Affect and emotions in placebo and nocebo effects: What do we know so far?

Once considered nuisance variance in clinical trials, placebo effects and nocebo effects are now widely recognized as important and mutable psychobiological contributors to mental and physical health. Psychological theory explaining these effects emphasizes associative learning and conscious expectations. It has long been suggested, however, that affective states such as moods, emotions, and distress could play a significant role. In this paper, we draw together and review the empirical data linking affective states to placebo and nocebo effects. To organize this disparate literature, three questions are addressed: (1) Does pre‐existing state and trait affect modulate placebo and nocebo effects? (2) Does administering placebo and nocebo treatments change affective states, and if so, does the resulting affect causally influence placebo and nocebo effects? Finally, (3) Can placebo treatments be successfully employed as a regulation strategy to modulate different affective states? In reviewing the evidence in relation to these three questions, it is clear that affect does play a key role in placebo and nocebo effects in many circumstances, and further, there may be a reciprocal dynamic at play between a treatment event, affect, and placebo/nocebo effects. The paper concludes by discussing implications for theory and intervention and recommends future research priorities.     

Coping Styles,Pain Expressiveness,and Implicit Theories of Chronic Pain

Whereas some individuals use active coping strategies and are able to adaptively cope with their pain, others use passive strategies and catastrophic appraisals, which are often associated with increased displays of pain behavior and negative pain-related outcomes. To investigate attribution-based implicit theories as a potential underlying mechanism that might affect coping success, we hypothesized that pain patients with an incremental implicit theory of pain (i.e., view pain as malleable) would have more active coping strategies, lower levels of pain expressiveness, and better pain-related outcomes than those with an entity implicit theory of pain (i.e., view pain as nonmalleable). Patients with chronic back pain undergoing a functional assessment completed a variety of self-report measures and participated in a pain-inducing physiotherapy procedure. The results revealed those with an incremental theory of pain used more active coping strategies, displayed less pain behavior, and reported better pain-related outcomes (e.g., lower levels of depression) than individuals with an entity theory of pain. The findings suggest implicit theories of pain may represent an underlying social-cognitive mechanism linked to important coping, emotional, and expressive reactions to chronic pain. Identifying such a mechanism may provide valuable information for the assessment and treatment of chronic pain.     

The placebo response complex

Placebo effects contribute to beneficial therapeutic responses and are common in anxiety and depressive disorders. It is posited that placebo effects are yielded by autonomous feeling-toned complexes capable of re-establishing background self-states of well-being. The relationship between the placebo response complex and modern neurobiological models of self is explored. The psychological roots of the placebo response complex in implicit memories of organized attachment between child and early caretakers and in Sandler's conception of the benign superego are examined. The relationships between the negative placebo (nocebo) response complex, Freud's negative therapeutic reaction, and Fordham's defence of the self are explored. Finally, it is suggested that approaches fundamental to the analytic encounter, e.g., mirroring, affectual exchanges, attunement, and containment are likely to optimize the salutary effects of both psychological and somatic therapeutic interventions.     

The error protection impact of inhibitory after-effects in a location-based task and its preservation with practice

In location-based tasks, responses related to (prime trial) distractor-occupied locations automatically undergo activation, followed by inhibition, which causes these responses to become execution-resistant (ER). Distractor-response ER takes time to override, delaying target reactions that later require this response (e.g., probe, ignored-repetition trials), causing the spatial negative priming (SNP) phenomenon. We learned in this study that distractor-response ER affords this output a degree of error protection. Specifically, when the probe target appeared at a new location, former (prime) distractor responses were used erroneously significantly less often than their control response counterparts, likely due to their ER feature, which discourages their inappropriate selection (i.e., “ER” provides error protection). This error protection also was evident when a previous distractor response was activated by a distractor on the probe (i.e., distractor-repeat trial). Notably, error protection remained effective over extensive practice, as did SNP size (i.e., ER override time) after an initial decline.     

Knowledge of the aetiology and cost of the nocebo effect is increasing,but conceptualising expectancy and partialling out misattribution remain challenges: Comment on Faasse (2019)

The nocebo effect is a concerning phenomenon in which adverse outcomes are triggered by the treatment context. Faasse (2019) summarises recent evidence on mechanisms of the nocebo effect, proposes an updated model, and describes emerging techniques for reducing the nocebo effect. Faasse's model marks an important advance over prior models focussing only on expectancy and classical conditioning by incorporating the role of anxiety, which emerging evidence indicates can mediate the nocebo effect. The review also emphasises the importance of preventing the nocebo effect, given its resistance to extinction, as well as the need for translational research, both of which are timely points. However, the review also raises two challenges for nocebo research. The first concerns the conceptualisation of expectancy, with Faasse's model appearing to combine expectancy and verbal information into a single node. Such an approach suggests that verbal information necessarily and only elicits nocebo effects via expectancy, which may not hold true. The second concerns distinguishing genuine nocebo effects from misattribution. Faasse's review intentionally focuses only on the former, but it is argued that understanding the latter is necessary to accurately estimate the true cost of the nocebo effect as well as for prioritising interventions to minimise non-medication side effects. As such, in addition to Faasse's call for translational research—which I fully support—I propose that key nocebo research goals should be to understand how verbal information elicits nocebo effects outside of expectancy and to tease apart genuine nocebo effects and misattributed adverse symptoms.     

The placebo phenomenon and medical ethics: Rethinking the relationship between informed consent and risk–benefit assessment

It has been presumed within bioethics that the benefits and risks of treatments can be assessed independently of information disclosure to patients as part of the informed consent process. Research on placebo and nocebo effects indicates that this is not true for symptomatic treatments. The benefits and risks that patients experience from symptomatic treatments can be shaped powerfully by information about these treatments provided by clinicians. In this paper we discuss the implications of placebo and nocebo research for risk–benefit assessment and informed consent.     

Who Cares? The Role of Job Involvement in Psychological Contract Violation

This study examined survey data from full‐time employees employed in a variety of occupations. We empirically examined how psychological involvement with one's job affects reactions to psychological contract violation. Data for control variables (i.e., age, gender, organizational tenure), the independent variable (i.e., psychological contract violation), and the moderator (i.e., job involvement) were taken at Time 1; and dependent variables (i.e., depressed mood at work, turnover intention) were taken at Time 2. Results illustrated that job involvement was an important construct in understanding individuals' negative reactions to psychological contract violations. Implications and limitations are discussed, and suggestions for future research are offered.     

Attribution theory, insomnia, and the reverse placebo effect: a reversal of Storms and Nisbett's findings.

Storms and Nisbett found that insomniacs got to sleep faster than usual on nights when they took placebos believed to be arousal pills. Our study attempted: (a) to replicate the reverse placebo effect using a method of measurement considered more accurate than the original technique, (b) to evaluate the effect of an arousal pill therapy after therapy is discontinued, and (c) to clarify which of two hypotheses better accounts for the effect. Using 42 insomniacs, the design varied whether pills were administered (pill) or withheld (no pill) and whether or not high justification was provided for taking the pills. The high-justification-pill and the high-justification-no-pill groups were given information intended to justify their participation, while the no-justification-pill and no-pill-no-justification groups were treated like the original arousal and control groups. Instead of a decrease in latency to sleep, the no-justification-pill group but not the high-justification-pill troup displayed a typical placebo reaction on nights they took the pills. Our results cast suspicion on the original finding. The lack of response by the high-justification-pill group is discussed in terms of Bem and Kelley's views of attribution theory.     

Influence of cognitive stance and physical perspective on subjective and autonomic reactivity to observed pain and pleasure: An immersive virtual reality study

Observing others’ pain may induce a reaction called personal distress that may be influenced by top-down (imagine self or other in pain, i.e., self- vs other-oriented stance) and bottom-up (physical perspective of those who suffer, i.e., first vs third person perspective- 1PP vs 3PP) processes. The different contributions of these processes have not been teased apart. By capitalizing on the power of Immersive Virtual Reality, we explored how behavioural (subjective ratings) and physiological reactivity (skin conductance reactivity, SCR) to pain and pleasure delivered to an avatar was influenced by Cognitive stance and Physical perspective. Taking an Other-Oriented stance leads to attributing higher congruent valence (i.e. pain rated as unpleasant and pleasure as pleasant) and intensity to the stimuli and induces reduced SCR. Ownership over the virtual limb was maximal in 1PP where physiological reactivity to the stimuli was comparable. Our results highlight different components underpinning reactivity to pain and pleasure.     

Real men are made,not born! Incidental exposure to energy drinks may promote men's tolerance of physical pain

The energy drink market has grown exponentially since the debut of Red Bull. Advertising of energy drinks tends to reinforce an emphasis on masculine identification. However, no previous study has addressed the symbolic effect of energy drinks on pain tolerance, that is, a particular masculine characteristic. We conducted a priming‐based experiment to show that energy drink primes elevated men's pain tolerance. Induced conformity to masculinity norms mediated the priming effect of energy drinks on pain tolerance. These findings suggest that mere reminders of masculinity‐related products can lead men to behave accordingly in seemingly irrelevant domains (i.e., pain tolerance). Besides distraction and placebo treatment, the connection between a symbolic masculinity prime and greater tolerance of pain may shed lights on an alternative route for pain control.     

Automatization through Practice: The Opportunistic-Stopping Phenomenon Called into Question

As a theory of skill acquisition, the instance theory of automatization posits that, after a period of training, algorithm-based performance is replaced by retrieval-based performance. This theory has been tested using alphabet-arithmetic verification tasks (e.g., is A + 4  = E?), in which the equations are necessarily solved by counting at the beginning of practice but can be solved by memory retrieval after practice. A way to infer individuals’ strategies in this task was supposedly provided by the opportunistic-stopping phenomenon, according to which, if individuals use counting, they can take the opportunity to stop counting when a false equation associated with a letter preceding the true answer has to be verified (e.g., A + 4  = D). In this case, such within-count equations would be rejected faster than false equations associated with letters following the true answers (e.g., A + 4  = F, i.e., outside-of-count equations). Conversely, the absence of opportunistic stopping would be the sign of retrieval. However, through a training experiment involving 19 adults, we show that opportunistic stopping is not a phenomenon that can be observed in the context of an alphabet-arithmetic verification task. Moreover, we provide an explanation of how and why it was wrongly inferred in the past. These results and conclusions have important implications for learning theories because they demonstrate that a shift from counting to retrieval over training cannot be deduced from verification time differences between outside and within-count equations in an alphabet-arithmetic task.     

Life before and after quitting smoking: an electronic diary study

This article describes a multidimensional, multivariate, and multilevel approach to the assessment of nicotine withdrawal. In this prospective study, 70 adult smokers assigned to an active or placebo nicotine patch condition completed multiple daily assessments using an electronic diary. Average and individual growth curves were estimated for affective and nonaffective withdrawal symptoms. All symptoms but hunger increased significantly on the quit day and remained elevated for three weeks. Variability in symptom experiences across individuals increased from pre- to post-quit. Relations between symptom reports (e.g., negative affect or craving) and episodic events (e.g., stressful events or seeing someone smoke) changed from pre-quit to post-quit. Pre-quit increases in negative affect and quit-day increases in craving were inversely related to abstinence three months after the quit day, suggesting that anticipatory and immediate reactions to quitting influence success.     

Placebo, belief, and health. A cognitive–emotion model

The present paper reviews empirical research on placebo effects, and presents a cognitive–emotional model of the psychological mechanisms involved. It is argued that illness often involves psychological aspects; people not only sense their signs of physical illness, but also interpret these signs, and respond emotionally to their interpretations. Cognitions of danger (e.g. fear of dying) produce anxiety, whereas cognitions of loss (e.g. loss of one's health) produce sadness or depression. It is argued that an important part of the placebo effect is due to the development of placebo beliefs (beliefs of the form "This treatment is going to cure me"), which may counteract the kind of cognitions that produce anxiety and depression; placebo beliefs produce emotional responses (hope, calm, etc.), which are antagonistic to depression and anxiety. Further, if anxiety and depression tend to affect a person's physical health negatively, placebo beliefs may be expected to have a positive influence on physical health. Placebo effects may occur not only with pure placebos (e.g. sugar pills), but with all kinds of medical and psychological treatments; even treatments that contain active ingredients of a non-placebo nature may involve important placebo components. Placebo effects may vary in strength, depending on the therapist's behaviour (verbal information to the patient, enthusiasm, optimism, interest, etc.), and on the patient's idiosyncratic meaning structures (which invest various kinds of treatment with different placebo value).     

Synesthetic colors are elicited by sound quality in Japanese synesthetes

Determinants of synesthetic color choice for Japanese phonetic characters were studied in six Japanese synesthetes. The study used Hiragana and Katakana characters, which represent the same set of syllables although their visual forms are dissimilar. From a palette of 138 colors, synesthetes selected a color corresponding to each character. Results revealed that synesthetic color choices for Hiragana characters and those for their Katakana counterparts were remarkably consistent, indicating that color selection depended on character-related sounds and not visual form. This Hiragana–Katakana invariance cannot be regarded as the same phenomenon as letter case invariance, usually reported for English grapheme-color synesthesia, because Hiragana and Katakana characters have different identities whereas upper and lower case letters have the same identity. This involvement of phonology suggests that cross-activation between an inducer (i.e., letter/character) brain region and that of the concurrent (i.e., color) area in grapheme-color synesthesia is mediated by higher order cortical processing areas.     

Implicit and explicit self-esteem in the context of internet addiction

Previous research has repeatedly found that people suffering from some clinical disorders (e.g., bulimia nervosa, depression) possess low explicit (i.e., conscious, deliberate) self-esteem while at the same time displaying high implicit (i.e., unconscious, automatic) self-esteem. This phenomenon has been termed damaged self-esteem and was proposed to be an indicator of psychological distress. Although Internet addiction has been found to be associated with low levels of explicit self-esteem, as well as with high levels of psychological distress, its relation to implicit self-esteem has, to our knowledge, not been investigated thus far. We therefore hypothesized that the phenomenon of damaged self-esteem could also be found amongst people suffering from Internet addiction, and conducted two studies using the Initial Preference Task as a measure of implicit self-esteem. As expected, we found that individuals scoring high on Internet addiction possess low explicit and high implicit self-esteem. This effect was, however, only found for the first name initial of the Initial Preference Task, leading to the conclusion that first and last name initials might tap into different parts of implicit self-esteem.     

The dual-task practice advantage: Empirical evidence and cognitive mechanisms

Practice of two simultaneous component tasks in dual-task situations leads to an improvement in dual-task performance. The present paper reviews empirical evidence for this practice-related improvement and discusses its underlying cognitive mechanisms. In particular, the robustness of the phenomenon of dual-task practice advantage (DTPA) is evaluated. This phenomenon is described as an advantage in dual-task performance at the end of dual-task practice (i.e., simultaneous task practice) in comparison to the dual-task performance after single-task practice (i.e., separate task practice). The review investigates the existence of empirical evidence of the DTPA phenomenon and specifications of its mechanisms in the context of the allocation and scheduling hypothesis and the integration hypothesis. Evidence for the existence of the DTPA phenomenon and the allocation and scheduling hypothesis was demonstrated in dual tasks with (1) combinations of two sensorimotor tasks, (2) combinations of one continuous task and one sensorimotor task, (3) combinations of two working-memory tasks, and (4) combinations of one motor task and one cognitive task. In contrast, the findings demonstrate that the DTPA phenomenon in dual tasks with (5) combinations of two long-term memory retrieval tasks can instead be explained by the integration hypothesis. The relevance of these findings is discussed in relation to real-world problems.

     

Overcoming the winner's curse: an adaptive learning perspective

The winner's curse phenomenon refers to the fact that the winner in a common value auction, in order to actually win the auction, is likely to have overestimated the item's value and consequently is likely to gain less than expected and may even lose (i.e., it is said to be “cursed”). Past research, using the “Acquiring a company” task has shown that people do not overcome this bias even after they receive extensive feedback. We suggest that the persistence of the winner's curse is due to a combination of two factors: variability in the environment that leads to ambiguous feedback (i.e., choices and outcomes are only partially correlated) and the tendency of decision makers to learn adaptively. We show in an experiment that by reducing the variance in the feedback, performance can be significantly improved. Copyright © 2007 John Wiley & Sons, Ltd.     

The effects of self-injury on acute negative arousal: A laboratory simulation

Research suggests that performance of non-suicidal self-injury (NSSI) is associated with the reduction of high-arousal negative affect. The present study examined this phenomenon in a laboratory setting. Individuals with a history of NSSI (n?=?39) and non-NSSI controls (n?=?33) underwent an anger induction, and were randomized to self-administer either a high level of electric shock, or a mild shock (control condition) to their upper arm. Consistent with previous research, injurers displayed greater pain analgesia than controls. Contrary to expectations, high shock did not result in enhanced arousal reduction for injurers. However, the high shock led to greater arousal reduction for injurers than controls. Notably, in the high shock condition, higher levels of electrical stimulation (i.e., voltage administered) predicted greater reductions in negative arousal, whereas higher subjective ratings of pain predicted smaller reductions in negative arousal. This pattern suggests that more intense self-inflicted pain facilitates reduction of negative arousal provided the subjective experience of pain is not too aversive. Findings help clarify emotion-regulation models of NSSI.     

Further analysis of picture interference when teaching word recognition to children with autism

Previous research indicates that pairing pictures with associated words when teaching sight-word reading may hinder acquisition (e.g., Didden, Prinsen, & Sigafoos, 2000; Singh & Solman, 1990; Solman & Singh, 1992). The purpose of the current study was to determine whether this phenomenon was due to a previously learned association between the spoken word and picture (i.e., blocking) or due to the mere presence of a picture as an extrastimulus prompt (i.e., overshadowing). Three participants were taught to recognize words that were presented alone or paired with pictures that the participants either could or could not identify prior to training. All participants learned the words more quickly when they were presented alone rather than with pictures, regardless of their prior learning history with respect to pictures representing the words. This finding is consistent with the phenomenon of overshadowing. Nonetheless, consistent with blocking, all participants also acquired the words presented alone more quickly if they could not identify the associated pictures prior to training. Together, these findings have important implications for using prompts when teaching skills to individuals with developmental disabilities.     

IT STICKS IN MY THROAT

In challenging the implications of my putative counter-example to Wittgenstein's claim that "It's on the tip of my tongue" (TT) is not the expression of an experience (cf. Philosophical Investigations , p.219)¹, Professor Slater writes²
… the obvious way in which to meet the threat to the adequacy of (b₁) [which is that the speaker should believe that he may be able to produce the missing word (fairly soon)] is to claim that the utterer of "It's on the tip of my tongue" must not merely believe that he may recall the word fairly soon, he must also believe, i.e., not rule out the possibility that, he may do so without any treatment , i.e., without being prompted by an external source such as cues, pills, or shock, (p.51)