Lecture 4: Psychic Healing n 1.Introduction n 2.The nature of illness n 3.Controlled studies n 4.Single case studies n 5.Fraudulent techniques n 6. A closer.

Lecture 4: Psychic HealingLecture 4: Psychic Healing

1.1. IntroductionIntroduction 2.2. The nature of illnessThe nature of illness 3.3. Controlled studiesControlled studies 4.4. Single case studiesSingle case studies 5.5. Fraudulent techniquesFraudulent techniques 6. A closer look at the placebo effect6. A closer look at the placebo effect

– 6.1 Introduction6.1 Introduction– 6.2 The nature of placebo effects6.2 The nature of placebo effects– 6.3 Some myths about placebos6.3 Some myths about placebos– 6.4 Explaining the placebo effect6.4 Explaining the placebo effect– 6.5 Conclusion6.5 Conclusion

A Modern HealerA Modern Healer

Jesus HealsJesus Heals

Battlefield WoundsBattlefield Wounds

Solfvin (1984)Solfvin (1984)

In summary, the studies reviewed here show a In summary, the studies reviewed here show a rather high rate of success for observing, with rather high rate of success for observing, with varying degrees of control, apparent varying degrees of control, apparent influences on living matter in mental healing influences on living matter in mental healing contexts. This is very encouraging in that it contexts. This is very encouraging in that it represents a solid first step toward building a represents a solid first step toward building a science of mental healing, or mental intention science of mental healing, or mental intention to heal. It is clear, too, that it is only a first to heal. It is clear, too, that it is only a first step. Many basic questions, such as “what step. Many basic questions, such as “what caused these effects”, “is psi operating here” caused these effects”, “is psi operating here” and “how can we best model and research and “how can we best model and research these phenomena” are yet to be answered.these phenomena” are yet to be answered.

Benor (1990)Benor (1990)

Though many studies are flawed in minor Though many studies are flawed in minor aspects and some flawed in major ways, aspects and some flawed in major ways, there still remains a convincing number there still remains a convincing number of excellent experiments with significant of excellent experiments with significant results. If healing were a drug, I believe results. If healing were a drug, I believe it would be accepted as effective on the it would be accepted as effective on the basis of this evidence.basis of this evidence.

Schouten (1992-93)Schouten (1992-93)

An overview of the research on the effectiveness An overview of the research on the effectiveness of ‘psychic’ healing on human subjects of ‘psychic’ healing on human subjects indicates that psychic healing can be effective, indicates that psychic healing can be effective, especially on subjectively experienced state of especially on subjectively experienced state of health. Objectively measured effects are much health. Objectively measured effects are much less pronounced. However, the strength of the less pronounced. However, the strength of the effect of psychic healing seems strongly effect of psychic healing seems strongly dependent upon the patient’s knowledge that dependent upon the patient’s knowledge that treatment is attempted and appears to be treatment is attempted and appears to be mainly related to psychological variables mainly related to psychological variables associated with the patient and with the associated with the patient and with the healer-patient interaction.healer-patient interaction.

Schouten (1992-93)Schouten (1992-93)

Although experimental evidence suggests the Although experimental evidence suggests the existence of a paranormal anomalous effect, existence of a paranormal anomalous effect, the size of the effect is small compared to the size of the effect is small compared to the effects observed in psychic healing. In the effects observed in psychic healing. In the case of many complaints, it is also the case of many complaints, it is also unclear how a possible paranormal effect unclear how a possible paranormal effect could result in an improvement in health. could result in an improvement in health. Hence, although the possible contribution of Hence, although the possible contribution of a paranormal process cannot be excluded, it a paranormal process cannot be excluded, it is unlikely to account for the observed is unlikely to account for the observed effects of psychic healing on patients.effects of psychic healing on patients.

Randi’s (1987) Criteria for Randi’s (1987) Criteria for Assessing Single Case StudiesAssessing Single Case Studies

1.The disease must not normally be self-terminating.1.The disease must not normally be self-terminating. 2.The recovery must be complete.2.The recovery must be complete. 3.The recovery must take place in the absence of any 3.The recovery must take place in the absence of any

medical treatment that might normally be expected to medical treatment that might normally be expected to affect the disease.affect the disease.

4.There must be adequate medical opinion that the 4.There must be adequate medical opinion that the disease was present before the application of whatever disease was present before the application of whatever means were used to bring about the miracle.means were used to bring about the miracle.

5.There must be adequate medical opinion that the 5.There must be adequate medical opinion that the disease is not present after the application of whatever disease is not present after the application of whatever means were used to bring about the miracle.means were used to bring about the miracle.

Televangilist Miracle?Televangilist Miracle?

Psychic Surgery (1)Psychic Surgery (1)

Psychic Surgery (2)Psychic Surgery (2)

Psychic Surgery (3)Psychic Surgery (3)

““If you can believe fervently in your If you can believe fervently in your treatment, even though controlled studies treatment, even though controlled studies show that it is quite useless, then your show that it is quite useless, then your results are much better, your patients are results are much better, your patients are much better, and your income is much much better, and your income is much better too. I believe this accounts for the better too. I believe this accounts for the remarkable success of some of the less remarkable success of some of the less gifted, but more credulous members of our gifted, but more credulous members of our profession, and for the violent dislike of profession, and for the violent dislike of statistics and controlled tests which statistics and controlled tests which fashionable and successful doctors are fashionable and successful doctors are accustomed to display”accustomed to display”

Richard Asher, 1972Richard Asher, 1972

Introduction: DerivationsIntroduction: Derivations and and DefinitionsDefinitions

Placebo - from the Latin, “I will please”?Placebo - from the Latin, “I will please”? Shapiros’ (1997) definition of placebo: “any therapy Shapiros’ (1997) definition of placebo: “any therapy

prescribed … for its therapeutic effect on a prescribed … for its therapeutic effect on a symptom or disease, but which is actually symptom or disease, but which is actually ineffective or not specifically effective for the ineffective or not specifically effective for the symptom or disorder being treated”symptom or disorder being treated”

Shapiros’ (1997) definition of placebo effect: “the Shapiros’ (1997) definition of placebo effect: “the nonspecific, psychological, or psychophysiologic nonspecific, psychological, or psychophysiologic therapeutic effect produced by a placebo, or the therapeutic effect produced by a placebo, or the effect of spontaneous improvement attributed to the effect of spontaneous improvement attributed to the placebo”placebo”

Nocebo - from the Latin, “I will harm”Nocebo - from the Latin, “I will harm”

History of the Placebo EffectHistory of the Placebo Effect

usnea (moss from the skull of victims of usnea (moss from the skull of victims of violent death), Vigo’s plaster (viper’s flesh, violent death), Vigo’s plaster (viper’s flesh, live frogs and worms), parts of the skulls of live frogs and worms), parts of the skulls of executed criminals, oil of brick, ants, executed criminals, oil of brick, ants, spiders’ webs, saliva of a fasting man, spiders’ webs, saliva of a fasting man, sexual organs, excreta of all kinds …sexual organs, excreta of all kinds …

purging, puking, poisoning, cutting, purging, puking, poisoning, cutting, cupping, blistering, bleeding, freezing, cupping, blistering, bleeding, freezing, heating, sweating, leeching, and shocking.heating, sweating, leeching, and shocking.

Bleeding a PatientBleeding a Patient

Blood Letting with LeechesBlood Letting with Leeches

SteamingSteaming

History of the Placebo EffectHistory of the Placebo Effect

usnea (moss from the skull of victims of violent usnea (moss from the skull of victims of violent death), Vigo’s plaster (viper’s flesh, live frogs death), Vigo’s plaster (viper’s flesh, live frogs and worms), parts of the skulls of executed and worms), parts of the skulls of executed criminals, oil of brick, ants, spiders’ webs, saliva criminals, oil of brick, ants, spiders’ webs, saliva of a fasting man, sexual organs, excreta of all of a fasting man, sexual organs, excreta of all kinds …kinds …

purging, puking, poisoning, cutting, cupping, purging, puking, poisoning, cutting, cupping, blistering, bleeding, freezing, heating, sweating, blistering, bleeding, freezing, heating, sweating, leeching, and shocking.leeching, and shocking.

Negative attitudes to placebo effect within Negative attitudes to placebo effect within modern Western medicine (association with modern Western medicine (association with quackery; not seen as “true” therapeutic effect).quackery; not seen as “true” therapeutic effect).

Nature of Placebo EffectsNature of Placebo Effects

Found in all areas of medicine, e.g., treatment Found in all areas of medicine, e.g., treatment of depression, anxiety, insomnia, headaches, of depression, anxiety, insomnia, headaches, nausea, asthma, diabetes, multiple sclerosis …nausea, asthma, diabetes, multiple sclerosis …

Much research in area of pain control.Much research in area of pain control. Although mechanisms not fully understood, Although mechanisms not fully understood,

patient’s expectations, determined largely by patient’s expectations, determined largely by the behaviour of those administering the the behaviour of those administering the treatment, are crucially important.treatment, are crucially important.

Double-Blind Randomised Double-Blind Randomised Clinical Trials (RCTs)Clinical Trials (RCTs)

Compare therapeutic effectiveness of active Compare therapeutic effectiveness of active treatment with placebo treatmenttreatment with placebo treatment

Neither patient nor therapist should be aware Neither patient nor therapist should be aware of treatment conditionof treatment condition

Placebo condition should be as similar as Placebo condition should be as similar as possible to treatment conditionpossible to treatment condition

Allocation to conditions should be randomAllocation to conditions should be random Triple-blind studies require that those Triple-blind studies require that those

assessing outcome are also blind until analysis assessing outcome are also blind until analysis complete.complete.

Types of Treatment Exempt from Types of Treatment Exempt from Requirement of RCTsRequirement of RCTs

Surgery - but note findings of Cobb et al. (1959) Surgery - but note findings of Cobb et al. (1959) and Dimond et al. (1960). Sham operations were and Dimond et al. (1960). Sham operations were as effective in relieving symptoms of angina as as effective in relieving symptoms of angina as real operations in which internal mammary real operations in which internal mammary arteries were ligated.arteries were ligated.

Alternative therapies - practitioners and clients Alternative therapies - practitioners and clients usually convinced of effectiveness on basis of usually convinced of effectiveness on basis of personal experience and anecdotal evidence.personal experience and anecdotal evidence.

Psychotherapies - highlight the problems of Psychotherapies - highlight the problems of defining suitable placebo conditions which differ defining suitable placebo conditions which differ in terms of nothing but “active ingredient”in terms of nothing but “active ingredient”

Myths and Methodology (1)Myths and Methodology (1)

Myth 1: The placebo differentiates between Myth 1: The placebo differentiates between organic and mental disease.organic and mental disease.– Wall (1999): many “old-school clinicians Wall (1999): many “old-school clinicians

drilled in classic theory” still subscribe to drilled in classic theory” still subscribe to this “cruellest and most dangerous myth”this “cruellest and most dangerous myth”

Myths and Methodology (2)Myths and Methodology (2)

Myth 2: The placebo is the equivalent of no Myth 2: The placebo is the equivalent of no therapy.therapy.– Most studies using placebos do not include a Most studies using placebos do not include a

“no treatment” condition, making it “no treatment” condition, making it impossible to conclude that any placebo impossible to conclude that any placebo effect has even occurred.effect has even occurred.

– Ernst & Resch (1995) differentiate “perceived Ernst & Resch (1995) differentiate “perceived placebo effect” (response of placebo group in placebo effect” (response of placebo group in an RCT) and the “true placebo effect” an RCT) and the “true placebo effect” (difference between that response and (difference between that response and response of no-treatment group).response of no-treatment group).

Myths and Methodology (3)Myths and Methodology (3)

Myth 2: The placebo is the equivalent of no therapy Myth 2: The placebo is the equivalent of no therapy (cont.)(cont.)– No-treatment group could improve for a variety of No-treatment group could improve for a variety of

reasons:reasons: The natural history of the disease (cf. Beecher, The natural history of the disease (cf. Beecher,

1955, on the common cold)1955, on the common cold) Regression towards the meanRegression towards the mean Other time-related effectsOther time-related effects

– Estimates that 70% of patients treated with Estimates that 70% of patients treated with ineffective therapies show improvement may be ineffective therapies show improvement may be true (Roberts et al., 1993) but this does not true (Roberts et al., 1993) but this does not represent solely placebo effects.represent solely placebo effects.

Myths and Methodology (4)Myths and Methodology (4)

Myth 3: A fixed fraction of patients respond to Myth 3: A fixed fraction of patients respond to placebosplacebos– ““about a third” often quoted.about a third” often quoted.– Beecher (1955) gave figure of 35.2% - but based Beecher (1955) gave figure of 35.2% - but based

on average over 11 studies with widely varying on average over 11 studies with widely varying rates.rates.

– Rates can vary from 0% to 100%Rates can vary from 0% to 100% Myth 4: Placebo responders have a special mentalityMyth 4: Placebo responders have a special mentality

– Most studies show no correlations between Most studies show no correlations between placebo response and personality measures and placebo response and personality measures and the rest are contradictory (Wall, 1999).the rest are contradictory (Wall, 1999).

Myths and Methodology (5)Myths and Methodology (5)

Myth 5: Placebos only affect subjective aspects of Myth 5: Placebos only affect subjective aspects of illness not objective measures of diseaseillness not objective measures of disease..– E.g., “Placebos have no effect on the progress or E.g., “Placebos have no effect on the progress or

outcome of disease but they may exert a powerful outcome of disease but they may exert a powerful effect upon the subjective phenomena of illness, effect upon the subjective phenomena of illness, pain, discomfort and distress. Their success is based pain, discomfort and distress. Their success is based upon this fact.” (Skrabanek & McCormick, 1989)upon this fact.” (Skrabanek & McCormick, 1989)

– But majority opinion:But majority opinion: “Objective variables such as “Objective variables such as the results of blood tests, postoperative tissue the results of blood tests, postoperative tissue swelling, body temperature or the healing of wounds swelling, body temperature or the healing of wounds are also placebo-prone.” (Ernst & Abbot, 1999)are also placebo-prone.” (Ernst & Abbot, 1999)

Myths and Methodology (6)Myths and Methodology (6)

Myth 6: Patients in double-blind trials do not Myth 6: Patients in double-blind trials do not know which condition they are in.know which condition they are in.– In fact evidence shows that patients, In fact evidence shows that patients,

patients’ relatives and doctors are often patients’ relatives and doctors are often able to guess which group patient is in, e.g., able to guess which group patient is in, e.g., on basis of side-effects of active treatmenton basis of side-effects of active treatment

Myths and Methodology (7)Myths and Methodology (7)

Myth 7: In controlled trials, the placebo never has a Myth 7: In controlled trials, the placebo never has a specific therapeutic effect upon the condition being specific therapeutic effect upon the condition being treated.treated.– Kienle & Kiene (1996) cite the much-reported Kienle & Kiene (1996) cite the much-reported

study by Ho et al. (1988) comparing ultrasound study by Ho et al. (1988) comparing ultrasound treatment, placebo treatment and no treatment treatment, placebo treatment and no treatment on pain and swelling following tooth extraction. on pain and swelling following tooth extraction. Strong placebo effect was claimed BUT both Strong placebo effect was claimed BUT both ultrasound and placebo conditions differed from ultrasound and placebo conditions differed from no treatment condition by including application of no treatment condition by including application of moist, cooling cream - which may have directly moist, cooling cream - which may have directly affected pain and swelling.affected pain and swelling.

Myths and Methodology (8)Myths and Methodology (8)

Myth 8: Patients will always give an honest and Myth 8: Patients will always give an honest and accurate account of their subjective well-being.accurate account of their subjective well-being.– Kienle and Kiene (1996) refer to Kienle and Kiene (1996) refer to experimental experimental

subordinationsubordination: “This term means that the subjects : “This term means that the subjects of an investigation say what they believe is of an investigation say what they believe is expected from them without being careful to expected from them without being careful to ensure that their statements are based on actual ensure that their statements are based on actual experiences or perceptions”.experiences or perceptions”.

– A true placebo effect would be one in which A true placebo effect would be one in which patients genuinely felt better and were not simply patients genuinely felt better and were not simply saying they did in order to please their doctor or a saying they did in order to please their doctor or a researcher.researcher.

Attempts to Explain the Attempts to Explain the Placebo Effect (1)Placebo Effect (1)

Classical ConditioningClassical Conditioning– e.g., drug treatment = USe.g., drug treatment = US– physiological responses = URphysiological responses = UR– eventually physiological responses become eventually physiological responses become

CR associated with contextual cues, e.g., pills, CR associated with contextual cues, e.g., pills, syringes, white coats, etc. (CS)syringes, white coats, etc. (CS)

– Animal research appears to show some Animal research appears to show some support BUT CR (to say injection of saline support BUT CR (to say injection of saline following conditioning trials) is sometimes in following conditioning trials) is sometimes in same direction as initial UR, sometimes in same direction as initial UR, sometimes in opposite direction.opposite direction.

Attempts to Explain the Attempts to Explain the Placebo Effect (2)Placebo Effect (2)

Classical Conditioning (cont.)Classical Conditioning (cont.)– Voudouris and colleagues appeared to Voudouris and colleagues appeared to

demonstrate conditioning of placebo response in demonstrate conditioning of placebo response in humans (e.g., Voudouris, Peck, & Coleman, 1989).humans (e.g., Voudouris, Peck, & Coleman, 1989).

– Participants trained to reliably report intensity of Participants trained to reliably report intensity of painful electric shock, with intensity levels in full painful electric shock, with intensity levels in full view.view.

– Given inert cream and told it was powerful Given inert cream and told it was powerful analgesic.analgesic.

– A few showed higher thresholds, i.e., a weak A few showed higher thresholds, i.e., a weak placebo effectplacebo effect

Attempts to Explain the Attempts to Explain the Placebo Effect (3)Placebo Effect (3)

Classical Conditioning (cont.)Classical Conditioning (cont.)– With different group, experimenters surreptitiously With different group, experimenters surreptitiously

reduced shock level after cream applied, so it reduced shock level after cream applied, so it appeared to participants that cream was very appeared to participants that cream was very effective.effective.

– On subsequent testing with original intensity levels, On subsequent testing with original intensity levels, large proportion of participants showed higher large proportion of participants showed higher thresholds.thresholds.

– BUT: Montgomery & Kirsch (1997) repeated study, BUT: Montgomery & Kirsch (1997) repeated study, included a group like second group above but told included a group like second group above but told them that cream was inert. This group showed no them that cream was inert. This group showed no placebo affect, suggesting results due to …placebo affect, suggesting results due to …

Attempts to Explain the Attempts to Explain the Placebo Effect (4)Placebo Effect (4)

ExpectancyExpectancy– supported by wide range of evidence (see supported by wide range of evidence (see

Kirsch, 1997) …Kirsch, 1997) …– … … BUT Kienle & Kiene (1996) present BUT Kienle & Kiene (1996) present

convincing evidence that results of Voudouris convincing evidence that results of Voudouris and colleagues (and, by implication, Kirsch & and colleagues (and, by implication, Kirsch & Montgomery) are best explained in terms of Montgomery) are best explained in terms of ……

Experimental subordination effectsExperimental subordination effects– Has the placebo effect ever been convincingly Has the placebo effect ever been convincingly

demonstrated at all?demonstrated at all?

Attempts to Explain the Attempts to Explain the Placebo Effect (5)Placebo Effect (5)

Endorphins as an explanation of placebo Endorphins as an explanation of placebo analgesiaanalgesia– Although early studies (e.g., Levine et al., Although early studies (e.g., Levine et al.,

1978) were open to methodological 1978) were open to methodological criticism, later methodologically superior criticism, later methodologically superior studies support the notion that placebo pain studies support the notion that placebo pain reduction is indeed mediated by the release reduction is indeed mediated by the release of endorphins (see review by ter Riet et al., of endorphins (see review by ter Riet et al., 1998).1998).

– These results cannot be explained in terms These results cannot be explained in terms of experimental subordination.of experimental subordination.

Conclusion (1)Conclusion (1)

Although a neurochemical explanation for placebo-Although a neurochemical explanation for placebo-related pain reduction is now supported by a related pain reduction is now supported by a growing amount of convincing experimental growing amount of convincing experimental evidence, it is fair to point out that this by no evidence, it is fair to point out that this by no means represents the end of the story. As Anne means represents the end of the story. As Anne Harrington (1997) points out, “Endorphin release, Harrington (1997) points out, “Endorphin release, rather, became just one more placebo-generated rather, became just one more placebo-generated phenomenon to be explained – and we still did not phenomenon to be explained – and we still did not understand the processes whereby a person’s understand the processes whereby a person’s belief in a sham treatment could send a message belief in a sham treatment could send a message to his or her pituitary gland to release its own to his or her pituitary gland to release its own endogenous pharmaceutics.”endogenous pharmaceutics.”

Conclusion (2)Conclusion (2)

This presentation has hopefully illustrated the This presentation has hopefully illustrated the great need for further studies, employing great need for further studies, employing improved methodology and clearer improved methodology and clearer conceptualisations of the placebo effect itself. conceptualisations of the placebo effect itself. It will almost certainly turn out to be the case It will almost certainly turn out to be the case that we should speak of placebo effects, rather that we should speak of placebo effects, rather than of a single effect, and each effect may than of a single effect, and each effect may have a different explanation. In the future, we have a different explanation. In the future, we can hope that further research will unravel the can hope that further research will unravel the mysteries of these effects and perhaps even mysteries of these effects and perhaps even render the term “placebo effect” redundant.render the term “placebo effect” redundant.

AcknowledgementAcknowledgement

With thanks to Hilary Evans, With thanks to Hilary Evans, proprietor of the Mary Evans proprietor of the Mary Evans Picture Library, for permission to Picture Library, for permission to use illustrations featured in this use illustrations featured in this presentation. These illustrations presentation. These illustrations must not be reproduced in any must not be reproduced in any form without permission from the form without permission from the Mary Evans Picture Library.Mary Evans Picture Library.