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Seewald A, Rief W. Therapist's warmth and competence increased positive outcome expectations and alliance in an analogue experiment. Psychother Res 2024; 34:663-678. [PMID: 37531315 DOI: 10.1080/10503307.2023.2241630] [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: 04/17/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023] Open
Abstract
Objective: The quality of the therapeutic alliance, treatment motivation, outcome expectations (OE), and specific health behaviour predicts psychotherapy success. Therapists should be able to improve these factors to optimize outcomes. This study investigated the therapist's interpersonal behaviour to optimize alliance, motivation, OE, and health behaviour. Method: A stressed study sample (N = 465) completed an online analogue experiment. We gave participants positive information about psychotherapy effectiveness and varied the therapist's interpersonal behaviour along the dimensions of warmth and competence.Results: High (vs. low) competence and high (vs. low) warmth increased alliance, OE, and help-seeking scores, while high (vs. low) competence increased motivation to do psychotherapy. We found no effects on health behaviour.Conclusion: In contrast to previous correlational analyses, our experimental study supports the causal role of the therapist's warmth and competence and its impact on alliance, motivation, and OE. We discuss approaches for future studies and clinical implications.
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Affiliation(s)
- Anna Seewald
- Department of Psychology, Clinical Psychology & Psychotherapy, University of Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Psychology, Clinical Psychology & Psychotherapy, University of Marburg, Marburg, Germany
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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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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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Daniali H, Ruben MA, Aslaksen PM, Fiskum C, Kaptchuk TJ, Flaten MA. The Effect of Singular Nonverbal Behaviours of Experimenters on Pain Reports. J Pain Res 2024; 17:1345-1360. [PMID: 38584862 PMCID: PMC10999184 DOI: 10.2147/jpr.s449150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/02/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Studies suggest facial expressions of caregivers may be important in placebo effects; however, this has not been systematically tested. This experiment investigated the effects of caregivers' singular positive nonverbal behaviours (NBs) on pain reports. Methods Fifty-one males and 53 females (total of 104) participants were randomized to four groups that were displayed positive facial expressions, tone of voice, body movement, or neutral NBs of videotaped experimenters. Subjective reports of pain, stress, arousal, and cardiac activity were obtained in a pre-test, a conditioning phase, and at a post-test. Four minutes of heat pain was induced in each test, and a placebo cream was administered before the conditioning and post-test in all groups. Results There were no differences between the NB groups in the reduced pain. Males had larger reduction in pain in the post-test, and females had lower arousal than the opposite sex. During the conditioning, females had larger reduction in pain ie, unconditioned pain response (UPR). In females, the UPR predicted the reinforced expectation ie, increase in expectations from conditioning to post-test, and fear of minor pain negatively predicted both the UPR and reinforced expectation. Discussion Singular NBs of caregiver were weak to enhance placebo effects. Females had lower pain during conditioning, and the UPR amplitude in females was associated with positive expectations. Moreover, for females, fear of minor pain weakened the UPR and expectations of cream. Conclusion No NB of caregivers is more effective in reducing pain. Caregivers' NBs are less effective when displayed individually. Males and females may be different in underlying mechanisms of placebo effects.
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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, USA
| | - Per M Aslaksen
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Charlotte Fiskum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ted J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center/ Harvard Medical School, Boston, MA, USA
| | - Magne A Flaten
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Ko SJ, Kim K, Kaptchuk TJ, Napadow V, Kuo B, Gerber J, Ha NY, Lee J, Kelley JM, Park JW, Kim J. Influence of patient-clinician relationship style on acupuncture outcomes in functional dyspepsia: A multi-site randomized controlled trial in Korea. PATIENT EDUCATION AND COUNSELING 2024; 121:108133. [PMID: 38199174 DOI: 10.1016/j.pec.2023.108133] [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: 02/01/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Research suggests that a warm and empathic "patient-centered" patient-clinician relationship produces better clinical outcomes when compared with a more neutral "disease-centered" relationship. Acupuncturists performed both styles of therapy for patients with functional dyspepsia in Korea. METHODS The present randomized controlled trial assigned patients (n = 73) to identical acupuncture treatment with either patient-centered augmented care or disease-centered limited care. The Korean version of the Nepean Dyspepsia Index (NDI-K) was the primary outcome measure. Secondary outcome measures included Consultation And Relational Empathy (CARE) scale. RESULTS Both groups showed improvement in NDI-K. Patient-centered augmented acupuncture produced less effective symptom improvement compared to disease-centered limited acupuncture (NDI-K sum score and frequency; P = 0.008 and P = 0.037 respectively). CARE scores were higher for the augmented versus limited group (P = 0.001), supporting the fidelity of the experimentally controlled patient/clinician relationship. There were no significant differences between the groups in any of other secondary outcomes. CONCLUSION Patients demonstrated greater improvement following acupuncture conducted with a more neutral, "disease-centered" style of relationship. This result is counter to similar research conducted in Western countries and suggests that cultural factors can significantly shape optimum styles of acupuncture therapy. PRACTICE IMPLICATIONS Clinicians should consider cultural differences when applying acupuncture therapy.
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Affiliation(s)
- Seok-Jae Ko
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - Keumji Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - Ted J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Vitaly Napadow
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Network, Harvard Medical School, Boston, MA, USA
| | - Braden Kuo
- Gastroenterology Unit, Center for Neurointestinal Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica Gerber
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Na-Yeon Ha
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - Junhee Lee
- Department of Sasang Constitutional Medicine, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - John M Kelley
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Psychology Department, Endicott College, Beverly, MA, USA
| | - Jae-Woo Park
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea.
| | - Jinsung Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea.
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Horan WP, Sachs G, Velligan DI, Davis M, Keefe RS, Khin NA, Butlen-Ducuing F, Harvey PD. Current and Emerging Technologies to Address the Placebo Response Challenge in CNS Clinical Trials: Promise, Pitfalls, and Pathways Forward. INNOVATIONS IN CLINICAL NEUROSCIENCE 2024; 21:19-30. [PMID: 38495609 PMCID: PMC10941857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Excessive placebo response rates have long been a major challenge for central nervous system (CNS) drug discovery. As CNS trials progressively shift toward digitalization, decentralization, and novel remote assessment approaches, questions are emerging about whether innovative technologies can help mitigate the placebo response. This article begins with a conceptual framework for understanding placebo response. We then critically evaluate the potential of a range of innovative technologies and associated research designs that might help mitigate the placebo response and enhance detection of treatment signals. These include technologies developed to directly address placebo response; technology-based approaches focused on recruitment, retention, and data collection with potential relevance to placebo response; and novel remote digital phenotyping technologies. Finally, we describe key scientific and regulatory considerations when evaluating and selecting innovative strategies to mitigate placebo response. While a range of technological innovations shows potential for helping to address the placebo response in CNS trials, much work remains to carefully evaluate their risks and benefits.
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Affiliation(s)
- William P. Horan
- Dr. Horan is with Karuna Therapeutics in Boston, Massachusetts, and University of California in Los Angeles, California
| | - Gary Sachs
- Dr. Sachs is with Signant Health in Boston, Massachusetts, and Harvard Medical School in Boston, Massachusetts
| | - Dawn I. Velligan
- Dr. Velligan is with University of Texas Health Science Center at San Antonio in San Antonio, Texas
| | - Michael Davis
- Dr. Davis is with Usona Institute in Madison, Wisconsin
| | - Richard S.E. Keefe
- Dr. Keefe is with Duke University Medical Center in Durham, North Carolina
| | - Ni A. Khin
- Dr. Khin is with Neurocrine Biosciences, Inc. in San Diego, California
| | - Florence Butlen-Ducuing
- Dr. Butlen-Ducuing is with Office for Neurological and Psychiatric Disorders, European Medicines Agency in Amsterdam, The Netherlands
| | - Philip D. Harvey
- Dr. Harvey is with University of Miami Miller School of Medicine in Miami, Florida
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Gianola M, Llabre MM, Losin EAR. Does pain hurt more in Spanish? The neurobiology of pain among Spanish-English bilingual adults. Soc Cogn Affect Neurosci 2023; 19:nsad074. [PMID: 38102223 PMCID: PMC10868134 DOI: 10.1093/scan/nsad074] [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: 06/04/2023] [Revised: 10/24/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023] Open
Abstract
We previously found Spanish-English bilingual adults reported higher pain intensity when exposed to painful heat in the language of their stronger cultural orientation. Here, we elucidate brain systems involved in language-driven alterations in pain responses. During separate English- and Spanish-speaking fMRI scanning runs, 39 (21 female) bilingual adults rated painful heat intermixed between culturally evocative images and completed sentence reading tasks. Surveys of cultural identity and language use measured relative preference for US-American vs Hispanic culture (cultural orientation). Participants produced higher intensity ratings in Spanish compared to English. Group-level whole-brain differences in pain-evoked activity between languages emerged in somatosensory, cingulate, precuneus and cerebellar cortex. Regions of interest associated with semantic, attention and somatosensory processing showed higher average pain-evoked responses in participants' culturally preferred language, as did expression of a multivariate pain-predictive pattern. Follow-up moderated mediation analyses showed somatosensory activity mediated language effects on pain intensity, particularly for Hispanic oriented participants. These findings relate to distinct ('meddler', 'spotlight' and 'inducer') hypotheses about the nature of language effects on perception and cognition. Knowledge of language influences on pain could improve efficacy of culturally sensitive treatment approaches across the diversity of Hispanic adults to mitigate documented health disparities in this population.
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Affiliation(s)
- Morgan Gianola
- Psychology, University of Miami, Coral Gables, Florida 33146, USA
| | - Maria M Llabre
- Psychology, University of Miami, Coral Gables, Florida 33146, USA
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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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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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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: 31] [Impact Index Per Article: 31.0] [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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Hui D, Puac V, Shelal Z, Dev R, Hanneman SK, Jennings K, Ma H, Urbauer DL, Shete S, Fossella F, Liao Z, Blumenschein G, Chang JY, O'Reilly M, Gandhi SJ, Tsao A, Mahler DA, Bruera E. Effect of dexamethasone on dyspnoea in patients with cancer (ABCD): a parallel-group, double-blind, randomised, controlled trial. Lancet Oncol 2022; 23:1321-1331. [PMID: 36087590 PMCID: PMC10618956 DOI: 10.1016/s1470-2045(22)00508-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Systemic corticosteroids are commonly prescribed for palliation of dyspnoea in patients with cancer, despite scarce evidence to support their use. We aimed to assess the effect of high-dose dexamethasone versus placebo on cancer-related dyspnoea. METHODS The parallel-group, double-blind, randomised, controlled ABCD (Alleviating Breathlessness in Cancer Patients with Dexamethasone) trial was done at the at the University of Texas MD Anderson Cancer Center and the general oncology clinic at Lyndon B Johnson General Hospital (both in Houston, TX, USA). Ambulatory patients with cancer, aged 18 years or older, and with an average dyspnoea intensity score on an 11-point numerical rating scale (NRS; 0=none, 10=worst) over the past week of 4 or higher were randomly assigned (2:1) to receive dexamethasone 8 mg orally every 12 h for 7 days followed by 4 mg orally every 12 h for 7 days, or matching placebo capsules for 14 days. Pharmacists did permuted block randomisation with a block size of six, and patients were stratified by baseline dyspnoea score (4-6 vs 7-10) and study site. Patients, research staff, and clinicians were masked to group assignment. The primary outcome was change in dyspnoea NRS intensity over the past 24 h from baseline to day 7 (±2 days). Analyses were done by modified intention-to-treat (ie, including all patients who were randomly assigned and started the study treatment, regardless of whether they completed the study). Enrolment was stopped after the second preplanned interim analysis, when the futility criterion was met. This study is registered with ClinicalTrials.gov (NCT03367156) and is now completed. FINDINGS Between Jan 11, 2018, and April 23, 2021, we screened 2867 patients, enrolled 149 patients, and randomly assigned 128 to dexamethasone (n=85) or placebo (n=43). The mean change in dyspnoea NRS intensity from baseline to day 7 (±2 days) was -1·6 (95% CI -2·0 to -1·2) in the dexamethasone group and -1·6 (-2·3 to -0·9) in the placebo group, with no significant between-group difference (mean 0 [95% CI -0·8 to 0·7]; p=0·48). The most common all-cause grade 3-4 adverse events were infections (nine [11%] of 85 patients in the dexamethasone group vs three [7%] of 43 in the placebo group), insomnia (seven [8%] vs one [2%]), and neuropsychiatric symptoms (three [4%] vs none [0%]). Serious adverse events, all resulting in hospital admissions, were reported in 24 (28%) of 85 patients in the dexamethasone group and in three (7%) of 43 patients in the placebo group. No treatment-related deaths occurred in either group. INTERPRETATION High-dose dexamethasone did not improve dyspnoea in patients with cancer more effectively than placebo and was associated with a higher frequency of adverse events. These data suggest that dexamethasone should not be routinely given to unselected patients with cancer for palliation of dyspnoea. FUNDING US National Cancer Institute.
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Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Veronica Puac
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zeena Shelal
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rony Dev
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sandra K Hanneman
- Cizik School of Nursing at UTHealth, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kristofer Jennings
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hilary Ma
- Department of General Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diana L Urbauer
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanjay Shete
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Frank Fossella
- Department of Thoracic Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhongxing Liao
- Department of Thoracic Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - George Blumenschein
- Department of Thoracic Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joe Y Chang
- Department of Thoracic Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael O'Reilly
- Department of Thoracic Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Saumil J Gandhi
- Department of Thoracic Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anne Tsao
- Department of Thoracic Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Donald A Mahler
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Respiratory Services, Valley Regional Hospital, Claremont, NH, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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12
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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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13
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Affiliation(s)
- Iñigo R Arandia
- Department of Philosophy, IAS-Research Center for Life, Mind and Society, University of the Basque Country, Donostia, Spain
- ISAAC Lab, Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
| | - Ezequiel A Di Paolo
- Department of Philosophy, IAS-Research Center for Life, Mind and Society, University of the Basque Country, Donostia, Spain
- Ikerbasque, Basque Foundation for Science, Bizkaia, Spain
- Centre for Computational Neuroscience and Robotics, University of Sussex, Brighton, United Kingdom
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14
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Intention of Collaboration among Dental Students during the COVID-19 Pandemic. Dent J (Basel) 2022; 10:dj10030040. [PMID: 35323242 PMCID: PMC8947484 DOI: 10.3390/dj10030040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/15/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022] Open
Abstract
Interpersonal communication skills (ICS) are crucial for effective dental practice and interprofessional collaboration. The current study aimed to assess the attitudes of Greek dental undergraduate students towards team working and their cooperation abilities during the COVID-19 pandemic. One-hundred and twenty-seven fourth-semester dental students (N1 = 127) out of 145 (N0) filled in the online survey placed on Google forms. The “Dental Students Cooperation Questionnaire” (DSC) consisted of 49 questions and was available for completion for one week during April 2020. Bivariate (ANOVA) and linear regression analysis of data revealed that mean scores of the questionnaire increased as the parents’ educational level also increased. Data analysis showed that dental students had the required ICS and the intention to collaborate with each other. Many participants managed to achieve group goals, were willing to support other members to fulfill the project’s goals, and there was no competition among them. They acknowledged the importance of feedback, the reward at the end of a group project and social media as a tool for teamworking communication. The students reported that the most important characteristics of an academic teacher were patience, willingness to cooperate, friendliness, politeness, willingness to help, accessibility and availability. It is suggested that group work should be included in the curriculum of dental schools to enhance the integration and evolution of students’ ICS, and the DSC questionnaire can be an effective tool to assess these skills.
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15
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Weng L, van Laarhoven AIM, Peerdeman KJ, Evers AWM. Do individual psychological characteristics predict induction and generalization of nocebo and placebo effects on pain and itch? Front Psychiatry 2022; 13:838578. [PMID: 35990075 PMCID: PMC9386339 DOI: 10.3389/fpsyt.2022.838578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nocebo and placebo effects, i.e., adverse or beneficial treatment effects, respectively, putatively due to expectancies can modulate pain and itch. These effects can generalize within the pain or itch modality. Predicting the induction and generalization of these effects can be helpful in clinical practice. This study aims to investigate whether psychological characteristics related to the fear-avoidance model predict the induction and generalization of nocebo and placebo effects on pain and itch in young healthy participants. METHODS Data from two previous experiments were analyzed. In Experiment 1, we induced nocebo and placebo effects on heat pain and tested generalization to pressure pain and to cowhage-evoked itch (n = 33 in a nocebo group, n = 32 in a placebo group). In Experiment 2, we induced nocebo effects on cowhage-evoked itch and tested generalization to mechanical itch and to mechanical touch (n = 44). Potential predictors were anxiety- and stress symptoms, attention to pain/itch, and pain/itch catastrophizing. Multiple regression analyses were performed. RESULTS For nocebo effects, none of the individual psychological characteristics significantly predicted induction of nocebo effects nor their generalization. For placebo effects, only less stress symptoms, lower attention to pain, and higher pain catastrophizing weakly predicted a stronger generalization of placebo effects from heat pain to pressure pain. CONCLUSION The tested psychological characteristics may not play an important role in the induction and generalization of nocebo and placebo effects in healthy individuals. However, firm conclusions cannot be drawn with the current sample. Future studies should validate findings in larger and more diverse samples.
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Affiliation(s)
- Lingling Weng
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Antoinette I M van Laarhoven
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Kaya J Peerdeman
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands.,Medical Delta, Leiden University, Technical University Delft, Rotterdam University, Rotterdam, Netherlands
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16
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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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17
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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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18
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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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19
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McHugh D, Tagawa S, Moryl N, Milowsky M, Heller G, Osborne J, Rathkopf D, Basch E, Pandit-Taskar N, Morris MJ. A Phase II, Nonrandomized Open Trial Assessing Pain Efficacy with Radium-223 in Symptomatic Metastatic Castration-resistant Prostate Cancer. Clin Genitourin Cancer 2021; 19:447-456. [PMID: 34088618 DOI: 10.1016/j.clgc.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prostate Cancer Working Group 3 and FDA guidelines recommend a standardized approach to pain assessment in preapproval trials. No prior trial has examined pain palliation of Radium-223 using standard dosing and contemporary PRO pain-assessment tools. METHODS In this multicenter phase II trial, patients with Brief Pain Inventory (BPI) ≥3 were eligible for Radium-223 per its label. Primary endpoint was a 30% decrease in BPI Worst Pain from baseline to Week 8, sustained at Week 12 without escalation of medication on the World Health Organization (WHO) analgesic ladder. Secondary endpoints included changes in Brief Fatigue Inventory (BFI) Worst fatigue and BPI pain interference. If six of 27 subjects (22%) met the primary endpoint, the trial would expand by another 36 subjects. RESULTS Twenty-nine subjects were accrued. Nine of 29 (31%) subjects met the primary endpoint, with 21 (72%) evaluable for the primary endpoint. Among responders: median worst pain declined 62% (range 36-100) at Week 8 and 63% (range 38-100) at Week 12; median reduction of pain interference with general activity and sleep at Week 12 was 62% (range 18-100) and 53% (range 8-100) respectively; median reduction in worst fatigue of 45% (range 10-85) at Week 12. CONCLUSIONS In the first prospective trial using standard Ra-223 doses, contemporary pain endpoints and PRO collection tools, Ra-223 palliated pain, reduced fatigue, and improved pain interference. The pain response rate easily exceeded the requirements for expansion to the second phase, but the trial was closed due to slow accrual.
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Affiliation(s)
- Deaglan McHugh
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Genitourinary Oncology Service, Weill Cornell Medicine, New York, NY.
| | - Scott Tagawa
- Genitourinary Oncology Service, Weill Cornell Medicine, New York, NY
| | - Natalie Moryl
- Genitourinary Oncology Service, Weill Cornell Medicine, New York, NY; Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew Milowsky
- Urologic Oncology Service, University of North Carolina, Chapel Hill, North Carolina
| | - Glenn Heller
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Genitourinary Oncology Service, Weill Cornell Medicine, New York, NY
| | - Joseph Osborne
- Genitourinary Oncology Service, Weill Cornell Medicine, New York, NY; Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dana Rathkopf
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Genitourinary Oncology Service, Weill Cornell Medicine, New York, NY
| | - Ethan Basch
- Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neeta Pandit-Taskar
- Genitourinary Oncology Service, Weill Cornell Medicine, New York, NY; Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael J Morris
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Genitourinary Oncology Service, Weill Cornell Medicine, New York, NY
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20
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Sondermann W, Reinboldt-Jockenhöfer F, Dissemond J, Pfaar O, Bingel U, Schedlowski M. Effects of Patients' Expectation in Dermatology: Evidence from Experimental and Clinical Placebo Studies and Implications for Dermatologic Practice and Research. Dermatology 2021; 237:857-871. [PMID: 33498052 DOI: 10.1159/000513445] [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: 10/02/2020] [Accepted: 11/28/2020] [Indexed: 11/19/2022] Open
Abstract
Patients' expectations towards the benefit of a treatment are key determinants of placebo responses and can affect the development and course of medical conditions and the efficacy and tolerability of active medical treatment. The mechanisms mediating these placebo and nocebo effects have been best described in the field of experimental pain and placebo analgesia. However, also in dermatology experimental and clinical studies demonstrate that various skin diseases such as inflammatory dermatoses and allergic reactions can be modulated by patients' expectations. Dermatologists should consider the important modulatory role of patients' expectations on the efficacy and tolerability of specific treatments and the key role of verbal information, patients' prior treatment experiences (associative learning), and the quality and quantity of doctor-patient communication in shaping treatment expectation. As a consequence, techniques aiming at maximizing patients' expectation effects should be implemented into daily clinical routine. By contrast, in clinical studies expectation effects should be maximally controlled and harmonized to improve the "assay sensitivity" to detect new compounds. Further translational studies, also in dermatoses that have not been investigated yet, are needed to better characterize the mechanisms underlying patients' expectation and to gain further insights into potential clinical implications of these effects in dermatologic conditions. Therefore, in this review, we provide a brief overview on the concept of expectation effects on treatment outcome in general, summarize what is already known about this topic for dermatologic diseases, and finally present the relevance of this topic in clinical dermatology.
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Affiliation(s)
- Wiebke Sondermann
- Department of Dermatology, Venereology, and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany,
| | - Finja Reinboldt-Jockenhöfer
- Department of Dermatology, Venereology, and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology, and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Oliver Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Ulrike Bingel
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
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21
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Gianola M, Llabre MM, Losin E. Effects of Language Context and Cultural Identity on the Pain Experience of Spanish-English Bilinguals. ACTA ACUST UNITED AC 2020; 2:112-127. [PMID: 34327336 DOI: 10.1007/s42761-020-00021-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
While language and culture influence cognition, their role in shaping pain remains understudied. We tested whether language and cultural identification influence pain report among Spanish-English bilinguals. Eighty bilingual Hispanics/Latinos (40 female) experienced painful thermal stimulations, providing pain intensity and unpleasantness ratings, on separate English and Spanish testing days. Participants' skin conductance responses (SCRs) during stimulations served as measures of physiological arousal. Bilingual participants showed larger SCRs and higher pain intensity when speaking the language congruent with their dominant cultural identification. That is, those endorsing more Hispanic cultural identification showed higher pain in Spanish, while US-American-dominant participants demonstrated increased pain in English. Follow-up moderated mediation demonstrated that SCRs mediated language effects on pain ratings for participants endorsing greater Hispanic cultural identification. Together, our results suggest language, cultural associations, and bodily arousal synergistically influence pain evaluations among bilingual people, potentially contributing to well-documented health disparities between Hispanic and non-Hispanic communities.
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Affiliation(s)
- Morgan Gianola
- University of Miami, Department of Psychology, Miami, FL, USA
| | - Maria M Llabre
- University of Miami, Department of Psychology, Miami, FL, USA
| | - Elizabeth Losin
- University of Miami, Department of Psychology, Miami, FL, USA
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22
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Shen Z, Xu Q, Jin L. Structured procedures promote placebo effects. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2020. [DOI: 10.1016/j.jesp.2020.104029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Akroyd A, Gunn KN, Rankin S, Douglas M, Kleinstäuber M, Rief W, Petrie KJ. Optimizing patient expectations to improve therapeutic response to medical treatment: A randomized controlled trial of iron infusion therapy. Br J Health Psychol 2020; 25:639-651. [PMID: 32519431 DOI: 10.1111/bjhp.12435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/03/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Patient expectations have the ability to influence health outcomes and have been shown to play an important role as part of the placebo effect to influence the response to medical treatments. Increasing positive expectations have been proposed as an intervention to improve treatment response, although evidence for this to date is limited. We investigated whether a brief 10-min intervention directly targeting patient expectations prior to an iron infusion could enhance expectations and improve treatment response, in terms of patients' reported fatigue. DESIGN Randomized controlled trial. METHODS Forty-three patients diagnosed with iron deficiency anaemia were randomized to a brief expectation intervention or active control group prior to an intravenous iron infusion. Chalder Fatigue Scale scores were assessed prior to randomization and at one and four weeks. RESULTS The expectation intervention significantly improved patients' expectations about the effectiveness of the intravenous iron infusion, t(21) = -3.95, p = .001. While there were no significant differences between groups in fatigue at the one-week follow-up, fatigue was significantly lower in the intervention group at the four-week follow-up compared to the control group, F(1, 25) = 6.25, p = .019. This was largely influenced by a significant reduction in physical, as opposed to mental fatigue scores. CONCLUSIONS Boosting patients' positive expectations may be an effective way of enhancing patient response to treatment. In particular, targeting patient expectations with a brief intervention prior to medical treatments may result in a greater and longer therapeutic effect.
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Affiliation(s)
- Amelia Akroyd
- Department of Psychological Medicine, University of Auckland, New Zealand
| | - Kerry N Gunn
- Department of Anaesthesia, Auckland City Hospital, New Zealand
| | - Sarah Rankin
- Department of Psychological Medicine, University of Auckland, New Zealand
| | - Meihana Douglas
- Department of Psychological Medicine, University of Auckland, New Zealand
| | - Maria Kleinstäuber
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Winfried Rief
- Division of Clinical Psychology, University of Marburg, Germany
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, New Zealand
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24
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Czerniak E, Oberlander TF, Weimer K, Kossowsky J, Enck P. "Placebo by Proxy" and "Nocebo by Proxy" in Children: A Review of Parents' Role in Treatment Outcomes. Front Psychiatry 2020; 11:169. [PMID: 32218746 PMCID: PMC7078585 DOI: 10.3389/fpsyt.2020.00169] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 02/21/2020] [Indexed: 12/12/2022] Open
Abstract
The "placebo (effect) by proxy" (PbP) concept, introduced by Grelotti and Kaptchuk (1), describes a positive effect of a patient's treatment on persons in their surrounding such as family members or healthcare providers, who feel better because the patient is being treated. The PbP effect is a complex dynamic phenomenon which attempts to explain a change in treatment outcome arising from an interaction between a patient and an effect from proxies such as parents, caregivers, physicians or even the media. By extension the effect of the proxy can also have a negative or adverse effect whereby a proxy feels worse when a patient is treated, giving rise to the possibility of a "nocebo (effect) by proxy" (NbP), and by extension can influence a patient's treatment response. While this has yet to be systematically investigated, such an effect could occur when a proxy observes that a treatment is ineffective or is perceived as causing adverse effects leading the patient to experience side effects. In this narrative review, we take these definitions one step further to include the impact of PbP/NbP as they transform to affect the treatment outcome for the patient or child being treated, not just the people surrounding the individual being treated. Following a systematic search of literature on the subject using the Journal of Interdisciplinary Placebo Studies (JIPS) database (https://jips.online) and PubMed (NCBI) resulted in very few relevant studies, especially in children. The effect of PbP per se has been studied in parents and their children for temper tantrums, acupuncture for postoperative symptoms, as well as for neuroprotection in very preterm-born infants. This paper will review the PbP/NbP concepts, show evidence for its presence in children's treatment outcome and introduce clinical implications. We will also offer suggestions for future research to further our understanding of the role of the proxy in promoting or distracting from treatment benefit in children. Increasing an appreciation of the PbP and NbP phenomena and the role of the proxy in children's treatment should improve research study design and ultimately harness them to improve clinical child healthcare.
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Affiliation(s)
- Efrat Czerniak
- Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Tim F Oberlander
- Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Joe Kossowsky
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States.,Department of Clinical Psychology & Psychotherapy, University of Basel, Basel, Switzerland
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Tübingen, Germany
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25
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Dumitrescu TP, McCune J, Schmith V. Is Placebo Response Responsible for Many Phase III Failures? Clin Pharmacol Ther 2019; 106:1151-1154. [PMID: 31713241 DOI: 10.1002/cpt.1632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 01/02/2023]
Affiliation(s)
| | - Jeanine McCune
- Department of Population Sciences, Beckman Research Institute/City of Hope, Duarte, California, USA
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26
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Howe LC, Leibowitz KA, Crum AJ. When Your Doctor "Gets It" and "Gets You": The Critical Role of Competence and Warmth in the Patient-Provider Interaction. Front Psychiatry 2019; 10:475. [PMID: 31333518 PMCID: PMC6619399 DOI: 10.3389/fpsyt.2019.00475] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 06/14/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Research demonstrates that the placebo effect can influence the effectiveness of medical treatments and accounts for a significant proportion of healing in many conditions. However, providers may differ in the degree to which they consciously or unconsciously leverage the forces that produce placebo effects in clinical practice. Some studies suggest that the manner in which providers interact with patients shapes the magnitude of placebo effects, but this research has yet to distill the specific dimensions of patient-provider interactions that are most likely to influence placebo response and the mechanisms through which aspects of patient-provider interactions impact placebo response. Methods: We offer a simplifying and unifying framework in which interactions that boost placebo response can be dissected into two key dimensions: patients' perceptions of competence, or whether a doctor "gets it" (i.e., displays of efficiency, knowledge, and skill), and patients' perceptions of warmth, or whether a doctor "gets me" (i.e., displays of personal engagement, connection, and care for the patient). Results: First, we discuss how this framework builds on past research in psychology on social perception of competence and warmth and in medical literature on models of effective medical care, patient satisfaction, and patient-provider interactions. Then we consider possible mechanisms through which competence and warmth may affect the placebo response in healthcare. Finally, we share original data from patients and providers highlighting how this framework applies to healthcare. Both patient and provider data illustrate actionable ways providers can demonstrate competence and warmth to patients. Discussion: We conclude with recommendations for how researchers and practitioners alike can more systematically consider the role of provider competence and warmth in patient-provider interactions to deepen our understanding of placebo effects and, ultimately, enable providers to boost placebo effects alongside active medications (i.e., with known medical ingredients) and treatment in clinical care.
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Affiliation(s)
- Lauren C. Howe
- Department of Business Administration, University of Zurich, Zurich, Switzerland
| | - Kari A. Leibowitz
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Alia J. Crum
- Department of Psychology, Stanford University, Stanford, CA, United States
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Petrie KJ, Rief W. Psychobiological Mechanisms of Placebo and Nocebo Effects: Pathways to Improve Treatments and Reduce Side Effects. Annu Rev Psychol 2019; 70:599-625. [PMID: 30110575 DOI: 10.1146/annurev-psych-010418-102907] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Placebo effects constitute a major part of treatment success in medical interventions. The nocebo effect also has a major impact, as it accounts for a significant proportion of the reported side effects for many treatments. Historically, clinical trials have aimed to reduce placebo effects; however, currently, there is interest in optimizing placebo effects to improve existing treatments and in examining ways to minimize nocebo effects to improve clinical outcome. To achieve these aims, a better understanding of the psychological and neurobiological mechanisms of the placebo and nocebo response is required. This review discusses the impact of the placebo and nocebo response in health care. We also examine the mechanisms involved in the placebo and nocebo effects, including the central mechanism of expectations. Finally, we examine ways to enhance placebo effects and reduce the impact of the nocebo response in clinical practice and suggest areas for future research.
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Affiliation(s)
- Keith J Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand;
| | - Winfried Rief
- Division of Clinical Psychology, University of Marburg, 35032 Marburg, Germany;
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28
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Sagy I, Abres J, Winnick A, Jotkowitz A. Placebos in the era of open-label trials: An update for clinicians. Eur J Clin Invest 2019; 49:e13038. [PMID: 30316203 DOI: 10.1111/eci.13038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/07/2018] [Accepted: 10/10/2018] [Indexed: 12/19/2022]
Abstract
Placebos have been used extensively by vast numbers of physicians, in a majority of clinical trials. Placebo effects involve behavioural, psychological and genetic factors and have been subject to ethical controversies stemming from the use of deception in treating patients. The patient-physician encounter, endogenous pharmacological pathways, personality traits and genetic diversity have all been reported to be key players in placebo responses. In the last decade, a new methodological paradigm of placebo research has emerged, using open-label placebos to investigate their effects which showed promising results for various common medical conditions. In this review, we will summarize the current body of evidence on placebos in clinical practice, with a view to open-label placebo trials in particular. It is our view that future larger-scale randomized blinded open placebo trials will benefit physicians and improve patient outcomes.
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Affiliation(s)
- Iftach Sagy
- Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.,Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Jonathan Abres
- Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Ariel Winnick
- Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Alan Jotkowitz
- Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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29
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Daniali H, Flaten MA. A Qualitative Systematic Review of Effects of Provider Characteristics and Nonverbal Behavior on Pain, and Placebo and Nocebo Effects. Front Psychiatry 2019; 10:242. [PMID: 31037059 PMCID: PMC6476260 DOI: 10.3389/fpsyt.2019.00242] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/29/2019] [Indexed: 01/23/2023] Open
Abstract
Background: Previous research has indicated that the sex, status, and nonverbal behaviors of experimenters or clinicians can contribute to reported pain, and placebo and nocebo effects in patients or research participants. However, no systematic review has been published. Objective: The aim of this study was to investigate the effects of experimenter/clinician characteristics and nonverbal behavior on pain, placebo, and nocebo effects. Methods: Using EmBase, Web of Knowledge, and PubMed databases, several literature searches were conducted to find studies that investigated the effects of the experimenter's/clinician's sex, status, and nonverbal behaviors on pain, placebo, and nocebo effects. Results: Thirty-four studies were included, 20 on the effects of characteristics of the experimenter/clinician, 11 on the role of nonverbal behaviors, and 3 on the effects of both nonverbal behaviors and characteristics of experimenters/clinicians on pain and placebo/nocebo effects. There was a tendency for experimenters/clinicians to induce lower pain report in participants of the opposite sex. Furthermore, higher confidence, competence, and professionalism of experimenters/clinicians resulted in lower pain report and higher placebo effects, whereas lower status of experimenters/clinicians such as lower confidence, competence, and professionalism generated higher reported pain and lower placebo effects. Positive nonverbal behaviors (e.g., smiling, strong tone of voice, more eye contact, more leaning toward the patient/participant, and more body gestures) contributed to lower reported pain and higher placebo effects, whereas negative nonverbal behaviors (i.e., no smile, monotonous tone of voice, no eye contact, leaning backward from the participant/patient, and no body gestures) contributed to higher reported pain and nocebo effects. Conclusion: Characteristics and nonverbal behaviors of experimenters/clinicians contribute to the elicitation and modulation of pain, placebo, and nocebo effects.
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Affiliation(s)
- Hojjat Daniali
- Department of Humanity Sciences, Shahed University, Tehran, Iran
| | - Magne Arve Flaten
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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30
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Karnieli-Miller O, Michael K, Segal O, Steinberger A. Assessing an Intervention Focused on Enhancing Interpersonal Communication Skills and Humor: A Multi-Method Quasi-Experiential Study Among Medical Students. HEALTH COMMUNICATION 2018; 33:1560-1572. [PMID: 29058509 DOI: 10.1080/10410236.2017.1384347] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Teaching and applying interpersonal communication skills (ICS) and humor in medicine is challenging. The present study assessed an innovative course focused on enhancing ICS and humor based on the Four Habits Model and theater concepts. Medical students enrolled in the course (the study group) were assessed pre- and post-intervention, as well as compared with their peers (the control group) using quantitative methods to measure attitudes, self-efficacy, and behaviors. Qualitative methods were used to learn about students' change in perceptions related to ICS and humor following the course, as well as their experiences of developing these skills during the course. Post-intervention study group participants scored significantly higher on all ICS measurements and on humor behavior compared with pre-intervention, and significantly higher on all humor measurements compared with control group participants. Interviews indicated students' increased understanding and difficulties in learning these skills. Analyses showed how framing humor as one possible ICS and focusing on specific parts of the medical encounter can promote patient-centered care.
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Affiliation(s)
- Orit Karnieli-Miller
- a Department of Medical Education, Sackler Faculty of Medicine , Tel Aviv University
| | - Keren Michael
- b Department of Human Services , The Max Stern Yezreel Valley College
| | - Oz Segal
- a Department of Medical Education, Sackler Faculty of Medicine , Tel Aviv University
| | - Aharon Steinberger
- a Department of Medical Education, Sackler Faculty of Medicine , Tel Aviv University
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31
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Unique aspects of clinical trials of invasive therapies for chronic pain. Pain Rep 2018; 4:e687. [PMID: 31583336 PMCID: PMC6749926 DOI: 10.1097/pr9.0000000000000687] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/07/2018] [Indexed: 12/18/2022] Open
Abstract
Nearly all who review the literature conclude that the role of invasive procedures to treat chronic pain is poorly characterized because of the lack of “definitive” studies. The overt nature of invasive treatments, along with the risks, technical skills, and costs involved create challenges to study them. However, these challenges do not completely preclude evaluating invasive procedure effectiveness and safety using well-designed methods. This article reviews the challenges of studying outcomes of invasive therapies to treat pain and discuss possible solutions. Although the following discussion can apply to most invasive therapies to treat chronic pain, it is beyond the scope of the article to individually cover every invasive therapy used. Therefore, most of the examples focus on injection therapies to treat spine pain, spinal cord stimulation, and intrathecal drug therapies.
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32
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Huntzinger M, Bielefeldt K. Expanding the Scope of Telemedicine in Gastroenterology. Fed Pract 2018; 35:26-31. [PMID: 30766378 PMCID: PMC6263446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A specialty outreach program relied on telemedicine to reach patients with gastrointestinal and liver diseases in a large service area.
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Affiliation(s)
- Michelle Huntzinger
- is a Nurse and Case Manager and is the Chief of the gastroenterology section at George E. Wahlen VAMC in Salt Lake City, Utah
| | - Klaus Bielefeldt
- is a Nurse and Case Manager and is the Chief of the gastroenterology section at George E. Wahlen VAMC in Salt Lake City, Utah
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33
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Flaten MA, Bjørkedal E, Lyby PS, Figenschau Y, Aslaksen PM. Failure to Find a Conditioned Placebo Analgesic Response. Front Psychol 2018; 9:1198. [PMID: 30104988 PMCID: PMC6077950 DOI: 10.3389/fpsyg.2018.01198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/21/2018] [Indexed: 12/26/2022] Open
Abstract
Background: Associative learning has, in several studies, been modulated by the sex of the participant. Consistent with this, a recent review found that conditioned nocebo effects are stronger in females than in males. Purpose: It has been suggested that conditioned placebo responses are stronger in females, and this hypothesis was investigated in the present study. Cortisol and measures of negative emotions were taken to investigate if these processes could mediate any conditioned placebo effects. Methods: Cold pain was applied to the volar forearm. The Conditioned group received inert capsules prior to two presentations of less painful stimulations, to associate intake of the capsules with reduced pain. The pain control group received the same painful stimulation as the Conditioned group, but no capsules. The Capsule control group received the capsules in the same way as the Conditioned group, but no decrease in the painful stimulation. Participant sex was crossed across groups. It was hypothesized that in the Conditioned group, an expectation of reduced pain should be induced after administration of the capsules, and this should generate placebo analgesia, and mostly so in females. Results: The Conditioned group reported lower pain during conditioning, and rated the capsules as more effective painkillers than the capsule control group. However, placebo analgesia was not reliably observed in the Conditioned group. Conclusion: The placebo capsules were rated as effective painkillers, but this did not translate into a placebo analgesic effect. This could be due to violation of response expectancies, too few conditioning trials, and differences in pain ratings in the pre-test that could be due to previous experience with painkillers.
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Affiliation(s)
- Magne A Flaten
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Espen Bjørkedal
- Department of Psychology, University of Tromsø, Tromsø, Norway
| | - Peter S Lyby
- Department of Psychology, University of Tromsø, Tromsø, Norway
| | - Yngve Figenschau
- Department of Medical Biochemistry, University of Tromsø, Tromsø, Norway.,Department of Medical Biochemistry, University Hospital of North Norway, Tromsø, Norway
| | - Per M Aslaksen
- Department of Psychology, University of Tromsø, Tromsø, Norway
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34
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Abstract
Existing approaches to describe social interactions consider emotional states or use ad-hoc descriptors for microanalysis of interactions. Such descriptors are different in each context thereby limiting comparisons, and can also mix facets of meaning such as emotional states, short term tactics and long-term goals. To develop a systematic set of concepts for second-by-second social interactions, we suggest a complementary approach based on practices employed in theater. Theater uses the concept of dramatic action, the effort that one makes to change the psychological state of another. Unlike states (e.g. emotions), dramatic actions aim to change states; unlike long-term goals or motivations, dramatic actions can last seconds. We defined a set of 22 basic dramatic action verbs using a lexical approach, such as ‘to threaten’–the effort to incite fear, and ‘to encourage’–the effort to inspire hope or confidence. We developed a set of visual cartoon stimuli for these basic dramatic actions, and find that people can reliably and reproducibly assign dramatic action verbs to these stimuli. We show that each dramatic action can be carried out with different emotions, indicating that the two constructs are distinct. We characterized a principal valence axis of dramatic actions. Finally, we re-analyzed three widely-used interaction coding systems in terms of dramatic actions, to suggest that dramatic actions might serve as a common vocabulary across research contexts. This study thus operationalizes and tests dramatic action as a potentially useful concept for research on social interaction, and in particular on influence tactics.
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35
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Rozenkrantz L, Mayo AE, Ilan T, Hart Y, Noy L, Alon U. Placebo can enhance creativity. PLoS One 2017; 12:e0182466. [PMID: 28892513 PMCID: PMC5593173 DOI: 10.1371/journal.pone.0182466] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/19/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The placebo effect is usually studied in clinical settings for decreasing negative symptoms such as pain, depression and anxiety. There is interest in exploring the placebo effect also outside the clinic, for enhancing positive aspects of performance or cognition. Several studies indicate that placebo can enhance cognitive abilities including memory, implicit learning and general knowledge. Here, we ask whether placebo can enhance creativity, an important aspect of human cognition. METHODS Subjects were randomly assigned to a control group who smelled and rated an odorant (n = 45), and a placebo group who were treated identically but were also told that the odorant increases creativity and reduces inhibitions (n = 45). Subjects completed a recently developed automated test for creativity, the creative foraging game (CFG), and a randomly chosen subset (n = 57) also completed two manual standardized creativity tests, the alternate uses test (AUT) and the Torrance test (TTCT). In all three tests, participants were asked to create as many original solutions and were scored for originality, flexibility and fluency. RESULTS The placebo group showed higher originality than the control group both in the CFG (p<0.04, effect size = 0.5) and in the AUT (p<0.05, effect size = 0.4), but not in the Torrance test. The placebo group also found more shapes outside of the standard categories found by a set of 100 CFG players in a previous study, a feature termed out-of-the-boxness (p<0.01, effect size = 0.6). CONCLUSIONS The findings indicate that placebo can enhance the originality aspect of creativity. This strengthens the view that placebo can be used not only to reduce negative clinical symptoms, but also to enhance positive aspects of cognition. Furthermore, we find that the impact of placebo on creativity can be tested by CFG, which can quantify multiple aspects of creative search without need for manual coding. This approach opens the way to explore the behavioral and neural mechanisms by which placebo might amplify creativity.
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Affiliation(s)
- Liron Rozenkrantz
- Theater lab, Weizmann Institute of Science, Rehovot, Israel
- Dept. Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
- Dept. Neuroscience, Weizmann Institute of Science, Rehovot, Israel
| | - Avraham E. Mayo
- Theater lab, Weizmann Institute of Science, Rehovot, Israel
- Dept. Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Tomer Ilan
- Theater lab, Weizmann Institute of Science, Rehovot, Israel
| | - Yuval Hart
- Theater lab, Weizmann Institute of Science, Rehovot, Israel
- Dept. Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Lior Noy
- Theater lab, Weizmann Institute of Science, Rehovot, Israel
- Dept. Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
- * E-mail: (LN); (UA)
| | - Uri Alon
- Theater lab, Weizmann Institute of Science, Rehovot, Israel
- Dept. Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
- * E-mail: (LN); (UA)
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36
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Paltiel O, Lowenstein L, Demma J, Manor O. International workshop on "professionalism in the practice of medicine- where are we now?". Isr J Health Policy Res 2017; 6:19. [PMID: 28653585 PMCID: PMC5379495 DOI: 10.1186/s13584-017-0144-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/22/2017] [Indexed: 11/17/2022] Open
Abstract
Medical professionalism refers to attributes, values, behaviors, responsibilities and commitments of physicians that are congruent with the public’s expectations. An international workshop on medical professionalism took place at the Dead Sea, Israel, on December 11–12, 2016. The meeting brought together local medical professionals, physicians and others, as well as international experts, to discuss definitions of professionalism and wrestle with current challenges facing the profession including its perceived status and physician satisfaction, unprofessional behavior and its relation to health care quality and patient safety, and professionalism as a learned competence. Individual medical schools reported on educational efforts to promote professionalism in their curricula. Patient complaints as an improvement mechanism were explored on a national and health plan level. I was found that complaints regarding physician behavior are rare in the Israeli context and need to be dealt with expeditiously at a local level in order to be effective tools for change. The meeting provided a venue to understand local and international strategies and mechanism for regulation and self-regulation, highlighting the role of the Israel Medical Association. A major focus of the meeting was on intergenerational differences in attitude and practice and the necessary adaptation of medicine to the digital age. We provide an overview of the topics addressed, synopsis, evaluation and lessons learned in this first-ever national meeting on medical professionalism in Israel.
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Affiliation(s)
- Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Jonathan Demma
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,National Institute of Health Policy Research, Gertner Institute, Tel Hashomer, Israel
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37
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Hart Y, Czerniak E, Karnieli-Miller O, Mayo AE, Ziv A, Biegon A, Citron A, Alon U. Automated Video Analysis of Non-verbal Communication in a Medical Setting. Front Psychol 2016; 7:1130. [PMID: 27602002 PMCID: PMC4993763 DOI: 10.3389/fpsyg.2016.01130] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/14/2016] [Indexed: 12/30/2022] Open
Abstract
Non-verbal communication plays a significant role in establishing good rapport between physicians and patients and may influence aspects of patient health outcomes. It is therefore important to analyze non-verbal communication in medical settings. Current approaches to measure non-verbal interactions in medicine employ coding by human raters. Such tools are labor intensive and hence limit the scale of possible studies. Here, we present an automated video analysis tool for non-verbal interactions in a medical setting. We test the tool using videos of subjects that interact with an actor portraying a doctor. The actor interviews the subjects performing one of two scripted scenarios of interviewing the subjects: in one scenario the actor showed minimal engagement with the subject. The second scenario included active listening by the doctor and attentiveness to the subject. We analyze the cross correlation in total kinetic energy of the two people in the dyad, and also characterize the frequency spectrum of their motion. We find large differences in interpersonal motion synchrony and entrainment between the two performance scenarios. The active listening scenario shows more synchrony and more symmetric followership than the other scenario. Moreover, the active listening scenario shows more high-frequency motion termed jitter that has been recently suggested to be a marker of followership. The present approach may be useful for analyzing physician-patient interactions in terms of synchrony and dominance in a range of medical settings.
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Affiliation(s)
- Yuval Hart
- The Theater Lab, Weizmann Institute of Science Rehovot, Israel
| | - Efrat Czerniak
- The Department of Neuroscience, Sackler Faculty of Medicine, Tel Aviv UniversityTel Aviv, Israel; The Psychiatry Department, Chaim Sheba Medical CenterRamat-Gan, Israel
| | - Orit Karnieli-Miller
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel
| | - Avraham E Mayo
- The Theater Lab, Weizmann Institute of Science Rehovot, Israel
| | - Amitai Ziv
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv UniversityTel Aviv, Israel; Israel Center for Medical Simulation, Chaim Sheba Medical CenterRamat-Gan, Israel
| | - Anat Biegon
- Department of Neurology, Stony Brook University, New York New York, NY, USA
| | - Atay Citron
- Department of Theater, Haifa University Haifa, Israel
| | - Uri Alon
- The Theater Lab, Weizmann Institute of Science Rehovot, Israel
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