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PloS One 2017The placebo effect is usually studied in clinical settings for decreasing negative symptoms such as pain, depression and anxiety. There is interest in exploring the...
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.
Topics: Cognition; Creativity; Humans; Odorants; Placebo Effect; Pliability; Thinking
PubMed: 28892513
DOI: 10.1371/journal.pone.0182466 -
Wiener Klinische Wochenschrift May 2020The history of medicine and the history of placebo are closely intertwined. To understand placebo and its effects this article gives a brief overview about its history,... (Review)
Review
The history of medicine and the history of placebo are closely intertwined. To understand placebo and its effects this article gives a brief overview about its history, the possible mechanisms of action and its counterpart, nocebo.The Catholic Church used placebo around the sixteenth century for the separation from real and incorrect exorcisms, but it needed Henry Beecher during World War II to quantify the placebo effect as control arm in well-designed studies.Until today the different mechanisms of action of placebo remain poorly researched. Understanding them would allow its effect to be modulated to better serve in research and clinical settings. Expectation, psychosocial context and conditioning play a significant role in the effect size and amplitude.The counterpart, nocebo, is even less investigated, even it is commonly observed as adverse effects during medical treatments.Conclusion: Placebo and nocebo are both underestimated and underresearched in their value. Through further investigation doctors could strengthen the placebo response and prevent adverse effects to help their patients at low cost. These techniques would benefit the patient-doctor relationship, which is the alter of a trust-based successful therapy.
Topics: Drug-Related Side Effects and Adverse Reactions; Humans; Male; Nocebo Effect; Pain; Physician-Patient Relations; Placebo Effect
PubMed: 32211987
DOI: 10.1007/s00508-020-01626-9 -
Omics : a Journal of Integrative Biology Jan 2021Pharmacogenomics, nutrigenomics, vaccinomics, and the nascent field of plant omics are examples of variability science. They are embedded within an overarching framework... (Review)
Review
Pharmacogenomics, nutrigenomics, vaccinomics, and the nascent field of plant omics are examples of variability science. They are embedded within an overarching framework of personalized medicine. Across these public health specialties, the significance and biology of the placebo response have been historically neglected. A placebo is any substance such as a sugar pill administered in the guise of medication, but one that does not have pharmacological activity. Placebos do have clinical effects, however, that can be substantive in magnitude and vary markedly from person-to-person depending, for example, on the type of disease, symptoms, or clinical trial design. Research over the past several decades attests to a genuine neurobiological basis for placebo effects. All drugs have placebo components that contribute to their overall treatment effect. Placebos are used in clinical trials as control groups to ascertain the net pharmacological effect of a drug candidate. Not only less well known but also relevant to rational therapeutics and personalized medicine is the nocebo. A nocebo effect occurs when an inert substance is administered in a context that induces negative expectations, worsening patients' symptoms. With the COVID-19 pandemic, there are high public expectations for new vaccines and medicines to end the contagion, while at the same time antiscience, post-truth, and antivaccine movements are worrisomely on the rise. These social movements, changes in public health cultures, and conditioned behavioral responses can trigger both placebo and nocebo effects. Hence, in clinical trials, forecasting and explaining placebo and nocebo variability are more important than ever for robust science and personalized health care. Against this overarching context, this article provides (1) a brief history of placebo and (2) a discussion on biology, mechanisms, and variability of placebo effects, and (3) discusses three emerging new concepts: placebogenomics, nocebogenomics, and augmented placebo, that is, the notion of a "placebo dose." We conclude with a roadmap for placebogenomics, its synergies with the nascent field of social pharmacology, and the ways in which a new taxonomy of drug and placebo variability can be anticipated in the next decade.
Topics: Clinical Trials as Topic; Dose-Response Relationship, Drug; Genomics; Humans; Nocebo Effect; Outcome Assessment, Health Care; Placebo Effect; Precision Medicine; Research Design
PubMed: 33305994
DOI: 10.1089/omi.2020.0208 -
Movement Disorders : Official Journal... Dec 2014DBS of the STN improves quality of life (QoL) and motor function not only in advanced Parkinson's disease (PD), but also in PD with early motor complications, as shown... (Review)
Review
DBS of the STN improves quality of life (QoL) and motor function not only in advanced Parkinson's disease (PD), but also in PD with early motor complications, as shown in the recent EARLYSTIM study. In spite of the evidence in favor of STN-DBS, the findings of the EARLYSTIM study have recently been controversially debated. Here, we argue that a placebo or lessebo effect is unlikely to have relevantly contributed to the favorable outcome of STN-DBS in the EARLYSTIM study. The method of quantification of the placebo effect of DBS in a previous publication reveals flaws leading to implausible results, and therefore the placebo effect of DBS remains currently elusive, especially because blinding of PD patients with STN-DBS as a crucial preassumption for assessing a placebo effect is practically impossible. Moreover, we claim that the extent of such a placebo effect is most likely very small. Specific challenges of STN-DBS at an earlier stage of PD and inclusion criteria are the risk of inclusion of patients who later evolve to atypical parkinsonism, the risk of a floor effect for the benefit from DBS, the need for experienced multidisciplinary care including prevention of suicidal behavior, and the need for highly qualified long-term follow-up. The EARLYSTIM study has shown that STN-DBS may be proposed earlier on in the course of PD, as soon as motor complications start to cause relevant disability despite proper medical management. This can lead to a gain of several years of improved QoL.
Topics: Deep Brain Stimulation; Humans; Movement; Parkinson Disease; Placebo Effect; Quality of Life; Subthalamic Nucleus
PubMed: 25399678
DOI: 10.1002/mds.26080 -
Arquivos de Neuro-psiquiatria Jan 2015Knowledge of placebo and nocebo effects is essential to identify their influence on the results in clinical practice and clinical trials, and thereby properly interpret... (Review)
Review
Knowledge of placebo and nocebo effects is essential to identify their influence on the results in clinical practice and clinical trials, and thereby properly interpret their results. It is known that the gold standard of clinical trials research is the double-blind, placebo-controlled, randomized clinical study. The objective of this review is to distinguish specific from non-specific effects, so that the presence of positive effects in the group that received placebo (placebo effect) and the presence of adverse effects in the group receiving placebo (nocebo effect) lead to confounding in interpreting the results. Placebo and nocebo effects have been considered in neurological diseases such as depression, pain, headache, multiple sclerosis, epilepsy. As placebo and nocebo effects are also present in clinical practice, the purpose of this review is to draw attention to their influence on neurological practice, calling attention to the development of measures that can minimize them.
Topics: Headache; Humans; Neuralgia; Neurology; Nocebo Effect; Placebo Effect; Randomized Controlled Trials as Topic
PubMed: 25608129
DOI: 10.1590/0004-282X20140180 -
Scientific Reports Feb 2023The placebo effect demonstrates how positive expectancies shape the effectiveness of various treatments. Across studies, placebo treatments are interventions (creams,... (Clinical Trial)
Clinical Trial
The placebo effect demonstrates how positive expectancies shape the effectiveness of various treatments. Across studies, placebo treatments are interventions (creams, pills, etc.) that are presented to individuals as, and are learned to be, beneficial for them. This study tested whether placebo-induced expectancies can be harnessed to improve individuals' internal emotion regulation attempts. Participants implemented two types of distraction, an emotion regulation strategy involving attentional disengagement, to attenuate fear of pain. In a typical conditioning paradigm, the placebo-distraction was introduced as an effective strategy (verbal suggestion) and was surreptitiously paired with reduced pain (conditioning), whereas the control-distraction was introduced as noneffective and was surreptitiously paired with increased pain. As predicted, we found that during a later test phase, where pain intensity was identical, the placebo-distraction resulted in reduced self-reported fear of pain, relative to the control-distraction. Moreover, we utilized a robust behavioral choice measure, demonstrating increased preferences for the placebo-distraction. We additionally tested whether these effects generalize to a different emotional context of fear of unpleasant pictures. In that context, the placebo-distraction was as effective as the control-distraction, but was substantially preferred. This study demonstrates that the placebo effect can be expanded to include individuals' internal attempts to influence their conditions.
Topics: Humans; Emotional Regulation; Emotions; Fear; Pain; Placebo Effect
PubMed: 36759537
DOI: 10.1038/s41598-023-29045-6 -
L'Encephale Feb 2016The placebo effect is an excellent model for understanding the mechanisms underlying the interaction between a subjective and complex mental activity (beliefs,... (Review)
Review
The placebo effect is an excellent model for understanding the mechanisms underlying the interaction between a subjective and complex mental activity (beliefs, expectations, hopes, learning, patient-physician relationship, socio-cultural context .) with different neural and biological systems. Initially, research on the placebo effect has focused on the mechanisms of pain and analgesia. The cognitive processes of conditioning and reward anticipation (hope of a relief) were highlighted. The involvement of different neurobiological pathways has been clearly shown: endogenous opioids, CCK, dopaminergic pathways, endocannabinoids, immunological factors... More recently, the field has open towards new perspectives: depression and anxiety, motor disorders, immune system, endocrine system. Intensive research in the field emerges because of its fundamental implications in neuroscience research but also because of the ethical, clinical and therapeutical issues. Moreover, the placebo effect is considered as a main methodological mean issue in clinical trials that allows the demonstration of the efficacy and tolerance of new drugs. In the field of psychiatry, depression is a placebo highly-sensitive disorder: placebo response rates in clinical trials are of the order of 30 % to 40 %. The identification of biological markers of placebo response, such as neuroimaging and quantitative electroencephalography may lead to develop more efficient models in clinical research.
Topics: Depressive Disorder; Depressive Disorder, Major; Humans; Placebo Effect
PubMed: 26879253
DOI: 10.1016/S0013-7006(16)30016-1 -
European Journal of Sport Science Apr 2020The aim of this review was to determine the magnitude of the placebo and nocebo effect on sport performance. Articles published before March 2019 were located using...
The aim of this review was to determine the magnitude of the placebo and nocebo effect on sport performance. Articles published before March 2019 were located using Medline, Web of Science, PubMed, EBSCO, Science Direct, and Scopus. Studies that examined placebo and nocebo effects of an objective dependent variable on sports performance, which included a control or baseline condition, were included in the analysis. Studies were classified into two categories of ergogenic aids: (1) nutritional and (2) mechanical. Cohen's effect sizes were calculated from 32 studies involving 1513 participants. Small to moderate placebo effects were found for both placebo ( = 0.36) and nocebo ( = 0.37) effects and when separated by nutritional ( = 0.35) and mechanical ( = 0.47) ergogenic aids. The pooled effect size revealed a small to moderate effect size across all studies ( = 0.38). Results suggest that placebo and nocebo effects can exert a small to moderate effect on sports performance.
Topics: Athletic Performance; Dietary Supplements; Humans; Nocebo Effect; Performance-Enhancing Substances; Placebo Effect; Transcutaneous Electric Nerve Stimulation
PubMed: 31414966
DOI: 10.1080/17461391.2019.1655098 -
Clinical Therapeutics Mar 2017This overview focuses on placebo and nocebo effects in clinical trials and routine care. Our goal was to propose strategies to improve outcomes in clinical practice,... (Review)
Review
PURPOSE
This overview focuses on placebo and nocebo effects in clinical trials and routine care. Our goal was to propose strategies to improve outcomes in clinical practice, maximizing placebo effects and reducing nocebo effects, as well as managing these phenomena in clinical trials.
METHODS
A narrative literature search of PubMed was conducted (January 1980-September 2016). Systematic reviews, randomized controlled trials, observational studies, and case series that had an emphasis on placebo or nocebo effects in clinical practice were included in the qualitative synthesis. Search terms included: placebo, nocebo, clinical, clinical trial, clinical setting, placebo effect, nocebo effect, adverse effects, and treatment outcomes. This search was augmented by a manual search of the references of the key articles and the related literature.
FINDINGS
Placebo and nocebo effects are psychobiological events imputable to the therapeutic context. Placebo is defined as an inert substance that provokes perceived benefits, whereas the term nocebo is used when an inert substance causes perceived harm. Their major mechanisms are expectancy and classical conditioning. Placebo is used in several fields of medicine, as a diagnostic tool or to reduce drug dosage. Placebo/nocebo effects are difficult to disentangle from the natural course of illness or the actual effects of a new drug in a clinical trial. There are known strategies to enhance clinical results by manipulating expectations and conditioning.
IMPLICATIONS
Placebo and nocebo effects occur frequently and are clinically significant but are underrecognized in clinical practice. Physicians should be able to recognize these phenomena and master tactics on how to manage these effects to enhance the quality of clinical practice.
Topics: Drug-Related Side Effects and Adverse Reactions; Humans; Nocebo Effect; Placebo Effect; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 28237673
DOI: 10.1016/j.clinthera.2017.01.031 -
Seminars in Arthritis and Rheumatism Dec 2019The placebo effect, once considered only a nuisance in clinical research, is today a target of scientific inquiry that allows us understand how words, rituals and, more... (Review)
Review
The placebo effect, once considered only a nuisance in clinical research, is today a target of scientific inquiry that allows us understand how words, rituals and, more in general, the whole psychosocial context around the patient, affect the response to a treatment and the course of a disease. Today we are in a good position to study all these complex psychological factors by using a physiological and neuroscientific approach that uses modern neurobiological tools to probe different brain functions. Since a placebo is represented by the whole ritual of the therapeutic act, the main concept that has emerged today is that words and rituals may modulate the same biochemical pathways that are modulated by drugs. Most of our knowledge about these mechanisms comes from the field of pain, and represents a biomedical, psychological and philosophical enterprise that is changing the way we approach and interpret medicine, psychology and human biology. If on the one hand we know some of the mechanisms of drug action in the central nervous system, on the other we can now understand how the clinician-patient interaction may affect different physiological functions. In fact, the placebo effect and the therapist-patient relationship can be approached by using the same biochemical, cellular and physiological tools of the materia medica. This represents an epochal transition, in which the distinction between drugs and words is progressively getting thinner, and which helps us overcome the old dichotomy between psychology and biology.
Topics: Analgesics; Biomedical Research; Humans; Nervous System Diseases; Neurology; Nocebo Effect; Physician-Patient Relations; Placebo Effect; Psychotherapy
PubMed: 31779844
DOI: 10.1016/j.semarthrit.2019.09.015