Written by Elif Gulce Batgi
Nick Sitzman, a restaurant worker, was staying in the restaurant that night. While he was working, he needed to grab something from the freezer. When he opened the door of the freezer and went inside, the door was locked behind him. He pushed the door, but he couldn’t open it. He kicked the door and gradually started to feel anxious. After a while, he accepted the fact that there is no exit and left himhelf to his fate. He was sure that he would die, he believed it so hard. He found a paper and pen to leave a message for his family. Finally, he died in the middle of his sentence.
That seems like a good story for those who are looking for motivational speeches. In fact, this story is unreal. Even though, brain is one of the most complex systems that humanity has ever seen, some physiological truths can not be affected by those thoughts. However, the brain still has a strong power on our body. The story would be told as the man was anxious and it caused stress, which caused irregular heartbeat, and finally he had a heart attack. The line helps us to differentiate these two stories by causing death indirectly. In the second story we can see that thought doesn’t directly affect the human body, there are steps which are more likely to occur compared to the first story.
The thing laying under physiological reactions is the placebo effect itself. Placebo effect is all about experiencing a benefit after administering an inactive substance and treatment that seems like one (1). The effect is usually used in experiments to test the validity of the outcomes. In an experimental setup, two groups are created and groups are randomly assigned to either the placebo or real substance or treatment (2). In addition, individuals are not aware whether they are exposed to any substance or treatment model. The studies that individuals don't know what they are being exposed to are called single-blind studies. whereas even researchers don’t know what is administered to which group is called double-blind studies. Double-blind method is mostly preferred to prevent them conveying demand characteristics to participants that might influence the study results (2).
(Image Credit: https://www.scribbr.com/research-bias/placebo-effect/.)
To see how the placebo effect works, we can break the stages into four steps.
Expectation and Conditioning: The most powerful part of the placebo effect lies under expectations of individuals taking the drugs, whether it be real or placebo. This expectation may cause a drop in stress hormones and cause them to recategorize their symptoms as well (3). On the other hand, if the individual doesn’t believe that the substance will affect him/her, or expect any side effects, the substance may result in negative outcomes. In such circumstances, placebo is referred to as nocebo (3). It is also believed that classical conditioning is related to the placebo effect. People who use medication feel better, meaning it elicits a positive response.
The Placebo Effect and the Brain: Brain imaging studies demonstrate measurable effects that occurred in the neural activity of people experiencing placebo analgesia. The part of brains affected by the impact involves brain stem, spinal cord, amygdala, and nucleus accumbens (3). Strong placebo responses can lead to an increase in dopamine and opioid receptor activity, whereas nocebo causes reduction on them. Both chemicals are included in reward and motivation pathways in the brain.
Psychoneuroimmunology: It is a new area of scientific study focusing on brain activities’ direct effects on the immune system. Similar to how dogs salivate to the sound of the bell, which means it is conditioned, so can mice use conditioning to restrain their immune system when presented with a specific stimulus. Indeed, a positive attitude during the illness can help the recovery process and immune system.
Evolved Health Regulation: The evolved health regulation theory represents that a strong belief in a medication might relieve symptoms (3). The brain “decides” if it is needed to mount the appropriate response, such as fever or pain.
(Image Credit: https://sciencenotes.org/placebo-effect-what-it-is-and-how-it-works/.)
For many years, the placebo effect has been considered a sign of failure. Placebo is used in clinical experiments, mostly drug studies, to measure the effectiveness of a substance or treatment model (4). Two groups are constituted. One group is given active and the other group is given inactive drugs. If the reactions of each group are the same, the drug is not effective and fails. However, recently it has been found out that similarity of directions are not evidence of effectiveness of drugs, presentation of a non-pharmacological system instead (4).
Moreover, ethical dimensions of placebo effect in clinical trials such as using sham invasive procedures, withholding potential proven treatments, or deception are issues of concern in studies (5).
In conclusion, the placebo effect shows our brain has control on our physiology, but not able to affect us directly. Additionally, common stories should’t be believed and people must be told that these stories are hearsay and for motivation by giving the message that we can achieve anything with believing.
References:
Cherry, K. (2022, September 12). What Is the Placebo Effect? Verywell Mind. https://www.verywellmind.com/what-is-the-placebo-effect-2795466.
Nikolopoulou, K. (2023, March 6). What Is the Placebo Effect? | Definition & Examples. Scribbr. https://www.scribbr.com/research-bias/placebo-effect/.
Newman, T. (2017, September 7). Is the placebo effect real? https://www.medicalnewstoday.com/articles/306437#examples-of-the-placebo-effect.
Harvard Health. (2021, December 13). The power of the placebo effect. https://www.health.harvard.edu/mental-health/the-power-of-the-placebo-effect.
Munnangi, S. (2022, June 23). Placebo Effect. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK513296/.
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