Psychotherapy and Placebos: Manifesto for Conceptual Clarity

Blease, Charlotte

doi:10.3389/fpsyt.2018.00379

Cited by 17 publications

(9 citation statements)

References 28 publications

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“…Placebo-controlled trials in surgery and other “instrumental” and manual therapies (acupuncture, stimulation techniques such as TENS, TMS, physical therapies, and alike) (Enck, 2018) often use the term “sham” instead, to denote that the provision of placebos in not “inert” any longer: sham surgery for instance can be associated with significant violating of the body’s integrity. The application of the concept of placebos for psychotherapy and therapies alike has received very little and rather late attention and raises substantial controversy nowadays (Blease, 2018) over the question whether psychotherapy is to a large extent only placebo therapy (Gaab et al, 2016), or whether the placebo concept should not be applied at all to psychotherapy (Kirsch, 2005).…”

Section: The Short History Of Placebo Researchmentioning

confidence: 99%

Does Sex/Gender Play a Role in Placebo and Nocebo Effects? Conflicting Evidence From Clinical Trials and Experimental Studies

Enck¹,

Klosterhalfen²

2019

Front. Neurosci.

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Sex has been speculated to be a predictor of the placebo and nocebo effect for many years, but whether this holds true or not has rarely been investigated. We utilized a placebo literature database on various aspects of the genuine placebo/nocebo response. In 2015, we had extracted 75 systematic reviews, meta-analyses, and meta-regressions performed in major medical areas (neurology, psychiatry, internal medicine). These meta-analyses were screened for whether sex/gender differences had been noted to contribute to the placebo/nocebo effect: in only 3 such analyses female sex was associated with a higher placebo effect, indicating poor evidence for a contribution of sex to it in RCTs. This was updated with another set of meta-analyses for the current review, but did not change the overall conclusion. The same holds true for 18 meta-analyses investigating adverse event (nocebo) reporting in RCT in the placebo arm of trials. We also screened our database for papers referring to sex/gender and the placebo effect in experimental studies, and identified 28 papers reporting 29 experiments. Their results can be summarized as follows: (a) Despite higher sensitivity of pain in females, placebo analgesia is easier to elicit in males; (b) It appears that conditioning is effective specifically eliciting nocebo effects; (c) Conditioning works specifically well to elicit placebo and nocebo effects in females and with nausea; (d) Verbal suggestions are not sufficient to induce analgesia in women, but work in men. These results will be discussed with respect to the question why nausea and pain may be prone to be responsive to sex/gender differences, while other symptoms are less. Lastly, we will discuss the apparent discrepancy between RCT with low relevance of sex, and higher relevance of sex in specific experimental settings. We argue that the placebo response is predominantly the result of a conditioning (learning) response in females, while in males it predominantly may be generated via (verbal) manipulating of expectancies. In RCT therefore, the net outcome of the intervention may be the same despite different mechanisms generating the placebo effect between the sexes, while in experimental work when both pathways are separated and explicitly explored, such differences may surface.

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Section: The Short History Of Placebo Researchmentioning

confidence: 99%

Does Sex/Gender Play a Role in Placebo and Nocebo Effects? Conflicting Evidence From Clinical Trials and Experimental Studies

Enck¹,

Klosterhalfen²

2019

Front. Neurosci.

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“…Instead, we will follow an argument raised by Blease (20, 21); according to which, there is general scientific consensus that the placebo concept exists, but unnecessary debate in placebo studies persists due to the failure to recognize this fact. In principle, the same underlying definitions for placebo response and placebo effect that apply in biomedical research interventions also apply to psychological interventions for which the concept “placebo” was not developed.…”

Section: Historical Rootsmentioning

confidence: 99%

“…By contrast, of the many smartphone health applications presently available (now numbering over 300,000), those with a psychotherapeutic approach still lack clear control strategies that would enable us to estimate the overall efficacy of their placebo effect (110). Using “virtual” doctors or therapists (111) in the future may enable us to exert a much better control of the nonspecific factors not only in psychotherapy but also in medical therapy in general (21, 112).…”

Section: Common Control Problems In All Psychotherapy Trials and Theimentioning

confidence: 99%

Placebo Effects in Psychotherapy: A Framework

Enck¹,

Zipfel²

2019

Front. Psychiatry

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The issue of placebo response and the extent of its effect on psychotherapy is complex for two specific reasons: i) Current standards for drug trials, e.g., true placebo interventions, double-blinding, cannot be applied to most psychotherapy techniques, and ii) some of the “nonspecific effects” in drug therapy have very specific effects in psychotherapy, such as the frequency and intensity of patient–therapist interaction. In addition, different psychotherapy approaches share many such specific effects (the “dodo bird verdict”) and lack specificity with respect to therapy outcome. Here, we discuss the placebo effect in psychotherapy under four aspects: a) nonspecific factors shared with drug therapy (context factors); b) nonspecific factors shared among all psychotherapy traditions (common factors); c) specific placebo-controlled options with different psychotherapy modalities; and d) nonspecific control options for the specific placebo effect in psychotherapy. The resulting framework proposes that the exploration and enumeration of context factors, common factors, and specific factors contributes to the placebo effects in psychotherapy.

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“…Also, placebos with a psychotherapeutic meaning have been shown to be effective and to have effects comparable to those observed in subjects undergoing established psychotherapy treatments (16). These methodological and epistemological issues prompted Cuijpers and Cristea (17) to publish a guideline on “[h]ow to prove that your therapy is effective, even when it is not (…).” Thus, the acknowledgment and understanding of the relationship between psychotherapy and placebo is just as much problematic as it is relevant for research (18, 19) and an ethically sound clinical practice (20). But how about nocebo effects?…”

Section: Psychotherapy Placebo and Nocebomentioning

confidence: 99%

The Other Side of the Coin: Nocebo Effects and Psychotherapy

et al. 2019

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Psychotherapy and placebo have a long history, and both have been shown to have significant and clinically meaningful effects. In the last 100 years and up to today, psychotherapy has been subject to an enduring and often heated debate about its mechanisms and its possible relationship to placebos and their effects. However, there is little awareness of the placebo effects’ counterpart—nocebo effects (from Latin “I will harm”)—in the context of psychotherapy. Embedded in the controversy of whether psychotherapy and placebo share some unwanted proximity in terms of effects and mechanisms, the question arises which role nocebo effects may play in relation to psychotherapy. By using two examples, this article analyzes and discusses two different kinds of possible associations between psychotherapy and nocebo effects. We close with possibilities of how to prevent the occurrence of nocebo effects in psychotherapy, including some specific recommendations for clinical practice.

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Psychotherapy and Placebos: Manifesto for Conceptual Clarity

Cited by 17 publications

References 28 publications

Does Sex/Gender Play a Role in Placebo and Nocebo Effects? Conflicting Evidence From Clinical Trials and Experimental Studies

Does Sex/Gender Play a Role in Placebo and Nocebo Effects? Conflicting Evidence From Clinical Trials and Experimental Studies

Placebo Effects in Psychotherapy: A Framework

The Other Side of the Coin: Nocebo Effects and Psychotherapy

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