Investigating the role of expectancy in caffeine withdrawal using the balanced placebo design

Abstract

Objective: This study investigated psychological influences on drug withdrawal symptomatology using a caffeine-based model. Methods:Using the 2 × 2 balanced placebo design caffeine dose (given caffeinated vs decaffeinated coffee) was crossed with dose expectancy (told caffeine vs. decaf) among 87 (16-hr abstinent) regular coffee consumers in a 2-day study.Results: There were effects of expectancy and pharmacology that differed depending on the measure. Those told decaf reported greater caffeine cravings than those told caffeine 45 min and 8 hr postmanipulation. There were no expectancy effects on withdrawal symptoms or cognitive performance. There were pharmacological effects on all measures. Those given decaf reported greater withdrawal symptoms and showed poorer cognitive performance 45 min and 8 hr postmanipulation, with effects for headache and flu-like symptoms first emerging 8 hr postmanipulation (i.e., 24 hr abstinence in given decaf conditions). Caffeine readministration alleviated all withdrawal symptoms and cognitive decrements within 45 min. No drug by expectancy interactions were observed. Conclusions: These findings confirm a strong pharmacological basis for caffeine withdrawal and an important role of cognition in drug craving. Future research should investigate the role of expectancy in drug withdrawal and craving and the potential use of expectancy manipulations in symptom prevention and management. KEYWORDS balanced placebo design, caffeine, drug withdrawal, expectancy, nocebo effect

The impacts of caffeine administration, expectancies, and related stimuli on coffee craving, withdrawal, and self-administration

“…Questionnaire (CWSQ; Juliano et al, 2012) is a 23-item questionnaire used to assess caffeine withdrawal. The CWSQ has been shown to have high internal consistency (α = 0.90) and to be sensitive to caffeine abstinence in daily caffeine users (Juliano et al, 2019) and has been tested in samples comparable to ours (Juliano et al, 2012).…”

Caffeine and Exercise Performance: Possible Directions for Definitive Findings

“…This fact seems to be even more relevant, since caffeine and adjacent metabolites play a substantial role in the CNS, "silencing" the adenosine signals while caffeine is present in the body (Daly et al, 1983). However, as most of the reported symptoms are subjective (Juliano and Griffiths, 2004;Juliano et al, 2012) and caffeine blinding is usually difficult, some authors (Dews et al, 2002;Juliano et al, 2019) propose that the effects of caffeine withdrawal could be related to negative expectation effects (nocebo effect).…”

“…In this sense, a recent study (Juliano et al, 2019) has successfully investigated the blinding process and caffeine withdrawal effects by evaluating caffeine withdrawal in 87 heavy caffeine consumers (±525 mg.day −1 ), after 16 h from an initial coffee containing 100 mg of caffeine. The research tested the expectation of caffeine withdrawal through the consumption of a cup of coffee containing 280 mg of caffeine or a decaffeinated version of it.…”

“…For each condition, the participants filled out a standardized questionnaire in accordance with self-reported measurements on the Withdrawal Symptom Questionnaire and Caffeine Craving for 24 h, showing that higher scores were correlated to the expected absence of caffeine consumption (Juliano et al, 2019). This nocebo effect due to the expectation of not consuming caffeine was also addressed in a study that performed the reduction of caffeine in habitual caffeine consumers, and it pointed out greater more withdrawal symptoms among the groups that had the perception of dose reductions during the taper dose (Mills et al, 2019).…”

Belief in caffeine's ergogenic effect on cognitive function and endurance performance: A sham dose‐response study

“…To date, 11 studies have examined the effect of placebo caffeine expectancy effects on exercise performance (Anderson et al, 2020; C.; Beedie et al, 2006;Costa et al, 2019;Duncan, 2010;Duncan et al, 2009;Foad et al, 2008;Hurst et al, 2020;Pollo et al, 2008;Saunders et al, 2017;Shabir et al, 2019;Tallis et al, 2016) and 12 on cognitive performance (Dawkins et al, 2011;Denson et al, 2012;Dömötör et al, 2014;Elliman et al, 2010;Fillmore & Vogel-Sprott, 1992;Harrell & Juliano, 2009;Juliano et al, 2019;Kirsch & Weixel, 1988;Oei & Hartley, 2005;Schneider et al, 2006;Walach et al, 2001;Walach et al, 2002). While successfulness of manipulating treatment expectation is described in most studies (i.e.…”