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Thinking yourself better – placebo explained

According to a recent article in the Economist the alternative health industry is worth in excess of $60 Billion a year.  However there is little quantitative evidence to support many of the treatments and therapies in the field.  So why do people spend so much money without supporting evidence? Are vulnerable people taken in by the therapy business?  This is of course an important issue for us at Breathe London.  We have massage, acupuncture, hypnotherapy, life coaching, yoga, mediation and many other therapies.

My own background is mathematical. I studied economics and chartered accountancy before becoming a yoga teacher, massage therapist and coach and setting up Breathe London. As a natural sceptic I avoided yoga and therapies throughout my 20s.  In my early 30s living in Sydney the combination of corporate finance work, stress and lots of gym work meant that my back often hurt.  I began to take yoga and pilates classes and get regular massages and this combination seemed to reduce my stress levels, improve the balance of my hips and shoulders and lengthen my hamstrings.

This seems to be the experience of a lot of people.  Although the hard evidence base is not necessarily there to support many alternative therapies, people have a gut feel that pain and suffering goes hand in hand with stress.  When we find therapists and therapies which help us tap into relaxation the body and mind can recover.

There are lots of reasons why it’s difficult to measure a positive effect for alternative therapies.  For example finding adequate test and control groups for research may be difficult.  People who turn up for treatment are obviously a self selecting group who are seeking help and want to feel better.  Cold double blind studies lack this positive intention.  Similarly it’s hard to quantify pain and discomfort because pain assessment is very arbitrary.

One of the many reasons why people who go to therapists feel better is the placebo effect.  As soon as I bring this up many people will then doubt the validity of the therapy.  You shouldn’t.  The placebo effect is real, powerful and little understood.  Irving Kirsch, a professor at Harvard medical school has demonstrated that giving sugar coated pills in a placebo trial for depression was almost as powerful as taking antidepressants. Belief and trust in the treatment is almost as powerful as the treatment.  If you tell someone you are dosing them with morphine compared to aspirin, but both are placebo, neuro imaging shows that the deception stimulates naturally occurring pain killers.  Those people told they are receiving morphine produce more of these naturally occurring pain killers.

The research suggests that the more trust the patient has of the doctor prescribing the treatment and the more elaborate the ceremony around the treatment, the more effective the treatment is.  For example injecting a placebo is more powerful than taking a placebo pill.  To further illustrate the power of placebo Ted Kaptchuk at Harvard medical school conducted a study where participants with IBS were told by a doctor about the placebo effect and how it was almost as effective as real pills.  They were told they were taking part in a study to demonstrate this effect and were then told to take sugar the coated pills – and it was again emphasised that they were placebo.  The study found that even though participants were aware that it was a placebo study, the overall effect was almost as powerful as conventional placebo studies.  What was important was the trust that participants had in what the doctor was saying about the placebo effect.

Karin Meissner of Ludwig Maximillians University, Cologne demonstrated that the placebo effect  was able to effect autonomic nervous system, ie heartbeat , blood pressure etc.

So it seems that when it comes down to treatment it has a lot to do with trust and belief.  In the fields of coaching and counselling research suggests that it is the quality of the relationship between the practitioner and client rather than the type of the therapy which is the most important factor.

In addition to the placebo effect there are lots of reasons why therapies such as massage have a strong positive impact.  Human touch has a powerful physiological and neurological effect.  For example Oxytocin production is stimulated, which has a positive impact on trust, empathy, confidence and wellbeing.

Maybe it’s just about being around good people.  They make us feel good, stimulate us, help us feel relaxed and confident.  If the therapist has positive intention towards you, believes in what they are doing and experience tells you they help you tap into good feelings then go with it and listen to your own intuition.  Your own observations of your own wellbeing are often as valid as cold research on participants with no interest in the process or the outcomes.