The Influence of Expectancy Level and Personal Characteristics on Placebo Effects: Psychological Underpinnings

Zhou, Lili; Wei, Hua; Zhang, Huijuan; Li, Xiaoyun; Bo, Cunju; Wan, Li; Lu, Xuejing; Hu, Li

doi:10.3389/fpsyt.2019.00020

Cited by 22 publications

(22 citation statements)

References 67 publications

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“…These findings are consistent with the simulation theory of empathy, which proposed that empathy for others' pain relies on psychological and neural representations that are similar to those needed for the perception of self-pain (Decety & Jackson, 2004;Lamm & Majdandžić, 2015). It is widely recognized that pain perception in healthy volunteers not only depends on noxious inputs (Hu & Iannetti, 2019), but also is influenced by emotions and beliefs about the pain that they have (Zhang, Lu, Bi, & Hu, 2019;Zhou et al, 2019), such as pain-related anxiety (Wiech & Tracey, 2009), pain catastrophizing (Kjogx et al, 2016), and pain-related fear (Hirsh et al, 2008). Accordingly, it is reasonable to hypothesize that others' pain would be spontaneously matched to the prepared schema for the processing of self-pain, thereby instigating similar pain-related emotional and cognitive processing.…”

Section: The Relationship Between Pain Sensitivity and Empathy Was supporting

confidence: 87%

Can self‐pain sensitivity quantify empathy for others' pain?

Ren

Zhao

et al. 2020

Psychophysiology

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Empathy is essential for the survival of social species. In many studies, especially those with animal models, empathy for pain was evaluated by the modulation of pain sensitivity. However, the relationship between pain sensitivity and empathy for pain is not well established. Here, by performing two experiments, we aimed to investigate their relationship at both behavioral and electrophysiological levels. In Experiment 1, we characterized individual pain sensitivity using pain threshold and tolerance in a cold pressor test, self‐report empathy using Interpersonal Reactivity Index, and pain‐related psychological factors, including pain‐related anxiety, depression, pain catastrophizing, and pain‐related fear, using well‐validated questionnaires. We observed that pain sensitivity was positively correlated with emotional empathy, and their relationship was mediated by pain‐related anxiety, pain catastrophizing, and pain‐related fear. In Experiment 2, we quantified empathy for pain using pain intensity and unpleasantness as well as event‐related potentials (ERPs) in an empathy for pain task. Positive correlations were observed between pain sensitivity and psychophysiological empathic responses (i.e., the P3 component and the late positive potential in ERPs), and their relationship was mediated by pain‐related fear. These results suggested that being influenced by some pain‐related psychological factors, individuals with higher pain sensitivity tended to have stronger empathy for pain, manifested as stronger emotional reactions to others' pain. Our results indicated that the conventional strategy of using pain sensitivity to quantify empathy should be treated with caution, as their relationship could be disturbed by experimental manipulations or pathological modulations that could influence individual emotional states or cognitive processes.

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Section: The Relationship Between Pain Sensitivity and Empathy Was supporting

confidence: 87%

Can self‐pain sensitivity quantify empathy for others' pain?

Ren

Zhao

et al. 2020

Psychophysiology

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“…Since placebo effects seem to be determined by a variety of different factors (social, psychological, neurobiological, genetic), future studies may need to incorporate more sophisticated statistical methods to test the combined effect of several predictors at once in order to identify the placebo responder [for some recent examples in pain, see, e.g., Refs. (111, 112)].…”

Section: Identifying the Placebo Respondermentioning

confidence: 99%

Placebo and Nocebo Effects Across Symptoms: From Pain to Fatigue, Dyspnea, Nausea, and Itch

2019

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Placebo and nocebo effects are, respectively, the helpful and harmful treatment effects that do not arise from active treatment components. These effects have thus far been researched most often in pain. It is not yet clear to what extent these findings from pain can be generalized to other somatic symptoms. This review investigates placebo and nocebo effects in four other highly prevalent symptoms: dyspnea, fatigue, nausea, and itch. The role of learning mechanisms (verbal suggestions, conditioning) in placebo and nocebo effects on various outcomes (self-reported, behavioral, and physiological) of these different somatic symptoms is explored. A search of experimental studies indicated that, as in pain, the combination of verbal suggestion and conditioning is generally more effective than suggestion alone for evoking placebo and nocebo effects. However, conditioning appears more and verbal suggestions less relevant in symptoms other than pain, with the exception of placebo effects on fatigue and nocebo effects on itch. Physiological measures, such as heart rate, lung function, or gastric activity, are rarely affected even when self-reported symptoms are. Neurobiological correlates are rarely investigated, and few commonalities appear across symptoms. Expectations generally predict placebo and nocebo effects for dyspnea and itch but seem less involved in fatigue and nausea. Individual characteristics do not consistently predict placebo or nocebo effects across symptoms or studies. In sum, many conclusions deriving from placebo and nocebo pain studies do appear to apply to other somatic symptoms, but a number of important differences exist. Understanding what type of learning mechanisms for which symptom are most likely to trigger placebo and nocebo effects is crucial for generalizing knowledge for research and therapies across symptoms and can help clinicians to optimize placebo effects in practice.

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“…As an additional limitation, the study was not powered to investigate higher-level interactions of Expectancy and other determinants. For example, complex interactions between Expectancy, sex, optimism and anxiety may be involved in the generation of placebo effects 68 . The observed interactions with our experimental conditions support the notion that the identification of "simple" predictors of placebo responding 34 may be a fool's errand, with more interactional processes likely but harder to investigate 35,69 .…”

Section: Discussionmentioning

confidence: 99%

A virtual experimenter does not increase placebo hypoalgesia when delivering an interactive expectancy manipulation

Horing

Beadle

Inks

et al. 2020

Sci Rep

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Lack of standardization and unblinding threaten the research of mechanisms involved in expectancy effects on pain. We evaluated a computer-controlled virtual experimenter (VEx) to avoid these issues. Fifty-four subjects underwent a baseline-retest heat pain protocol. Between sessions, they received an expectancy manipulation (placebo or no-treatment) delivered by VEx or text-only control condition. The VEx provided standardized “social” interaction with the subjects. Pain ratings and psychological state/trait measures were recorded. We found an interaction of expectancy and delivery on pain improvement following the intervention. In the text conditions, placebo was followed by lower pain, whereas in the VEx conditions, placebo and no-treatment were followed by a comparable pain decrease. Secondary analyses indicated that this interaction was mirrored by decreases of negative mood and anxiety. Furthermore, changes in continuous pain were moderated by expectation of pain relief. However, retrospective pain ratings show an effect of expectancy but not of delivery. We conclude that we successfully applied an automated protocol for inducing expectancy effects on pain. The effect of the VEx regardless of treatment may be due to interactions of attention allocation and locus of control. This points to the diversity of expectancy mechanisms, and has implications for research and computer-based treatment applications.

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The Influence of Expectancy Level and Personal Characteristics on Placebo Effects: Psychological Underpinnings

Cited by 22 publications

References 67 publications

Can self‐pain sensitivity quantify empathy for others' pain?

Can self‐pain sensitivity quantify empathy for others' pain?

Placebo and Nocebo Effects Across Symptoms: From Pain to Fatigue, Dyspnea, Nausea, and Itch

A virtual experimenter does not increase placebo hypoalgesia when delivering an interactive expectancy manipulation

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