Brain Health,
Smart Drugs,

#164: Placebo: the Power of the Mind to Heal

January 20, 2017

The mind is a powerful thing — it can heal the body or harm the body.  Of course, it can’t affect everything; no amount of wishing is going to take away our basic needs like eating and drinking.

Still, the power of placebo should not be underestimated.  Dr. Tor Wager, director of the Cognitive and Affective Neuroscience laboratory at the University of Colorado, Boulder, joins Jesse to talk to us about the mystery of placebo.

The Placebo Effect

The placebo effect occurs when a person is unknowingly given a sham treatment (no active ingredients) that has the positive effect the person was expecting.

That placebo painkillers really work has been proven time and again.  Researchers can even see changes in the brain consistent with reduced pain.  But the exact mechanism remains a mystery.

The prior expectation of a benefit appears to be key to influencing the brain.  The benefits follow your expectations.  That’s why if you believe a drug will actually make your pain worse, you’ll often experience a nocebo effect, and you’ll feel more pain.

A Partial Explanation

At least part of what’s going on seems to be an extension of the constant work your brain is doing to adjust to current circumstances.

So, if you expect to feel pain, your brain will pre-emptively mount an anti-pain response, releasing opioids, which are natural painkillers.  It may be that, as you expect to receive a benefit, your brain starts to prepare for it, and actually ends up causing that benefit to occur.

Self-Induced Placebo?

If the placebo effect is dependent on belief, could you ever self-induce placebo?  If you know that you’re taking a placebo pill, could you ever experience a benefit?

Traditional wisdom says you can’t.  That you have to be fooled and believe you’re taking a real medication.  But new “open label” placebo studies are challenging that belief.

Expectations are still critical, but it turns out that the expectation of a real benefit is what’s critical, not the belief that you are taking a real medication.

Susceptibility to Placebo

Some people are higher responders to placebo than others.  Old studies from the ‘60s seemed to point to the idea that the more neurotic you are, the more likely you are to experience placebo.  But those results were predicated on the idea that placebo is a fake treatment for a fake illness, which is blatantly false.

Newer studies, on the other hand, indicate that optimistic people are more likely to benefit from placebo, although it’s hard to pin down a single personality trait correlated with placebo effects.

PS:  We don’t know if our weekly Brain Breakfasts are placebo, but you’ll definitely benefit!

One comment

  1. ben says:

    What’s amazing is how a placebo/nocebo works even when you know it’s being applied.. the most striking example I’ve seen is V.S. Ramachandran’s mirror-box treatment for those that suffer from a phantom limb. For a nice video of it in action, see Brain Games’ Trick on the Ellen Degeneres show!

    Not mentioned by Dr. Wager, but the idea of expectations and reward seem to overlap the placebo effect. The Hidden Brain podcast episode “Backup Plans” talks about how you’re likely to not try as hard when you know you have a backup plan. Similarly, and the Great Courses ‘Outsmart Yourself’, has great examples of how telling people your goal can sometimes make you more motivated to accomplish it, but in many other cases it can backfire giving you the sense of already accomplishing it without doing anything further!

    See Jo Merchant’s “Cure” for a great book on the placebo!

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