Placebo Revisited – surprising news…

Know it’s a placebo? Study shows the ‘medicine’ could still work

The word ‘placebo’ has its origins in the Latin for ‘to please’. While its meaning has varied over the centuries, we use the name for an inert or pretend medical therapy, such as a sugar pill, saline injection or sham procedure, used intentionally as it has nothing in it that is able to make a healing difference and so when used validates the efficacy of the real medical therapy.

I previously thought that a person has to believe the placebo is the real medication or spiritual belief, before it kicks into place and heals despite the placebo being inert. In other words, it is a case of tricking the brain. That is not what a new study shows.

The new study shows that the placebo effect still works under certain conditions, despite the research participants knowing that the treatment they are receiving has no medical or God belief value whatsoever.

It seems that we should show our client’s evidence of cases where it showed the placebo did the healing.   The study says that the trick is to reinforce this placebo positive outcome for a minimum of four sessions, to condition the client to believe the placebo works.

*Thought –Are we able to reinforce this placebo positive outcome repetition in the first session in the hypnosis trance state? I suggest that we can. When my client puts in a non smoking outcome, or a full up feeling to release weight, I take them forward 5 years in time as a repetition of being a non-smoker with every year that passes from 1 to 5 years. And when they are happy with the outcome of what they feel, I then bring back that feeling to the present time.

After the conditioning when the participant was informed that the treatment was fake, the client continues to get the relief outcome anyway. However, the research also showed that telling the client only the one time about the placebo effect working, the client did not show a continued placebo effect.

*Thought – The above then would not bring about this discontinuing effect.

The researchers say; “We’re still learning a lot about the critical ingredients of placebo effects. What we think now is that they require both belief in the power of the treatment and experiences that are consistent with those beliefs. Those experiences make the brain learn to respond to the treatment as a real event. After the learning has occurred, your brain can still respond to the placebo even if you no longer believe in it.” ¹

   *Thought – As a hypnotherapist we are aware of this. We also aware that we can have a non-belief in the conscious mind, yet the subconscious does not suffer from the burden of the need to evaluate in a analytical or rational mindset. An example of this would be to ask the client’s subconscious mind to imagine that you have tied a piece of string to its wrist with a balloon at the other end, and when they watch the balloon rise, their arm is lifted without any conscious thought, without using muscles, and feeling their arm lift on its own.

Some Placebos More Effective Than Others

A study on the effectiveness of various pharmacological treatments for knee osteoarthritis could differ based on how alternative placebos were treated within a network analysis model. For example, Intra-articular placebo and topical placebo had significantly greater effects than oral placebo.

The take-home message for physicians and researchers is that placebos are not null in efficacy, nor are they equivalent to one another. Physicians should consider the method of administration when choosing [in this case] knee osteoarthritis treatments. For researchers, selection of appropriate placebo controls is an important consideration in the design of future clinical trials. Also, the comparative effectiveness of active treatments depends on the type of placebo it is being compared to.” Added to that; differences in trial design or study populations, could also confirm the potential clinical benefits associated with treatment administration methods. ²

Thoughts – See the end of this article to find some further research links called; ‘Heal your body on command’ a series of youtube 5 part series on various placebo effects.⁸

Placebo effect in psychiatry: what do we really know?”

500 randomised placebo-controlled trials across psychiatry were reviewed for factors identified to be associated with an increased placebo response. Based on this review, factors that might drive the placebo response in randomised controlled trials in psychiatry were grouped into either patient-centred factors that relate to individual characteristics or study design based factors that relate to characteristics of the trial itself.

This review focused on mediator and moderator analyses of the placebo response in psychiatric drug and non-drug trials.

Age, sex or ethnicity did not appear to have any effect on the placebo response in psychiatry trials. The most predictive individual factor for a high placebo response was that the less severe the symptoms of a person’s mental illness are, the more likely they are to experience a placebo response to an inactive treatment they thought to be an active psychiatric treatment.

This was the case across studies in schizophrenia, psychosis, children with autism, obsessive-compulsive disorder, attention deficit hyperactivity disorder, binge-eating disorder, and depression. So basically a hefty portion of the DSM-V.

The placebo response appeared to be greater in more recently published studies. In randomised controlled trials of people with depression, the placebo response increased by approximately 7% per decade between 1981 and 2000. It did not matter which antidepressant that the placebo was being compared with, however results differed when patient assessments of treatment outcome was the focus as opposed to efficacy, which could mean that the increase in placebo response in more modern trials is driven by bias on the part of the assessors.

Only one mediator of high placebo responses was consistent across studies and mental illness categories: unbalanced randomisation (any deviation from a 1:1 randomisation allocation). An increased chance of being randomly assigned to the drug group increased the efficacy of both drug and placebo within the studies examined.³

Placebo Effect May Account for Half of Drug’s Efficacy

The benefit of placebo effects – specifically the power of suggestion and expectation – was again shown to have merit in a study reported in Science Translational Medicine online.

In this study, the researchers compared the effects of an active drug on migraine headaches with the effects of placebo. When migraine patients were told by their doctor that a pill would help ease their headaches, this advice seemed to produce results whether or not the pill was a real migraine medication or a dummy placebo.

The active drug outperformed placebo for pain relief, but the added benefit of the suggestion and expectation increased the pain relief under each of the following conditions:

1) being told the patient was given a placebo, 2) being told the patient was given the active drug or a placebo and 3) being told that the patient was given the active drug.

The efficacies of the active drug labelled as placebo and placebo labelled as the active drug were similar. The efficacy of open-label placebo was superior to that of no treatment.”

Essentially, telling the patient they were taking a placebo did not take away the benefit it provided.

Compared to no-treatment at all, the placebo showed value and the researchers reported that it “…accounted for more than 50% of the drug effect.”

What we as clinicians say to our clients/patients matters. Moreover, it shows how important it is that we learn to use our words effectively! The study pointed out that experiential approaches such as hypnosis and mindfulness are vehicles for helping people access their hidden resources to achieve their goals. It’s not the technique that holds the key, it’s making the words and suggestions align with the personal values and goals of the clients/patients we treat that has the greatest potential for growth and change. ⁴

Placebo more effective than mere sugar pills

Growing evidence suggests the placebo and its effects are far more significant in modern medical practice than has been recognised. Some are arguing that instead of viewing it with disdain, we should instead be embracing it.

Finniss, a clinician and researcher at the Pain Management Research Institute, Sydney Medical School says; “What we’re really doing when we give a placebo is we’re simulating normal treatment without actually delivering a particular treatment itself. Our brain effectively fills in the gap created by the absent medication or treatment. In the case of pain, where we’ve done a lot of research, if you give someone a morphine-like drug repeatedly, and then you switch it over to a placebo, the placebo effect that we see is mediated by morphine-like chemicals in the brain. If you do the same thing with a non-steroidal anti-inflammatory and you give the real drug for several days and switch to a sugar tablet, that mechanism is completely different – in fact that’s mediated by our endogenous cannabinoids – even when the patient doesn’t know.”

Research also shows that, depending on what effect a placebo is expected to have, it influences different parts of the brain. If you are given a sugar tablet and told it will relieve pain, then a certain network in your brain is activated; however, if you are given a sugar tablet and told it will improve the symptoms of a movement disorder then a different network will be activated. “So what was deemed to be very simple – that some people got better to a sugar tablet – in fact we realise there’s a highly selective series of mechanisms that are activated depending on the therapeutic context in which we receive treatment,” says Finniss.

Placebos appear to be most effective at relieving the symptoms of disease, such as pain, but not the disease itself. So while a placebo inhaler won’t necessarily change the way the lung works during an asthma attack, it could change the person’s perception of breathlessness so that it doesn’t affect them as much.

This is what makes placebos so valuable in medical research, because they allow researchers to separate out the true biological effect of a drug or intervention from its placebo component. In the case of some drugs, such as anti-depressants, there is a particularly large placebo effect – so much so that when data from a number of placebo-controlled antidepressant trials were analysed it showed the actual clinical benefit from the antidepressant falls below the line of clinical significance.

But the placebo effect extends even further. There is growing evidence that the result of just about any medical treatment is partly due to the placebo effect, even if a placebo isn’t given, because the ritual and interaction of a medical consultation induces a placebo effect all of its own.

For example, a study was done with patients receiving intravenous morphine. One group of patients were administered the morphine by a doctor, while the other group of patients were hooked up to an intravenous line through which morphine was delivered, by computer, at an unspecified time, without the doctor being present.

Both patients were receiving the same dose of morphine yet it was around half as effective at relieving pain in the patients who weren’t given it by a doctor and didn’t know when they were receiving it. It places a therapeutic value on good old-fashioned bedside manner – something Finniss argues should be incorporated into medical training.⁵

Placebo Response Occurs at Nonconscious Level…

With the discovery that the unconscious mind plays a key role in the placebo effect, researchers have identified a novel mechanism that helps explain the power of placebos and nocebos.

Findings demonstrated that the placebo effect can be activated outside of conscious awareness. In this study, the authors used a novel experimental design and found that placebo and nocebo [negative placebo] effects rely on brain mechanisms that are not dependent on cognitive awareness.

It has long been believed that placebo responses are related to conscious beliefs or thoughts and that when given an inert pill or therapy, patients get better because they have the expectation that they will get better, or in the case of nocebos, get worse because they anticipate that they will get worse.

However, more recently, scientists have recognized that humans learn to expect either reward or threat quickly and automatically without needing to consciously register the idea in their brains. As the authors write, neuroimaging studies of the human brain have suggested that certain structures, such as the striatum and the amygdala, can process incoming stimuli before they reach conscious awareness, and, as a result, may mediate non-conscious effects on human cognition and behaviour.

On 40 healthy volunteers, two experiments were conducted: In the first, researchers administered heat stimulation to participants’ arms while simultaneously showing them images of male human faces on a computer screen. The first face was associated with low pain stimulations and the second image with high pain. Patients were then asked to rate their experience of pain on a scale of 0 to 100, 0 being no pain and 100 being the worst imaginable pain, but without the patient’s knowledge that all heat stimulations would have the same moderate heat intensity. As predicted, the pain ratings correlated with the previously learned associations, with a pain rating of 19 when the subjects saw the low pain face while the high pain face resulted in subjects’ mean reports of 53 on the pain scale (nocebo effect).

Then, in the second experiment, the participants were administered the same levels of thermal heat stimulation. Once again, the facial images were projected on the computer screen — but this time, they flashed by so quickly that subjects could not consciously recognize them. The participants once again rated their pain, and despite a lack of consciously recognizable cues, the participants reported a mean pain rating of 25 in response to the low pain face (placebo effect) and a mean pain rating of 44 in response to the high pain face (nocebo response) even though they did not consciously recognize the faces on the screen.

It’s not what patients think will happen [that influences outcomes] it’s what the nonconscious mind anticipates despite any conscious thoughts. This mechanism is automatic, fast and powerful, and does not depend on deliberation and judgment. These findings open an entirely new door towards understanding placebos and the ritual of medicine.” ⁶

“In a poll conducted by Norcross (1986), therapists attributed 67% of the variance in outcome to the client. Lambert (1992) has reported that 40% of the outcome variance is due to extratherapeutic factors, which consist of the client and factors in the client’s life; 30% to common therapeutic factors, which primarily consist of relationship factors, or factors that occur through the relationship; 1 5 % to techniques; and 1 5 % to placebo factors. Considering that placebo factors are client factors (client self-healing through hope and belief), and clients contribute at least as much to the therapeutic relationship as does the therapist, Lambert’s figures also imply that the client is responsible for 70% or more of the outcome variance. “⁷

* My own Thoughts…

Cited @:

¹ ScienceDaily, Jul. 24,2015 “Know it’s a placebo? Study shows the ‘medicine’ could still work.” University of Colorado at Boulder. Source: http://www.sciencedaily.com/releases/2015/07/150724135629.htm.

² Medscape. Jul 27, 2015 “Some placebos More Effective Than Others in Osteoarthritis.”– Source: http://bit.ly/1D6N2qL

³ Steele D Jun. 8,2015,” Placebo effect in psychiatry: what do we really know?” http://www.nationalelfservice.net/publication-types/literature-review/placebo-effect-in-psychiatry-what-do-we-really-know/

⁴ Gholipour B, Jan. 08,2014. Placebo Effect May Account for Half of Drug’s Efficacy. Source: http://www.livescience.com/42430-placebo-effect-half-of-drug-efficacy.html#sthash.I64245kq.dpuf

⁵  Nogrady B. Nov.11,2013. “Placebo more effective than mere sugar pills – ABC Health & Wellbeing” Source: http://www.abc.net.au/health/features/stories/2013/11/11/3888346.htm

 ⁶ Science Daily, Sep. 10,2012. Placebo Response Occurs at Nonconscious Level: Findings Demonstrate Unconscious Mind Plays a Key Role in Pain Experiences. Source: http://www.sciencedaily.com/releases/2012/09/120910152011.htm

⁷ http://www.researchgate.net/publication/276991595_Psychotherapy_outcome_research

 ⁸ Heal your body on command videos –

• http://youtu.be/z_CB-6u9sqk
• http://youtu.be/i4a3B_g24zo
• http://youtu.be/v7QjcxDIwdU
• http://youtu.be/smZwIPBibFg
• http://youtu.be/EUAiyi4umpc