Magazine article Psychotherapy Networker

FROM RESEARCH TO PRACTICE; beyond the Sugar Pill: Energy Therapies Promise Rapid Resolution of Frozen Traumas

Magazine article Psychotherapy Networker

FROM RESEARCH TO PRACTICE; beyond the Sugar Pill: Energy Therapies Promise Rapid Resolution of Frozen Traumas

Article excerpt

Last spring, a metaanalysis of research published in the New England Journal of Medicine stirred up some well-publicized controversy (covered in, among other places, The New York Times ) by casting doubt upon the long-held assumption that the placebo effect is a potent source of change in healthcare. Asbjorn Hrobjartsson and Peter Gotzsche, physicians at the University of Copenhagen, found that placebos--by which they meant the simple belief that one is receiving an effective treatment--had little impact on patients. Their report challenged a tenet held by researchers and practitioners alike since the 1950s--the premise that as long as people think they're receiving useful treatment, improvement will occur, even when the treatment is only a sugar pill.

Placebos (be they medical, psychological, or physical) are usually defined as treatmentlike interventions that evoke patients' expectations of improvement despite lacking any active ingredient specifically intended to affect  a particular disorder. Just as a placebo pill may look and feel like medicine but contain only sugar, placebo therapy looks like therapy--it may involve two people talking--but it entails no intervention designed to have an impact on the problem at hand.

In medicine, placebos have been assumed to have a marked impact on health since 1955, when Henry Beecher, in a milestone review of 15 studies, documented their effect. Hrobjartsson and Gotzsche's analysis, however, included 114 subsequent studies, covering such diverse problems as pain, asthma, colds, seasickness, high blood pressure, myocardial infarction, alcoholism, and schizophrenia. Many had been more carefully constructed than those reviewed by Beecher. Hrobjartsson and Gotzsche concluded that where outcomes could be divided clearly between success and failure, placebos weren't sufficiently impactful to have a useful influence. When outcomes ranged along a continuum (as in producing, for example, a certain degree of pain relief), the authors found that placebos had small positive effects, but since many studies that reported such effects were based on small samples, Hrobjartsson and Gotzsche suggested the results were erroneous. They concluded that the effects of placebos are too meager to have much effect on clinical practice.

A side effect of their study was to highlight the variety of the processes subsumed under the umbrella of the placebo effect and how sloppy the common usage of the term has become. Following up on similar concerns, Richard Bootzin, professor of psychology at the University of Arizona, has led a movement aimed at achieving a better understanding of what we mean by a placebo. In research on treating insomnia, he has seen some methods appear to produce significant results only to learn that these results derived from factors other than his intervention, such as the way bedroom lighting can affect sleep cycles. To establish a more rigorous methodology for studying how interventions work, Bootzin has focused on separating the effects of treatment from effects that have other causes.

Bootzin points out that a patient may improve for many reasons that have little to do with the treatment. These include:

- Spontaneous remission unrelated to treatment, as when people get better just because of the natural recovery cycle of a disorder;

-The tendency of people presenting extreme behavior to develop less extreme behavior later, so a client initially assessed as extremely depressed may become less depressed without any intervention;

- Clients who report nonexistent improvement to please their treatment provider;

- Clients who improve after presenting their illness as more acute than it is.

Bootzin's point is that patients can improve in many ways that have little to do with treatment. Bootzin argues that even if thinking one is receiving a treatment has as little impact as the Danish researchers suggest, expectation, relationship, and other factors can significantly influence the process of change. …

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