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Conditioning a Placebo

The archetypal placebo event occurs in a medical setting. A physician gives a patient a pill that, unbeknownst to the patient, is merely a sugar pill. This is the placebo. Presently, the patient’s health improves, apparently because of the belief that the pill was a pharmacological agent, effective for the condition. This is the placebo effect (Stewart-Williams and Podd, 2004).

Although a placebo can be defined, what may be beneficial to one person may be harmful (nocebo) or have no benefit to another.

Conditioning of a placebo is when a procedure is given and produces certain results; the procedure is then substituted for something similar but should have no effect. Benedetti et al. (2003) looked at a person with Parkinson’s and a sub thalamic stimulator which increases movement speed. In the study the machine was turned off twice and then the third time was left on although the patient was told it was turned off. This should have showed that there was no change in movement speed; this was not the case, movement speed still decreased. This demonstrates a conditioned response.

In a sporting context placebos can be as simple as telling someone they are able to do something which they are attempting to do or as seen in the movie Looney Tunes where bugs bunny gives the players water and says it is a performance enhancer. Benedetti et al. (2007) demonstrated that a conditioned placebo may be affective for up to a week after the drug has stopped being administered. This raises many questions for doping during competition, if someone is able to condition themselves enough to get a benefit during the competition they will have an advantage over the competition and won’t show up any drugs in their system.

A placebo in sport doesn’t have to be a drug it may be as simple as routine or lucky clothing, which the player believes makes them play better. This belief creates a placebo effect. The reverse is also true, if a player thinks they aren’t able to perform without this “lucky clothing” or routine then they are likely to underperform without it.

Many studies have looked at the conditioning of a placebo, most are in relation to pain and being able to withstand pain as long as possible. In particular a study by Benedetti et al. 2003 who looked at the pain in response to a tourniquet. Benedetti measured his study by comparing 5 different treatment options.

Having a blind study would be the most beneficial as a comparison of multiple different aspects could be seen along with making it simple enough to impart a placebo by verbal suggestion.

There are many studies which investigate placebo and what we do understand is that some treatments can have a dampening effect on a conditioned placebo, Naloxone was seen by Pollo et al. (2011) and they concluded the endogenous opioid system was being interfered with.

The opioid system is a top-down regulatory system extending from cognitive and affective cortical brain regions to the brainstem and spinal cord dorsal horns, with the ability to negatively modulate the incoming nociceptive signals (Pollo et al. 2011).

In terms of a conditioned placebo there still has to be more research into how long the placebo effect can last, this could be especially useful for WADA (world anti-doping association) and making regulations so as to make sure everyone is on a level playing field.

If coaches are able to utilise the effect of creating a routine and getting players thinking that they can perform well the players are likely to perform better in competition. The question becomes difficult in relation to giving a substance which is to be used during the training week and a placebo in competition. If the player knows about the placebo will they still perform without or will they rely on the substance? Let alone will the player be able to trust the coach after when they find out about the placebo?  Should players be relying on substances in the first place?

Reference list

Stewart-Williams, S., & Podd, J. (2004). The Placebo Effect: Dissolving the Expectancy Versus Conditioning Debate. Psychological Bulletin. 130(2), 324-340.

Benedetti, F., Pollo, A., Lopiano L., Lanotte, M., Vighetti, S., & Rainero I. (2003). Conscious Expectation and Unconscious Conditioning in Analgesic, Motor, and Hormonal Placebo/Nocebo Responses. The Journal of Neuroscience. 23(10), 4315-4323.

Benedetti, F., Pollo, A., & Colloca, L. (2007). Opioid-Mediated Placebo Responses Boost Pain Endurance and Physical Performance: Is It Doping in Sport Competitions? The Journal of Neuroscience. 27(44), 11934-11939.

Pollo, A., Carlino, E., & Benedetti, F. (2011). Placebo Mechanisms Across Different Conditions: From the Clinical Setting to Physical Performance. Philosophical Transactions of the Royal Society B. 366, 1790-1798, doi:10.1098/rstb.2010.0381.

Benedetti, F., Mayberg, H., Wager, T., Stohler, C., Zubieta, J. (2005). Neurobiological Mechanisms of the Placebo Effect. The Journal of Neuroscience. 25(45), 10390-10402.

Deharhnais, R., Jobin, J., Cote, C., Levesque, L., Godin, G. (1993). Aerobic Exercise and the Placebo Effect: A Controlled Study. Psychosomatic Medicine. 55, 149-154.

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Author:

This blog was started for a Uni subject, and has since evolved into a place where I can voice my thoughts, typically about coaching and sport. I grew up in Sydney, then moved to Canberra for some further study in 2011 and when I finished in 2014 I moved up to Brisbane. I have played, coached and generally been involved with volleyball since 2013. As of 2017 I am now the QAS Volleyball Assistant Coach.

2 thoughts on “Conditioning a Placebo

  1. An interesting article and I particularly liked the thought of superstitions (lucky underwear) having an effect on performance through the placebo effect. Do you have a reference for this or is it your own idea? If so, you’d need to state that it is your theory, as you have actually stated it as ‘fact’. I’d also try and steer clear of talking about Looney Tunes, as not everyone will have seen that movie! Also, be careful saying it can replace drug use in a medical environment, as it will actually not work for the majority of cases.

    A good point about WADA and the need to identify a possible placebo effect. However, assuming we are talking about a drug that is banned during competition but not banned outside of competition, then is the use of a placebo actually illegal, or is it just giving a psychological edge. It’s the same sort of discussion as to whether altitude training should be allowed pre-competition when blood doping is not.

    1. The “lucky clothing” idea was my own and hence why it has been referenced to anyone else. In relation to Looney tunes, hopefully if you haven’t seen the movie, this post will at least youtube the section of the movie or watch the entire movie. The medical replacement was a reference from (Stewart-Williams and Podd, 2004)

      Benedetti, F., Pollo, A., & Colloca, L. (2007) was asking the question whether it is doping in sport to condition a response. This paper offered some advise for WADA that is all, they could look into which drugs are easier to condition etc. maybe making WADA change the way they test and which drugs are banned.

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