The Symptomatic Relief of Anxiety With Meprobamate, Phenobarbital and Placebo

Uhlenhuth, E. H.; Canter, Arthur; Neustadt, John; Payson, Henry E.

doi:10.1176/ajp.115.10.905

Cited by 101 publications

(37 citation statements)

References 4 publications

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“…Though placebo effects seem fairly well controlled in this study, such mechanisms cannot be excluded. Even in double-blind drug trials, therapists obtain results in accord with their respective expectations, 33 which means that the therapist may have more subtle influences on the placebo response. 31 Since there was no difference between any of the groups, the results of this study do not reinforce the need for acupuncture as additional treatment for patients with acute stroke.…”

Section: Discussionmentioning

confidence: 99%

Effects of Acupuncture Treatment on Daily Life Activities and Quality of Life

Gosman‐Hedström

Claesson

Klingenstierna

et al. 1998

Stroke

104

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Background and Purpose-A number of studies have indicated that acupuncture might improve the functional recovery of stroke patients. These studies vary in inclusion criteria, sample size, and evaluation methods. The present study was designed to investigate whether electroacupuncture treatment favorably affects stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services. Methods-One hundred four consecutive patients Ͼ40 years of age admitted to hospital because of an acute stroke were randomized to 3 groups: deep, superficial, and no acupuncture treatment. The acupuncture treatment given by 4 physiotherapists started 4 to 10 days after randomization and was given twice a week for 10 weeks. All patients underwent conventional stroke rehabilitation as well. Two occupational therapists, blinded regarding the patients' allocation, evaluated the treatment effects. The assessments were performed 4 times during the first year after randomization by means of interviews and observations. Results-There were no differences between the groups with reference to changes in the neurological score and the Barthel and Sunnaas activities of daily living index scores after 3 and 12 months. Regarding the Nottingham Health Profile, the no acupuncture group had somewhat fewer mobility problems. No differences in health care and social services were found between the groups. Conclusions-The present study does not give support to the previous studies, which indicates that acupuncture treatment may have a beneficial effect on acute stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services. (Stroke. 1998;29:2100-2108.)

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Section: Discussionmentioning

confidence: 99%

Effects of Acupuncture Treatment on Daily Life Activities and Quality of Life

Gosman‐Hedström

Claesson

Klingenstierna

et al. 1998

Stroke

104

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“…Such a study has recently been replicated [35]. In specific settings, only the interested and enthusiastic physician obtained significant improvement with active drugs compared with placebo, whereas the physician's lack of interest did not yield such differences [36,37]. A new therapy whose indications, contraindications, and side effects are not fully appreciated is likely to elicit a greater intellectual and emotional investment of the physician, and this partially explains the success of novel treatments [13].…”

Section: Treatment Outcome As a Multifactorial Productmentioning

confidence: 99%

The Clinical Inadequacy of the Placebo Model and the Development of an Alternative Conceptual Framework

Fava

Guidi

Rafanelli

et al. 2017

Psychother Psychosom

101

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Placebo effects are often attributed to clinical interactions and contextual factors that affect expectations of the patient about the treatment and result in symptom changes. The prevailing conceptualization consists of an undifferentiated placebo response that needs to be minimized in controlled investigations and maximized in clinical practice. However, treatment outcome is the cumulative result of the interaction of several classes of variables with a selected treatment: living conditions (housing, nutrition, work environment, social support), patient characteristics (age, sex, genetics, general health conditions, personality, well-being), illness features and previous therapeutic experience, self-management, and treatment setting (physician's attitude and attention, illness behavior). Such variables may be therapeutic or countertherapeutic, and are unlikely to be simply additive. In certain patients their interactive combination may lead to clinical improvement, whereas in other cases it may produce no effect, and, in a third group, it may lead to worsening of the condition. Maximizing patients' expectations does not necessarily result in sustained effects and, in due course, may actually lead to worsening of the condition (violation of expectations). In this paper, we outline a multifactorial conceptual model that may have implications for the design of clinical trials as well as for clinical practice, with special reference to psychopharmacology and psychotherapy. The effects of drug treatment may be potentiated by specific nonpharmacological treatment strategies, and this synergism may disclose significant differences against placebo. Medical outcomes may be unsatisfactory not because technical interventions are missing, but because our conceptual models and thinking are inadequate.

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“…He reported similar findings in a follow-up study, and observed that unsuccessful therapists had a greater commitment to psychoanalysis than to psychochemotherapy (131). The results were confirmed in an important double blind study by Uhlenruth (55). Only the interested and enthusiastic physician ob tained significant improvement with active drugs compared with placebos, while no differences between active and inactive drugs were obtained by the disinterested and unenthusiastic physician.…”

Section: Attitude To Treatmentmentioning

confidence: 67%

“…Interest in the patient is related to success ful treatment with antidepressants (54), minor tranquilizers (55,56), type of LSD response (56), and drug acceptance by patients (58).…”

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confidence: 99%

Iatroplacebogenics

Shapiro¹

1969

Int Pharmacopsychiatry

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This paper discussed how the psychosociology of the physician contributes to therapeutic and placebo effects. The mechanisms was referred to as iatroplacebogenics, a term describing the study of placebo effects produced by physicians. Iatroplacebogenesis can be direct or indirect. Direct iatroplacebogenesis includes: 1. Attitude to patients, which refers to the therapist’s interest, warmth, friendliness, liking, sympathy, empathy, neutrality, disinterest, hostility, and rejection. 2. Attitude to treatment, which refers to the therapist’s interest, faith, belief, enthusiasm, conviction, commitment, optimism, positive and negative expectations, skepticism, disbelief, and pessimism. 3. Attitude to results, which refers to data distortion caused by random observer effects and by intentional and unintentional nonrandom observer bias. An extensive review of the literature demonstrates that these attitudes of the physician are associated with therapeutic and placebo effects. The explanation of how these factors influence results is less clear, bift the following are suggested: The primary and direct effect of the healer’s interest in the patient is on reduction of guilt. It is also associated with increased potentials for learning, conditioning, suggestibility, catharsis, and it stimulates other factors which have been correlated with placebo effects. The primary and direct effect of the therapist’s interest in treatment is the mobilization of the patient’s hope and optimism. This factor also has a direct effect on reduction of guilt. The direct effect of interest in results is on nonrandom intentional or nonintentional observer bias. Data are influenced, communicated, distorted, and then used to confirm hypotheses. All of these factors may now interact with the potential specific effects of various therapies. Indirect iatroplacebogenesis is a subtle mechanism that has not been considered in the literature. The physician’s interest may be indirect, subtle, and paradoxical. An interest in a theory and method of treatment, despite disinterest in the patient, may produce placebo effects. This occurs when the patient displaces the interest from the therapy to himself and experiences the physician’s interest in his treatment as a personal one. Thus, placebo effects are produced or augmented when the physician is prestigious, dedicated to his theory and therapy, especially if it is of his own innovation, or if he is a recent convert, and when the therapies are elaborate, detailed, expensive, time-consuming, fashionable, esoteric, and dangerous. Data in support of the concept of direct and indirect iatroplacebogenesis were derived from the history of medicine, psychopharmacology, case histories of patients treated with psychochemotherapy and psychoanalysis, and many clinical and experimental studies and observations about placebo and therapeutic effects. The conclusion was reached that although the placebo effect is a multideterminedphenomenon,iatroplacebogenesismay parsimoniously help explain many observations about therapeut...

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The Symptomatic Relief of Anxiety With Meprobamate, Phenobarbital and Placebo

Cited by 101 publications

References 4 publications

Effects of Acupuncture Treatment on Daily Life Activities and Quality of Life

Effects of Acupuncture Treatment on Daily Life Activities and Quality of Life

The Clinical Inadequacy of the Placebo Model and the Development of an Alternative Conceptual Framework

Iatroplacebogenics

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