Цитата из этой статьи ↑
elgru в посте Metapractice (оригинал в ЖЖ)
openly prescribed placebos.
The importance of a certain rationale, i.e. a verbal suggestion, is
also of relevance regarding the augmentation of nocebo effects [57] and in other domains such as in psychotherapy [8,22]. Therefore, our findings emphasise that the power of verbal suggestions deserves further scrutiny in relation to future placebo research. This is in line with the recommendation that physicians may best benefit from placebo effects by enhancing patients’ expectations through communication.
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Не очень понятно. У группы со скрытым плацебо УСИЛИЛАСЬ боль (по сравнению с тем, какая у них была изначально)? Если так, то работали какие-то косвенные внушения. Так как при прочих равных делать что-то безвредное vs ничего не делать — не может не дать заметного положительного результата.
При открытом плацебо, которое давалось без объяснения, почему оно должно действовать, боль была больше, чем при использовании открытого плацебо с объяснением.
NT - без лечения, OPR- открытое плацебо без объяснения, OPR+ открытое плацебо с объяснением, DP тайное (закрытое) плацебо
Т.е. открытое плацебо без объяснения таки усиливало боль? А с объяснением немного снижало. А без объяснения снижало заметно. Точно действие набора косвенных внушений, нивелирующих плацебо-эффект. Плюс субъективная оценка боли — неизвестно, какие внутренние референты уровня боли человек будет неявно использовать при такой оценке. Может быть скрытое сравнение того, насколько по факту полегчало, с тем, насколько "должно было" или "хотелось бы".
На предшествующей картинке - интенсивность боли после "лечения".
В этой таблице показатели до лечения, после, а в последних 2-х столбиках ожидаемые значения.
В группе OPR- интенсивность боли увеличилась (но не факт, что статистически значимо), а субъективная неприятность боли осталась прежней.
Группы довольно маленькие, по 37-40 человек. Статистическая достоверность различий выявлена только при сравнении группы открытого плацебо без объяснения с объединенной группой открытого плацебо с объяснением + закрытого плацебо.
Вот только это различие и следует обсуждать. Но стоит ли? Гора родила мышь.
Понятно. А конкретные формулировки вопроса на уровень боли не приводятся? Боль такая штука, которая официально "лечится" гипнозом. А вот насколько простые объяснения влияют на объективные показатели лечения от чего-нибудь, что измеряется анализами крови и т.п. – вот это было бы интересно.
Participants in the NT group did not receive any treatment and were told that they are in the “no treatment group”.
All participants in the three other groups (OPR-, OPR+, and DP)
received an inert white placebo cream. However, the provided rationale in the three groups differed.
In the OPR- group, participants were told: “You are receiving a placebo cream. This means that your cream does not contain any pharmacological ingredient, hence it is an inert substance”. No additional information regarding placebo mechanisms was provided to this group.
In the OPR+ group, participants were informed that they are receiving an inert placebo cream. In accordance with Kaptchuk et al. [32], the investigator explained that (a) the placebo effect is powerful, explaining that “it is well known that placebos are very effective, particularly in the area of pain, Parkinson’s disease, depression, migraine, and asthma” and described findings of placebo analgesia and open-label placebo studies. Further, the investigator mentioned that (b) the “body can automatically respond to placebos like Pavlov’s
dogs who salivated when they heard a bell” after explaining the classical conditioning theory.
In addition, “researchers assume that this culturally anchored ritual activates automatic selfhealing processes, which in turn may lead to an effective analgesia”. Finally, the investigator stated that (c) “an advantage of placebos is that a positive attitude can be helpful but is not necessary”. We did not mention the importance of compliance (i.e., taking the placebo faithfully is critical) as in Kaptchuk et al. [32], since our treatment consisted of a single
application of the placebo cream.
In the DP group, participants were told: “You are receiving a generic analgesic cream, which contains lidocaine, the main ingredient used in Stilex [a local anaesthetic commonly used in Switzerland]. The “Antidolor” cream prevents and treats pain or itching related to dermatological diseases such as small burns (…). The effectiveness of lidocaine was proven in several high quality studies.”– while in fact they received an inert placebo cream.
All participants in the three other groups (OPR-, OPR+, and DP)
received an inert white placebo cream. However, the provided rationale in the three groups differed.
In the OPR- group, participants were told: “You are receiving a placebo cream. This means that your cream does not contain any pharmacological ingredient, hence it is an inert substance”. No additional information regarding placebo mechanisms was provided to this group.
In the OPR+ group, participants were informed that they are receiving an inert placebo cream. In accordance with Kaptchuk et al. [32], the investigator explained that (a) the placebo effect is powerful, explaining that “it is well known that placebos are very effective, particularly in the area of pain, Parkinson’s disease, depression, migraine, and asthma” and described findings of placebo analgesia and open-label placebo studies. Further, the investigator mentioned that (b) the “body can automatically respond to placebos like Pavlov’s
dogs who salivated when they heard a bell” after explaining the classical conditioning theory.
In addition, “researchers assume that this culturally anchored ritual activates automatic selfhealing processes, which in turn may lead to an effective analgesia”. Finally, the investigator stated that (c) “an advantage of placebos is that a positive attitude can be helpful but is not necessary”. We did not mention the importance of compliance (i.e., taking the placebo faithfully is critical) as in Kaptchuk et al. [32], since our treatment consisted of a single
application of the placebo cream.
In the DP group, participants were told: “You are receiving a generic analgesic cream, which contains lidocaine, the main ingredient used in Stilex [a local anaesthetic commonly used in Switzerland]. The “Antidolor” cream prevents and treats pain or itching related to dermatological diseases such as small burns (…). The effectiveness of lidocaine was proven in several high quality studies.”– while in fact they received an inert placebo cream.
Вот это принципиальный момент!