Depression and the Placebo Effect Psychogenic Illness and Suggestion Hypnosis, Pain Reduction, and A

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Depression and the Placebo Effect Psychogenic
Illness and Suggestion Hypnosis, Pain
Reduction, and Adherence with Medical Instruction

• Irving Kirsch
• Faculty of Health and Social Work
• University of Plymouth

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Common Theme

• Suggestion Effects in Health Psychology

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Depression and the Placebo Effect

• Irving Kirsch
• Faculty of Health and Social Work
• University of Plymouth

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Suicides in Adults(Healy, 2003)
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Suicides in Adults(Healy, 2003)
x5
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Are Antidepressants Effective?

• Listening to Prozac
• But Hearing Placebo
• (Kirsch Sapirstein, 1999)

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Pre-post Effect Sizes for Drug, Placebo, and
No-treatment Controls
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Partitioning the Antidepressant Drug Response
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This cant be true
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The Emperors New DrugsAn Analysis of the FDA
Data Set

• Fluoxetine (Prozac)
• Paroxetine (Seroxat/Paxil)
• Sertraline (Lustral/Zoloft)
• Venlafaxine (Effexor)
• Nefazodone (Dutonin/Serzone)
• Citalopram (Cipramil/Celexa)

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Advantages of the FDA data set

• Includes unpublished trials
• Same outcome measure (HAM-D)

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of Trials Showing Significant Drug/Placebo
Differences
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Improvement Across Drugs

• Duplication by Placebo 82
• Mean HAM-D change 1.80 points

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FDA Dose-response Studies(10 Trials)
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Findings replicated by NICE

• Conclusion
• The response to antidepressant medication is
  primarily a placebo effect

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Psychogenic Illness and Suggestion

• Irving Kirsch
• Faculty of Health and Social Work
• University of Plymouth

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Mass Psychogenic Illness

• Occurrence of physical symptoms in the absence of
  an identifiable pathogen
• Perceived threat of biochemical terrorism makes
  MPI more likely
• Psychogenic implies that symptoms are produced
  by psychological factors
• Diagnosis based mostly on failure to find a
  physical pathogen

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Our StudyPurposes

• Can typical MPI symptoms be produced in the lab?
• Investigate two psychological factors
• Expectancy
• Contagion by observation

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Instructions to Participants

• I am a Research Assistant and part of a Medical
  Psychology Research Team that is studying a
  suspected environmental toxin. This substance
  has been reported to produce a number of
  temporary symptoms in workplaces in the
  Northeast. The most frequently reported symptoms
  are headache, nausea, itchy skin and drowsiness.
  These symptoms seem to develop very quickly after
  exposure to this substance, but they are
  relatively mild, and they do not last very
  long--rarely more than an hour or so.

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• Target symptoms
• Headache
• Nausea
• Itchy skin
• Drowsiness
• Non-target symptoms
• Watery eyes
• Scratchy throat
• Chest tightness
• Breathing difficulty

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Design
Confederate
Participant
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Effect of Inhalation
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Effect of Observation
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Conclusions

• Expectancy can cause people to experience
  psychogenic symptoms.
• Effect of observation remains unclear

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Hypnosis, Pain Reduction, and Adherence with
Medical Instruction

• Irving Kirsch
• Faculty of Health and Social Work
• University of Plymouth

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Hypnotic analgesia

• Correlated with suggestibility
• 75 show substantial relief
• Reduces need for medication
• Accompanied by changes in the brain
• Surgery without drugs
• But
• Seldom used

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The Effects of Hypnotic and Nonhypnotic
Imaginative Suggestion on Pain

• (Milling, Kirsch, Allen, Reutenauer, in press)

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Pain Stimulus

• Forgione-Barber Strain Gauge Pain Stimulator

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Suggestion

• Imagine that your hand is insensitive and numb,
  as if you were wearing a thick glove

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Procedure
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Pain Reduction by Hypnotic and Nonhypnotic
SuggestionMilling et al. (in press)
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Pain Reduction by Hypnotic and Nonhypnotic
SuggestionMilling et al. (in press)
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Hypnosis and Adherence

• Types of non-adherence
• Voluntary
• Involuntary
• Methods of enhancing voluntary adherence
• Specifying time and place
• Hypnotic suggestion to enhance memory
• The idea ofwill come easily to mind

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Study 1Compliance with Pill Taking Instructions
C Control I Implementation instructions S
suggestion
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Study 2Compliance with Exercise Instructions
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Conclusions

• Suggestion can reduce pain and enhance adherence
  to medical instruction
• The effect on pain does not require the induction
  of hypnosis
• The effect on compliance depends on the persons
  suggestibility