The Placebo Effect — A Love Story
Hope and expectation are powerful psychological forces. For this reason, we often use them as a baseline against which to test the efficacy of new medical treatments. This baseline is referred to as the placebo control, and has been relevant in medicine for several centuries. We know that some drugs will cure our problems purely because we anticipate that they will. So when we test whether medical innovations are a success, we want to know that they will do a better job than a chemically useless but psychologically convincing sugar pill.
Inert treatments may be more powerful than you think. When patients with Parkinson’s disease receive a placebo drug, their brains release additional dopamine and activate one of the primary systems damaged by the disorder. Patients with irritable bowel syndrome benefit from placebo acupuncture, but benefit even more from placebo acupuncture combined with a warm, attentive, and confident practitioner. The colors of placebo pills also affect our expectations: red, orange, and yellow drugs are perceived to be stimulating, while blue and green drugs are associated with calming effects.
These studies, and many others, demonstrate that the placebo effect is not just powerful, it is multidimensional. Benefits emerge from several directions, and some placebos are more effective than others, even though they are equally inert in their chemical contents. We may even be able to layer different types of placebo together to build a super-placebo.
To call the benefits of placebo treatments “fake” would be to do them a disservice. The point is that both our psychology and physiology can be agreeable subjects for treatment (of course, they are both technically the products of biological processes). Active drugs directly manipulate the mechanics of tissues in our body, and consequently improve our mental states. Psychological treatments manipulate the contents of our minds, and consequently improve the mechanics of our bodily tissues. Both routes — typically described as bottom-up and top-down processes — can be practical and effective.
Placebo effects are usually studied in the context of medical treatments and symptom outcomes. A study published in the middle of 2018 took a different approach, by asking whether the placebo effect could increase our prosocial behavior.
Participants in this 2018 study were told about the social benefits of an oxytocin hormone drug, and were then given a nasal spray that they believed was oxytocin, but was in fact an inert saline solution. Despite never receiving actual oxytocin, would the participants still demonstrate the enhanced social behaviors that they were taught?
The first test of social behavior was a trust game. In this game, participants could give some money to a second person, knowing that the second person would then receive triple that amount of money before deciding how much of that final total to return to the trusting participant. If the investing participants had faith in the trustee, they would presumably invest all of their money, in anticipation of a larger return than their investment. If they believed the trustee was greedy and would keep the money, they would risk less of their own cash.
Compared to a control condition with no spray at all, the placebo spray participants invested significantly more money with the trustee. The saline spray made them more trusting. And it did far more too. While high on the inert drug, male participants were more comfortable interacting with a female experimenter who stood a little too close to them (at least if the participants were single), and they perceived less anxiety in the experimenter during eye contact.
In explaining the benefits of placebo treatments, the point of this article is certainly not to support fishy therapies or snake oils. Quite the contrary. I hope it’s a warning signal about the dangers of believing too strongly in the value of particular products or substances that we may have bought into. It’s worthwhile to realize when we are helping ourselves and no longer need to rely on the promises of expensive supplements to our lives.
If the placebo effect proves anything, it’s that we should never underestimate the influence that we have on our own health and wellness, purely through the way we think and decisions we make. Perhaps we can harness the psychological effects of placebos without the need to believe other people’s deceptions.
For many medical problems, we have amazing treatments available to us that perform significantly better than placebo, and we trust our doctors to prescribe those to us. But for many other everyday issues, our levels of self-efficacy — our confidence in our own abilities and successes — may be the biggest hurdle standing in our way.
Belief can have a dramatic impact on the existing health activities in our lives, like regular physical exercise. In a study of 84 hotel cleaners, some were told that their work satisfied a doctor’s physical activity recommendations for a healthy lifestyle, while others in a control group were told nothing about their work in relation to good exercise. A month later, the informed cleaners perceived that they were exercising more, and showed healthier reductions in body fat and blood pressure than the control group.
The placebo effect won’t help us fly, but it may help us with many of the typical problems we suffer in daily life. During our moments of anxiety, sadness, lethargy, and listlessness, we can be our own hero by pushing ourselves into the right mindset. Optimistic self-belief is a tailwind rather than a headwind; it can give us the favorable momentum we need to overcome seemingly intractable challenges. Eventually, we may even be strong enough to throw out the sugar pills.