While the placebo effect can be powerful, it is sometimes stated incorrectly that hypnosis works as a placebo, and that the effects of hypnosis are merely a placebo effect due to the patient’s beliefs and expectations. While positive expectancy is an important part of hypnosis, hypnosis is not the same as the placebo effect in terms of responsiveness, physiological effect, or administration.
A placebo effect represents benefits perceived by a patient or identified by a practitioner arising solely from the effects after the treatment is delivered. A placebo effect does not require that a pill be given. Placebos have documented to have an effect on pain, asthma, tension, anxiety, depression, blood pressure, heart rate, sexual arousal, skin conditions, nausea, vomiting, gastric motility, and angina.
In one study, 6,000 psychiatric patients were given placebo pills and told that the pills would help determine the effectiveness of next therapy. Soon after, 51% improved, 12% deteriorated, 37% had no response; the interesting part of this study was 57% had side effects. A placebo can assist to create therapeutic responses, but the range of responses and interventions makes determining of the effects of a placebo difficult to determine.
The responsiveness is an important consideration from a practical standpoint. There are significant differences between hypnosis and the placebo effect. One study found individuals who were susceptible to hypnosis achieved some pain reduction and it corresponds to the reduction by placebo. However, for subjects who were highly susceptible to hypnosis, pain reduction with hypnosis was superior to placebo. For these individuals, the average placebo response was negligible or even negative. Responsiveness to hypnosis is characteristically typical, while responses to placebos can be comparatively unreliable.
Placebo effects can differ by the type of intervention. A dose response does exists, Blue (vs. pink) placebo pills are sedating, yellow (vs. green) placebo pills are stimulating, Red (vs. beige) placebos encourage a cardiac response. Branded is more effective than generic. Four-times-a-day is more potent than twice-a-day. Larger capsules are stronger than smaller ones. Interventions, injections, and surgery give larger effects than pills.
A nocebo effect represents harm perceived by a patient or identified by a practitioner arising solely from the appearance of a treatment delivered. Healthy individuals have had adverse effects related to noceboes. Repeat dosing increases nocebo effects; old age is associated with an increase in nocebo response. If patients are specifically asked about adverse effects, the percent can rise to almost triple. The nocebo effect might lead to secondary gains, disability, or even death. Women report nocebo responses to therapy more than men do.
Adverse, often unsubstantiated, drug effects and drug side effects may be nothing more than nocebo. Conventional wisdom that medications have common adverse effects is not always substantiated and may be in part a nocebo effect amplified by reading package inserts and warnings or by talking with biased physicians.
Physician advice, although an indirect form of intervention, can have powerful placebo or, regrettably, nocebo effects. Patients can generate their own nocebo effect unconsciously. From the Framingham Heart Study, women, with similar risk factors, were 4 times more likely to die if they believed they were predisposed to heart disease. Recent evidence suggests a link between emotions (for example fear or depression), cardiomyopathy, and even death.
Whenever a new and previously unknown recognized medical condition moves into the consciousness, a significant amount of confusion and anxious can arise. If an individual is affected by such a disease state, the natural reaction is, “I have never heard of what I have,” triggering considerable anxiety. Such is the case with the condition identified as Takotsubo Cardiomyopathy. Takotsubo cardiomyopathy starts abruptly and unpredictably, with symptoms of chest pain and, often, shortness of breath, usually triggered by an emotions; it is more prevalent in women and appears related to an adverse intense emotional stressor.
Nocebo and placebo responses can be utilized to explain much of any therapy’s benefits and risks. Placebos require that they be presented deceptively. Hypnosis does not require deception in order to be effective. Hypnosis is a non-deceptive means of exploiting the therapeutic power of suggestion. Doctors and patients can benefit from understanding hypnosis and the power of suggestion.