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Nitzan U, Grossman-Girron A, Sedoff O, Maoz H, Arad O, Tilbor E, Dror C, Bitan DT. Inpatient's, therapist's and staff's expectations regarding treatment and their effects on placebo response in the psychiatric ward - results from an add-on oxytocin RCT. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06593-x. [PMID: 39052100 DOI: 10.1007/s00213-024-06593-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/15/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES Patient's and therapist's expectations are considered an important factor influencing placebo response in experimental and therapeutic settings. Nevertheless, the placebo effects of common neurological facilitators that promote treatment efficacy have not been explored. In the present study we examined the estimations of patients, therapists, and staff members, regarding their treatment type and assessed their influence on the facilitating effects of oxytocin. METHODS Patients (N = 87) were randomized and double-blindly allocated to receive either oxytocin or placebo, twice daily for a period of four weeks, as part of a larger randomized, double-blind, placebo-controlled trial. Patient's, therapist's and staff's expectations were assessed based on their estimation of treatment type (agent or placebo). Multilevel modeling and univariate and multivariate regression analysis were performed to assess the effects of patient's, therapist's, and staff's estimations on treatment outcome beyond the effects of treatment type. RESULTS Staff's, therapist's, and patient's estimations were significantly associated with treatment outcomes. Nevertheless, only therapist's and patient's estimations significantly predicted improvement beyond actual administration, with therapist's and patient's estimations associated with improvement in trait anxiety (STAI-T, B=-1.80, p < .05, and B=-2.02, p < .05, respectively); therapist's estimations were associated with improvement in general distress (OQ-45, B=-3.71, p < .05), and patient's estimations were associated with symptom relief (HSCL-11, B=-0.13, p < .05). Overall, patient's estimations had a higher relative contribution to treatment success, with standardized coefficients across scales ranging from - 0.06 to -0.26. CONCLUSIONS The neurobiological factors that promote treatment success are also influenced by patient's and therapist's expectations. Future studies should consider these effects when examining their impact in inpatient settings.
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Affiliation(s)
- Uri Nitzan
- Shalvata Mental Health Center, 13 Aliyat-Hanoar st, Hod-Hasharon, 4534708, Israel.
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - A Grossman-Girron
- Shalvata Mental Health Center, 13 Aliyat-Hanoar st, Hod-Hasharon, 4534708, Israel
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - O Sedoff
- Shalvata Mental Health Center, 13 Aliyat-Hanoar st, Hod-Hasharon, 4534708, Israel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - H Maoz
- Shalvata Mental Health Center, 13 Aliyat-Hanoar st, Hod-Hasharon, 4534708, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - O Arad
- Shalvata Mental Health Center, 13 Aliyat-Hanoar st, Hod-Hasharon, 4534708, Israel
| | - E Tilbor
- Shalvata Mental Health Center, 13 Aliyat-Hanoar st, Hod-Hasharon, 4534708, Israel
| | - C Dror
- Shalvata Mental Health Center, 13 Aliyat-Hanoar st, Hod-Hasharon, 4534708, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - D Tzur Bitan
- Shalvata Mental Health Center, 13 Aliyat-Hanoar st, Hod-Hasharon, 4534708, Israel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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Westendorp J, van Vliet LM, Meeuwis SH, Olde Hartman TC, Sanders ARJ, Jutten E, Dirven M, Peerdeman KJ, Evers AWM. Optimizing placebo and minimizing nocebo effects through communication: e-learning and virtual reality training development. BMC MEDICAL EDUCATION 2024; 24:707. [PMID: 38951784 PMCID: PMC11218054 DOI: 10.1186/s12909-024-05671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 06/18/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND The effects of many treatments in healthcare are determined by factors other than the treatment itself. Patients' expectations and the relationship with their healthcare provider can significantly affect treatment outcomes and thereby play a major role in eliciting placebo and nocebo effects. We aim to develop and evaluate an innovative communication training, consisting of an e-learning and virtual reality (VR) training, for healthcare providers across all disciplines, to optimize placebo and minimize nocebo effects through healthcare provider-patient communication. The current paper describes the development, mid-term evaluation, optimization, and final evaluation of the communication training, conducted in The Netherlands. METHODS The development of both the e-learning and the VR training consisted of four phases: 1) content and technical development, 2) mid-term evaluation by healthcare providers and placebo/communication researchers, 3) optimization of the training, and 4) final evaluation by healthcare providers. To ensure the success, applicability, authenticity, and user-friendliness of the communication training, there was ongoing structural collaboration with healthcare providers as future end users, experts in the field of placebo/communication research, and educational experts in all phases. RESULTS Placebo/communication researchers and healthcare providers evaluated the e-learning positively (overall 7.9 on 0-10 scale) and the content was perceived as useful, accessible, and interesting. The VR training was assessed with an overall 6.9 (0-10 scale) and was evaluated as user-friendly and a safe method for practicing communication skills. Although there were some concerns regarding the authenticity of the VR training (i.e. to what extent the virtual patient reacts like a real patient), placebo and communication researchers, as well as healthcare providers, recognized the significant potential of the VR training for the future. CONCLUSIONS We have developed an innovative and user-friendly communication training, consisting of an e-learning and VR training (2D and 3D), that can be used to teach healthcare providers how to optimize placebo effects and minimize nocebo effects through healthcare provider-patient communication. Future studies can work on improved authenticity, translate the training into other languages and cultures, expand with additional VR cases, and measure the expected effects on providers communication skills and subsequently patient outcomes.
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Affiliation(s)
- Janine Westendorp
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.
- Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands.
| | - Liesbeth M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands
| | - Stefanie H Meeuwis
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ariëtte R J Sanders
- General Medical Practice Van Lennep Huisartsenpraktijk, Driebergen, The Netherlands
| | - Eric Jutten
- The Simulation Crew (TSC), Nijmegen, The Netherlands
| | - Monique Dirven
- Dutch Institute for Rational Use of Medicine (IVM), Utrecht, The Netherlands
| | - Kaya J Peerdeman
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands
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Hansson LS, Tognetti A, Sigurjónsson P, Brück E, Wåhlén K, Jensen K, Olsson MJ, Toll John R, Wilhelms DB, Lekander M, Lasselin J. Perception of unfamiliar caregivers during sickness - Using the new Caregiver Perception Task (CgPT) during experimental endotoxemia. Brain Behav Immun 2024; 119:741-749. [PMID: 38670241 DOI: 10.1016/j.bbi.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/25/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024] Open
Abstract
Social withdrawal is a well-established part of sickness behavior, but in some contexts sick animals might gain from keeping close instead of keeping away. For instance, sick individuals are more willing to be near known individuals who can provide care and safety (close others) compared to when healthy. Yet, interactions with some strangers might also be beneficial (i.e., healthcare professionals), but it is not known how sickness interplay with social behavior towards such individuals. Here, we assessed if sickness affects perception of caregivers, and developed a new task, the Caregiver Perception Task (CgPT). Twenty-six participants performed the CgPT, once after an injection of lipopolysaccharide (LPS, 0.8 ng/kg body weight, n = 24), and once after an injection of saline (n = 25), one hour and forty-five minutes post-injection. During the task, participants watched short video clips of three types of caregivers: a healthcare professional taking care of a sick individual, a healthcare professional not taking care of a sick individual, and a non-healthcare professional taking care of their sick adult child or partner. After each video clip, the likability, trustworthiness, professionalism, and willingness to interact with and receive care from the caregiver were rated on visual analogue scales. Results showed that participants injected with saline rated healthcare professionals who did not take care of a sick individual less positively on all aspects compared to healthcare professionals who took care of a sick individual. Moreover, compared to saline, LPS increased the participants' willingness to receive care from healthcare professionals and non-healthcare professionals providing care, but not from healthcare professionals not providing care. Thus, our results indicate that sick individuals may approach unknown individuals with potential to provide care and support.
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Affiliation(s)
- L S Hansson
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden; Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Osher Center for Integrative Health, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - A Tognetti
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; CEE-M, CNRS, INRAE, Institut Agro, University of Montpellier, Montpellier, France
| | | | - E Brück
- Karolinska University Hospital, Stockholm, Sweden
| | - K Wåhlén
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - K Jensen
- Osher Center for Integrative Health, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Division of Neuro, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - M J Olsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - R Toll John
- Department of Biomedical and Clinical Sciences, Linköping University, Sweden; Department of Emergency Medicine in Linköping, Local Health Care Services in Central Östergötland, Region Östergötland
| | - D B Wilhelms
- Department of Biomedical and Clinical Sciences, Linköping University, Sweden; Department of Emergency Medicine in Linköping, Local Health Care Services in Central Östergötland, Region Östergötland
| | - M Lekander
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden; Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Osher Center for Integrative Health, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - J Lasselin
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden; Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Osher Center for Integrative Health, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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Wilhelm M, Hermann C, Rief W, Schedlowski M, Bingel U, Winkler A. Working with patients' treatment expectations - what we can learn from homeopathy. Front Psychol 2024; 15:1398865. [PMID: 38860049 PMCID: PMC11163137 DOI: 10.3389/fpsyg.2024.1398865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
The usual homeopathic remedy, "globules," does not contain any pharmacologically active ingredient. However, many patients and practitioners report beneficial effects of homeopathic treatment on various health outcomes. Experimental and clinical research of the last two decades analyzing the underlying mechanisms of the placebo effect could explain this phenomenon, with patients' treatment expectations as the predominant mechanism. Treatment expectations can be optimized through various factors, such as prior information, communication, and treatment context. This narrative review analyses how homeopathy successfully utilizes these factors. Subsequently, it is discussed what evidence-based medicine could learn from homeopathic practice to optimize treatment expectations (e.g., using an empathic, patient-centered communication style, deliberately selecting objects in practice rooms, or using clear treatment rituals and salient contextual stimuli) and thereby treatment effectiveness. Homeopathic remedy does not work beyond the placebo effect but is recommended or prescribed as an active treatment by those who believe in it. Thus, practitioners need to understand the manner in which homeopathy (as an example of inert treatment) works and are advised to reintegrate its underlying effective placebo mechanisms into evidence-based medicine. This promises to increase treatment efficacy, tolerability, satisfaction, and compliance with evidence-based treatments, and addresses the desires patients are trying to satisfy in homeopathy in an ethical, fully informed way that is grounded in evidence-based medicine.
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Affiliation(s)
- Marcel Wilhelm
- Department of Clinical Psychology, Philipps-University Marburg, Marburg, Germany
| | - Christiane Hermann
- Department of Clinical Psychology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Winfried Rief
- Department of Clinical Psychology, Philipps-University Marburg, Marburg, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Clinic Essen, Essen, Germany
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro-and Behavioral Sciences, University Medicine Essen, Essen, Germany
- Translational Pain Research Unit, University Medicine Essen, Essen, Germany
| | - Alexander Winkler
- Department of Clinical Psychology, Justus-Liebig-University Giessen, Giessen, Germany
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Krahé C, Koukoutsakis A, Fotopoulou A. Updating beliefs about pain following advice: Trustworthiness of social advice predicts pain expectations and experience. Cognition 2024; 246:105756. [PMID: 38442585 PMCID: PMC7616089 DOI: 10.1016/j.cognition.2024.105756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/09/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024]
Abstract
Prior expectations influence pain experience. These expectations, in turn, rely on prior pain experience, but they may also be socially influenced. Yet, most research has focused on self rather than social expectations about pain, and hardly any studies examined their combined effects on pain. Here, we adopted a Bayesian learning perspective to investigate how explicitly communicated social expectations ('advice about pain tolerance') affect own pain expectations, and ultimately pain tolerance, under varying conditions of social epistemic uncertainty (trustworthiness of the advice). N = 72 female participants took part in a coldpressor (cold water) task before (self-learning baseline) and after (socially-influenced learning) receiving advice about their likely pain tolerance from a confederate, the trustworthiness of whom was experimentally manipulated. We used path analysis to test the hypothesis that social advice from a highly trustworthy confederate would influence participants' expectations about pain more than advice from a less trustworthy source, and that the degree of this social influence would in turn predict pain tolerance. We further used a simplified, Bayesian learning, computational approach for explicit belief updating to examine the role of latent parameters of precision optimisation in how participants subsequently changed their future pain expectations (prospective posterior beliefs) based on the combined effect of the confederate's advice on their own pain expectations, and their own task experience. Results confirmed that participants adjusted their pain expectations towards the confederate's advice more in the high- vs. low-trustworthiness condition, and this advice taking predicted their pain tolerance. Furthermore, the confederate's trustworthiness influenced how participants weighted the confederate's advice in relation to their own expectations and task experience in forming prospective posterior beliefs. When participants received advice from a less trustworthy confederate, their own sensory experience was weighted more highly than their socially-influenced prior expectations. Thus, explicit social advice appears to impact pain by influencing one's own pain expectations, but low social trustworthiness leads to these expectations becoming more malleable to novel, sensory learning.
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Affiliation(s)
- Charlotte Krahé
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
| | - Athanasios Koukoutsakis
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Aikaterini Fotopoulou
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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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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Barnes K, Wang R, Faasse K. Practitioner warmth and empathy attenuates the nocebo effect and enhances the placebo effect. Appl Psychol Health Well Being 2024; 16:421-441. [PMID: 37793644 DOI: 10.1111/aphw.12497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
Augmented patient-practitioner interactions that enhance therapeutic alliance can increase the placebo effect to sham treatment. Little is known, however, about the effect of these interactions on maladaptive health outcomes (i.e., the nocebo effect). Healthy participants (N = 84) were randomised to a 3-day course of Oxytocin nasal drops (actually, sham treatment) in conjunction with a high-warmth interaction (Oxy-HW: N = 28), a low-warmth interaction (Oxy-LW: N = 28) or to a no treatment control group (NT: N = 28). All participants were informed that the Oxytocin treatment could increase psychological well-being but was associated with several potential side effects. Treatment-related side effects, unwarned symptoms, and psychological well-being were measured at baseline and all post-treatment days. Side effect reporting was increased in the Oxy-LW condition compared to the other groups across all days. Conversely, increased psychological well-being was observed in the Oxy-HW condition, relative to the other conditions, but only on Day 1. Among those receiving treatment, positive and negative expectations, and treatment-related worry, did not vary by interaction-style, while psychological well-being and side effect reporting were inversely associated at the level of the individual. Results have important implications for practice, suggesting poorer quality interactions may not only reduce beneficial health outcomes but also exacerbate those that are maladaptive.
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Affiliation(s)
- Kirsten Barnes
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Rachelle Wang
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate Faasse
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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De Brochowski V, Rubin GJ, Webster RK. The effect of nocebo explanation and empathy on side-effect expectations of medication use following a fictional GP consultation. PSYCHOL HEALTH MED 2024; 29:809-821. [PMID: 37491019 DOI: 10.1080/13548506.2023.2240072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Abstract
The simple act of informing patients about side-effects increases the likelihood they will experience them (i.e. the nocebo effect). Explaining this psychological phenomenon could help to reduce side-effect experience, however, it is yet to be explored if this can be applied to clinical settings where new medication is prescribed. In addition, the degree to which a health-care provider empathetically communicates this to patients may have an impact. To investigate this, we carried out 2 × 2 factorial trial to assess the effect of nocebo explanation and empathy (plus their interaction) on side-effect expectations following a fictional GP consultation prescribing a new medication. Overall, 208 participants were randomised to watch one of the four fictive GP consultations and play the role of the patient. In all videos, participants received information about the reason for the consultation, the recommendation of a new fictive medicine, how to take it, benefits and side-effects. The videos differed in whether the GP provided an explanation of the nocebo effect (yes/no) and whether they communicated in an empathetic style (yes/no). After watching the video, participants were asked about their side-effect expectations and rated the quality of the GP's communication. Two-way ANOVAs revealed no main effect of nocebo explanation on expectation of side-effects warned or not warned about in the consultation. However, there was a main effect of empathy, with participants watching the empathetic consultations having significantly lower expectations of non-warned-about side-effects. There was no significant interaction. Findings suggest that explaining the nocebo effect and GP empathy did little to allay expectations of side-effects that were specifically mentioned in the consultation. However, GP empathy had an effect by helping to reduce additional side-effect expectations participants still had. Future work should extend these findings to real GP consultations where the full dimensions of empathy can be explored.
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Affiliation(s)
- Valentine De Brochowski
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - G James Rubin
- Health Protection Research Unit in Emergency Preparedness and Response at, King's College London, London, United Kingdom
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Hohenschurz-Schmidt D, Phalip J, Chan J, Gauhe G, Soliman N, Vollert J, Lunde SJ, Vase L. Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Eur J Pain 2024; 28:513-531. [PMID: 37985188 DOI: 10.1002/ejp.2205] [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: 07/20/2023] [Revised: 09/18/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The magnitude of placebo effects from physical and psychological 'sham' is unknown but could impact efficacy trials and treatment understanding. To quantify placebo effects, this systematic review of three-armed randomised controlled trials (RCTs) of physical and psychological interventions for pain compared outcomes in 'sham' control intervention and non-exposure arms. METHODS RCTs with treatment, 'sham' control intervention, and non-exposure groups were included, enrolling adults with any pain. A protocol was pre-registered (PROSPERO: CRD42023413324), and twelve databases searched from 2008 to July 2023. Trial methods and blinding were analysed descriptively and risk of bias assessed. Meta-analysis of pain measures at short-, medium- and long-term was performed with random-effects models of standardised mean differences (SMD).Studies were sub-grouped according to control intervention type. RESULTS Seventeen RCTs were included. The average short-term placebo effect was small (0.21 SMD, 0.1-0.33 95% CI, p = 0.0002, 1440 participants). It showed no heterogeneity (Tau2 = 0.1, I2 = 11%, p = 0.3), preventing meta-regression analyses of effect modifiers. However, sub-group analyses revealed larger placebo effects in manual control interventions compared to disabled devices and miscellaneous control interventions. Overall, placebo analgesia accounted for 39% of treatments' short-term effectiveness. No placebo effects were found at medium-term (7 RCTs, 381 participants) or long-term follow-up (3 RCTs, 173 participants). CONCLUSIONS The observed placebo analgesia has mechanistic and methodological implications, though its clinical importance may be limited. Control intervention design affects placebo effects, highlighting the importance of considering methodology in RCT interpretation. Review limitations include a small number of long-term studies and sample heterogeneity. SIGNIFICANCE This systematic review directly quantifies placebo effects from physical and psychological 'sham' control interventions and compares them to treatments' overall effectiveness. By doing so, the review enhances our understanding of placebo effects, their relative contribution in clinical trials, and their susceptibly to trial design. It poses further questions regarding the influence of blinding, participant expectations, and features of the therapeutic context. Overall, the insights provided by this review carry methodological significance and are important for the interpretation and synthesis of efficacy trials in this field.
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Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
- Research Department, University College of Osteopathy, London, UK
| | - Jules Phalip
- Institut ANALGESIA, Faculté de Médecine, Université Clermont Auvergne, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de pharmacologie médicale, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jessica Chan
- Faculty of Medicine, Imperial College London, London, UK
| | - Greta Gauhe
- Centre for Dance Research, Coventry University, Coventry, UK
| | - Nadia Soliman
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sigrid Juhl Lunde
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
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Dai B, Xiao C, Wang Y, Li T, Duan Y, Jiang Y, Shi L, Hong X, Geng W, Hu J, Cao J, Wei J. Development and psychometric validation of the hospitalized patients' expectations for treatment scale-clinician version. Front Psychiatry 2024; 14:1325013. [PMID: 38283892 PMCID: PMC10811258 DOI: 10.3389/fpsyt.2023.1325013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/15/2023] [Indexed: 01/30/2024] Open
Abstract
Objective Patient safety management systems in general hospitals require a comprehensive tool for assessing the expectations of inpatients across different wards. This study aimed to develop and psychometrically validate a new scale, the hospitalized patients' expectations for treatment scale-clinician version (HOPE-C), to meet this requirement. Methods We interviewed 35 experts and 10 inpatients while developing the HOPE-C scale. The scale was initially designed with three dimensions: clinicians' expectations regarding doctor-patient communication, clinicians' expectations regarding treatment outcome, and clinicians' expectations regarding disease management. We recruited 200 inpatients from a general hospital in China. At the same time, 51 clinicians were assigned to the enrolled patients who completed the HOPE-C to examine the reliability, validity, and psychometric characteristics of the questionnaire. We applied item analysis, assessed construct validity, evaluated internal consistency, and conducted a test-retest reliability analysis over 7 days. Results Both exploratory and confirmatory analyses supported a 2-dimensional structure, comprising doctor-patient communication expectations and treatment outcome expectations, with favorable model fit parameters (root mean square residual [RMR] = 0.042, root mean square error of approximation [RMSEA] = 0.049, comparative fit index [CFI] = 0.989, Tucker-Lewis index [TLI] = 0.984). Item analysis demonstrated appropriate item design (r = 0.744-0.961). The scale exhibited strong internal consistency, with Cronbach's α values of 0.884, 0.816, and 0.840 for the overall scale, the doctor-patient communication expectation subscale, and the treatment outcome expectation subscale, respectively. The 7-day test-retest reliability was 0.996 (p < 0.001). Conclusion Our findings suggest that the HOPE-C is a reliable and valid assessment tool for measuring the expectations of inpatients in general hospitals. It effectively identifies patients' expectations concerning doctor-patient communication and treatment outcomes.
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Affiliation(s)
- Bindong Dai
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunfeng Xiao
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yufei Wang
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Li
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanping Duan
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yinan Jiang
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lili Shi
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xia Hong
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenqi Geng
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaojiao Hu
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinya Cao
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Aungle P, Langer E. Physical healing as a function of perceived time. Sci Rep 2023; 13:22432. [PMID: 38104155 PMCID: PMC10725481 DOI: 10.1038/s41598-023-50009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/14/2023] [Indexed: 12/19/2023] Open
Abstract
In this study we wounded study participants following a standardized procedure and manipulated perceived time to test whether perceived time affected the rate of healing. We measured the amount of healing that occurred across three conditions using a within-subjects design: Slow Time (half as fast as clock time), Normal Time (clock time), and Fast Time (twice as fast as clock time). Based on the theory of mind-body unity-which posits simultaneous and bidirectional influences of mind on body and body on mind-we hypothesized that wounds would heal faster or slower when perceived time was manipulated to be experienced as longer or shorter respectively. Although the actual elapsed time was 28 min in all three conditions, significantly more healing was observed in the Normal Time condition compared to the Slow Time condition, in the Fast Time condition compared to the Normal Time condition, and in the Fast Time condition compared to the Slow Time condition. These results support the hypothesis that the effect of time on physical healing is directly affected by one's psychological experience of time, independent of the actual elapsed time.
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Affiliation(s)
- Peter Aungle
- Psychology Department, Harvard University, Cambridge, USA.
| | - Ellen Langer
- Psychology Department, Harvard University, Cambridge, USA
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12
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Daniali H, Ruben MA, Flaten MA. Systematic manipulation of experimenters' non-verbal behaviors for the investigation of pain reports and placebo effects. Front Psychol 2023; 14:1248127. [PMID: 38023052 PMCID: PMC10644817 DOI: 10.3389/fpsyg.2023.1248127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/01/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Non-verbal behaviors (NBs) of caregivers affect pain reports and placebo effects. However, little experimental research has systematically examined the caregivers' NBs. This study protocol and preparatory study report a systematic manipulation of experimenters' NBs to investigate pain report and placebo effects. Methods We propose an experiment in which videotaped experimenters (VEs) conduct a pain stimulation and a placebo treatment study. The VEs express one positively enhanced NB and keep the other NBs neutral. Participants will be randomized to either the positive facial expressions (+FE), tone of voice (+TV), body movement (+BM), or neutral NBs (i.e., neutral condition; NC) of the VEs. As a preparatory study for proof of concept, two groups of NB coders from Norway and the USA separately rated the degree of NBs (eye contact, body postures and movements, and tone of voice), and impressions of dominance and being in charge, positivity, and expressivity from each NB video. The NB videos had construct validity and reliability. The +BM and +FE were rated as more dominant and in charge than the +TV and the NC. The +FE and +BM were rated as the most positive and expressive NBs, respectively. Expected results +FE will have the largest placebo effects on pain and stress levels. However, transmitting the NBs to patients by VEs is challenging. Moreover, controlling for the effects of research assistants present in the testing room is challenging. Discussion We propose that caregivers' NBs affect pain reports and placebo effects. Moreover, different NBs elicit different impressions, and a better understanding of the role of caregiver NBs requires more rigorous investigations. Lastly, aiming to investigate the caregiver NBs, the varying degrees of micro-NBs and their effects on the formation of impressions should be considered.
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Affiliation(s)
- Hojjat Daniali
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mollie A. Ruben
- Department of Psychology, University of Rhode Island, Kingston, RI, United States
| | - Magne Arve Flaten
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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13
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Tobiassen AH, Sundal T, Stänicke E, Folmo EJ. The cultural change narrative as a core component of therapeutic change. Front Psychiatry 2023; 14:1149984. [PMID: 37867772 PMCID: PMC10587421 DOI: 10.3389/fpsyt.2023.1149984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Research indicates a similar effect of Mentalization-based treatment (MBT) and Dialectical behavior therapy (DBT) for borderline personality disorder (BPD). However, there is a paucity in studies investigating the change narrative received from and developed in these treatments. The aim of the present study is to investigate similarities and differences in the change narratives provided by MBT and DBT, and how these narratives reflect the rationale, explanations, and procedures of the provided treatment. Methods The study is a qualitative analysis of seven interviews conducted by the authors. Three of the participants had received MBT, and four of the participants had received DBT. This study presents an Interpretative Phenomenological Analysis (IPA) of the change narratives received in two specialized treatments for BPD. Results The main findings from the IPA were that the change narratives described by the participants reflected the treatment they received. The DBT participants highlighted explicit learning of tools and techniques, with predictable and safe therapists. In contrast, the MBT participants emphasized a long-lasting process of exploring to create procedural learning with therapists who followed their lead. Discussion The participants' stories of change shed light on how a change narrative was developed, and therefore how the rationale, explanations and procedures were conveyed differently by MBT and DBT.
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Affiliation(s)
| | | | - Erik Stänicke
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
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14
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Pronovost-Morgan C, Hartogsohn I, Ramaekers JG. Harnessing placebo: Lessons from psychedelic science. J Psychopharmacol 2023; 37:866-875. [PMID: 37392012 PMCID: PMC10481630 DOI: 10.1177/02698811231182602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
The randomized controlled trial (RCT) research design assumes that a drug's "specific" effect can be isolated, added, and subtracted from the "nonspecific" effect of context and person. While RCTs are helpful in assessing the added benefit of a novel drug, they tend to obscure the curative potential of extra-pharmacological variables, known as "the placebo effect." Ample empirical evidence suggests that person/context-dependent physical, social, and cultural variables not only add to, but also shape drug effects, making them worth harnessing for patient benefits. Nevertheless, utilizing placebo effects in medicine is challenging due to conceptual and normative obstacles. In this article, we propose a new framework inspired by the field of psychedelic science and its employment of the "set and setting" concept. This framework acknowledges that drug and nondrug factors have an interactive and synergistic relationship. From it, we suggest ways to reintegrate nondrug variables into the biomedical toolbox, to ethically harness the placebo effect for improved clinical care.
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Affiliation(s)
- Chloé Pronovost-Morgan
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ido Hartogsohn
- The Program for Science, Technology and Society Studies, Bar-Ilan University, Ramat Gan, Israel
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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15
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Henrich L, Wilhelm M, Lange P, Rief W. The role of the communicated treatment rationale on treatment outcome: study protocol for a randomized controlled trial. Trials 2023; 24:540. [PMID: 37592320 PMCID: PMC10433650 DOI: 10.1186/s13063-023-07557-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/30/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Placebo effects are a well-established phenomenon in the treatment of depression. However, the mechanism underlying these effects are not fully understood. Treatment expectations are considered one explanation for why placebos work. Treatment expectations are likely to be affected by clinician-patient interactions. This study aims to investigate the role of the communicated treatment rationale in modulating treatment expectations and its effects on the treatment outcomes of a pharmacological and a psychological active placebo intervention for depression. In this study, treatment expectations are modulated by presenting illness models that are either congruent or incongruent with the treatment intervention that follows. METHODS This 2 × 2 randomized controlled trial will involve patients with major depression. Participants will either receive a biological or a psychological illness model from a clinician. Following this, they are randomly assigned to receive either a pharmacological or a psychological active placebo intervention. The illness model and the treatment are either congruent or incongruent with each other, resulting in four groups. In addition, a natural course control group will be included. DISCUSSION This study will provide insights into the mechanism of expectation modulation in active placebo treatments for major depression. The results may provide insights for clinicians to improve their communication with patients by focusing on treatment expectations. By identifying the factors that contribute to placebo effects, this study has the potential to improve the effectiveness of existing depression treatments and reduce the burden of this highly prevalent mental health condition. TRIAL REGISTRATION This trial has been registered prospectively at ClinicalTrials.gov under the identifier: NCT04719663. Registered on January 22, 2021.
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Affiliation(s)
- Liv Henrich
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| | - Marcel Wilhelm
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Philipp Lange
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Winfried Rief
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
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Moral L, Mori F. Drug provocation tests in children: All that glitters is not gold. Pediatr Allergy Immunol 2023; 34:e14002. [PMID: 37622259 DOI: 10.1111/pai.14002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/21/2023] [Accepted: 07/11/2023] [Indexed: 08/26/2023]
Abstract
A proper allergy work-up, based on the gold standard drug provocation test (DPT), usually rules out suspected drug hypersensitivity in children. These tests are generally open, given their high efficiency compared with double-blind placebo-controlled DPTs. Although their negative predictive value is excellent, no studies have calculated their positive predictive value, highly dependent on the prevalence of the disease. Most studies have found a rate of <5%-10% of true beta-lactam hypersensitivity in children. Given this low prevalence (pre-test probability), a few false-positive results can significantly reduce the estimated positive predictive value. False positives may arise from the nocebo effect during the test, including nocebo by proxy, or from observer bias, which depends on professional expertise and organizational circumstances. Some studies have found a high rate of tolerance on a second DPT in children who failed the first, but these results may be affected by the interval between the two tests, of a year or more in most cases, reflecting a loss of hypersensitivity over time. Taking into account the low rate of positive DPTs, with commonly mild reactions, we suggest confirming nonsevere positive DPTs with a second provocation performed soon after the first, especially in the case of beta-lactam antibiotics, in order to improve the diagnostic accuracy, de-label more patients, and achieve a better estimation of true drug hypersensitivity prevalence. In case of mild immediate reactions, the potential benefits of a second DPT should be carefully weighed against the risk of anaphylaxis.
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Affiliation(s)
- Luis Moral
- Pediatric Allergy and Respiratory Unit, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital, IRCCS Florence, Florence, Italy
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17
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Fawsitt CG, Thom H, Regnier SA, Lee XY, Kymes S, Vase L. Comparison of indirect treatment methods in migraine prevention to address differences in mode of administration. J Comp Eff Res 2023; 12:e230021. [PMID: 37222593 PMCID: PMC10508308 DOI: 10.57264/cer-2023-0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/02/2023] [Indexed: 05/25/2023] Open
Abstract
Aim: Indirect treatment comparisons (ITCs) are anchored on a placebo comparator, and the placebo response may vary according to drug administration route. Migraine preventive treatment studies were used to evaluate ITCs and determine whether mode of administration influences placebo response and the overall study findings. Materials & methods: Change from baseline in monthly migraine days produced by monoclonal antibody treatments (subcutaneous, intravenous) was compared using fixed-effects Bayesian network meta-analysis (NMA), network meta-regression (NMR), and unanchored simulated treatment comparison (STC). Results: NMA and NMR provide mixed, rarely differentiated results between treatments, whereas unanchored STC strongly favors eptinezumab over other preventive treatments. Conclusion: Further investigations are needed to determine which ITC best reflects the impact of mode of administration on placebo.
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Affiliation(s)
| | - Howard Thom
- Clifton Insight, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
| | | | | | | | - Lene Vase
- Department of Psychology & Behavioural Sciences, Aarhus University, Aarhus, Denmark
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18
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Koch EAT, Steeb T, Bender-Säbelkampf S, Busch D, Feustel J, Kaufmann MD, Maronna A, Meder C, Ronicke M, Toussaint F, Wellein H, Berking C, Heppt MV. Poor Adherence to Self-Applied Topical Drug Treatment Is a Common Source of Low Lesion Clearance in Patients with Actinic Keratosis-A Cross-Sectional Study. J Clin Med 2023; 12:jcm12113813. [PMID: 37298008 DOI: 10.3390/jcm12113813] [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: 05/04/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Many treatments for actinic keratosis (AK) have been proven efficient in clinical trials. However, patients with AK may still experience unsatisfactory therapeutic outcomes in clinical practice. OBJECTIVES To investigate patient adherence to self-applied topical interventions for AK and to explore factors associated with adherence in a real-world setting. METHODS A cross-sectional study was conducted. Patients presenting with AK were asked to complete a self-administered questionnaire about their last topical AK treatment. RESULTS A total of 113 patients participated with a median age of 78.5 years (range 58-94). Fifty-four patients (47.8%) received topical diclofenac, ten (8.8%) imiquimod, nine (8%) 5-fluorouracil, nine (8%) 5-fluorouracil plus salicylic acid, and eight (7.1%) photodynamic therapy. The non-adherence rate was 46.9% (n = 53), and only 30.9% (n = 35) used the topical treatments according to the summary of product characteristics (SmPC). These subgroups were compared. Patients of the non-compliant group were significantly less informed about the application time of the specific topical intervention (p = 0.002) and adjusted the timeframe (p < 0.001) and application frequency of the therapy (p = 0.02) independently of their physician. Conversely, patients reporting a sufficient pre-treatment consultation (p = 0.019) generally complied with the SmPC compliance application. CONCLUSIONS A thorough pre-treatment consultation can help to increase treatment adherence and ensure lesion clearance.
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Affiliation(s)
- Elias A T Koch
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Theresa Steeb
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Sophia Bender-Säbelkampf
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Dorothee Busch
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Janina Feustel
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Matthias D Kaufmann
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Andreas Maronna
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Christine Meder
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Moritz Ronicke
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Frédéric Toussaint
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Hedwig Wellein
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
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Thomaidou MA, Blythe JS, Peerdeman KJ, van Laarhoven AIM, Van Schothorst MME, Veldhuijzen DS, Evers AWM. Learned Nocebo Effects on Cutaneous Sensations of Pain and Itch: A Systematic Review and Meta-analysis of Experimental Behavioral Studies on Healthy Humans. Psychosom Med 2023; 85:308-321. [PMID: 36961347 PMCID: PMC10171297 DOI: 10.1097/psy.0000000000001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 01/24/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE In past decades, the field of nocebo research has focused on studying how sensory perception can be shaped by learning. Nocebo effects refer to aggravated sensory experiences or increased sensitivity to sensations such as pain and itch resulting from treatment-related negative experiences. Behavioral conditioning and verbal suggestions of a negative treatment outcome may aggravate pain and itch perception. Gaining a comprehensive view of the magnitude of nocebo effects and contributing factors will help steer nocebo research toward fruitful directions for understanding complex sensory phenomena. METHODS We conducted a systematic review and meta-analysis of a total of 37 distinct experimental nocebo studies on healthy participants (all published in English between 2008 and 2021), with four separate meta-analyses for nocebo effects on pain or itch. We conducted subgroup analyses and meta-regression on factors such as type and intensity of sensory stimuli, and length of conditioning paradigms. RESULTS This meta-analysis showed that, on average, effect sizes of nocebo effects were moderate to large (Hedges g between 0.26 and 0.71 for the four primary outcomes). The combination of conditioning and verbal suggestions yielded stronger nocebo responses on pain in particular. Subgroup analyses, including factors such as the type of sensory stimulation, did not explain the moderate heterogeneity in nocebo magnitudes between different studies. Risk of bias was generally low and was not related to nocebo magnitudes either. CONCLUSIONS We discuss these results in relation to the role of conditioning and aversive learning, and we recommend more consistency in designing and reporting nocebo experiments.
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Anderson SR, Gianola M, Medina NA, Perry JM, Wager TD, Losin EAR. Doctor trustworthiness influences pain and its neural correlates in virtual medical interactions. Cereb Cortex 2023; 33:3421-3436. [PMID: 36001114 PMCID: PMC10068271 DOI: 10.1093/cercor/bhac281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 11/13/2022] Open
Abstract
Trust is an important component of the doctor-patient relationship and is associated with improved patient satisfaction and health outcomes. Previously, we reported that patient feelings of trust and similarity toward their clinician predicted reductions in evoked pain in response to painful heat stimulations. In the present study, we investigated the brain mechanisms underlying this effect. We used face stimuli previously developed using a data-driven computational modeling approach that differ in perceived trustworthiness and superimposed them on bodies dressed in doctors' attire. During functional magnetic resonance imaging, participants (n = 42) underwent a series of virtual medical interactions with these doctors during which they received painful heat stimulation as an analogue of a painful diagnostic procedure. Participants reported increased pain when receiving painful heat stimulations from low-trust doctors, which was accompanied by increased activity in pain-related brain regions and a multivariate pain-predictive neuromarker. Findings suggest that patient trust in their doctor may have tangible impacts on pain and point to a potential brain basis for trust-related reductions in pain through the modulation of brain circuitry associated with the sensory-discriminative and affective-motivational dimensions of pain.
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Affiliation(s)
- Steven R Anderson
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA
| | - Morgan Gianola
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA
| | - Natalia A Medina
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA
| | - Jenna M Perry
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, 3 Maynard St, Hanover, NH 03755-3565, USA
| | - Elizabeth A Reynolds Losin
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA
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21
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Hohenschurz-Schmidt D, Draper-Rodi J, Vase L, Scott W, McGregor A, Soliman N, MacMillan A, Olivier A, Cherian CA, Corcoran D, Abbey H, Freigang S, Chan J, Phalip J, Sørensen LN, Delafin M, Baptista M, Medforth NR, Ruffini N, Andresen SS, Ytier S, Ali D, Hobday H, Ngurah Agung Adhiyoga Santosa AA, Vollert J, Rice AS. Blinding and sham control methods in trials of physical, psychological, and self-management interventions for pain (article II): a meta-analysis relating methods to trial results. Pain 2023; 164:509-533. [PMID: 36271798 PMCID: PMC9916063 DOI: 10.1097/j.pain.0000000000002730] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/16/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Sham interventions in randomized clinical trials (RCTs) of physical, psychological, and self-management (PPS) therapies for pain are highly variable in design and believed to contribute to poor internal validity. However, it has not been formally tested whether the extent to which sham controls resemble the treatment under investigation consistently affects trial outcomes, such as effect sizes, differential attrition, participant expectancy, and blinding effectiveness. Placebo- or sham-controlled RCTs of PPS interventions of clinical pain populations were searched in 12 databases. The similarity of control interventions to the experimental treatment was rated across 25 features. Meta-regression analyses assessed putative links between employed control interventions, observed effect sizes in pain-related outcomes, attrition, and blinding success. The sample included 198 unique control interventions, dominated by manual therapy and chronic musculoskeletal pain research. Meta-analyses indicated small-to-moderate benefits of active treatments over control interventions, across subgroups of manual therapies, exercise, and rehabilitation, and psychological intervention trials. Multiple meta-regression modelling demonstrated that similarity between sham control and tested interventions predicted variability in pain-related outcomes, attrition, and blinding effectiveness. Influential variables were differences relating to the extent of intervention exposure, participant experience, and treatment environments. The results support the supposed link between blinding methods and effect sizes, based on a large and systematically sourced overview of methods. However, challenges to effective blinding are complex and often difficult to discern from trial reports. Nonetheless, these insights have the potential to change trial design, conduct, and reporting and will inform guideline development.
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Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Jerry Draper-Rodi
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, Section for Psychology and Neuroscience, Aarhus University, Aarhus, Denmark
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alison McGregor
- Human Performance Group, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Nadia Soliman
- Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Andrew MacMillan
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Axel Olivier
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Cybill Ann Cherian
- Chemical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Hilary Abbey
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Sascha Freigang
- Department of Neurosurgery, Medical University Graz, Graz, Austria
| | - Jessica Chan
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Lea Nørgaard Sørensen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Maite Delafin
- The Penn Clinic, Hertfordshire, Hatfield, United Kingdom
| | - Margarida Baptista
- Wolfson Centre for Age Related Diseases, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Nuria Ruffini
- National Centre Germany, Foundation C.O.M.E. Collaboration, Berlin, Germany
| | | | | | - Dorota Ali
- Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Harriet Hobday
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Jan Vollert
- Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster,Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Andrew S.C. Rice
- Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
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22
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Bavbek S, Ozyigit LP, Baiardini I, Braido F, Roizen G, Jerschow E. Placebo, Nocebo, and Patient-Reported Outcome Measures in Drug Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:371-379. [PMID: 36521832 DOI: 10.1016/j.jaip.2022.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Sevim Bavbek
- Division of Allergy and Clinical of Immunology, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey.
| | - Leyla Pur Ozyigit
- Adult Allergy Service, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Ilaria Baiardini
- Istituti di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genova, Italy; Università di Genova, (DIMI), Genova, Italy
| | - Fulvio Braido
- Istituti di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genova, Italy; Università di Genova, (DIMI), Genova, Italy
| | - Gigia Roizen
- Department of Immunology, Clinica Alemana De Santiago, Santiago, Chile
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23
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Wampold BE, Flückiger C. The alliance in mental health care: conceptualization, evidence and clinical applications. World Psychiatry 2023; 22:25-41. [PMID: 36640398 PMCID: PMC9840508 DOI: 10.1002/wps.21035] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 01/15/2023] Open
Abstract
The concept of alliance reflects the collaborative relationship between a clinician and a patient, defined as consisting of three elements: a) the agreement on the goals of treatment; b) the agreement on a task or series of tasks; c) the development of a bond. Although much of the theory and research on the alliance comes from the domain of psychotherapy, the concept is applicable to any practice involving a person seeking help and a socially sanctioned healer. An extensive research evidence suggests that the alliance (typically measured at the third or fourth session) is a robust predictor of the outcomes of various forms of psychotherapy, even when prior symptom improvement and other factors are considered. Both the clinician and the patient bring to the therapy situation different capacities to form an alliance. Factors concerning the patient include, among others, the diagnosis, attachment history and style, motivation, and needs for affiliation. However, the benefits of the alliance have been found to be mostly due to the therapist's contribution, in particular his/her facilitative interpersonal skills, including verbal fluency, communication of hope and positive expectations, persuasiveness, emotional expression; warmth, acceptance and understanding; empathy, and alliance rupture-repair responsiveness. Placebo studies have allowed to experimentally manipulate aspects of the relationship between a therapist and a patient in non-psychotherapy contexts. In these settings, two components of the relationship have emerged: an emotional one (involving being cared for and understood by the clinician) and a cognitive one (including the belief in the competence of the therapist to select and administer an effective treatment). Here we propose a model that describes three pathways through which the alliance creates benefits, named CARE (caring, attentive, real and empathic), EXPECTANCY, and SPECIFIC. Although research and clinical attention have mostly focused on the alliance between a clinician and a patient in face-to-face interactions, there is preliminary evidence concerning the alliance between patients and other clinic staff, systems of care, or the program in Internet-mediated services. These new research areas clearly require further development.
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Affiliation(s)
- Bruce E Wampold
- Modum Bad Psychiatric Center, Vikersund, Norway
- University of Wisconsin-Madison, Madison, WI, USA
| | - Christoph Flückiger
- Department of Psychology, University of Zürich, Zürich, Switzerland
- Department of Psychology, University of Kassel, Kassel, Germany
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24
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Salzmann S, Wilhelm M, Schindler S, Rief W, Euteneuer F. Optimising the efficacy of a stress-reducing psychological intervention using placebo mechanisms: A randomized controlled trial. Stress Health 2022; 38:722-735. [PMID: 35043534 DOI: 10.1002/smi.3128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/17/2021] [Accepted: 01/12/2022] [Indexed: 11/11/2022]
Abstract
This study examined whether i) brief videos aiming to optimise outcome expectations would augment the efficacy of progressive muscle relaxation (PMR) and ii) whether participants' characteristics would moderate these effects. Sixty-eight healthy subjects randomized to one of three experimental manipulations before undergoing a single PMR session either watched i) a video displaying a neutral expert, ii) a video with a warm expert, or iii) were part of an active control condition. Constrained linear mixed models indicated increased relaxation and decreased stress levels for all participants after the PMR session. The primary outcome was the change of perceived relaxation/stress from pre to post. Participants with high neuroticism and trait anxiety indicated an augmented PMR's efficacy and increased outcome expectations when watching the warm expert video compared to the control group or the less warm expert. Brief videos displaying an expert aiming to optimise outcome expectations regarding a brief stress-reducing psychological intervention may boost or decrease an intervention's efficacy. Effects may depend on the viewer's personality and the (video) expert's communication style. Trial Registration: The study protocol was approved by the local Ethics Committee of the University of Marburg, Germany. This study was registered at www.clinicaltrials.gov (NCT03330431).
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Affiliation(s)
- Stefan Salzmann
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Marcel Wilhelm
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Sebastian Schindler
- Institute of Medical Psychology and Systems Neuroscience and Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Frank Euteneuer
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.,Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
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25
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Haines ST. Pills and potions: Mindsets influence our thoughts, behaviors, and physiologic responses to medications. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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26
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Rajagopalan D, Thomas J, Ring D, Fatehi A. Quantitative Patient-Reported Experience Measures Derived From Natural Language Processing Have a Normal Distribution and No Ceiling Effect. Qual Manag Health Care 2022; 31:210-218. [PMID: 35383720 DOI: 10.1097/qmh.0000000000000355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Patient-reported experience measures have the potential to guide improvement in health care delivery. Many patient-reported experience measures are limited by the presence of strong ceiling effects that limit their analytical utility. METHODS We used natural language processing to develop 2 new methods of evaluating patient experience using text comments and associated ordinal and categorical ratings of willingness to recommend from 1390 patients receiving specialty or nonspecialty care at our offices. One method used multivariable analysis based on linguistic factors to derive a formula to estimate the ordinal likelihood to recommend. The other method used the meaning extraction method of thematic analysis to identify words associated with categorical ratings of likelihood to recommend with which we created an equation to compute an experience score. We measured normality of the 2 score distributions and ceiling effects. RESULTS Spearman rank-order correlation analysis identified 36 emotional and linguistic constructs associated with ordinal rating of likelihood to recommend, 9 of which were independently associated in multivariable analysis. The calculation derived from this model corresponded with the original ordinal rating with an accuracy within 0.06 units on a 0 to 10 scale. This score and the score developed from thematic analysis both had a relatively normal distribution and limited or no ceiling effect. CONCLUSIONS Quantitative ratings of patient experience developed using natural language processing of text comments can have relatively normal distributions and no ceiling effect.
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Affiliation(s)
- Dayal Rajagopalan
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin
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27
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Fiorio M, Braga M, Marotta A, Villa-Sánchez B, Edwards MJ, Tinazzi M, Barbiani D. Functional neurological disorder and placebo and nocebo effects: shared mechanisms. Nat Rev Neurol 2022; 18:624-635. [PMID: 36075980 DOI: 10.1038/s41582-022-00711-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/09/2022]
Abstract
Functional neurological disorder (FND) is characterized by neurological symptoms that cannot be explained by a structural neurological cause. Among the different aetiological models that have been proposed for FND, of note is the Bayesian predictive coding model, which posits that perception relies on top-down cortical predictions (priors) to infer the source of incoming sensory information. This model can also apply to non-pathological experiences, such as placebo and nocebo effects, wherein sensory information is shaped by prior expectations and learning. To date, most studies of the relationship between placebo and nocebo effects and FND have focused on the use of placebos for diagnosis and treatment of FND. Here, we propose that this relationship might go beyond diagnosis and therapy. We develop a framework in which shared cognitive, personality and neuroanatomical factors justify the consideration of a deeper link between FND and placebo and nocebo effects. This new perspective might offer guidance for clarification of the pathogenesis of FND and for the identification of potential biomarkers and therapeutic targets.
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Affiliation(s)
- Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Miriam Braga
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Marotta
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Mark J Edwards
- Institute of Molecular and Clinical Sciences, St George's University of London, London, UK
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Diletta Barbiani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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28
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White patients' physical responses to healthcare treatments are influenced by provider race and gender. Proc Natl Acad Sci U S A 2022; 119:e2007717119. [PMID: 35749352 PMCID: PMC9271156 DOI: 10.1073/pnas.2007717119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The healthcare workforce in the United States is becoming increasingly diverse, gradually shifting society away from the historical overrepresentation of White men among physicians. However, given the long-standing underrepresentation of people of color and women in the medical field, patients may still associate the concept of doctors with White men and may be physiologically less responsive to treatment administered by providers from other backgrounds. To investigate this, we varied the race and gender of the provider from which White patients received identical treatment for allergic reactions and measured patients' improvement in response to this treatment, thus isolating how a provider's demographic characteristics shape physical responses to healthcare. A total of 187 White patients experiencing a laboratory-induced allergic reaction interacted with a healthcare provider who applied a treatment cream and told them it would relieve their allergic reaction. Unbeknownst to the patients, the cream was inert (an unscented lotion) and interactions were completely standardized except for the provider's race and gender. Patients were randomly assigned to interact with a provider who was a man or a woman and Asian, Black, or White. A fully blinded research assistant measured the change in the size of patients' allergic reaction after cream administration. Results indicated that White patients showed a weaker response to the standardized treatment over time when it was administered by women or Black providers. We explore several potential explanations for these varied physiological treatment responses and discuss the implications of problematic race and gender dynamics that can endure "under the skin," even for those who aim to be bias free.
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29
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Schwartz M, Fischer LM, Bläute C, Stork J, Colloca L, Zöllner C, Klinger R. Observing treatment outcomes in other patients can elicit augmented placebo effects on pain treatment: a double-blinded randomized clinical trial with patients with chronic low back pain. Pain 2022; 163:1313-1323. [PMID: 35262315 PMCID: PMC9199107 DOI: 10.1097/j.pain.0000000000002513] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/08/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Clinical research on social observational learning (SoL) as an underlying mechanism for inducing expectancy and eliciting analgesic placebo effects is lacking. This double-blinded randomized controlled clinical trial investigated the influence of SoL on medication-augmenting placebo effects in 44 patients with chronic low back pain. Our hypothesis was that observing positive drug effects on pain and mobility in another patient could increase pain reduction and functional capacity. To test this, we compared the effects of observing positive treatment outcomes in a sham patient (the social learning group [SoLG]) vs hearing the same sham patient report neutral effects (the control group). In the SoLG, the sham patient told peers about pain reduction due to amitriptyline and demonstrated his improved mobility by bending forwards and sideways while he told the control group only that he was taking amitriptyline. The primary outcome was a reduction in clinical low back pain self-ratings. The secondary outcome was perceptions of pain-related disability. The exploratory outcome was mood and coping statements. Data collection occurred before and after the intervention and 2 weeks later. After the intervention, pain decreased in both groups (F [1, 41] = 7.16, P < 0.05, d = 0.83), with no difference between groups. However, the SoLG showed a significantly larger decrease in perceived disability (F [1, 41] = 5, P < 0.05, d = 0.63). The direct observation of patient with chronic low back pain of positive treatment outcomes in the sham patient seems to have enhanced the treatment effects while indirect verbal reports of reduced pain did not.
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Affiliation(s)
- Marie Schwartz
- Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Laura-Marie Fischer
- Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Corinna Bläute
- Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Jan Stork
- Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Luana Colloca
- University of Maryland School of Nursing & School of Medicine, Baltimore, MD, United States
| | - Christian Zöllner
- Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Regine Klinger
- Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Germany
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30
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Schamong I, Bollmann S, Struck N, Kube T, D’Astolfo L, Brakemeier EL. Can we Modulate Therapeutic Interpersonal Style Experimentally to Address Alliance? A Proof-of-Concept Study. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Background
With a lack of experimental designs that explore which therapeutic style is helpful for which patient, the aim of this study was to test the feasibility of experimentally varying the therapeutic style under realistic conditions and to investigate how this affects alliance ratings by clients and counselors.
Methods
We defined two manualized therapeutic styles (neutral/distant relational style vs. high affiliation relational style) based on the interpersonal circumplex. In a randomized two-group design, 64 healthy university students (70% female, Mage = 23.78, SDage = 2.81) received a single psychological counseling session on interpersonal conflicts by one of four counselors and in one of the two styles. We checked the manipulation success using observer-rated degree of affiliation and ratings of counselors’ interpersonal behavior with the Interpersonal Message Inventory (IMI-R). A series of linear regression models analyzed whether the style predicted working alliance, assessed via the Working Alliance Inventory (WAI).
Results
In accordance with the hypotheses, significant differences in the rated degree of affiliation (p ≤ .001) and IMI-R ratings (p ≤ .001 in friendly, p = .003 in hostile dimension) were found between the two groups. Overall, alliance ratings were high across groups and raters (WAI overall scores ranging from 3.76 to 4.07). The style did not predict clients’ alliance ratings.
Conclusion
The experimental variation of the therapeutic style proved feasible under realistic conditions with high overall alliance ratings. The novel experimental design may provide a basis for further research.
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31
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Itskovich E, Bowling DL, Garner JP, Parker KJ. Oxytocin and the social facilitation of placebo effects. Mol Psychiatry 2022; 27:2640-2649. [PMID: 35338314 PMCID: PMC9167259 DOI: 10.1038/s41380-022-01515-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/16/2022] [Accepted: 02/25/2022] [Indexed: 01/30/2023]
Abstract
Significant clinical improvement is often observed in patients who receive placebo treatment in randomized double-blind placebo-controlled trials. While a proportion of this "improvement" reflects experimental design limitations (e.g., reliance on subjective outcomes, unbalanced groups, reporting biases), some of it reflects genuine improvement corroborated by physiological change. Converging evidence across diverse medical conditions suggests that clinically-relevant benefits from placebo treatment are associated with the activation of brain reward circuits. In parallel, evidence has accumulated showing that such benefits are facilitated by clinicians that demonstrate warmth and proficiency during interactions with patients. Here, we integrate research on these neural and social aspects of placebo effects with evidence linking oxytocin and social reward to advance a neurobiological account for the social facilitation of placebo effects. This account frames oxytocin as a key mediator of treatment success across a wide-spectrum of interventions that increase social connectedness, thereby providing a biological basis for assessing this fundamental non-specific element of medical care.
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Affiliation(s)
- Elena Itskovich
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305
| | - Daniel L. Bowling
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305
| | - Joseph P. Garner
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305.,Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA 94305
| | - Karen J. Parker
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305.,Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA 94305
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32
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Tanaka T, Hayashida K, Morioka S. Verbal Suggestion Modulates the Sense of Ownership and Heat Pain Threshold During the "Injured" Rubber Hand Illusion. Front Hum Neurosci 2022; 16:837496. [PMID: 35547193 PMCID: PMC9082029 DOI: 10.3389/fnhum.2022.837496] [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: 12/16/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
The appearance of the self-body influences the feeling that one's body belongs to oneself, that is, a sense of ownership (SoO) and pain perception. This can be identified by measuring the SoO and pain thresholds after performing the rubber hand illusion (RHI) with an injured rubber hand. The generation of SoO is thought to be caused by multisensory integration of bottom-up factors (vision, proprioceptive, and touch), and by top-down factors, such as the context effect. The appearance is one of the context effects which may become more effective when used simultaneously with other context effects (e.g., verbal suggestion). However, in the RHI, when appearance and other context effects are used simultaneously, the effect is unclear. In this study, we attempted to identify the influence of verbal suggestion on the SoO and heat pain threshold (HPT). As a preliminary step, in Experiment 1, the "normal" rubber hand and "penetrated nail" as injured rubber hand were used to clarify the context effect with appearance alone during RHI (synchronous/asynchronous), which was conducted within-subjects. In Experiment 2, we only used the "penetrated nail" rubber hand to clarify the context effect with verbal suggestion and appearance during RHI. We randomly classified participants into two suggestion groups ("fear" and "no-fear"). The RHI (synchronous/asynchronous) was conducted for each group. In each experiment, the effect of each condition was assessed by subjective measures of SoO, such as questionnaire, and objective measures of SoO, such as proprioceptive drift and electrodermal activity. Following RHI in each condition, HPT was measured. The main finding was that, in the synchronous condition, the "penetrated nail" appearance with "fear" verbal suggestion modulated questionnaire and HPT, but not electrodermal activity. We conclude that the context-included multisensory integration affected the subjective factors because it contains a higher cognitive process by verbal suggestion.
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Affiliation(s)
- Tomoya Tanaka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Koryo, Japan
- Department of Rehabilitation, Fukuchiyama City Hospital, Fukuchiyama, Japan
| | - Kazuki Hayashida
- Neurorehabilitation Research Center, Kio University, Koryo, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Koryo, Japan
- Neurorehabilitation Research Center, Kio University, Koryo, Japan
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33
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Wang Z, Zhang Y, Li Q, Zou Q, Liu Q. A road map for happiness: The psychological factors related cell types in various parts of human body from single cell RNA-seq data analysis. Comput Biol Med 2022; 143:105286. [PMID: 35183972 DOI: 10.1016/j.compbiomed.2022.105286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/16/2022] [Accepted: 01/24/2022] [Indexed: 12/13/2022]
Abstract
Massive evidence from all sources including zoology, neurobiology and immunology has confirmed that psychological factors can raise remarkable physiological effects. Researchers have long been aware of the potential value of these effects and wanted to harness them in the development of new drugs and therapies, for which the mechanism study is a necessary prerequisite. However, most of these studies are restricted to neuroscience, or starts with blood sample and fall into the area of immunity. In this study, we choose to focus on the psychological factor of happiness, mining existing publicly available single cell RNA sequencing (scRNA-seq) data for the expression of happiness-related genes collected from various sources of literature in all types of cells in the samples, finding that the expression of these genes is not restricted within neuro-regulated cells or tissue-resident immune cells, on the opposite, cell types that are unique to tissue and organ without direct regulation from nervous system account for the majority to express the happiness-related genes. Our research is a preliminary exploration of where our body respond to our mind at cell level, and lays the foundation for more detailed mechanism research.
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Affiliation(s)
- Ziwei Wang
- Institute of Fundamental and Frontier Sciences, University of Electronic Science and Technology, China
| | - Ying Zhang
- Department of Anesthesiology, Hospital T.C.M Affiliated to Southwest Medical University, Luzhou, China
| | - Qun Li
- Department of Pain, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Quan Zou
- Institute of Fundamental and Frontier Sciences, University of Electronic Science and Technology, China; Yangtze Delta Region Institute Quzhou, University of Electronic Science and Technology of China, Quzhou, Zhejiang, China.
| | - Qing Liu
- Department of Algology, Hospital T.C.M Affiliated to Southwest Medical University, Luzhou, China.
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Friehs T, Rief W, Glombiewski JA, Haas J, Kube T. Deceptive and non-deceptive placebos to reduce sadness: A five-armed experimental study. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Heiss U, Rosenfield M, Bernstein MH. Can the Open Label Placebo Rationale Be Optimized? FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 2:734882. [PMID: 35295434 PMCID: PMC8915569 DOI: 10.3389/fpain.2021.734882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Uwe Heiss
- Zeebo Effect, LLC, Burlington, VT, United States
| | - Maayan Rosenfield
- School of Public Health, Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
| | - Michael H Bernstein
- School of Public Health, Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
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Watanabe T, Sieg M, Lunde SJ, Taneja P, Baad-Hansen L, Pigg M, Vase L. What is the nocebo effect and does it apply to dentistry? A narrative review. J Oral Rehabil 2022; 49:586-591. [PMID: 35043415 PMCID: PMC9310768 DOI: 10.1111/joor.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/08/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
Background Evidence for the nocebo effect, a phenomenon characterised by suboptimal treatment efficacy, worsening of symptoms, or the occurrence of adverse events caused by an individual’s negative treatment expectations, is growing across a multitude of medical fields. However, little attention has been paid to patients’ negative expectations and the nocebo effect within dentistry. Aim This review summarises essential evidence of the nocebo phenomenon especially in relation to pain and drug administration. Subsequently, an overview of the current evidence of the nocebo phenomenon in the dental field is presented. Methods A PubMed search was performed using keywords related to “nocebo,” “placebo,” “expectations,” and “dentistry.” In addition to the articles selected from the search, placebo/nocebo researchers and dental researchers added important references from their respective fields. Results Although research on the nocebo effect in dentistry is limited, available current evidence suggests that the factors, which is related to the nocebo effect are likely to play a role in dental practice. Conclusion Preliminary evidence from the review warrants further investigation into the nocebo effect in dentistry. Finally, based on the general knowledge of the nocebo effect, the review indicates fruitful arrays of research into the nocebo effect in dentistry.
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Affiliation(s)
- Takeshi Watanabe
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark.,Department of Preventive Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Mette Sieg
- 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
| | - Pankaj Taneja
- Section of Oral and Maxillofacial Surgery and Oral Pathology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center of Orofacial Neurosciences, Aarhus, Denmark, Malmö, Sweden
| | - Lene Baad-Hansen
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center of Orofacial Neurosciences, Aarhus, Denmark, Malmö, Sweden
| | - Maria Pigg
- Scandinavian Center of Orofacial Neurosciences, Aarhus, Denmark, Malmö, Sweden.,Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
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Yetman HE, Cox N, Adler SR, Hall KT, Stone VE. What Do Placebo and Nocebo Effects Have to Do With Health Equity? The Hidden Toll of Nocebo Effects on Racial and Ethnic Minority Patients in Clinical Care. Front Psychol 2022; 12:788230. [PMID: 35002881 PMCID: PMC8733207 DOI: 10.3389/fpsyg.2021.788230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022] Open
Abstract
A placebo effect is a positive clinical response to non-specific elements of treatment with a sham or inert replica of a drug, device, or surgical intervention. There is considerable evidence that placebo effects are driven by expectation of benefit from the intervention. Expectation is shaped by a patient's past experience, observations of the experience of others, and written, verbal, or non-verbal information communicated during treatment. Not surprisingly, expectation in the clinical setting is strongly influenced by the attitude, affect, and communication style of the healthcare provider. While positive expectations can produce beneficial effects, negative information and experiences can lead to negative expectations, and consequently negative or nocebo effects. Key components identified and studied in the placebo and nocebo literature intersect with factors identified as barriers to quality care in the clinical setting for Black patients and other patients of color, including poor patient-clinician communication, medical mistrust, and perceived discrimination. Thus, in the context of discrimination and bias, the absence of placebo and presence of nocebo-generating influences in clinical settings could potentially reinforce racial and ethnic inequities in clinical outcomes and care. Healthcare inequities have consequences that ripple through the medical system, strengthening adverse short- and long-term outcomes. Here, we examine the potential for the presence of nocebo effects and absence of placebo effects to play a role in contributing to negative outcomes related to unequal treatment in the clinical encounter.
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Affiliation(s)
- Hailey E Yetman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Nevada Cox
- Penn State College of Medicine, Hershey, PA, United States
| | - Shelley R Adler
- Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA, United States
| | - Kathryn T Hall
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Valerie E Stone
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
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Sezer D, de Leeuw M, Netzer C, Dieterle M, Meyer A, Buergler S, Locher C, Ruppen W, Gaab J, Schneider T. Open-Label Placebo Treatment for Acute Postoperative Pain (OLP-POP Study): Study Protocol of a Randomized Controlled Trial. Front Med (Lausanne) 2021; 8:687398. [PMID: 34805194 PMCID: PMC8602681 DOI: 10.3389/fmed.2021.687398] [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: 03/29/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Open-label placebos have been proposed as way of using long recognized analgesic placebo effects in an ethical manner. Recent evidence shows efficacy of open-label placebos for clinical conditions, but there is need for more research on open-label placebos in acute pain. In the treatment of acute postoperative pain, minimization of opioid related side effects remains one of the key challenges. Therefore, this study aims at investigating the potential of adding unconditioned open-label placebos to treatment as usual as a means of reducing opioid consumption and its related side effects in patients with acute postoperative pain. Methods and Analysis: This is the protocol of an ongoing single site randomized controlled trial. The first patient was enrolled in May 2020. In total, 70 patients suffering from acute postoperative pain following dorsal lumbar interbody fusion are randomized to either a treatment as usual group or an experimental intervention group. The treatment as usual group consists of participants receiving a patient-controlled morphine pump. On day 1 and 2 post-surgery, patients in the intervention group receive, in addition to treatment as usual, two open-label placebo injections per day along with an evidence-based treatment rationale explaining the mechanisms of placebos. The primary outcome is measured by means of self-administered morphine during day 1 and 2 post-surgery. Several other outcome measures including pain intensity and adverse events as well as potential predictors of placebo response are assessed. Analysis of covariance will be used to answer the primary research question and additional statistical techniques such as generalized linear mixed models will be applied to model the temporal course of morphine consumption. Discussion: This study will provide valuable insights into the efficacy of open-label placebos in acute pain and will potentially constitute an important step toward the implementation of open-label placebos in the clinical management of acute postoperative pain. In addition, it will shed light on a cost-efficient and patient-centered strategy to reduce opioid consumption and its related side effects, without any loss in pain management efficacy. Ethics and Dissemination: The "Ethikkommission Nordwest- und Zentralschweiz" (BASEC2020-00099) approved the study protocol. Results of the analysis will be submitted for publication in a peer-reviewed journal. Clinical Trial Registration: The study is registered at ClinicalTrials.gov (NCT04339023) and is listed in the Swiss national registry at kofam.ch (SNCTP000003720).
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Affiliation(s)
- Dilan Sezer
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Matthijs de Leeuw
- Pain Unit, Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
| | - Cordula Netzer
- Department of Spine Surgery, University Hospital of Basel, Basel, Switzerland
| | - Markus Dieterle
- Pain Unit, Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
| | - Andrea Meyer
- Division of Clinical Psychology and Epidemiology, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Sarah Buergler
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Wilhelm Ruppen
- Pain Unit, Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Tobias Schneider
- Pain Unit, Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
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Atlas LY. A social affective neuroscience lens on placebo analgesia. Trends Cogn Sci 2021; 25:992-1005. [PMID: 34538720 PMCID: PMC8516707 DOI: 10.1016/j.tics.2021.07.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/26/2022]
Abstract
Pain is a fundamental experience that promotes survival. In humans, pain stands at the intersection of multiple health crises: chronic pain, the opioid epidemic, and health disparities. The study of placebo analgesia highlights how social, cognitive, and affective processes can directly shape pain, and identifies potential paths for mitigating these crises. This review examines recent progress in the study of placebo analgesia through affective science. It focuses on how placebo effects are shaped by expectations, affect, and the social context surrounding treatment, and discusses neurobiological mechanisms of placebo, highlighting unanswered questions and implications for health. Collaborations between clinicians and social and affective scientists can address outstanding questions and leverage placebo to reduce pain and improve human health.
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Affiliation(s)
- Lauren Y Atlas
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA; National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA; National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA.
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40
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Drossman DA, Chang L, Deutsch JK, Ford AC, Halpert A, Kroenke K, Nurko S, Ruddy J, Snyder J, Sperber A. A Review of the Evidence and Recommendations on Communication Skills and the Patient-Provider Relationship: A Rome Foundation Working Team Report. Gastroenterology 2021; 161:1670-1688.e7. [PMID: 34331912 DOI: 10.1053/j.gastro.2021.07.037] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Over several decades, changes in health care have negatively impacted meaningful communication between the patient and provider and adversely affected their relationship. Under increasing time pressure, physicians rely more on technology than face-to-face time gathering data to make clinical decisions. As a result, they find it more challenging to understand the illness context and fully address patient needs. Patients experience dissatisfaction and a diminution of their role in the care process. For patients with disorders of gut-brain interaction, stigma leads to greater care dissatisfaction, as there is no apparent structural basis to legitimize the symptoms. Recent evidence suggests that practical communication skills can improve the patient-provider relationship (PPR) and clinical outcomes, but these data are limited. METHODS The Rome Foundation convened a multidisciplinary working team to review the scientific evidence with the following aims: a) to study the effect of communication skills on patient satisfaction and outcomes by performing an evidence-based review; b) to characterize the influence of sociocultural factors, health care system constraints, patient perspective, and telehealth on the PPR; c) to review the measurement and impact of communication skills training on these outcomes; and d) to make recommendations to improve communication skills training and the PPR. RESULTS Evidence supports the fact that interventions targeting patient-provider interactions improve population health, patient and provider experience, and costs. Communication skills training leads to improved patient satisfaction and outcomes. The following are relevant factors to consider in establishing an effective PPR: addressing health care system constraints; incorporating sociocultural factors and the role of gender, age, and chronic illness; and considering the changing role of telehealth on the PPR. CONCLUSIONS We concluded that effective communication skills can improve the PPR and health outcomes. This is an achievable goal through training and system change. More research is needed to confirm these findings.
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Affiliation(s)
- Douglas A Drossman
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, and the Rome Foundation, Chapel Hill, North Carolina.
| | - Lin Chang
- Vatche and Tamar Manoukian Division of Digestive Diseases, G. Opopenbhemer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, Calfornia
| | - Jill K Deutsch
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Alexander C Ford
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK; Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
| | - Albena Halpert
- Gastroenterology,Harvard University Health Services, Boston, Massachusetts
| | - Kurt Kroenke
- Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - Johannah Ruddy
- Center for Education and Practice of Biopsychosocial Care and Rome Foundation, Raleigh, North Carolina
| | - Julie Snyder
- Gastrointetinal Psychology Service, Boston University, Harvard Medical School, Boston, Massachusetts
| | - Ami Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Niszczota P, Petrova D. Treatment choice in the presence of conflicting information: The role of physician likeability in the choice of non-proven therapies against conventional treatment. Br J Health Psychol 2021; 27:501-515. [PMID: 34542194 DOI: 10.1111/bjhp.12559] [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: 04/09/2020] [Revised: 09/02/2021] [Indexed: 11/27/2022]
Abstract
Research on why patients sometimes choose non-proven therapies (NPT) instead of conventional treatments is limited. We investigated how physician likeability influences the choice of NPT instead of conventional treatment. In an experiment with three medical scenarios, participants (N = 384) consulted two physicians who gave conflicting recommendations: The first physician recommended a conventional treatment and the second one recommended a NPT. We manipulated the likeability of the first physician, who was either likeable or unlikeable. Using mediation analyses, we explored how the effect of likeability was channelled and whether time pressure influenced treatment choice. Participants chose the NPT more often (OR = 1.43, 95% CI [1.03-2.00]), had more positive affective responses, and perceived more benefit from NPT when the conventional treatment was recommended by an unlikeable (vs. likeable) physician. Time pressure had no effect on treatment choice. Physicians' likeability might play an important role in treatment choice in the presence of conflicting information. Providers should be cognizant that poor communication might push patients to prefer the advice of more likeable physicians, even when they prescribe NPT instead of conventional treatment.
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Affiliation(s)
| | - Dafina Petrova
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Andalusian School of Public Health (Escuela Andaluza de Salud Pública), Granada, Spain.,Biomedical Research Institute ibs.GRANADA (Instituto de Investigación Biosanitaria ibs.GRANADA), Spain.,University of Granada, Spain
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42
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Zhang J, Li Z, Li Z, Li J, Hu Q, Xu J, Yu H. Progress of Acupuncture Therapy in Diseases Based on Magnetic Resonance Image Studies: A Literature Review. Front Hum Neurosci 2021; 15:694919. [PMID: 34489662 PMCID: PMC8417610 DOI: 10.3389/fnhum.2021.694919] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/21/2021] [Indexed: 01/18/2023] Open
Abstract
The neural mechanisms of acupuncture are not well-understood. Over the past decades, an increasing number of studies have used MRI to investigate the response of the brain to acupuncture. The current review aims to provide an update on acupuncture therapy in disease. The PubMed, Embase, Web of Science, and Cochrane Library databases were searched from inception to January 31, 2021. Article selection and data extraction were conducted by two review authors. A total of 107 publications about MRI in acupuncture were included, the collective findings of which were as follows: (1) stroke and GB34 (Yanglingquan) are the most studied disease and acupoint. Related studies suggested that the mechanism of acupuncture treatment for stroke may associate with structural and functional plasticity, left and right hemispheres balance, and activation of brain areas related to movement and cognition. GB34 is mainly used in stroke and Parkinson's disease, which mainly activates brain response in the premotor cortex, the supplementary motor area, and the supramarginal gyrus; (2) resting-state functional MRI (rs-fMRI) and functional connectivity (FC) analysis are the most frequently used approaches; (3) estimates of efficacy and brain response to acupuncture depend on the type of sham acupuncture (SA) used for comparison. Brain processing after acupuncture differs between patients and health controls (HC) and occurs mainly in disorder-related areas. Factors that influence the effect of acupuncture include depth of needling, number and locations of acupoints, and deqi and expectation effect, each contributing to the brain response. While studies using MRI have increased understanding of the mechanism underlying the effects of acupuncture, there is scope for development in this field. Due to the small sample sizes, heterogeneous study designs, and analytical methods, the results were inconsistent. Further studies with larger sample sizes, careful experimental design, multimodal neuroimaging techniques, and standardized methods should be conducted to better explain the efficacy and specificity of acupuncture, and to prepare for accurate efficacy prediction in the future.
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Affiliation(s)
- Jinhuan Zhang
- Department of Acupuncture, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Zihan Li
- Department of Acupuncture, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Zhixian Li
- Department of Acupuncture, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jiaying Li
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Chinese Academy of Sciences (CAS) Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Haibo Yu
- Department of Acupuncture, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
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Wampold BE. Healing in a Social Context: The Importance of Clinician and Patient Relationship. FRONTIERS IN PAIN RESEARCH 2021; 2:684768. [PMID: 35295467 PMCID: PMC8915743 DOI: 10.3389/fpain.2021.684768] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/18/2021] [Indexed: 12/13/2022] Open
Abstract
When a patient presents to a health provider, the course of the disorder is composed of three effects: natural effects, specific effects, and contextual effects. Part of the contextual effect is due to the relationship between the healer and the patient. Social healing appears to be present in eusocial species and particularly well-developed in humans. Evidence for the importance of the relationship in healing is found in placebo studies, including placebo analgesics, medicine, and psychotherapy. Although the theory for how the relationship is therapeutic is not well-developed, four possible mechanisms are discussed. The implications for health care and the treatment of pain are discussed.
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Affiliation(s)
- Bruce E. Wampold
- Modum Bad Psychiatric Center, Research Institute, Vikersund, Norway
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, United States
- *Correspondence: Bruce E. Wampold
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Expectations about pain and analgesic treatment are shaped by medical providers' facial appearances: Evidence from five online clinical simulation experiments. Soc Sci Med 2021; 281:114091. [PMID: 34126294 DOI: 10.1016/j.socscimed.2021.114091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/23/2021] [Accepted: 05/29/2021] [Indexed: 11/23/2022]
Abstract
RATIONALE There is a robust link between patients' expectations and clinical outcomes, as evidenced by the placebo effect. Expectations depend in large part on the context surrounding treatment, including the patient-provider interaction. Prior work indicates that providers' behavior and characteristics, including warmth and competence, can shape patient outcomes. Yet humans rapidly form trait impressions of others before any in-person interaction. It is unknown whether these first impressions influence subsequent health care choices and expectations. OBJECTIVE Our goal was to test whether trait impressions of hypothetical medical providers, based exclusively on facial images, influence the choice of medical providers and expectations about pain and analgesia following hypothetical painful medical procedures. METHOD Across five online experiments, participants (total N = 1108) viewed and made judgments about hypothetical healthcare providers. Experiments 1-4 included computer-generated faces that varied in features associated with competence, while experiment 5 included real faces. We measured how apparent competence affected expectations about pain and anticipated analgesic use in all studies. We also measured warmth and similarity. RESULTS Across five online studies, participants selected providers who appeared more competent, based on facial visual information alone. Further, providers' apparent competence predicted participants' expectations about post-procedural pain and medication use. Participants' perception of their similarity to providers also shaped expectations about pain and treatment outcomes. CONCLUSIONS Results from our experimental simulations suggest that humans develop expectations about pain and health outcomes before even setting foot in the clinic, based exclusively on first impressions. These findings have strong implications for health care, as individuals increasingly rely on digital services to select healthcare providers and even receive treatment, a trend that is exacerbated as the world embraces telemedicine.
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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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Wilhelm M, Euteneuer F. Does Health Literacy Make a Difference? Comparing the Effect of Conventional Medicine Versus Homeopathic Prescribing on Treatment Credibility and Expectancy. Front Psychol 2021; 12:581255. [PMID: 34140910 PMCID: PMC8204743 DOI: 10.3389/fpsyg.2021.581255] [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: 07/08/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objective While homeopathic remedies are often used to treat non-specific complaints such as headaches, empirical evidence suggests their treatment effect is due to the placebo effect. Low health literacy seems to be connected to higher use of complementary and alternative medicine (CAM). The aim of this study was to examine what people with occasional headaches expect from conventional medicine or homeopathic remedies and if health literacy interacts with this expectation. Methods In this experimental study, n = 582 participants with occasional headaches were randomized to read one of two vignettes, which described the prescription of either conventional medicine or a homeopathic remedy. Subsequently, the participants were asked to rate treatment credibility and expectancy with regard to their assigned vignette. Health literacy was assessed as a potential moderator. Results Participants in the conventional medicine group rated treatment credibility and expectancy higher than in the homeopathic remedy group. Moderation analysis revealed that when being offered conventional medicine, participant reports of treatment credibility and expectancy decreased with lower health literacy, while these outcomes increased with lower health literacy for homeopathic remedies. Discussion People with occasional headaches estimate the effectiveness of conventional medication properly. However, health care professionals should pay special attention to patients with low health literacy, as they might need more time and information to give their informed consent.
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Affiliation(s)
- Marcel Wilhelm
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Frank Euteneuer
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.,Department of Psychology, Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
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Bishop F, Al-Abbadey M, Roberts L, MacPherson H, Stuart B, Carnes D, Fawkes C, Yardley L, Bradbury K. Direct and mediated effects of treatment context on low back pain outcome: a prospective cohort study. BMJ Open 2021; 11:e044831. [PMID: 34006548 PMCID: PMC8130743 DOI: 10.1136/bmjopen-2020-044831] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Contextual components of treatment previously associated with patient outcomes include the environment, therapeutic relationship and expectancies. Questions remain about which components are most important, how they influence outcomes and comparative effects across treatment approaches. We aimed to identify significant and strong contextual predictors of patient outcomes, test for psychological mediators and compare effects across three treatment approaches. DESIGN Prospective cohort study with patient-reported and practitioner-reported questionnaire data (online or paper) collected at first consultation, 2 weeks and 3 months. SETTING Physiotherapy, osteopathy and acupuncture clinics throughout the UK. PARTICIPANTS 166 practitioners (65 physiotherapists, 46 osteopaths, 55 acupuncturists) were recruited via their professional organisations. Practitioners recruited 960 adult patients seeking treatment for low back pain (LBP). PRIMARY AND SECONDARY OUTCOMES The primary outcome was back-related disability. Secondary outcomes were pain and well-being. Contextual components measured were: therapeutic alliance; patient satisfaction with appointment systems, access, facilities; patients' treatment beliefs including outcome expectancies; practitioners' attitudes to LBP and practitioners' patient-specific outcome expectancies. The hypothesised mediators measured were: patient self-efficacy for pain management; patient perceptions of LBP and psychosocial distress. RESULTS After controlling for baseline and potential confounders, statistically significant predictors of reduced back-related disability were: all three dimensions of stronger therapeutic alliance (goal, task and bond); higher patient satisfaction with appointment systems; reduced patient-perceived treatment credibility and increased practitioner-rated outcome expectancies. Therapeutic alliance over task (ηp2=0.10, 95% CI 0.07 to 0.14) and practitioner-rated outcome expectancies (ηp2=0.08, 95% CI 0.05 to 0.11) demonstrated the largest effect sizes. Patients' self-efficacy, LBP perceptions and psychosocial distress partially mediated these relationships. There were no interactions with treatment approach. CONCLUSIONS Enhancing contextual components in musculoskeletal healthcare could improve patient outcomes. Interventions should focus on helping practitioners and patients forge effective therapeutic alliances with strong affective bonds and agreement on treatment goals and how to achieve them.
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Affiliation(s)
- Felicity Bishop
- Department of Psychology, University of Southampton, Southampton, UK
| | - Miznah Al-Abbadey
- Department of Psychology, University of Southampton, Southampton, UK
- Department of Psychology, University of Portsmouth, Portsmouth, UK
| | - Lisa Roberts
- Health Sciences, University of Southampton, Southampton, UK
- Therapy Services, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Beth Stuart
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Dawn Carnes
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Carol Fawkes
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
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Blackburn J, van der Oest MJW, Chen NC, Feitz R, Duraku LS, Zuidam JM, Vranceanu AM, Selles RW. Are Patient Expectations and Illness Perception Associated with Patient-reported Outcomes from Surgical Decompression in de Quervain's Tenosynovitis? Clin Orthop Relat Res 2021; 479:1147-1155. [PMID: 33861217 PMCID: PMC8052037 DOI: 10.1097/corr.0000000000001577] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Psychological factors such as depression, pain catastrophizing, kinesiophobia, pain anxiety, and more negative illness perceptions are associated with worse pain and function in patients at the start of treatment for de Quervain's tenosynovitis. Longitudinal studies have found symptoms of depression and pain catastrophizing at baseline were associated with worse pain after treatment. It is important to study patients opting for surgery for their condition because patients should choose surgical treatment based on their values rather than misconceptions. Psychological factors associated with worse patient-reported outcomes from surgery for de Quervain's tenosynovitis should be identified and addressed preoperatively so surgeons can correct any misunderstandings about the condition. QUESTION/PURPOSE What preoperative psychosocial factors (depression, anxiety, pain catastrophizing, illness perception, and patient expectations) are associated with pain and function 3 months after surgical treatment of de Quervain's tenosynovitis after controlling for demographic characteristics? METHODS This was a prospective cohort study of 164 patients who underwent surgery for de Quervain's tenosynovitis between September 2017 and October 2018 performed by 20 hand surgeons at 18 centers. Our database included 326 patients who underwent surgery for de Quervain's tenosynovitis during the study period. Of these, 62% (201 of 326) completed all baseline questionnaires and 50% (164 of 326) also completed patient-reported outcomes at 3 months postoperatively. We found no difference between those included and those not analyzed in terms of age, sex, duration of symptoms, smoking status, and workload. The mean ± SD age of the patients was 52 ± 14 years, 86% (141 of 164) were women, and the mean duration of symptoms was 13 ± 19 months. Patients completed the Patient-Rated Wrist Evaluation (PRWE), the VAS for pain and function, the Patient Health Questionnaire for symptoms of anxiety and depression, the Pain Catastrophizing Scale, the Credibility/Expectations Questionnaire, and the Brief Illness Perceptions questionnaire at baseline. Patients also completed the PRWE and VAS for pain and function at 3 months postoperatively. We used a hierarchical multivariable linear regression model to investigate the relative contribution of patient demographics and psychosocial factors to the pain and functional outcome at 3 months postoperatively. RESULTS After adjusting for demographic characteristics, psychosocial factors, and baseline PRWE score, we found that only the patient's expectations of treatment and how long their illness would last were associated with the total PRWE score at 3 months postoperatively. More positive patient expectations of treatment were associated with better patient-reported pain and function at 3 months postoperatively (ß = -2.0; p < 0.01), while more negative patient perceptions of how long their condition would last were associated with worse patient-reported pain and function (timeline ß = 2.7; p < 0.01). The final model accounted for 31% of the variance in the patient-reported outcome at 3 months postoperatively. CONCLUSION Patient expectations and illness perceptions are associated with patient-reported pain and functional outcomes after surgical decompression for de Quervain's tenosynovitis. Addressing misconceptions about de Quervain's tenosynovitis in terms of the consequences for patients and how long their symptoms will last should allow patients to make informed decisions about the treatment that best matches their values. Prospective studies are needed to investigate whether addressing patient expectations and illness perceptions, with decision aids for example, can improve patient-reported pain and function postoperatively in those patients who still choose surgery for de Quervain's tenosynovitis. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Julia Blackburn
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Mark J W van der Oest
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Neal C Chen
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Reinier Feitz
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Liron S Duraku
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - J Michiel Zuidam
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Ana-Maria Vranceanu
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Ruud W Selles
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
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Leach MJ. Development and validation of the ADVANCER framework for naturopathic education and practice: A delphi study. Complement Ther Clin Pract 2021; 44:101397. [PMID: 33940334 DOI: 10.1016/j.ctcp.2021.101397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/08/2021] [Accepted: 04/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND There has been little attempt to date to narrow the education-practice gap in naturopathic medicine. A framework that brings naturopathic medicine education and practice closer together could help codify the knowledge of naturopathic medicine by providing simultaneous guidance on curriculum development and clinical decision-making in the discipline. OBJECTIVE To develop, refine and validate the Advancing Naturopathic Education and Practice (ADVANCER) framework. METHODS Published literature and pertinent government, professional association and institutional websites were scoped to identify key constructs for the ADVANCER framework. The constructs were grouped into ten domains, with each domain defined and translated into teaching and clinical practice outcomes. A two-round e-Delphi method, comprising international experts in naturopathic medicine education, was used to refine and validate the framework definitions and outcomes. RESULTS Sixteen academics, from five different countries, participated in the Delphi study. In round one, nine of the ten domains of the ADVANCER framework were rated as either very important or extremely important by 81.2% of participants. Only 68.8% of participants rated the tenth domain as either very important or extremely important. Participant feedback on each domain were pooled and reviewed, and where suggested changes were recommended by more than one participant, respective definitions and outcomes of each domain were amended. In round two, at least 90% of participants rated each domain of the amended ADVANCER framework as either very important or extremely important, meaning consensus to retain these domains, definitions and outcomes had been reached. CONCLUSIONS The study findings indicate that the ADVANCER framework is conceptually sound and potentially applicable to diverse institutions and countries. An important next step of this research is to establish whether implementation of the ADVANCER framework within naturopathic medicine education and practice is feasible, effective and sustainable.
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Affiliation(s)
- Matthew J Leach
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia.
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Thomas JG, Sharp PB, Niznikiewicz MA, Heller W. A double-blind study of empathic support and expectation as mechanisms of symptom change. Psychother Res 2021; 32:128-138. [PMID: 33844622 DOI: 10.1080/10503307.2021.1909770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Objective: A novel brief intervention was used to investigate how empathic support and expectation can induce changes in mood, anxiety, and perceived stress. Method: Seventy-six undergraduates with high negative affect were assigned to three conditions of a program involving tasks with no known therapeutic benefit. In Group 1: Expectation Only, participants were given a deceptive description of the benefits of the program to quantify the magnitude of symptom change due to expectation alone. In Group 2: Empathic Support + Expectation, participants were also instructed to write about past and current sources of distress and provided with supportive notes each week to quantify the role of empathic support plus expectation. In Group 3: Control, participants were told they were "norming" the instruments. Results: Participants in Groups 1 and 2 demonstrated decreases in depression, anxiety, and rumination, with significant medium effect reductions found in the empathic support plus expectation condition. Conclusions: Evidence suggests that empathic support and expectation cause reduction of symptoms spanning depression and anxiety.
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Affiliation(s)
- Joel G Thomas
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Paul B Sharp
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
| | | | - Wendy Heller
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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