Zusammenfassung
Hintergrund
Placeboeffekte sind bedeutsame, wissenschaftlich messbare, komplexe psychobiologische Veränderungen, die u. a. durch positive Erwartungen an die Wirksamkeit einer Behandlung hervorgerufen werden.
Fragestellung
Nach einer kurzen Übersicht über den Einfluss von Erwartungen auf den Placeboeffekt liegt der Hauptfokus des Beitrags auf den Implikationen für die psychotherapeutische Praxis. Anhand der bisherigen Forschungsergebnisse werden Strategien zur Veränderung dieser Erwartungen im Rahmen der psychotherapeutischen Behandlung skizziert.
Material und Methoden
Die Fragestellung wird in Form eines narrativen Reviews beantwortet.
Ergebnisse
Die Maximierung von Placebo- und die Minimierung von Noceboeffekten durch die Veränderung dahinterliegender Erwartungen sollte Teil einer jeden Behandlung sein. Es existieren verschiedene Strategien zur Veränderung dieser Erwartungen: von der Aufklärung über Placebo- und Noceboeffekte bis hin zur direkten Veränderung von Behandlungserwartungen des Patienten und Behandlers. Diese Strategien werden jeweils mit praxisnahen Beispielen verdeutlicht. Zudem ist eine indirekte Beeinflussung der Erwartungen durch die Gestaltung des Behandlungskontextes und der Patient-Behandler-Interaktion möglich.
Diskussion
Trotz der bislang geringen Studienlage zur Anwendung dieser Strategien in der psychotherapeutischen Praxis zeigen diese in der Placeboforschung und im medizinischen Kontext vielversprechende Ergebnisse. Dennoch muss beachtet werden, dass es auch einige gut angelegte Studien gibt, die keinen Zusammenhang von positiven Erwartungen und Placeboeffekten fanden.
Abstract
Background
Placebo effects are significant, scientifically measurable, complex psychobiological changes caused, among other things, by positive expectations of the effectiveness of a treatment.
Objective
After a brief overview of the influence of expectations on the placebo effect, the article focuses on the implications for psychotherapeutic practice. Based on previous research, strategies for changing patients’ expectations in the context of psychotherapeutic treatment are outlined.
Material and methods
The objective is addressed by means of a narrative review.
Results
Maximizing placebo effects and minimizing nocebo effects by changing the underlying expectations should be part of any treatment. Various strategies exist to change these expectations. Different strategies, ranging from education about placebo and nocebo effects to directly changing treatment expectations of the patient and practitioner, are presented and illustrated with practical examples. In addition, it is possible to indirectly influence these expectations by shaping the treatment context and the patient-practitioner interaction.
Discussion
Despite the small number of studies on the application of these strategies in psychotherapeutic practice, they have shown promising results in placebo research and in the medical context. Nevertheless, it must be noted that there are also some well-designed studies that found no correlation between positive expectations and placebo effects.
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T. Friehs und T. Kube geben an, dass kein Interessenkonflikt besteht.
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Friehs, T., Kube, T. Erwartungen als Kernmechanismus des Placeboeffekts: Implikationen für die psychotherapeutische Praxis. Psychotherapeut 67, 195–203 (2022). https://doi.org/10.1007/s00278-022-00591-0
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DOI: https://doi.org/10.1007/s00278-022-00591-0