Placebo Effect: Theory, Mechanisms and Teleological Roots

Hashmi, Javeria A.

doi:10.1016/bs.irn.2018.07.017

Cited by 24 publications

(15 citation statements)

References 79 publications

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“…The effect of subjective intervention to impact objective behavioural outcomes and neural activity (Hashmi, 2018;Schmidt et al, 2014;Oken et al, 2008). Independently of this possibility, we argue that the effect of subjective intervention on self-reported outcomes shall not be underestimated.…”

Section: Discussionmentioning

confidence: 81%

The Importance of Individual Beliefs in Assessing Treatment Efficacy: Insights from Neurostimulation Studies

Fassi

Kadosh

2020

Preprint

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In recent years, there has been debate about the effectiveness of interventions from different fields (e.g., non-invasive brain stimulation (NIBS), neurofeedback, cognitive training programs) due to contradictory and nuanced experimental findings. Up to date, studies are focused on comparing the effects of an active form of the intervention to a placebo/control condition. However, a neglected question is how to consider individual differences in response to blinding procedures, and their effect on behavioural outcomes, rather than merely compare the efficacy of blinding using a group-based approach. To address this gap in the literature, we here suggest using subjective intervention—the participants’ subjective beliefs about receiving or not receiving an intervention—as a factor. Specifically, we examined whether subjective intervention and subjective dosage (i.e. participants’ subjective beliefs about the intensity of the intervention they received) affected performance scores independently, or interacting with, the active experimental condition. We carried out data analysis on an open-access dataset that has shown the efficacy of active NIBS in altering mind wandering. We show that subjective intervention and subjective dosage successfully explained alteration in mind wandering scores, over and beyond the objective intervention. These findings highlight the importance of accounting for the participants’ beliefs about receiving interventions at the individual level by demonstrating their effect on human behaviour independently of the actual intervention. Altogether, our approach allows more rigorous and improved experimental design and analysis, which will strengthen the conclusions coming from basic and clinical research, for both NIBS and non-NIBS interventions.

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Section: Discussionmentioning

confidence: 81%

The Importance of Individual Beliefs in Assessing Treatment Efficacy: Insights from Neurostimulation Studies

Fassi

Kadosh

2020

Preprint

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“…This study offers empirical evidence for the influence of learning and inference on pain intensity and offers new insights into the nature of pain as a signal for detecting and evaluating threats. The role of threat detection in biasing pain perception has been suggested, and there is a need to re-evaluate classical assumptions of pain as a bottom-up system for representing properties of noxious stimuli (Craig, 2003;Hashmi, 2018). Through this research, a new understanding of pain is emerging to review the role of pain as a learning signal that reinforces aversions to threats in addition to signaling actual or potential tissue damage (Davis et al, 2015;Wiech, 2016;Apkarian, 2019;Seymour, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…A useful adaptation for conserving resources, schemas allow us to rapidly extract meaning from sensory inputs. Studies have shown the influence of prior context on pain primarily with pavlovian conditioning and placebo suggestion (Ashar et al, 2017;Hashmi, 2018), but models that can test effects of cognitive processes such as logical reasoning in building top-down schemas of the relationship between cue and pain properties have not yet been tested. Thus, the direct influence of higher-order predictions in directing pain perception remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Threat Prediction from Schemas as a Source of Bias in Pain Perception

et al. 2020

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Oursensoryimpressionsofpainaregenerallythoughttorepresentthenoxiouspropertiesofanagentbutcanbeinfluencedbythepredictedlevel of threat. Predictions can be sourced from higher-order cognitive processes, such as schemas, but the extent to which schemas can influence pain perception relative to bottom-up sensory inputs and the underlying neural underpinnings of such a phenomenon are unclear. Here, we investigate how threat predictions generated from learning a cognitive schema lead to inaccurate sensory impressions of the pain stimulus. Healthy male and female participants first detected a linear association between cue values and stimulus intensity and rated pain to reflect the linear schemawhencomparedwithuncuedheatstimuli.Theeffectofbiasonpainratingswasreducedwhenpredictionerrors(PEs)increased,butpain perception was only partially updated when measured against stepped increases in PEs. Cognitive, striatal, and sensory regions graded their responses to changes in predicted threat despite the PEs (p Ͻ 0.05, corrected). Individuals with more catastrophic thinking about pain and with low mindfulness were significantly more reliant on the schema than on the sensory evidence from the pain stimulus. These behavioral differences mapped to variability in responses of the striatum and ventromedial prefrontal cortex. Thus, this study demonstrates a significant role of higher-order schemas in pain perception and indicates that pain perception is biased more toward predictions and less toward nociceptive inputs in individuals who report less mindfulness and more fear of pain.

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“…A final consideration is the placebo effect [9,10]. The concepts of bias and motivation referred to in the above paragraphs are a part of the placebo effect.…”

Section: The Placebo Effectmentioning

confidence: 99%

Patients with shoulder pain referred to specialist care; treatment, predictors of pain and disability, emotional distress, main symptoms and sick-leave: a cohort study with a 6-months follow-up

Butler

2020

Scandinavian Journal of Pain

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Placebo Effect: Theory, Mechanisms and Teleological Roots

Cited by 24 publications

References 79 publications

The Importance of Individual Beliefs in Assessing Treatment Efficacy: Insights from Neurostimulation Studies

The Importance of Individual Beliefs in Assessing Treatment Efficacy: Insights from Neurostimulation Studies

Threat Prediction from Schemas as a Source of Bias in Pain Perception

Patients with shoulder pain referred to specialist care; treatment, predictors of pain and disability, emotional distress, main symptoms and sick-leave: a cohort study with a 6-months follow-up

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