Hi Reader,
The placebo response is often thought of as something that was ‘all in your head.’ In research and medical communities, it has been treated as an inconvenience in part because a specific mechanism that causes the placebo response has not been identified and because it is not understood. Much like the human energy system, because the current science does not understand the process, it must not be real. And we all know that isn’t true.
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Another barrier is the use of deceit in using placebos, whether as a control in research or when a physician has run out of options. The use of deceit has decreased the credibility of the placebo response. With current technological advances, we can non-intrusively measure brain activity, monitor neurochemical responses, and track genetic expression giving us a glimpse inside the workings of the mechanisms of placebos. Proving conclusively it is not an imagined response.
Many studies show that when a placebo is introduced, there are psychophysiological changes in the autonomic nervous system, activation of the neuroendocrine cascade, and neurobiological brain changes in the prefrontal cortex, insula, and nucleus acumens. This is not an imagined response but an actual measurable physical response.
The three components that make up the placebo response are the neurophysiological, psychological, and treatment.
Psychological Component
The psychological component includes memories, expectancy, and evaluation of treatment. It’s triggered by verbal cues, social cues, and environmental cues, which in turn activates the prefrontal cortex, which triggers the autonomic nervous system and the neuroendocrine system, producing emotional responses, memory activation, various levels of motivation, and expectancy states- what we think is likely to happen.
Each of us creates neural pathways based on the experiences we have. When the placebo response is activated, these unique neural pathways make the process specific to us. Think of a time when you got an upset stomach and then stayed away from the food you ate prior to, whether or not it was the cause of the upset stomach. Your brain links your upset stomach to the food item. This happens regularly on the conscious and subconscious levels.
Treatment Component
The treatment component is made up of the delivery aspects of the placebo, including how the placebo is given, oral, injection, etc., and the relationship of the patient with their healer/healthcare provider. The manner information is relayed affects the placebo response: an optimistic, positive, encouraging delivery of information is directly related to higher symptomology relief. It makes sense that if a healer is friendly, kind, encouraging, and approachable, we feel a sense of being cared for. The manner in which the placebo is administered is another significant factor in the treatment component. I have found with clients receiving distance healing, if they are instructed to participate by sitting quietly in a receiving state, the response is stronger than in those that are not actively participating. This was replicated in three separate research projects.
Neurophysiological Component
The response of the brain and the neurochemical mechanisms that take place in the body makes up the neurophysiological component. The neurophysiological responses can be assessed with functional magnetic resonance imaging (fMRI) and positron emission tomography (PET). These technologies allow researchers to see what is being activated in the brain during placebo use with minimal invasiveness. Research identifies the following areas in the brain; the anterior cingulate cortex, thalamus, insula, amygdala, and dorsolateral prefrontal cortex as being to be active during the placebo response. This map of brain activity is now being used to identify patterns to recognize a person’s susceptibility to the placebo response. Early research indicates that those more responsive to placebo treatment show increased electromagnetic activity in the limbic and paralimbic regions, diminished activity in the insula, and amplified activity in the dorsolateral prefrontal cortex. Admittedly these findings are early responses; they do hold promise in formulating a personalized approach to using placebo response in active medical treatment.
Placebo Response in Action
Each component moves from one to the next in a similar pattern. The initiation of the placebo response begins with the introduction of treatment. The response is heightened or reduced by the interaction with the healer/healthcare provider and the way the placebo is administered. The person’s beliefs, values, and history have the ability to impact the response. Some of the elements that strongly affect the response at this point are the expectations of the patient – “Does this treatment seem to be an effective one for me?”, the trust level the patient has with the healer/healthcare provider- “Do I believe this person is knowledgeable and trustworthy?”, and the social cues – “Are my family and friends in agreements, is this something my community agrees with?” that the patient is receiving.
Our understanding of the placebo response in its infancy, with technology allowing for a glimpse into the mechanisms that are triggered in the brain in response to treatments, and our ability to understand the scope and mechanism of placebo response is increasing. What was once regarded as an annoyance could conceivably become an effective and economical treatment, in what I believe is a centralized healing response that each of us innately has.
Placebo Research
There is evidence that the placebo effect can improve symptoms on average 35%. Research on the open use of placebos showed that when participants were educated on the mechanism of the placebo response in plain everyday language that, the participant could relate to, showed no decrease in symptom relief. This result challenges the assumption that deceit is needed for effective placebo use.
This is the research that had me investigating the use of placebos more thoroughly. Colaguri et al. (2015) reported an experimental knee surgery study where the placebo response was effective in alleviating joint pain for two years. The placebo group received only a minor incision but no surgery, and the results were on par with the group that actually had knee surgery.
What Does This Mean For You?
When looking at options for treatment, lean into your gut feeling. It matters. Becoming aware of your values, beliefs, and the social cues you’re receiving can influence the efficacy of treatment.
Seek out healers/healthcare practitioners that treat you with dignity and respect, it’s worth the effort, and you will see an improved response to treatments. Providers who treat their patients as whole self–determining beings with valuable insight into their own health and well-being can foster a powerful healing environment.
Tune in to your body and listen to what it’s telling you. Collaborating with a practitioner differs from allowing a practitioner to dictate what is right or wrong for your unique body. Test simple measures and build trust in your ability to notice the changes in your body, mind, and energy field.
The ‘how’ of the placebo response is in the early stages of being understood. What was once considered a nuisance in medical research has become a strong influence and has provided insight into components of health and well-being that have been previously unknown. As we better understand the physiological functioning of the placebo response, we can begin to develop methods to activate it consciously.
Be Well,
Cathy
References
Colagiuri, B., Schenk, L., Kessler, M., Dorsey, S., & Colloca, L. (2015). Neuroscience forefront review: The placebo effect: from concepts to genes. Neuroscience, 307171-190. doi:10.1016/j.neuroscience.2015.08.017
Colloca, L., & Benedetti, F. (2016). Placebo and nocebo effects: Unfolding the complex interplay between distinct phenotypes and physiological mechanisms. Psychology Of Consciousness: Theory, Research, And Practice, 3(2), 162-174. doi:10.1037/cns0000054
Enck, P., Klosterhalfen, S., & Weimer, K. (2016). Unsolved, forgotten, and ignored features of the placebo Rresponse in medicine. Clinical Therapeutics, doi:10.1016/j.clinthera.2016.11.016
Faasse, K., Grey, A., Jordan, R., Garland, S., & Petrie, K. J. (2015). Seeing is believing: Impact of social modeling on placebo and nocebo responding. Health Psychology, 34(8), 880-885. Doi:10.1037
Haug, M. (2011). Explaining the placebo effect: Aliefs, beliefs, and conditioning. Philosophical Psychology, 24(5), 679-698. doi:10.1080/09515089.2011.559624
Jubb, J., & Bensing, J. M. (2013). Review: The sweetest pill to swallow: How patient neurobiology can be harnessed to maximise placebo effects. Neuroscience And Biobehavioral Reviews, 37(Part 2), 2709-2720. doi:10.1016/j.neubiorev.2013.09.006
Kisaalita, N. R., Hurley, R. W., Staud, R., & Robinson, M. E. (2016). Placebo use in pain management: A mechanism-based educational intervention enhances placebo treatment acceptability. Journal of Pain, 17257-269. doi:10.1016/j.jpain.2015.10.017
Klarić, M., Mandić, V., Lovrić, S., Ćorić, M. K., & Zovko, N. (2017). Placebo and nocebo effects and their significance in clinical practice. Medicinski Glasnik, 14(1), 16-24. doi:10.17392/892-16
Schafer, S. M., Colloca, L., & Wager, T. D. (2015). Original Report: Conditioned Placebo Analgesia Persists When Subjects Know They Are Receiving a Placebo. Journal Of Pain, 16412-420. doi:10.1016/j.jpain.2014.12.008
Schwarz, K. A., Pfister, R., & Büchel, C. (2016). Review: Rethinking Explicit Expectations: Connecting Placebos, Social Cognition, and Contextual Perception. Trends In Cognitive Sciences, 20469-480. doi:10.1016/j.tics.2016.04.001
Wager, T. D., & Atlas, L. Y. (2015). The neuroscience of placebo effects: connecting context, learning and health. Nature Reviews Neuroscience, 16(7), 403-418. doi:10.1038/nrn3976