Chapter Nine - The Role of Social and Interpersonal Factors in Placebo Analgesia

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Abstract

Placebo effects are beneficial clinical outcomes that emerge as a result of nonspecific contextual factors, transmitted primarily by the treating physician and the social, physical, and behavioral cues he or she displays. The patient–provider therapeutic alliance is critical for determining placebo effects and health outcomes. In this chapter, we review the recent literature, suggesting that provider social characteristics modulate placebo and clinical outcomes. We highlight the importance of studying not only the provider but also the patient's perception of the provider, which is subject to the influence of the patient's psychosocial orientation, such as their psychosocial motivations and perceptions of their interpersonal relationships broadly. We argue that psychosocial orientation can exaggerate the influence of the patient–provider relationship on placebo effects and can directly affect the likelihood of placebo effects emerging by modulating the underlying biological systems that support them. Here, we examine patient loneliness, or perceived social isolation, as a case example for understanding how patients’ psychosocial orientation may affect placebo effects across diseases. We propose psychosocial mechanisms by which loneliness might modulate placebo effects across medical outcomes, and focus in particular on how loneliness might specifically alter behaviorally conditioned immune responses and placebo analgesia. Future studies should directly measure social factors to formally test the effects of social isolation on placebo effects and better elucidate the role of psychosocial and interpersonal factors in placebo effects and clinical outcomes.

Section snippets

Patient–Provider Interactions and Placebo Effects

Characteristics of the physician critically influence the relation between patients’ expectations and placebo effects, as revealed by studies that have measured or manipulated features of the medical provider (rather than focusing simply on the patient). In the clinic, a supportive patient–provider relationship can reduce symptom severity twice as much as receiving placebo treatment alone (Kaptchuk et al., 2008), and positive expectations delivered by a physician in a supportive and reassuring

Loneliness as a Potential Determinant of Placebo Effects

Perceived social isolation, i.e., loneliness, is a potent example of the influence psychosocial factors can have on health outcomes. Loneliness can be considered a psychosocial motivational state—just as hunger motivates eating behavior, loneliness motivates attempts at social reconnection (Qualter et al., 2015). Many people experience bouts of transitory loneliness from time to time and change their behavior to foster relationship development (Qualter, Brown, Munn, & Rotenberg, 2010; Vanhalst

What Loneliness and the Study of Individual Differences in Social Perceptions Can Tell Us About Placebo

Psychosocial factors modulate endogenous physiological processes that impact clinical outcomes in placebo. Accumulating scientific literature echoes Hippocrates’ ancient observation: the patient–provider therapeutic alliance is critical in determining placebo effects. In many cases, the patient's experience (that is, their perceptions) may be a more meaningful predictor of their likelihood to exhibit a placebo effect than more objective assessments of providers’ social behaviors. Thus, a key

Acknowledgment

This work was supported by the Intramural Research program of the NIH's National Center for Complementary and Integrative Health.

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