How do placebo effects and patient-clinician relationships influence behaviors and clinical outcomes?

Colloca, Luana

doi:10.1097/pr9.0000000000000758

Cited by 9 publications

(9 citation statements)

References 17 publications

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“…Patients' expectations are mediated through verbal information, e.g., from health care professionals, or via per-sonal prior treatment experiences. In addition, observing treatment benefits in others affects treatment expectation as well as characteristics of the therapeutic context or intervention itself [17,[22][23][24].…”

Section: Psychological Factors Shaping Treatment Expectationmentioning

confidence: 99%

Effects of Patients’ Expectation in Dermatology: Evidence from Experimental and Clinical Placebo Studies and Implications for Dermatologic Practice and Research

Sondermann

Reinboldt-Jockenhöfer

Dissemond

et al. 2021

Dermatology

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Patients’ expectations towards the benefit of a treatment are key determinants of placebo responses and can affect the development and course of medical conditions and the efficacy and tolerability of active medical treatment. The mechanisms mediating these placebo and nocebo effects have been best described in the field of experimental pain and placebo analgesia. However, also in dermatology experimental and clinical studies demonstrate that various skin diseases such as inflammatory dermatoses and allergic reactions can be modulated by patients’ expectations. Dermatologists should consider the important modulatory role of patients’ expectations on the efficacy and tolerability of specific treatments and the key role of verbal information, patients’ prior treatment experiences (associative learning), and the quality and quantity of doctor-patient communication in shaping treatment expectation. As a consequence, techniques aiming at maximizing patients’ expectation effects should be implemented into daily clinical routine. By contrast, in clinical studies expectation effects should be maximally controlled and harmonized to improve the “assay sensitivity” to detect new compounds. Further translational studies, also in dermatoses that have not been investigated yet, are needed to better characterize the mechanisms underlying patients’ expectation and to gain further insights into potential clinical implications of these effects in dermatologic conditions. Therefore, in this review, we provide a brief overview on the concept of expectation effects on treatment outcome in general, summarize what is already known about this topic for dermatologic diseases, and finally present the relevance of this topic in clinical dermatology.

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Section: Psychological Factors Shaping Treatment Expectationmentioning

confidence: 99%

Effects of Patients’ Expectation in Dermatology: Evidence from Experimental and Clinical Placebo Studies and Implications for Dermatologic Practice and Research

Sondermann

Reinboldt-Jockenhöfer

Dissemond

et al. 2021

Dermatology

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“…Researchers have speculated that clinicians can have a therapeutic effect independent of the treatment type [107]. This is the first study to evaluate whether therapy delivered by multiple clinicians has a significant effect on voice outcomes.…”

Section: Effect Of Diagnosis and Service Deliverymentioning

confidence: 99%

Active Ingredients of Voice Therapy for Muscle Tension Voice Disorders: A Retrospective Data Audit

Madill

Chacon

Kirby

et al. 2021

JCM

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Background: Although voice therapy is the first line treatment for muscle-tension voice disorders (MTVD), no clinical research has investigated the role of specific active ingredients. This study aimed to evaluate the efficacy of active ingredients in the treatment of MTVD. A retrospective review of a clinical voice database was conducted on 68 MTVD patients who were treated using the optimal phonation task (OPT) and sob voice quality (SVQ), as well as two different processes: task variation and negative practice (NP). Mixed-model analysis was performed on auditory–perceptual and acoustic data from voice recordings at baseline and after each technique. Active ingredients were evaluated using effect sizes. Significant overall treatment effects were observed for the treatment program. Effect sizes ranged from 0.34 (post-NP) to 0.387 (post-SVQ) for overall severity ratings. Effect sizes ranged from 0.237 (post-SVQ) to 0.445 (post-NP) for a smoothed cepstral peak prominence measure. The treatment effects did not depend upon the MTVD type (primary or secondary), treating clinicians, nor the number of sessions and days between sessions. Implementation of individual techniques that promote improved voice quality and processes that support learning resulted in improved habitual voice quality. Both voice techniques and processes can be considered as active ingredients in voice therapy.

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“…Because conditioning plays a large role in the proposed design, this may also pose as a concern. However, recommendations that focused specifically on the psychological constructs of side effects (nocebo effects) stress the importance of managing patient expectations, considering patient-physician communication and relationships, positive framing of treatment information and emphasizing therapeutic effects, which can be employed by focusing on the positive conditioning effects in this study design (39,40). To optimally integrate conditioning principles in drug regimens, it would therefore be important to explain the potential of pharmacological conditioning by primarily focusing on the therapeutic effects of MTX (40).…”

Section: Testing the Hypothesismentioning

confidence: 99%

Pharmacological conditioning for juvenile idiopathic arthritis: a potential solution to reduce methotrexate intolerance

et al. 2020

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Background Methotrexate (MTX) therapy has proven to be a successful and safe treatment for Juvenile Idiopathic Arthritis (JIA). Despite the high efficacy rates of MTX, treatment outcomes are often complicated by burdensome gastro-intestinal side effects. Intolerance rates for MTX in children are high (approximately 50%) and thus far no conclusive effective treatment strategies to control for side effects have been found. To address this need, this article proposes an innovative research approach based on pharmacological conditioning, to reduce MTX intolerance. Presentation of the hypothesis A collaboration between medical psychologists, pediatric rheumatologists, pharmacologists and patient groups was set up to develop an innovative research design that may be implemented to study potential improved control of side effects in JIA, by making use of the psychobiological principles of pharmacological conditioning. In pharmacological conditioning designs, learned positive associations from drug therapies (conditioning effects) are integrated in regular treatment regimens to maximize treatment outcomes. Medication regimens with immunosuppressant drugs that made use of pharmacological conditioning principles have been shown to lead to optimized therapeutic effects with reduced drug dosing, which might ultimately cause a reduction in side effects. Testing the hypothesis This research design is tailored to serve the needs of the JIA patient group. We developed a research design in collaboration with an interdisciplinary research group consisting of patient representatives, pediatric rheumatologists, pharmacologists, and medical psychologists. Implications of the hypothesis Based on previous experimental and clinical findings of pharmacological conditioning with immune responses, we propose that the JIA patient group is particularly suited to benefit from a pharmacological conditioning design. Moreover, findings from this study may potentially also be promising for other patient groups that endure long-lasting drug therapies.

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How do placebo effects and patient-clinician relationships influence behaviors and clinical outcomes?

Cited by 9 publications

References 17 publications

Effects of Patients’ Expectation in Dermatology: Evidence from Experimental and Clinical Placebo Studies and Implications for Dermatologic Practice and Research

Effects of Patients’ Expectation in Dermatology: Evidence from Experimental and Clinical Placebo Studies and Implications for Dermatologic Practice and Research

Active Ingredients of Voice Therapy for Muscle Tension Voice Disorders: A Retrospective Data Audit

Pharmacological conditioning for juvenile idiopathic arthritis: a potential solution to reduce methotrexate intolerance

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