Irving Kirsch

Irving Kirsch
University of Plymouth | UoP · School of Psychology

About

162
Publications
71,680
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14,552
Citations
Citations since 2016
38 Research Items
6890 Citations
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Publications

Publications (162)
Article
Full-text available
In placebo research, expectations are highlighted as one of the most influential subjective factors. While some studies have shown a relationship between expectations and pain relief, others have not. However, little is known about how methods of assessment of expectations may affect these conclusions. One of the fundamental considerations is that...
Article
The patient-clinician therapeutic alliance is a powerful modulator shaping patients’ treatment experience and clinical outcomes. Before and after a 3-week electro-acupuncture intervention (6 sessions), fMRI hyper-scanning was applied to investigate the influence of either an Augmented (warm/attentive) or a Limited (neutral/business-like) clinician...
Article
Objective: There is growing evidence that open-label placebo (OLP) may be an efficacious treatment for chronic and functional conditions. However, patient-level predictors of response to OLP have not been clearly identified. The aim of this study is to evaluate psychological predictors of response to OLP and to compare this to double-blind placebo...
Article
Full-text available
Music interventions accommodate the profound need for non-pharmacological pain treatment. The analgesic effect of listening to music has been widely demonstrated across studies. Yet, the specific mechanisms of action have still to be elucidated. Although the endogenous opioid and dopamine systems have been suggested to play an important role, a dir...
Article
Background & Aims Many of the reported adverse events in clinical trials of IBS are extra-intestinal symptoms, which are typically assessed by open-ended questions during the trial and not at baseline. This may lead to misattribution of some pre-existing symptoms as side effects to the treatment. Methods The current study analyzed data from a 6-we...
Article
Full-text available
Patient–clinician concordance in behavior and brain activity has been proposed as a potential key mediator of mutual empathy and clinical rapport in the therapeutic encounter. However, the specific elements of patient–clinician communication that may support brain-to-brain concordance and therapeutic alliance are unknown. Here, we investigated how...
Article
While patient/clinician relationships significantly impact pain outcomes, the behavioral and neural mechanisms supporting this phenomenon are unknown. Specifically, the precise role of facial expressions in contributing to analgesia and brain-to-brain communication has not been investigated. In this Hyperscan fMRI study, we explored how pain-relate...
Article
Research suggests that a good patient-clinician therapeutic alliance can improve clinical outcomes. In this ongoing, longitudinal study, we applied fMRI hyper-scanning to determine whether behavioral, neural, and clinical variables associated with the therapeutic relationship between chronic pain patients and their clinicians influences clinical ou...
Article
Full-text available
The brain systems underlying placebo analgesia are insufficiently understood. Here we performed a systematic, participant-level meta-analysis of experimental functional neuroimaging studies of evoked pain under stimulus-intensity-matched placebo and control conditions, encompassing 603 healthy participants from 20 (out of 28 eligible) studies. We f...
Article
It is commonly believed that blinding to treatment assignment is necessary for placebos to have an effect. However, placebos administered without concealment (i.e., open-label placebos [OLP]) have recently been shown to be effective in some conditions. This study had two objectives: first, to determine whether OLP treatment is superior to no-pill c...
Article
Expectancies can shape pain and other experiences. Generally, experiences change in the direction of what is expected (i.e., assimilation effects), as seen with placebo effects. However, in case of large expectation-experience discrepancies, experiences might change away from what is expected (i.e., contrast effects). Previous research has demonstr...
Article
Long-term follow-up of patients treated with open-label placebo (OLP) are non-existent. Herein, we report a 5-year follow-up of a three-weeks OLP randomized controlled trial (RCT) in chronic low back pain patients. We re-contacted the original participants of original RCT and reassessed their pain, disability, and use of pain medication. We obtaine...
Article
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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...
Article
Full-text available
The patient-clinician interaction can powerfully shape treatment outcomes such as pain but is often considered an intangible “art of medicine” and has largely eluded scientific inquiry. Although brain correlates of social processes such as empathy and theory of mind have been studied using single-subject designs, specific behavioral and neural mech...
Article
Full-text available
Background and aim: Despite recent publications, practitioners remain unfamiliar with the current terminology related to the placebo and nocebo phenomena observed in clinical trials and practice, nor with the factors that modulate them. To cover the gap, the European Headache Federation appointed a panel of experts to clarify the terms associated...
Article
This paper connects findings from the field of placebo studies with research into patients’ interactions with their clinician’s visit notes, housed in their electronic health records. We propose specific hypotheses about how features of clinicians’ written notes might trigger mechanisms of placebo and nocebo effects to elicit positive or adverse he...
Preprint
Full-text available
The patient-clinician interaction can powerfully shape treatment out-comes such as pain, but is often considered an intangible 'art-of-medicine', and has largely eluded scientific inquiry. Although brain correlates of social processes such as empathy and theory-of-mind have been studied using single-subject designs, the specific behavioral and neur...
Article
We present 21 prominent myths and misconceptions about hypnosis in order to promulgate accurate information and to highlight questions for future research. We argue that these myths and misconceptions have (a) fostered a skewed and stereotyped view of hypnosis among the lay public, (b) discouraged participant involvement in potentially helpful hypn...
Article
Full-text available
Importance Placebo responses in the treatment of erectile dysfunction (ED) are poorly described in the literature to date. Objective To quantify the association of placebo with ED outcomes among men enrolled in placebo-controlled, phosphodiesterase 5 inhibitor (PDE5I) trials. Data Sources For this systematic review and meta-analysis, a database s...
Article
Full-text available
Introduction Recent evidence suggests that for certain clinical conditions, placebos can improve clinical outcomes even without deception. These so-called open-label placebos (OLPs) bear the advantage of a significant lower risk of adverse events and comply with ethical principles. Although premenstrual syndrome (PMS) seems to be considerably susce...
Article
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Over 11 million people in the United States report opioid misuse, almost exclusively (>90%) from prescription opioids [1]. Doctors are facing increasing pressure to reduce opioid prescriptions, particularly for acute pain. In the United States, nearly 50% of the states passed legislation between 2016 and 2017 that regulated initial opioid prescript...
Article
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Side effects are frequent in pharmacological pain management, potentially preceding analgesia and limiting drug tolerability. Discussing side effects is part of informed consent, yet can favor nocebo effects. This study aimed to test whether a positive suggestion regarding side effects, which could act as reminders of the medication having been abs...
Article
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The single-arm first phase of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial was designed to assess the efficacy of a selective serotonin reuptake inhibitor in “real-world” patients. STAR*D improvement scores and response rates based on the Hamilton Rating Scale for Depression (HRSD), which had been designated as the prim...
Article
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Background: Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching int...
Article
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Objectives Expectation can significantly modulate pain and treatment effects. This study aims to investigate if boosting patients' expectancy can enhance the treatment of knee osteoarthritis (KOA), and its underlying brain mechanism. Methods Seventy-four KOA patients were recruited and randomized to three groups: boosted acupuncture (with a manipu...
Article
Full-text available
Placebo treatments and healing rituals share much in common, such as the effects of expectancy, and have been used since the beginning of human history to treat pain. Previous mechanistic neuroimaging studies investigating the effects of expectancy on placebo analgesia have used young, healthy volunteers. Using functional magnetic resonance imaging...
Article
Importance Depressive disorders (DDs), anxiety disorders (ADs), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD) are common mental disorders in children and adolescents. Objective To examine the relative efficacy and safety of selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors...
Article
Full-text available
Research on open-label placebos questions whether deception is a necessary characteristic of placebo effects. Yet, comparisons between open-label and deceptive placebos are lacking. We therefore assessed effects of open-label and deceptive placebos in comparison to no treatment with a standardized experimental heat pain paradigm in a RCT in healthy...
Article
Full-text available
Background Placebo medications, by definition, are composed of inactive ingredients that have no physiological effect on symptoms. Nonetheless, administration of placebo in randomized controlled trials (RCTs) and in clinical settings has been demonstrated to have significant impact on many physical and psychological complaints. Until recently, conv...
Article
Full-text available
Objective: To determine the placebo component of treatment responses in patients with intellectual disability (ID). Methods: A statistical meta-analysis comparing bias-corrected effect sizes (Hedges g) of drug responses in open-label vs placebo-controlled clinical trials was performed, as these trial types represent different certainty of receiv...
Article
In randomized controlled trials (RCTs), medication side effects may lead to beliefs that one is receiving the active intervention and enhance active treatment responses, thereby majoring drug-placebo differences. We tested these hypotheses with an experimental double-blind RCT of a nonsteroidal anti-inflammatory medication (NSAID) with and without...
Article
Objectifs Le but de cette étude est de déterminer s’il existe une réponse au placebo chez les patients déficients intellectuels (DI) d’origine génétique. Ces patients présentent en effet une atteinte des capacités qui semblent cruciales pour susciter une réponse au placebo. Matériel et méthodes Nous avons réalisé une méta-analyse (logiciel CMA) co...
Article
Objective: To assess parental attitudes regarding placebo use in pediatric randomized controlled trials and clinical care. Study design: Parents with children under age 18 years living in the US completed and submitted an online survey between September and November 2014. Results: Among all 1300 participants, 1000 (76.9%; 538 mothers and 462 f...
Article
Full-text available
This randomized controlled trial was performed to investigate whether placebo effects in chronic low back pain could be harnessed ethically by adding open-label placebo (OLP) treatment to treatment as usual (TAU) for 3 weeks. Pain severity was assessed on three 0- to 10-point Numeric Rating Scales, scoring maximum pain, minimum pain, and usual pain...
Article
Full-text available
Background: Expectancy is widely accepted as a key contributor to placebo effects. However, it is not known whether non-conscious expectancies achieved through semantic priming may contribute to placebo analgesia. In this study, we investigated if an implicit priming procedure, where participants were unaware of the intended priming influence, aff...
Article
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Our experience with the world is shaped not only directly through personal exposure but also indirectly through observing others and learning from their experiences. Using a conditioning paradigm, we investigated how directly and observationally learned information can affect pain perception, both consciously and non-consciously. Differences betwee...
Article
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Background: Genetically determined Intellectual Disability (ID) is an intractable condition that involves severe impairment of mental abilities such as learning, reasoning and predicting the future. As of today, little is known about the placebo response in patients with ID. Objective: To determine if placebo response exists in patients with gen...
Article
Significance It is unclear to what extent new learning can take place outside of conscious awareness. In the present study, we used psychophysical measures and classical conditioning to establish whether psychologically mediated analgesic and hyperalgesic responses could be acquired by unseen (subliminally presented) stimuli. Our study demonstrates...
Article
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The Division 30 (American Psychological Association)'s revised definition of hypnosis (2014) is analyzed, and it is considered to be really an old definition, written by Spiegel & Spiegel in 1987. In addition, the biases of the new definition are analyzed, concluding that, as a whole, it alters the consensus of other definitions, which hinders rese...
Chapter
Hypnosis has long generated controversy as a recall-enhancement method. Concerns about hypnosis are warranted by findings of a tradeoff between the number of memories recalled and memory accuracy. Moreover, witnesses often express confidence in hypnotically augmented remembrances, regardless of their accuracy, increasing the risk of juror bias stem...
Article
Full-text available
This article elucidates an integrative model of hypnosis that integrates social, cultural, cognitive, and neurophysiological variables at play both in and out of hypnosis and considers their dynamic interaction as determinants of the multifaceted experience of hypnosis. The roles of these variables are examined in the induction and suggestion stage...
Article
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This study explores the conceptual relationship between the placebo effect and psychotherapy. There is considerable evidence that the placebo effect can be exceptionally powerful under some circumstances. This begs the question: How much of the effectiveness of psychotherapy is attributable to the placebo effect? In an effort to answer this questio...
Article
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Fundamental aspects of human behavior operate outside of conscious awareness. Yet, theories of conditioned responses in humans, such as placebo and nocebo effects on pain, have a strong emphasis on conscious recognition of contextual cues that trigger the response. Here, we investigated the neural pathways involved in nonconscious activation of con...
Article
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Background Attention to and perception of physical sensations and somatic states can significantly influence reporting of complaints and symptoms in the context of clinical care and randomized trials. Although anxiety and high neuroticism are known to increase the frequency and severity of complaints, it is not known if other personality dimensions...
Article
Full-text available
Music has pain-relieving effects, but its mechanisms remain unclear. We sought to verify previously studied analgesic components and further elucidate the underpinnings of music analgesia. Using a well-characterized conditioning-enhanced placebo model, we examined whether boosting expectations would enhance or interfere with analgesia from strongly...
Article
Full-text available
Expectancy and conditioning are often tested as opposing explanations of placebo analgesia, most commonly by pitting the effects of a conditioning procedure against those of a verbally induced expectation for pain reduction. However, conditioning procedures can also alter expectations, such that the effect of conditioning on pain might be mediated...
Article
Objective: Catechol-O-methyltransferase (COMT), a key enzyme in catecholamine metabolism, is implicated in cardiovascular, sympathetic, and endocrine pathways. This study aimed to confirm preliminary association of COMT genetic variation with incident cardiovascular disease (CVD). It further aimed to evaluate whether aspirin, a commonly used CVD p...
Chapter
Hypnosis comprises two components: an induction procedure centering on the suggestion to enter a hypnotic state, and imaginative suggestions for various changes in experience and behavior. Hypnotherapy is the addition of hypnosis to a psychological or medical treatment. Research indicates that hypnosis can augment the effects of psychological treat...
Article
The effects of posthypnotic suggestion on health-related behavior, using a behavioral measure of adherence, were investigated. Three hundred twenty-three students covering the full range of hypnotic suggestibility were prescribed an easy (mood rating) or a difficult (physical activity) task. Participants were randomly assigned to receive either a)...
Article
Full-text available
Information provided to patients is thought to influence placebo and drug effects. In a prospective, within-subjects, repeated-measures study of 66 subjects with episodic migraine, we investigated how variations in medication labeling modified placebo and drug effects. An initial attack with no treatment served as a control. In six subsequent migra...
Article
Full-text available
In this study participants were provided with either the standard rationale that accompanies the Harvard Group Scale of Hypnotic Susceptibility: A (Shor & Orne, 196224. Shor , R. E. and Orne , E. C. 1962. Harvard Group Scale of Hypnotic Susceptibility, Form A, Palo Alto, CA: Consulting Psychologists Press. View all references) or a rationale that...
Article
Full-text available
Placebo treatments and healing rituals have been used to treat pain throughout history. The present within-subject crossover study examines the variability in individual responses to placebo treatment with verbal suggestion and visual cue conditioning by investigating whether responses to different types of placebo treatment, as well as conditionin...
Article
Full-text available
To investigate the effectiveness of non-benzodiazepine hypnotics (Z drugs) and associated placebo responses in adults and to evaluate potential moderators of effectiveness in a dataset used to approve these drugs. Systematic review and meta-analysis. US Food and Drug Administration (FDA). Randomised double blind parallel placebo controlled trials o...
Data
Appendix 1: Details of how to obtain drug trial data from FDA
Article
Neuroimaging studies have suggested the presence of alterations in the anatomo-functional properties of the brain of patients with chronic pain. However, investigation of the brain circuitry supporting the perception of clinical pain presents significant challenges, particularly when using traditional neuroimaging approaches. While potential neuroi...