Does personality play a relevant role in the placebo effect?

Department of Psychiatry, University Hospital Center Zagreb, Kišpatićeva 12, 10 000 Zagreb, Croatia, .
Psychiatria Danubina (Impact Factor: 1.3). 03/2013; 25(1):17-23.
Source: PubMed


Subjective factors influencing placebo response have been a focus of numerous theoretical conceptualizations and empirical research. One such factor, individual's personality, has been linked to different clinical conditions, their expressions and treatment outcomes. Thus, there is little surprise many researchers have tried to identify placebo-prone personality over the years. Because of certain methodological and conceptual issues of the earlier studies, these efforts have not been very fruitful. However, recent scientific endeavours, facilitated by improved experimental designs and neuroimaging technology, have 'reignited the old fires'. It is now suggested that studies exploring the placebo-related personality traits, such as optimism/pessimism, neuroticism, and novelty seeking, need to take into account situational variables (e.g., positive or negative expectations, patient-clinician relationship) and relevant underlying neurobiological mechanisms (e.g., endogenous opioid and dopaminergic systems). Even though many questions still remain to be answered, such as the identification of different situational variables interacting with personality traits, exploration and better understanding of placebo-related personality would facilitate the use of placebo in clinical practice and improve the methodology of clinical trials.

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Available from: Nenad Jakšić,
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    • "Contextual factors are known to be centrally important in the placebo effect (Colloca & Benedetti, 2005), and the utility of considering an interaction between disposition and environment has been noted in placebo discourse (Jakšić, et al., 2013; Pecina, et al., 2013). However, this interaction has not been thoroughly investigated (Jakšić, et al., 2013), and a model incorporating such an interaction has not yet been offered. A model of placebo responsiveness that considers the interaction between dispositional characteristics and environmental cues may provide an integral piece of the placebo 'puzzle'. "
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    ABSTRACT: The placebo effect is now recognised as a genuine psychobiological phenomenon; however, the question of how it can be systematically harnessed to improve health outcomes is not yet clear. One issue that remains unresolved is why some respond to placebos and others do not. A number of traits have been linked to responding, but findings are scattered. In extending prior work, this paper offers three considerations. First, attempts to describe the placebo responder via a single personality trait may be limiting. A synthesis of findings to date suggest placebo responsiveness may reflect a two faceted construct, with ‘inward’ and ‘outward’ orientation representing the different but related facets of placebo responsiveness. Second, the lack of theoretically driven research may be hindering progress. Personality measures rather than personality theory appear to be driving research and higher order traits are descriptive tools with limited use in predicting behaviour. A biologically based stimulus-response model of personality that considers how individuals respond to certain environmental cues may be more appropriate. Third, a transactional model of placebo responding in which dispositional characteristics interact with environmental contingencies is presented. Responsiveness may manifest in placebo environments where there is a match between an individual’s biological trait-like response systems and environmental contingencies. This type of model may be useful in both research and clinical settings. Systematic consideration of how different individuals might respond to different placebo environments might facilitate identification of stable individual characteristics predictive of responding. The ability to determine who is responsive to placebo treatments, and in what context, may enable the matching of individual to treatment, thereby maximising the effectiveness of treatment and minimizing possible iatrogenic harm. In the increasingly overtaxed modern healthcare industry non-pharmacological treatment alternatives are of critical importance.
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  • The Journal of Neuropsychiatry and Clinical Neurosciences 10/2013; 25(4):vi-254. DOI:10.1176/appi.neuropsych.13090207 · 2.82 Impact Factor
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    ABSTRACT: Aim: To identify personality traits related to placebo responding outside the context of pain. Methods. Sixty three healthy volunteers completed the study. Personality traits were measured online one week prior to a laboratory session in which two psychosocial stress tests were administered. Prior to the second test, the placebo group received an intranasal spray of ‘serotonin’ (placebo) with the suggestion it would enhance recovery. Subjective stress, heart rate and heart rate variability were measured. Self reported and physiological responses to the placebo suggestion were assessed against personality variables. Results. Placebo effects were demonstrated in both self reported and physiological stress metrics. Lower optimism and less empathic concern predicted greater perceived benefits from the placebo treatment; and lower drive, fun, and sensation seeking were related to a greater physiological response to the manipulation. Multivariate analyses revealed lower optimism and behavioural drive to be predictive of responding to the placebo manipulation. Conclusion. Findings are in contrast with prior work in pain paradigms which found higher levels of the same traits to be related to greater placebo analgesic responses. A cluster of traits characterised by behavioural drive, extraversion, optimism and novelty or fun seeking appears to be germane to placebo responsiveness, but contextual stimuli may generate different patterns of responding. A new conceptualisation of placebo responsiveness may be useful. Rather than a ‘placebo personality’ it may be that responsiveness is better typified by a two faceted transactional model, in which different personality facets respond to different contextual contingencies.
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