Week11; Placebos Benedetti

Question 1

Define Placebo

Answer 1

fake therapies that induce real therapeutic effects. Inert treatment

Question 2

How are movies and placebos similar?

Answer 2

They’re similar to films, as films produce fiction-induced physiological and psychological effects like fear love, tears etc whilst placebos reduce pain, anxiety etc and are also fiction-induced improvements

Placebo’s consist not only of the inert treatment but like films also have an important psychosocial context, involving the sensory and social stimuli present when the treatment is given
* Eg. patient doctor relationship
* Theres also a role for anxiety to expectancy responses, to social learning and classical conditioning

Question 3

role of placebos in research

Answer 3

o Understanding placebo effects is important particularly in the instance of clinical trials. As in these trials scientists are assessing if the drug is more or less effective than the placebo

Question 4

Define Nocebo

Answer 4

inert treatment that makes clinical symptoms worse

Question 5

 Move induced physiological responses

Answer 5

o Movies are powerful triggers of strong emotional responses, ranging from love and tears to heartache and fear
o Whilst we know films aren’t real, the emotional and behavioural response to films is very much real
o The behavioural and psychological responses to films are mediated by a range of changes such as autonomic activation to emotional distress or cognitive changes to behaviour. Bloodcurdling movies can also alter coagulation and blood flow

Question 6

Open-Placebos

Answer 6

 Deception isn’t necessary for placebos since open label treatments produce a placebo effect too
 Eg. in a conditioning procedure a painfiller was given to patients several days in a row, then they were given a placebo called an antibiotic. The placebo still produced an analgesic effect. So, the simple routine of an injection appears to work and the role of conditioning in placebos is profound
 Open label placebos have also been shown to help with ibs, depression, pain, itch and cancer-related fatigue

Question 7

Research on open placebos and emotional distress

Answer 7

 A recent study found that placebos administered without deceptioin reduced self-report and neural measures of emotional distress. So maybe expectation isn’t crucial for deceptive placebos to work. It may instead be due to unconscious (automatic) mechanisms as with open-label placebos and movies, where the unconscious mechanisms still take an effect even if your conscious system knows the ‘truth’
* These automatic associations and mechanisms are likely not linked to expectation but instead past experience

Question 8

How do placebos work

Answer 8

o Leading belief is that placebos modulate the same biochemical pathways that are modulated by drugs
o Eg. in the field of pain this is the cannabinoid and opioid systems and for motor disorders the dopamine system

Question 9

Role of words and rituals and placebos

Answer 9

Words on the one hand and drugs on the other, may affect similar regions of a patients’ brain

They are like placebos and films;
o Eg. seeing a syringe with water in it is analogous to watching a horror movie knowing the blood is tomato sauce  the real situatin isn’t required to elicit an emotional and behavioural response
o This is true for watching movies but also telling stories or having rituals
 So this should be part of any treatment be it pharmacological or not as it can play a crucial role in therapeutic outcome
 Clinicians need good communication skills and better non-verbal practises to help with this

Question 10

o Role of pseudoscience

Answer 10

 There is a risk however, as words, stories and rituals may boost pseudoscience
 The argument from these charlatons is that even if their non-evidence-backed treatment isn’t legit, it though positive expectation or psychophysiological changes in the patient will activate the same biochemical pathways and neural networks that have been identified through hard science

Question 11

Role for ethics in open placebos

Answer 11

• It always needs to be emphasised that placebos do not cure illness but may improve quality of life
  o Placebos can reduce pain and muscle rigidity for example in parkinsons but can’t change the progression fo the disease
• The type of disease is crucial for the role of placebo
  o Eg. cancer and anxiety differs from infectious disease
  o Placebos won’t stop the growth of cancer or kill the bacteria that causes pneumonia

Question 12

Conclusion on movies and placebos

Answer 12

 Placebos aren’t at odds with common sense, they are like movie-induced responses
 They are not a specific aspect of the healing setting, but a function of the human mind
 Sometimes the simulation of reality, as occurs in movies, is sufficient to trigger physiological reactions; in the same way, the simulation of a therapy, as occurs with placebos is enough to trigger therapeutic effects