Have you ever felt your own shoulders relax when you saw a friend getting a shoulder massage? For those of you who said “yes”, congratulations, your brain is using its power to create a “placebo effect”. For those who said “no”, you are not alone, but luckily the brain can be trained.
Since the 1800s, the word placebo has been used to refer to a fake treatment, that is, a treatment that does not contain any active physical substance. You may have heard of placebos called “sugar pills”.
Today, placebos play a crucial role in medical studies in which some participants receive the treatment containing the active ingredients of the drug, and others receive a placebo. These types of studies help tell researchers which drugs work and how well they do. Surprisingly, however, in some areas of medicine, placebos themselves provide patients with clinical improvement.
As two psychologists interested in how psychological factors affect physical conditions and beliefs about mental health, we help our patients heal from various threats to well-being. Could the placebo effect teach us something new about the power of our minds and how our bodies heal?
Today, scientists define these so-called placebo effects as those positive results that cannot be scientifically explained by the physical effects of the treatment. Research suggests that the placebo effect is caused by positive expectations, the caregiver-patient relationship, and the rituals around receiving medical care.
Depression, pain, fatigue, allergies, irritable bowel syndrome, Parkinson’s disease, and even osteoarthritis of the knee are just a few of the conditions that respond positively to placebos.
Despite their effectiveness, there is stigma and debate about the use of placebos in American medicine. And in common medical practice, they are rarely used on purpose. But based on a new understanding of how non-pharmacological aspects of care, safety and patient preferences work, some experts have begun to recommend increasing the use of placebos in medicine.
The US Food and Drug Administration, the organization that regulates drugs cleared for sale, requires all new drugs to be tested in randomized controlled trials that show them to be better than placebo treatments. This is an important part of ensuring that the public has access to high quality medicines.
But studies have shown that the placebo effect is so strong that many drugs provide no more relief than placebo treatments. In these cases, drug developers and researchers sometimes view placebo effects as a nuisance that obscures the therapeutic benefits of the manufactured drug. This prompts drugmakers to try to cut out placebos so that drugs pass FDA tests.
Placebos are such a problem for the drug development business that one company developed a coaching script to discourage patients who received placebos from reporting benefits.
Prior to the COVID-19 pandemic, approximately 1 in 12 American adults had been diagnosed with depression. During the pandemic, those numbers jumped to 1 in 3 adults. This sharp increase helps explain why $26.25 billion worth of antidepressant drugs were used worldwide in 2020.
Brain imaging studies show that the brain has an identifiable response to the expectations and context that come with placebos.
But according to psychologist and placebo expert Irving Kirsch, who has studied placebo effects for decades, much of what makes antidepressants useful for relieving depression is the placebo effect – in other words, the belief that the medication will be beneficial.
Depression isn’t the only condition for which medical treatments actually work at placebo levels. Many well-meaning clinicians offer treatments that seem to work on the basis that patients get better. But a recent study reported that only 1 in 10 medical treatments sampled met the standards of what is considered by some to be the gold standard for high-quality evidence, according to a rating system from an international non-profit organization. . This means that many patients improve even though the treatments they receive have not proven to be better than the placebo.
The power of the placebo comes down to the power of the mind and a person’s skill in harnessing it. If a patient has a tension headache and their trusted doctor gives them medication that they are sure will treat them, the relief they expect is likely to reduce their stress. And since stress is a trigger for tension headaches, the magic of the placebo response is no longer so mysterious.
Now suppose the doctor gives the patient an expensive brand name pill to take several times a day. Studies have shown that it’s even more likely to make them feel better because all of these subtly convey the message that they should be good treatments.
Part of the beauty of placebos is that they activate existing healing systems in the mind and body. Elements of the body once thought to be beyond an individual’s control are now known to be modifiable. A legendary example of this is the Tibetan monks who meditate to generate enough body heat to dry damp sheets in temperatures of 40 degrees Fahrenheit.
A field called Mind Body Medicine developed from the work of cardiologist Herbert Benson, who observed these monks and other experts mastering the control of automatic processes in the body. It is well understood in the medical field that many diseases are aggravated by the automatic changes that occur in the body under stress. If a placebo interaction reduces stress, it can reduce certain symptoms in scientifically explainable ways.
Placebos also work by creating conditioned expectations and responses. Most people are familiar with Pavlovian conditioning. A bell is rung before the dogs are fed meat which makes them salivate. Eventually, the sound of the bell makes them salivate even when they don’t get any meat. A recent Harvard Medical School study successfully used the same conditioning principle to help patients use fewer opioid pain medications after spine surgery.
Additionally, several brain imaging studies demonstrate changes in the brain in response to effective placebo treatments for pain. This is great news, given the ongoing opioid epidemic and the need for effective pain management tools. There is even evidence that individuals who respond positively to placebos show increased activity in areas of the brain that release natural opioids.
And emerging research suggests that even when people know they’re getting a placebo, the inactive treatment still has effects on the brain and reports levels of improvement.
In addition to the ever-growing body of evidence surrounding their effectiveness, placebos offer multiple benefits. They have no side effects. They are inexpensive. They are not addictive. They provide hope when there may not be a specific chemically active treatment available. They engage a person’s own ability to heal through multiple pathways, including those studied in the field of psychoneuroimmunology. It is the study of the relationships between the immune system, hormones and the nervous system.
By defining a placebo as the act of creating positive expectations and providing hope through psychosocial interactions, it becomes clear that placebos can improve traditional medical treatments.
The placebo effect is recognized as being powerful enough that the American Medical Association considers it ethical to use placebos to enhance healing alone or with standard medical treatments if the patient consents.
Clinically, doctors use placebo principles in a more subtle way than in research studies. A 2013 UK study found that 97% of doctors acknowledged in a survey that they had used some form of placebo during their career. It can be as simple as expressing a strong belief that a patient is likely to feel better regardless of the treatment the doctor prescribes, even if the treatment itself is not chemically potent.
There is now even an international society for interdisciplinary placebo studies. They wrote a consensus statement on the use of placebos in medicine and recommendations on how to discuss it with patients. In the past, patients who improved through a placebo effect might feel embarrassed, as if their disease wasn’t real.
But with the medical field’s growing acceptance and promotion of placebo effects, we can look forward to a time when patients and clinicians alike will take pride in their ability to harness the placebo response.
This article is republished from The Conversation, an independent, non-profit source of news, analysis and commentary from academic experts, licensed under Creative Commons.