Hope is a placebo for conscious living
"The more Klimbim there is, the more effective a placebo"
Mr. Gaab, when someone puts a rock crystal in front of the computer to get rid of a headache, is it just imagination or does the crystal work?
If we believe in it, it can be of use. I don't know any research on rock crystals. But belief alone can have an effect.
You are a psychotherapist researching the placebo effect. How do you define placebo?
What we understand by the placebo and also by the opposite, the nocebo effect, is something that is communicated socially. That someone else tells me: The rock crystal can help you.
Effect without active ingredient - the placebo effect
Placebo is a drug that does not contain any active ingredient, but which can still have an effect. Therapeutic measures can also have a placebo effect. The opposite is the nocebo effect: a harmful effect without a harmful influence.
How do you research this effect scientifically?
We do studies. That means we create a study plan, which we send to the ethics committee, which has to give the okay. Because the use of placebos is actually not allowed. A doctor is not allowed to give a placebo.
Healthy volunteers or sick patients are then included in our studies. We give them a pill, a cream, a nasal spray, or some kind of psychotherapy that isn't really any. And we say that this is a real drug, a real therapy. Then let's see what happens. For some we say that placebo is included, for some we don't - or only afterwards.
Can you measure the placebo effect?
We can demonstrate very well in the brain what happens when a placebo is given. The pain system reacts on different levels. If, on the other hand, we briefly switch off part of the brain, the so-called frontal lobe, using magnetic fields, there is no such effect. This shows that the frontal lobe, where we think, where we perceive our ego, is necessary for the placebo effects.
Is there any other way to prove the effect?
We can also demonstrate physiological placebo effects: When pain occurs, opioids, i.e. the body's own painkillers, are released in the body. For example, when we are in shock, we do not notice the pain because the brain initially floods everything with opioids. A side effect of this is that the breathing rate becomes slower. Breathing is also reduced when we give placebo - because opioids are released in the brain. So the effect is real.
Jens Gaab talks to Beat Glogger about the placebo effect.
How does it work in the clinic?
Patients with headaches want the pain to go away. When I offer them a drug, even if it's not, there is a lot of hope and expectation. And that has a powerful effect.
Apparently, the color and size of the pill also play a role. A red looks more than a white one, a big one more than a small one ...
... a large one, one syringe more than a pill, has two more small ones: the more invasive, the more cluttered there is, the more effective a placebo is. And that brings us to an important mechanism of action of placebo: It has to be plausible - you can also say that there has to be a somehow believable story behind it. The second mechanism of action: the placebo must be in a therapeutic relationship. This is the case when someone goes to a doctor, a physiotherapist or a psychotherapist. Someone takes care of you in a very friendly manner and you are understood. Half of the therapeutic success is the placebo effect.
Do placebo work equally well for everyone?
If someone is optimistic, they are more likely to have placebo effects. Gamers and people who are more likely to take risks also have more placebo effects. There are genetic dispositions for this: People who are more likely to react with the so-called dopaminergic system show a stronger placebo response.
You said the administration of placebo is not allowed in medicine because it is considered unethical. Isn't conventional medicine forgiving itself if it doesn't use placebo more consciously?
On the contrary, I would say it is unethical not to use placebo. But placebo is used in every treatment anyway.
In what way?
If you have a doctor whom you fully trust and she gives you a real medication, then there is always a placebo effect in the effect of this medication.
Studies show that in chronic intestinal inflammation, for example, up to 40 percent of the drug's effect is based on the placebo effect.
In operations it is even two thirds. There is a very famous study of knee operations on people who were, on average, a little over 50 years old. They were in severe pain, and some of them could hardly walk. Then an operation was carried out. In one group you made a small incision in the knee and went in for an arthroscopic procedure, milled something off, rinsed with salt water. The other group only made the cut and rinsed, and a third group only cut open and sewn up again. So it was a placebo operation - the placebo is the scar that the patient sees afterwards. Then you measured how people were doing for over two years. Placebo was just as good as the other surgeries!
Research shows that placebos work. But as a doctor, you can't use placebo therapy because it's unethical. How can you still use the effect?
Today we give openly declared placebos. That means, we say: “This is a placebo. You don't have to believe in it, you just have to take it regularly. " Even that works! The next step would be not to give any placebos at all, just to say: «Imagine you are taking a tablet. They swallow you down, it reaches the bottom, it dissolves. You notice the effect. " We are currently investigating this «imagined pill». Initial results show that it works.
"Psychotherapy and placebo are actually the same interventions."
This is more likely to be suggestion or hypnosis.
This is psychotherapy. From this we can also see the connection between placebo and psychotherapy. Both work with the same mechanisms.
Are the boundaries fluid?
Yes, psychotherapy and placebo are actually the same interventions.
As a psychotherapist, what is it about placebo research that fascinates you so much?
That we discover the genuinely human, the social that happens between people. Interestingly enough, psychotherapy also emerged from the placebo.
Around 1760 a certain Franz Anton Mesmer invented "animal magnetism". That is what rock crystals and homeopathy is probably the continuation of today. Mesmer claimed that he could influence animal, not physical, magnetism. He claimed that this way he could relieve people of their headaches. And it worked wonderfully. Mesmer became famous. But then there was a commission to investigate it. People have been "treated" in front of a curtain. And regardless of whether there was a "therapist" behind the curtain, the therapy worked because people believed in it. As a result, Mesmer's therapy was dismissed as nonsense. But this animal magnetism lived on, then became a kind of hypnotic sleep, and this ultimately resulted in hypnosis, psychoanalysis and psychotherapy.
So it's about being touched psychologically as a person.
This is what the placebo taught me: Therapy is not just the application of substances, but a very social, very touching, very personal process. I find it interesting that I learned that from the placebo. I completed a degree in psychology and psychotherapy training. I didn't learn any of that then.
If you compare conventional medicine and homeopathy, you often hear: the homeopath takes a lot more time. So does homeopathy work simply because someone receives attention?
In fact, I have avoided the topic of homeopathy so far because it leads to uncomfortable controversy. And then you always get emails from people who abuse you and things like that. But in the end I would say: yes, homeopathy relies on placebo.
"Placebo cannot stop physiologically detectable pathological processes."
There are other things, like spiritual healers, for example. They are ridiculed by many and dismissed as fraud. Is that wrong? Because it ultimately works for those who believe in it.
I think we should always be respectful of personal decisions. If someone is with the spiritual healer and finds it good, then it is a personal choice. What I don't like is when a spirit healer insists that there are spirits.
As a psychotherapist I would say with certain things: "I believe in it, I have had good experiences with it, whether it can be scientifically proven is rather difficult." The other person can then decide whether he or she wants to accept that or not. We have to acknowledge personal experience. But when the personal is made into science, it is difficult.
Where are the limits of the placebo effect? What can't placebo do?
Placebo cannot stop physiologically detectable pathological processes.
But the osteoarthritis in this knee, it was there ...
Here comes the but: We cannot cure cancer with placebos. It does not work even with a severe infection. That is why we are not even allowed to test placebo in research in certain areas because patients may die. That is clear.
On the other hand, with HIV infection, for example, we know that patients who are in a relationship live longer. We see that psychological and social factors also play a role in other serious somatic diseases. The social relationship is an active factor in placebo. Social relationships have an impact on the course of illness. And if I come back to the osteoarthritis of the knee: This osteoarthritis is probably not influenced by placebo.
A placebo can help reduce side effects, such as chemotherapy.
But people were doing better.
Exactly. Of course you can do something surgically, there are also certain medications, but the doctor recommends exercise. This is the common therapy for osteoarthritis. Move your leg, don't focus on the pain, try to deal with it.
Now I'll get a placebo operation, then go home. It still hurts. But I say to myself, “It's probably good pain. It is probably healing right now. " And then maybe I'll go for a walk a little more, maybe I'll sleep better, maybe I'll go dancing with my wife again. And all of this has an effect on the knee. Such processes can also be physiological, so they only have to do with the placebo indirectly.
To be clear, placebo won't get rid of HIV infection and cancer, but it can help deal with them and it can improve the quality of life.
If the somatic disease progresses, the placebo has no chance. But it can help reduce side effects, such as chemotherapy. If we also give placebos and tell the patient: “This placebo can help you reduce the side effects”, then that works. Of course not against the cancer, but chemotherapy may be better tolerated. And because of that, the cancer progression may be better.
Similar mechanisms can also trigger negative effects. People talk about the nocebo effect. The prime example: a man wanted to commit suicide, he has collected pills from his brother, who took them as part of a clinical study. The tired of life then suffered a circulatory collapse and ended up in the intensive care unit. His condition was life threatening. In the end it turned out that the brother was not treated with the active ingredient, but with the placebo. So the imaginary tablets even triggered an emergency.
I keep hearing these anecdotes at congresses, but have never seen a scientific article on them. In fact, there are nocebo effects. A few years ago, Coca-Cola fell into disrepute in Belgium. It was said that any contamination caused poisoning. The symptoms of poisoning spread like an epidemic: in schools, among teenagers who had drunk Coca-Cola. The contamination could never be detected, in the end it was probably a nocebo effect.
A myriad of side effects are stated on medication leaflets: headache, dizziness, nausea, rash, depression, cardiac arrhythmia, and so on. Shouldn't such leaflets be banned?
In fact, that is being discussed. So not to forbid it, but to deal with it differently. Side effects of drugs are triggered by drugs - and by knowing that they have side effects. One way of dealing with this would be for the doctor to say, “Do you want to be informed about side effects? Because if I let you know, the chances are that you will. If you don't want it, I won't tell you. "
"I have to incorporate the patient's goal into my therapeutic concept, even if I cannot understand his or her suffering."
Cell phone antennas, for example, also have side effects. I don't know of any serious, scientific report that could prove radiation sensitivity. But there are people who suffer from the rays. That would be nocebo, right?
I don't know the research on radio waves in detail. But there are studies on wind turbines in New Zealand, for example. They make very deep tones that are supposed to be harmful - it is said. These tones were then "neutralized" and the complaints promptly disappeared. So you can also treat the nocebo with placebo.
People complain to authorities because they have a headache over a cellular antenna. Sometimes the antenna is not turned on, but people have headaches. How should one deal with such imaginary diseases?
The first information must be: The antenna is not switched on at all. Then I would ask what is your goal? I have to incorporate the patient's goal into my therapeutic concept, even if I cannot understand his or her suffering. I would also say: How can I help you? Then it is up to the other person to decide whether or not I can help them.
It's about developing an understanding that people have reasons that are plausible in their living environment. And I think someone who gets a headache from blasting has reasons. Just as a person has reasons to have a rock crystal in front of a monitor.
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