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Placebo analgesia was produced by conditioning trials wherein heat induced experimental pain was surreptitiously reduced in order to test psychological factors of expectancy and desire for pain reduction as possible mediators of placebo analgesia. The magnitudes of placebo effects were assessed after these conditioning trials and during trials wherein stimulus intensities were reestablished to original baseline levels. In addition, analyses were made of the influence of these psychological factors on concurrently assessed pain and remembered pain intensities. Statistically reliable placebo effects on sensory and affective measures of pain were graded according to the extent of surreptitious lowering of stimulus strength during the manipulation trials, consistent with conditioning. However, all of these effects were strongly associated with expectancy but not desire for relief. These results show that although conditioning may be sufficient for placebo analgesia, it is likely to be mediated by expectancy. The results further demonstrated that placebo effects based on remembered pain were 3 to 4 times greater than those based on concurrently assessed placebo effects, primarily because baseline pain was remembered as being much more intense than it actually was. However, similar to concurrent placebo effects, remembered placebo effects were strongly associated with expected pain levels that occurred just after conditioning. Taken together, these results suggest that magnitudes of placebo effect are dependent on multiple factors, including conditioning, expectancy, and whether analgesia is assessed concurrently or retrospectively.

Virtual reality uses computer technology to immerse the individual in a multisensory, 3-dimensional environment. This meta-analysis is the first to quantify the effect of virtual reality distraction on pain. To be included in the meta-analysis, studies were required to use a between-subjects or mixed-model design in which virtual reality distraction was compared with a control condition in reducing pain. Of the 299 records screened, 14 studies met the inclusion criteria. The mean weighted effect size for virtual reality distraction was .90, indicating that the average participant receiving this intervention showed more improvement than about 82% of control participants. Virtual reality distraction was more effective in reducing experimental than clinical pain and when used with adults versus children. However, there was no difference in the relief produced by computer software developed specifically for virtual reality distraction and commercial games with a 3-dimensional environment. The findings of the meta-analysis suggest that virtual reality distraction is a highly effective pain intervention. More research is needed on the application of this intervention to chronic pain, as well as the role of presence and fun as moderator variables. Clinicians may wish to consider virtual reality distraction as a promising treatment choice for patients who suffer from pain.

A comprehensive, methodologically informed review of studies of the effectiveness of hypnosis for reducing procedure-related pain in children and adolescents is provided. To be included in the review, studies were required to use a between-subjects or mixed model design in which hypnosis was compared with a control condition or an alternative intervention in reducing the procedure-related pain of patients younger than age 19. An exhaustive search identified 13 studies satisfying these criteria. Hypnosis was consistently found to be more effective than control conditions in alleviating discomfort associated with bone marrow aspirations, lumbar punctures, voiding cystourethograms, the Nuss procedure, and post-surgical pain. Furthermore, hypnosis was as at least as effective as distraction. Three hypnotic interventions met criteria as a possibly efficacious empirically supported therapy for reducing post-surgical or lumbar puncture pain. Several other hypnotic interventions would have achieved the status of a possibly efficacious therapy had studies used a treatment manual.

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A comprehensive review of research evaluating psychological treatments of musical performance anxiety is provided. Studies were evaluated against key methodological criteria for psychotherapy outcome research. Available literature points to the utility of exposure and cognitive therapies, although there is no clear-cut evidence suggesting the superiority of one approach or benefits of combining the two. Past research is characterized by recurring methodological limitations, particularly overreliance on self-report outcome measures. Future investigations should consider screening out individuals who do not evidence marked dysfunction and whose anxiety results from weak technical ability, as well as including treatment manuals, multiple therapists, multichannel outcome measures, and follow-up data. Clinicians working with musicians experiencing performance anxiety may wish to incorporate exposure and cognitive restructuring in treatment.

Immediate and persisting effects of misleading questions and hypnosis on memory reports were assessed. After listening to a story, 52 highly suggestible students and 59 low and medium suggestible students were asked misleading or neutral questions in or out of hypnosis. All participants were then asked neutral questions without hypnosis. Both hypnosis and misleading questions significantly increased memory errors, and misleading questions produced significantly more errors than did hypnosis. The 2 effects were additive, so that misleading questions in hypnosis produced the greatest number of errors. There were no significant interactions with level of hypnotic suggestibility. Implications of these findings for the per se exclusion of posthypnotic testimony are discussed.

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