Dossier: Strong mind

The placebo effect: real or imagined?

There are medicines that are not medicines and yet work. Conversely, the mere knowledge of possible side effects sometimes makes people ill. How is that possible? And how can we use these effects in everyday life?

Text: Katharina Rilling; photo: iStock

A grandmother sticks a plaster on her granddaughter’s wound or blows briefly on her scraped knee – and it stops hurting. We’ve all experienced the amazing power of thinking in everyday life and in minor accidents. This phenomenon is also well-known in medicine and is called the placebo effect.

The placebo effect – what is it?

Placebos, that is, medicines that don’t contain any active ingredient, were originally used in clinical trials. They were supposed to make it possible to compare real treatments with non-treatments. Surprisingly, however, the complaints of those in the comparison groups who had actually received an ineffective substance, a placebo, also improved. The effect is now well documented. It’s even estimated that placebos have an influence on the recovery of about one in three people. In some studies, almost all of the participants (90%) respond to treatment with placebo medicine. It tends to help women a little better than men.

But there’s more to it than just imagination. The effect also works for major ailments such as depression, Parkinson’s or migraines, for example by releasing the body’s own pain-relieving neurotransmitters such as endorphins or dopamine. Changes in the brain can even be detected on MRI images after the ‘sham treatment’. However, they don’t always help: if brain functions are severely impaired – for example, in the case of Alzheimer’s disease – there is no placebo effect.

Fear and nocebo effects

The positive effect can also be turned on its head: nocebo effects refer to negative health consequences that are not actually related to the treatment. These may be triggered, for example, by reading the possible side effects on the package insert or by fear of the dentist. The frightened patient often ends up more sensitive to pain than the confident one.  

What strengthens the placebo effect?

Those who trust their treatment and the medical team, who see how the treatment works for others, and who expect an improvement in their condition will benefit more. That’s why it’s important that doctors take their time and signal to the patient: “This medicine will help you.” A placebo pill taken alongside normal medicine can enhance the effect of the latter – without further side effects. The status of the person providing the treatment is also a factor: placebos administered by the chief consultant have a stronger effect than those administered by nurses.

Experience with real active substances also plays a crucial role. If you associate the tingling sensation and taste of a painkiller in a glass of water in your brain with pain relief, suddenly even a simple fizzy tablet can help. Simply as a result of the sensory impressions evoked again. What’s more, because unconscious neurobiological processes are at play, placebo medicines work even when “placebo” is written in bold letters on the pillbox. 

What placebos should look like

Studies show that coloured sugar pills trigger a greater placebo effect than white ones, large and small ones have a stronger effect than medium-sized ones, while blue capsules are perceived as calming and red ones as stimulating. Also, a placebo should taste bitter and medicinal.

Injections, sham operations in which only a superficial incision is made in the skin, and sham acupuncture – in which the needles do not actually pierce the skin – often have an even greater placebo effect than pills, according to science magazine “Quarks”. Once again, expectations played a major role: most people consider invasive treatment methods to be more effective.

Learn more easily using placebos

What works in medicine can also be applied to other areas such as learning. Anything that’s associated with something pleasurable can serve as a placebo. We don’t have to take any dummy pills: the ritual or a gesture on its own is enough.

For example, if you’ve experienced that jogging before an exam works, you know what to do next time. Music or meditation can also help us to concentrate better. They already have a positive effect on our ability to think per se, and this effect can be further strengthened when they’re turned into a ritual. The placebo effect then acts as a “mental anchor”, giving a sense of security.

Just as faith in the doctor is important in medicine, it’s important to have a trusting relationship with the teacher in school. Those who’re encouraged to believe they can solve difficult problems prefer to learn, and learn better. Pupils who are constantly criticised, on the other hand, are less confident, which has a negative effect on their grades.

The fact that girls eventually do worse than boys in maths is attributed to this nocebo effect. After all, they’re initially just as good and sometimes even better at maths than their male classmates. However, it’s possible to weaken this nocebo by continually making children, parents and teachers aware of it.

The placebo effect for leaders

Leaders can also use the placebo effect to motivate their employees. If you tell your employees that they have to work even harder because of the difficult market, you set off a collective nocebo effect. Their brains then focus on dangers and problems instead of solutions.

The consequence? Stress and rash decision-making. Instead, it’s better to use positive words to paint an optimistic picture of success. And show that you believe in the team. Leaders should give employees a feeling of care and security, just like doctors or teachers. Team rituals also have a bolstering effect when challenging times lie ahead. The motivation that comes from hearing about colleagues’ successes can help team members take on their tasks with a positive mindset.

Sweat less during sport thanks to the placebo effect

Researchers from Freiburg have also discovered a placebo effect in sports. Those who believed that they were athletic and that the training would be beneficial actually found it to be less sweaty than those who considered themselves unfit. Sports magazines, apps and documentaries can help to create a positive image of sport in people’s minds. In this way, the training is perceived as well-being and me-time rather than drudgery.

Treating yourself to something new can also help: researchers have found that sports articles such as compression shirts also have an effect on athletic performance. The mere belief that they support us during training makes us perform better.

The power of perception over reality can have far-reaching consequences. Researchers at Stanford University found that those who think they’re fitter and healthier than the average are likely to live longer than average for that very reason alone!