Posts Tagged ‘Nocebo’

Suggestible You 6

March 22, 2017

“Suggestible You” is the title of a book by Erik Vance.  The subtitle is “The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.  This post is about the placebo response and related phenomena.   This is the sixth post on this book.

This post is on nocebos.  Remember that placebo is Latin for “I shall please.”  Nocebo means “I shall harm.”  So nocebos can be thought of as negative placebos.

In 1886 a physician named John Mackenzie was treating a woman with a serious case of hay fever and asthma.  For a variety of reasons, he was not convinced that the patient’s condition was fully authentic.  For her next visit he place a rose in his office.  As soon as she sat it she had powerful allergic reaction that brought on an asthma attack.  The flower was artificial and served as the nocebo.

Cholecystokinin (CCK) is a key messenger in activating intestinal functions, including digestion and the release of gastric acid and bile.  It also plays a role in making you feel full after a good meal.  But if you inject CCK into someone, it causes anxiety and nausea and can induce panic attacks.  It also seems to increase pain by lessening the impact of internal opioids.  Fabrizio Benedetti set up an experiment with patients recovering from  minor surgery in which he gave them a drug and told them it would make their pain worse when it was actually just saline.  The patients did report more pain with the saltwater injection.  Then Benedetti blocked their brains’  CCK release with another drug.  Now the patients felt better when the CCK was blocked.  Vance wrote,”What opioids are for placebos is what CCK is for nocebos; a mechanism giving expectation power in the body.  And whereas blocking opioids killed the placebo response and made patients feel worse, blocking CCK actually supercharged pain relief by allow the brain’s internal pharmacy to run wild.”

Nocebo effects are much easier to create than placebo effects.  Negative expectations can be stronger than positive expectations.  Vance note that nocebos and placebos in the brain take two different routes.  They look similar, go to similar places, share some of the same highways, but still are totally different routes, and nocebos take all the best shortcuts.  This does make  sense, as the aversion to pain is fundamental not just to being human, but also to being alive.  Colloca notes that although the nocebo affects the same reward/expectation regions in the brain, it also includes one more that placebos do not:  fear.  The hippocampus plays a key role in the storage of memories and it also plays a key role in fear conditioning anxiety.  Brain imaging indicates that while the hippocampus is mostly absent from placebo effects, it lights up during the experience of nocebos.

Fear is at the heart of nocebos, and fear is a powerful emotion.  Fear headlines in the news elicit much stronger responses that do pleasant ones.  In 2014, even before anyone had died of Ebola in the United States, 25% of Americans were worried they or their families could contract it.  Thousands of people visited doctors claiming they had signs of the virus, and 650 of those people had symptoms serious enough for their cases to be passed on to federal officials.  As it turned out, only four people in the United States had the disease:  a visitor who got it in Liberia, two nurses who had treated him, and a doctor who had been working in an Ebola.

So we need to be careful to not let our fears get out of hand.  And let us hope that doctors make more use of nocebos in treating pain.

The Patient

May 12, 2016

The third cryptomind discussed in “The Mind Club” is the Patient.  The authors expand the concept of patient well beyond the medical context.  “Patients are perceived to have experiences and to be sensitive and susceptible to the actions of others.  Whereas agents are the thinking doers of the world, patients are the vulnerable feelers.  The word patient is likely to bring to mind the concept of pain.  The experience of pain  forces to focus on the present and how to deal with it.”

The authors wrote “Pain may have overwhelming psychological power, but the physical reality is comparatively unsubstantial.  Pain is a mental construction resulting from a handful of nerve signals.  The intensity of pain  stems only from the microscopic electrical pulses of neurons.  Moreover, pain can be triggered by nothing at all as in the case of people with neuropathic pain who live in constant agony due to a few rogue neurons.

Phantom limb pain, although quite real, indicates the fickleness.  This pain is the pain amputees feel in their amputated limb.  Neuroscientist V.S. Ramachanadran developed a special box with a mirror and two holes into which the patients place each of their arms.  The mirror faced the still-presents right hand and its reflection provided he patient with what appeared to be an intact missing limb.  Seeing this illusion significantly reduced the patient’s pain.

The placebo effect provides strong evidence on the mind’s power to influence pain.  Studies of popular drugs such as Tylenol or paracetamol for back pain, and Prozac, Effexor, or Paxil of mild depression suggest that they are no more effective than the combination of sugar pills and optimism.  Previous healthy memory blog posts have reported research in which placebos are effective even when the patients know they are placebos.

As you should know from previous healthy memory blog posts there is also a nocebo effect.  One study  found that people felt real pain after researchers put sham electrodes onto their heads  and pretended to send electric current through them.

Neuroimaging studies suggest that there is both a sensory component and an affective component to pain.  The sensory component represents actual tissue damage.  The affective component is its felt badness, its aversiveness and unpleasantness.  These components can be dissociated.  For example, morphine eliminates the aversive affect while keeping the sensory experience.    A car-accident victim treated with morphine described his experience of traumatic injury as “Pain…but not painful.”  That is the unpleasantness was dulled, but specific sensations remained intact.

In some circumstances tissue damage does not automatically translate to pain even without drugs as has been found in combat situations where soldiers carry on the battle even after having suffered grievous injuries.

Empathy is an important concept and an important skill.  Proximity is an important factor affecting empathy.   The philosopher Peter Singer formulated this thought experiment.  Imagine you are walking by a pond, wearing a new three-hundred dollar suit, when you see a drowning child.  Should you save the child even if doing so would ruin the suit?  You likely wouldn’t hesitate  to dive in.  Now consider a different scenario.  You are walking down he street after payday when a charity canvasser tells you that twenty dollars will save the life of a starving child.  Chances are you would keep your money and let the child die, even though saving the child costs a fraction of the cost of the suit.  Of course, there are factors in the comparison other than proximity.  You can actually see the drowning child, but you might have questions about the honesty of the solicitor.  But you should get the general point.

Our capacity for empathy is limited.  Although some empathy is helpful, too much can be counterproductive causing our empathy to shut down.  Psychologists Daryl Cameron and Keith Payne did an experiment illustrating the “collapse of compassion.”  They presented participants with pleas from either one or eight suffering victims.  In spite of the objectively greater total suffering of eight victims, the participants were overwhelmed by it and demonstrated less compassion.

The authors note how the Patient Mind can be mistreated as the Machine Mind.  Recent advances in neurobiology have focused attention away from human suffering and feelings and toward drugs that influence brain circuits and neurotransmitters..  Thomas Szasz has described this new psychiatry as mechanomorphic, treating patients like “defective machines” rather than fellow human beings.  The authors note “Paradoxically, physicians of the mind may fail to see their patients as members of the mind club.”

Research by Stephanie Brown of the University of Michigan has revealed that helping others can add years to your life.  She examined the mortality of older people who were the pimrary caregivers of their ill spouses.  This is a highly stressful role as caregiver must manage every aspect of their spouses’s treatment and take ultimate responsibility for the spouse’s life.  In spite of stress being linked to early death, these caregivers lived significantly longer, presumably because of increased feelings of agency.

Some time will be given to plants before ending this post.  Taking care of plants can increase longevity.  In one study,m nursing home residents given responsibility  for a houseplant outlived those who had plants that were looked after by nursing home staff.

Types of Placebos

February 25, 2016

When people think of placebos, people tend to think of pills.  Placebos can also be injections, operations, acupuncture, and so forth.  The anthropologist Moerman says that the active ingredient in placebos is meaning.   The meaning of placebo is positive.  However, there are nocebos whose meaning is negative.  Nocebos can be an effective weapon for terrorists.  Were terrorists to spray a gas over an area, people would likely get sick., even if the gas was harmless.  Or they could claim that water had been poisoned and sicknesses would likely result.  There is one theory that adverse side effects of medications are a type of nocebo.

Placebos are available for sale on the internet.  You can even find them at amazon.com.  And given their effectiveness, you might want to try some of these yourself.  Remember that a placebo can work even you know it is a placebo.  There are also ways of making a placebo more effective.  Size, larger being more effective, and number, more being more beneficial, are also effective.  The effects of color are more complicated with different colors being more effective for different outcomes.

This post is based on content from “Cure:  A Journey Into the Science of Mind Over Body” by Jo Marchant,

The Importance of Ikigai

November 2, 2011

Ikigai is a Japanese word roughly translated as “the reason for which we wake up in the morning.” In other words, having a purpose in life. Knowing your purpose in life is important to your well being.1 Many studies have purported to show a link between some aspect of religion and better health. For example, religion has been associated with lower rates of cardiovascular disease, stroke, blood pressure, metabolic disorders, better immune functioning, improved outcomes for infections such as HIV and meningitis, and lower risk of developing cancer. Of course, it was not possible for any of these studies to be Random Controlled Trials (RCTs), where participants were randomly assigned to religious and non-religious groups. So it is possible that there is a strong element of self-selection here.

However, there are other possible reasons for these results. Religious people tend to pursue lower risk lifestyles. Churchgoers typically enjoy strong social support. And, of course, seriously ill people are less likely to attend church. However, there was recent study that tried to statistically control for these factors and concluded that “religiosity/spirituality” does have a protective effect, but only for healthy people.2 Some researchers attribute this to the placebo effect (See the Healthymemory Blog Post, “”Placebo and Nocebo Effects”). Others believe that positive emotions (See the Healthymemory Blog Post, “Optimism”) associated with “spirituality” promote beneficial physiological responses.

Still others think that what really matters is having a sense of purpose in life, whatever it might be. Presumably knowing why we are here and what is important increases our sense of control over events making them less stressful. Remember the study by Saron that was reported in the Healthymemory Blog Post, “The Benefits of Meditation.” The increase in the levels of the enzyme that repairs teleomeres correlated with an increased sense of control and an increased sense of purpose in life. The meditators were doing something they loved and provided a purpose in life.

So, it is important to have a purpose in life when you awaken in the morning. This is important throughout one’s life and is something that needs to be considered before retiring (See the Healthymemory Blog Posts, “The Second Half of Life,” and “Could the AARP Be Telling Us Not to Retire?”).

1Much of this post is based on an article, Know your purpose, by Jo Marchant in the New Scientist, 27 August 2011, p. 35.

2Psychotherapy and Psychosomatics, 78, p.81.

© Douglas Griffith and healthymemory.wordpress.com, 2011. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and healthymemory.wordpress.com with appropriate and specific direction to the original content.

Placebo and Nocebo Effects

October 16, 2011

Although you’ve probably heard of placebo effects, it is less likely that you have heard of nocebo effects. The placebo effect occurs when an inert substance, say a sugar pill or a saline injection, has curative or beneficial effects. The nocebo effect is the opposite; merely believing that a drug has harmful effects can make you suffer them. The nocebo effect can even kill.1

The expression, “It’s only a placebo effect” has almost become a cliché. But the placebo effect is one of the most amazing effects in medicine. It underscores the role that the psychology of the mind plays in healing. No respectable research in medicine can be done without a placebo control. Otherwise the effect of whatever is being tested could be attributed to a placebo effect. Placebo effects are the rule, rather than the exception, and they can be substantial.

What is more remarkable is that placebos work even when the people receiving them know that they are placebos. In one study2 the experimental group was given placebo pills with the open label placebo pills presented as “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in irritable bowel syndrome (IBS) through mind-body self healing processes.” The no treatment control group had the same quality of interaction with the providers, but they were not given the placebo.

The placebo group showed significantly higher scores than the control group on the IBS Global Improvement Scale, the IBS Symptom Severity Scale, and the IBS Adequate Relief Scale.

So the placebo effect cannot be simply the result of deception. Somehow, belief, a psychological variable, affects the body.

1Marchant, J. (2011). Fool Yourself. New Scientist, 27 August, 33.

2Kaptchuk, T.J., Friedlander, E., Kelley, J.M., Sanchez, M.N., Kokkotou, E., Singer, J.P., Kowalczykowski, M., Miller, F.G., Kirsch, I., Lembo, A.J. (2010). Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome. Http://www.plosone.org/article/info/doi:10.1371/journal.pone.0015591