Psycho-Social Mediators of Placebo Effects

Placebo effects are dynamic and act synergistically with other therapeutic elements. Expectancy, Pavlovian conditioning, meaning effects, and therapeutic relationship are common mediators of placebo effects. In clinical situations, patients' intensity for expectation of help is the main trigger of placebo response. Even physician expectations, belief, and empathy can produce placebo responsiveness in the patient. Ego development psychologists speculating on the mechanisms of placebo response see it as a rekindled soothing pattern of the early interaction with a caregiver projected as a healing symbol on the therapist. In the emotionally charged interactions in the doctor's office, the prescriptions, pills, worksheets, and medical devices act as "transitional objects" mediating between the self and the world to promote patient's sense of autonomy and self-efficacy. Psychoanalytic experts have stressed the healing power of positive transference in promoting placebo response by reduction of stress and anxiety and increasing positive emotions. Desire, belief, and expectancy combine to produce hope, which in itself is a potent mediator of the placebo effect. Hope can consciously or unconsciously motivate people to follow health-promoting behaviors and adhere to therapeutic regimens. The coronary drug project showed lower mortality even in the placebo-compliant group. Expectation also plays a major role in subjective and behavioral effects of the drugs acting on the central nervous system. Pharmacologically conditioned placebo responses mimic drug effects and can be used to decrease the dose and side effects of drugs in clinical practice. The psychosocial processes involved in placebo responding can apply to any treatment in the form of "embodied experience." Personal suffering, when given a socially acceptable meaning, constitutes "meaning response," which can be a wellspring of placebo effect. Therapeutic relationship is considered to be the most important component in promoting placebo effects. Physicians, by virtue of empathic communication; positive framing of the diagnosis; and a gentle, reassuring manner can transmit an impressive healing force in the treatment setting. The physical characteristics of the drugs sometimes account more than the chemical ingredients of the medication. These "meaning effects" are driven by unconscious symbolic images. Some important personality factors in eliciting placebo effects are: optimists respond better than pessimists, extroversion and openness helps, and acquiescing personalities are more likely to make use of others as a healing resource. Therapeutic relationship remains the most important progenitor of placebo effect, and incremental dose of quality and quantity time with a likable, empathic, reassuring doctor has been shown to produce a robust beneficial effect, even when no active treatment was employed.