2022. [DOI: 10.1007/s00278-022-00591-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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4
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Rosenkjær S, Lunde SJ, Kirsch I, Vase L. Expectations: How and when do they contribute to placebo analgesia? Front Psychiatry 2022; 13:817179. [PMID: 36147975 PMCID: PMC9488555 DOI: 10.3389/fpsyt.2022.817179] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 08/16/2022] [Indexed: 11/20/2022] Open
Abstract
In placebo research, expectations are highlighted as one of the most influential subjective factors. While some studies have shown a relationship between expectations and pain relief, others have not. However, little is known about how methods of assessment of expectations may affect these conclusions. One of the fundamental considerations is that participants in placebo trials rate their expectations when prompted to rate them on scales in advance, but are less likely to report their prior expectations, when asked to report their experience retroactively in an unprompted manner, often expressing, for example, prior hope or wishes of recovery. This article presents previously unpublished data to elucidate and explore the concepts highlighted by individuals in a placebo analgesia trial when assessed in a prompted and unprompted manner. The data corroborates the role of expectations involved in placebo effects, particularly in placebo analgesia. Thus, the question may be a matter of how and when expectations contribute to placebo effects, rather than if.
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Affiliation(s)
- Sophie Rosenkjær
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Sigrid Juhl Lunde
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Irving Kirsch
- Program in Placebo Studies, Beth Israel Deaconess Medical Center Harvard Medical School, Boston, MA, United States
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
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5
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Meeuwis SH, van Middendorp H, Veldhuijzen DS, Evers AWM. Associations Between Interindividual Differences, Expectations and Placebo and Nocebo Effects in Itch. Front Psychol 2021; 12:781521. [PMID: 34966334 PMCID: PMC8711701 DOI: 10.3389/fpsyg.2021.781521] [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: 09/22/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Placebo and nocebo effects are positive and negative health outcomes that can be elicited by the psychosocial context. They can be mediated by expectations, and may emerge in somatic symptoms even when people are aware of these effects. Interindividual differences (e.g., in personality, affective states) could impact placebo and nocebo responding, but findings are inconsistent. Methods: The current work examined expectation as a mediator of the association between verbal placebo and nocebo suggestions (VSs) and histamine-induced itch across three experimental studies. Moreover, we examined whether interindividual differences (e.g., in optimism, neuroticism, behavioral activation system (BAS), body ignorance) modulated: (1) the direct association between VSs and itch (direct moderation), and (2) the indirect, expectation-mediated association between VSs and itch (moderated mediation). Positive VSs were compared to neutral instructions (Study 1; n = 92) or negative VSs (Studies 2+3; n = 203) in an open-label (i.e., explaining placebo and nocebo effects) or closed-label (concealed) context using PROCESS. First, mediation of VSs effects on itch by expectations was tested. Next, moderation by individual traits was explored using conditional process analyses. Results: The effects of VSs on itch were significantly mediated by expectation in Study 1 and in the open-label (but not closed-label) contexts of Studies 2 and 3. Ignorance of bodily signals marginally moderated the direct effects of VSs on itch when closed-label suggestions were given: at low levels of body ignorance, effects of positive and negative VSs were stronger. Moreover, moderated mediation was observed in the open-label groups of Studies 2 and 3: The expectation-mediated effects of VSs on itch were stronger when BAS drive was lower. Conclusion: Overall, the effects of VSs on itch were mediated by expectations in the open-label, but not the closed-label context. Moreover, the current work suggests that placebo and nocebo effects may be moderated by ignorance of bodily signals and the BAS. There was limited evidence that other interindividual differences modulated placebo and nocebo responding in itch.
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Affiliation(s)
- Stefanie H Meeuwis
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland.,Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, Netherlands
| | - Dieuwke S Veldhuijzen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands.,Medical Delta Healthy Society, Leiden University, Technical University Delft, Erasmus University Rotterdam, Rotterdam, Netherlands
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6
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Arandia IR, Di Paolo EA. Placebo From an Enactive Perspective. Front Psychol 2021; 12:660118. [PMID: 34149551 PMCID: PMC8206487 DOI: 10.3389/fpsyg.2021.660118] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/28/2021] [Indexed: 12/12/2022] Open
Abstract
Due to their complexity and variability, placebo effects remain controversial. We suggest this is also due to a set of problematic assumptions (dualism, reductionism, individualism, passivity). We critically assess current explanations and empirical evidence and propose an alternative theoretical framework-the enactive approach to life and mind-based on recent developments in embodied cognitive science. We review core enactive concepts such as autonomy, agency, and sense-making. Following these ideas, we propose a move from binary distinctions (e.g., conscious vs. non-conscious) to the more workable categories of reflective and pre-reflective activity. We introduce an ontology of individuation, following the work of Gilbert Simondon, that allow us to see placebo interventions not as originating causal chains, but as modulators and triggers in the regulation of tensions between ongoing embodied and interpersonal processes. We describe these interrelated processes involving looping effects through three intertwined dimensions of embodiment: organic, sensorimotor, and intersubjective. Finally, we defend the need to investigate therapeutic interactions in terms of participatory sense-making, going beyond the identification of individual social traits (e.g., empathy, trust) that contribute to placebo effects. We discuss resonances and differences between the enactive proposal, popular explanations such as expectations and conditioning, and other approaches based on meaning responses and phenomenological/ecological ideas.
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Affiliation(s)
- Iñigo R. Arandia
- IAS-Research Center for Life, Mind and Society, University of the Basque Country, Leioa, Spain
- ISAAC Lab, Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
| | - Ezequiel A. Di Paolo
- IAS-Research Center for Life, Mind and Society, University of the Basque Country, Leioa, Spain
- Ikerbasque-Basque Foundation for Science, Bilbao, Spain
- Center for Computational Neuroscience and Robotics, University of Sussex, Brighton, United Kingdom
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7
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Association of nocebo hyperalgesia and basic somatosensory characteristics in a large cohort. Sci Rep 2021; 11:762. [PMID: 33436821 PMCID: PMC7804006 DOI: 10.1038/s41598-020-80386-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/18/2020] [Indexed: 02/06/2023] Open
Abstract
Medical outcomes are strongly affected by placebo and nocebo effects. Prediction of who responds to such expectation effects has proven to be challenging. Most recent approaches to prediction have focused on placebo effects in the context of previous treatment experiences and expectancies, or personality traits. However, a recent model has suggested that basic somatosensory characteristics play an important role in expectation responses. Consequently, this study investigated not only the role of psychological variables, but also of basic somatosensory characteristics. In this study, 624 participants underwent a placebo and nocebo heat pain paradigm. Additionally, individual psychological and somatosensory characteristics were assessed. While no associations were identified for placebo responses, nocebo responses were associated with personality traits (e.g. neuroticism) and somatosensory characteristics (e.g. thermal pain threshold). Importantly, the associations between somatosensory characteristics and nocebo responses were among the strongest. This study shows that apart from personality traits, basic somatosensory characteristics play an important role in individual nocebo responses, in agreement with the novel idea that nocebo responses result from the integration of top-down expectation and bottom-up sensory information.
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8
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Horing B, Beadle SC, Inks Z, Robb A, Muth ER, Babu SV. A virtual experimenter does not increase placebo hypoalgesia when delivering an interactive expectancy manipulation. Sci Rep 2020; 10:20353. [PMID: 33230290 PMCID: PMC7684301 DOI: 10.1038/s41598-020-77453-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/10/2020] [Indexed: 12/18/2022] Open
Abstract
Lack of standardization and unblinding threaten the research of mechanisms involved in expectancy effects on pain. We evaluated a computer-controlled virtual experimenter (VEx) to avoid these issues. Fifty-four subjects underwent a baseline-retest heat pain protocol. Between sessions, they received an expectancy manipulation (placebo or no-treatment) delivered by VEx or text-only control condition. The VEx provided standardized "social" interaction with the subjects. Pain ratings and psychological state/trait measures were recorded. We found an interaction of expectancy and delivery on pain improvement following the intervention. In the text conditions, placebo was followed by lower pain, whereas in the VEx conditions, placebo and no-treatment were followed by a comparable pain decrease. Secondary analyses indicated that this interaction was mirrored by decreases of negative mood and anxiety. Furthermore, changes in continuous pain were moderated by expectation of pain relief. However, retrospective pain ratings show an effect of expectancy but not of delivery. We conclude that we successfully applied an automated protocol for inducing expectancy effects on pain. The effect of the VEx regardless of treatment may be due to interactions of attention allocation and locus of control. This points to the diversity of expectancy mechanisms, and has implications for research and computer-based treatment applications.
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Affiliation(s)
- Bjoern Horing
- Affective Neuroscience Group, Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Sarah C Beadle
- Department of Psychology, Clemson University, Clemson, SC, USA
| | - Zachariah Inks
- Division of Human Centered Computing, School of Computing, Clemson University, Clemson, SC, USA
| | - Andrew Robb
- Division of Human Centered Computing, School of Computing, Clemson University, Clemson, SC, USA
| | - Eric R Muth
- Department of Psychology, Clemson University, Clemson, SC, USA
- Division of Research and Economic Development, North Carolina Agricultural and Technical State University, Greensboro, NC, USA
| | - Sabarish V Babu
- Division of Human Centered Computing, School of Computing, Clemson University, Clemson, SC, USA
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9
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Geers AL, Faasse K, Guevarra DA, Clemens KS, Helfer SG, Colagiuri B. Affect and emotions in placebo and nocebo effects: What do we know so far? SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2020. [DOI: 10.1111/spc3.12575] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Andrew L. Geers
- Department of Psychology University of Toledo Toledo Ohio USA
| | - Kate Faasse
- School of Psychology University of New South Wales Sydney New South Wales Australia
| | - Darwin A. Guevarra
- Department of Psychology Michigan State University East Lansing Michigan USA
| | | | | | - Ben Colagiuri
- School of Psychology University of Sydney Sydney New South Wales Australia
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10
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Briñol P, Petty RE. Changing prejudiced attitudes, promoting egalitarianism, and enhancing diversity through fundamental processes of persuasion. EUROPEAN REVIEW OF SOCIAL PSYCHOLOGY 2020. [DOI: 10.1080/10463283.2020.1798102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Pablo Briñol
- Facultad de Psicología, Universidad Autónoma de Madrid, Campus de Cantoblanco, Madrid, Spain
| | - Richard E. Petty
- Distinguished University Professor, Department of Psychology, The Ohio State University, Columbus, OH, USA
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11
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Hyland ME. A reformulated contextual model of psychotherapy for treating anxiety and depression. Clin Psychol Rev 2020; 80:101890. [PMID: 32682187 PMCID: PMC7352110 DOI: 10.1016/j.cpr.2020.101890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 11/18/2022]
Abstract
This paper describes a reformulated contextual model that uses cognitive theory (dual process theory), motivation theory (personality) and behavioral adaptation (self-correcting control systems) to show how anxiety and depression are caused, treated and prevented by an interaction between people and contexts. Depression and anxiety are the result of implicit beliefs (not cognitions) that all experience is unrewarding and threatening, these being components of the implicit belief that life is bad. Implicit beliefs are formed automatically from contextual cues and in healthy individuals are consistent with rational appraisal. They become more negative than reality through a process of adaptation when behaviors, directed by rational thinking, repeatedly create cues that signify lack of reward or threat. Such behaviors occur when social or other obligations lead people to choose behaviors that fail to satisfy their own unique goals in life and approach threatening situations, contrary to their automatic reactions. Therapeutic interventions and lifestyle change reverse these adaptive processes by positive experiences that create positive implicit beliefs, a change effected in different ways by contextual and specific mechanisms both of which correct the same fault of negative implicit beliefs. Effective therapeutic relationships and interventions are achieved by detecting and responding to a patient's unique needs and goals and their associated implicit beliefs. Mental health requires not only that people experience life as good as defined by their own goals and beliefs but also the avoidance of contexts where social and other pressures induce people to behave in ways inconsistent with their automatically generated feelings.
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Affiliation(s)
- Michael E Hyland
- Plymouth Marjon University, Derriford Road, Plymouth PL6 8BH, United Kingdom; University of Plymouth, Drakes Circus, Plymouth PL4 8AA, United Kingdom.
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12
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Abstract
Can people improve their lives by smiling more, trying to have a better posture, and by thinking about good memories? Can individuals become more successful by deliberatively engaging in positive actions and thoughts? Do people feel better by following recommendations from naïve psychology? In the present article we discuss these questions, noting that although some popular interventions thought to be universally beneficial (e.g., inductions of happiness, self-affirmation, empowerment, self-distancing) can sometimes yield positive outcomes, at other times the outcomes can also be negative. Taking an empirical approach based on experimental evidence, we postulate that understanding the underlying processes discovered in the science of persuasion is the key for specifying why, when, and for whom these practical initiatives are more likely to work or to backfire.
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13
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Faasse K, Helfer SG, Barnes K, Colagiuri B, Geers AL. Experimental Assessment of Nocebo Effects and Nocebo Side Effects: Definitions, Study Design, and Implications for Psychiatry and Beyond. Front Psychiatry 2019; 10:396. [PMID: 31258492 PMCID: PMC6587910 DOI: 10.3389/fpsyt.2019.00396] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/20/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Kate Faasse
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Suzanne G Helfer
- Department of Psychology, Adrian College, Adrian, MI, United States
| | - Kirsten Barnes
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Ben Colagiuri
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Andrew L Geers
- Department of Psychology, University of Toledo, Toledo, OH, United States
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