Placebo Psychotherapies and Nonconscious Learning in the Placebo Effect: Reply to Kirsch (2004).

In this reply, the authors explore several issues raised by I. Kirsch (2004; see record 2004-11156-008) concerning their original article (S. Stewart-Williams & J. Podd, 2004; see record 2004-11156-007), which dealt with the roles of expectancy and classical conditioning in the placebo effect. The only notable disagreement concerns a definitional issue, namely, Stewart-Williams and Podd's claim that the placebo concept can be extended to inert psychotherapies. The authors defend this claim against the criticisms Kirsch raised. In addition, they comment on the suggestion that nonconscious learning processes play only a small role in human placebo effects, arguing that there are theoretical reasons to expect these processes to be more important than has previously been recognized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Placebo Effect: Dissolving the Expectancy Versus Conditioning Debate.

The authors review the literature on the 2 main models of the placebo effect: expectancy theory and classical conditioning. A path is suggested to dissolving the theoretical impasse that has long plagued this issue. The key is to make a clear distinction between 2 questions: What factors shape placebo effects? and What learning mediates the placebo effect? The reviewed literature suggests that classical conditioning procedures are one shaping factor but that verbal information can also shape placebo effects. The literature also suggests that conditioning procedures and other sources of information sometimes shape conscious expectancies and that these expectancies mediate some placebo effects; however, in other cases conditioning procedures appear to shape placebo effects that are not mediated by conscious cognition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Placebo Puzzle: Putting Together the Pieces.

This article outlines and assesses the main theories of the placebo effect and suggests how they might sit together in a larger model of placebo etiology. Among the approaches considered are expectancy theory, emotional change theory, classical conditioning, and the biological approach. Although these are sometimes assumed to be competing models, in many cases they shed light on different pans of the placebo puzzle. Expectancies are the core of most placebo effects in human beings. The effects of expectancies are sometimes unmediated but in other cases are mediated by changes in emotional state, immune system function, perception, or behavior. Although expectancies are implicated in most placebo effects, a small number of placebo effects may be solely attributable to nonconscious contingency learning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)