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.
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.