A recent article in The Wall Street Journal summarizes some of the explanations about how we think placebos work. If you read an earlier blog post I wrote about placebos, what I find so fascinating about all this is that even when subjects/patients are told they are receiving a placebo (either in the form of a sub-therapeutic dosage of a real medication or just a sugar pill), they often still show the suggested effects of that “treatment.” If people expect something to happen when they take a pill, it often does. For example, this self-confirming bias occurs with medication side effects: you read that horrible insert from the pharmacist that lists every possible side effect that has been reported for the drug and sure enough you start to experience some of the effects… right away, before it’s really physiologically possible for the medication to have caused them.
Though some of my colleagues may not like this, I’d imagine that a nice chunk of what happens in psychotherapy is related to the placebo effect. We might call it a safe holding environment, positive future orientation or something like that, but the fact of the matter is that when a patient comes into therapy expecting a positive outcome, they typically experience that. (Similarly, when patients initiate treatment with negative expectations, they often don’t get much from treatment.) Clearly, a difference between psychotherapy and placebo is that actual treatment is being provided with psychotherapy, but patient expectation, therapist suggestions and patient suggestibility all play a significant role in therapy and should not be underestimated.
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