Small safe experiments and ‘contextual healing’ (or placebos).

Much has been written in medical science about placebos and I comment on the ‘‘placebo’ here. It is a strange phenomenon that sees people with well-established medical conditions, e.g. pain,  ‘get better’ without medicine.

The placebo effect is a psycho-biological phenomenon. Little is understood about it and it seems to arise from a number of different mechanisms. These include our own expectations – sometimes, if we expect to improve, we can. Also, there are matters relating to how we learn to be in good health. We are not always aware of how we learn and adapt. In the web page on Tapping I talk further about the practicalities of the ‘placebo’.

Therefore, there is not a single placebo effect, but many. Indeed, there is the ‘nocebo’, when the ‘evil spell’ is cast and ‘bad’ things happen to us without any obvious explanation.

All these effects are important complications in treatment; medical science can appear to offer effective treatment, seemingly,  by ‘doing nothing’! The tricky word here is ‘nothing’. and there is a whole book that provides some fun reading!

The placebo feature is a big topic in its own right and curious folk might want to look at. One starting point might be:

https://drysdaleosteopathy.wordpress.com/2013/09/22/a-placebo-conundrum-by-michael-brooks/,   or

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6725834/

Here’s what Christian Jarrett had to say about it in the February 2021 BPS Research Digest

“The Placebo Effect Is A Bit Of A Pain For Many Psychology Researchers

The placebo effect is fascinating in its own right, but for researchers interested in establishing the efficacy of psychological interventions, it can be maddening. The influence of expectations on our thoughts, feelings and behavior is so powerful and pervasive that it complicates the interpretation of many studies, unless they are very carefully designed. In their 2013 paper titled “The Pervasive Problem With Placebos In Psychology“, a team led by Walter Boot at Florida State University argued that in fact many psychology studies (on things like brain training, expressive writing and internet therapy) do not do enough to match participants’ expectations across different conditions. They explain that simply having an active control condition is not adequate if participants in the control group do not expect it to have as beneficial or powerful an effect as participants in the intervention condition expect of their experience. The way around this, Boot and his colleagues explained, is to measure participants’ expectations and take steps to try to match them across control and intervention conditions as much as possible. “‘We are hopeful that, with better designs and better checks on placebo effects, future research will provide more compelling evidence for the effectiveness of interventions,’ they concluded.

The Placebo Effect Appears To Be Getting Stronger

Curiously, it’s become apparent in recent years that the placebo effect is getting stronger – this has been shown for placebo antipsychotic medications, placebo anti-depressants, and – in the US only – for placebo analgesics. With regards to that last finding, research team leader Jeffrey Mogil told Nature News, “We were absolutely floored when we found out”. Specifically, in the 90s, they found that participants receiving an active drug reported 27 per cent greater pain relief than participants receiving placebo, but by 2013, the difference was just 9 per cent. One explanation is that drug trials have become larger and more elaborate, especially in the US, thus increasing the drama and intensity of the experience for participants only receiving placebo.

Another possibility is that the general public has become more aware of the placebo effect – and of the idea that its impact on symptoms can be real (as reflected in less pain-related brain activity, for instance) and not merely illusory. That was the argument put forward by anesthesiologist Gary Bennett in the journal Pain last year. In fact, Bennett goes so far as to suggest that, because the term placebo now elicits such a strong placebo effect, its use should be dropped from drug trials. “The word ‘placebo’ should be avoided in all information and instructions given to the patients,” he advises. “Patient instructions should have the goal of forcing the patient’s expectations to the form: ‘I may receive pain relief’ vs. ‘I will not obtain pain relief’.”

However hard we try to control, conceal and comprehend the placebo effect, it looks certain it will continue to baffle and amaze us for a long time to come.”

From my point of view, the small safe experiment can use the placebo effect.  small, safe experiments can provide both clear and present results, as well as less easily understood ones. For that reason, I speak of ‘small victories’ – when the result is clear and helpful, as well as ‘small defeats’ when the results are unclear and discomforting.

Both are essential to making changes.

The small, safe experiment can be ‘context healing’ in action.

Your actions bring change, one way or another, and you did it. You make change by taking actions within your own world – not mine, not your doctor’s or your parent’s or your children’s – but within your own life, as you understand it.

This notion of “contextual healing”; was a phrase used by two researchers.

So what is ‘contextual healing’?

In an article, published in the early 2000’s,  Miller and Kaptchuk say the idea of ‘placebo’ should be ditched. They suggest that doctors and researchers should think in terms of “contextual healing” –  an aspect of healing produced, activated or enhanced by the context of the clinical encounter, rather than by the specific treatment given.  Healing resulting from the clinical encounter arises from interactions between the treater-and- treated. Those interactions, alone,  can improve the condition of the treated – and, indeed, possibly the treater. Many people I have met have added much to my life.

Such healing, activated by that encounter, is distinct from healing that arises from specific treatments, a prescription for tablets or physical manipulations. Elsewhere on this web site I have emphasised how the relationship between treater-and-treated is more important than the ‘medicine’ that is on offer.

How might ‘placebos’ help you design your own safe experiments? Much depends on our belief in self and the positive outlook you may have about ‘life’. This is tricky, as many of us seek help and support precisely because we are sdoubtful about our levels of self-esteem after life dealt us a number of  bad experiences. However, some of the pages listed below specialise in focusing attention on improving self-esteem.

A sample of small, safe experiments can be found at:

Affirmation work

Assertiveness

Relaxation

Tapping

Getting down to safe experiments

Practical meditation

My suggestions for helping yourself

 

Return to:

Welcome

What is a nudge

How to design a safe experiment