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We evaluate the hypothesis that the power of nonspecific ejects may account for as much as two thirds of successful treatment outcomes when both the healer and the patient believe in the efficacy of a treatment. Five medical and surgical treatments, once considered to be eJiicacious by their proponents but no longer considered effective based upon later controlled trials, were selected according to strict inclusion criteria. A search of the English literature was condtutedfor all studies published for each treatment area. The results of these studies were categorized, where possible, into excellent, good, and poor outcomes. For these five treatments combined, 40% excellent, 30% good, and 30% poor results were reported by proponents. We conclude that, under conditions of heightened expectations, the power of nonspeczfic eflects far exceeds that commonly reported in the literature. The implications of these results in evaluating the relative eflicacy of biological and psychosocial treatments is discussed. The issue of specific and nonspecific effects in psychiatric and psychological interventions continues to be a matter of intense interest and debate. Controversies involve both biological (Fisher & Greenberg, 1989a; Margraf et al., 1991) and psychosocial (Beutler,

Common criticisms of behavioral treatment programs for chronic pain are summarized. Some criticisms are based on conceptual misunderstandings; therefore, basic concepts and goals of behavioral programs are presented. Other criticisms question the effectiveness of these programs; therefore, the role of social reinforcers in maintaining or reducing pain behaviors is reviewed. The failure to isolate specific treatment variables is alleged; this is acknowledged, along with the practical and ethical questions making this virtually impossible. Finally we describe the need to change the thinking about 'pain' from the pathological or disease model, appropriate to acute pain, to a learning model when discussing the excess disability and suffering of chronic pain patients.