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psychology applied to health > 8 - complementary theories and placebo effects > Flashcards

8 - complementary theories and placebo effects Flashcards

1
Q

define complementary therapies

A

a group of therapies that share a focus on, or integration of, treatment of mind and spirit as well as body

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2
Q

focus of complementary therapy

A

symptom relief

prevention

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3
Q

why are many people not confident with the benefits of alternative therapy

A

there is much less supporting evidence

however this does not mean it is not effective

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4
Q

how might complementary therapy benefit the NHS

A

pain or discomfort relief for patients
improvement of well-being for patients
may save NHS money

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5
Q

what might prevent the NHS from offering complementary therapies

A

little/no evidence to suggest that they arent harmful
NHS has limited resources
treatments must be cost-effective

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6
Q

examples of complementary therapy

A 
acupuncture
acupressure
aromatherapy 
herbal medicine
yoga 
reiki
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7
Q

definition of placebo effects

A

treatment effects of remedies that are not understood to have any direct link to the outcome

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8
Q

features of placebo effects

A

mimic drug effects
mimic drug side effects
powerful
complex interaction between psychological and physiological mechanisms

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9
Q

research evidence that shows that placebos have important effects

A

van Laarhoven 2015
systematic review of 34 trials of people with chronic itch due to a skin condition e.g. psoriasis

results:
placebo arm significantly decreased itch compared with baseline (1.3 out of 10)

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10
Q

psychological mechanisms of placebo effect

A

outcome expectancies

classical conditioning

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11
Q

neurobiological mechanisms of placebo effect

A

opioid mechanisms

non-opioid mechanisms

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12
Q

what factors influence outcome expectancies of treatment

A

manipulation via verbal cues

mode of treatment delivery (IV, oral, cream)

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13
Q

how does classical conditioning work in the placebo effect

A

repeated associations between neutral stimulus and an active drug (unconditioned stimulus)

neutral stimulus elicits response characteristic of the unconditioned stimulus

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14
Q

disadvantage of relying on the classical conditioning mechanism

A

its difficult to exclude any other cognitive components in human trials such as outcome expectancies

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15
Q

opioid mechanisms

A

underly placebo effect
changes in brain activity can be seen using PET imaging or fMRI similar to opioid changes following placebo administration

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16
Q

role of opioid antagonist naloxone

A

administered to completely or partly reverse the pain related placebo effects

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17
Q

role of opioid antagonist naloxone

A

administered to completely or partly reverse the pain related placebo effects

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18
Q

effect of drug type on conditioned response

A
  • whilst conditioning the patient to have a response to a drug, the different drug chosen can elicit different placebo mechanisms
19
Q

non-opioid mechanisms seen as a placebo response in parkinsons patients

A

changes in dopamine release in the striatum, basal ganglia and thalamus

decrease in tremors and shaking

20
Q

non-opioid mechanisms seen as a placebo response in patients with depression

A

changes in metabolic activity in the brain seen

21
Q

example and results of research on placebos to treat headaches caused by hypoxia

A

1 aspirin tablet placebo–> effects seen via inhibition of cyclooxygenase
1 oxygen mask placebo –> effects seen by reduced ventilation and reduced blood alkalosis

result –> larger physiological effects exerted by oxygen mask placebo

evidence that placebo effect is more than psychological

22
Q

impact of types of outcome expectancies on outcome

A

conscious expectancies lead to behaviour changes and schematic processing resulting in subjective placebo effects

unconscious outcome expectancies lead to objective physiological placebo effects

23
Q

impact of placebo effect on beliefs about interventions

A

when placebo effects are large, they cast doubt on the intervention efficacy and on the proposed mechanism of action of the “real” treatment

people start to think the effect of the drug is wholly due to psychological processes

24
Q

evidence to suggest there is no difference between giving a drug and a placebo

A

howick et al 2013
systematic review of 115 studies
found no significant difference between treatment and placebo effects

25
Q

ernst et al 1995

A

says that clincial trials should always be double blind

says trials should have 3 arms not just 2
intervention, placebo and no treatment

26
Q

why is the 3rd arm (control) so important

A

controls for normal regression towards the mean over time, spontaneous remission, unknown parallel interventions or trial drop-outs

makes sure we know people are only getting better due to the intervention or placebo and not due to other confounding factors

27
Q

how do you calculate results of the trial using the 3 arm method

A

treatment effect = intervention arm - placebo arm

placebo effect = placebo arm - no treatment arm

28
Q

example of an intervention that it very difficult to create a placebo for

A

cognitive behavioural therapy (CBI)

patient is actively involved in the treatment

29
Q

example of a 3-arm trial

A

single-blind RCT for 262 patients with IBS

–> looked at effects of how patients are treated by the clincian

30
Q

method of 3 arm IBS trial

A

arm 1 –> validated placebo acupuncture device and supportive patient-clinician relationship (attention, warmth, confidence)

arm 2 –> validated placebo acupuncture device

arm 3 –> no treatment

31
Q

results of 3 arm IBS trial

A

adequate relief on validated measure for IBS patients shown by:

62% for arm 1
44% for arm 2
28% for arm 3

shows changes in expectation encouraged by the clinician can significantly effect results

32
Q

factors involved in strength of placebo effects

A 
treatment characteristics (shape, colour, size of drug)
healthcare setting (hospital works better than home)
patient characteristics (beliefs, expectations, anxiety levels)
HCP characteristics (gender, status, beliefs, job satisfaction)
HCP-patient relations (information provision, reassurance, compassion, changing expectations)
33
Q

who came up with the taxonomy of placebo effects for clinical practice/research

A

bishop et al 2017

34
Q

techniques for creating placebo effects in research

A

creating positive expectancy
reduce negative expectancy
select patients based on treatment history
sham interventions-attention only

35
Q

how does a clinician create positive expectancy in patients

A

deliberately and explicitly suggest to patients that the intervention will be negative for them

36
Q

how does a clinician reduce negative expectancy in patients

A

deliberately minimise the potentially negative or harmful procedures and characteristics of the treatment

reassure the patient that the treatment is unlikely to be ineffective

37
Q

which patients would you recruit for a successful placebo study

A

patients naive to the intervention being tested (check their treatment history)

38
Q

what does bishop et al 2017 mean by sham intervention-attention only

A

patients only receive study-specific attention in terms of numbers and visits and time spent with study staff but no additional intervention

39
Q

why are the results from placebo research studies useful

A

help to create other treatments that are perhaps more cost effective
provides evidence on how HCPs should interact and communicate with patients to improve patient outcome and adherence to medication

40
Q

how do HCPs provide cognitive care

A

HCPs can influence patients’ beliefs and expectations through descriptions of the illness/treatment

41
Q

how do HCPs provide emotional care

A

HCPs reduce negative effects by providing empathy, warmth, reassurance and support to patient

42
Q

evidence that care from HCPs is important for patient outcomes

A

Di Blasi et al 2001
systematic review of 25 RCTs

25 manipulated cognitive care, 4 manipulated cognitive and emotional care

overall found manipulation of care improved patient outcomes

43
Q

ethical issues behind placebos

A

deception of patients is wrong
doing research where we dont know the outcome is risky
patients consenting to placebo surgery (e.g. knee slit) that may have damaging effects

44
Q

evidence to show that placebos can work without deception

A

kaptchuk et al 2010 Harvard

IBS patients tested

arm 1: pills presented as placebos, patient told about benefits of the placebo effect

arm 2: no treatment

same patient care maintained throughout

significantly higher mean IBS improvment scores in arm 1

psychology applied to health (11 decks)

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