Issue link: https://www.massageandbodyworkdigital.com/i/1492048
THE PLACEBO EFFECT A traditional definition of placebo effect is a brain-body response to an inert treatment in a specific psychosocial context. 1 Did you just think of a doctor in a white coat in a lab administering a sugar pill? I did. But it's possible to have a placebo response with a treatment that is not a sugar pill. Picture a nutritionist in an office handing a patient a vitamin pill (active ingredient) for a specific vitamin deficiency. The patient takes the vitamin pill and instantly feels more energy. The instant energy response was likely a placebo response, since vitamin supplementation would need time to produce an effect. Massage is more like a vitamin pill than a sugar pill in the sense that both the massage and the vitamin pill have "active" ingredients and are capable of producing a brain-body response. So, let's expand the placebo definition to include active treatments that can be enhanced by placebo- related mechanisms. 2 HOW DO YOU PRODUCE A PLACEBO EFFECT? You produce a placebo effect through expectancy and learned associations, according to placebo researcher Darwin Guevarra, PhD. 3 Expectancy means anticipating an intended beneficial effect. For example, a doctor tells their client "Azur" that a cream (actually a placebo cream) will reduce his joint pain. Azur believes the cream will help his arthritic knee, and it does. A learned association happens when a beneficial effect is paired with a placebo object or procedure. It's automatic and the person is unaware. For example, "Elaine" is injected with a pain-killing medication. Later, she is given a second injection, but this time, unbeknownst to Elaine, the painkiller is a placebo (saline solution). Elaine experiences less pain after the placebo injection. WHAT A PLACEBO CAN DO It's notable that a saline injection can reduce pain. 4 An even more dramatic example of a placebo effect occurred in Paris in the late 18th century when Charles Mesmer temporarily returned the sight of a blind girl using a treatment called animal magnetism, which was proven to be a placebo. 5 In a Harvard Health Publishing article, professor Ted Kaptchuk says, "Placebos may make you feel better, but they will not cure you." 6 He also goes on to say placebos ". . . have been shown to be most effective for conditions like pain management, stress- related insomnia, and cancer treatment side effects like fatigue and nausea." 7 Pain management is in our massage wheelhouse. Our goal is to tap into placebo pathways to help clients manage pain and feel better. Let's apply the research. ENHANCING THE PLACEBO EFFECT THROUGH COMPETENCE AND WARMTH In 2019, Lauren Howe, PhD, and her colleagues identified two key components for enhancing a placebo response in the therapeutic relationship: competence and warmth. Howe explains, "A provider's competence and warmth make a provider more credible, believable, and/or persuasive, which may boost the impact of the expectations they set about treatment." 8 Howe refers to competence and warmth as "gets it" and "gets you." The doctor who gets it does things like conduct a thorough exam and demonstrate mastery over the subject matter. The doctor who gets you is nice and calls you by name. We're not doctors, but like doctors, we have placebo potential through the therapeutic relationship—and we should not let this healing potential fritter away. Recently, a person in persistent pain, we'll call her "Shari," was referred to me by another health-care provider. Here's how I applied warmth, competence, and other research-backed findings in the massage room. 46 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 2 3 Be Warm Shari has persistent hip pain. She has been through the gamut of diagnostics and treatments and was cleared of any life-threatening malady. Basically, she was coming to me as a last hope. No pressure, right? When Shari came in, I smiled and introduced myself like I do with every new client. I offered her water and made sure to call her by her first name. I didn't get a lot of warm fuzzies back from her. Later, as we talked, I realized she was on the fence about massage. Nothing worked so far, so why should this work? Be Competent Shari filled out the intake and we started to talk. At the time, I didn't realize I was actually engaged in another placebo-enhancing activity—ritual. Yes, filling out a massage intake is a ritual. How so? Think about your first time at a dentist, physical therapist, primary doctor, nutritionist, or almost any health- care provider—what do you do? Fill out an intake. In fact, if you weren't asked to fill out an intake, you'd probably think twice about the quality of care you were about to receive. Intakes are a modern medicine ritual. And rituals are powerful because they induce changes in the brain via the release of feel- good hormones. 9 We make a big deal out of our intake in our office. The form itself is comprehensive and designed to get the client to talk and tell their story. We also put ample time between clients so the therapist can get all the information they want and the client doesn't feel rushed. After Shari filled out the intake, I asked questions. She talked and I listened. Besides providing me with valuable information, listening strengthened therapeutic rapport. Then, I explained my massage approach to pain relief, but Shari interrupted me. She asked, "Do you think I can feel better?"