The Placebo and Nocebo Effect

One of my favourite topics is the placebo effect and, on the down side, the nocebo effect. I feel very strongly that we should be leveraging the placebo effect more for our benefit, and be acutely aware not to be affected negatively by the nocebo effect. Today, I want to share a conversation I had with my colleague naturopathic doctor Felicia Assenza on this topic. You can also read her article below.

Join us for a 30 minute podcast episode about

the placebo and the nocebo effect.

 

The Placebo Effect

BY FELICIA ASSENZA, ND

What if it’s just placebo?’ Many of us have heard or asked this question before, especially in the healthcare field, but what if there’s something powerful and healing about the placebo effect that we might be missing by simply brushing it off?

WHAT EXACTLY IS A PLACEBO EFFECT?

A placebo effect can be defined as a beneficial effect from a substance or procedure that cannot be attributed to the specific properties of the substance or procedure itself. In other words, someone gets better from taking something that doesn’t, on its own, have any medicinal properties. For example, someone is given a new cutting edge pill for migraines (actually a plain old sugar pill) and the migraine disappears.

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HOW POWERFUL IS THE PLACEBO EFFECT?

Since its discovery in the 1700’s, the placebo effect has unfortunately been looked at as more of an annoyance or something that needed to be controlled for in studies of ‘real medicines’ or drugs or therapies being tested for their efficacy. For example, looking at whether or not Drug X is more effective than a placebo sugar pill. It wasn’t until the 1950’s that the placebo effect itself began to be investigated in more depth and we’re now realizing the incredible role it can have in very real healing1.

The placebo effect has been shown to play an important role in many ailments that our modern healthcare system has much difficulty with treating, such as pain, depression, anxiety, osteoarthritis, immune health, and ADHD. It has even been shown to be effective in the context of surgery! A fascinating 2002 study by Mosely and colleagues demonstrated that placebo knee surgery (where an incision was made but no actual surgery was performed) was just as effective at relieving symptoms of osteoarthritis as the commonly used arthroscopic debridement surgery2.

DO I HAVE TO BE TRICKED FOR IT TO WORK? 

No! It seems the most important part for a placebo to work is believing that it will work, believing that things will improve or that the outcome you are hoping for is possible. A 2010 study by Ted Kaptchuck and colleagues found that when patients with irritable bowel syndrome (IBS) were given a placebo, told they were given a placebo, and given up to date information on the placebo effect, their IBS symptoms still improved3.

THE NOCEBO EFFECT

By this point, it shouldn’t surprise you that when it comes to health (and I’d argue other areas of life as well, but that’s a discussion for another day) if you think something will help, chances are it will! Turns out the opposite seems to be true as well. If you think something will be harmful, chances are it will be. This has become known as the nocebo effect. In other words, the expectation that a harmful effect will happen actually leads to that harmful effect happening. For example, a couple of studies have shown that nebulized saline, which is just airborne salt water droplets, actually triggered asthma attacks in individuals who were told they were being exposed to something they were allergic to5,6. An earlier study even showed that people who thought they were being exposed to trees that they were allergic to triggered the same visible, itchy rash that actually being exposed to the trees caused7.

IT’S NOT QUITE THE SAME FOR EVERYONE

Like everything in medicine and healing, the placebo effect does not look the same for everyone. If you’ve been to one of my workshops or read any previous blog posts, you have probably heard me emphasize the importance of individualized medicine or, as I sometimes like to call it, personalized medicine. Everyone is different and I have yet to come across any therapeutic approach to healing that has exactly the same effect in everyone. The placebo effect is no exception. There has, however, been some interesting study into more specific individual variations in genetics, neurobiology, past experiences, and how they relate to the placebo effect and a person’s susceptibility to the placebo effect1,4.

SO WHAT DOES ALL THIS MEAN WHEN IT COMES TO MY HEALTH?

I think one of the most important things that the placebo effect shows us is our own healing abilities. One of the most powerful medicines is you! Realizing that your state of health ultimately falls on you is such an empowering way to approach your health but also quite a large responsibility. However, while you are the most important person on your healthcare team, you definitely don’t have to be the only person on your team. That’s where healthcare professionals come in to offer help and guidance to move you forward on your health journey, which brings me to my next point…

It is so so so IMPORTANT that you trust your healthcare professionals and have a positive therapeutic relationship with them. As we already talked about, the placebo effect can be a great asset to your healing but the nocebo effect can be quite the opposite. It is important that you feel comfortable enough with your healthcare providers to voice your thoughts or experiences with certain treatments and can collaborate on a treatment plan that you both believe is in your best interest.

What’s your experience with the placebo effect?

Do you have any experience with the nocebo effect?

We’d love to hear from you.

 

Want to work together on your health journey? Have more questions about the placebo effect? Let’s chat. Send us an email, give us a call, or book a free 15 minute consult.

Dr. Felicia Assenza can be reached by e-mail:

felicia.assenza@gmail.com

or through the

Awakening Health Clinic in Burlington

Invested in Your Relationship

As a relationship coach, I hear different people’s theories about love and relationships. I hear what I know to be myths. However, sometimes they are rather explanations which we have adopted to make sense of the fact that a marriage or long-term relationship ended, or as we tend to look at it, “failed”.

One of my clients in his late fifties said the other day, ”I was married for 13 years in my twenties and early thirties, I have had three other long-term relationships since then, which all lasted between 4-8 years, but I don’t see how I could have continued any of these relationships beyond that time. Do you believe a relationship has a shelf life?”

What he experienced is quite typical. Statistics Canada describes in their 2008 report that an average marriage last 13.7 years. Second and third marriages end even earlier. And that statistic does not include long-term relationships.

But to answer my client’s question, I do not believe that a relationship has an expiration date, per se. I do believe that relationships change and go through different stages. I also know for a fact, that we are very ill-equipped to make the transition to the next phase and to handle relationship challenges in general.

Nobody ever teaches us how to “do relationships”. My wish for future generations is to have the school subject “Living Successful Relationships”. That subject would need to include how to connect to our own feelings and protective responses, how to self-soothe, how to truly listen and communicate from a vulnerable place, how to solve conflicts, make compromises and create win-win situations. This school subject could help us in our intimate love relationships and in all our professional relationships. It would allow us to create a different society in which everybody is capable of connecting. I even believe that by teaching non-violent communication and other relationship skills, we could prevent wars and save the future of this planet.

So why do relationships end? A friend sent me this quote by relationship coach Mark Groves the other day which summarizes it perfectly:

What does it mean to outgrow a relationship? It often means that two people have grown away from each other, instead of having been able to stay connected. I used to say that this is what happened with the father of my daughters. However, it is just as true that in my thirties, I did not have the skills necessary to navigate this relationship and steer it back on course.

Another aspect of relationships deteriorating which the quote highlights is our level of investment. The moment one or even both partners are not invested in the relationship anymore, or maybe never were all that invested in the first place, the relationship has received its death sentence. One person alone cannot keep a relationship going. When it feels like you are dragging a partner along who is not willing to devote the necessary time and work into the relationship anymore, you have no other choice but to accept that. Both people need to be invested in the relationship.

One important investment you can make into your long-term relationship or marriage is to see a counselor or coach. You can learn the skills you need to navigate the changes every relationship undergoes. If you are longing to connect with your partner and steer your relationship boat through a tough time, reach out for a free phone consultation.

Also check out my packages for couples.

Angelika

905-286-9466

greendoorrelaxation@yahoo.ca

10 Relationship Myths We Are Conditioned to Believe

I just re-read the book “Brave New World” by Aldous Huxley because my niece in Germany had an English exam on that topic and I had volunteered to help her prepare for it. This novel, published in 1932, is a dystopia in which a world government completely controls all citizens from the moment of their conception in a test tube to the moment they die alone and drugged up. There are no mothers, fathers or spouses, and emotional ties of all kinds are frowned upon. The methods used to control the population are “genetic engineering”, “sleep conditioning” and the happiness drug “soma”, which turns the workers of different casts into willing laborers for a consume oriented society.

One of the questions which came up in the discussion with my 17-year-old niece was what signs of social conditioning she sees in our society today, especially regarding our relationships. We spoke about different ways of conditioning through our society, parents, peer groups, the education system, the media, popular culture, religion and so on.  Once I named a few examples, she realized that no social group, no matter how liberal, democratic or tolerant, exists without training individuals to think and respond in a manner generally approved by the respective society.

In contrast to Huxley’s dystopia, we have the freedom to examine and question our conditioning, and we have the freedom to change those learned beliefs, and conditioned emotional responses and desires, if we so choose. However, analyzing and changing our conditioning is not always easy. We have been programmed to believe and hence feel that we are a failure if we don’t look a certain way, make X amount of money, have what is called a “successful career”, and are not in the societally expected relationships at a certain age. That idea of being a failure can literally paralyze us and keep us stuck in the social conditioning that is to blame for the feeling of not being “good enough” to begin with.

Anne is depressed because she has been struggling with her weight all her life. Martin is beating himself up because he has been out of a job for the past year and he wishes he had made other professional choices when he was younger. Laura is 30 and feels like a failure because all her friends are married. Peter is angry because he works long hours but still cannot afford the lifestyle his brothers have. Marie is a 38-year-old midwife who has been struggling to conceive for the past six years. Frank is a 68-year-old widower and is convinced he won’t be able to find a new partner. Lisa is 59 and ashamed to be alone since her husband of 25 years has left her for a younger woman. And this list goes on and on. There is an incredible amount of suffering in our society when we don’t manage to meet the norms we have been conditioned to meet.

In fact, our Inner Critic voice can always find something to criticize because it is literally impossible to meet the societal standards for success in every single way. The conditioning of how we should think, feel, act and what goals or relationship markers we should have reached at arbitrary points in our life has a strong hold on us. As a belief-change and relationship coach, I come across limiting beliefs every day. Today I want to highlight a few about love and committed relationships.

In “Brave New World”, committed relationships or marriages do not exist, instead “everyone belongs to everyone else”. Family, monogamy, and romantic notions are highly discouraged and regarded as a crime against the state. Promiscuity is in this future world the only way to interact with the members of your own caste. Citizens are given the happiness drug soma to relieve their depression about being lonely or insecure.

It is so obvious how the citizens of Huxley’s dystopia are manipulated and conditioned about love and relationships. Yet, what beliefs have we learned about love and relationships?

Here are ten of the top myths:

  1. Love is all you need to make a relationship last

Long-term relationships go through different stages. What is essential at every stage is to adapt and work with what life brings us. We start out with the honeymoon phase, but that is not supposed to last. It is just supposed to bring us together. Instead, love ideally matures more and more with each new phase. A book that describes this with beautiful metaphors is Anne Morrow Lindbergh’s “Gift from the Sea”.

  1. Good relationships don’t require work

Absolutely all relationships require ongoing attention, successful communication and the willingness to work through issues together. Or as Carroll Bryant says: “Love is a two-way street constantly under construction.”

  1. If my partner really loved me…

Those beliefs that start with “If my partner really loved me…” are another trap we fall into, e.g. If they really loved me, they would know what I feel/want/need. Our partner is not a mind reader. For a successful relationship, we need to learn to express our feelings and needs.

  1. He/she will change if I just keep trying to change them

It is completely impossible to change your partner! You only end up in a tug of war. In fact, focusing on how the other person should change keeps you stuck in your problems. Instead, a successful relationship is all about the question “How can I change? What is going to be required of ME to create a better relationship?”

  1. Couples in good relationships don’t argue

Many people still believe that conflicts in a relationship are a bad sign. Relationship scientist and expert John Gottman has proven that arguments are not the problem, but that how couples argue can destabilize a relationship. We want to practice how to deliver and receive criticism successfully and learn how to argue with less defensiveness and without stonewalling or showing contempt for our partner.

  1. Couples should have sex x-number of times per week/month

You should not compare yourself to other couples. Whatever amount of sex you both are comfortable having is exactly the right amount. Getting too stuck on average numbers when it comes to having sex, distracts from the actual problems which might be behind changes in the sexual desire. The desire to be intimate is about making time to connect and be vulnerable with each other. If a couple has a huge discrepancy between how often each partner wants sex, that is an issue to work through with a coach or therapist.

  1. True love is all about passion

I have seen people leave a perfectly good marriage because they felt it was lacking the passion. Often that meant that they have exchanged one stale relationship with one that is exciting but filled with drama and jealousy. Love can be both, passionate and safe. A solid relationship has achieved the right balance for a couple and their individual needs for passion.

  1. If we are struggling in our relationship it means we made a wrong choice and are just not destined to be together

Every couple goes through ups and downs. Every relationship is a constant dance between closeness and distance that we need to navigate. A belief like “every relationship has a shelf-life and ours must be over” gets in the way of putting in the work which every relationship requires.

  1. Talking about my past wounds will only make them worse

You cannot change your past, but you can change how you feel about it and heal your childhood wounds in your grown-up relationship. Speaking about your vulnerabilities and wounds with your partner is one answer to healing them. Ideally, the purpose of a relationship is to provide a safe space to be vulnerable and feel loved.

  1. Couples don’t need coaching or counselling unless their relationship is in serious trouble

Seeing a professional is beneficial at any stage of our relationship to help us navigate the transitions. In fact, a fabulous time to come in for coaching sessions is before you get married to lay a solid foundation for this next step of your relationship.

 

Do any of these myths sound familiar? Are you feeling stuck in your communication or struggling to navigate the current phase of your relationship? Perhaps it is time for you and your partner to come in for relationship coaching to work through a tough time or to get ready for a bigger commitment.

Check out my packages for couples.

Angelika

905-286-9466

greendoorrelaxation@yahoo.ca