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Placebo

Look on the Bright Side Because Your Mindset Always Matters

Our belief in outcomes can alter efficacy of treatment and achievement.

Key points

  • Folks will always have some kind of an expectation of a treatment outcome.
  • An expectation of a benefit can produce outcomes that rival those of actual treatment.
  • This is especially amplified when the treatment is applied directly to the brain but is widely applicable.

We have all experienced how our expectations can influence our reactions, including our enjoyment or lack thereof of any event or interaction. Belief and confidence set the tide level for background efficacy, and everything we experience is superimposed on that. But how much can we actually influence physiologic responses by our psychological perceptions?

Thinking it sets the stage for being it

In neurotherapeutics, placebo responses in the so-called "control" group are typically used as a comparison for the effectiveness of treatments. Yet, individual experience and expectations and the effects these might have on responses to treatment are not accounted for in this model, a particular concern for studies on neuromodulation. To address this issue in a rigorous and deep statistical way, Luisa Fassi, Shachar Hochman, Zafiris Daskalakis, Daniel Blumberger, and Roi Kadosh in the United Kingdom, United States, and Canada published a paper, "The importance of individual beliefs in assessing treatment efficacy," that synthesized data from four prior studies.

These studies were about neuromodulation—temporarily stimulating the brain for the treatment of depression, attention-deficit/hyperactivity disorder (ADHD), and mind wandering. The analysis of Fassi and colleagues showed that, in two studies, subjective perceptions and expectations of treatment status were clearly more predictive of changes in mind wandering and depression than was experimental treatment. For the other two studies on depression and ADHD, the results were mixed. The important takeaway here is that including subjective beliefs about treatment is probably necessary both in applications of and treatments with neuromodulation as well as other modalities.

Placebos are real and powerful things

The fact that belief in a neuromodulatory treatment outcome can rival or exceed the treatment itself should not be interpreted as treatments being ineffective or magical thinking. Rather, we can enable or disable a large amount of physiological and psychological responses by how we precondition ourselves. You cannot literally think yourself well, but you can think yourself to receive wellness assistance.

I think this comes up in a lot of interventions, whether the treatment is pharmaceutical, behavioral, exercise, or whatever, and the concept of placebo comes up. A lot of times, different interventions are listed as "no better than placebo," as if this is a kind of failure. In the view I'm trying to advance, it's actually a failure to understand what placebo is, and that the idea of placebo is not best served by the word placebo.

Instead, placebo becomes a thing to focus a person's belief and enable potential success. Some people probably can do this without anything special. They're able to adapt how they think and how they behave in ways that lead to better health outcomes almost automatically and with no thought whatsoever. But others require a focal point for the belief. Perhaps it's the white pill; perhaps it's the certain way to do journaling; perhaps it's the certain mindfulness practice. These all do things, but they also gain additional traction by being a focal point for belief in something happening.

Monty Python was right to tell us to always look on the bright side of life

Some people require a thing to believe in when they can't believe in themselves. Or not yet, in any case. These results suggest empowerment of the end user. Things like this would certainly not have been ignored in Eastern thought, but certainly with Western traditions. The idea of separating brain and body has persisted and been pervasive in preventing an understanding of holistic health. Really, what we're talking about here in Western scientific terms would be integrative systems physiology—that is, understanding that the whole body and all its systems work together in concert to produce health. If we can leverage access to better interactions and function across and within multiple systems in the body, and if that arises from something that we might still call a "placebo effect," better health is still the outcome.

© E. Paul Zehr (2025)

References

Luisa Fassi, Shachar Hochman, Zafiris J Daskalakis, Daniel M Blumberger, Roi Cohen Kadosh (2024) The importance of individual beliefs in assessing treatment efficacy. eLife 12:RP88889. https://doi.org/10.7554/eLife.88889.3

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