Placebo Effect

Medications and other treatments can provide relief from the symptoms of a wide variety of illnesses. However, in some cases, it’s also true that the belief in their effectiveness alone can have measurable health benefits when compare with medical treatment. This is what’s known as the placebo effect, which occurs when an individual experiences an improvement in symptoms of a mental or physical health condition while undergoing a neutral treatment that they incorrectly believe to have active effects. 

The placebo effect is a proven phenomenon that has a range of implications when it comes to medication, healing, and even mental health. Below, we’ll explore the power of the placebo: it’s history, why it occurs, and how it works in real-world examples.

History of research on the placebo effect

In centuries past, many believed that the most important part of a medical professional’s job was to comfort the patient. This belief led to the practice of providing treatments that we now refer to as placebos, which were utilized to help assuage a patient’s concerns until they healed. 

As early as the 18th and 19th centuries, people began to explore the possibility that placebo treatment may have measurable beneficial effects. The concept of the placebo effect was first fleshed out by T.C. Graves in 1920, when he authored a paper that described placebos as having a therapeutic influence on the mind. The term was officially coined in 1955 by Henry Beecher in a paper called The Powerful Placebo.

Since then, researchers have uncovered extensive evidence that placebo treatment can have positive effects and help improve symptoms of a wide range of health challenges. When a person expects to derive benefits from a real drug or other treatment, they tend to experience measurable improvements. In fact, research suggests that a person’s symptoms can improve even if they know they’re taking a placebo. These potential benefits of placebos have significant implications regarding clinical practice and research. 

The role of placebos in clinical trials and on side effects

Placebos have played a crucial role in many studies over the years to determine the effectiveness of treatments, as well as check for side effects, through clinical trials. Researchers and treatment developers use a placebo to determine if a new drug or medical treatment is effective. In a double-blind study, one group of participants (the experimental group) is given an active medication while the other (the control group) is given an inactive medication or placebo—usually salt water, a sugar pill, a placebo pill, or similar. 

In psychiatry, to study the placebo effect, psychology experts conduct clinical trials where one group is given the actual active treatment and another placebo group is given a placebo. If the outcomes for both groups are similar, the medication or treatment is often thought to be ineffective. Complicating these results, however, is the fact that participants who take placebos in double-blind studies often experience measurable health benefits as well. Researchers may also ask study participants to report whether they experience side effects as a result of either the active or inactive (placebo) treatment. 

Researchers then look at the treatment outcomes and if the placebo-labeled treatment presents a therapeutic benefit lower than the active medical treatment then the new treatment is considered effective.

Can a sugar pill improve well-being? How placebos work

Throughout the years, there has been extensive debate about why exactly placebo occurs. More recently, studies have found that the mind-body connection may help explain the placebo effect. For example, a 2014 study in Science Translational Medicine, of people who experience episodic migraine attacks found that placebos showed some efficacy for pain relief. In fact, as the study states, the placebos “accounted for more than 50% of the drug effect.” Researchers concluded that the participants’ belief that they were taking the actual medication could increase its efficacy and help relieve pain. 

According to the American Cancer Society, the placebo effect may explain why many people continue utilizing alternative medicine techniques that do not have proven therapeutic effects. Additionally, some experts have suggested that the benefits of the placebo effect can be increased through the doctor-patient relationship. In one study, researchers concluded that medical professionals can facilitate a more powerful placebo effect through comprehensive discussions of treatment, patience, and a caring attitude.  

There is an opposite effect that can happen when an individual anticipates negative effects from new treatments. The nocebo effect occurs when a person’s expectations that a modality will be ineffective or damaging lead to poor outcomes. Research suggests that people who are given information about a placebo’s negative effects can experience those adverse events, despite the fact that it isn’t an actual drug. For example, if an individual is told that they will experience a sharp pain in the abdomen or uncomfortable tingling in their hands when taking a placebo, they may be more likely to experience these effects. It is thought that, like the effects of a placebo, nocebo effects occur due to the activation of certain neural pathways in the brain that influence physical sensations. 

Benefits of the placebo effect: Blood pressure, pain relief, and mental health

Because placebos have been used extensively in studies of medications and other treatments, there’s a large body of research that suggests the placebo effect can improve symptoms of various health conditions. Studies show that the placebo effect can engender measurable improvements in areas as varied as blood pressure, gastrointestinal health, and athletic performance. The following are examples of benefits to mental and physical health concerns that the placebo effect can provide. 

Understanding Parkinson’s disease

One study sought to find out how placebos might improve the conditions of people with Parkinson’s, a brain disorder that causes uncontrollable movements and issues with coordination and balance. Through PET scans performed on participants who were given placebo pills, researchers discovered that their brains were releasing dopamine in response to the inactive treatment. Researchers concluded that this release is the reason for the established efficacy of placebos when treating Parkinson’s.

Improving irritable bowel syndrome (IBS)

Irritable bowel syndrome is a relatively common disorder that causes gastrointestinal problems like abdominal pain, diarrhea, and constipation. In one study, people with IBS were given either no treatment or a placebo acupuncture treatment, either with or without supportive interactions with a doctor. Both placebo groups had better results than the group with no treatment with regard to pain intensity. It's also important to note that those who received supportive care from a professional along with the placebo treatment had even better results.

Alleviating symptoms of mental health conditions

Placebos have also been successfully utilized in the treatment of various mental health disorders. In one study, for instance, researchers examined the benefits of an antidepressant compared to those of a placebo sugar pill when treating unipolar depression. PET scans of the brains of both groups of participants—those who received a placebo and those who received an antidepressant—showed an increase in cortical glucose metabolism and a decrease in paralimbic activity, which helped to reduce symptoms of depression. Researchers noted that the active approach to pursuing treatment—even if it was a placebo—helped boost the mood of participants and improve their symptoms. However, the antidepressant brought about additional brain changes that gave participants further relief.

In another study, researchers gave participants placebos that were labeled either “serotonin” or “oxytocin” and asked them to self-report stress-related symptoms, anxiety, and depression. Researchers found reductions in all three areas, leading them to conclude that placebo treatment could potentially be part of an effective treatment plan based on the provision of information to patients (i.e., telling the individual they were taking a specific medication). 

The placebo effect can offer pain relief 

Medical research suggests that individuals taking a placebo can experience tangible improvements in pain symptoms. According to a study published in the journal Pulmonary Pharmacology & Therapeutics, this is partly due to endogenous opioids, which facilitate one of the body’s pain-management systems. Researchers in the study also state that even a real treatment can have a powerful placebo effect on pain symptoms (cough suppressants are estimated to primarily work because of the placebo effect). 

Studies show that even when participants know they’re receiving fake treatment, they can experience pain reduction. Open-label placebos (OLPs) are placebos that patients take while being aware that they have no therapeutic properties. In a clinical trial examining open-label placebo effects on pain, researchers found that participants taking the OLP experienced significant reductions in pain. 

Harnessing the power of the mind through mental health treatment

As studies observing the placebo effect show, the mind can be a powerful healing tool for chronic pain. Another way to harness it is through therapy—especially a modality like cognitive behavioral therapy (CBT), which aims to shift emotional responses and behaviors by teaching an individual to notice and adjust unhelpful thought patterns. 

Research shows that therapy—whether online or in person—can be a useful form of active treatment for various mental health-related concerns. In a review of over 90 studies on the efficacy of online therapy in particular, researchers concluded that online therapy can reduce the symptoms of a range of disorders and can be as effective as in-person treatment. For those who prefer the convenience of speaking with a therapist from the comfort of home, online therapy is a viable option.

With online therapy through a platform like BetterHelp, you can find out more about how to use your mind—through reframing and other methods—to improve your mental health. You can participate in therapy with a licensed provider completely remotely, via video call, voice call, and/or in-app messaging.