hyland-inpress-context-NEPRINTAT

hyland-inpress-context-NEPRINTAT - Placebos as therapeutic...

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Placebos as therapeutic rituals 1 Running head: PLACEBOS AS THERAPEUTIC RITUALS M OTIVATIONAL CONCORDANCE : AN IMPORTANT MECHANISM IN SELF - HELP THERAPEUTIC RITUALS INVOLVING INERT ( PLACEBO ) SUBSTANCES
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Placebos as therapeutic rituals 2 Abstract We tested the contribution of two mechanisms, response expectancy and motivational concordance, to reported psychological benefit from a popular, biologically inactive, self-help, complementary therapy (a placebo). Flower essences were taken by 251 people for self-selected symptoms and were randomized to receive three different kinds of information. When the flower essence was presented as a spiritual therapy, then baseline spirituality ( β = .35, p = .01) and expectancy ( β = .25, p = .03) independently predicted outcome. When flower essences were presented as a suggestive (i.e., non-spiritual) therapy, then spirituality negatively ( β = -.27, p = .03) and expectancy ( β = .33, p = .01) predicted outcome. For both groups expectancy predicted outcome after controlling for spirituality and compliance, but did not after controlling for ease of task completion. Expectancy failed to predict outcome in the non-enhanced ritual group. The results suggest that motivational concordance is an important therapeutic mechanism for real-life placebos. Keywords: Placebo, placebo responder, motivation, therapeutic ritual, psychotherapy, contextual model, flower essence
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Placebos as therapeutic rituals 3 MOTIVATIONAL CONCORDANCE: AN IMPORTANT MECHANISM IN SELF-HELP THERAPEUTIC RITUALS INVOLVING INERT (PLACEBO) SUBSTANCES Placebo or non-specific responses play a role in most therapeutic encounters, on occasions accounting for the majority of variance in outcome for both conventional medicines (1, 2) and complementary medicines (3-5). Nevertheless, the underlying mechanisms remain uncertain. There is considerable consensus that conditioning and expectancy can both play a role (6), but there is also evidence for the existence of additional mechanisms. (7-11). All therapies involve some kind of ritual – a therapeutic ritual. By therapeutic ritual we denote the totality of meaning which is attached to the therapeutic encounter, as perceived by the person, client or patient (12). Self-help rituals are simpler than many others in that they do not involve a therapist, and so minimise therapist-mediated effects. In this paper we show that when an inert substance is taken in a self-help therapeutic ritual the mechanisms that affect outcome, and hence the correlations between baseline and outcome variables, can be manipulated by altering characteristics of the therapeutic ritual. We focus on two mechanisms: expectancy and motivational concordance. Expectancy is a conventionally accepted placebo mechanism for which there is considerable evidence. Motivational concordance is a recently proposed mechanism (11), which may prove important
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hyland-inpress-context-NEPRINTAT - Placebos as therapeutic...

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