The placebo effect is defined as the “beneficial effect produced by a placebo drug or treatment, which cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient’s belief in that treatment.”
Scientists in clinical studies go through a lot of effort to reduce the placebo effect because it can negatively effect their results. The placebo effect is a drug company’s nightmare. When testing a particular treatment or drug, researchers usually split participants into two groups. One group receives the active drug or real treatment and the other group receives a placebo drug or placebo treatment that has no active ingredients or effects.
The reason for the placebo group is to allow scientists to be able to establish a cause and effect relationship between a particular drug or treatment and certain outcomes.
If there was no placebo groups in research studies the scientists would be unable to know if the positive outcome of a drug/treatment was actually due to the drug/treatment or the patients belief that the treatment/drug will work.
Although we spend a lot of time trying to control the placebo effect, the fact we know it exists and is a real thing, means that it can be harnessed as a powerful tool in healing. The use of randomised control trials detracted us away from appreciating the power of the mind in health. We are so focused on finding if one drug/treatment has a direct effect on another variable, that we lose sight about the healing potential of the placebo effect.
The need for causative relationships to be drawn between drugs and certain outcomes is certainly needed, however we cannot discourage the importance of the placebo effect in healing.
The fact that a placebo effect exists demonstrates the power of our beliefs, mindset and thoughts, over our physical physiology and health.
Examples of the placebo effect.
A great example is anti-depressants. They have been shown to be no more effective than placebo in the treatment of depression. This means that placebo pills are just as effective as anti-depressants for treating depression without the side effects. This also means that anti-depressants are likely to work in some cases because the patient believes it will work (influenced by the media and doctors), rather than the drug actually having physiological effects that relieve the symptoms of depression.
Another example is Valium, which is widely prescribed for anxiety disorders, seems to have no effect unless patients know that they are taking it for their anxiety.
Lastly, my favourite example of the power of the placebo effect was the sham knee surgery study. This study took patients who all needed a knee replacement surgery. They split the participants into two groups where one group received an actual knee replacement, and the other group was the placebo group. The placebo group went through the whole surgery routine where the surgeon opened up the knee and made an incision, however, he sprayed it with some water, then closed it back up. The patients in the placebo group who didn’t get the actual knee surgery improved just as much as in the group who did receive the proper surgery. To me, that is absolutely amazing!
The placebo effect is not just in the patients mind.
We used to think that the placebo effect was all in the patient’s mind, so there weren’t any measurable effects associated with it. It was just the patient believing that they were better. However, there have been a bunch of studies that have shown there are actually measurable biochemical effects that can be elicited by taking placebo, which are similar to the biochemical effects of the active drug/treatment.
An example is where patients given placebo painkillers can trigger a release of endorphins in the brain, which are natural pain-relieving chemicals that opioid drugs like morphine, are designed to mimic. Therefore the reduction in the patient’s pain after taking the placebo painkiller was caused by a similar physical change that would occur if they took the actual drug. So it is not all in their mind.
These studies that show physiological changes as a result of taking a placebo, which are similar to the active drug, only seem to occur if the active drug has been taken previously for that particular condition. Therefore a learned association occurs between a particular drug and a condition.
For example, if you’ve taken a drug in the past for a particular condition, that has a particular physical effect on your body, your body learns that response, so that in the future if you take a placebo with the intention of treating that same condition in which you used the drug for, it may trigger the same response, but it won’t happen if you just took a placebo for the first time.
This effect can be harnessed in trying to reduce dosages of drugs that carry some very negative and toxic side effects. For example, once the body has a learned response to a drug, we could potentially decrease the dose of the active drug in order to minimize side effects and toxicity. A doctor could even tell the patient that this is going to occur because studies have also indicated that the placebo is still effective even when the patients know they are taking a placebo, which opens the door for placebo to be used ethically. This is largely due to the mechanisms described above. If the patient knows they are taking a placebo for a given condition that they used to take an active drug for, therefore when the placebo is ingested, the brain mimics the effects of what the active drug used to do as the ritual of taking a pill for a given condition has conditioned the brain.
The power of the therapeutic relationship.
There are also many studies that look at the power of a practitioner-client relationship in healing. This is similar to the placebo effect because it demonstrates how the power of a good therapeutic relationship can have very positive effects on the patients healing, beyond the actual treatments of what the patient is receiving.
In naturopathic school we are taught very early on about the importance of establishing a good relationship with your patients where there is trust and the patient feels heard. It is important that the patient feels like they have a collaborative relationship with the practitioner.
If there is trust and a good rapport between the patient and practitioner it increases the chances of the patient feeling better. A good therapeutic relationship can enhance the effects of treatments. This means that for a client, it is important to find a good practitioner that you trust, who is empathetic and that you bond with.
A great example of how the therapeutic relationship can enhance patient outcomes was a trial done on IBS patients. The patients were divided into three groups. The first group received no treatment, the second group received fake acupuncture from a polite but cold practitioner, and the third group received fake acupuncture from a warm, caring practitioner who sat with them throughout the treatment. 28% of the group that didn’t receive any treatment got adequate relief from their symptoms. 44% of those that received fake acupuncture alone got adequate relief. But in the group that received both fake acupuncture and empathic care, 62% achieved “adequate relief.”
I do feel like the modern medical model is built around the doctor being the expert who tells the patient what to do, rather that the patient and practitioner working together in a collaborative relationship to achieve the goal of helping the patient get healthier.
We tend to think that a treatment involves finding the right drug (or other interventions) for the right symptoms or condition, with little focus on how the treatment is delivered to the patient. However, we know that the therapeutic relationship and the way in which a treatment is administered has a lot to do with its healing capacity.
The placebo effect also helps us understand the importance of a positive mindset especially when we are unhealthy. Really believing in our treatments and putting faith in them can go a long way. We sometimes underestimate the bodies amazing ability to heal itself and that under the right conditions, the body will always tend towards good health.
All of this suggests that the effects of an intervention—whether it is pharmaceutical, herbal, dietary, or something else—depend in large part on our thoughts, feelings, and beliefs about that intervention.
What about the nocebo effect?
What is a nocebo effect? Well, it is essentially the opposite of the placebo effect. It is the idea that our beliefs and mindset can also have a negative effect on our health.
Examples of the nocebo effect are clearly demonstrated in the Framingham Heart Study, which is the longest running study on heart disease that’s been done so far. Women who believed that they were prone to heart disease were nearly four times as likely to die as women with similar risk factors who didn’t hold the same views.
Furthermore, we often see people suffering from side effects of pharmaceutical drugs if they are told about the side effects. So maybe you shouldn’t read the side effects on the side of a drug packaging and maybe practitioners should be careful about the way they word their informed consent about a particular drug.
Another great example of the nocebo effect was a study that happened in Japan, where researchers took 57 high school boys and tested them for their sensitivity to poison ivy trees. The boys who reported having severe reactions to this tree were blindfolded, and then the researchers brushed one arm with leaves from a poison ivy tree, but they told the boys that they were chestnut tree leaves. And then they stroked the other arm with chestnut tree leaves, but they said that that foliage actually came from a poison ivy tree. And within minutes, the arm that the boys believed to have been exposed to the poison ivy tree began to break out in a rash, even though it was the chestnut tree. In most cases, the arm that had contact with the actual poison ivy tree did not react.
So what does this all mean?
Well, for a practitioner like me, it highlights the importance of developing good relationships with my clients and delivering my treatments in very specific ways in order to maximize clinical outcomes. If a client is resistant to getting a certain treatment, it should be my goal to try and find ways to get the client actively involved with their treatment and help them believe that it will work. There is no point giving a treatment if the client is opposed to it, even though biochemically I know it should work.
It will not be enough to just give a treatment for a certain condition, based on what I know about the mechanisms of that treatment.
Therefore, if you have a health issue, find practitioners who are collaborative in their approach with you. Meaning they are willing to work together with you in a collaborative manner to help you get healthier. They make their treatment plans easy to follow and so that it fits into your life. Find a practitioner that you respect, trust and feel a bond with.
Also, if you are given a treatment, make a ritual out of it. Do the treatment at the same time under the same conditions if possible. Imagine how the treatment will work for your certain condition and what improvements you want to see. We need to take an active role in our own health, not just blindly take a prescription and carry on.
The placebo and nocebo effect shows how our mindset thoughts, feelings, and beliefs has a huge effect over our health and can cause physiological changes. The body has an innate, powerful ability to heal itself in the right conditions. This is why stress reduction and having a balanced/positive mindset/self talk in life is so important for health. Therefore, going to see a psychologist and finding other means to look after your mental health could be a huge part of a healing process. Changing your mindset not only towards your health, but also towards all aspects of your life in general, could be a huge factor in keeping you healthy and happy.