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Healing

Placebo Pocket Guide

Fast Facts

  • Simple changes in manner and behavior during clinical encounters can enhance the effects of any treatment.
  • The rituals of medicine, along with patient expectations and conditioning, optimize healing.
  • The placebo response, when defined as a response to the context and meaning of treatment, helps patients tap into their inherent healing capacity.

How Does Placebo Really Work?

Placebo is usually defined as an inert substance such as a sugar pill used in treatment. A more useful clinical definition is:

A response to the context and meaning of a treatment.

Using this definition, research on the placebo response can—and should—be used to enhance the effects of any treatment.

Within a clinical encounter, ritual and context give the treatment meaning. Together with patient expectations and conditioning, rituals and context create measurable physiological changes and tap into a patient’s inherent healing capacity.

  1. Inform the patient about what he/she/they can expect and use positive messages.
  2. Listen and provide empathy and understanding. Base positive messages on the patient’s expectations. When possible, touch the patient with empathy and reassurance.
  3. Be warm and caring when delivering treatments. Use a calm tone of voice, look at the patient and touch him/her/ them.
  4. Be confident and credible when delivering treatments. Show your confidence in the treatment’s power to heal. Know the treatment’s mechanism of action and the supporting science. Explain how it works to the patient.
  5. Incorporate reassurance, relaxation, suggestion and anxiety-reduction methods. This can be as simple as a smile or an expression of caring.
  6. Deliver a safe and easy-to-use conditioned stimulus along with the therapy. The repeated ritual of treatment (taking a pill each day), preparing special food and linking treatment to smell or light exposure are examples.
  7. Align all beliefs congruently. Align your beliefs with those of the patient, his/her family and the culture.

By tapping into our inherent healing capacity, placebo can enhance the effects of any treatment. It’s especially effective for patients with chronic disease, for whom drugs don’t work well.

10 More Ways to Enhance Healing 1

  1. Follow up through text messages or phone calls from staff, or with more frequent visits. 2
  2. Determine what your patient believes in and recommend safe treatments that are aligned with those beliefs.
  3. Use a light, laser or electronic device to deliver and track the treatment, when possible.
  4. Match the appearance of the pills to the desired effect. For example, soft colors are calming while bright colors are stimulating.
  5. Use more frequent dosing to create a larger therapeutic conditioning.
  6. Apply therapies in “therapeutic” settings such as clinics and hospitals.
  7. Pay attention to the route of administration. Needles, when appropriate, produce a greater effect than pills.
  8. Use the newest and most prominent treatment, which patients believe works best.
  9. Use a well-known name brand identified with success, which patients believe works best.
  10. Cut or stick the skin or poke into an orifice when appropriate.

Is there evidence that placebo works?

A vast body of evidence supports the use of the mechanism behind the placebo response in clinical practice, showing a healing response rate of 30 to 70 percent when using known inert treatments. 3 4

Many studies show the impact of the physician’s manner and behavior on healing. In one study of patients with symptoms but no abnormal physical disease, more patients who received a positive consultation improved than those who received a negative consultation: 64 versus 39 percent. 5

The effects of acupuncture for chronic pain are due more to how acupuncture was delivered (60%) than to the specific acupuncture points used in treatment (40%). 6

Antidepressants and placebo are almost equally effective in treating patients with depression. 7

How can I use knowledge from placebo research in my practice?

The HOPE note, a free tool available on DrWayneJonas.com, provides a practical, systematic process for using knowledge from placebo research in your practice.

The HOPE note guides you through a patient-centered process to infuse knowledge from the placebo literature into your therapeutic encounters. The process guides you in identifying what matters most to the patient in life and tailoring the treatment to that goal.

Learn more

17 Ways to Harness the Power of Placebo for Your Patients

Download the complete provider guide at DrWayneJonas.com/Placebo

References

  1. Walach H, Jonas WB. Placebo research: the evidence base for harnessing self-healing capacities. J Altern Complement Med. 2004;10(suppl 1):S103-S112. Accessed January 9, 2020.
  2. Stewart-Williams S, Podd J. The placebo effect: dissolving the expectancy versus conditioning debate. Psychological Bulletin. 2004;130(2): 324–340. Accessed January 27, 2020.
  3. Beecher HK. The powerful placebo. JAMA. 1955;159(17):1602-1606. Accessed January 9, 2020.
  4. Roberts AH, Kewman DG, Mercier L, Hovell M. The power of nonspecific effects in healing: implications for psychosocial and biological treatments. Clin Psychol Rev. 1993;13(5):357-391. Accessed January 9, 2020.
  5. Thomas KB. General practice consultations: Is there any point in being positive? Br Med J (Clin Res Ed). 1987;294:1200-1202. Accessed January 9, 2020.
  6. Vickers AJ, Cronin AM, Maschino AC, Lewith G, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012;172(19):1444-1453. Accessed January 28, 2020.
  7. Kirsch I. The Emperor’s New Drugs, Exploding the Antidepressant Myth. New York, NY: Basic Books; 2010

Photo by Yoann Boyer on Unsplash

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Topics: Chronic Disease | Integrative Health

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