Posted in Uncategorized

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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Posted in Uncategorized

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.

Posted in Uncategorized

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.

Posted in Uncategorized

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.

Posted in Coaching

Placebos in High Performance Sport

A Placebo is something of no intrinsic remedial value that is used to appease or reassure another. There is no completely agreed upon definition of what a placebo is, and the scope of therapy can extend from an ingested agent to a physically inert external treatment. The concept of the placebo effect can extend to include
every conceivable beneficial biological, social, or human interaction that doesn’t involve some drug well-known to the pharmacopoeia. Irving Kirsch hypothesised that the self-fulfilling effects of response expectancies, in which the belief that one will feel different, leads a person to actually feel different. This effect is the placebo effect.

Despite the vast amount of research in the area of placebos, the phenomenon has remained largely unchallenged in the area of sport and performance. In high performance it is likely that there are a great number of therapies and ergogenic aids that are used with no real effect of the athlete. Instead, there is the potential for a placebo effect to occur providing a false positive for improved performance. Expectation and conditioning are among the strongest areas for explaining the placebo effect and a large component of high performance sport involves mental training of an athlete by their coaches and support staff.

The placebo effect is a psychobiological reaction attributed to numerous mechanisms including expectation of improvement and Pavlovian conditioning. These psychological reactions can have performance benefits, and when you look at high performance sport the single highest priority is performance outcome. Numerous studies have been completed where athletes falsely believe they have been administered performance enhancing agents, and obtain performance improvements over baselines and controls. These improvements may only be an increase of 1% however at top levels that can be enough to mean the difference between winning and losing. With restrictions on what agents an athlete can use and what equipment and techniques are allowed win each sport it is necessary to look at every possible option for getting the winning edge on the opposition. Some aids that can be used may only provide a placebo effect on the athlete, but this can lead to real performance outcomes.

It is shown that false belief may enhance performance. This can be achieved through a conscious decision making process as opposed to any direct somatic or psychological mechanism. To be able to determine the real benefit of a placebo however, it would be necessary to look deeper into the actual reasoning for the performance enhancements that are achieved. At the moment the only true way of determining whether there is a placebo effect in place is through performance measures and recording athlete results. If there were some neurobiological mechanism that has a physiological effect on the individual causing these changes, it would be necessary to determine what it is and then measure the impact that it has.

Posted in Uncategorized

Placebos and High Performance Sport

A Placebo is something of no intrinsic remedial value that is used to appease or reassure another. There is no completely agreed upon definition of what a placebo is, and the scope of therapy can extend from an ingested agent to a physically inert external treatment.7 The concept of the placebo effect can extend to include every conceivable beneficial biological, social, or human interaction that doesn’t involve some drug well-known to the pharmacopoeia.10 Irving Kirsch hypothesised that the self-fulfilling effects of response expectancies, in which the belief that one will feel different, leads a person to actually feel different. This effect is the placebo effect.8

Despite the vast amount of research in the area of placebos, the phenomenon has remained largely unchallenged in the area of sport and performance.12 In high performance it is likely that there are a great number of therapies and ergogenic aids that are used with no real effect of the athlete. Instead, there is the potential for a placebo effect to occur providing a false positive for improved performance. Expectation and conditioning are among the strongest areas for explaining the placebo effect13 and a large component of high performance sport involves mental training of an athlete by their coaches and support staff.

The placebo effect is a psychobiological reaction attributed to numerous mechanisms including expectation of improvement and Pavlovian conditioning.3,4 These psychological reactions can have performance benefits, and when you look at high performance sport the single highest priority is performance outcome. Numerous studies have been completed where athletes falsely believe they have been administered performance enhancing agents, and obtain performance improvements over baselines and controls.1,2,5,6,10,11 These improvements may only be an increase of 1% however at top levels that can be enough to mean the difference between winning and losing. With restrictions on what agents an athlete can use and what equipment and techniques are allowed win each sport it is necessary to look at every possible option for getting the winning edge on the opposition. Some aids that can be used may only provide a placebo effect on the athlete, but this can lead to real performance outcomes.

By working with sports science, psychological benefits can be enhanced for an athlete resulting in further improved results. Items such as compression garments have no proven benefit for their use, however they have shown no negative impact either, and by combining the placebo effect of using such ergogenic aids with the possibility of real physiological benefits could potentially result in an amplified boost for the athlete. Many items such as these become products that are viewed by the general population as necessary for elite athletes. It is unclear with these products if the use at high performance breeds the idea that they have a physical benefit, or if there is a physical benefit that causes the population to believe that high performance athletes need them to compete on an international stage. What is clear however is that some athletes believe that they need them to perform and as such they have a real impact on the athletes performance, whether it is through a placebo effect or physiological or neurobiological mechanism.

It is shown that false belief may enhance performance. This can be achieved through a conscious decision making process as opposed to any direct somatic or psychological mechanism.3 To be able to determine the real benefit of a placebo however, it would be necessary to look deeper into the actual reasoning for the performance enhancements that are achieved. At the moment the only true way of determining whether there is a placebo effect in place is through performance measures and recording athlete results. If there were some neurobiological mechanism that has a physiological effect on the individual causing these changes, it would be necessary to determine what it is and then measure the impact that it has.

1. Ariel, G. and Saville, W. (1972) Anabolic steroids: the physiological effects of placebos. Medicine and Science in Sport and Exercise 4, 124-126.

2. Beedie, C. J., and Foad, A. J. (2006). The effect of belief on sports performance. Invited symposium, Annual Conference of the British Association of Sport and Exercise Sciences. University of Wolverhampton.

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

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

5. Clark, V.R., Hopkins, W.G., Hawley, J.A., and Burke, L.M. (2000) Placebo effect of carbohydrate feeding during a 4-km cycling time trial. Medicine and Science in Sport and Exercise 32, 1642-1647

6. Foster, C., Felker, H., Porcari, J.P., Mikat, R.P. and Seebach, E. (2004) The placebo effect on exercise performance, Medicine and Science in Sport and Exercise 36, Supplement S171

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

8. Kirsch, I., (1985). Response expectancy as a determinant of experience and behaviour. American Psychologist 40 (11):1189-1202

9. Maganaris, C.N., Collins, D. and Sharp, M. (2000) Expectancy effects and strength training: do steroids make a difference? The Sport Psychologist 14, 272-278

10. Moerman, D.E. and Jonas, W.B. (2002). Deconstructing the placebo effect and finding the meaning response. Ann Intern Med. 136 (6): 471–6

11. Sonetti, D.A., Wetter, T.J. Pegelow, D.F., and Dempsey, J A. (2001) Effects of respiratory muscle training versus placebo on endurance exercise performance. Respiration Physiology 127 (2-3), 185-199.

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

13. Stewart-Williams S, Podd J. (2004) The placebo effect: dissolving the expectancy versus conditioning debate. Psychol Bull 130:324–40.

 

Posted in Uncategorized

Massage, is it all in your head?

Massage, is it all in your head? By Simon Hone

Massage, or forms of massage, have been around for many hundreds of years. Back then massage would have been used to relax and calm people and although it is still used in that manner to this day massage has become a popular recovery method for athletes competing in high level sport (Hemmings et al., 2000). Massage has large following and many positive expectations about it and how it can lead to a wide variety of benefits including a lowering of heart rate, increase of blood flow, removal of blood lactate from the muscles, increased range of motion of joints, as well as having a positive effect on the athletes mind (Hemmings et al., 2000, Hume et al., 2005, Robertson et al., 2004).

A study carried out by Hemmings et al, (2000) looked at massage as a recovery method after repeated work periods. The study was carried out on boxers with at least 2 years experience of the sport and focused on whether massage could lower blood lactate levels in the muscle after a period of work. They found that massage post exercise did nothing to help the removal of blood lactate from the muscles; in fact the group that received the massage actually had higher levels of blood lactate post exercise. However they did find that massage, as opposed to standard static recovery, showed a large perceived increase of recovery. There has also been work looking at whether a combination of active recovery, which has been shown to have a positive effect on recovery, mixed with massage as a recovery method could be highly beneficial (Martin et al., 1998). So if the massage was actually causing them to have higher blood lactate levels in the body how come they were feeling more recovered? What was at play? Placebo!

The concept of placebo is fairly simple; a stimulus which has minimal to nil proven benefits is applied or taken and then an improvement in condition or performance follows (Bialosky et al., 2011). An easy to understand example would be a doctor prescribing a “new” form of medication. The medication may be nothing different to what the patient is already taking but the pill might look different or have a slight different colour. This change, with a newly perceived outcome, may show a placebo effect (Benedetti et al., 2003, Geers et al., 2005).

The level of response observed from a placebo is reliant on several key factors; negative mood, expectation and conditioning (Bialosky et al., 2011). A person who is suffering from an injury may look into recovery methods and the placebo surrounding them. If they are willing, open minded and positive towards the treatment a faster recovery will likely be observed (Gaitan-Sierra et al., 2011, Geers et al., 2005) as opposed to someone with a negative mood or expectation about treatment where negative expectations will offer a slower recovery and poorer results (Benedetti et al., 2003).
massage
Overall massage is shown to have very few physiological benefits for the body after sports performance however the psychological benefits are not to be over-looked. Being able to appear fresher and feel like you have recovered faster is good. Massage would appear to have no negative benefits, so why not use it all the time? This notion brings into play that if you do sustain an injury during sport but it feels better after a massage could the massage be in fact masking the injury? If you do muscle tissue damage and your immediate response is, I will get a massage and it will feel better, are you actually masking the problem and possibly risking a further and worse injury?

References
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

Bialosky, J, E., Bishop, M, D., George, S, Z & Robinson, M, E., (2011). Placebo Response to Manual Therapy: Something out of Nothing? The Journal of Manual and Manipulative Therapy. 19(1): 11–19.
Gaitan-Sierra, C & Hyland, M, E., (2011). Nonspecific Mechanism That Enhance Well-being in Health-Promoting Behaviours. Health Psychology, American Psychological Association. 30 (6), 793-796

Geers, A, L., Weiland, P, E., Kosbab, K., Landry, S, J & Helfer, S, G. (2005). Goal Activation, Expectations, and the Placebo Effect. Journal of Personality and Social Psychology. 89 (2), 143-159.

Hemmings, B., Smith, M., Graydon, J & Dyson, R. (2000). Effects of Massage on Physiological Restoration, Perceived Recovery, and Repeated Sports Performance. British Journal of Sports Medicine. 34 (2), 109-114

Hume, P, A & Kolt, G, S., (2005). The Mechanisms of Massage and Effects on Performance, Muscle Recovery and Injury Prevention. Journal of Sports Medicine. 35 (3), 235-256.

Martin, N, A., Zoeller, R, F., Robertson, R, J & Lephart, S, M. (1998). The Comparative Effects of Sports Massage, Active Recovery, and Rest in Promoting Blood Lactate Clearance after Supramaximal Leg Exercise. Journal of Athletic Training. 33 (1), 30-35.

Robertson, A., Watt, J, M & Galloway, S, D, R. Effects of Leg Massage on Recovery From High Intensity Cycling Exercise. Journal of Sports Medicine. 38 (2), 173-176.

Posted in Uncategorized

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.

Posted in Ella's blog posts

Sports performance, placebo effects and kinesio-tape

Author: Ella Ward, date published: 29/08/13

Kinesio tape

Kinesio®-tape (KT) is widely used by athletes despite its unexplained performance benefits and clinical evidence of its futility (Kamper & Williams, 2013; Stedge et al., 2012). There are anecdotal reports ranging from improvements in circulation to greater strength, but researchers suggest these improvements in performance are due to a placebo effect, not from the KT itself (Stedge et al., 2012). This blog explores the issues associated with KT tape and associated limitations of research, as well as the psychological concepts of the placebo effect.

A method commonly employed by researchers to measure the efficacy of KT is the improper application of KT. For example, in a study by Ayter and colleagues in 2011, researchers used a treatment (proper application of KT) and a placebo group (sticking plaster without stretch) to assess the effect of KT on patellofemoral pain syndrome. Researchers did observe increases in pain, proprioception, balance and muscle strength with both the placebo and treatment groups (Aytar et al., 2011). However, as no control group was employed in this study, we are unable to determine whether the improvements observed were due to a placebo effect, the effect of taping alone or from the KT (Beedie, 2007). In addition, more research is needed in the field in competitive environments, rather than in a laboratory environment for KT to be accepted as therapeutic intervention in sport and performance (Beedie, 2007).

Despite the vast amount of research in the area of placebos, the phenomenon has remained largely unchallenged in the area of sport and performance (Stedge et al., 2012). In many studies, like the one above, researchers aim to investigate the efficacy of KT as a placebo assuming the outcome is a result of a placebo effect. However, if we are directly observing its effect, studies would be best served by measuring what actually causes it and explaining how and why this effect is observed in this situation, not just assuming a placebo effect has occurred. It is also important to note that care must be taken when measuring and observing the placebo effect due to psychosocial influences, as both belief and expectancy have been acknowledged as determining factors in the efficacy of placebo effects (Beedie, 2007; Benedetti et al., 2005). As these factors are not accounted for in many of the studies investigating the efficacy of KT, it may be beneficial to also conduct questionnaires and interviews in conjunction with clinical trials to generate an understanding of one’s psychosocial expectations and beliefs.

One’s belief influences the outcome in the belief of receiving a beneficial treatment (Beedie, 2007). However it is difficult to measure, quantify and determine the strength of one’s belief of its effects on athletic performance. For example, would a recreational athlete with the same belief as an elite athlete show a greater improvement in performance? And if the athlete was Usian Bolt, could he physiologically improve his performance anymore or is it at the “limit” of belief and placebo effect?

In comparison, expectancy refers to how an individual’s behaviour is influenced by the expectation of how they are meant to feel (Aktas & Baltaci, 2011). If we can elicit a placebo effect by verbally persuading someone of how they are expected to feel, it would also be of interest to examine the effect of reversing expectancy and whether this results in decrements in performance. Expectancy in KT application may also be associated with Pavlov’s theory of classical conditioning (Benedetti et al., 2005). However, the majority of studies look at the immediate effect after its application, not the effect of repeated trials on the efficacy of KT (Aytar et al., 2011; Stedge et al., 2012).

Overall, KT and the placebo effect are relevant in sport and performance, as psychologists can manipulate this intervention to enhance athletic performance; avoiding more intrusive, unethical and expensive treatment methods. However, sport practitioners and psychologists need to be confident that KT is actually beneficial for their athletes in order to recommend it as a therapeutic intervention, and convincing empirical evidence is not available yet. Therefore, practitioners need to make an informed appraisal, taking into consideration the individual’s specific psychosocial context. As it is a harmless intervention, and there potential for performance improvement, there is no harm in using Kinesio-tape.

Now after reading this, please vote on this pole:

Reference list:

Image sourced from Flickr creative commons; http://www.flickr.com/photos/zenmama/8653547400/

Aktas, G., & Baltaci, G. (2011). Does kinesiotaping increase knee muscles strength and functional performance? Isokinetics & Exercise Science, 19(3), 149-155.

Aytar, A., Ozunlu, N., Surenkok, O., Baltacı, G., Oztop, P., & Karatas, M. (2011). Initial effects of kinesio® taping in patients with patellofemoral pain syndrome: A randomized, double-blind study. Isokinetics & Exercise Science, 19(2), 135-142.

Beedie, C. J. (2007). Placebo effects in competitive sport: Qualitative data. Journal of Sports Science and Medicine, 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.

Kamper, S. J., & Williams, C. M. (2013). The placebo effect: powerful, powerless or redundant? British Journal of Sports Medicine, 47(1), 6-9.

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