Exploring the Placebo Effect in the Therapeutic Relationship

hope-thumbnailEver heard someone say, “That’s just the placebo effect” and been confused? Me too, which is why I turned to Hope DeVall Morgan—licensed massage therapist, reiki master, yoga teacher, and continuing education provider—to discuss placebo effects and massage therapy research.

Below you can read her very thought-provoking guest post, “Exploring the Placebo Effect in the Therapeutic Relationship.”  And, if you scroll down, you can also watch my interview of Hope where we discuss what the placebo effect is and how it’s related to massage therapy. Enjoy, and thanks, Hope!

 

Exploring the Placebo Effect in the Therapeutic Relationship, by Hope DeVall Morgan

In a time of swift changes in the field of Massage Therapy, there has been a shift from a history of intuitive based practices, towards a greater understanding and utilizing of scientific research. While this is something we have wanted as a profession for a long time, the research doesn’t always turn out the way we’d like.  As we gain knowledge and understanding about how we affect our clients’ bodies physically, often we are required to modify our long held beliefs about the effectiveness of different techniques and modalities.  For many of us this is a very difficult task because we have worked with these techniques for years and have seen, felt and experienced real changes in our clients’ therapeutic outcomes.  How can these physical changes occur so frequently, yet scientific evidence is unable to validate these methods when tested against a placebo?

In search of answers to this difficult question, we must first be able to fully grasp what the placebo effect is.  Most of us have a general understanding about what the placebo effect means, but I would like to dig a little deeper here and discuss its role in the therapeutic relationship.  In Latin, the word “Placebo” literally means, “I shall please”.  A placebo is a pretend or non-existent treatment for a condition with the intention to deceive the recipient into believing that it is real. The Placebo Effect is when the recipient of a placebo treatment has a perceived or actual improvement.  Each of us has likely experienced the placebo effect at some point in our lives.  Think back to your childhood, to a time when you fell and scraped your knee or elbow.  It hurt! The pain and tears were real. But once mom put that Band-Aid on and sealed it with a kiss, like a medicine, you were as good as new.

Often we misunderstand this to mean that with the placebo, an individual gets better through the power of positive thoughts or mind over matter.  Unfortunately, it seems a belief in The Secret will not cure cancer.  That sobering fact does not change the apparently miraculous results recorded in decades of clinical studies.  In fact in many trials, participants (up to 30-40%) have had significant positive perceived and/or physiological responses to a sugar pills or sham treatment.  In some cases, placebo effects have been shown to be equal to or exceed the effects of “real” treatments.  To date, we still do not fully understand why.

Since the 1960’s placebos have been used as a means in which we evaluate a therapy’s validity.   They have also served as an illustration of the powerful connection between our mind and body creating conflict between our understanding of psychology and biology.

In an attempt to bridge the gap between these two fields of study, research in the field of neuroscience may offer a new perspective.  A review titled, ‘Placebo and the New Physiology of the Doctor-Patient Relationship’, by Dr. Fabrizio Benedetti, provides a thorough explanation of his research and new findings that help us understand the biopsychological way in which placebo effects patients and ultimately what role the therapeutic relationship plays in the outcome. This review has given any practitioner involved in healthcare something to think about.

Here are a few examples discussed in this review which may be relevant to our work as massage therapists:

  • “Any health related treatment is surrounded by a psychosocial context that affects the therapeutic outcome.”  The data from this research indicates that different social interaction, such as words and rituals of the therapy, may actually change the chemistry of the patient’s brain. 
  • This study reminds us that there is no one way in which the placebo effect works.  For example, it involves the brain mechanisms of expectation, anxiety, reward, and the cognitive and social ways in which we learn.
  • “Expectation has an effect on the brain and body, and is required for the placebo effect to work. The expectation elicits improvements through a reduction of anxiety, reward or positive reinforcement.”
  • “The complexity of the psychological state of the patient during the course of treatment; including the perception of the treatment, the setting and experience can influence therapeutic outcome.”
  • “When the expectation is removed, for example when treatments are administered without patient knowledge there is no placebo effect. Note: this is also true for the efficacy of drugs administered without a patients’ knowledge.”

In this knowledge we must be willing to entertain the possibility that many factors occur in which our clients are able to respond to treatment, and not all of them have to do with our techniques or methods.   This study helps us understand how and why our clients’ perceptions, thoughts, and emotions play such an important role in the therapeutic outcome.  In light of this new and exciting evidence, we have enhanced our understanding of how a healthcare practitioner’s words, attitudes, and behaviors may impact the physiological response of their clients. This research further emphasizes the importance of a professional’s ability to be empathetic and compassionate in all forms of treatment.

This review provides evidence to the idea that patient care is indeed an art AND science.  Words spoken best by Voltaire, “The art of medicine consists of amusing the patient while nature cures the disease.”

 

References:

http://www.ncbi.nlm.nih.gov/pubmed/23899563

http://serendip.brynmawr.edu/bb/neuro/neuro99/web1/Kinser.html

http://www.sciencedaily.com/releases/2013/09/130919201241.htm

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3055515/

 

Hope DeVall Morgan is a licensed massage therapist, reiki master, yoga teacher, and continuing education provider. She and John Morgan are owners of Mind Body Connection, an Asheville based center for Massage, Natural Health and Wellness.

 

Comments from original Massamio post:

I am a qualified Ayurvedic Massage Therapist – practicing for more than 20 years [in Pune, India.] I found your blog very much interesting.   Well, our whole thinking process is always within the limit of some Logic boundaries. So, any healing process beyond our Logic understanding is labelled as ‘placebo’. That’s all.
I translated your blog into our language (Marathi) and mailed it to my many colleagues in massage field.
Well, massage therapy also requires an “integrated medicine” approach. Many other disciplines like Ayurveda, Homeopathy, TCM should be taken into consideration while taking the case of your patient / client.
For example, if my patient is complaining of acute pains in the RIGHT side of his body, I give him a few doses of Sanguinaria ( a homeopathic medicine ): that may prove to be valuable in palliating his pains. So, he finds massage treatment more comfortable.  There are so many other ‘sub-therapies’ like Cupping, Pinda Sweadanam, Basti etc. that are required to be included in the total package of massage therapy.  My warm thanks to Hope DeVall Morgan for her beautiful Blog! — Posted @ Thursday, February 13, 2014 1:35 AM by chandrakant kulkarni