Posted in Ella's blog posts

A placebo effect without deception

Author: Ella Ward, date published: 28/10/13

The problem of using placebo’s in sport arises when a coach’s desire to improve performance involves deception and compromises the coach-athlete relationship. A solution would be to demonstrate a placebos efficacy without deception (Benedetti et al., 2011). Recently, a study by Friedlander et al. (2010) supported the solution, concluding open-label placebos improved the symptoms in patients with Irritable Bowel Syndrome (IBS). Conversely, a study by Fitzpatrick et al. (2007) reported a decline in force production after disclosing the nature of the placebo intervention. Contrary to these two studies, the solution is sparsely investigated in the literature. Thus, a research proposal will be constructed to investigate a placebo intervention without deception. This will also provide coaches and sports scientists with a framework to optimise a placebo effect without deception.

The purpose of the proposed study is to determine whether Kinesio-tape improves circulation in the gastrocnemius muscle during cycling. The study design will be within-group. This is an improvement to Friedlander’s between-group design, where participants assigned no treatment may have been disappointed. This may have negatively influenced the results (Kaptchuk et al., 2011). Furthermore, the study will be unblinded. This is integral to its validity because it needs to reflect the circumstances where both the coach and athlete are agreeable to the placebo. However, unblinded studies have associated risks of bias (Chen et al., 2011; Kaptchuk et al., 2011).

For example, participants may change their behaviour during experimental research. This change is known as the Hawthorne Effect (Campbell et al., 2009; Rowland, 1994). Despite being difficult to overcome in a laboratory environment, measures will be taken to prevent this. For example, the cycle ergometer wattage and revolutions per minute would be maintained at constant values throughout the testing to prevent participants exercising at a higher work rate.

Another limitation is response bias, which occurs through self-reporting methods (Kaptchuk et al., 2011). An example of this occurs when participant’s who are overweight tend to over-estimate duration and intensity of exercise to “please” the experimenters (Acra et al., 1999). This bias was a limitation of Friedlander’s study because only subjective measures were collected. This inhibited researchers from discriminating between response bias or the placebo physiologically improving the condition (Kaptchuk et al., 2010). Therefore, this study will collect objective measures (Kaptchuk et al., 2011). For example, circulation will be measured by exercise physiologists using a non-invasive Laser Doppler. This method has been used in previous studies investigating KT and circulation (Docherty et al., 2012; Hashimoto & Kase, 1998). Differences between responders and non-responders will be investigated by sports psychologists. This would consist of a pre-participation questionnaire, examining the individual’s expectations, beliefs and personality traits such as Five Factor Model (McCrae & John, 1992). Each participants subjective results would be compared to their objective results.

Lastly, an unblinded study may heighten a placebo effect through the expectancy effect (Kaptchuk et al., 2011). Expectancy plays an important role in the efficacy of placebos (Benedetti et al., 2005). Friedlander’s study contained this bias due to its persuasive debriefing, which inadvertently communicated to the participants the expected results (Campbell et al., 2009; Kaptchuk et al., 2010). It is important to note that discussion of the pros and cons of treatment and shared decision making is an integral component in the coach-athlete relationship (Miller et al., 2012). Therefore, the debriefing rationale will not induce expectation, but will present multiple findings from clinical studies. For example: “one study concluded KT did not affect circulation, however another study concluded KT improved circulation when combined with low-strength exercises” (Docherty et al., 2012; Hashimoto & Kase, 1998).

The results from this study would further advance the knowledge in this field. It would also have the potential to improve performance and provide an alternate route for coaches to pursue which does not compromise the coach-athlete relationship. However overall, there is no empirical evidence supporting the efficacy of placebo’s without deception (Fitzpatrick et al., 2007). Thus, the solution would require large amounts of clinical research to match the literature that has been previously published on placebos, which may be unrealistic. The solution may also have implications to previous research, which may become invalid and meaningless when compared to overt placebo trials. The question still exists that if the research yields significant findings, will sports scientists and coaches use the results? Or will the traditional method of deception still be used due to its simplistic nature?

 

Reference list:

Acra, S. A., Buchowski, M. S., Chen, K. Y., Sun, M., & Townsend, K. M. (1999). Energy expenditure determined by self-reported physical activity is related to body fatness. Obes Res, 7(1), 23-33.

Benedetti, F., Carlino, E., & Pollo, A. (2011). Placebo mechanisms across different conditions: from the clinical setting to physical performance. Philosophical Transactions of the Royal Society B: Biological Sciences, 366(1572), 1790-1798.

Benedetti, F., Mayberg, H. S., Wager, T. D., Stohler, C. S., & Zubieta, J.-K. (2005). Neurobiological mechanisms of the placebo effect. The Journal of Neuroscience, 25(45), 10390-10402.

Campbell, Cumming, Gerrig, Wilkes, & Zimbardo. (2009). Psychology and Life (Australian ed.). Australia: Pearson Education Australia.

Chen, M. H., Horsley, T., Moher, D., Morissette, K., & Tricco, A. C. (2011). Blinded versus unblinded assessments of risk of bias in studies included in a systematic review. Cochrane Database Systemic Review, 7(9).

Docherty, C. L., Kroskie, R. M., & Stedge, H. L. (2012). Kinesio Taping and the circulation and endurance ratio of the gastrocnemius muscle. Journal of Athletic Training, 47(6), 635-642.

Fitzpatrick, J., Kalasountas, V., & Reed, J. (2007). The effect of placebo-induced changes in expectancies on maximal force production in college students. Journal of Applied Sport Psychology, 19(1), 116-124.

Hashimoto, T., & Kase, K. (1998). Changes in the volume of the peripheral blood flow by using Kinesio Taping®. Available at www.kinesiotaping.com.

Kaptchuk, T. J., Friedlander, E., Kelley, J. M., & Kirsch, I. (2010). Placebos without deception: a randomized controlled trial in irritable bowel syndrome. PLoS One, 5(12), e15591.

Kaptchuk, T. J., Hrobjartsson, A., & Miller, F. G. (2011). Placebo effect studies are susceptible to response bias and to other types of biases. Journal of Clinical Epidemiology, 64(11), 1223-1229.

McCrae, R. R., & John, O. P. (1992). An introduction to the five-factor model and its applications. Journal of personality, 60(2), 175-215.

Miller, F. G., Brody, H., & Colloca, L. (2012). The placebo phenomenon: implications for the ethics of shared decision-making. Journal of General Internal Medicine(6), 739-742.

Rowland, T. W. (1994). On exercise physiology and the psyche. Pediatric Exercise Science, 6(2), 111-113.

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Psychological Responses to Massage seen in Infants; Are Infants our best Indicators to Combat Worldwide Problems?

Psychological Responses to Massage seen in Infants; Are Infants our best Indicators to Combat Worldwide Problems?

Building on from my previous blog post about the placebo regarding general techniques massage, I have decided to look at some less known, positive effects of massage, how they affect the mind and body, and whether they can be classified as true placebo effects. For instance; light massage versus moderate massage in infant children, and how it affects their growth and development after birth. Infants are ideal to carry studies out when testing for placebo. Their mind is not yet fully developed, thus they don’t normally elicit placebo responses (Harris et al, 2013).

Harris’s study looked at whether giving dextrose gel was an effective way to treat hypoglycaemic infants (infants with very low blood sugar levels), to prevent brain damage later in life. The study( 0-1 month of life) concluded that it was a viable method of decreasing the chance of hypoglycaemia, but what was most interesting about this study was that the control group, the infants who got placebo gel, did not illicit a response and were at higher risk of being hypoglycaemic later in life- no placebo was observed. Similar responses in infants was also observed by Ang et al, 2012, thus the idea that infants, who are still yet to fully develop their brain, will not illicit a placebo is likely a viable one, as opposed to older people (children and adults) where a placebo response is much more likely (Weeks et al, 2011).

The first month of infant development is crucial as the mind and body are both growing rapidly. A study carried out by Field (2004) was to compare the growth rates of infants (0-1 month) that received light pressure massage versus moderate pressure massage. The trial, (n=96), was made up of a range of cultures; with 57% Hispanic, 23% African American, 5% Caucasian, and 15% other. The results clearly showed that infants who received moderate pressure massage as opposed to light pressure massage had improved weight and length after one month, likely due to increased efficiency of food absorption (Field et al, 2004, Field et al, 2007). Having already considered the idea that infants show minimal to nil signs of placebo, and any response that is seen must actually be happening and helping is intriguing in this study. As well as positive physiological outcomes from the study positive results were seen happening on the mind.

A test that was implemented during the study, called The Brazelton Scale, is a multi area assessment used to determine a newborn’s development in areas including orientation, habituation and depression (Brazelton Institute). The results of the Field’s study indicated a significant difference (p= 0.001) when it came to the different types of massage in several areas (orientation and habituation) as well a lower depression score (p= 0.2). These changes on the mind and how the infant was acting could not be described as placebo; infants of this age simply do not elicit such strong responses to these tests.

If there is such a strong case shown in infants, where placebo has minimal to nil effects; that massage can positively impact both physiological and psychological changes why is there no proof of this in the adult population? Could malnourished children benefit from massage? Could children who find it difficult to learn also benefit from massage therapy? Could even depressed people who are struggling in life show some sort of positive outcome associated with massage?

It is hard to tell whether anything witnessed in the infancy stage of life can be reflected in later years but it is worth a try. What is the worst that can happen? Further research is a must.

I hope you have gained a better understanding about the effects of massage on infants and maybe even ponder a question about what positive effects massage could have on your life?

Thanks for reading

Simon

Word Count: 653

 

References:

Ang, J, Y,. Lua, J, L,. Mathur, A,. Thomas, R,. Asmar, B, I,. Savasan, S,. Buck, S,. Long, M & Shankaran, S. 2012. A Randomised Placebo-Controlled Trial of Massage Therapy on the Immune System of Preturn Infants. Official Journal of American Academy of Paediatrics. 130, (6).

Brazelton Institute, Updated 2012, Multiple Authors

Field, T,. Hernandez-Reif, M,. Diego, M,. Feijo, L,. Vera, Y & Gil, K,. 2004. Massage Therapy by Parents Improves early growth and Development. University of Miami Department of Paediatrics, School of Medicine.

 

Field, T,. Diego, M & Hernandez-Reif, M,. 2007. Massage Therapy Research. University of Miami Department of Paediatrics, School of Medicine.

Harris, D, L,. Weston, P, J,. Signal, M,. Chase, G, J & Harding, J, E,. 2013. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies); a randomised, double-blind, Placebo-controlled trial. Newborn Intensive care unit Hamilton, New Zealand, Pediactrics.

Weeks, R, E & Newman, E,. 2011. Behavioural factors in the placebo response. Neurological Science, The official Journal of the Italian Neurological Society. Springer. (32), 1.

 

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Interventions and Confidence

The perception of one’s ability to perform a task successfully is a situation specific for of self-confidence (Bandura 1986), and high levels of self-efficacy have been documented to be associated with optimal levels of sport performance (Feltz 2008; Barker 2013). Self efficacy, is the belief in one’s ability to successfully perform the desired behaviour successfully (Bandura 1977) and it is important to have a strong sense of personal efficacy to maintain the effort needed to succeed, as such people with a high sense of self-efficacy are more likely to have the staying power to endure the obstacles that must be overcome for success (Bandura 1994). The problem that arises for athletes and coaches is determining whether the use of a placebo or ergogenic aid to increase self-efficacy will result in an ability to achieve a higher level of performance.

The coach-athlete relationship is regarded as a critical component to athlete success; with the quality of the relationship positively influencing an athlete’s self-efficacy, motivation and satisfaction (Davis et al., 2013), this alone can be an important factor in altering an athletes self efficacy, and may impact on the placebo’s effect on the athlete. Coaches need to ensure that any placebo interventions used are managed properly and assess the benefit to an athletes’ self-efficacy in relation to the burden on resources that the use of the placebo will have.

The use of a placebo often exerts some influence on performance (Beedie 2007). Elite athletes are always looking to gain an advantage and some athletes may believe, having success following the use of a placebo one time, will mean that future success will be dependant on that intervention. Given the significant association between self-efficacy and sport performance, research exploring effective techniques that facilitate such beliefs are worthy additions to the sport psychology literature (Barker 2013). As the use of a placebo may lead to dependency (Saljoughian 2011) it is important to be certain that an athletes best interest is maintained when considering the use of any placebo interventions.

Humans have evolved an advanced capacity for observational learning that enables them to expand their knowledge and skills on the basis of information conveyed by modelling influences (Bandura 1989) and because of this it is possible to think that success comes from the use of something such as a placebo if that is the most obvious difference between two people. When a group uses a placebo and achieves success following this, the “social persuasion” (Bandura 1994) involved strengthens the beliefs that they have what it takes to succeed, resulting in an increase in self-efficacy. The phenomenon of believing something will improve your performance can act as a placebo effect or simply provide a boost to confidence. This increased self-efficacy can be seen in the use of some products such as skins, kinaesiotape and supplements where the athlete believes they are going to perform better because they have the additional boost of the aid, even though there may be no proven physiological benefit.

In many cases, placebos can create an increased self-efficacy for a person, leading to performance improvement, rather than through the use of physiological enhancement. If the concept of the placebo effect is limited to a physiological process, then it can be problematic to identify and distinguish this effect from the somatic consequences of other psychological processes and motivational changes (Beedie 2007). These changes may in other instances be caused due to increased confidence and self-efficacy, instead of a direct physiological benefit. Performance attainment is the single most powerful influence on one’s perceived physical competence (Bell 1997, Feltz 2008) and so it is important for an athlete to both; believe in themself, as well as achieve performance results to be able to maintain success in the future.

Determining whether an athlete should use a placebo to improve their self-efficacy, will be different from person to person and may be dependant on the resources available. The burden on resources that the use of the placebo consumes, will impact the ability to manage the intervention, and may mean that other mechanisms that will have a greater impact on performance will be missing. There are definite benefits to using any intervention, whether it is a placebo or has a physiological impact, it is just up to the individual to weigh up the benefit of each intervention they wish to use.

References
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioural
change. Psychological Review, 84, 191-215

Bandura, A. (1989). Social cognitive theory. Annals of child development. Vol. 6, 1-60.

Bandura, A. (1994). Self efficacy. Encyclopaedia of human behaviour. Vol. 4, 71-81

Barker, J.B., Jones, M.V., & Greenlees, I. (2013) Using hypnosis to enhance self-efficacy in sport performers. Journal of Clinical Sport Psychology Vol. 7, 228-247

Bell, K.W. (1997) The relationship between perceived physical competence and the physical activity patterns of fifth and seventh grade children. Dissertation, Virginia Polytechnic Institute and State University

Beedie, C. J. (2007). Placebo effects in competitive sport: qualitative data. Journal of Sports Science and Medicine, 6, 21-28

Davis, L., & Jowett, S. (2013). Attachment styles within the coach-athlete dyad: preliminary investigation and assessment development. Journal of Clinical Sport Psychology, 7(2), 120-145.

Feltz, D.L., Short, S.E., & Sullivan, P.J. (2008). Self-efficacy in sport: Research and strategies for working with athletes, teams and coaches. Human Kinetics

Saljoughian, P., & Saljoughan, M. (2011) The placebo effect: Usage, mechanisms, and legality. US Pharm. 36(12):Epub.

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Interventions and their Impact on Self Efficacy

The perception of one’s ability to perform a task successfully is a situation specific for of self-confidence (Bandura 1986), and high levels of self-efficacy have been documented to be associated with optimal levels of sport performance (Feltz 2008; Barker 2013). Self efficacy, is the belief in one’s ability to successfully perform the desired behavior successfully (Bandura 1977) and it is important to have a strong sense of personal efficacy to maintain the effort needed to succeed, as such people with a high sense of self-efficacy are more likely to have the staying power to endure the obstacles that must be overcome for success (Bandura 1994). The problem that arises for athletes and coaches is determining whether the use of a placebo or ergogenic aid to increase self-efficacy will result in an ability to achieve a higher level of performance.

The coach-athlete relationship is regarded as a critical component to athlete success; with the quality of the relationship positively influencing an athlete’s self-efficacy, motivation and satisfaction (Davis et al., 2013), this alone can be an important factor in altering an athletes self efficacy, and may impact on the placebo’s effect on the athlete. Coaches need to ensure that any placebo interventions used are managed properly and assess the benefit to an athletes’ self-efficacy in relation to the burden on resources that the use of the placebo will have.

The use of a placebo often exerts some influence on performance (Beedie 2007). Elite athletes are always looking to gain an advantage and some athletes may believe, having success following the use of a placebo one time, will mean that future success will be dependant on that intervention. Given the significant association between self-efficacy and sport performance, research exploring effective techniques that facilitate such beliefs are worthy additions to the sport psychology literature (Barker 2013). As the use of a placebo may lead to dependency (Saljoughian 2011) it is important to be certain that an athletes best interest is maintained when considering the use of any placebo interventions.

Humans have evolved an advanced capacity for observational learning that enables them to expand their knowledge and skills on the basis of information conveyed by modeling influences (Bandura 1989) and because of this it is possible to think that success comes from the use of something such as a placebo if that is the most obvious difference between two people. When a group uses a placebo and achieves success following this, the “social persuasion” (Bandura 1994) involved strengthens the beliefs that they have what it takes to succeed, resulting in an increase in self-efficacy.

In many cases, placebos can create an increased self-efficacy for a person leading to performance improvement, rather than through the use of physiological enhancement. If the concept of the placebo effect is limited to a physiological process, then it can be problematic to identify and distinguish this effect from the somatic consequences of other psychological processes and motivational changes (Beedie 2007). These changes may in other instances be caused due to increased confidence and self-efficacy, instead of a direct physiological benefit. Performance attainment is the single most powerful influence on one’s perceived physical competence (Bell 1997, Feltz 2008) and so it is important for an athlete to both; believe in themself as well as achieve performance results to be able to maintain success in the future.

Determining whether an athlete should use a placebo to improve their self-efficacy, will be different from person to person and may be dependant on the resources available. The burden on resources that the use of the placebo consumes, will impact the ability to manage the intervention. There are definite benefits to using any intervention, whether it is a placebo or has a physiological

References

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191-215

Bandura, A. (1989). Social cognitive theory. Annals of child development. Vol. 6, 1-60.

Bandura, A. (1994). Self efficacy. Encyclopedia of human behavior. Vol. 4, 71-81

Barker, J.B., Jones, M.V., & Greenlees, I. (2013) Using hypnosis to enhance slf-efficacy in sport performers. Journal of Clinical Sport Psychology Vol. 7, 228-247

Bell, K.W. (1997) The relationship between perceived physical competence and the physical activity patterns of fifth and seventh grade children. Dissertation, Virginia Polytechnic Institute and State University

Beedie, C. J. (2007). Placebo effects in competitive sport: qualitative data. Journal of Sports Science and Medicine, 6, 21-28

Davis, L., & Jowett, S. (2013). Attachment styles within the coach-athlete dyad: preliminary investigation and assessment development. Journal of Clinical Sport Psychology, 7(2), 120-145.

Feltz, D.L., Short, S.E., & Sullivan, P.J. (2008). Self-efficacy in sport: Research and strategies for working with athletes, teams and coaches. Human Kinetics

Saljoughian, P., & Saljoughan, M. (2011) The placebo effect: Usage, mechanisms, and legality. US Pharm. 36(12):Epub.

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Ethics in Sport (Doping)

The use of drugs is not a new thing and it isn’t new in sport either, the question is what makes an athlete take a drug. Since the 1950s anabolic steroids have been used to gain an advantage over the competition. (Dawson, 2001) There is huge pressure to train longer and harder and to take a scientific approach to nutrition and fluid and electrolyte balance, to seek every biomechanical and psychological advantage. It is almost inevitable that some will seek an advantage through drugs. (Mottram, 1999)

In a professional team there are many influences, team mate, coaches and the pressure of winning are just some. A major influence is the player’s physician who is supposed to look after the players and get them to play at their best. “A physician has a primary obligation to the patient’s well-being, is challenged by the emergence of the doctor-patient-team triad, in which the team’s priorities can conflict with or even replace those of the patient-athlete”. (Dunn, et al. 2007) When does the chance of winning become more valuable than your health or enjoyment of the game? This is where the problem arises, if people are able to be given drugs from whomever they come into contact with and then they are able to taper off before competition and use a placebo during competition, what is stopping them. You would think that ethically the player/coach/physician would be thinking, is this right to be cheating my fellow competitors out of the game.

“The use of performance-enhancing drugs is no longer limited to the elite athlete. In 1993 the Canadian Centre for Drug-free Sport estimated that 83 000 children between the ages of 11 and 18 had used anabolic steroids in the previous 12 months. Recent evidence suggests anabolic steroids are now the third most commonly offered drugs to children in the UK, behind cannabis and amphetamines.” (Dawson, 2001)

With this research it shows how not only elite athletes are put under pressure to win and win at all costs. What may be worse is how would a child get their hands on such drugs, an outside source would need to provide the child with such things. Has the use of drugs in sport become common enough that everyone are being influenced to use them, or are drugs needed by everyone these days to perform to their best. Suvelescu, et al. (2004) said “The enormous rewards for the winner, the effectiveness of the drugs, and the low rate of testing all combine to create a cheating ‘‘game’’ that is irresistible to athletes.”

There are many ethical problems with using a drug which enhances performance, the drugs may not be available to everyone and therefore gaining an unfair advantage, The drugs may harm the user and the player may not know what they are taking if given by their physician or coach which would normally be trusted to be doing the best for the player.

How can this problem be solved, the easiest method would be to remove all drugs from sport, although as seen in the previous blog there are ways of getting around the drug testing such as using a placebo for competition which is not detected to be a drug. More testing could be used especially during the lead up to competition and throughout the off season, this would minimise the use of drugs as they are more likely to be caught no matter when they use the drug. Players that are involved in the reduction of drug use can be useful as a role model for the younger generation (Goldberg, et al. 2000). “For athletes who want to compete clean, the threat that they may be beaten by a competitor who is not faster, stronger, or more dedicated, but who takes a drug to gain the edge, is profoundly personal” (Murray, 2009)

“The role of the physician of today is to regain our position of impartiality and objectivity within both the sporting and general community. Only then will we be able to pursue a harm minimisation strategy designed to convince the public that it is better to be the best you can be naturally.” (Dawson, 2001) This is not always the case as explained earlier they are likely to be the ones giving the drugs to the players due to pressure put on them, this should be addressed in order to help remove drugs from sport.

With the help of all whom are involved, the coach, the players and the physicians the solution should be simple and the problem could be resolved. Players should be playing the game at their best and not there drug filled best, coaches should be coaching to help the players perform at their best and similar for the physician who should look to get the players to perform at their best with the use of legal aids and training.

Reference list

Dawson, R. (2001). Drugs in sport – the role of the physician. Journal of Endocrinology. 170, 55-61.

Mottram, D. (1999). Banned Drugs in Sport. British Journal of Sports Med. 27(1), 1-10.

Dunn, W., George, M., Churchill, L., Spindler, K. (2007). Ethics in Sports Medicine. British Journal of Sports Med. 35(5), 840-844.

Suvelscu, J., Foddy, B., Clayton, M. (2004). Why we should Allow Performance Enhancing Drugs in Sport. British Journal of Sports Med. 38, 666-670.

Murray, T. (2009). Drugs, Sport, and Ethics. Exploring Bioethics. 1-7.

MacAuley, D. (1996). Drugs in Sport. British Journal of Sports Medicine. 313, 211-215.

Goldberg, L., Mackinnon, D., Elliot, D., Moe, E., Clarke, G., Cheong, J. (2000). The Adolescent Training and Learning to Avoid Steroid Program. Arch paediatric Adolescent Med. 154, 332-338.

Posted in Ella's blog posts

The effect of deceit on the coach-athlete relationship

Author: Ella Ward, date published: 03/10/13

As well as being influenced by one’s psychosocial context, the efficacy of a placebo is attributed to deceitful administration (Benedetti et al., 2005; Justman, 2013). An infamous high-performance example of this is of French cyclist Richard Virenque, who attributed his success one day to a stimulant he had been injected with, however unbeknown to him, the injection contained just glucose and not the stimulant he was expecting (Vogt, 1999). As demonstrated in this example, a placebo is often administered by a third party such as a coach (Beedie, 2007). Thus, the problem arises when coach’s desire to improve performance involves deceit and compromises the coach-athlete relationship.

The coach-athlete relationship is regarded as a critical component to athlete success; with the quality of the relationship positively influencing an athlete’s self-efficacy, motivation and satisfaction (Davis et al., 2013; Jowett et al., 2012). Over the past decade there has been an abundance of conceptual frameworks developed to model this interdependent dyadic relationship; with Jowett’s (2007) model “3Cs” receiving heightened attention due to its divergence from traditional attachment theories (Davis et al., 2013). This model purports the quality of the relationship is dependent on the equilibrium of three key constructs: closeness, co-orientation and complementarity (Jowett, 2003; Jowett, 2007). However, negating anecdotal reports, there is little empirical evidence regarding the implications of deceit on the relationship (Beedie & Foad, 2009). Therefore, the next section discusses the possible implications of this, drawing upon examples from a case study by Jowett (2003) on relationships in crisis.

An athlete’s motivation has been attributed to their perception of shared closeness with the coach, thus in the event of deceit, feelings, anger, isolation, manipulation and undermining of trust may emerge, changing with how the athlete interacts with their coach and sport (Jowett, 2003).  In addition, because the efficacy of a placebo is attributed to deceit, an athlete may be misinformed about the placebo treatment or even excluded from the decision making (Brody et al., 2012; Justman, 2013). From a coaches perspective, the deception may be justified in that it improves performance, however this lack of co-orientation and incongruent expectations may result in conflict (Jowett, 2003). Higher quality relationships exhibit balanced complementarity. Contrary to this, if the athlete perceives their coach in a more powerful position, it is speculated that a placebo is more likely to be effective (Beedie, 2007). Despite the potential performance improvements, the resultant power imbalance can reverse the effectiveness of the relationship resulting in dysfunction (Davis & Jowett, 2013).

Interestingly, qualitative studies have reported individual sport athletes perceive greater relationship quality compared to team sport athletes, suggesting that overall conflict in this relationship may be more damaging (Jowett et al., 2012). Overall, the deceitful administration of a placebo is speculated to be more prevalent in high-performance sport, where athletes performance is continually being influenced and manipulated by coaches and sports scientists.  However, deceit does not only effect the coach-athlete relationship. A congruent problem is a placebo may avert people from seeking proper treatment, thus also highlighting the problem of long-term implications of delayed treatment (Clemence, 2001).

I believe the relationship shared between the coach and athlete is more powerful than any placebo effect. However, this problem is still not easily solved as coaches will continue to strive to improve performance by that fraction of a percent, possibly regardless of the implications. Therefore it is critical that research is conducted by sports psychologists and exercise scientists is aimed at demonstrating placebo effects can be achieved under circumstances in which the athlete knows it is a placebo. In the meantime, coaches need further education regarding the detrimental effects of their actions. Coaches have a ethical commitment to their athletes, therefore need to exercise full disclosure even though it may negate the efficacy of any placebo.

Reference list:

Beedie, C. J. (2007). Placebo effects in competitive sport: qualitative data. Journal of Sports Science and Medicine, 6, 21-28.

Beedie, C. J., & Foad, A. J. (2009). The placebo effect in sports performance. Sports Medicine, 39(4), 313-329.

Benedetti, F., Mayberg, H. S., Wager, T. D., Stohler, C. S., & Zubieta, J.-K. (2005). Neurobiological mechanisms of the placebo effect. The Journal of Neuroscience, 25(45), 10390-10402.

Brody, H., Colloca, L., & Miller, F. G. (2012). The placebo phenomenon: implications for the ethics of Shared Decision-Making. Journal of General Internal Medicine(6), 739-742.

Clemence, M. (2001). Developing the ethics of placebos in physiotherapy. Physiotherapy, 87(11), 582-586.

Davis, L., & Jowett, S. (2013). Attachment styles within the coach-athlete dyad: preliminary investigation and assessment development. Journal of Clinical Sport Psychology, 7(2), 120-145.

Davis, L., Jowett, S., & Lafrenière, M.-A. (2013). An attachment theory perspective in the examination of relational processes associated with coach-athlete dyads. Journal of Sport & Exercise Psychology, 35, 156-167.

Jowett, S. (2003). When the” honeymoon” is over: a case study of a coach-athlete dyad in crisis. Sport Psychologist, 17(4), 444-460.

Jowett, S. (2007). Interdependence analysis and the 3 + 1Cs in the coach-athlete relationship. In S. Jowett & D. Lavallee (Eds.), Social psychology in sport (pp. 63-77). Champaign, IL: Human Kinetics.

Jowett, S., Rhind, D. J. A., & Yang, S. X. (2012). A comparison of athletes’ perceptions of the coach-athlete relationship in team and individual sports. Journal of Sport Behavior, 35(4), 433-452.

Justman, S. (2013). Deceit and transparency in placebo research. Yale Journal of Biology and Medicine, 86, 323-331.

Vogt, W. (1999). Breaking the chain: drugs and cycling, the true story. London: Random House/Yellow Jersey Press. In Beedie, C. J. (2007). Placebo effects in competitive sport: qualitative data. Journal of Sports Science and Medicine, 6, 21-28.

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Causality

Causality is the relation between an event and a second event, or the event and the effect. Usually the second event is identified as a consequence of the first, however sometimes it is not as simple as that. In general, science looks at a correlation between to events, and this is often mistreated as causation.

When you deal with emotions and personality traits it is much less defined as to where correlation becomes causation. The type theory by Eysenck says that behaviour is based on biological causation and describes a person based on dispositional tendencies. This is a common theme in behavioural science and often there is seen to be a causation between personality and activity.