1
|
Augustat N, Endres D, Mueller EM. Uncertainty of treatment efficacy moderates placebo effects on reinforcement learning. Sci Rep 2024; 14:14421. [PMID: 38909105 PMCID: PMC11193823 DOI: 10.1038/s41598-024-64240-z] [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: 06/02/2023] [Accepted: 06/06/2024] [Indexed: 06/24/2024] Open
Abstract
The placebo-reward hypothesis postulates that positive effects of treatment expectations on health (i.e., placebo effects) and reward processing share common neural underpinnings. Moreover, experiments in humans and animals indicate that reward uncertainty increases striatal dopamine, which is presumably involved in placebo responses and reward learning. Therefore, treatment uncertainty analogously to reward uncertainty may affect updating from rewards after placebo treatment. Here, we address whether different degrees of uncertainty regarding the efficacy of a sham treatment affect reward sensitivity. In an online between-subjects experiment with N = 141 participants, we systematically varied the provided efficacy instructions before participants first received a sham treatment that consisted of listening to binaural beats and then performed a probabilistic reinforcement learning task. We fitted a Q-learning model including two different learning rates for positive (gain) and negative (loss) reward prediction errors and an inverse gain parameter to behavioral decision data in the reinforcement learning task. Our results yielded an inverted-U-relationship between provided treatment efficacy probability and learning rates for gain, such that higher levels of treatment uncertainty, rather than of expected net efficacy, affect presumably dopamine-related reward learning. These findings support the placebo-reward hypothesis and suggest harnessing uncertainty in placebo treatment for recovering reward learning capabilities.
Collapse
Affiliation(s)
- Nick Augustat
- Department of Psychology, University of Marburg, Marburg, Germany.
| | - Dominik Endres
- Department of Psychology, University of Marburg, Marburg, Germany
| | - Erik M Mueller
- Department of Psychology, University of Marburg, Marburg, Germany
| |
Collapse
|
2
|
Teymoori H, Amiri E, Tahmasebi W, Hoseini R, Grospretre S, Machado DGDS. Effect of tDCS targeting the M1 or left DLPFC on physical performance, psychophysiological responses, and cognitive function in repeated all-out cycling: a randomized controlled trial. J Neuroeng Rehabil 2023; 20:97. [PMID: 37496055 PMCID: PMC10373277 DOI: 10.1186/s12984-023-01221-9] [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: 02/01/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Despite reporting the positive effects of transcranial direct current stimulation (tDCS) on endurance performance, very few studies have investigated its efficacy in anaerobic short all-out activities. Moreover, there is still no consensus on which brain areas could provide the most favorable effects on different performance modalities. Accordingly, this study aimed to investigate the effects of anodal tDCS (a-tDCS) targeting the primary motor cortex (M1) or left dorsolateral prefrontal cortex (DLPFC) on physical performance, psychophysiological responses, and cognitive function in repeated all-out cycling. METHODS In this randomized, crossover, and double-blind study, 15 healthy physically active men underwent a-tDCS targeting M1 or the left DLPFC or sham tDCS in separate days before performing three bouts of all-out 30s cycling anaerobic test. a-tDCS was applied using 2 mA for 20 min. Peak power, mean power, fatigue index, and EMG of the quadriceps muscles were measured during each bout. Heart rate, perceived exertion, affective valence, and arousal were recorded two minutes after each bout. Color-word Stroop test and choice reaction time were measured at baseline and after the whole anaerobic test. RESULTS Neither tDCS montage significantly changed peak power, mean power, fatigue index, heart rate, affective valence, arousal, and choice reaction time (p> 0.05). a-tDCS over DLPFC significantly lowered RPE of the first bout (compared to sham; p=0.048, Δ=-12.5%) and third bout compared to the M1 (p=0.047, Δ=-12.38%) and sham (p=0.003, Δ=-10.5%), increased EMG of the Vastus Lateralis muscle during the second (p=0.016, Δ= +40.3%) and third bout (p=0.016, Δ= +42.1%) compared to sham, and improved the score of color-word Stroop test after the repeated all-out task (p=0.04, Δ= +147%). The qualitative affective response (valence and arousal) was also higher under the M1 and DLPFC compared to the sham. CONCLUSION We concluded that tDCS targeting M1 or DLPFC does not improve repeated anaerobic performance. However, the positive effect of DLPFC montage on RPE, EMG, qualitative affective responses, and cognitive function is promising and paves the path for future research using different tDCS montages to see any possible effects on anaerobic performance. TRIAL REGISTRATION This study was approved by the Ethics Committee of Razi University (IR.RAZI.REC.1400.023) and registered in the Iranian Registry of Clinical Trials (IRCT id: IRCT20210617051606N5; Registration Date: 04/02/2022).
Collapse
Affiliation(s)
- Hafez Teymoori
- Exercise Metabolism and Performance Lab (EMPL), Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran
| | - Ehsan Amiri
- Exercise Metabolism and Performance Lab (EMPL), Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran.
| | - Worya Tahmasebi
- Exercise Metabolism and Performance Lab (EMPL), Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran
| | - Rastegar Hoseini
- Exercise Metabolism and Performance Lab (EMPL), Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran
| | - Sidney Grospretre
- EA4660-C3S Laboratory - Culture, Sports, Health and Society, University Bourgogne France- Comte, Besancon, France
| | - Daniel Gomes da Silva Machado
- Research Group in Neuroscience of the Human Movement (NeuroMove), Department of Physical Education, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| |
Collapse
|
3
|
Klichowski M, Wicher A, Kruszwicka A, Golebiewski R. Reverse effect of home-use binaural beats brain stimulation. Sci Rep 2023; 13:11079. [PMID: 37422545 PMCID: PMC10329717 DOI: 10.1038/s41598-023-38313-4] [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: 01/12/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023] Open
Abstract
Binaural beats brain stimulation is a popular strategy for supporting home-use cognitive tasks. However, such home-use brain stimulation may be neutral to cognitive processes, and any intellectual improvement may be only a placebo effect. Thus, without belief in it, it may bring no benefits. Here we test 1000 individuals at their homes as they perform a two-part fluid intelligence test. Some took the second part listening to binaural beats, while others took it in silence or listening to other sounds. The binaural beats group was divided into three subgroups. The first one was informed that they would listen to sounds that improve the brain's work, the second that neutral sounds, and the third that some sounds the nature of which was not defined. We found that listening to binaural beats was not neutral, as it dramatically deteriorated the score irrespective of the condition. Silence or other sounds had no effect. Thus, home-use binaural beats brain stimulation brings reverse effects to those assumed: instead of supporting the effectiveness of cognitive activities, it may weaken them.
Collapse
Affiliation(s)
- Michal Klichowski
- Cognitive Neuroscience Center, Adam Mickiewicz University, Poznan, Poland.
- Learning Laboratory, Faculty of Educational Studies, Adam Mickiewicz University, Poznan, Poland.
| | - Andrzej Wicher
- Cognitive Neuroscience Center, Adam Mickiewicz University, Poznan, Poland
- Department of Acoustics, Faculty of Physics, Adam Mickiewicz University, Poznan, Poland
| | - Agnieszka Kruszwicka
- Cognitive Neuroscience Center, Adam Mickiewicz University, Poznan, Poland
- Learning Laboratory, Faculty of Educational Studies, Adam Mickiewicz University, Poznan, Poland
| | - Roman Golebiewski
- Cognitive Neuroscience Center, Adam Mickiewicz University, Poznan, Poland
- Department of Acoustics, Faculty of Physics, Adam Mickiewicz University, Poznan, Poland
| |
Collapse
|
4
|
Villa-Sánchez B, Gandolfi M, Emadi Andani M, Valè N, Rossettini G, Polesana F, Menaspà Z, Smania N, Tinazzi M, Fiorio M. Placebo effect on gait: a way to reduce the dual-task cost in older adults. Exp Brain Res 2023; 241:1501-1511. [PMID: 37085646 DOI: 10.1007/s00221-023-06620-x] [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: 11/30/2022] [Accepted: 04/15/2023] [Indexed: 04/23/2023]
Abstract
The ability to perform two tasks simultaneously is essential for daily activities. In older adults, this ability is markedly reduced, as evidenced by the dual-task cost on gait. Preliminary evidences indicate that the dual-task cost can be influenced by different types of manipulations. Here, we explored the effectiveness of a new approach to reduce the dual-task cost, based on the placebo effect, a psychobiological phenomenon whereby a positive outcome follows the administration of an inert device thought to be effective. Thirty-five healthy older adults were asked to walk on a sensorized carpet (single-task condition) and to walk while counting backward (dual-task condition) in two sessions (pre-test and post-test). A placebo group, randomly selected, underwent sham transcranial direct current stimulation over the supraorbital areas between sessions, along with information about its positive effects on concentration and attention. A control group did not receive any intervention between sessions. The dual-task cost was significantly reduced in the placebo group at the post-test session compared to the pre-test for several gait parameters (Cohen's d > 1.43). At the post-test session, the dual-task cost was also lower in the placebo group than in the control group (d > 0.73). Cognitive (number of subtractions and number of errors) and subjective (perceived mental fatigability) variables remained stable across sessions. The reduced dual-task cost in the placebo group could indicate the ability to re-establish the allocation of attentional resources between tasks. These findings could contribute to the development of cognitive strategies that leverage positive expectations to boost motor control in older adults.
Collapse
Affiliation(s)
- Bernardo Villa-Sánchez
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati 43, 37131, Verona, Italy.
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Corso Bettini, 31, 38068, Rovereto, Italy.
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati 43, 37131, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), University of Verona, Verona, Italy
| | - Mehran Emadi Andani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati 43, 37131, Verona, Italy
| | - Nicola Valè
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati 43, 37131, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), University of Verona, Verona, Italy
| | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | - Federico Polesana
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati 43, 37131, Verona, Italy
| | - Zoe Menaspà
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati 43, 37131, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), University of Verona, Verona, Italy
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati 43, 37131, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati 43, 37131, Verona, Italy
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati 43, 37131, Verona, Italy.
| |
Collapse
|
5
|
Del Mauro L, Vergallito A, Gattavara G, Juris L, Gallucci A, Vedani A, Cappelletti L, Farneti PM, Romero Lauro LJ. Betting on Non-Invasive Brain Stimulation to Treat Gambling Disorder: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:698. [PMID: 37190663 PMCID: PMC10136786 DOI: 10.3390/brainsci13040698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Gambling disorder (GD) is a behavioral addiction that severely impacts individuals' functioning, leading to high socioeconomic costs. Non-invasive brain stimulation (NiBS) has received attention for treating psychiatric and neurological conditions in recent decades, but there is no recommendation for its use for GD. Therefore, this study aimed to systematically review and analyze the available literature to determine the effectiveness of NiBS in treating GD. Following the PRISMA guidelines, we screened four electronic databases up to July 2022 and selected relevant English-written original articles. We included ten papers in the systematic review and seven in the meta-analysis. As only two studies employed a sham-controlled design, the pre-post standardized mean change (SMCC) was computed as effect size only for real stimulation. The results showed a significant effect of NiBS in reducing craving scores (SMCC = -0.69; 95% CI = [-1.2, -0.2], p = 0.010). Moreover, considering the GD's frequent comorbidity with mood disorders, we ran an exploratory analysis of the effects of NiBS on depressive symptoms, which showed significant decreases in post-treatment scores (SMCC = -0.71; 95% CI = [-1.1, -0.3], p < 0.001). These results provide initial evidence for developing NiBS as a feasible therapy for GD symptoms but further comprehensive research is needed to validate these findings. The limitations of the available literature are critically discussed.
Collapse
Affiliation(s)
- Lilia Del Mauro
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
- Fondazione Eris Onlus, 20134 Milano, Italy
| | - Alessandra Vergallito
- Department of Psychology & Neuromi, University of Milano-Bicocca, 20126 Milano, Italy
| | - Gaia Gattavara
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
| | | | - Alessia Gallucci
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Anna Vedani
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
| | | | | | | |
Collapse
|
6
|
Quinn V, Pearson S, Huynh A, Nicholls K, Barnes K, Faasse K. The influence of video-based social modelling on the nocebo effect. J Psychosom Res 2023; 165:111136. [PMID: 36610337 DOI: 10.1016/j.jpsychores.2022.111136] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Seeing someone else experience side effects (i.e., social modelling) can increase negative expectations and subsequent nocebo effects. In face-to-face contexts, this effect appears stronger in female participants. Less is known about the influence of gender on negative expectations and nocebo effects generated via video-based social modelling. METHODS One hundred and seven undergraduate participants recruited from a participant pool at an Australian university took part in a study ostensibly investigating the influence of beta-blocker medications (actually a sham treatment) on physiological and psychological aspects of anxiety. Participants were randomly assigned to either a no-treatment control group, a standard treatment group, or a video modelling group, in which participants viewed video-recorded confederates (one male, one female) report experiencing four side effects (two each) after taking the study treatment. Symptoms were assessed 15-min following pill ingestion, and at follow-up 24 h later. RESULTS Video modelling of side effects, compared to standard treatment, interacted with gender and was associated with increased reporting of modelled symptoms in female compared to male participants, p = .01, ηp2=0.06. Video modelling also increased negative expectations in female compared to male participants, p = .03, ηp2=0.07, and expectations mediated the influence of modelling on modelled symptoms in female participants. CONCLUSIONS Social modelling of side effects via video increased negative expectations, and nocebo symptoms, to a greater extent in female participants. These findings suggest that males and females are differentially impacted by video-based side effect modelling. Results have implications for social modelling of side effects via social media and patient-support websites.
Collapse
Affiliation(s)
- Veronica Quinn
- Department of Psychology, Macquarie University, Australia
| | - Sarah Pearson
- School of Psychology, University of New South Wales, Australia
| | - Anna Huynh
- School of Psychology, University of New South Wales, Australia
| | - Kate Nicholls
- School of Psychology, University of New South Wales, Australia
| | - Kirsten Barnes
- School of Psychology, University of New South Wales, Australia
| | - Kate Faasse
- School of Psychology, University of New South Wales, Australia.
| |
Collapse
|
7
|
O'Connor PJ, Chen X, Coheley LM, Yu M, Laing EM, Oshri A, Marand A, Lance J, Kealey K, Lewis RD. The effects of 9 months of formulated whole-egg or milk powder food products as meal or snack replacements on executive function in preadolescents: A randomized, placebo-controlled trial. Am J Clin Nutr 2022; 116:1663-1671. [PMID: 36173384 DOI: 10.1093/ajcn/nqac281] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/27/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Elevated brain choline is associated with better executive functions in preadolescents. Manipulating dietary choline prospectively in preadolescents using egg supplementation could improve executive functions via effects on brain cellular and neurotransmitter functions. OBJECTIVES We tested the 9-month impacts of egg supplementation on executive functions. It was hypothesized that preadolescents who consumed meal or snack replacement products containing powder made from whole eggs would have the largest improvements in executive functions after 9 months compared to those consuming similar products with either added milk powder or gelatin as a placebo. METHODS A randomized, parallel-group, double-blinded, placebo-controlled trial design was used. The executive functions of 122 preadolescents (58 females) aged 9-13 were analyzed before and after the 9-month intervention. The primary outcomes were 3 NIH Toolbox-Cognitive Battery measures of executive function: mental flexibility, working memory, and selective attention and inhibitory control. Participants were randomized to consume food products with either: 1) whole egg powder; 2) milk powder; or 3) gelatin as a placebo, all matched on macronutrient content and used as replacements for commonly consumed foods (i.e., waffles, pancakes, macaroni and cheese, ice cream, and brownies). Hypothesis testing used mixed-effects models that included physical activity and sleep scores as covariates. RESULTS A statistically significant group × time interaction for selective attention and inhibitory control was found (P = 0.049) for the milk group. This interaction resulted from no change for the placebo group and an improvement in selective attention and inhibitory control performance for the milk group by a T-score of 5.8; the effect size (d) was 0.44 SD units. Other comparisons were statistically insignificant. CONCLUSIONS Consumption of foods with added milk powder as a replacement for snacks or meals for 9 months improves selective attention and inhibitory control in preadolescents. Replacement of foods with added whole egg powder does not impact 9-month changes in preadolescent executive functions. This trial was registered at clinicaltrials.gov as NCT03739424.
Collapse
Affiliation(s)
| | - Xianyan Chen
- Department of Statistics, University of Georgia, Athens, GA, USA
| | - Lauren M Coheley
- Department of Nutrition, Texas A&M University, College Station, TX, USA
| | - Mengyun Yu
- Department of Statistics, University of Georgia, Athens, GA, USA
| | - Emma M Laing
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA
| | - Assaf Oshri
- Department of Human Development & Family Science, University of Georgia, Athens, GA, USA
| | - Alicia Marand
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA
| | - Julia Lance
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA
| | - Kirk Kealey
- Food Product Innovation & Commercialization Center, University of Georgia, Griffin, GA, USA
| | - Richard D Lewis
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA
| |
Collapse
|
8
|
Russell K, Duncan M, Price M, Mosewich A, Ellmers T, Hill M. A comparison of placebo and nocebo effects on objective and subjective postural stability: a double-edged sword? Front Hum Neurosci 2022; 16:967722. [PMID: 36061498 PMCID: PMC9434487 DOI: 10.3389/fnhum.2022.967722] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Positive expectations (i.e., placebo effect) can improve postural control during quiet standing. This raises an important question: if postural control is susceptible to positive expectations, is it possible to elicit the opposite, a decline in postural stability, simply by suggesting a performance impairment (i.e., nocebo) will take place? Yet no studies have examined the nocebo effect on balance performance. To better understand both phenomena, comparative studies, which include both placebo and nocebo conditions, are needed. Method: Forty-two healthy adults were initially assessed for objective (center of pressure movement) and subjective (perceived) postural stability and performance expectations. Participants were then randomly assigned in equal numbers to a placebo (positive expectation), nocebo (negative expectation) or control (no suggestion) group. Participants in the placebo/nocebo groups were deceptively administered an inert capsule described as a potent supplement which would either positively or negatively influence their balance performance. Objective and subjective postural stability, and performance expectations were reassessed 20 min later. Results: The nocebo procedure evoked an increase in COP sway movements and reduced perceived stability compared to a control group. The placebo group presented with reductions COP sway movements and increased perceived stability following expectation manipulation. Compared to the control group, the placebo group showed a significantly higher performance expectation whilst the nocebo group showed a significantly lower performance expectation. Regression analyses also revealed that performance expectations following the placebo/nocebo procedure significantly predicted perceptions of postural instability (i.e., perceived performance), accounting for around 50% of the variance. These results remained even when controlling for actual performance (i.e., objective postural stability). Conclusion: Our findings indicate that positive and negative performance expectations evoked by instructional manipulation can profoundly influence both objective and subjective postural stability. Postural control—and perceptions regarding such—are clearly susceptible to expectation manipulation, which could have important practical implications and repercussions on testing, training interventions and rehabilitation programs. Positive and negative expectancies are a double-edged sword for postural control.
Collapse
Affiliation(s)
- Katherine Russell
- Centre for Sport, Exercise and Life Sciences, School of Life Sciences, Coventry University, Coventry, United Kingdom
| | - Michael Duncan
- Centre for Sport, Exercise and Life Sciences, School of Life Sciences, Coventry University, Coventry, United Kingdom
| | - Michael Price
- Centre for Sport, Exercise and Life Sciences, School of Life Sciences, Coventry University, Coventry, United Kingdom
| | - Amber Mosewich
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Toby Ellmers
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Mathew Hill
- Centre for Sport, Exercise and Life Sciences, School of Life Sciences, Coventry University, Coventry, United Kingdom
- *Correspondence: Mathew Hill
| |
Collapse
|
9
|
Lecci L, Page GR, Keith JR, Neal S, Ritter A. The Effects of Health Anxiety and Litigation Potential on Symptom Endorsement, Cognitive Performance, and Physiological Functioning in the Context of a Food and Drug Administration Drug Recall Announcement. Front Psychol 2022; 13:818724. [PMID: 35769761 PMCID: PMC9236552 DOI: 10.3389/fpsyg.2022.818724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Drug recalls and lawsuits against pharmaceutical manufacturers are accompanied by announcements emphasizing harmful drug side-effects. Those with elevated health anxiety may be more reactive to such announcements. We evaluated whether health anxiety and financial incentives affect subjective symptom endorsement, and objective outcomes of cognitive and physiological functioning during a mock drug recall. Hundred and sixty-one participants reported use of over-the-counter pain medications and presented with a fictitious medication recall via a mock Food and Drug Administration (FDA) website. The opportunity to join a class-action lawsuit was manipulated. We assessed health anxiety, recalled drug usage, blood pressure, heart rate, and performance on a computerized Trail Making Test (TMT). Symptom endorsement was strongly predicted by health anxiety. When combined, three health anxiety measures explained 28.5% variance (Cohen’s d = 1.26). These effects remain strong after controlling for depression and anxiety. Litigation condition did not predict symptom endorsement. Blood pressure and heart rate were modestly predicted by health anxiety, but not by litigation condition. TMT performance was consistently predicted by health anxiety, with higher scores associated with poorer performance. Although there were no main effects for litigation, interactions consistently emerged for the TMT, with generally poorer performance for those with higher health anxiety in the non-litigation condition; whereas health anxiety was unrelated to performance for the litigation condition. All but one participant joined the litigation when given the opportunity, despite a healthy sample and minimal use of pain medication. Subsequent data from 67 individuals with no mention of the FDA scenario or litigation showed that health anxiety still significantly predicts symptom endorsement (12.6% variance), but the explained variance is less than half that obtained in the FDA scenario. The findings suggest that health anxiety plays a significant role in adverse symptom reporting, beyond anxiety or depression, and this effect is independent of the presence of the FDA recall. The lack of differences for health anxiety and symptom endorsement between litigation and non-litigation conditions rules out malingering. Although it is general practice in drug recalls to list potential adverse side effects caused by medications, this may elicit unintended symptom experiences and health anxious individuals may be more susceptible.
Collapse
|
10
|
Antal A, Luber B, Brem AK, Bikson M, Brunoni AR, Cohen Kadosh R, Dubljević V, Fecteau S, Ferreri F, Flöel A, Hallett M, Hamilton RH, Herrmann CS, Lavidor M, Loo C, Lustenberger C, Machado S, Miniussi C, Moliadze V, Nitsche MA, Rossi S, Rossini PM, Santarnecchi E, Seeck M, Thut G, Turi Z, Ugawa Y, Venkatasubramanian G, Wenderoth N, Wexler A, Ziemann U, Paulus W. Non-invasive brain stimulation and neuroenhancement. Clin Neurophysiol Pract 2022; 7:146-165. [PMID: 35734582 PMCID: PMC9207555 DOI: 10.1016/j.cnp.2022.05.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/19/2022] [Accepted: 05/18/2022] [Indexed: 12/15/2022] Open
Abstract
The available data frame with a wide parameter space of tES does not allow an overarching protocol recommendation. Established engineering risk-management procedures with regard to manufacturing should be followed. Consensus among experts is that tES for neuroenhancement is safe as long as tested protocols are followed.
Attempts to enhance human memory and learning ability have a long tradition in science. This topic has recently gained substantial attention because of the increasing percentage of older individuals worldwide and the predicted rise of age-associated cognitive decline in brain functions. Transcranial brain stimulation methods, such as transcranial magnetic (TMS) and transcranial electric (tES) stimulation, have been extensively used in an effort to improve cognitive functions in humans. Here we summarize the available data on low-intensity tES for this purpose, in comparison to repetitive TMS and some pharmacological agents, such as caffeine and nicotine. There is no single area in the brain stimulation field in which only positive outcomes have been reported. For self-directed tES devices, how to restrict variability with regard to efficacy is an essential aspect of device design and function. As with any technique, reproducible outcomes depend on the equipment and how well this is matched to the experience and skill of the operator. For self-administered non-invasive brain stimulation, this requires device designs that rigorously incorporate human operator factors. The wide parameter space of non-invasive brain stimulation, including dose (e.g., duration, intensity (current density), number of repetitions), inclusion/exclusion (e.g., subject’s age), and homeostatic effects, administration of tasks before and during stimulation, and, most importantly, placebo or nocebo effects, have to be taken into account. The outcomes of stimulation are expected to depend on these parameters and should be strictly controlled. The consensus among experts is that low-intensity tES is safe as long as tested and accepted protocols (including, for example, dose, inclusion/exclusion) are followed and devices are used which follow established engineering risk-management procedures. Devices and protocols that allow stimulation outside these parameters cannot claim to be “safe” where they are applying stimulation beyond that examined in published studies that also investigated potential side effects. Brain stimulation devices marketed for consumer use are distinct from medical devices because they do not make medical claims and are therefore not necessarily subject to the same level of regulation as medical devices (i.e., by government agencies tasked with regulating medical devices). Manufacturers must follow ethical and best practices in marketing tES stimulators, including not misleading users by referencing effects from human trials using devices and protocols not similar to theirs.
Collapse
Affiliation(s)
- Andrea Antal
- Department of Neurology, University Medical Center, Göttingen, Germany
- Corresponding author at: Department of Neurology, University Medical Center, Göttingen, Robert Koch Str. 40, 37075 Göttingen, Germany.
| | - Bruce Luber
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Anna-Katharine Brem
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Marom Bikson
- Biomedical Engineering at the City College of New York (CCNY) of the City University of New York (CUNY), NY, USA
| | - Andre R. Brunoni
- Departamento de Clínica Médica e de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil
| | - Roi Cohen Kadosh
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Veljko Dubljević
- Science, Technology and Society Program, College of Humanities and Social Sciences, North Carolina State University, Raleigh, NC, USA
| | - Shirley Fecteau
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Université Laval, CERVO Brain Research Centre, Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Florinda Ferreri
- Unit of Neurology, Unit of Clinical Neurophysiology, Study Center of Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Agnes Flöel
- Department of Neurology, Universitätsmedizin Greifswald, 17475 Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Standort Greifswald, 17475 Greifswald, Germany
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Roy H. Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christoph S. Herrmann
- Experimental Psychology Lab, Department of Psychology, Carl von Ossietzky Universität, Oldenburg, Germany
| | - Michal Lavidor
- Department of Psychology and the Gonda Brain Research Center, Bar Ilan University, Israel
| | - Collen Loo
- School of Psychiatry and Black Dog Institute, University of New South Wales; The George Institute; Sydney, Australia
| | - Caroline Lustenberger
- Neural Control of Movement Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Sergio Machado
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
- Laboratory of Physical Activity Neuroscience, Neurodiversity Institute, Queimados-RJ, Brazil
| | - Carlo Miniussi
- Center for Mind/Brain Sciences – CIMeC and Centre for Medical Sciences - CISMed, University of Trento, Rovereto, Italy
| | - Vera Moliadze
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Kiel, Germany
| | - Michael A Nitsche
- Department Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors at TU, Dortmund, Germany
- Dept. Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Simone Rossi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Paolo M. Rossini
- Department of Neuroscience and Neurorehabilitation, Brain Connectivity Lab, IRCCS-San Raffaele-Pisana, Rome, Italy
| | - Emiliano Santarnecchi
- Precision Neuroscience and Neuromodulation Program, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Margitta Seeck
- Department of Clinical Neurosciences, Hôpitaux Universitaires de Genève, Switzerland
| | - Gregor Thut
- Centre for Cognitive Neuroimaging, School of Psychology and Neuroscience, EEG & Epolepsy Unit, University of Glasgow, United Kingdom
| | - Zsolt Turi
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
| | | | - Nicole Wenderoth
- Neural Control of Movement Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ulf Ziemann
- Department of Neurology and Stroke, University of Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Walter Paulus
- Department of of Neurology, Ludwig Maximilians University Munich, Germany
| |
Collapse
|
11
|
Psycho-Neuro-Endocrine-Immunological Basis of the Placebo Effect: Potential Applications beyond Pain Therapy. Int J Mol Sci 2022; 23:ijms23084196. [PMID: 35457014 PMCID: PMC9028312 DOI: 10.3390/ijms23084196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 12/12/2022] Open
Abstract
The placebo effect can be defined as the improvement of symptoms in a patient after the administration of an innocuous substance in a context that induces expectations regarding its effects. During recent years, it has been discovered that the placebo response not only has neurobiological functions on analgesia, but that it is also capable of generating effects on the immune and endocrine systems. The possible integration of changes in different systems of the organism could favor the well-being of the individuals and go hand in hand with conventional treatment for multiple diseases. In this sense, classic conditioning and setting expectations stand out as psychological mechanisms implicated in the placebo effect. Recent advances in neuroimaging studies suggest a relationship between the placebo response and the opioid, cannabinoid, and monoaminergic systems. Likewise, a possible immune response conditioned by the placebo effect has been reported. There is evidence of immune suppression conditioned through the insular cortex and the amygdala, with noradrenalin as the responsible neurotransmitter. Finally, a conditioned response in the secretion of different hormones has been determined in different studies; however, the molecular mechanisms involved are not entirely known. Beyond studies about its mechanism of action, the placebo effect has proved to be useful in the clinical setting with promising results in the management of neurological, psychiatric, and immunologic disorders. However, more research is needed to better characterize its potential use. This review integrates current knowledge about the psycho-neuro-endocrine-immune basis of the placebo effect and its possible clinical applications.
Collapse
|
12
|
Mind-wandering: mechanistic insights from lesion, tDCS, and iEEG. Trends Cogn Sci 2022; 26:268-282. [PMID: 35086725 PMCID: PMC9166901 DOI: 10.1016/j.tics.2021.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 01/04/2023]
Abstract
Cognitive neuroscience has witnessed a surge of interest in investigating the neural correlates of the mind when it drifts away from an ongoing task and the external environment. To that end, functional neuroimaging research has consistently implicated the default mode network (DMN) and frontoparietal control network (FPCN) in mind-wandering. Yet, it remains unknown which subregions within these networks are necessary and how they facilitate mind-wandering. In this review, we synthesize evidence from lesion, transcranial direct current stimulation (tDCS), and intracranial electroencephalogram (iEEG) studies demonstrating the causal relevance of brain regions, and providing insights into the neuronal mechanism underlying mind-wandering. We propose that the integration of complementary approaches is the optimal strategy to establish a comprehensive understanding of the neural basis of mind-wandering.
Collapse
|
13
|
Stanković M, Živanović M, Bjekić J, Filipović SR. Blinding in tDCS Studies: Correct End-of-Study Guess Does Not Moderate the Effects on Associative and Working Memory. Brain Sci 2021; 12:brainsci12010058. [PMID: 35053802 PMCID: PMC8773753 DOI: 10.3390/brainsci12010058] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has become a valuable tool in cognitive neuroscience research as it enables causal inferences about neural underpinnings of cognition. However, studies using tDCS to modulate cognitive functions often yield inconsistent findings. Hence, there is an increasing interest in factors that may moderate the effects, one of which is the participants’ beliefs of the tDCS condition (i.e., real or sham) they received. Namely, whether participants’ correct guessing of sham condition may lead to false-positive tDCS effects. In this study, we aimed to explore if participants’ beliefs about received stimulation type (i.e., the success of blinding) impacted their task performance in tDCS experiments on associative (AM) and working memory (WM). We analyzed data from four within-subject, sham-controlled tDCS memory experiments (N = 83) to check if the correct end-of-study guess of sham condition moderated tDCS effects. We found no evidence that sham guessing moderated post-tDCS memory performance in experiments in which tDCS effects were observed as well as in experiments that showed null effects of tDCS. The results suggest that the correct sham guessing (i.e., placebo-like effect) is unlikely to influence the results in tDCS memory experiments. We discuss the results in light of the growing debate about the relevance and effectiveness of blinding in brain stimulation research.
Collapse
Affiliation(s)
- Marija Stanković
- Human Neuroscience Group, Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia; (M.S.); (S.R.F.)
| | - Marko Živanović
- Institute of Psychology and Laboratory for Research of Individual Differences, Department of Psychology, Faculty of Philosophy, University of Belgrade, 11000 Belgrade, Serbia;
| | - Jovana Bjekić
- Human Neuroscience Group, Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia; (M.S.); (S.R.F.)
- Correspondence:
| | - Saša R. Filipović
- Human Neuroscience Group, Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia; (M.S.); (S.R.F.)
| |
Collapse
|
14
|
Vergallito A, Gallucci A, Pisoni A, Punzi M, Caselli G, Ruggiero GM, Sassaroli S, Romero Lauro LJ. Effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders: a meta-analysis of sham or behaviour-controlled studies. J Psychiatry Neurosci 2021; 46:E592-E614. [PMID: 34753789 PMCID: PMC8580831 DOI: 10.1503/jpn.210050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/23/2021] [Accepted: 07/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The possibility of using noninvasive brain stimulation to treat mental disorders has received considerable attention recently. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are considered to be effective treatments for depressive symptoms. However, no treatment recommendation is currently available for anxiety disorders, suggesting that evidence is still limited. We conducted a systematic review of the literature and a quantitative analysis of the effectiveness of rTMS and tDCS in the treatment of anxiety disorders. METHODS Following PRISMA guidelines, we screened 3 electronic databases up to the end of February 2020 for English-language, peer-reviewed articles that included the following: a clinical sample of patients with an anxiety disorder, the use of a noninvasive brain stimulation technique, the inclusion of a control condition, and pre/post scores on a validated questionnaire that measured symptoms of anxiety. RESULTS Eleven papers met the inclusion criteria, comprising 154 participants assigned to a stimulation condition and 164 to a sham or control group. We calculated Hedge's g for scores on disorder-specific and general anxiety questionnaires before and after treatment to determine effect size, and we conducted 2 independent random-effects meta-analyses. Considering the well-known comorbidity between anxiety and depression, we ran a third meta-analysis analyzing outcomes for depression scores. Results showed a significant effect of noninvasive brain stimulation in reducing scores on disorder-specific and general anxiety questionnaires, as well as depressive symptoms, in the real stimulation compared to the control condition. LIMITATIONS Few studies met the inclusion criteria; more evidence is needed to strengthen conclusions about the effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders. CONCLUSION Our findings showed that noninvasive brain stimulation reduced anxiety and depression scores compared to control conditions, suggesting that it can alleviate clinical symptoms in patients with anxiety disorders.
Collapse
Affiliation(s)
| | | | - Alberto Pisoni
- From the Department of Psychology, University of Milano Bicocca, Milan, Italy (Vergallito, Pisoni, Punzi, Romero Lauro); the Neuromi, Milan, Italy (Vergallito, Gallucci, Pisoni, Romero Lauro); the Department of Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy (Gallucci); the Studi Cognitivi, Milan, Italy (Caselli, Ruggiero, Sassaroli); and the Faculty of Psychology, Sigmund Freud University, Milan, Italy (Caseli, Ruggiero, Sassaroli)
| | | | | | | | | | | |
Collapse
|
15
|
Acute effect of high-definition and conventional tDCS on exercise performance and psychophysiological responses in endurance athletes: a randomized controlled trial. Sci Rep 2021; 11:13911. [PMID: 34230503 PMCID: PMC8260713 DOI: 10.1038/s41598-021-92670-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 06/03/2021] [Indexed: 02/06/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) has been used aiming to boost exercise performance and inconsistent findings have been reported. One possible explanation is related to the limitations of the so-called "conventional" tDCS, which uses large rectangular electrodes, resulting in a diffuse electric field. A new tDCS technique called high-definition tDCS (HD-tDCS) has been recently developed. HD-tDCS uses small ring electrodes and produces improved focality and greater magnitude of its aftereffects. This study tested whether HD-tDCS would improve exercise performance to a greater extent than conventional tDCS. Twelve endurance athletes (29.4 ± 7.3 years; 60.15 ± 5.09 ml kg-1 min-1) were enrolled in this single-center, randomized, crossover, and sham-controlled trial. To test reliability, participants performed two time to exhaustion (TTE) tests (control conditions) on a cycle simulator with 80% of peak power until volitional exhaustion. Next, they randomly received HD-tDCS (2.4 mA), conventional (2.0 mA), or active sham tDCS (2.0 mA) over the motor cortex for 20-min before performing the TTE test. TTE, heart rate (HR), associative thoughts, peripheral (lower limbs), and whole-body ratings of perceived exertion (RPE) were recorded every minute. Outcome measures were reliable. There was no difference in TTE between HD-tDCS (853.1 ± 288.6 s), simulated conventional (827.8 ± 278.7 s), sham (794.3 ± 271.2 s), or control conditions (TTE1 = 751.1 ± 261.6 s or TTE2 = 770.8 ± 250.6 s) [F(1.95; 21.4) = 1.537; P = 0.24; η2p = 0.123]. There was no effect on peripheral or whole-body RPE and associative thoughts (P > 0.05). No serious adverse effect was reported. A single session of neither HD-tDCS nor conventional tDCS changed exercise performance and psychophysiological responses in athletes, suggesting that a ceiling effect may exist.
Collapse
|
16
|
Horváth Á, Köteles F, Szabo A. Nocebo effects on motor performance: A systematic literature review. Scand J Psychol 2021; 62:665-674. [PMID: 34145580 DOI: 10.1111/sjop.12753] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/06/2021] [Accepted: 05/06/2021] [Indexed: 01/08/2023]
Abstract
Directionally opposite to placebo effects are the nocebo effects that negatively impact people's thoughts, feelings, and actions. An important but scarcely studied aspect of everyday functioning is motor performance, in which nocebo effects might impair athletic skills and the much-needed purposeful daily movements and motor actions. The aim of this literature review is to unveil the nocebo effects on motor performance. Searched databases were PubMed, PsycINFO, and SPORTDiscus. Twenty-one articles, reporting 23 studies, met the eligibility criteria for inclusion in the current review. All reports exhibited "some" risk of bias. Of the 23 studies, 14 found a nocebo effect on motor performance, equivocal results emerged from two studies, and negative findings were reported in seven studies. Most (10/12) studies using a between-subjects design have reported a nocebo effect. The mean effect size was 0.60, suggesting a medium-to-large effect of nocebo intervention on motor performance. Based on this review, we conclude that nocebo effects do influence motor performance and can be evoked with negative verbal information. This effect may be more robust than the placebo effect but also depends on the type of motor performance, on the examined sample, and on the nocebo agent. Hence, nocebo effects should be recognized and controlled in empirical research on motor performance, and they should be prevented or extinguished in practical and therapeutic settings. More extensive examination of the nocebo effect on motor performance is warranted, especially using between-subjects research design and a "no agent" control condition.
Collapse
Affiliation(s)
- Áron Horváth
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Attila Szabo
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| |
Collapse
|
17
|
Wang P, Hooyman A, Schambra HM, Lohse KR, Schaefer SY. Expectations from the general public about the efficacy of transcranial direct current stimulation for improving motor performance. Brain Stimul 2021; 14:500-502. [PMID: 33722659 DOI: 10.1016/j.brs.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/23/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Peiyuan Wang
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Andrew Hooyman
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Heidi M Schambra
- Departments of Neurology and Rehabilitation Medicine, NYU Grossman School of Medicine, New York University, NY, USA
| | - Keith R Lohse
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Sydney Y Schaefer
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA.
| |
Collapse
|
18
|
Villa-Sánchez B, Emadi Andani M, Cesari P, Fiorio M. The effect of motor and cognitive placebos on the serial reaction time task. Eur J Neurosci 2021; 53:2655-2668. [PMID: 33587782 DOI: 10.1111/ejn.15148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 11/26/2022]
Abstract
Motor learning is a key component of human motor functions. Repeated practice is essential to gain proficiency over time but may induce fatigue. The aim of this study was to determine whether motor performance and motor learning (as assessed with the serial reaction time task, SRTT) and perceived fatigability (as assessed with subjective scales) are improved after two types of placebo interventions (motor and cognitive). A total of 90 healthy volunteers performed the SRTT with the right hand in three sessions (baseline, training and final). Before the training and the final session, one group underwent a motor-related placebo intervention in which inert electrical stimulation (TENS) was applied over the hand and accompanied by verbal suggestion that it improves movement execution (placebo-TENS). The other group underwent a cognitive-related placebo intervention in which sham transcranial direct current stimulation (tDCS) was delivered to the supraorbital area and accompanied by verbal suggestion that it increases attention (placebo-tDCS). A control group performed the same task without receiving treatment. Overall better performance on the SRTT (not ascribed to sequence-specific learning) was noted for the placebo-TENS group, which also reported less perceived fatigability at the physical level. The same was observed in a subgroup tested 24 hr later. The placebo-tDCS group reported less perceived fatigability, both at the mental and physical level. These findings indicate that motor- and cognitive-related placebo effects differently shape motor performance and perceived fatigability on a repeated motor task.
Collapse
Affiliation(s)
- Bernardo Villa-Sánchez
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mehran Emadi Andani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Paola Cesari
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| |
Collapse
|
19
|
Hansen E, Zech N, Benson S. [Nocebo, informed consent and doctor-patient communication]. DER NERVENARZT 2020; 91:691-699. [PMID: 32728796 DOI: 10.1007/s00115-020-00963-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Negative previous experiences (conditioning), observational learning and expectations can trigger nocebo effects. They are responsible for a substantial proportion of the side effects of medical treatment, and are induced primarily by risk information for informed consent. This has been demonstrated in studies on patient groups with or without modified medical information. Drug trials in the field of neurology and psychiatry have regularly revealed side effects and drop-out also in placebo groups. The underlying neurobiological mechanisms were experimentally investigated especially for nocebo-induced hyperalgesia, whereby the specifically involved regions of the brain could be identified by functional imaging as well as changes in the dopamine, endorphin and cholecystokinin systems. Nocebo effects are specific, i.e. they are closely related to patient information and can induce or aggravate exactly the symptoms addressed. Nevertheless, informed consent is an essential part of doctor-patient communication; however, information on risks can be markedly less damaging when unnecessary repetitions are avoided, misunderstandings are recognized or resolved and several different options are given. In addition, risks should always be named together with positive aspects, such as the advantages of the appropriate treatment, the prophylactic measures applied or the early detection and treatment of developing side effects. The best protection against harm caused by information on risks is a trustful doctor-patient relationship. Poor knowledge of nocebo effects or lack of countermeasures constitute a serious threat to patients and according to the current state of knowledge could be rated as medical malpractice.
Collapse
Affiliation(s)
- E Hansen
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - N Zech
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - S Benson
- Institut für Medizinische Psychologie und Verhaltensbiologie, Universitätsklinikum Essen, Essen, 45122, Deutschland
| |
Collapse
|
20
|
Pohl H, Moisa M, Jung HH, Brenner K, Aschmann J, Riederer F, Ruff CC, Schoenen J, Luechinger R, Widmer L, Petersen JA, Gantenbein AR, Sandor PS, Michels L. Long-Term Effects of Self-Administered Transcranial Direct Current Stimulation in Episodic Migraine Prevention: Results of a Randomized Controlled Trial. Neuromodulation 2020; 24:890-898. [PMID: 33078518 DOI: 10.1111/ner.13292] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Migraine is a multifactorial neurovascular disorder, which affects about 12% of the general population. In episodic migraine, the visual cortex revealed abnormal processing, most likely due to decreased preactivation level. Transcranial direct current stimulation (tDCS) is able to modify cortical excitability and might result in an alleviation of migraine occurrence if used repetitively. OBJECTIVE To test the hypothesis that self-administered anodal tDCS over the visual cortex significantly decreases the number of monthly migraine days in episodic migraine. MATERIALS AND METHODS The study was single-blind, randomized, and sham-controlled. Inclusion criteria were age 18-80 years and an ICHD-3 diagnosis of episodic migraine. Exclusion criteria were pregnancy, presence of a neurodegenerative disorder, a contraindication against MRI examinations, and less than two migraine days during the 28-day baseline period. Patients in whom the baseline period suggested chronic migraine were excluded. After baseline, participants applied daily either verum (anodal-1 mA to 20 min) or sham tDCS (anodal-1 mA to 30 sec) at Oz (reference Cz electrode) for 28 days. Headache diaries were used to record the number of migraine days at baseline, during the stimulation period, and during four subsequent 28-day periods. RESULTS Twenty-eight patients were included; two were excluded after the baseline period because less than two migraine days occurred; three were excluded because their headache diaries suggested the diagnosis of chronic migraine. Twenty-three datasets were taken for further analysis. Compared to sham tDCS (n = 12), verum tDCS (n = 11) resulted in a lower number of migraine days (p = 0.010) across all follow-up periods. We found no significant change in total headache days (p = 0.165), anxiety (p = 0.884), or depression scores (p = 0.535). No serious adverse events occurred; minor side effects were similar in both groups. CONCLUSIONS This study provides Class II evidence that self-administered anodal tDCS over the visual cortex in episodic migraine results in a significantly lower number of monthly migraine days. However, it has neither an immediate nor a long-term effect.
Collapse
Affiliation(s)
- Heiko Pohl
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Marius Moisa
- Zurich Center for Neuroeconomics (ZNE), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Hans-H Jung
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Kathrin Brenner
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Jessica Aschmann
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Franz Riederer
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,Neurological Center Rosenhügel and Karl Landsteiner Institute for Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Christian C Ruff
- Zurich Center for Neuroeconomics (ZNE), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Jean Schoenen
- Headache Research Unit, Department of Neurology-Citadelle Hospital, University of Liège, Liège, Belgium
| | - Roger Luechinger
- Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland
| | - Lukas Widmer
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | - Andreas R Gantenbein
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,RehaClinic Bad Zurzach, Bad Zurzach, Switzerland
| | - Peter S Sandor
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,RehaClinic Bad Zurzach, Bad Zurzach, Switzerland
| | - Lars Michels
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
21
|
Kravvariti E, Kotsani M, Mitsikostas DD, Sfikakis PP. Nocebo phenomena may be enhanced in aging: Implications for clinical practice. Maturitas 2020; 143:10-16. [PMID: 33308614 DOI: 10.1016/j.maturitas.2020.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 11/30/2022]
Abstract
Nocebo effects, denoting unfavourable outcomes after a medical intervention because of negative expectations rather than a direct pharmacologic action, are an important cause of dropout from clinical trials and non-adherence to medication, and may be especially pertinent for older adults. Several characteristics of aging individuals and their medical care have a potential to augment nocebo susceptibility, such as depression and anxiety, neurodegenerative diseases and chronic pain states, adverse healthcare experiences, generic drug use, age-related stereotypes, and strained patient-physician communication. Nocebo-related research in older adults is hindered by under-representation in clinical trials, medical complexity of geriatric patients, and lack of validated tools to accurately assess susceptibility and efficacy of preventive efforts.
Collapse
Affiliation(s)
- E Kravvariti
- Postgraduate Medical Studies in the Physiology of Aging and Geriatric Syndromes, National and Kapodistrian University of Athens' Medical School, Athens, Greece.
| | - M Kotsani
- Université de Lorraine, CHRU-Nancy, Pôle « Maladies du Vieillissement, Gérontologie et Soins Palliatifs », F-54000, Nancy, France
| | - D D Mitsikostas
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens' Medical School, Athens, Greece
| | - P P Sfikakis
- Postgraduate Medical Studies in the Physiology of Aging and Geriatric Syndromes, National and Kapodistrian University of Athens' Medical School, Athens, Greece
| |
Collapse
|
22
|
Grashow R, Weisskopf MG, Baggish A, Speizer FE, Whittington AJ, Nadler L, Connor A, Keske R, Taylor H, Zafonte R, Pascual-Leone A. Premortem Chronic Traumatic Encephalopathy Diagnoses in Professional Football. Ann Neurol 2020; 88:106-112. [PMID: 32281676 PMCID: PMC7383807 DOI: 10.1002/ana.25747] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE American-style football (ASF) has gained attention because of possible links between repetitive head injury and neurodegenerative diseases. Although postmortem pathologic changes consistent with chronic traumatic encephalopathy (CTE) have been reported in ASF players, there are currently no established premortem diagnostic criteria for CTE. Nevertheless, presented with symptoms of cognitive impairment, clinicians treating former players may be inclined to suggest CTE without a thorough exploration of comorbid factors that demonstrate similar clinical phenotypes to putative CTE. METHODS A survey of 3,913 former ASF players aged 24 to 89 was conducted for those who responded by March 2019. RESULTS Despite being a postmortem diagnosis, 108 players (2.8%) self-reported clinician-diagnosed CTE. The percentage of players under age 60 years reporting a CTE diagnosis was 2.3% versus 3.7% in participants age 60 or older. Comorbidities in participants self-reporting CTE were significantly more common, including sleep apnea, hypercholesterolemia, obesity, indicators of past or current depression, hypertension, prescription pain medication use, heart conditions, and low testosterone when compared to non-CTE respondents. Patterns of reporting for obesity, hypertension, heart conditions, or hypercholesterolemia differed between older and younger participants. Cognitive impairment symptoms were significantly higher in participants self-reporting CTE. INTERPRETATION Some former professional football players have been clinically diagnosed with CTE, a postmortem condition. Comorbidities that can affect cognition were associated with CTE diagnoses in both older and younger players. Although underlying neuropathology cannot be ruled out, treatable conditions should be explored in former athletes demonstrating CTE-linked clinical phenotypes or symptoms as a means of improving cognitive health in these patients. ANN NEUROL 2020 ANN NEUROL 2020;88:106-112.
Collapse
Affiliation(s)
- Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Marc G Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Aaron Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Frank E Speizer
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alicia J Whittington
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Lee Nadler
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Dana Farber Cancer Institute, Boston, MA
| | - Ann Connor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Neurology, Harvard Medical School, Boston, MA
| | - Robyn Keske
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Herman Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital and Harvard Medical School Boston, Boston, MA
| | - Alvaro Pascual-Leone
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Neurology, Harvard Medical School, Boston, MA.,Center for Memory Health and Marcus Institute for Aging Research, Hebrew Senior Life, Harvard Medical School, Boston, MA.,Institut Guttmann, Universitat Autónoma, Barcelona, Spain
| |
Collapse
|
23
|
BinDawood A, Dickinson A, Aytemur A, Howarth C, Milne E, Jones M. Investigating the effects of tDCS on Visual Orientation Discrimination Task Performance: 'The possible influence of placebo'. JOURNAL OF COGNITIVE ENHANCEMENT 2019; 4:235-249. [PMID: 32747876 DOI: 10.1007/s41465-019-00154-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The non-invasive neuromodulation technique tDCS offers the promise of a low cost tool for both research and clinical applications in psychology, psychiatry and neuroscience. However, findings regarding its efficacy are often equivocal. A key issue is that the clinical and cognitive applications studied are often complex and thus effects of tDCS are difficult to predict given its known effects on the basic underlying neurophysiology, namely alterations in cortical inhibition-excitation balance. As such, it may be beneficial to assess the effects of tDCS in tasks whose performance has a clear link to cortical inhibition-excitation balance such as the visual orientation discrimination task (ODT). In prior studies in our laboratory no practise effects were found during 2 consecutive runs of the ODT, thus in the current investigation, to examine the effects of tDCS, subjects received 10 minutes of 2mA occipital tDCS (sham, anode, cathode) between a first and second run of ODT. Surprisingly, subjects' performance significantly improved in the second run of ODT compared to the first one regardless of the tDCS stimulation type they received (anodal, cathodal, or sham-tDCS). Possible causes for such an improvement could have been due to either a generic 'placebo' effect of tDCS (as all subjects received some form of tDCS) or an increased delay period between the two runs of ODT of the current study compared to our previous work (10 minutes duration required to administer tDCS as opposed to ~2 minutes in previous studies as a 'break'). As such, we tested these two possibilities with a subsequent experiment in which subjects received 2 minutes or 10 minutes delay between the 2 runs (with no tDCS) or 10 minutes of sham-tDCS. Only sham-tDCS resulted in improved performance thus these data add to a growing literature suggesting that tDCS has powerful placebo effect that may occur even in the absence of active cortical modulation.
Collapse
Affiliation(s)
- A BinDawood
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield UK, S1 2LT.,Department of Psychology, King Saud University, Riyadh, Saudi Arabia
| | - A Dickinson
- Center for Autism Research and Treatment, University of California, Semel Institute for Neuroscience, 760 Westwood Plaza, Suite A7-448, Los Angeles, CA 90095, United States of America
| | - A Aytemur
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield UK, S1 2LT
| | - C Howarth
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield UK, S1 2LT
| | - E Milne
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield UK, S1 2LT
| | - M Jones
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield UK, S1 2LT
| |
Collapse
|
24
|
Zeng FG, Tran P, Richardson M, Sun S, Xu Y. Human Sensation of Transcranial Electric Stimulation. Sci Rep 2019; 9:15247. [PMID: 31649289 PMCID: PMC6813324 DOI: 10.1038/s41598-019-51792-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 10/08/2019] [Indexed: 01/22/2023] Open
Abstract
Noninvasive transcranial electric stimulation is increasingly being used as an advantageous therapy alternative that may activate deep tissues while avoiding drug side-effects. However, not only is there limited evidence for activation of deep tissues by transcranial electric stimulation, its evoked human sensation is understudied and often dismissed as a placebo or secondary effect. By systematically characterizing the human sensation evoked by transcranial alternating-current stimulation, we observed not only stimulus frequency and electrode position dependencies specific for auditory and visual sensation but also a broader presence of somatic sensation ranging from touch and vibration to pain and pressure. We found generally monotonic input-output functions at suprathreshold levels, and often multiple types of sensation occurring simultaneously in response to the same electric stimulation. We further used a recording circuit embedded in a cochlear implant to directly and objectively measure the amount of transcranial electric stimulation reaching the auditory nerve, a deep intercranial target located in the densest bone of the skull. We found an optimal configuration using an ear canal electrode and low-frequency (<300 Hz) sinusoids that delivered maximally ~1% of the transcranial current to the auditory nerve, which was sufficient to produce sound sensation even in deafened ears. Our results suggest that frequency resonance due to neuronal intrinsic electric properties need to be explored for targeted deep brain stimulation and novel brain-computer interfaces.
Collapse
Affiliation(s)
- Fan-Gang Zeng
- Center for Hearing Research, Departments of Anatomy and Neurobiology, Biomedical Engineering, Cognitive Sciences, Otolaryngology - Head and Neck Surgery, University of California Irvine, Irvine, California, 92697, USA.
| | - Phillip Tran
- Center for Hearing Research, Departments of Anatomy and Neurobiology, Biomedical Engineering, Cognitive Sciences, Otolaryngology - Head and Neck Surgery, University of California Irvine, Irvine, California, 92697, USA
| | - Matthew Richardson
- Center for Hearing Research, Departments of Anatomy and Neurobiology, Biomedical Engineering, Cognitive Sciences, Otolaryngology - Head and Neck Surgery, University of California Irvine, Irvine, California, 92697, USA
| | - Shuping Sun
- Center for Hearing Research, Departments of Anatomy and Neurobiology, Biomedical Engineering, Cognitive Sciences, Otolaryngology - Head and Neck Surgery, University of California Irvine, Irvine, California, 92697, USA
- Department of Otolaryngology - Head and Neck Surgery, The First Affiliated Hospital, Zhengzhou University, Henan, 450052, China
| | - Yuchen Xu
- Center for Hearing Research, Departments of Anatomy and Neurobiology, Biomedical Engineering, Cognitive Sciences, Otolaryngology - Head and Neck Surgery, University of California Irvine, Irvine, California, 92697, USA
- Department of Precision Instrument, Tsinghua University, Beijing, 100084, China
| |
Collapse
|
25
|
Beedie C, Benedetti F, Barbiani D, Camerone E, Lindheimer J, Roelands B. Incorporating methods and findings from neuroscience to better understand placebo and nocebo effects in sport. Eur J Sport Sci 2019; 20:313-325. [PMID: 31573836 PMCID: PMC10181912 DOI: 10.1080/17461391.2019.1675765] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Placebo and nocebo effects are a factor in sports performance. However, the majority of published studies in sport science are descriptive and speculative regarding mechanisms. It is therefore not unreasonable for the sceptic to argue that placebo and nocebo effects in sport are illusory, and might be better explained by variations in phenomena such as motivation. It is likely that, in sport at least, placebo and nocebo effects will remain in this empirical grey area until researchers provide stronger mechanistic evidence. Recent research in neuroscience has identified a number of consistent, discrete and interacting neurobiological and physiological pathways associated with placebo and nocebo effects, with many studies reporting data of potential interest to sport scientists, for example relating to pain, fatigue and motor control. Findings suggest that placebos and nocebos result in activity of the opioid, endocannabinoid and dopamine neurotransmitter systems, brain regions including the motor cortex and striatum, and measureable effects on the autonomic nervous system. Many studies have demonstrated that placebo and nocebo effects associated with a treatment, for example an inert treatment presented as an analgesic or stimulant, exhibit mechanisms similar or identical to the verum or true treatment. Such findings suggest the possibility of a wide range of distinct placebo and nocebo mechanisms that might influence sports performance. In the present paper, we present some of the findings from neuroscience. Focussing on fatigue as an outcome and caffeine as vehicle, we propose three approaches that researchers in sport might incorporate in their studies in order to better elucidate mechanisms of placebo/nocebo effects on performance.
Collapse
Affiliation(s)
- Christopher Beedie
- School of Psychology, University of Kent, Canterbury, UK
- CHX Performance, London, UK
| | - Fabrizio Benedetti
- Medicine and Physiology of Hypoxia, Plateau Rosà, Italy/Switzerland
- Neuroscience Dept, University of Turin Medical School, Turin, Italy
| | - Diletta Barbiani
- Neuroscience Dept, University of Turin Medical School, Turin, Italy
| | | | - Jacob Lindheimer
- Department of Veterans Affairs, William S. Middleton Veterans Memorial Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, USA
| | - Bart Roelands
- Department of Human Physiology, Vije Universiteit Brussels, Belgium
| |
Collapse
|
26
|
Turi Z, Csifcsák G, Boayue NM, Aslaksen P, Antal A, Paulus W, Groot J, Hawkins GE, Forstmann B, Opitz A, Thielscher A, Mittner M. Blinding is compromised for transcranial direct current stimulation at 1
mA
for 20 min in young healthy adults. Eur J Neurosci 2019; 50:3261-3268. [DOI: 10.1111/ejn.14403] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/27/2019] [Accepted: 03/11/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Zsolt Turi
- Department of Clinical Neurophysiology University Medical Center Göttingen Göttingen Germany
| | - Gábor Csifcsák
- Department of Psychology University of Tromsø Tromsø Norway
| | | | - Per Aslaksen
- Department of Psychology University of Tromsø Tromsø Norway
| | - Andrea Antal
- Department of Clinical Neurophysiology University Medical Center Göttingen Göttingen Germany
- Medical Psychology Otto‐Guericke University Magdeburg Magdeburg Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology University Medical Center Göttingen Göttingen Germany
| | - Josephine Groot
- Department of Psychology University of Tromsø Tromsø Norway
- Integrative Model‐based Cognitive Neuroscience Research Unit University of Amsterdam Amsterdam The Netherlands
| | - Guy E. Hawkins
- School of Psychology University of Newcastle Newcastle New South Wales Australia
| | - Birte Forstmann
- Integrative Model‐based Cognitive Neuroscience Research Unit University of Amsterdam Amsterdam The Netherlands
| | - Alexander Opitz
- Department of Biomedical Engineering University of Minnesota Minneapolis Minnesota
| | - Axel Thielscher
- Department of Electrical Engineering Technical University of Denmark Lyngby Denmark
- Danish Research Centre for Magnetic Resonance Centre for Functional and Diagnostic Imaging and Research Copenhagen University Hospital Hvidovre Copenhagen Denmark
| | | |
Collapse
|
27
|
Cai L, He L. Placebo effects and the molecular biological components involved. Gen Psychiatr 2019; 32:e100089. [PMID: 31552390 PMCID: PMC6738668 DOI: 10.1136/gpsych-2019-100089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/18/2019] [Accepted: 07/30/2019] [Indexed: 12/20/2022] Open
Abstract
Pharmacologically inactive substances have been used in medicine for more than 700 years and can trigger beneficial responses in the human body, which is referred to as the placebo effects or placebo responses. This effect is robust enough to influence psychosocial and physiological responses to the placebo and to active treatments in many settings, which has led to increased interest from researchers. In this article, we summarise the history of placebo, the characteristics of placebo effects and recent advancements reported from the studies on placebo effects and highlight placebome studies to identify various molecular biological components associated with placebo effects. Although placebos have a long history, the placebome concept is still in its infancy. Although behavioural, neurobiological and genetic studies have identified that molecules in the dopamine, opioid, serotonin and endocannabinoid systems might be targets of the placebo effect, placebome studies with a no-treatment control (NTC) are necessary to identify whole-genome genetic targets. Although bioinformatics analysis has identified the molecular placebome module, placebome studies with NTCs are also required to validate the related findings.
Collapse
Affiliation(s)
- Lei Cai
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Center of Genetics and Development, Shanghai Jiaotong University, Shanghai 200240, China
| | - Lin He
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Center of Genetics and Development, Shanghai Jiaotong University, Shanghai 200240, China
| |
Collapse
|
28
|
Winkler A, Hermann C. Placebo- and Nocebo-Effects in Cognitive Neuroenhancement: When Expectation Shapes Perception. Front Psychiatry 2019; 10:498. [PMID: 31354552 PMCID: PMC6640161 DOI: 10.3389/fpsyt.2019.00498] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/24/2019] [Indexed: 01/03/2023] Open
Abstract
Objective: The number of students using prescription drugs to improve cognitive performance has increased within the last years. There is first evidence that the expectation to receive a performance-enhancing drug alone can result in improved perceived and actual cognitive performance, suggesting a substantial placebo effect. In addition, expecting a placebo can result in lower perceived and actual cognitive performance, suggesting a nocebo effect. Yet, the underlying mechanisms of these effects remain to be elucidated. The aim of our study was to investigate whether the expectation of receiving a performance-increasing drug or a performance-impairing drug leads to changes in actual and perceived cognitive performance, compared to a control group without expectation manipulation. Methods: A total of N = 75 healthy adults were recruited for an experiment to "try cognitive performance-modulating drugs." A participant's actual cognitive performance (alertness, working memory, sustained attention, and divided attention) using the standardized test of attentional performance (TAP) as well as their performance expectation were assessed. Participants were randomly assigned in equal numbers to either receiving a placebo performance increasing nasal spray ("Modafinil") or a nocebo performance impairing nasal spray ("Vividrin®") or no nasal spray (natural history). After placebo/nocebo nasal spray administration, cognitive performance was reassessed. Subsequent to the second assessment, participants rated their perceived change in cognitive performance, as well as adverse symptoms. Results: Unlike hypothesized, a positive or negative performance expectation did not result in changes in actual performance, corresponding to the induced expectation. Participants in the placebo-Modafinil group rated their perceived change in cognitive performance subsequent to the application of the nasal spray significantly better (d = 1.16) compared to the nocebo-Vividrin® group. Additionally, participants who expected to receive Modafinil felt less tired than participants in the Vividrin® group (d = 0.96). Conclusion: Manipulation of performance expectation affects the perceived change in performance and tiredness, but not the actual cognitive performance in healthy adults. This may explain why college students use such drugs despite their little impact on actual cognitive functioning.
Collapse
Affiliation(s)
- Alexander Winkler
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University, Giessen, Germany
| | - Christiane Hermann
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University, Giessen, Germany
| |
Collapse
|