Objective: Recent research on open-label placebos, or placebos administered without deception or concealment, suggests that they can be effective in a variety of conditions. The current research sought to unpack the mechanisms underlying the treatment efficacy of open-label placebos. Method: A health care provider induced an allergic reaction in 148 participants via a histamine skin prick test. Participants were then exposed to 1 of 4 conditions additively leveraging various mechanisms of open-label placebo treatments: a supportive patient-provider relationship, a medical ritual, positive expectations, and a rationale about the power of placebos. Results: There were no main effects of condition on allergic responses. However, participant beliefs about placebos moderated the effect of open-label placebo treatment condition on physiological allergic reactions: the condition including all 4 components of open-label placebos (a supportive patient-provider relationship, a medical ritual, positive expectations, and a rationale about the power of placebos) significantly reduced physiological allergic reaction among participants with a strong belief in placebos compared with participants in the control group. Conclusion: Participants’ beliefs about placebos interact with information from the provider to reduce physiological allergic reactions in response to an open-label placebo treatment. This study underscores the importance of measuring and understanding how participants’ beliefs influence outcomes of treatment, and furthers our understanding of when and how open-label placebo treatments work.

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Functional analytic psychotherapy (FAP), with its emphasis on the creation of a safe, evocative, attuned, authentic, and mutually vulnerable therapeutic relationship, offers strategies that are especially relevant for therapeutic beginnings that yield an engaging and potent treatment. The 5 rules of FAP provide behavioral specificity in the early tasks of therapy that can build a powerful alliance with clients: creating trust and safety, moving the conversation from content to in-the-moment process, evoking and naturally reinforcing client target behaviors related to authentic expression, instilling hope, being aware of clinical impact, and promoting generalization of in-session gains to daily life. It is hoped that FAP offers a conceptually clear and inspiring transtheoretical framework that sets the stage for a deeply meaningful and unforgettable therapy. Clinical Impact StatementQuestion: How can therapists best engage their clients in the first sessions of therapy as conceptualized from a Functional Analytic Psychotherapy perspective? Findings: Strategies from Functional Analytic Psychotherapy provide behavioral specificity in the early tasks of therapy that can build a powerful alliance with clients. Meaning: Therapeutic skill in evoking and naturally reinforcing client target behaviors in session related to authentic expression will increase client engagement and retention. Next Steps: Future research can focus on specific mechanisms of change in the beginning of therapy.

The healthcare workforce in the United States is becoming increasingly diverse, gradually shifting society away from the historical overrepresentation of White men among physicians. However, given the long-standing underrepresentation of people of color and women in the medical field, patients may still associate the concept of doctors with White men and may be physiologically less responsive to treatment administered by providers from other backgrounds. To investigate this, we varied the race and gender of the provider from which White patients received identical treatment for allergic reactions and measured patients’ improvement in response to this treatment, thus isolating how a provider’s demographic characteristics shape physical responses to healthcare. A total of 187 White patients experiencing a laboratory-induced allergic reaction interacted with a healthcare provider who applied a treatment cream and told them it would relieve their allergic reaction. Unbeknownst to the patients, the cream was inert (an unscented lotion) and interactions were completely standardized except for the provider’s race and gender. Patients were randomly assigned to interact with a provider who was a man or a woman and Asian, Black, or White. A fully blinded research assistant measured the change in the size of patients’ allergic reaction after cream administration. Results indicated that White patients showed a weaker response to the standardized treatment over time when it was administered by women or Black providers. We explore several potential explanations for these varied physiological treatment responses and discuss the implications of problematic race and gender dynamics that can endure “under the skin,” even for those who aim to be bias free.