The Stress Resilient Mind Blog
The Placebo Response, How It Works & How It's Relevant In Biofeedback Therapy
The placebo response is that facinating medical phenomenon whereby people actually improve in spite of receiving some "fake" treatment such as an inert pill. The placebo response is usually attributed to the power of belief. I have a different idea.
The placebo response is powerful. Many will have heard the famous case of Mr Wright, who in 1957 was diagnosed with cancer and had just days to live, when he heard of a new treatment and begged to be given it. His doctor eventually agreed and injected him - with water. Mr Wright made a "miraculous" recovery - his tumors "melted like snowballs on a hot stove". But then Mr Wright found out the drug had proved ineffective in trials, and relapsed. His doctor gave him a further injection - again water - but this time saying it was a super-refined form of the drug. Mr Wright again recovered - but only temporarily and later died.
Of course one case doesn't prove anything, but the placebo effect is an established fact. In medical research, new druges must prove themselves to be superior to placebo. In trials, the control group gets a placebo (e.g. a sugar pill) without knowing whether it's the drug or the placebo. Typically about a third of the placebo-receiving controls show improvement (though I believe it tends not to last).
Placebo responders aren't simply deluding themselves that they feel better - there are objectively measurable physiological effects from a placebo. Jo Marchant, in her excellent book "Cure: A Journey Into The Science Of Mind Over Body" reports a brain imaging study where Parkinson's disease patients underwent a measurable recovery of brain function after receiving placebo.
It can't be "merely" belief or expectation either - there are plenty of studies that show a real placebo response even when the subjects know they are being given an inert substance.
So what is the key to the placebo response? I think it's down to the power of imagination.
I think this relates to something fundamental about the way the mind works: it's an experiential simulator. If I ask would you like tea or coffee, some part of your mind (or brain if you prefer) asks what would it be like to have tea, and to have coffee, and then it creates something of the experience (albeit not the full blown thing). That's how you know to have tea or coffee - it's not a reasoned decision but a felt sense.
This kind of experiential simulation happens every time you wonder what it woud be like if X happened, or if you did Y. You feel something of how it would feel.
Being in a medical trial, you're bound to wonder what it would be like if I got better. I think this is key to the placebo effect, and also to the power of suggestion, even indirect suggestion (e.g. in hypnotherapy).
That's not to say I've come up with a comprehensive explanation of placebo - there's still a huge mystery gaping there.
I've noticed the imagination plays a similarly important role in biofeedback therapy. Let's say I've connected a client up to measure their muscle tension (i.e. for EMG biofeedback). It's common to see that they don't really know how to fully relax consciously, but they can respond non-volitionally to ideas, suggestions, even just questions.
For example I might ask, do your shoulders feel loose, or do your shoulders feel heavy? To answer the question they have to wonder what it would feel like if the shoulders were loose or heavy - and then the shoulders relax. Not through effort or willpower but quite automatically, without trying.
So I noticed that imagination is often a much more effective way to invoke clients' resources which lie at a non-volitional or sub-conscious level of the mind. My clients recognise it too, and I teach them to consciously use the power of imagination.
Other therapists and medical practitioners should too - the placebo response is not just an awkward problem that makes life difficult for medical researchers, but a powerful force for healing.
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READ MORE ABOUT BIOFEEDBACK FOR STRESS MANAGEMENT
How To Manage Your Mind With Biofeedback & Mindfulness
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- Underlying dynamics in stress & anxiety
- Science of the mind-body connection & how it can be applied
- Why breathing is at the heart of stress management
- Practical models for framing self-control challenges & solutions
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