PSYC: Placebo/Nocebo Flashcards Preview

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Flashcards in PSYC: Placebo/Nocebo Deck (19):

  • Define placebo and nocebo (using Latin roots).
  • Define the placebo and nocebo response.
    • Give an example of each.

  • Placebo = 'to please'.
  • Nocebo = 'to harm'.


  • Beneficial effect on disease resulting from accidental/intentional creation of positive expectancy or conditioning of positive belief.
    • Eg acupuncture, homeopathic therapy.
    • Psychotherapy = purest placebo.
  • Harmful effect resulting from accidental/intentional creation of negative expectancy or conditioning of negative belief.
    • Eg doctor handing out death sentence, patient believing that they are doomed.


For placebos to be more likely to work, which of the involved parties must believe in the therapy?

  • Patient.
  • Doctor AS WELL.


In DSM-IV, the previous terminology/classification of
‘Psychosomatic Disorders’ was replaced with
’Psychological Factors Affecting Medical Conditions’. Why?

Psychological/behavioral factors play a role in
almost every medical condition, whether that role is
in the initiation, progression, aggravation or
predisposition, and varies from disorder to disorder.


What are the five P factors when conceptualising an individual's mental health?

  • Presenting problem(s)
  • Predisposing.
  • Precipitating.
  • Perpetuating.
  • Protective.


Differentiate between top-down and bottom-up causation (using examples) in the context of disease.

Any event at any level of organization of the human organism - from the symbolic to the molecular - may have repercussions at all the other levels.​

  • Top-down.
    • Social interactions → poor mental health → disease.

  • Bottom-up.

    • Underlying physical pathology → disease.


According to the DSM-IV/DSM V, what are the six psychological factors affecting medical conditions?

  • Axis I disorder (GAD, depression, schizophrenia, etc.)
  • Sub-syndromal symptoms (e.g. of anxiety, depression)
  • Personality traits or ‘coping style’
  • ‘Maladaptive’ life-style, health-related behavior
  • Stress-related physiological response
  • ‘Other’ (cultural, religious)


Placebo effect should be _____ from the ___ ______ effect.

Placebo effect should be subtracted from the net therapeutic effect.

  • All kinds of treatment, even active drugs
    and invasive surgery, produced powerful placebo
    effects in addition to their specific effects.




Name a factor that harms the placebo effect?

The patient guessing that the placebo is a placebo.


A clinical trial testing effects of a placebo vs no placebo requires how many arms?

  • What are these arms?

Four arms.

  • Experimental group.
  • No-treatment group.
    • Without a ‘no treatment group’ can’t comment reliably pm ‘placebo effect’ because factors such as natural remission, variation in symptoms, may be having effect.
    • No treatment groups are not included in most trials today.
  • ‘Pure’ placebo group.
  • ‘Active’ placebo group.
    • An active placebo is a placebo that produces noticeable side effects that may convince the person being treated that they are receiving a legitimate treatment, rather than an ineffective placebo.

    • Eg inert pure placebo and atropine (causes dry mouth) in studies of antidepressants.

    • Has side effects to convince the patients that they are receiving therapeutic benefit.


Trials with ____ placebo show much lower drug effects than those with ____ placebo.

Trials with active placebo show much lower drug effects than those with pure placebo.


There is strong evidence for the evidence of the placebo response in the treatment of what?



The colours of tablets used to treat psychiatric disorders have been found to elicit placebo/nocebo effect. Which colours are most/least effective for anxiety/depression?

  • Green most effective for anxiety.
  • Yellow best for depression.
  • Red is least effective for anxiety and depression.


Give two examples of objective somatic changes that lead from placebo/suggestion.

  • Reduction in swelling and trismus with fake ultrasound treatment after dental surgery
  • Similar dopamine activation with apomorphine and placebo in Parkinson’s Disease.


What are the psychological manifestations of inflammation?

Sickness behaviour

  • Lethargy.
  • Apathy.
  • Loss of appetite.
  • Increased sensitivity to pain.


  • What is a theory regarding the mechanism of action of placebos?
  • There is evidence that _____ and _____ are involved as mediators of the placebo effect.

  • Different analgesics work by suppressing innate immune response (steroids, salicylates).
  • Evidence suggests placebos also suppresses innate immune response (less convincing effect on acquired/adaptive immune response).
  • 2002 study showed that a subset of brain regions was similarly affected by either a placebo intervention or treatment with the opioid agonist remifentanil.
  • 2001 study showed EXPECTATION of pain relief activates mu-opioid receptor signalling in the human brain.


  • Evidence that endorphins and dopamine are
    involved as mediators of the placebo effect.





  • What are the six suggested features of a personality that makes someone placebo prone?
  • What is the role of classical conditioning in placebo response?

  • Novelty seeking, reward responsiveness, altruism, optimism, empathy, spirituality.
    • NOTE: No clear placebo-prone personality type.
  • When active treatment replaced by inactive
    treatment, benefit of active treatment continues.


Hidden application vs open application.

A image thumb

What are the four conditions with poor placebo response?

  • Bacterial & viral infections.
  • Chronic degenerative diseases.
  • Cancer.
  • Schizophrenia.


  • Describe the effect of the nocebo response in drug trials.

  • Nocebo effects are unwanted side effects (of placebo or medication) in drug trials.
  • Patients intensively informed about the potential side effects of medication report more symptoms than patients who were given limited information.
  • Theory: Expectation of symptoms (drug side effects) stimulates similar areas of the brain as the experience of symptoms.



NOTE: Nocebo effects are estimated to account for 72% of drop-outs in drug trials for fibromyalgia.