Journal of Behavioral Medicine

, Volume 29, Issue 2, pp 171–178 | Cite as

Expectations and Placebo Response: A Laboratory Investigation into the Role of Somatic Focus

  • Andrew L. GeersEmail author
  • Suzanne G. Helfer
  • Paul E. Weiland
  • Kristin Kosbab

It has been theorized that expectations are an important causal determinant of the placebo effect. Placebo expectations, however, do not always yield placebo effects. In a laboratory study, we tested the hypothesis that one's level of somatic focus moderates the effect of placebo expectations on placebo responding. We also varied whether participants were told the placebo was a drug, could either be a drug or placebo, or was a placebo. The results revealed that individuals who thought they were taking a drug (i.e., unconditional expectations) reported more placebo symptoms when they closely focused on their symptoms. Individuals told they may or may not be receiving a drug (i.e., conditional expectations) did not differ from control participants regardless of how closely they attended to their symptoms. The findings have theoretical implications for expectancy models of the placebo effect as well as for practical research comparing the type of expectations held by individuals in clinical trials and clinical practice.


expectation placebo effect somatic focus 



We would like to thank Amber McLarney, Theresa Triftshouser, and Justin Wellman for their assistance with various aspects of the research.


  1. Ader, R. (2000). True or false: The placebo effect as seen in drug studies is definitive proof that the mind can bring about clinically relevant changes in the body. Adv. Mind-Body Med. 16: 1–11.PubMedGoogle Scholar
  2. Anderson, D. B., and Pennebaker, J. W. (1980). Pain and pleasure: Alternative interpretations for identical stimulation. Eur. J. Soc. Psychol. 10: 207–212.CrossRefGoogle Scholar
  3. Bootzin, R. R. (1985). The role of expectancy in behavior change. In White, L., Tursky, B., and Schwartz, G. E. (Eds.), Placebo: Theory, Research, and Mechanisms, Guilford, New York, pp. 196–210.Google Scholar
  4. Brody, H. (1980). Placebos and the Philosophy of Medicine, The University of Chicago Press, Chicago.Google Scholar
  5. Brody, H., and Brody, D. (2000). The Placebo Response, HarperCollins, New York.Google Scholar
  6. Brown, R. J. (2004). Psychological mechanisms of medically unexplained symptoms: An integrative and conceptual model. Psychol. Bull. 130: 793–812.CrossRefPubMedGoogle Scholar
  7. Bruner, J. S. (1957). On perceptual readiness. Psychol. Rev. 64: 123–152.PubMedCrossRefGoogle Scholar
  8. Caspi, O., and Bootzin, R. R. (2002). Evaluating how placebos produce change: Logical and causal traps and understanding cognitive explanatory mechanisms. Eval. Health Prof. 25: 436–464.CrossRefPubMedGoogle Scholar
  9. Cioffi, D. (1991). Beyond attentional strategies: A cognitive-perceptual model of somatic interpretation. Psychol. Bull. 109: 25–41.CrossRefPubMedGoogle Scholar
  10. Dennett, D. C. (1991). Consciousness Explained, Little, Brown, Boston.Google Scholar
  11. Dinnerstein, A. J., and Halm, J. (1970). Modification of placebo effects by means of drugs: Effects of aspirin and placebos on self-rated moods. J. Abnorm. Psychol. 75: 308–314.PubMedCrossRefGoogle Scholar
  12. Ditto, P. H., and Hilton, J. L. (1990). Expectancy processes in health care interaction sequences. J. Soc. Issu. 46: 97–124.Google Scholar
  13. Enserink, M. (1999). Can the placebo be the cure? Science 284: 238–240.CrossRefPubMedGoogle Scholar
  14. Ernst, E., and Resch, K. L. (1995). Concept of true and perceived placebo effects. Br. J. Med. 311: 551–553.Google Scholar
  15. Fillmore, M., and Vogel-Sprott, M. (1992). Expected effect of caffeine on motor performance predicts the type of response to placebo. Psychopharmacology 106: 209–214.PubMedCrossRefGoogle Scholar
  16. Fisher, S. (2000). Is there really a placebo effect, professor? Adv. Mind-Body Med. 16: 19–21.PubMedGoogle Scholar
  17. Fiske, S. T., and Neuberg, S. L. (1990). A continuum model of impression formation: From category-based to individuating processes: Influences of information and motivation on attention and interpretation. In Zanna, M. P. (Ed.), Advances in Experimental Social Psychology, Vol. 23, Academic, San Diego, CA, pp. 1–74.Google Scholar
  18. Flaten, M. A., Simonsen, T., and Olsen, H. (1999). Drug-related information generates placebo and nocebo responses that modify the drug response. Psychosom. Med. 61: 250–255.PubMedGoogle Scholar
  19. Geers, A. L., Helfer, S. G., Kosbab, K., Weiland, P. E., and Landry, S. J. (2005a). Reconsidering the role of personality in placebo effects: Dispositional optimism, situational expectations, and the placebo response. J. Psychosom. Res. 58: 121–127.CrossRefPubMedGoogle Scholar
  20. Geers, A. L., and Lassiter, G. D. (1999). Affective expectations and information gain: Evidence for assimilation and contrast effects in affective experience. J. Exp. Soc. Psychol. 35: 394–413.CrossRefGoogle Scholar
  21. Geers, A. L., and Lassiter, G. D. (2002). Effects of affective expectations on affective experience: The moderating role of optimism–pessimism. Pers. Soc. Psychol. Bull. 29: 1026–1039.CrossRefGoogle Scholar
  22. Geers, A. L., Weiland, P. E., Kosbab, K., Landry, S., and Helfer, S. G. (2005b). Goal activation, expectations, and the placebo effect. J. Pers. Soc. Psychol. 89: 143–159.CrossRefPubMedGoogle Scholar
  23. Hamilton, D. L., Sherman, S. J., and Ruvolo, C. M. (1990). Stereotype-based expectancies: Effects on information processing and social behavior. J. Soc. Issu. 46: 35–60.CrossRefGoogle Scholar
  24. Hammersley, R., Finnigan, F., and Millar, K. (1998). Verbal expectancies and performance after alcohol. Addict. Behav. 23: 489–496.CrossRefPubMedGoogle Scholar
  25. Harrington, A. (1997). The Placebo Effect: An Interdisciplinary Exploration, Harvard University Press, Cambridge, MA.Google Scholar
  26. Higgins, E. T., and Bargh, J. A. (1987). Social cognition and social perception. Annu. Rev. Psychol. 38: 369–425.CrossRefPubMedGoogle Scholar
  27. Hróbjartsson, A. (1996). The uncontrollable placebo effect. Eur. J. Clin. Pharmacol. 50: 345–348.CrossRefPubMedGoogle Scholar
  28. Jospe, M. (1978). The Placebo Effect in Healing, Lexington books, Lexington, MA.Google Scholar
  29. Kahneman, D. (1973). Attention and Effort, Prentice-Hall, Englewood Cliffs, NJ.Google Scholar
  30. Kienle, G. S., and Kiene, H. (1997). The powerful placebo: Fact or fiction? J. Clin. Epidemiol. 50: 1311–1318.CrossRefPubMedGoogle Scholar
  31. Kirsch, I. (1997). Specifying nonspecifics: Psychological mechanisms of placebo effects. In Harrington, A. (Ed.), The Placebo Effect: An Interdisciplinary Exploration, Harvard University Press, Cambridge, MA, pp. 166—186.Google Scholar
  32. Kirsch, I. (1999). How Expectancies Shape Experience, American Psychological Association, Washington, DC.Google Scholar
  33. Kirsch, I., and Rosadino, M. J. (1993). Do double-blind studies with informed consent yield externally valid results? An empirical test. Psychopharmacology 110: 437–442.CrossRefPubMedGoogle Scholar
  34. Kirsch, I., and Sapirstein, G. (1998). Listening to Prozac but hearing placebo: A meta-analysis of antidepressant medication. Prev. Treat. [cited 2002 Apr 1];1, Article 0002a. Available from:
  35. Kirsch, I., and Weixel, L. J. (1988). Double-blind versus deceptive administration of a placebo. Behav. Neurosci. 102: 319–323.CrossRefPubMedGoogle Scholar
  36. Klaaren, K. J., Hodges, S. D., and Wilson, T. D. (1994). The role of affective expectations in subjective experience and decision-making. Soc. Cogn. 12: 77–101.Google Scholar
  37. Lasagna, L., Mostellar, F., von Felsinger, J. M., and Beecher, H. K. (1954). A study of the placebo response. Am. J. Med. 16: 770–779.CrossRefPubMedGoogle Scholar
  38. Lundh, L. (1987). Placebo, belief, and health: A cognitive-emotional model. Scand. J. Psychol. 28: 128–143.PubMedCrossRefGoogle Scholar
  39. McDonald, D., Mazzuca, S., and McCabe, G. P. (1983). How much of the placebo “effect” is really statistical regression?. Stat. Med. 2: 417–427.PubMedGoogle Scholar
  40. McNair, D. M., Gardos, D. S., Haskell, D. S., and Fisher, S. (1979). Placebo response, placebo effect, and two attributes. Psychopharmacology 63: 245–250.CrossRefPubMedGoogle Scholar
  41. Medvedev, V. I., Zavyalova, E. K., Ovchinnikov, B. V., and Posokhova, S. T. (1984). Functional structure of the placebo response. Hum. Physiol. 10: 216–221.PubMedGoogle Scholar
  42. Mitchell, S. H., Laurent, C. L., and deWit, H. (1996). Interaction of expectancy and the pharmacological effects of d-amphetamine: Subjective effects and self-administration. Psychopharmacology 125: 371–378.CrossRefPubMedGoogle Scholar
  43. Moerman, D. (2002). Meaning, Medicine, and the “placebo effect, Cambridge University press, Cambridge, UK.Google Scholar
  44. Montgomery, G. H., and Kirsch, I. (1996). Mechanisms of placebo pain reduction: An empirical investigation. Psychol. Sci. 7: 174–176.CrossRefGoogle Scholar
  45. Nash, J. M., Holroyd, K. A., Rokicki, L. A., Kvaal, S., and Penzien, D. B. (2002). The influence of placebo awareness on stimulant drug response in a double-blind trial. Psychpharmacology 161: 213–221.CrossRefGoogle Scholar
  46. Nickerson, R. S. (1998). Confirmation bias: A ubiquitous phenomenon in many guises. Rev. Gen. Psychol. 2: 175–220.CrossRefGoogle Scholar
  47. Olson, J. M., Roese, N. J., and Zanna, M. P. (1996). Expectancies. In Higgins, E. T., and Kruglanski, A. W. (Eds.), Social Psychology: Handbook of Basic Principles, Guilford , New York, pp. 211–238.Google Scholar
  48. Orne, M. T. (1962). On the social psychology of the psychological experiment, with particular reference to demand characteristics and their implications. Am. Psychol. 17: 776–783.CrossRefGoogle Scholar
  49. Pennebaker, J. W., and Skelton, J. A. (1981). Selective monitoring of physical sensations. J. Pers. Soc. Psychol. 41: 213–223.CrossRefPubMedGoogle Scholar
  50. Peters, D. (2001). Understanding the Placebo Effect in Complementary Medicine, Harcourt, London, UK.Google Scholar
  51. Pincus, T., and Morley, S. (2001). Cognitive-processing bias in chronic pain: A review and integration. Psychol. Bull. 127: 599–617.CrossRefPubMedGoogle Scholar
  52. Pollo, A., Amanzio, M., Arslanian, A., Casadio, C., Maggi, G., and Benedetti, F. (2001). Response expectancies in placebo analgesia and their clinical relevance. Pain 93: 77–84.CrossRefPubMedGoogle Scholar
  53. Ross, M., and Olson, J. M. (1981). An expectancy-attribution model of the effects of placebos. Psychol. Rev. 88: 408–437.CrossRefPubMedGoogle Scholar
  54. Shapiro, A. K., Mike, V., Barten, H., and Shapiro, E. (1973). Study of the placebo effect with a self-administered placebo test. Compr. Psychiatry 14: 535–548.CrossRefPubMedGoogle Scholar
  55. Shapiro, A. K., and Shapiro, E. (1997). The Powerful Placebo Effect, John Hopkins University Press, Baltimore.Google Scholar
  56. Spiro, H. M. (1986). Doctors, Patients, and Placebos, Yale University Press, New Haven, CT.Google Scholar
  57. Stewart-Williams, S. (2004). The placebo puzzle: Putting together the pieces. Health Psychol. 23: 198–206.CrossRefPubMedGoogle Scholar
  58. Stewart-Williams, S., and Podd, J. (2004). The placebo effect: Dissolving the expectancy versus conditioning debate. Psychol. Bull. 130: 324–340.CrossRefPubMedGoogle Scholar
  59. Vase, L., Riley, J. L., and Price, D. D. (2002). A comparison of placebo effects in clinical analgesic trials versus studies of placebo analgesia. Pain 99: 443–452.CrossRefPubMedGoogle Scholar
  60. Voudouris, N. J., Peck, C. L., and Coleman, G. (1990). The role of conditioning and expectancy in the placebo response. Pain 43: 121–128.CrossRefPubMedGoogle Scholar
  61. Walach, H., Schmidt, S., Dirhold, T., and Nosch, S. (2002). The effects of a caffeine placebo and suggestion on blood pressure, heart rate, well-being, and cognitive performance. Int. J. Psychophysiol. 43: 247–260.CrossRefPubMedGoogle Scholar
  62. Wegner, D. M., and Guiliano, T. (1980). Arousal-induced attention to the self. J. Pers. Soc. Psychol. 38: 719–726.CrossRefGoogle Scholar
  63. White, L., Tursky, B., and Schwartz, G. (1985). Placebo: Theory, Research, and Mechanisms, Guilford, New York.Google Scholar
  64. Wilson, T. D., Lisle, D. J., Kraft, D., and Wetzel, C. G. (1989). Preferences as expectation-driven inferences: Effects of affective expectations on affective experiences. J. Pers. Soc. Psychol. 56: 519–530.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Andrew L. Geers
    • 1
    • 3
    Email author
  • Suzanne G. Helfer
    • 2
  • Paul E. Weiland
    • 1
  • Kristin Kosbab
    • 1
  1. 1.University of ToledoToledoUSA
  2. 2.Adrian CollegeBostonUSA
  3. 3.Department of PsychologyUniversity of ToledoToledoUSA

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