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Placebo effect, how important is thinking?

The placebo effect is a phenomenon that we have always known and that teaches us that chemistry and physiology are not the only beneficial agents of a drug: a fundamental component is in fact given by the patient’s predisposition towards treatment and the relationship of trust with the doctor. .

Could the mere belief that something can help us feel better actually induce beneficial effects? Can maintaining a positive mental attitude really affect our body and its well-being? Scientific research in recent years tells us yes: in some cases, just the thought that something can make us feel good can trigger an improvement in our body, demonstrating how much mind and body are connected in the processes of health and disease.

What is the placebo effect?

The placebo effect is the sum total of all positive changes – physical and psychological – that take place in people due to their conscious or unconscious expectations of recovery, without the intervention of drugs. More simply: if a patient believes that a treatment is effective, she will focus attention on every slightest sign of improvement, not considering all those elements that suggest the opposite. In this way, even if the treatment is useless, the patient’s perception will be of improvement. These benefits are often also dictated by experience: for example, a drug that we have already tried with good results will be more effective than a new drug that we do not yet “trust”. The same is true with the observation of third parties: if we see someone reach a state of well-being from taking a drug, when it’s our turn to take it we develop an even stronger and more effective response. Placebo (literally “I will like it”) is the oldest and most effective therapeutic treatment in man’s possession, but although it has been known for millennia, its neuropsychological foundations and its concrete effects have only recently emerged.

When it is useful (and when not)

Placebos give the most surprising results in those conditions in which physical and psychological discomfort are combined and complementary. A 2010 review, carried out on 202 placebo case studies through a careful analysis of this effect on specific clinical conditions and simultaneous comparison with a “control group” (while the experimental group is given a “sugar solution” as a placebo drug, the control group is given nothing, precisely with the aim of bringing out the differences between the two modalities), demonstrates how this effect is curative in treating the symptoms of asthma, pain, nausea and phobias, while it has much less evident outcomes and satisfactory on dementia, insomnia, hypertension, obesity and depression. This is because placebos affect how the patient experiences symptoms, not their causes. In a 2011 study, some asthmatic patients were divided into four groups: the first was given a drug to dilate the airways; the second a water inhaler (a placebo), the third underwent interrupted acupuncture treatments before puncturing the skin with the needle and the fourth experienced no cure. An analysis of perceived and real symptoms revealed how bronchodilator, placebo and sham acupuncture patients all achieved the same results: more than half of patients reported benefits, when theoretically only the drug should have provided benefits. real. It is thus evident that the patient’s perception and tolerance of symptoms is as relevant as the symptoms themselves. Ultimately the placebo can intervene and act positively on all those symptoms that are conveyed by the mind and therefore in this case also on pain.

Without makeup and without deception

According to a 2017 study conducted by the University of Oxford, placebo can have beneficial effects even when the patient knows that what he is taking is not a real drug. The analysis of the scant research carried out on patients aware of taking a fake treatment, has produced valid results in cases of allergic rhinitis, back pain, irritable bowel, depression and attention deficit hyperactivity disorder. The studies conducted in this regard are still few, as they are difficult to reconcile with the methodology considered from a more precise and reliable scientific point of view, that is the double blind, according to which all the participants of the research, including experimenters and volunteers, do not know who is taking what. . The simple affirmation: “it does not contain any active ingredient, but in some cases we have observed improvements anyway” is able to generate a level of suggestion in the patient that induces real physiological changes, such as the production of pain-relieving endorphins. Even the conditioning studied by the physiologist Pavlov, could explain these results: the simple act of swallowing a pill, even if devoid of any active ingredient, is associated by the patient with the cure and therefore with a healing process.

The importance of the relationship

Usually the placebo effect takes place when the ideal conditions are created for which the person is induced to believe in their own healing or transformation process. In the therapeutic context, the doctor-patient relationship and trust are key elements of this belief, as they lead the patient to think that the therapy indicated will work. More specifically: the doctor’s words, his way of expressing himself, his non-verbal communication and his positive expectations will induce a powerful placebo effect in the patient. In this regard, a study shows that with the same treatment, the best result is found precisely in cases where the doctor is able to use empathic communication, based on trust, hope and positivity with respect to the benefits of the treatment administered.

Walnut effect

If it is true that the benefits obtained from taking a placebo are facilitated by communication tools such as explaining without haste, speaking clearly and using empathy, the opposite is also true: the doctor’s suggestion can sometimes also induce negative effects. on the patient. For example, the communication of a serious diagnosis can negatively affect the person, causing him to have the opposite effect to that of the placebo, that is, the nocebo, with adverse psychological repercussions. Cases of nocebo also occur in clinical trials, when the participants who are given the placebo pill show the same side effects that could only have occurred through taking the real drug. This is because the specialist’s communication focuses more on the possible contraindications of the substance than on its benefits. What emerges therefore is that the therapeutic effect of any medicine, even the most valid one, is attributable only in part to its chemical action because an equally significant component is precisely that given by the placebo effect. In other words, in clinical use, the effect of drugs will depend both on the pharmacology and their dosage, and on the expectations of doctors, patients, their indications and verbal and non-verbal warnings.

A new challenge

The study of the placebo effect teaches us something that ancient cultures have always known, namely that human feelings, emotions, beliefs and expectations directly affect biological processes and consequently also healing ones. The goal of modern medicine, therefore, must be to extend the gaze to man in his totality and entirety, within a therapeutic process focused on the relationship.

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