Open-label placebo treatment to improve relaxation training effects in healthy psychology students: a randomized controlled trial

Effects of Open-Label Placebos on Visual Food Cue Reactivity in Children and Adolescents

BACKGROUND

A high level of food cue reactivity (FCR) is a risk factor for overeating and weight gain. This randomized trial investigated whether open-label placebos (OLPs: placebos honestly administered) can reduce FCR (reported appetite) in children and adolescents.

METHOD

Children (n = 73; 8-12 years old) and adolescents (n = 187; 16-18 years old) were randomly assigned to either an OLP group or a control group (without OLP). Participants viewed images depicting food (sweets and fruits) and non-food items. Before viewing, the OLP group received a placebo for appetite reduction. Participants rated their desire to eat the depicted food items (0-100) and the perceived effectiveness of the OLP intervention.

RESULTS

The OLP exhibited a large effect in children, leading to a general reduction in appetite (group difference OLP vs. no OLP: M = -20.8; ηp2 = 0.20). This general effect was absent in adolescents, whose appetite reduction was restricted to fruits (OLP vs. no OLP: M = -8.1; ηp2 = 0.03). Additionally, children perceived the OLP as more effective than adolescents.

CONCLUSION

The reduced response and skeptical attitudes of adolescents towards OLP treatment require further investigation.

Placebo Effects on the Enjoyment of Physical Activity and Performance among Kindergarten Children: A Randomized Controlled Trial

Studies with adults and school children have shown that placebos can enhance motivation and performance in physical activities. This study aimed to investigate whether similar effects are present in kindergarten-aged children. A total of 101 children (58 girls, 43 boys) aged 3 to 6 years were randomly assigned to one of two groups that either received a deceptive placebo (DP: "magic potion") or a nondeceptive placebo (NDP: "water") to enhance physical abilities. Each child completed three tasks (sprinting; balancing: standing on a balance board; strength: using a handheld dynamometer) both with and without the placebo. The variables assessed included task performance, enjoyment, and expected and perceived placebo efficacy (measured with nonverbal pictorial rating scales). Results showed that both the DP and NDP increased speed. For strength, balance, and task enjoyment (which was very high), no placebo-induced changes were observed. Expected efficacy was higher for the DP; perceived efficacy did not differ between DP and NDP. In conclusion, reported outcome expectations indicated that kindergarten-aged children were already able to differentiate between the two types of placebos which exhibited positive effects concerning running performance. This encourages further research on using nondeceptive placebos to enhance physical activity, which is crucial for children's overall health.

Effects of (non)deceptive placebos on reported sleep quality and food cue reactivity

A lack of sleep can increase appetite, particularly for high-calorie food. The current study tested the effects of an open-label placebo for improving sleep quality and reducing food cue reactivity. In open-label placebo interventions, placebo recipients are informed that they are receiving a placebo without a pharmacologically active substance. Participants (n = 150) were randomly allocated to one of three groups that received either an open-label placebo to improve sleep quality, a deceptive placebo ("melatonin"), or no placebo. The placebo was administered daily before bedtime for 1 week. Sleep quality and reactivity to high-calorie food cues (appetite, visual attention to food images) were assessed. The deceptive placebo (but not the open-label placebo) reduced reported sleep-onset latency. The open-label placebo decreased perceived sleep efficiency. The placebo interventions did not change food cue reactivity. This study demonstrated that open-label placebos do not present an alternative to deceptive placebos for improving sleep quality. The undesirable open-label placebo effects found warrant further exploration.

Would You Take an Open-Label Placebo Pill or Give One to Your Child? Findings from a Cross-Sectional Survey

Background

Open-label placebos (OLPs), honestly prescribed regarding their inert nature, have been associated with positive health-related effects in both children and adults. However, OLPs are not always perceived by laypeople as a viable treatment option.

Methods

A brief online survey with 806 adult participants (age range: 18-75 years; 29% parents) was conducted to identify predictor variables that are associated with the willingness to take an OLP pill (criterion 1) or to give an OLP to one's child (criterion 2). The survey covered aspects including the perceived plausibility of the treatment concept for both OLPs and deceptive placebos (DPs), self-reported knowledge about placebos, the expected effectiveness of OLPs in treating emotional/ somatic problems, and attitudes concerning taking pills in general. Multiple hierarchical regressions were carried out.

Results

The expected effectiveness of OLPs in alleviating both emotional and physical ailments and the plausibility of the treatment concepts for both OLPs and DPs significantly predicted the willingness to use OLPs (R2 = 0.485). A similar finding was observed when predicting the willingness to administer an OLP to one's child (R2 = 0.443).

Conclusion

Favorable expectations regarding the reduction of emotional and somatic symptoms with OLPs, along with a strong belief in the credibility of placebo mechanisms, play a vital role in influencing the willingness to accept this kind of treatment. These factors can be incorporated into psychoeducational programs.

A randomized trial that compared brain activity, efficacy and plausibility of open-label placebo treatment and cognitive repappraisal for reducing emotional distress

Placebo pills can reduce emotional distress even when recipients have been informed about the inert nature of the treatment. However, before such open-label placebos (OLPs) can be recommended for general clinical use, their efficacy and acceptability need to be further investigated and compared with established methods for emotion regulation, such as cognitive reappraisal (CR). The current study with functional magnetic resonance imaging compared the effects of an OLP pill with CR for reducing a specific form of emotional distress: disgust. Participants (150 healthy females) were randomly allocated to one of three groups, all of which were exposed to disgusting and neutral images (OLP, CR, PV: passive viewing). It was tested whether the three groups would differ in brain activity and reported disgust. Ratings for the perceived efficacy and plausibility of treatment were also compared between OLP and CR. Both OLP and CR increased the activity in a cognitive control region, the ventrolateral prefrontal cortex. Relative to PV and OLP, CR reduced activity in the putamen and pallidum. These regions play an important role in decoding disgust signals from different modalities. Self-reports indicated that CR was perceived as a more effective and plausible intervention strategy than OLP. In conclusion, CR was a superior method for disgust regulation compared to OLP, both on the subjective as well as the neurobiological level. Future OLP studies are needed to test whether the observed effects generalize to other forms of emotional distress.

Non-Deceptive Placebos Can Promote Acts of Kindness: A Randomized Controlled Trial

Placebos have often been used to reduce emotional distress but rarely to increase positive feelings. The present study investigated whether a placebo can promote acts of kindness (AoKs) that are associated with emotional well-being. A total of 160 university students were asked to perform an AoK daily for one week. They evaluated their emotional state (feelings of pleasantness, arousal, satisfaction) directly before and after the AoKs. This was monitored via a smartphone app. One group performed each AoK after taking a non-deceptive placebo; the other group received no placebo. Before and after the one-week program, the participants completed three questionnaires that assessed satisfaction with life, positive/negative affect, and flourishing. The participants reported higher pleasantness directly after engaging in an AoK and more satisfaction with life after the program. The motivation to carry out AoKs decreased strongly over the week. However, placebo receivers completed more AoKs than the no-placebo group. The results indicate that placebo treatment can promote the performance of acts of kindness.

Open-label placebos as adjunctive therapy for patients with depression

Background

Placebos prescribed as 'regular' medication can reduce symptoms of depression. However, using a placebo without patients' informed consent presents ethical issues. Therefore, the present study assessed the efficacy of an open-label placebo (OLP), which was administered concurrently with cognitive-behavioral therapy (CBT).

Methods

Sixty patients (mean age: 48 years) diagnosed with major depressive disorder were randomly assigned to a 4-week CBT outpatient program with or without daily OLP treatment. The patients were assessed directly before and after the program as well as three months after the therapy.

Results

Compared to the CBT group, the CBT + OLP group showed a greater reduction in symptoms of depression at the end of the program. Changes in categories pertaining to severity of depression did not differ between groups. All patients completed the program. Noncompliance with the follow-up appointment differed significantly between CBT + OLP (27%) and CBT (7%). Noncompliance was associated with a negative evaluation of the OLP.

Conclusions

The OLP intervention reduced symptoms of depression, however, these changes were not clinically meaningful. The OLP increased the risk for loss to follow-up. The high dropout rate in the present study raises questions concerning the acceptance of OLPs in the treatment of depression.