July 19, 2016
A recent article in The Wall Street Journal summarizes some of the explanations about how we think placebos work. If you read an earlier blog post I wrote about placebos, what I find so fascinating about all this is that even when subjects/patients are told they are receiving a placebo (either in the form of a sub-therapeutic dosage of a real medication or just a sugar pill), they often still show the suggested effects of that “treatment.” If people expect something to happen when they take a pill, it often does. For example, this self-confirming bias occurs with medication side effects: you read that horrible insert from the pharmacist that lists every possible side effect that has been reported for the drug and sure enough you start to experience some of the effects… right away, before it’s really physiologically possible for the medication to have caused them.
Though some of my colleagues may not like this, I’d imagine that a nice chunk of what happens in psychotherapy is related to the placebo effect. We might call it a safe holding environment, positive future orientation or something like that, but the fact of the matter is that when a patient comes into therapy expecting a positive outcome, they typically experience that. (Similarly, when patients initiate treatment with negative expectations, they often don’t get much from treatment.) Clearly, a difference between psychotherapy and placebo is that actual treatment is being provided with psychotherapy, but patient expectation, therapist suggestions and patient suggestibility all play a significant role in therapy and should not be underestimated.
October 20, 2011
The CDC just put out a report about Americans’ use of antidepressants. The paper has already gotten a bunch of press (Washington Post, CNN, Reuters to name a few). Some of the key bullet points of the paper are:
- Eleven percent of Americans aged 12 years and over take antidepressant medication.
- Females are more likely to take antidepressants than are males, and non-Hispanic white persons are more likely to take antidepressants than are non-Hispanic black and Mexican-American persons.
- About one-third of persons with severe depressive symptoms take antidepressant medication.
- More than 60% of Americans taking antidepressant medication have taken it for 2 years or longer, with 14% having taken the medication for 10 years or more.
- Less than one-third of Americans taking one antidepressant medication and less than one-half of those taking multiple antidepressants have seen a mental health professional in the past year.
Wow, that’s a lot of info to digest, but a couple points stand out for me: 1) only one third of severely depressed people take antidepressants, and 2) less than one third of people taking antidepressants have seen a psychologist, psychiatrist or social worker. What this means is that the people who most need antidepressant medication are not taking any, and most people who are taking such medication don’t access services that can either replace, or serve as adjunctive treatment to, the antidepressant medication they are already taking.
March 17, 2011
A new study was released (and summarized in the APA Monitor) about the use of placebo medications. There have been many studies on the use of placebos, and they repeatedly demonstrate that when people are expecting a result to come from medication, it usually does… even when the “medication” is nothing more than a “sugar pill.”
What makes this study so interesting is that there was no deception. The investigators gave subjects placebos and told the subjects they were placebos. Remarkably, the research subjects still reported benefit from the sugar pills. The authors hypothesize that this may be related to the benefit of the behavior of taking the placebo pill. In other words, the act of going to the medicine cabinet twice per day, taking out a pill and pouring a glass of water and then swallowing the pill can bring you desired and anticipated, beneficial effects.
This is great news. For years I have been encouraging my patients to improve their self-care. This could come in the form of exercise, improved sleep hygiene, socializing, practicing relaxation training, taking needed breaks from work or school or just improving diet. Surely each of these behaviors are likely to improve one’s well-being, but there is a secondary (or perhaps even a primary) effect of “just doing” the behavior that may be of great benefit too. So the old Nike slogan, “Just do it” may be quite therapeutic: engaging in a behavior that you believe will help you may do so because it increases a sense of self-control and self-efficacy, it empowers you, and you just feel good about doing something to help yourself…. and all of these is on top of whatever benefits the actual exercise, diet or socializing brought you.
So, just do something good for yourself!