Super placebos: A feasibility study combining contextual factors to promote placebo effects

Abstract

Ample evidence demonstrates that placebo effects are modulated by contextual factors. Few interventions, however, attempt to combine a broad range of these factors. Here, we explore the therapeutic power of placebos by leveraging factors including social proof, positive suggestion, and social learning. This study aimed to test the feasibility of an elaborate "super placebo" intervention to reduce symptoms of various disorders in a pediatric population. In a single-arm qualitative study, participants entered an inactive MRI scanner which they were told could help their brain heal itself through the power of suggestion. The sample included 11 children (6-13 years old) diagnosed with disorders known to be receptive to placebos and suggestion (Attention Deficit Hyperactivity Disorder, Tourette Syndrome, chronic skin picking, and migraines). The children were given positive suggestions before entering the scanner for 2 to 4 sessions over the span of approximately one month. We assessed open-ended treatment outcomes via recorded interviews and home visits. The procedure was feasible and no adverse events occurred. Ten of the eleven parents reported improvements in their children after the intervention, ranging from minor transient changes to long-term reductions in subjective and objective symptoms (e.g., migraines and skin lesions). These preliminary findings demonstrate the feasibility and promise of combining a broad range of contextual factors in placebo studies. Future research is needed to assess the causal effects of such interventions.

A nudge-based intervention to reduce problematic smartphone use: Randomised controlled trial

“…Given participants' ratings (Tables S1 and S2), reducing notifications, hiding social media apps, and making the phone less accessible may be the strongest candidates. We have previously argued that intervention development could involve an initial "kitchen sink" approach to first determine whether the intervention as a whole is feasible and effective before dismantling the key components in future studies 76 . Still, given that participants choose which guidelines to follow, the intervention may be simple enough that dismantling it may be less necessary.…”

Culture, context, and ethics in the therapeutic use of hallucinogens: Psychedelics as active super-placebos?

“…Moreover, the active effects of a substance can be enhanced through suggestion, or leveraged to increase the impact of further suggestions as patients may interpret signs of active effects as proof that the intervention “works.” In the case of psychedelics, we suggest that the active component greatly enhances receptivity to contextual cues. Thus, while we might define a placebo intervention as one that mobilizes a range of contextual cues to leverage placebo effects (e.g., anticipation, charisma and warm tone of the healer, peer influences, ritual elaboration; see Olson et al, 2021), an active super-placebo—such as a psychedelic healing session—involves a substance that actually enhances the suggestive effects of contextual cues.…”

Presenting a Sham Treatment as Personalised Increases the Placebo Effect in a Randomised Controlled Trial

“…Research in placebo science has shown that the contextual factors surrounding the treatment, such as verbal suggestions, patient expectations, social cues, and observational learning increase intervention effectiveness and reduce the associated side effects [6][7][8] . Additionally, these effects are present for both subjective symptoms (e.g., pain, depression) and physiological ones (e.g., immune response, motor function) 9 .…”

“…Beyond the appeal to individuality, the personalisation process may implicitly suggest stronger treatment effectiveness by harnessing factors well-known to increase the placebo effect 7 . Pharmacological tailoring is an intricate process and often requires biomarker tests that are sometimes invasive 17 , take longer to process 18 , or use advanced technology 3 .…”

“…We developed an elaborate procedure to plausibly simulate treatment personalisation and tested it in a feasibility study (N1 = 17) before confirming the findings in a pre-registered double-blind experiment (N2 = 85). The procedure was based on studies of complex placebo interventions 7,31 and simulated both the nature of tests (i.e., genetic, physiology) and the medical context (i.e., room setting, location) of treatment tailoring. We also included several personality traits that could potentially interact with the placebo effects of personalisation.…”