465. The psychology of the placebo effect

0:04 Hello everybody, I'm Gemma Spake and welcome back to the Psychology of Your 20s, the podcast where we talk through the biggest changes, moments and transitions of our 20s and what they mean for our psychology. Hello everybody, welcome back to the show, welcome back to the podcast. It is so great to have you here. Back for another episode as we of course break down the psychology of our 20s and so much more. Today I have another debunking psychology bonus episode for you. If you are new here and new to this series, twice a month I like to take a break from talking about the psychology of our 20s and instead talk about a commonly used psychological phrase, term, concept, theory that has maybe been a little bit misconstrued by

0:58 the internet or misconstrued by public perception and just tell you what it really means and take all the evidence, all the history, siphon it down and give you the exact facts. Last week, we did the Stanford Prison Experiment. Before that, we did false memories. We did Stockholm syndrome. Today, we are turning our sights to the placebo effect, which I would say is one of the most culturally borrowed phrases from psychology out there. What does it actually mean, though?

1:34 When somebody says, oh, it's the placebo effect, when somebody references that, maybe not even in a medical sense, just in a general sense, what are they talking about? There is so much weird history to this. For example, Benjamin Franklin gets involved. There are big ethical considerations. There are studies on depression, IBS, everything you can imagine. It is a massive part of psychology and psychology research, and I feel like you deserve to know what it really means.

2:03 So without further ado, let's get into it. So the placebo effect is the phenomena where someone experiences an improvement in their physical and mental health symptoms after they have received a fake or inactive treatment or after they believe they have received a treatment that scientifically may not actually work.

2:28 This can include things like when you get a sugar pill or a saline treatment or a false procedure, anything that doesn't contain an actual active ingredient sometimes still produces a this effect, it still makes people get better. And scientists and psychologists have been trying to figure out why for a very long time. The idea of the placebo effect actually has a very long history. The word placebo comes from Latin. It roughly translates to, I shall or I will please, which I think that's a beautiful way of thinking about the placebo effect. desire and wanting to please and wanting to see change, whether it's going to happen or not. But one of the earliest experiments that basically recognized that this happens to us, that pure belief

3:21 that something will work sometimes does actually create changes, happened in the 1700s. In the 1700s, something weird was going on. there was this man, his name was Franz Anton Mesmer. He was in France and he was promoting something that he called animal magnetism. He basically believed that there was an invisible magnetic fluid that flowed through the body and illnesses resulted when that flow became disrupted. Now he was kind of gently getting at something like electrical signals and the fact that we have nerve cells all down us, but He was a bit far off and his treatments were really, really wacky and very elaborate to say the least.

4:07 It included things like he would get his patients to drink iron shavings, which is very dangerous. And then he would literally use magnets to, as he would say, draw the illnesses out using the iron within them. And he quickly realized that he didn't even need to use the metal magnets. if he just told people, if he just stared at people and said, and like waved his arms over them and said, I'm curing you, I'm realigning your fluids, like I'm realigning your, like how your energy travels, people would still have these intense reactions and they would see these massive improvements. And it became so popular that the King of France basically was like, somebody needs to get to the bottom of what this guy is talking about

4:59 and whether this is actually real. And so he assigned this group to investigate, one of them being Ben Franklin, one of the founding fathers of the United States. He was in France and he was like, I need to check this out. And he was basically tasked with getting to the bottom of what was going on. So what they realized was in order to test if this theory was real, that people were being cured by an invisible magnetic field that this man, Franz, could manipulate with his hands, They had to essentially create a control group. They needed to actually administer the treatment that he was telling people he was administering. But then they also had to tell people they were administering the treatment and give them nothing. Or,

5:45 you know, say that like, this is the same thing that Franz has given you and see if they were having the same reactions to basically tell whether what he was doing was actually special or whether it was just this belief. they figured out very quickly that Franz wasn't doing anything special. People were just so willing to feel differently and so willing to see results that some part of them seemed to make the results appear either by making them up for themselves or by making them up for other people. And it was kind of hard to distinguish what it was, but they were seeing and they were feeling differently. And so this is when the term placebo effect came came to be to describe this phenomena.

6:31 Another early example came from a treatment known as Perkins tractors. Sounds awful. Actually kind of was awful. These were this pair of like small metal rods that had been invented by this American doctor called Dr. Elijah Perkins. And the idea was that these metal rods, very similar to the previous idea, could be drawn over certain parts of the body and the metal would attract the pain. The metals could relieve illness by drawing away a harmful electrical influence from the body. Now, people promoted these for a whole range of things, headaches, toothaches, chronic illnesses. And they even got these really popular doctors at the time to basically say, these things work. This is the new this is how

7:22 we're going to cure all pain. So like, imagine like Dr. Phil, like Dr. Oz being like, this is my number one thing. Obviously he got a lot of money from that and he got a lot of popularity. People obviously became skeptical. And so they did the same thing. They looked back to this previous time where this had happened and they were like, we need to just see if this is actually working or whether it's again, this placebo effect we've been talking about. And so they created a fake prototype made of wood. And again, what they noticed was that When they told the people it was those metal tractors, it wasn't. But the outcome was still the same. So after so many stories like this, scientists were like, we

8:00 have a bit of a problem because we have been prescribing people things and we have been administering treatments. And are we actually testing if they are working or are we just testing somebody's belief in the fact that they can work? And is their belief what is changing their outcomes? This really kind of came to a head in like the 1900s. specifically after the release of a very famous paper in 1950. This paper was published by Harry Beecher.

8:28 He was a Harvard investigator and anesthesiologist. I can never say that word, anesthesiologist. Oh, I just did. Anyways, that's what he did. And he wrote this paper called The Powerful Placebo. This paper basically went viral in today's terms. And in it, he looked at data from across 15 studies and estimated that 35% of patients in that study or in these collection of studies improved from the placebo effect alone. One in three people. Nothing about their condition changed other than that they took this fake or false medication and their belief seemed to have an influence. That is a lot of people. And so this is when scientists really were like, we need a group, a placebo group or a control group, and we need an experimental

9:15 group to distinguish what is actually happening. That is now a central pillar in so much scientific research. So what is actually happening? How does this happen? So a placebo drug, a placebo treatment, it's not going to shrink a tumor. It's not going to fix a broken leg. But what it can do is work on symptoms that are modulated by the brain. Specifically, as one Harvard article put it, they can work on our perception. Their effect on our expectations and the way our expectations go on to inform our reality is probably the easiest way to see this.

9:52 If we expect a treatment to ease the pain we're feeling, that is going to influence how our brain interprets that sense of pain. It's not to say that thinking this won't hurt, I'll be fine, we'll simply switch off any pain we might feel. But pain isn't always a reliable indication of some of like specific physical damage. A lot of it is mental. people experience pain differently. They could have the same level of break. They could have the same exact injury, but their psychological reaction to it, their pain tolerance, their mental reaction to it will change their threshold or not their threshold, but will change how the pain is felt. Pain is a construction of the nervous system.

10:41 That's basically what we're saying. It uses signals from the body, of course, but it also uses signals from our attention and from our emotions, from our memory, from previous experiences of pain and from our attitude towards the pain. It is a combination of both tangible physical thing that is happening to us and our mental interpretation of it. So if we change our expectations about the experience of pain, that might change how we feel it. In 2014, they did the study looking at migraine treatment and participants were either given a real migraine drug that's called Maxalt or a placebo drug during their migraine attacks. The drug wasn't the only thing the researchers changed. They also told the

11:24 participants different things. They told the patients that they were getting the real drug, that maybe they would either get the real drug or the fake drug, or that sometimes they were just going to get the fake drug, but they weren't going to tell them which. What they found was that putting more positive labeling on the drug positively boosted the efficacy of both the real medication and the placebo.

11:45 So when they said this drug that we could potentially be giving you is the best line of treatment, it is number one, even though they knew there was a possibility they got the fake treatment and even though some of them did, they still felt better because the pain, it felt like it was being taken care of and therefore maybe required less attention. It felt like the best thing they could possibly do was already happening. This can also work in the opposite direction. If somebody expects a treatment to cause nausea, to cause headaches, to cause side effects, they also may likely, be more likely, sorry, to experience those symptoms as well. This is called the nocebo effect.

12:26 Here's an example of this for you. In 2007, a 26-year-old man enrolled in an antidepressant trial and he swallowed 29 capsules because I guess he thought If I do it all at once, it's definitely going to work. Like go big or go home. I really don't want to be depressed anymore. Now he said, I didn't want to overdose.

12:45 That wasn't my intention. I just really wanted this to get this over with. I really wanted to feel better, but he grew concerned. He was a bit worried. You know, he read the label and it said, don't take them all at once. And so he went to the hospital and when he got there, his blood pressure was through the roof. His heart rate was insanely high. He needed IV fluids. His body was showing signs of basically shutdown.

13:10 And the hospital was like, we need to call the people who are involved in this trial and figure out what he's taken because otherwise we don't know how to treat it. And they call them up and they go, we need to know. He's really not doing well. And they said, well, that's really strange because we gave him the placebo. There's no active substance in that drug that he took. And he was told that. They said, don't worry.

13:33 That was just a placebo. And his symptoms rapidly subsided. within about 15 minutes, his blood pressure, his heart rate, all returned to pretty much their normal levels, but also other indicators. And you might think, well, that's because he feels calm now. This was all psychological. Some parts of it weren't psychological. Some parts of it were deeply biological and things that you can't mentally change about yourself based on perception. Like your body has to do that for you.

14:03 This obviously provided like a very striking example about how our expectations of harm can also influence how our mind and our body responds to a medication we're taking or a treatment or something that's just happening to us. Another potential mechanism behind the effect of the placebo is not just expectations, it's conditioning. Many of us have years and years of experience linking certain things with feeling better You take a Panadol, the pain goes away. Your parents put a Band-Aid on your boo-boo, like suddenly it feels a lot better. You have a bath, your fever subsides, like all these little things that have worked in the past and now we begin to link them. After years of doing this sequence, after years of taking the tablet, the

14:51 headache going away, getting a cold compress, seeing the pain subside, things associated with the treatment like the pill, the taste of the medicine, the setting, the feeling, can become cues that tell our brain to feel better. The expectation of treatment, the sense that we are feeling taken care of, that we are taking care of the problem, appears to actually trigger activity in the biological systems already present in the body.

15:22 An inactive pill is not going to kill bacteria in the same way that an antibiotic will. Expecting a broken bone to heal faster won't physically speed up your recovery. But what we are seeing is that when you feel like something is being taken care of, when you are receiving the treatment, the supportiveness of that, the fact that there is a level of stress taken away with feeling like you don't have to worry about this thing, that something in your body behind the scenes is sorting it out, does seem to put your body and your mind and all your systems in a better state for healing. the ritual of treatment, the ritual of feeling listened to as well, especially when a doctor is involved or a GP or something,

16:11 that just the experience of being cared for can influence things like how we perceive our symptoms, our level of anxiety, and our body on a whole, its ability to regulate itself and put itself into rest and repair mode. And therefore, yeah, perhaps heal us faster, even if a Truly effective treatment isn't entirely present. In a study from 2008 from researchers at Harvard Medical School, they really demonstrated this effect quite well with a group of patients who had IBS, irritable bowel syndrome. Two groups received the same treatment, the exact same treatment. But in one group, the practitioner who administered the treatment was really, really nice, really, really warm, listened actively.

17:01 expressed confidence in the treatment. And in the other, the practitioner was really cold and rude and brief. Same treatment, but the group with the warm, attentive person reported significantly greater symptom relief and an improved quality of life. And I think that human connection component itself, like that is a powerful clinical intervention. That is a powerful part of feeling better. So I want to take a short break, but then I want to discuss If the placebo effect wears off eventually, you know, is there a timeline? Is there a, I guess, a deadline on how long this feeling or this, the impact of belief or delusion can make us feel better? We're going to explore that. And I also want to explore how we can use the

17:47 known placebo effect to change our behavior and to manipulate ourselves. Stay with us. So we have a lot of evidence that the placebo effect does exist and does produce a change in almost every single illness, every single area of medical investigation, the placebo effect is known and is reported on. But how long does that change actually last for? There is a very important distinction between changing a symptom and changing the thing that's causing that symptom. A placebo might reduce pain, but it's not repairing the damaged tissue producing the pain. It might alter how breathless somebody feels, but it's not actually opening their narrowed airways. It might temporarily increase dopamine activity because of belief, but it doesn't change

18:44 an underlying biological explanation for depression or for Parkinson's disease or for any number of conditions, diseases, or impairments. The underlying cause is still there. And eventually, If it's not being treated, like the placebo does wear out. The thing is, a lot of our research on the placebo effect is really short term. It's often minutes, hours, weeks, very rarely more than a few months. Because after a while, it's really unethical to keep someone on a placebo if there is a proven real drug that can help them. Take, for example, that depression trial with that 20-year-old guy who overdosed. Again, he didn't overdose deliberately, but you don't do a trial like that unless you need help and unless you are desperate.

19:37 Even if you are seeing some effects from the placebo, at some stage, if you see that the drug is also working or not working, you can't keep people from a legitimate treatment. That would be pretty awful. Unless you tell them that it's a placebo and they agree to the possibility. Think about this in terms of like cancer drug trials for people who are like at the end of their lives and really need like a bit of a Hail Mary or people with motor neuron disease or any of those things where it's like trial drugs are some of their last resort. there are a lot of ethical complications with knowing half the people participating are just going to be the dummy guinea pig group. And that you believe enough in this drug to have put it into,

20:21 to be testing it. You already know there is some evidence for it. To, for even a second, perhaps not give somebody that life-saving treatment or medication can be pretty brutal. And even if they know it's the conditions of the experiment, I think you know, there's a lot of limits to doing that. And it can just get very blurry, very, very quickly. What they now do is that they still do placebo trials, but they do it in a very specific way. It's called open label placebo procedure. And it is where people explicitly know that they might be receiving a placebo and they are told that this is part of how they're going to measure this. So basically they are informed. What they typically didn't want to do in

21:10 the past was tell people that there was even an option for them to receive a placebo because they thought that would show the effect more. Nowadays, they'll often say there is a chance that you actually aren't going to be getting any treatment. And obviously that maybe changes some of the results, but it's a lot nicer to tell people that. And even then, even then people do, even when they know they could be taking a placebo and they do still see improvements. There was a 2010 study involving people with, again, with IBS. And even though they were taking pills openly labeled as potentially placebo pills, they still felt better than people receiving no treatment at all.

21:54 Whatever was happening doesn't entirely depend on even deception. Even them knowing that they could be deceived, the slight possibility that maybe they aren't being deceived seems to still have an effect. You know as I said it's hard to see the long-term effects of the placebo effect because normally research like that is going to get shut down but one of the best examples of how long the placebo effect might last has been revealed recently and it came from a 2023 study on lower back pain. The researchers followed up with people who had previously taken a placebo and they assessed them three years later. And what they found was that after a while, the effects of receiving even a dud treatment wore off. There was no evidence

22:45 that there had been a lasting benefit compared with the control group. So the original short-term success of feeling like you're being taken care of, feeling like things are getting better, has a shelf life. It doesn't translate into a lasting improvement. So that is probably the most critical part of this.

23:05 We know a placebo effect does exist, but there is a deadline. It's a bit of a ticking clock as to how long it is going to before the body, and I think also the mind, catches on. There's only so much that we can psychologically trick ourselves into believing in. There's only so much that our body can feel motivated to do in the face of treatment or feeling like it's receiving treatment before it realizes, hey, actually, like, nothing is changing for me biologically. I'm not getting more resources. Like, nothing is actually helping me here. And we see a dip.

23:47 We see that the effect wears off. Regardless of this, though, the placebo effect can still be helpful in some areas. Some areas... beyond medical intervention. What I'm talking about is how we can use the placebo effect to make stuff happen for ourselves, to make us believe that things are working out for us, and to actually help us be more successful and achieve our dreams. We've spoken about the placebo effect only in terms of medications and only in terms of medical interventions, but all the principles underlying how the placebo effect does seem to show results or changes in behavior can be applied to things like exercise and productivity and audacity and goal setting. And I want to explain how do we use the placebo effect in our favor?

24:42 The first thing is to remember that your expectations change your reality. We are seeing this in a medical setting. We can also see it in a personal setting. If you manipulate your expectations before your expectations manipulate you, you can create an outcome through self-belief that is more preferred.

25:02 Your brain is constantly making predictions about what something is going to feel like, what something is going to be like. And those predictions influence the experience itself. We make these predictions all the time. The workout is going to be awful. I'm going to be so anxious at this party. This thing I have to do today is going to leave me exhausted. And typically... It's hard to prove that wrong once our brain believes it. You don't need to replace those thoughts with like delusional positivity. You just need to give your brain a different prediction. You know, a workout always feels good afterwards. I'm actually going to feel amazing.

25:37 I'm probably going to have more fun at that party than I thought I was. And if not, I'll just leave. You know, a busy day actually sometimes leaves me feeling energized. You are essentially giving your brain another outcome afterwards. to look for, another expectation to consider. Tell yourself first what you want to expect or what you want the outcome to be, and then work back from there. And your brain pays attention to evidence that supports your original expectation, even if at the beginning it feels forced. This is the same thing with the placebo effect. You say, this medication is going to make me feel better. Your brain searches for evidence that you do feel better, and you can do this for these examples as well. Secondly, you

26:19 can create your own placebo cues. If our brain learns through conditioning that certain objects, environments, rituals predict a particular feeling or a particular state, we can build those associations for ourselves. If you say, this type of music always gets me hyped. Eating this specific breakfast always gives me more energy. I always have a more productive day after I exercise. This outfit makes people see me as more confident.

26:44 You start to believe it. And those cues start to become psychological shortcuts for the feeling that you want, which is to feel good, to feel confident, to feel healthy, to feel happy. You wear the dress and because you've previously always said, this always makes me feel confident. People always treat me really well when I wear this. I always feel great. You're going to start creating those situations for yourself more because you want to support your initial belief or your initial claim. I did this personally with my brown noise playlist. I was like, I cannot focus.

27:14 I need something that's going to cue me into focus. And I convinced myself that every time I listened to brown noise, I worked better. Whether I actually did or not, I now do work better when I play it because my brain has been cued. And sometimes it's difficult to get past that initial hurdle of like, you kind of know you're tricking yourself. But what you will find is that after enough repetition, your brain is very gullible. And it's very easy to believe what you continuously tell yourself.

27:42 I think the final way that we can use the placebo effect in our favor, knowing everything we know about how belief literally shapes biology, physiology, psychology, and our emotions is Vivid visualization. This is a tip I got from Dr. David Hamilton. He wrote the book, The Joy of Actually Giving a Fuck. The other book he wrote that I feel like is really, really good if you like more of the spiritual psychology is Why Woo Woo Works. And he specifically focuses on the mind-body biochemistry connection, which is essentially what we've been speaking about for this entire episode.

28:20 And what he said was that when we can visualize and see with full clarity the future that we want and we believe it's possible and we believe that what we are doing is working and we can truly like see it in our mind's eye, we are more likely to work towards that thing and we are more likely to collect evidence that what we want is working for us and this will motivate us even more. It's very similar to the psychology of manifestation. The more detail you add, the more your dream feels real and which means the less dissuaded you will become, the more proactive you will be, the more confidence you will have, the greater likelihood that the thing you imagined all along happening will happen. Manifestation

29:10 and the placebo effect, the psychological underlyings are, and this is influences us in ways that we still don't understand on a tangible physical level um to to basically create a reality for ourselves that we want again this is not advice for medical conditions um it comes to diseases, illnesses, like eventually, like we said, the placebo effect wears out.

29:46 Real treatment, scientifically investigated treatment is always going to be better. You cannot cure yourself through your mindset alone. Belief cannot take away cancerous cells. It cannot take away chronic pain. It cannot eliminate a disease of your body. But for things separate to this that are more about self-belief in a personal success and a personal goal and a personal manifestation area, it is incredibly powerful. Reality is about 50% perception.

30:19 And so change your perception, you're better able to change the part of your reality that you can control. And you can change your perception by what you initially feed yourself about the likelihood or the chances of interventions that you are putting into your life being successful. So that, my friends, is our episode on the psychology and history of the placebo effect, with a little bit at the end about how you can use this in your favor.

30:44 Placebo continues to be fascinating researchers. We still can't fully explain this mechanism. I've given you the best explanations that we have so far, but it's a big research focus for those who study mind-body connection and it's constantly evolving. So we're going to see so much more of it in the future. There is a mechanism underlying all this we really just don't understand yet. Again, it's unethical for it to replace real treatments long-term. So it's hard to understand when exactly the effects start to wear off and why, but it's a very good way scientifically of measuring what actually works biologically and what actually works psychologically in a systematic way. And without placebo trials, placebo effects, control groups,

31:29 we would not have some of the life-saving like medications and treatments that we do that save lives literally every single minute of every single day. So that's, I think, everything we need to know about the placebo effect. Thank you to our researcher Libby Colbert for her assistance with this episode. Now, this episode, as I said, was part of our larger debunking psychology series. So if you like episodes like this, if you like more myth-busty historical type episodes where maybe we reference Benjamin Franklin and things like that, I'm going to leave a link to the full playlist below.

32:01 We cover everything from personality tests to dopamine, Stockard syndrome, Freud. There's literally so much there. So I hope you go and check it out. Make sure as well that you leave a five-star review if you feel called to do so, if you enjoyed this episode. send it to a friend, follow us on Instagram. There are so many other ways to connect. I'm going to leave a link in the description.

32:20 But until next time, be safe, be kind, be gentle to yourself. We will talk very, very soon.