Connie L. Peck

Conditioned response models of placebo phenomena: Further support.

&NA; Following our earlier research [37], we further investigated a model that conceptualizes placebo phenomena as the result of conditioning [40] and attempted to extend and replicate the finding that placebo responses can be conditioned in human subjects. Two groups of 10 subjects were told that they were receiving an analgesic which was in fact a placebo. During the conditioning, placebo administration was surreptitiously paired with an increase in the painful stimulus for half of the subjects and with a decrease for the other half. Subjects were tested pre and post conditioning for a placebo response. A second type of experimental pain was also used to determine stimulus generalization. The results confirmed a previous finding that placebo responses can be conditioned in human subjects. The implications for clinical practice of a learning model of placebo behavior are discussed.

Conditioned placebo responses.

Following earlier animal research, we attempt to condition placebo effects in human subjects. Four groups of 8 voluntary subjects were told that the experimenters would test a powerful new analgesic cream over three sessions by assessing its ability to reduce experimentally induced pain. The analgesic cream was, in fact, a placebo. In the first session all subjects were tested with and without the cream to assess their placebo response. In the second session, to condition two groups (with differing stimulation levels) to experience pain relief in response to the placebo, we repeatedly paired a reduction in nocioceptive stimulation with placebo administration. (Subjects were unaware that stimulation levels were manipulated). To condition the other two groups (with different stimulation levels) to experience an exacerbation of the pain, we paired an increase in nocioceptive stimulation with placebo administration. In the third session, all subjects were again tested for placebo response. Results suggested that placebo responses are conditionable in the laboratory in both a positive and negative direction. The clinical implications of a learning theory of placebo behavior are discussed.

Implications of placebo theory for clinical research and practice in pain management

We review three possible theoretical mechanisms for the placebo effect: conditioning, expectancy and endogenous opiates and consider the implications of the first two for clinical research and practice in the area of pain management. Methodological issues in the use of placebos as controls are discussed and include subtractive versus additive expectancy effects, no treatment controls, active placebo controls, the balanced placebo design, between- versus within-group designs, triple blind methodology and the double expectancy design. Therapeutically, the possibility of shaping negative placebo responses through placebo sag, overservicing and the use of placebos on their own are explored. Suggestions for using conditioned placebos strategically in conjunction with nonplacebos are made and ways of maximizing the placebo component of nonplacebo treatments are examined. Finally, the importance of investigating the placebo effect in its own right is advocated in order to better understand the long-neglected psychological aspects of the therapeutic transaction.

The timing of pre-operative preparatory information

Abstract The effect of varying the timing of pre-operative preparation on post-operative recovery was examined with 37 cholecystectomy patients. A group prepared two weeks before surgery was compared with a group prepared the day before surgery and a no treatment group on state anxiety, pain ratings, mood, physical recovery, length of hospitalisation and analgesic usage. The Early Preparation Group did not differ significantly from the Late Preparation and No Treatment Control Groups on a number of recovery variables, although there was a trend in favour of Late Preparation. The results suggest that Early Preparation for surgery may not lead to more rapid recovery as predicted by Johnston (1980).

A model for resolving conflict: Some theoretical, empirical and practical implications

This paper describes a model for resolving interpersonal, intergroup, and international conflict and sets it into a theoretical and empirical context. The model aims for a cooperative process resulting in integrative solutions. The following stages, similar to social problem solving approaches, are described: developing expectations for win-win solutions, identifying interests, brainstorming creative options, and combining options into win-win solutions. Also discussed are objective criteria, alternatives to negotiated agreements, and methods for managing emotions. Research related to each stage and areas needing further work are noted.

Compliance and the Doctor-Patient Relationship

A review of the literature suggests that patient noncompliance is more often a manifestation of dysfunctional practitioner-patient communication than a result of the patients personality. Noncompliance constitutes a major obstacle to the provision of adequate medical care. Among its consequences are poor patient health renewed rounds of diagnostic testing added discomfort for the patient less preferred choice of treatment increased costs to both the patient and the health care system deterioration of the physician-patient relationship and inaccurate research results. Physicians can help to ensure compliance by including the patient as a full participant in decisions about and implementation of medical treatments. It is also important for physicians to be aware of patients personal beliefs about disease and the extent to which these are in agreement or disagreement with the physicians belief. Diagnoses and treatment recommendations should be presented in jargon-free language. The research indicates that patients who understand why the treatment has been recommended are most likely to follow it. Praise and rewards should be an important part of any program aimed at promoting good patient compliance. Scolding or punishing patients for noncompliant behavior causes the physician-patient relationship to resemble an authoritarian parent-child interaction and detracts from the mutual participatory relationship that is most likely to resolve problems of noncompliance. Enhancing patient compliance through communication skills is a process that must begin with the physicians 1st contact with the patient.

Stress inoculation for acute pain: a clinical trial

The study attempted a clinical evaluation of the efficacy of stress inoculation training for postoperative pain control using patients undergoing coronary artery graft surgery. A treatment group receiving stress inoculation training was compared to attention-education and no-treatment control groups. No differences were found between the groups on two pain rating measures, analgesic intake, or measures of state anxiety and depression. The ineffectiveness of stress inoculation in this study may be due to the difference between experimental and clinical pain, the multiple demands of the preoperative period, possible memory difficulties which some patients may have experienced, or the possibility that the procedure is not sufficiently potent for the intensity of this type of pain.

Effectiveness of a Sex Education and Counseling Program for Spinal Cord Injured Patients

While there has been an increase in research and clinical interest in the sexual functioning of spinal cord injured persons and their partners, little has been reported of the effectiveness of sexual education and counseling procedures with this group of patients. The present study reported on a sex education and counseling program for spinal cord patients, an instrument used to assess the programs effectiveness and the impact of the program on the specific sexual information and concerns of a group of spinal cord injured patients.After a completion of the sex education and counseling program, patients were more accepting of a variety of sexual behaviors and less concerned about sexual function. Patients did not show a significant increase in sexual knowledge, nor any significant change in concern about non-sexual function following the program.

Conflict management and the prevention of war

This paper argues that the key to better management of international conflict lies in understanding the processes of conflict escalation and de-escalation. Since many of these processes are psychological, psychology as a discipline would seem to have much to contribute to theory, research and practice in this important area.