3 min read
I have a thought experiment for you. Imagine the place in your body where you feel the most pain. Maybe it’s an aching lower back, a pounding headache, or tightness in your chest from stress and worry.
. . . placebos can elicit a number of brain responses, including increased production of endorphins (which help reduce pain) and greater activity in brain regions responsible for emotion and evaluation.
-Dr. Jason Holland, Lifespark
Now, imagine that I gave you a bottle of pills labeled “placebo” and told you that if you took one every day, it could substantially reduce your pain and distress similar to a prescription painkiller or antidepressant. Would you believe me?
In a 2014 study conducted across several Harvard-affiliated hospitals by Ted Kaptchuk and his colleagues, the researchers did just that — prescribed placebos that were explicitly labeled as such to 66 migraine sufferers. They found that even when people knew they were taking an inert sugar pill, the placebo was still about 50% as effective as an active migraine medication. This finding challenges a long-standing assumption about the placebo effect — that it must involve deceiving people that they are taking “real” medications for it to work.
Other recent research on placebos, with patients suffering from a range of maladies (e.g., irritable bowel syndrome, chronic pain, and depression), suggests that their effects are real and represent genuine changes that can be measured in the brain.
For example, studies have found that placebos can elicit a number of brain responses, including increased production of endorphins (which help reduce pain) and greater activity in brain regions responsible for emotion and evaluation.
As Tor Wager, a neuroscientist and placebo researcher at the University of Colorado-Boulder, explained in an article published in Nature last year, “We think the placebo is causing a re-evaluation of the pain…It doesn’t mean the same thing to you.”
However, the placebo effect does not appear to be as simple as just deciding to feel better.
Instead, contemporary understandings of placebos acknowledge that their effects involve a complex interplay between a number of factors.
These factors include one’s expectation of improvement, the quality of the relationship with their provider, and the extent to which the healing ritual (e.g., taking a pill, sitting with a therapist, or undergoing surgery) is perceived as credible and consistent with one’s cultural understanding of illness.
The placebo effect also appears to be strongest for outcomes that involve some element of subjectivity, like depression, anxiety, or pain. It comes as no surprise then that placebo psychotherapy (e.g., sitting with a supportive therapist who is not delivering a bona fide treatment) and sugar pills masked as antidepressants produce results that are nearly as effective as active treatments. For example, in a 2002 review of antidepressant data submitted to the U.S. Food and Drug Administration, “Approximately 80% of the response to medication was duplicated in placebo control groups.”
So, how do we harness the power of the placebo effect to our advantage and teach the mind to unleash its healing powers? The scientific community is still working on that one, but for now Kaptchuk offers this tip in a recent piece published in Harvard Health: “Engaging in the ritual of healthy living — eating right, exercising, yoga, quality social time, meditating — probably provides some of the key ingredients of a placebo effect.”
If you’d like to take this a step further, try it yourself as an exercise. Come back to the pain that you identified at the beginning of this piece. Ask yourself, what would it take to change my relationship with the pain that I am feeling? What kinds of rituals or routines would make me feel better? And how might my own attitudes and beliefs about the pain be getting in the way?
Use these insights to develop a wellness plan for yourself. If you’re struggling to come up with ideas, try out this resource for developing a personalized Wellness Toolbox. And as always, let us know how it goes.
Baskin, T. W., Tierney, S. C., Minami, T., & Wampold, B. E. (2003). Establishing specificity in psychotherapy: A meta-analysis of structural equivalence of placebo controls. Journal of Consulting and Clinical Psychology, 71, 973-979.
Kam-Hansen, S., Jakubowski, M., Kelley, J. M., Kirsch, I., Hoaglin, D. C., Kaptchuk, T. J., & Burstein, R. (2014). Altered placebo and drug labeling changes the outcome of episodic migraine attacks. Science Translational Medicine, 6, 218ra5-218ra5.
Kaptchuk, T. J., Kelley, J. M., Conboy, L. A., Davis, R. B., Kerr, C. E., Jacobson, E. E., … & Park, M. (2008). Components of placebo effect: Randomised controlled trial in patients with irritable bowel syndrome. BMJ, 336, 999-1003.
Kirsch, I., Moore, T. J., Scoboria, A., & Nicholls, S. S. (2002). The emperor’s new drugs: An analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration. Prevention & Treatment, 5, Article ID 23.
Patel, S. M., Stason, W. B., Legedza, A., Ock, S. M., Kaptchuk, T. J., Conboy, L., … & Kerr, C. E. (2005). The placebo effect in irritable bowel syndrome trials: A meta‐analysis. Neurogastroenterology & Motility, 17, 332-340.
Wampold, B. E., Minami, T., Tierney, S. C., Baskin, T. W., & Bhati, K. S. (2005). The placebo is powerful: Estimating placebo effects in medicine and psychotherapy from randomized clinical trials. Journal of Clinical Psychology, 61, 835-854.
Wechsler, M. E., Kelley, J. M., Boyd, I. O., Dutile, S., Marigowda, G., Kirsch, I., … & Kaptchuk, T. J. (2011). Active albuterol or placebo, sham acupuncture, or no intervention in asthma. New England Journal of Medicine, 365, 119-126.