Rethinking Explicit Expectations: Connecting Placebos, Social Cognition, and Contextual Perception

Schwarz, Katharina A.; Pfister, Roland; Büchel, Christian

doi:10.1016/j.tics.2016.04.001

Cited by 87 publications

(93 citation statements)

References 123 publications

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“…Implicit expectancies refer to beliefs based on what usually occurs in the individual’s environment (Schwarz, Pfister, & Büchel, 2016). These beliefs can also be built by social observation (Colloca & Benedetti, 2009; Schwarz et al, 2016) where people adapt their behavior partially based on these sort of statistical probabilities. Explicit expectancies refer to personal beliefs about oneself, the others and the environment.…”

Section: Role and Manipulation Of Expectanciesmentioning

confidence: 99%

“…Explicit expectancies refer to personal beliefs about oneself, the others and the environment. There are two categories of explicit expectancies: the first one refers to the beliefs consciously used to make decisions and the second one refers to the beliefs that will “incidentally” influence the decision making (Schwarz et al, 2016). Oneself expectancies can also be influenced by someone else’s expectancies (Pygmalion effect), like a therapist’s expectation concerning a patient or a teacher’s expectation concerning a student (Schwarz et al, 2016).…”

Section: Role and Manipulation Of Expectanciesmentioning

confidence: 99%

“…While placebo effect varies between people with different characteristics (Corsi & Colloca, 2017; Geers, Kosbab, Helfer, Weiland, & Wellman, 2007) and within the same person when receiving more than one treatment (Whalley, Hyland, & Kirsch, 2008), the evaluation of the effect of expectancies is a challenge in research (Schwarz et al, 2016). Nevertheless, as mentioned elsewhere, numerous studies reveal that expectancies also modulate placebo and nocebo effects (Bartels et al, 2014; Bartels, van Laarhoven, Heijmans, et al, 2017; Bartels, van Laarhoven, Stroo, et al, 2017; Bingel et al, 2011; Bräscher, Witthöft, & Becker, 2018; Fiorio et al, 2012).…”

Section: Role and Manipulation Of Expectanciesmentioning

confidence: 99%

See 2 more Smart Citations

Pain Modulation: From Conditioned Pain Modulation to Placebo and Nocebo Effects in Experimental and Clinical Pain

Damien

Colloca

Belleï-Rodriguez

et al. 2018

International Review of Neurobiology

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Accumulating evidence reveal important applications of endogenous pain modulation assessment in healthy controls and in patients in clinical settings, as dysregulations in the balance of pain modulatory circuits may facilitate pain and promote chronification of pain. This article reviews data on pain modulation, focusing on the mechanisms and translational aspects of pain modulation from conditioned pain modulation (CPM) to placebo and nocebo effects in experimental and clinical pain. The specific roles of expectations, learning, neural and neurophysiological mechanisms of the central nervous system are briefly reviewed herein. The interaction between CPM and placebo systems in pain inhibitory pathways is highly relevant in the clinic and in randomized controlled trials yet remains to be clarified. Examples of clinical implications of CPM and its relationship to placebo and nocebo effects are provided. A greater understanding of the role of pain modulation in various pain states can help characterize the manifestation and development of chronic pain and assist in predicting the response to pain-relieving treatments. Placebo and nocebo effects, intrinsic to every treatment, can be used to develop personalized therapeutic approaches that improve clinical outcomes while limiting unwanted effects.

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Section: Role and Manipulation Of Expectanciesmentioning

confidence: 99%

Section: Role and Manipulation Of Expectanciesmentioning

confidence: 99%

Section: Role and Manipulation Of Expectanciesmentioning

confidence: 99%

See 1 more Smart Citation

Pain Modulation: From Conditioned Pain Modulation to Placebo and Nocebo Effects in Experimental and Clinical Pain

Damien

Colloca

Belleï-Rodriguez

et al. 2018

International Review of Neurobiology

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“…One set of patients was not told about the analgesic properties of the medication, a second was told they were receiving powerful pain medication or placebo, and a third was informed that they were receiving a powerful analgesic. This study showed a significant decrease in pain medication use in the third group when compared to the other two groups, and this result suggested that verbal communication influences explicit expectations, and thus placebo and nocebo effects (Blasini et al 2017; Colloca and Finniss 2012; Colloca and Miller 2011c; Klinger et al 2017a; Miller and Colloca 2010; Pollo et al 2001; Schwarz, Pfister, and Büchel 2016, 2018). Expectancies can also be modulated by a person’s emotional appraisal of the situation (in other words, by fear, anxiety, or the prospect of reward).…”

Section: The Expectancy Theorymentioning

confidence: 59%

“…Recent focus on the influences of personality and psychological traits and factors in placebo responsiveness has also revealed that suggestibility, catastrophizing, anxiety sensitivity, rumination, and helplessness can trigger the occurrence of nocebo effects (Blasini et al 2017; Corsi and Colloca 2017; Corsi et al 2016; Schwarz, Pfister, and Büchel 2016; Vogtle, Barke, and Kroner-Herwig 2013). However, in a study conducted by Corsi and Colloca (2017), it was shown that psychological factors did not directly influence participants’ expectations of pain.…”

Section: The Expectancy Theorymentioning

confidence: 99%

The Placebo Phenomenon: A Narrow Focus on Psychological Models

Peiris¹,

Blasini²,

Wright³

et al. 2018

Perspectives in Biology and Medicine

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The placebo effect is a complex phenomenon that can be described from neurobiological, psychosocial, and epistemological perspectives. Different leaders in the field have proposed multiple theories and models that attempt to describe both the nature and the mechanisms of action underlying placebo effects. This article focuses on the most relevant psychological models that have been suggested for characterizing the different mechanisms underlying the placebo effect. We outline how the dynamic psychoneurobiological aspects of the placebo phenomenon can be a potential reliable and useful tool in daily clinical practice for illness and symptom management within a wide variety of specialties and health-care practices.

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Influence of Role Expectancy on Patient-Reported Outcomes Among Patients With Migraine

May,

Carvalho,

Schwarz

et al. 2024

JAMA Netw Open

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ImportanceIt is usually assumed that an individual’s classification as a patient or a healthy person is determined by the presence or absence of disease, but little is known about whether the mere awareness of being a patient or a healthy control can play an important role for reporting outcomes.ObjectiveTo investigate whether assignment to the role of a patient or a healthy control has an effect on patient-reported outcomes.Design, Setting, and ParticipantsThis single center, double-blind, 3-group randomized clinical trial included consecutive patients from a tertiary headache clinic based at a single center in Germany who were invited to participate between October 2019 and June 2023. Statistical analysis was performed from January to March 2024.InterventionPatients with migraine were randomized into 2 groups. The first group was told that this study was centered on migraine symptoms, whereas the second group was told that healthy controls were being sought for a study about patients with vertigo. A third group of age- and sex-matched headache-free participants served as controls. All participants viewed 2 standardized roller coaster videos and provided ratings of their perceived levels of motion sickness and dizziness. Main Outcomes and MeasuresThe primary outcome was self-reported vestibular symptoms. Secondary outcomes included differences in motion sickness, headache burden, and migraine disability. Outcomes were assessed using standardized questionnaires.ResultsThe final sample included 366 participants: 122 patients with migraine assigned the role of patient (MP) (migraine as patient): mean [SD] age, 37.56 [12.93] years; 105 [86.1%] female), 122 patients with migraine assigned the role of healthy participant (MH) (migraine as healthy): mean [SD] age, 37.03 [13.10] years; 107 [87.7%] female), and 122 headache-free controls (HC): mean [SD] age, 37.55 [11.56] years; 100 [82.0%] female). The assigned role of the individuals with migraine (MP vs MH) had a significant effect on self-disclosure of (1) estimation that symptoms (dizziness) will occur under specific conditions (self-reported vestibular symptoms: 79 MP [64.8%]; 29 MH [23.8%]; 9 HC [7.4%]; P &lt; .001), (2) the increase of such symptoms (dizziness) after viewing the roller coaster video, and (3) the reported frequency (median [IQR] self-reported monthly headache days for MP: 7 [4-15] days; for MH: 5 [2-10] days; P = .008) and severity (median [IQR] migraine disability assessment score for MP: 35 [20-64] points; for MH: 25 [11-47] points; P = .005) of migraine symptoms. Statistically significant changes were also found for self-reported headache frequency and disability caused by migraine.Conclusions and RelevanceThis randomized clinical trial found an effect of expectations regarding the role of a patient with respect to clinical and study outcomes. These findings suggest that role expectations should be taken into account when, for example, invasive treatments are discussed.Trial RegistrationClinicalTrials.gov Identifier: NCT06322550

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Rethinking Explicit Expectations: Connecting Placebos, Social Cognition, and Contextual Perception

Cited by 87 publications

References 123 publications

Pain Modulation: From Conditioned Pain Modulation to Placebo and Nocebo Effects in Experimental and Clinical Pain

Pain Modulation: From Conditioned Pain Modulation to Placebo and Nocebo Effects in Experimental and Clinical Pain

The Placebo Phenomenon: A Narrow Focus on Psychological Models

Influence of Role Expectancy on Patient-Reported Outcomes Among Patients With Migraine

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