Objective
The current study soughtto better understand why good adherence to a placebotreatment has been reliably associated with health benefits. We proposed a model where initial expectations shape adherence, which then influences subsequent expectations that affect placebo response. Design: Seventy-two participants were told they were enrolling in a study of physical activity and memory and were asked to increase their physical activity by 35% for two weeks (placebo treatment). Main outcome measures: Adherence to this physical activity target was measured by pedometer. Expectations and short-term memory (free recall) were assessed before and after physical activity. Results: Initial expectations predicted adherence to physical activity (r = 0.27, p < 0.03), but adherence did not predict subsequent expectations (r = 0.06, p = 0.60). Testing a multi-step meditational model revealed that initial expectations predicted better memory even after controlling for adherence, subsequent expectations, baseline memory, and gender (c’= 1.10, 95% CI = 0.46 – 1.74). Stronger expectations for memory improvement predicted better memory performance, but adherence and later expectations did not mediate this association. Conclusions: Good adherence to a placebo may reflect strong treatment expectations which may convey benefits by enhancing the non-specific effects of treatment.