Guy H. Montgomery

An analysis of factors that contribute to the magnitude of placebo analgesia in an experimental paradigm

Placebo analgesia was produced by conditioning trials wherein heat induced experimental pain was surreptitiously reduced in order to test psychological factors of expectancy and desire for pain reduction as possible mediators of placebo analgesia. The magnitudes of placebo effects were assessed after these conditioning trials and during trials wherein stimulus intensities were reestablished to original baseline levels. In addition, analyses were made of the influence of these psychological factors on concurrently assessed pain and remembered pain intensities. Statistically reliable placebo effects on sensory and affective measures of pain were graded according to the extent of surreptitious lowering of stimulus strength during the manipulation trials, consistent with conditioning. However, all of these effects were strongly associated with expectancy but not desire for relief. These results show that although conditioning may be sufficient for placebo analgesia, it is likely to be mediated by expectancy. The results further demonstrated that placebo effects based on remembered pain were 3 to 4 times greater than those based on concurrently assessed placebo effects, primarily because baseline pain was remembered as being much more intense than it actually was. However, similar to concurrent placebo effects, remembered placebo effects were strongly associated with expected pain levels that occurred just after conditioning. Taken together, these results suggest that magnitudes of placebo effect are dependent on multiple factors, including conditioning, expectancy, and whether analgesia is assessed concurrently or retrospectively.

Classical conditioning and the placebo effect

Abstract Stimulus substitution models posit that placebo responses are due to pairings of conditional and unconditional stimuli. Expectancy theory maintains that conditioning trials produce placebo response expectancies, rather than placebo responses, and that the expectancies elicit the responses. We tested these opposing models by providing some participants with information intended to impede the formation of placebo expectancies during conditioning trials and by assessing placebo expectancies. Although conditioning trials significantly enhanced placebo responding, this effect was eliminated by adding expectancies to the regression equation, indicating that the effect of pairing trials on placebo response was mediated completely by expectancy. Verbal information reversed the effect of conditioning trials on both placebo expectancies and placebo responses, and the magnitude of the placebo effect increased significantly over 10 extinction trials. These data disconfirm a stimulus substitution explanation and provide strong support for an expectancy interpretation of the conditioned placebo enhancement produced by these methods.

Hypnosis as an Adjunct to Cognitive-Behavioral Psychotherapy: A Meta-Analysis.

: A meta-analysis was performed on 18 studies in which a cognitive-behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments.

The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis.

Hypnosis is a nonpharmacologic means for managing adverse surgical side effects. Typically, reviews of the hypnosis literature have been narrative in nature, focused on specific outcome domains (e.g., patients’ self-reported pain), and rarely address the impact of different modes of the hypnosis administration. Therefore, it is important to take a quantitative approach to assessing the beneficial impact of adjunctive hypnosis for surgical patients, as well as to examine whether the beneficial impact of hypnosis goes beyond patients’ pain and method of the administration. We conducted meta-analyses of published controlled studies (n = 20) that used hypnosis with surgical patients to determine: 1) overall, whether hypnosis has a significant beneficial impact, 2) whether there are outcomes for which hypnosis is relatively more effective, and 3) whether the method of hypnotic induction (live versus audiotape) affects hypnosis efficacy. Our results revealed a significant effect size (D = 1.20), indicating that surgical patients in hypnosis treatment groups had better outcomes than 89% of patients in control groups. No significant differences were found between clinical outcome categories or between methods of the induction of hypnosis. These results support the position that hypnosis is an effective adjunctive procedure for a wide variety of surgical patients.

Cognitive Behavioral Therapy Techniques for Distress and Pain in Breast Cancer Patients: A Meta-Analysis

This meta-analysis is the first to examine cognitive behavioral therapy (CBT) techniques for distress and pain specifically in breast cancer patients. Twenty studies that used CBT techniques with breast cancer patients were identified and effect sizes were calculated to determine (1) whether CBT techniques have a significant impact on distress and pain, (2) if individual or group treatments are more effective, (3) whether severity of cancer diagnosis influences distress and pain outcomes, and, (4) if there is a relationship between CBT technique efficacy for distress and pain. Results revealed effect sizes of d = 0.31 for distress (p < 0.05) and .49 for pain (p < 0.05), indicating that 62 and 69% of breast cancer patients in the CBT techniques treatment groups had less distress and less pain (respectively) relative to the control groups. Studies with individual treatment approaches had significantly larger effects compared to studies that employed group approaches for distress (p = 0.04), but not for pain (p > 0.05). There were no significant differences in effects between those with or without metastases (p > 0.05). The correlation between effect sizes for distress and pain was not significant (p = 0.07). Overall, the results support the use of CBT techniques administered individually to manage distress and pain in breast cancer patients. However, more well-designed studies are needed.

Forging Ahead: The 2003 APA Division 30 Definition of Hypnosis

Abstract The article describes the rationale for and the process of developing a new definition of hypnosis by the Society of Psychological Hypnosis, Division 30 of the American Psychological Association. Both theoretical and practical implications led to the production of the definition, which is targeted toward informing clinicians, researchers, and the lay public alike. The definition is presented at the conclusion of the article.

Mechanisms of Placebo Pain Reduction: An Empirical Investigation

Identical experimental pain stimuli were applied to the right and left index fingers of 56 university students, following the application of a placebo in the guise of a topical anesthetic to one of the fingers The pain stimuli were administered simultaneously to treated and untreated fingers for half of the subjects and sequentially for the others Significant and equivalent reductions in pain were reported in both conditions as a function of placebo administration These data indicate that reductions of experimental pain produced by placebos presented in the guise of local anesthetics are not mediated by such global mechanisms as anxiety reduction or the release of endogenous opioids

The therapeutic relationship in e-therapy for mental health: a systematic review.

Background E-therapy is defined as a licensed mental health care professional providing mental health services via e-mail, video conferencing, virtual reality technology, chat technology, or any combination of these. The use of e-therapy has been rapidly expanding in the last two decades, with growing evidence suggesting that the provision of mental health services over the Internet is both clinically efficacious and cost effective. Yet there are still unanswered concerns about e-therapy, including whether it is possible to develop a successful therapeutic relationship over the Internet in the absence of nonverbal cues. Objective Our objective in this study was to systematically review the therapeutic relationship in e-therapy. Methods We searched PubMed, PsycINFO, and CINAHL through August 2011. Information on study methods and results was abstracted independently by the authors using a standardized form. Results From the 840 reviewed studies, only 11 (1.3%) investigated the therapeutic relationship. The majority of the reviewed studies were focused on the therapeutic alliance—a central element of the therapeutic relationship. Although the results do not allow firm conclusions, they indicate that e-therapy seems to be at least equivalent to face-to-face therapy in terms of therapeutic alliance, and that there is a relationship between the therapeutic alliance and e-therapy outcome. Conclusions Overall, the current literature on the role of therapeutic relationship in e-therapy is scant, and much more research is needed to understand the therapeutic relationship in online environments.

Family and friends with disease:: their impact on perceived risk

BACKGROUND For many common diseases, having a family history is the strongest predictor of lifetime risk. Perceptions of personal risk, important for appropriate prevention efforts, have been found to be exaggerated in healthy individuals with family histories. These findings highlight the contribution of objective and experiential factors to perceived risk. This study examined, across a variety of diseases, whether (1) family history of the disease contributes to perceived risk, (2) history of disease in a friend or nonblood relative, which would not increase ones objective risk, nonetheless increases perceived risk, and (3) these effects are similar across genders. METHODS Participants (N = 522; 38% male; 56% Caucasian; mean age = 40 years) completed a brief health survey. RESULTS Analyses revealed an effect of having a family history of the disease on perceived risk for breast and colon cancers, heart disease, and diabetes (P < 0.001). Interestingly, having a friend diagnosed with the disease also contributed to perceived risk for breast and colon cancers, as well as heart disease and diabetes among women (P < 0.05), but not among men. CONCLUSIONS Results suggest that interventions to alter perceived risk of cancer should account for gender, as women appear to be impacted by who they know.

The application of a shortened version of the profile of mood states in a sample of breast cancer chemotherapy patients

Objectives. The Profile of Mood States (POMS) is a 65-item mood measure with demonstrated reliability and validity; however, its length can be of concern to researchers. The present study investigated the utility of a 37-item shortened version of the POMS (SV-POMS) developed by Shacham (1983). Design. In samples of breast cancer chemotherapy patients (patient group 1) and healthy volunteers, correlations between the subscales of the measures and internal consistencies were examined; these samples were also used to compare mood ratings of healthy women and patients. In another sample of breast cancer chemotherapy patients (patient group 2), the sensitivity to changes in mood of the measures was investigated. Methods. Patient group 1 comprised 114 women; patient group 2 comprised 48 women. Healthy volunteers were 55 women recruited through newspaper advertisements. Results. The correspondence between the measures was demonstrated by significant correlations of the shortened with the full-length scales. Internal consistencies of the measures were comparable. Both measures demonstrated mood differences between patients and volunteers. The responsiveness of the measures to change were comparable as demonstrated by changes in distress scores across chemotherapy infusions. Conclusions. Results suggest that the SV-POMS can be used when participant burden is of concern.