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

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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.

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REFERENCES

  • 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.

    PubMed  Google Scholar 

  • Anderson, D. B., and Pennebaker, J. W. (1980). Pain and pleasure: Alternative interpretations for identical stimulation. Eur. J. Soc. Psychol. 10: 207–212.

    Article  Google Scholar 

  • 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 

  • Brody, H. (1980). Placebos and the Philosophy of Medicine, The University of Chicago Press, Chicago.

    Google Scholar 

  • Brody, H., and Brody, D. (2000). The Placebo Response, HarperCollins, New York.

    Google Scholar 

  • Brown, R. J. (2004). Psychological mechanisms of medically unexplained symptoms: An integrative and conceptual model. Psychol. Bull. 130: 793–812.

    Article  PubMed  Google Scholar 

  • Bruner, J. S. (1957). On perceptual readiness. Psychol. Rev. 64: 123–152.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Cioffi, D. (1991). Beyond attentional strategies: A cognitive-perceptual model of somatic interpretation. Psychol. Bull. 109: 25–41.

    Article  PubMed  Google Scholar 

  • Dennett, D. C. (1991). Consciousness Explained, Little, Brown, Boston.

  • 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.

    Article  PubMed  Google Scholar 

  • Ditto, P. H., and Hilton, J. L. (1990). Expectancy processes in health care interaction sequences. J. Soc. Issu. 46: 97–124.

    Google Scholar 

  • Enserink, M. (1999). Can the placebo be the cure? Science 284: 238–240.

    Article  PubMed  Google Scholar 

  • Ernst, E., and Resch, K. L. (1995). Concept of true and perceived placebo effects. Br. J. Med. 311: 551–553.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Fisher, S. (2000). Is there really a placebo effect, professor? Adv. Mind-Body Med. 16: 19–21.

    PubMed  Google Scholar 

  • 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 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Hammersley, R., Finnigan, F., and Millar, K. (1998). Verbal expectancies and performance after alcohol. Addict. Behav. 23: 489–496.

    Article  PubMed  Google Scholar 

  • Harrington, A. (1997). The Placebo Effect: An Interdisciplinary Exploration, Harvard University Press, Cambridge, MA.

    Google Scholar 

  • Higgins, E. T., and Bargh, J. A. (1987). Social cognition and social perception. Annu. Rev. Psychol. 38: 369–425.

    Article  PubMed  Google Scholar 

  • Hróbjartsson, A. (1996). The uncontrollable placebo effect. Eur. J. Clin. Pharmacol. 50: 345–348.

    Article  PubMed  Google Scholar 

  • Jospe, M. (1978). The Placebo Effect in Healing, Lexington books, Lexington, MA.

    Google Scholar 

  • Kahneman, D. (1973). Attention and Effort, Prentice-Hall, Englewood Cliffs, NJ.

    Google Scholar 

  • Kienle, G. S., and Kiene, H. (1997). The powerful placebo: Fact or fiction? J. Clin. Epidemiol. 50: 1311–1318.

    Article  PubMed  Google Scholar 

  • 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 

  • Kirsch, I. (1999). How Expectancies Shape Experience, American Psychological Association, Washington, DC.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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: http://journals.apa.org/prevention/volume1/pre0010002a.html.

  • Kirsch, I., and Weixel, L. J. (1988). Double-blind versus deceptive administration of a placebo. Behav. Neurosci. 102: 319–323.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • Lundh, L. (1987). Placebo, belief, and health: A cognitive-emotional model. Scand. J. Psychol. 28: 128–143.

    Article  PubMed  Google Scholar 

  • McDonald, D., Mazzuca, S., and McCabe, G. P. (1983). How much of the placebo “effect” is really statistical regression?. Stat. Med. 2: 417–427.

    PubMed  Google Scholar 

  • McNair, D. M., Gardos, D. S., Haskell, D. S., and Fisher, S. (1979). Placebo response, placebo effect, and two attributes. Psychopharmacology 63: 245–250.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Moerman, D. (2002). Meaning, Medicine, and the “placebo effect, Cambridge University press, Cambridge, UK.

  • Montgomery, G. H., and Kirsch, I. (1996). Mechanisms of placebo pain reduction: An empirical investigation. Psychol. Sci. 7: 174–176.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Nickerson, R. S. (1998). Confirmation bias: A ubiquitous phenomenon in many guises. Rev. Gen. Psychol. 2: 175–220.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • Pennebaker, J. W., and Skelton, J. A. (1981). Selective monitoring of physical sensations. J. Pers. Soc. Psychol. 41: 213–223.

    Article  PubMed  Google Scholar 

  • Peters, D. (2001). Understanding the Placebo Effect in Complementary Medicine, Harcourt, London, UK.

    Google Scholar 

  • Pincus, T., and Morley, S. (2001). Cognitive-processing bias in chronic pain: A review and integration. Psychol. Bull. 127: 599–617.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Ross, M., and Olson, J. M. (1981). An expectancy-attribution model of the effects of placebos. Psychol. Rev. 88: 408–437.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Shapiro, A. K., and Shapiro, E. (1997). The Powerful Placebo Effect, John Hopkins University Press, Baltimore.

    Google Scholar 

  • Spiro, H. M. (1986). Doctors, Patients, and Placebos, Yale University Press, New Haven, CT.

    Google Scholar 

  • Stewart-Williams, S. (2004). The placebo puzzle: Putting together the pieces. Health Psychol. 23: 198–206.

    Article  PubMed  Google Scholar 

  • Stewart-Williams, S., and Podd, J. (2004). The placebo effect: Dissolving the expectancy versus conditioning debate. Psychol. Bull. 130: 324–340.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Voudouris, N. J., Peck, C. L., and Coleman, G. (1990). The role of conditioning and expectancy in the placebo response. Pain 43: 121–128.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Wegner, D. M., and Guiliano, T. (1980). Arousal-induced attention to the self. J. Pers. Soc. Psychol. 38: 719–726.

    Article  Google Scholar 

  • White, L., Tursky, B., and Schwartz, G. (1985). Placebo: Theory, Research, and Mechanisms, Guilford, New York.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

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ACKNOWLEDGMENT

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

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Correspondence to Andrew L. Geers.

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Geers, A.L., Helfer, S.G., Weiland, P.E. et al. Expectations and Placebo Response: A Laboratory Investigation into the Role of Somatic Focus. J Behav Med 29, 171–178 (2006). https://doi.org/10.1007/s10865-005-9040-5

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