Invited Presidential Session: "Take This, It's Good for You": The Placebo Effect is Real, Measurable, Powerful, and Underutilized

Abstract: We are generally unaware of how often we make placebo statements and even ‎less aware of how much the placebo effect is working in the background to help soothe ‎those we love and support those we care for. This presentation will enhance understanding ‎of placebo and nocebo by addressing key features of these phenomena:‎

‎The Placebo Effect is Real:

Expectations are potent. Placebos promote symptom relief because of positive ‎expectation, and physicians often report prescribing medication for the purpose of ‎eliciting a placebo effect. Expectations can be especially important in the context of ‎psychiatry. For example, much of the benefit of SSRI medication is due to the placebo ‎effect. In a mixed-method study, our group (Bernstein) found that psychiatrists are attuned ‎to maximizing patient expectation and hope. Research in open-label (honest) placebos ‎suggests that the benefit of the placebo effect can be harnessed transparently and ‎ethically. Dr. Bernstein will take us on a “deep (placebo) dive” during his discussion of ‎placebo and his NIDA-funded research, “Harnessing Placebo Analgesia to Address the ‎Opioid Epidemic.”‎

‎“Nocebo effects” refer to a worsening of symptoms due to negative expectations. They ‎include diminishment of expected therapeutic benefits and experience of unwanted “side ‎effects,” due to the negative expectations of the patient. This topic is less developed than ‎placebo research but equally powerful. It is relevant when considering how psychiatrists ‎respond to patients who describe difficult symptoms or life events, and how they should ‎discuss medication side effects.‎

Dr. Eyler will discuss therapeutic uses of the nocebo dynamic in consultation-liaison ‎psychiatry through case examples. Potential benefits of discussing the nocebo effect in a ‎consultation setting include setting patient-focused expectations, exploring the dynamics ‎and meaning of previous treatment failures, and more effectively assisting patients in ‎choosing treatment options that they accept and can invest in.‎

Measurable and Powerful: Dr. Wilson will review the neurobiological mechanisms ‎underlying the placebo effect. Simply because an investigational agent does not have a ‎direct biological effect does not mean that direct physiological changes have not occurred ‎in the brain and body of an individual who responds to an intervention. Placebo responses ‎are not merely psychological but complex psycho-neuro-biological processes that involve ‎activation of specific brain regions.‎

Dr. Wilson will also review the mind-brain responses which occur in the placebo response. ‎Many have speculated that, instead of there being a single placebo response, there are ‎multiple different mechanisms underlying responses across systems. Drawing from ‎specific examples in animal and human studies across different neuropsychiatric ‎conditions, she will review changes in the neurotransmitter systems (e.g., opiate and ‎dopamine), brain circuitry, and distinct brain regions (e.g., anterior cingulate cortex, ‎dorsolateral prefrontal cortex, and basal ganglia) involved in the neurobiology of the ‎placebo response.‎

Underutilized: Dr. Rabinowitz will discuss the ethical principles that apply to placebo and ‎nocebo, its underutilization in research in some minorities, and ways CL psychiatrists can ‎use these responses to enhance patient care.‎
Audience participation is a key feature of this presentation.‎

This talk will make you smarter!‎