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Is Self-Efficacy a Mechanism of the Placebo Effect?

Separating the effects of self-efficacy and the placebo effect is often a difficult task for a coach or athlete to complete. Traditionally self-efficacy has five primary mechanisms under which it acts; past mastery experience, modeling through vicarious experience, goal setting, verbal persuasion and anxiety (Bandura, 1982). Studies into the placebo effect have shown it too uses a number of different mechanisms including; opioid antagonism, expectation, classical conditioning, enhancing voluntary response and neural firing, reducing anxiety, increasing self distraction techniques and increasing working memory and executive attention (Benedetti 2005, Meissner 2011, Petrovic & Ingvar 2002, Wager & Smith 2003). Is it also possible that self-efficacy is a mechanism of effect for placebos, or do they exist independently of one another? Expectancy causes self-efficacy when a placebo is mediated by expectancy (Stewart-Williams 2004) and as such there is a relationship between placebo and self efficacy. This relationship has not been thoroughly examined and further research into the potential of a dual process.

Placebos inherently involve some kind of deception (Beedie 2007). Whether it is through the use of inert substances (Benedetti 2005) or an intervention with no intrinsic remedial value (Kamper & Williams 2013). This deception lies at the core of something being a placebo, however it has been suggested that it is possible to successfully induce a placebo effect without this deception occurring (Meissner 2011). If this is truly the case then further psychological mechanisms such as self-efficacy may explain this effect. The use of an intervention in which a person believes they will gain an increase in performance can lead to an actual improvement of results (Beedie 2007). If this is viewed as an increase in self efficacy through the intrinsic belief the individual gains, then how can we know if the placebo effect or self efficacy are the cause? Looking at double dissociation and dual process learning, it may be possible to analyse whether both mechanisms acting together, or whether there is a component of each acting independently, or potentially if both are required for the other to work.

Double dissociation is the demonstration that two experimental manipulations each have different effects on two dependent variables; if one manipulation affects the first variable and not the second, the other manipulation affects the second variable and not the first (Teuber 1955). This usually refers to two cognitive faculties, that are believed to be linked in some way, where each can receive damage whilst the other remains intact and functioning. Double dissociations partition human behaviour into component effects (Van Orden 2001) suggesting that the two things exist independently of one another. Dual process learning is a model involving both implicit and explicit learning, whereby there is a two-level interaction occurring where each interacts in different ways (Sun 2002). Often dual process theories are vague and without specific alignment to the processes that are described (Evans & Stanovich 2013) however this opens up these theories to use outside of the specific psychological learning that they model.

Not all dual process theories are the same, and they do not necessarily relate to the same systems (Evans & Stanovich 2013). By using parts of dual process cognitive theories to develop a relatable model for self efficacy and the placebo effect it may be possible to analyse both mechanisms as occurring independently of one another but also with an impact on the reciprocal result. The placebo effect can occur with and without both expectancy and conditioning (Stewart-Williams 2004), and in a similar fashion self efficacy can be present but is not necessarily a requirement. Implicit and explicit psychobiological mechanisms are inextricably associated with the therapeutic encounter, and are important factors for mediating placebo responses (Meissner 2011), however determining the specific impact of self efficacy to the placebo effect it may be beneficial to analyse self efficacy and placebo as both double dissociative and dual processing. Merging these concepts together could produce an increased understanding to the specific mechanisms that occur when an individual gains a performance benefit from the use of a placebo.

References

Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37, 122-147

Beedie, C. J. (2007). Placebo effects in competitive sport: Qualitative data. J. Sports Sci & Med, 6, 21-28.

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

Evans, J.B.T. & Stanovich, K.E. (2013) Dual-process theories of higher cognition: advancing the debate. Perspectives on Psychological Science 8(3) 223–241

Kamper, S.J. & Williams, C.M., (2013) The placebo effect: powerful, powerless or redundant. Br J Sports Med Vol 47 No 1, 6-9

Meissner, K., Kohls, N. & Colloca, L. (2011) Introduction to placebo effects in medicine: mechanisms and clinical implications Phil. Trans. R. Soc. B  366, 1783–1789

Petrovic, P. & Ingvar, M. (2002) Imaging cognitive modulation of pain processing. Pain 95:1–5.

Sun, R. (2002). Duality of the mind: A bottom-up approach toward cognition. Mahwah, NJ: Lawrence Erlbaum Associates.

Sun, R. (2013). Dual-process theories and cognitive architectures. Rensselaer Polytechnic Institute, Troy, NY, USA

Stewart-Williams, S. & Podd, J. (2004) The placebo effect: dissolving the expectancy versus conditioning debate Psychological Bulletin. 130(2), 324–340

Teuber, H. L. (1955). Physiological psychology. Annual Review of Psychology, 6, 267–296

Van Orden, G.V., Pennington, B.F. & Stone, G.O. (2001) What do double dissociations prove? Cognitive Science 25(1) 111-172

Wager, T.D. & Smith, E.E. (2003) Neuroimaging studies of working memory: a meta-analysis. Cognitive Affect of Behavioural Neuroscience 3:255–274.

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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.

4 thoughts on “Is Self-Efficacy a Mechanism of the Placebo Effect?

  1. Hey Toddy!

    Good point! Just two questions: how would you achieve this “solution” and what would it require? Is it copious amounts of clinical research? Or more subjective questionnaires? On another note I know you stated at the end how finding the interaction between these two variables would further enhance the research in the field and our understanding of the mechanisms of the placebo effect; but what other practical applications could it have for sport and coaching? Would showing that they are related and a placebo does enhance self-efficacy result in encouraging coaches to use placebo’s more in sport??

    Ella

  2. Hi Chris,

    You haven’t said anything incorrect, but unfortunately you have not done as asked! Sorry, you’ve obviously put some work into it, but you need to stay focussed on what you’re meant to be doing, which is:
    Suggest and critically analyse a solution to a problem. Instead, you have described self-efficacy and the placebo effect.

    Here’s what to do:
    Sentence one: “I am talking about…”
    Sentence two: “This issue I identified was…”
    Sentence three: this is an issue because…
    Sentence four: Start solving it!
    You DON’T need to stick with the issue you identified in part 2 (especially if you’re feedback said it was the wrong kind of issue).
    So, having read what you’re talking about, here’s my suggestion.
    “I am talking about self-efficacy. I identified that literature is unsure whether self-efficacy is a result of a placebo effect or not. This is an issue because…. To find out, research needs to…”
    From there, design some research to find out. Remember, you don’t have to do it, but it does have to be possible. Critically analyse your suggestion; the limitations, realism, where research needs to go after your study.
    Then you’ll at least be along the right lines.

    Sorry that this means redoing your essay, but hope it helps.

    Adam

    1. Overall, if you had been asked to write a standard essay this would be in really good shape – the difficulty is that you now need to present a *solution*. The problem is that we cannot accurately distinguish between SE and a placebo at the moment – so the solution is to do the study/studies that fixes that. This will involve not just telling us what a double dissociation is, but exactly the method/study that would achieve this… that would be the solution to the problem.

      Then, as Adam suggests, pause to think critically about whether it would work and what might need to be done afterwards (depending on the result)

      From a motivational standpoint – you’ve done all the hard work and just need to re-word/re-arrange things to specifically present a solution to a tightly defined problem. So it there on a plate and you deserve to convert all that effort into a high mark… so if you have it in you… go for it..!

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