Margot Darragh

Expressive writing and wound healing in older adults: a randomized controlled trial.

Objective To investigate whether expressive writing could speed wound reepithelialization in healthy, older adults. Methods In this randomized controlled trial, 49 healthy older adults aged 64 to 97 years were assigned to write for 20 minutes a day either about upsetting life events (Expressive Writing) or about daily activities (Time Management) for 3 consecutive days. Two weeks postwriting, 4-mm punch biopsy wounds were created on the inner, upper arm. Wounds were photographed routinely for 21 days to monitor wound reepithelialization. Perceived stress, depressive symptoms, health-related behaviors, number of doctor visits, and lipopolysaccharide-stimulated proinflammatory cytokine production were also measured throughout the study. Results Participants in the Expressive Writing group had a greater proportion of fully reepithelialized wounds at Day 11 postbiopsy compared with the Time Management group, with 76.2% versus 42.1% healed, &khgr;2(1, n = 40) = 4.83, p = .028. Ordinal logistic regression showed more sleep in the week before wounding also predicted faster healing wounds. There were no significant group differences in changes to perceived stress, depressive symptoms, health-related behaviors, lipopolysaccharide-induced proinflammatory cytokine production, or number of doctor visits over the study period. Conclusions This study extends previous research by showing that expressive writing can improve wound healing in older adults and women. Future research is needed to better understand the underlying cognitive, psychosocial, and biological mechanisms contributing to improved wound healing from these simple, yet effective, writing exercises. Trial Registration: Australian New Zealand Clinical Trials Registry (trial number 343095)

The placebo effect in inflammatory skin reactions: the influence of verbal suggestion on itch and weal size.

PURPOSE To investigate suggestion-induced placebo effects in inflammatory skin reactions. METHODS A healthy sample of volunteers (N = 48) attended two laboratory sessions. In each, a local short term inflammatory skin reaction was induced with histamine. Participants were told that one session was a control session and the other was a treatment session in which an antihistamine cream would be applied to the arm to reduce the size of the weal and the experience of itch. Inert aqueous cream was applied in both sessions. Participants were randomly allocated to undergo either the control or the treatment session first. RESULTS The placebo manipulation successfully reduced self-reported itch from the control to the placebo treatment session, but no placebo effect was demonstrated in weal size. Order effects were observed such that only those who underwent control procedures first had a smaller weal in the placebo treatment session as compared to the control session. The same order effect was seen for reported itch at one minute post histamine administration, but this disappeared at the three and five minute measures. CONCLUSION Findings suggest that explicit verbal suggestion can reduce the experience of itch. In addition to conscious awareness, a concrete representation of the suggested changes gained from prior experience to the stimulus may be an important component of placebo effects on inflammatory skin reactions.

Who responds to placebos? Considering the “placebo personality” via a transactional model

The placebo effect is now recognised as a genuine psychobiological phenomenon; however, the question of how it can be systematically harnessed to improve health outcomes is not yet clear. One issue that remains unresolved is why some respond to placebos and others do not. A number of traits have been linked to responding, but findings are scattered. In extending prior work, this paper offers three considerations. First, attempts to describe the placebo responder via a single personality trait may be limiting. A synthesis of findings to date suggests placebo responsiveness may reflect a two-faceted construct, with “inward” and “outward” orientation representing the different but related facets of placebo responsiveness. Second, the lack of theoretically driven research may be hindering progress. Personality measures rather than personality theory appear to be driving research and higher order traits are descriptive tools with limited use in predicting behaviour. A biologically based stimulus–response model of personality that considers how individuals respond to certain environmental cues may be more appropriate. Third, a transactional model of placebo responding in which dispositional characteristics interact with environmental contingencies is presented. Responsiveness may manifest in placebo environments where there is a match between an individual’s biological trait-like response systems and environmental contingencies. This type of model may be useful in both research and clinical settings. Systematic consideration of how different individuals might respond to different placebo environments might facilitate identification of stable individual characteristics predictive of responding. The ability to determine who is responsive to placebo treatments, and in what context, may enable the matching of individual to treatment, thereby maximising the effectiveness of treatment and minimising possible iatrogenic harm. In the increasingly overtaxed modern health care industry, non-pharmacological treatment alternatives are of critical importance.

Expectation and the placebo effect in inflammatory skin reactions: a randomised-controlled trial.

OBJECTIVE This study investigated the placebo effect on experimentally induced skin reactions via the manipulation of expectation. METHODS Fifty-eight healthy volunteers were randomised into either expectancy or control groups. All participants received a baseline administration of histamine on one arm (Time 1), then a second administration on the other arm, approximately 30 minutes later (Time 2). Prior to the second administration, the expectancy group was told that an antihistamine cream (the placebo) had been applied that would reduce their skin reaction to the histamine. Expected wheal area, actual wheal area, heart rate, and heart rate variability were measured at each time point. RESULTS There was a positive relationship between expected and actual wheal area at Time 1. While the expectancy group expected a smaller skin reaction on the second arm they did not experience a greater reduction in wheal area, compared to control. The expectancy group had a greater reduction in heart rate during the second skin reaction, after the manipulation of expectation (p<.05). CONCLUSION While wheal area was not modulated, it may be worth further investigating this possibility, with modifications to the protocol. The reduction of heart rate appears to be an expectation effect and future research could elucidate mechanisms involved. There is an indication that expectations and inflammatory skin reactions are associated. Further study might aim to clarify the direction and nature of this relationship.

Screening for risky behaviour and mental health in young people: the YouthCHAT programme

BackgroundThe prevalence of mental health concerns and risky health behaviours among young people is of global concern. A large proportion of young people in New Zealand (NZ) are affected by depression, suicidal ideation and other mental health concerns, but the majority do not access help. For NZ indigenous Māori, the burden of morbidity and mortality associated with mental health is considerably higher. Targeted screening for risky behaviours and mental health concerns among youth in primary care settings can lead to early detection and intervention for emerging or current mental health and psychosocial issues. Opportunistic screening for youth in primary care settings is not routinely undertaken due to competing time demands, lack of context-specific screening tools and insufficient knowledge about suitable interventions. Strategies are required to improve screening that are acceptable and appropriate for the primary care environment. This article outlines the development, utilisation and ongoing evaluation and implementation strategies for YouthCHAT.YouthCHATYouthCHAT is a rapid, electronic, self-report screening tool that assesses risky health-related behaviours and mental health concerns, with a ‘help question’ that enables youth to prioritise areas they want help with. The young person can complete YouthCHAT in the waiting room prior to consultation, and after completion, the clinician can immediately access a summary report which includes algorithms for stepped-care interventions using a strength-based approach. A project to scale up the implementation is about to commence, using a co-design participatory research approach to assess acceptability and feasibility with successive roll-out to clinics. In addition, a counter-balanced randomised trial of YouthCHAT versus clinician-administered assessment is underway at a NZ high school.ConclusionOpportunistic screening for mental health concerns and other risky health behaviours during adolescence can yield significant health gains and prevent unnecessary morbidity and mortality. The systematic approaches to screening and provision of algorithms for stepped-care intervention will assist in delivering time efficient, early, more comprehensive interventions for youth with mental health concerns and other health compromising behaviours. The early detection of concerns and facilitation to evidence-based interventions has the potential to lead to improved health outcomes, particularly for under-served indigenous populations.

Trait predictors of placebo responses in itch

This study investigated trait predictors of placebo responses in the context of inflammatory skin reactions. This was a randomized, cross-over, experimental study using a deceptive placebo protocol. A healthy sample of volunteers (N = 48) completed online personality measures, then attended two laboratory sessions in which short-term inflammatory skin reactions were induced. One was a control session and the other the ‘treatment’ session in which a placebo cream was administered with the suggestion of a reduced skin reaction. A placebo response was defined as smaller skin reactions in control vs. treatment sessions. The traits ego resiliency and neuroticism were selected as possible predictors of placebo responses. Traits were selected in consideration of the two-faceted transactional model of placebo responsiveness and in light of empirical and psychometric considerations ego resiliency emerged as a consistent predictor of placebo responses in itch (p < .05). This is the first study to identify trait predictors of placebo responses in inflammatory skin reactions. Ego resiliency may typify greater placebo responsiveness; however, this may only be in certain contexts. Matching treatment approaches to bio-behavioural response tendencies may be useful clinically if the placebo component of traditional treatments can be enhanced.

A take-home placebo treatment can reduce stress, anxiety and symptoms of depression in a non-patient population

Background: With a healthcare system burdened by symptomatic and mental-health related conditions, the placebo effect may represent a useful clinical tool. First, however, there is a need to broaden research attention and investigate placebo effects outside laboratories and beyond experimental pain. This study investigated the effectiveness of a take-home placebo treatment in the short-term alleviation of stress, anxiety and symptoms of depression in a non-patient population. Method: A sample of 77 participants was randomized to either the ‘oxytocin’ treatment group (n = 22), the ‘serotonin’ treatment group (n = 22) or the wait-list control group (n = 33). The two treatment groups were given an ‘anti-stress treatment spray’ (placebo) to self-administer for 3 days, and completed online measures of perceived stress (Perceived Stress Scale-10), anxiety (Cognitive Somatic Anxiety Questionnaire) and symptoms of depression (Centre for Epidemiological Studies – Depression) before and after the 3-day protocol. Results: Both the ‘serotonin’ and ‘oxytocin’ treatment sprays were effective in reducing symptoms of depression; however, only those in the ‘oxytocin’ group reported less stress and anxiety as compared with controls. Overall, the ‘oxytocin’ was perceived as more effective. Conclusion: Placebo effects can be translated to a real-life setting in the short-term reduction of stress, anxiety and symptoms of depression in a non-patient population. In treating psychological distress, placebos may be useful addition to the treatment repertoire. The information given with treatment may also be an important consideration for practitioners.