What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus.

INTRODUCTION: Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments. OBJECTIVE: There is an increasing need for up-to-date recommendations on how to inform patients about placebo and nocebo effects in clinical practice and train clinicians how to disclose this information. METHODS: Based on previous clinical recommendations concerning placebo and nocebo effects, a 3-step, invitation-only Delphi study was conducted among an interdisciplinary group of internationally recognized experts. The study consisted of open- and closed-ended survey questions followed by a final expert meeting. The surveys were subdivided into 3 parts: (1) informing patients about placebo effects, (2) informing patients about nocebo effects, and (3) training clinicians how to communicate this information to the patients. RESULTS: There was consensus that communicating general information about placebo and nocebo effects to patients (e.g., explaining their role in treatment) could be beneficial, but that such information needs to be adjusted to match the specific clinical context (e.g., condition and treatment). Experts also agreed that training clinicians to communicate about placebo and nocebo effects should be a regular and integrated part of medical education that makes use of multiple formats, including face-to-face and online modalities. CONCLUSIONS: The current 3-step Delphi study provides consensus-based recommendations and practical considerations for disclosures about placebo and nocebo effects in clinical practice. Future research is needed on how to optimally tailor information to specific clinical conditions and patients' needs, and on developing standardized disclosure training modules for clinicians.

Studying placebo effects in model organisms will help us understand them in humans.

The placebo effect is widely recognized but important questions remain, for example whether the capacity to respond to a placebo is an evolved, and potentially ubiquitous trait, or an unpredictable side effect of another evolved process. Understanding this will determine the degree to which the physiology underlying placebo effects might be manipulated or harnessed to optimize medical treatments. We argue that placebo effects are cases of phenotypic plasticity where once predictable cues are now unpredictable. Importantly, this explains why placebo-like effects are observed in less complex organisms such as worms and flies. Further, this indicates that such species present significant opportunities to test hypotheses that would be ethically or pragmatically impossible in humans. This paradigm also suggests that data informative of human placebo effects pre-exist in studies of model organisms.

Influence of accurate and inaccurate 'split-time' feedback upon 10-mile time trial cycling performance.

The objective of the study is to examine the impact of accurate and inaccurate 'split-time' feedback upon a 10-mile time trial (TT) performance and to quantify power output into a practically meaningful unit of variation. Seven well-trained cyclists completed four randomised bouts of a 10-mile TT on a SRM™ cycle ergometer. TTs were performed with (1) accurate performance feedback, (2) without performance feedback, (3) and (4) false negative and false positive 'split-time' feedback showing performance 5% slower or 5% faster than actual performance. There were no significant differences in completion time, average power output, heart rate or blood lactate between the four feedback conditions. There were significantly lower (p < 0.001) average [Formula: see text] (ml min(-1)) and [Formula: see text] (l min(-1)) scores in the false positive (3,485 ± 596; 119 ± 33) and accurate (3,471 ± 513; 117 ± 22) feedback conditions compared to the false negative (3,753 ± 410; 127 ± 27) and blind (3,772 ± 378; 124 ± 21) feedback conditions. Cyclists spent a greater amount of time in a '20 watt zone' 10 W either side of average power in the negative feedback condition (fastest) than the accurate feedback (slowest) condition (39.3 vs. 32.2%, p < 0.05). There were no significant differences in the 10-mile TT performance time between accurate and inaccurate feedback conditions, despite significantly lower average [Formula: see text] and [Formula: see text] scores in the false positive and accurate feedback conditions. Additionally, cycling with a small variation in power output (10 W either side of average power) produced the fastest TT. Further psycho-physiological research should examine the mechanism(s) why lower [Formula: see text] and [Formula: see text] scores are observed when cycling in a false positive or accurate feedback condition compared to a false negative or blind feedback condition.

The BASES expert statement on emotion regulation in sport.

Emotions experienced before and during sports competition have been found to influence sports performance. Emotion regulation is defined as the automatic or deliberate use of strategies to initiate, maintain, modify or display emotions (Gross & Thompson, 2007) and is proposed to occur when a discrepancy exists between current and desired emotions. Two distinct motivations to regulate emotion - hedonic and instrumental (in short, for pleasure or for purpose) - have been proposed (Tamir, 2009). The instrumental approach might provide a more fruitful area of investigation for sports researchers as some athletes hold beliefs that supposedly pleasant emotions such as happiness and calmness associate with poor performance and supposedly unpleasant emotions such as anxiety and anger associate with good performance (Hanin, 2010). Athletes are more likely to try to regulate an emotion if they believe that doing so will facilitate performance. Strategies that encourage re-appraisal of factors that trigger emotions are proposed to be preferable. In this British Association of Sport and Exercise Sciences (BASES) expert statement, a summary of the key theoretical issues are offered leading to evidence-based recommendations for practitioners and researchers.

Considerations of Control Groups: Comparing Active-Control with No Treatment for Examining the Effects of Brief Intervention.

BACKGROUND: A large-scale online study completed by this research team found that brief psychological interventions were associated with high-intensity pleasant emotions and predicted performance. The present study extends this work using data from participants (n = 3376) who completed all self-report data and engaged in a performance task but who did not engage with an intervention or control condition and therefore present as an opportunistic no-treatment group. METHODS: 41,720 participants were selected from the process and outcome focus goals intervention groups, which were the successful interventions (n = 30,096), active-control (n = 3039), and no-treatment (n = 8585). Participants completed a competitive task four times: first as practice, second to establish a baseline, third following an opportunity to complete a brief psychological skills intervention, and lastly following an opportunity to repeat the intervention. Repeated measures MANOVA indicated that over four performance rounds, the intensity of positive emotions increased, performance improved, and the amount of effort participants exerted increased; however, these increases were significantly smaller in the no-treatment group. CONCLUSIONS: Findings suggest that not engaging in active training conditions had negative effects. We suggest that these findings have implications for the development and deployment of online interventions.