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Predictors of positive opinion about Bach Flower Remedies in adults from three Latin-American countries: An exploratory study
Abstract and Figures
The current study aimed to determine if positive opinions about BFR interacts with spirituality in adults from three Latin-American countries using a CHAID algorithm. Participants were 703 adults from Cuba (n = 319), Costa Rica (n = 252) and Chile (n = 132).
Predictors:
demographic data, received information, received treatment, spirituality, dispositional optimism and willingness to use a placebo intervention were measured and analyzed. A supervised classification which included a training phase (n = 423) and a test phase (n = 280) was employed. Received information about BFR, spirituality and education were selected as significant predictors of the positive opinion about BFR (>90% of correct classifications).
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... On top of these, we have chronic pathologies or physiological conditions, as pregnancy, which alter the emotional status beside the physical one. At the same time, the educational and spiritual level, the opening of the patient to holistic therapies that lead to the state of inner balance and peace are particularly important [11]. ...
... A definição de terapia holística ou medicina complementar tem sido descrita como tratamento e/ou prevenção que complementa a medicina convencional por contribuir como um todo, por satisfazer as demandas não encontradas na medicina ortodoxa ou por diversificar o quadro conceitual da medicina (AGUIAR JÚNIOR; COSTA, 2011). Inclui formas de terapia que não possuem bases científicas ou eficácia comprovadas por métodos científicos biomédicos (RODRÍGUEZ-MARTÍN et al., 2017). ...
O modelo biomédico, hegemônico na doutrina e prática que informa a medicina na atualidade, é o sistema de saúde predominante em nossa sociedade. No entanto, observa-se um crescimento no número de praticantes de terapias holística, que surgem como uma opção de tratamento não alopático para complementar, contribuir e diversificar o quadro conceitual da medicina ortodoxa. Dentre as várias opções de práticas holísticas, encontramos os florais de Bach que são utilizados como remédios para tratar aspectos temperamentais de seus usuários. A terapia floral, criada por Dr. Edward Bach, consiste em uma forma farmacêutica líquida obtida a partir da diluição de flores. O objetivo deste estudo foi realizar a identificação e quantificação do metabólito secundário 2-hidroxi-1,4-naftoquinona no floral Impatiens, por meio de Cromatografia Líquida de Alta Eficiência (CLAE). A intenção da identificação desse marcador químico é provar que é possível estabelecer um método como controle de qualidade para florais de Bach.
... In fact, it has been suggested that spirituality could be the main dispositional predictor of the effect of BFR (24)(25)(26)(27). Furthermore, it has also been suggested that spirituality predicts self-opinion about BFR whenever individuals receive enough information about this therapy, regardless of their dispositional optimism, or whether they have or not already received treatment (28). ...
Background: We present two studies (hereafter Study 1 and Study 2), aimed to evaluate Bach Flower Remedies (BFR) effectiveness in controlling food cravings (FC), with assessment at three different stages: baseline, 1 month after baseline and 3 months after baseline.
Methods: Study 1 consisted in a double-blind placebo-controlled trial aimed to assess the specific effects of a BFR-formula and the overall effectiveness of the placebo-control on FC (n=173). Participants were assigned to BFR (n=65), Placebo (n=55) and Control group (n=53). On the other hand, Study 2 did not involve deception, and combined an implementation intention instruction with the BFR-formula, all aimed to reduce FC in overweight and obese adults while at home (n=74). Every participant received an implementation intention instruction to sip a glass of water whenever experiencing FC at home. BFR group (n=37) was instructed to sip water with BFR solution diluted in it, whereas Water group just sipped plain water (n=37).
Results: Study 1 did not support specific effects for BFR; placebo seemed to be effective in controlling FC. Moreover, findings from Study 2 suggest that BFR, used at least once a day, in conjunction with implementation intention intervention, may be helpful in reducing FC in overweight and obese adults while at home.
Conclusions: Results of both Studies helped us evaluate the ‘power of the placebo’ in helping individuals overcome FC in their everyday life.
... Some clinical evidence has been provided in the case of attention deficit hyperactivity, 144 several psychological problems and pain, 145 and external use in the treatment of carpal tunnel syndrome, 146 with relative good acceptance in Latin American countries. 147 Musicotherapy. Music is usually recognized as a healing therapy for emotional diseases, providing comfort beyond entertainment as suggesting usefulness in psychiatric disorders and mental health. ...
Introdução: A terapia floral faz parte de um campo emergente de terapias complementares, caracterizado pelo uso de meios menos onerosos, fundado numa visão integral da saúde e, principalmente, por métodos não invasivos e não tóxicos. No Brasil, esta terapia vem ganhando espaço, principalmente a partir da aprovação da Política Nacional de Práticas Integrativas Complementares (PNPIC), que possibilita a articulação entre os sistemas médicos complexos e a medicina tradicional e complementar, visando à prevenção de doenças, recuperação, promoção e racionalização das ações em saúde. Objetivo: avaliar a quantidade de cirurgiões-dentistas habilitados em terapia floral e número de cursos já oferecidos dessa habilitação por estados e regiões do Brasil. Material e Método: Os dados referentes aos números de cirurgiões-dentistas habilitados e a quantidade de cursos de habilitação em terapia floral foram coletados diretamente do site do Conselho Federal de Odontologia (CFO), assim como a distribuição geográfica desses no Brasil. Todos os dados utilizados nesta pesquisa são de acesso público. Resultados: São Paulo detém o maior número de cirurgiões-dentistas habilitados em terapia floral (n=16) e é o estado brasileiro, onde o único curso de habilitação foi ministrado. Por regiões, o Sudeste apresentou o maior número de profissionais habilitados no país (56,8%). No Sul, para cada habilitado existem 5.586,6 cirurgiões-dentistas, enquanto que no Nordeste este número cresce para 16.425. Conclusão: Há poucos cirurgiões-dentistas habilitados e cursos de habilitação em terapia floral em todo o país, tendo maior concentração na região Sudeste, principalmente no estado de São Paulo.
Descritores: Essências Florais; Terapias Complementares; Odontologia; Odontólogos.
Introduction: Floral therapy is part of an emerging field of complementary therapies, characterized by the use of less expensive means, based on an integral view of health and, mainly, non-invasive and non-toxic methods. In Brazil, this therapy has been gaining ground, especially since the adoption of the National Policy on Complementary Integrative Practices (PNPIC), which allows the articulation between complex medical systems and traditional and complementary medicine, aiming at disease prevention, recovery, promotion and rationalization of health actions. Objective: to evaluate the number of dentists qualified in floral therapy and the number of courses already offered by this qualification by states and regions of Brazil. Material and methods: The data referring to the numbers of qualified dental surgeons and the number of qualification courses in floral therapy were collected directly from the website of the Federal Council of Dentistry (CFO), as well as the geographical distribution of these in Brazil. All data used in this survey are publicly accessible. Results: São Paulo has the largest number of dentists qualified in floral therapy (n = 16) and is the Brazilian state, where the only qualification course was given. By region, the Southeast has the highest number of qualified professionals in the country (56.8%). In the South, there are 5,586.6 dental surgeons for each qualified, while in the Northeast this number grows to 16,425. Conclusion: There are few qualified dental surgeons and habilitation courses in flower therapy throughout the country, with a higher concentration in the Southeast region, mainly in the state of São Paulo.
Descriptors: Flower Essences; Complementary Therapies; Dentistry; Dentists. Resumen
Introducción: La terapia floral forma parte de un campo emergente de terapias complementarias, caracterizado por el uso de medios menos onerosos, fundado en una visión integral de la salud y, principalmente, por métodos no invasivos y no tóxicos. En Brasil, esta terapia viene ganando espacio, principalmente a partir de la aprobación de la Política Nacional de Prácticas Integrativas Complementarias (PNPIC), que posibilita la articulación entre los sistemas médicos complejos y la medicina tradicional y complementaria, buscando la prevención de enfermedades, recuperación, promoción y racionalización de las acciones en salud. Objetivo: evaluar la cantidad de dentistas habilitados en terapia floral y número de cursos ya ofrecidos de esa habilitación por estados y regiones de Brasil. Material y Método: Los datos referentes a los números de dentistas habilitados y la cantidad de cursos de habilitación en terapia floral fueron recolectados directamente del sitio del Consejo Federal de Odontología (CFO), así como la distribución geográfica de esos en Brasil. Todos los datos utilizados en esta investigación son de acceso público. Resultados: São Paulo posee el mayor número de dentistas habilitados en terapia floral (n = 16) y es el estado brasileño, donde el único curso de habilitación fue dictado. Por regiones, el Sudeste presentó el mayor número de profesionales habilitados en el país (56,8%). En el Sur, para cada habilitado existen 5.586,6 dentistas, mientras que en el Nordeste esta cifra crece a 16.425. Conclusión: Hay pocos dentistas habilitados y cursos de habilitación en terapia floral en todo el país, teniendo mayor concentración en la región Sudeste, principalmente en el estado de São Paulo.
Descriptores: Esencias Florales; Terapias Complementarias; Odontología; Odontólogos.
Background:
A randomized, pilot, placebo-controlled clinical trial was conducted with the aim of evaluating the effectiveness of a cream based on Bach flower remedies (BFR) on symptoms and signs of carpal tunnel syndrome.
Methods:
Forty-three patients with mild to moderate carpal tunnel syndrome during their "waiting" time for surgical option were randomized into 3 parallel groups: Placebo (n = 14), blinded BFR (n = 16), and nonblinded BFR (n = 13). These groups were treated during 21 days with topical placebo or a cream based on BFR.
Results:
Significant improvements were observed on self-reported symptom severity and pain intensity favorable to BFR groups with large effect sizes (η(2) partial > 0.40). In addition, all signs observed during the clinical exam showed significant improvements among the groups as well as symptoms of pain, night pain, and tingling, also with large effect sizes (φ > 0.5). Finally, there were significant differences between the blinded and nonblinded BFR groups for signs and pain registered in clinical exam but not in self-reports.
Conclusion:
The proposed BFR cream could be an effective intervention in the management of mild and moderate carpal tunnel syndrome, reducing the severity symptoms and providing pain relief.
Recent findings on placebo research corroborate the evidence that the placebo effect represents a promising model to shed new light on the brain-mind-body interactions. In particular, this research has partially elucidated the role of how patients' expectations and the quality of physician-patient communication can influence the efficacy of interventions and overall clinical outcomes. Accordingly, the study of the placebo effect should be incorporated in the core clinical practice curriculum of all health practitioners. While the growing knowledge of the placebo effect points to it as an irreducible primary reality of the medical sciences, an ethical analysis aimed at avoiding the misuse of placebos is needed, while maximizing the opportunity for beneficial placebo effects.
Data mining of treatment study results can reveal unforeseen but critical insights, such as who receives the most benefit from treatment and under what circumstances. The usefulness and legitimacy of exploratory data analysis have received relatively little recognition, however, and analytic methods well suited to the task are not widely known in psychology. With roots in computer science and statistics, statistical learning approaches offer a credible option: These methods take a more inductive approach to building a model than is done in traditional regression, allowing the data greater role in suggesting the correct relationships between variables rather than imposing them a priori. Classification and regression trees are presented as a powerful, flexible exemplar of statistical learning methods. Trees allow researchers to efficiently identify useful predictors of an outcome and discover interactions between predictors without the need to anticipate and specify these in advance, making them ideal for revealing patterns that inform hypotheses about treatment effects. Trees can also provide a predictive model for forecasting outcomes as an aid to clinical decision making. This primer describes how tree models are constructed, how the results are interpreted and evaluated, and how trees overcome some of the complexities of traditional regression. Examples are drawn from randomized clinical trial data and highlight some interpretations of particular interest to treatment researchers. The limitations of tree models are discussed, and suggestions for further reading and choices in software are offered. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Introducción: quizás ningún otro término haya sido tan indebidamente utilizado y causado tanta confusión como «placebo». Sus efectos han potenciado los tratamientos médicos en la historia sin el debido reconocimiento. Entendido como eventos atribuibles al significado que adquiere una intervención dentro de un contexto terapéutico dado, se redimensiona y aleja de las definiciones tautológicas dominantes.
Objetivo: analizar los retos que esta postura teórica plantea, así como sus potencialidades para la investigación y la práctica clínica.
Métodos: Se analizan las limitaciones de su uso en Ensayos Clínicos Aleatorizados, entre las que se destaca la paradoja de la eficacia. Se contrasta la evidencia sobre su efectividad, generada en distintos contextos. Se describen los placebos disponibles en la práctica clínica y situaciones de uso; así como las opiniones de médicos y pacientes. Se introduce su efecto desde la dimensión biopsicosocial, dentro de la Medicina del Estilo de Vida. Se esbozan razones que impiden a las medicinas alternativas «ser mejor que un placebo». Por último, se identifica y ejemplifica su espacio dentro la práctica clínica.
Conclusiones: el efecto del placebo debe ser comprendido como un efecto del contexto, estructurado sobre la base del significado individual asignado a la intervención dentro de una cultura e historia específicas, que resulta significativo sobre numerosas enfermedades, mediante la activación y modificación variables psicológicas y fisiológicas. Concebido como Ambiente Curativo Óptimo, adquiere el «principio activo» necesario para actuar por sí mismo (cuando la alternativa es no hacer nada), o potenciando el efecto de los tratamientos convencionales.
To examine the attitudes of US patients about the use of placebo treatments in medical care.
One time telephone surveys.
Northern California.
853 members of Kaiser Permanente Northern California, aged 18-75, who had been seen by a primary care provider for a chronic health problem at least once in the prior six months.
The response rate was 53.4% (853/1598) of all members who were eligible to participate, and 73.2% (853/1165) of all who could be reached by telephone. Most respondents (50-84%) judged it acceptable for doctors to recommend placebo treatments under conditions that varied according to doctors' level of certainty about the benefits and safety of the treatment, the purpose of the treatment, and the transparency with which the treatment was described to patients. Only 21.9% of respondents judged that it was never acceptable for doctors to recommend placebo treatments. Respondents valued honesty by physicians regarding the use of placebos and believed that non-transparent use could undermine the relationship between patients and physicians.
Most patients in this survey seemed favorable to the idea of placebo treatments and valued honesty and transparency in this context, suggesting that physicians should consider engaging with patients to discuss their values and attitudes about the appropriateness of using treatments aimed at promoting placebo responses in the context of clinical decision making.
RESUMEN El objetivo de este estudio experimental, controlado a doble ciegas, fue evaluar el efecto del White Chestnut sobre los pensamientos intrusos indeseados en una muestra de adultos supuestamente sanos que reportaron presentarlos de forma regular. La muestra quedó conformada por 70 participantes (47 mujeres y 23 hombres), con un rango de edad de 20-60 (36,42 ± 10,52) años, asignados aleatoriamente a 2 grupos: White Chestnut y placebo (n1= n2= 35). Para la evaluación de los cambios se utilizó el White Bear Suppression Inventory. Se observaron diferencias significativas intergrupos para la calificación global de la prueba [t (68)= -2,16, p< 0,05 y d= 0,51], con un predominio del factor que mide los pensamientos intrusos [t (68)= -2,84, p< 0,01 y d= 0,67]. Los resultados sugieren que el White Chestnut puede ser un efectivo recurso para la reducción de los pensamientos intrusos indeseados y que su acción es diferenciable del placebo. ABSTRACT A controlled double-blind experimental study was conducted to evaluate the effect of white chestnut on unwanted intrusive thoughts in a sample of seemingly healthy adults who reported having these thoughts regularly. The sample was composed of 70 participants (47 women and 23 men) aged 20-60 (36.42 ±10.52), randomly assigned to one of two groups: white chestnut and placebo (n1=n2=35). The White Bear Suppression Inventory was used for change evaluation. Significant differences were found between the two groups in the global test score [t (68)= -2.16, p<0.05 and d= 0.51], with a predominance of the factor measuring intrusive thoughts [t (68)= -2.84, p< 0.01 and d= 0.67]. Results suggest that white chestnut may be an effective resource for reducing unwanted intrusive thoughts, its effect being clearly distinguishable from that of the placebo.
Previous research shows religiosity (across several religions) is associated with conservative values (tradition, conformity and security) from the Schwartz value scale and not with spiritually oriented, self-transcendent values. The relationship between religiosity and spirituality is controversial. We developed a 48-item scale, the Spiritual Connection Questionnaire (SCQ)-48, to measure experience and beliefs of spiritual connection, an aspect of spirituality that is consistent with religious and non-religious or New Age interpretations of spirituality. We selected 14 items (SCQ-14) that best predicted health and then tested the correlation between the SCQ-14 and the SVS in a student and an older population in the UK. In both populations the SCQ-14 was negatively associated with values at the self-enhancing value pole (power, security and hedonism) and in the older population was positively associated with a value at the self-transcendent value pole (universalism, but not benevolence). Religiosity has been shown to be associated with values that enhance societal identification and hence inter-group differentiation and conflict. By contrast, we found that the experience of spiritual connection is associated with values that reduce inter-group differentiation. Despite these differences, we found that self-reported religiosity enhances spiritual experience. Copyright © 2008 John Wiley and Sons, Ltd.
The terms 'placebo' and 'placebo effects' cause confusion among patients, practitioners and scientists. This confusion results in both the adoption of practices that have no evidence of specificity yet considerable risk (such as surgery for low back pain) or the elimination of clinical practices proven to facilitate healing because they are not 'better than placebo' (such as acupuncture for low back pain). In this article, I discuss these issues and introduce the concept of optimal healing environment as a framework for disentangling what is useful from placebo research for adopting into clinical practice in a manner that is ethical and evidence-based.
This paper challenges the common assumption that the mechanisms underlying short-term placebo paradigms (where there is no motivation for health improvement) and long-term placebo paradigms (where patients value improvement in their health) are the same. Three types of motivational theory are reviewed: (i) classical placebo motivation theory that the placebo response results from the desire for therapeutic improvement; (ii) goal activation model that expectancy-driven placebo responses are enhanced when the placebo response satisfies an activated goal; and (iii) motivational concordance model that the placebo response is the consequence of concordance between the placebo ritual and significant intrinsic motives. It is suggested that current data are consistent with the following theory: response expectancy, conditioning and goal activation are responsible for short-term placebo effects but long-term therapeutic change is achieved through the effects of goal satisfaction and affect on the inflammatory response system and hypothalamic-pituitary-adrenal axis. Empirical predictions of this new theory are outlined, including ways in which placebo effects can be combined with other psychologically mediated effects on short-term and long-term psychological and physiological state.
The field of placebo research has made considerable progress in the last years and it has become a major focus of interest. We know now that the placebo effect is a real neurobiological phenomenon and that the brain's 'inner pharmacy' is a critical determinant for the occurrence of psychobiological and behavioural changes relevant to healing processes and well-being. However, harnessing the advantages of placebo effects in healthcare is still a challenge. The first part of the theme issue summarizes and discusses the various kinds of placebo mechanisms across medical fields, thereby not only focusing on two main explanatory models-expectation and conditioning theory-but also taking into account empathy and social learning, emotion and motivation, spirituality and the healing ritual. The second part of the issue focuses on questions related to transferring knowledge from placebo research into clinical practice and discusses implications for the design and interpretation of clinical trials, for the therapeutic settings in daily patient care, and for future translational placebo research.
Bach flower remedies continue to be popular and its proponents make a range of medicinal claims for them. The aim of this systematic review was to critically evaluate the evidence for these claims. Five electronic databases were searched without restrictions on time or language. All randomised clinical trials of flower remedies were included. Seven such studies were located. All but one were placebo-controlled. All placebo-controlled trials failed to demonstrate efficacy. It is concluded that the most reliable clinical trials do not show any differences between flower remedies and placebos.
Bach Flower Remedies are thought to help balance emotional state and are commonly recommended by practitioners for psychological problems and pain. We assessed whether Bach Flower Remedies (BFRs) are safe and efficacious for these indications by performing a systematic review of the literature.
We searched MEDLINE, Embase, AMED, and the Cochrane Library from inception until June 2008 and performed a hand-search of references from relevant key articles. For efficacy, we included all prospective studies with a control group. For safety, we also included retrospective, observational studies with more than 30 subjects. Two authors abstracted data and determined risk of bias using a recognised rating system of trial quality.
Four randomised controlled trials (RCTs) and two additional retrospective, observational studies were identified and included in the review. Three RCTs of BFRs for students with examination anxiety, and one RCT of BFRs for children with attention-deficit hyperactivity disorder (ADHD) showed no overall benefit in comparison to placebo. Due to the number and quality of the studies the strength of the evidence is low or very low. We did not find any controlled prospective studies regarding the efficacy of BFRs for pain. Only four of the six studies included for safety explicitly reported adverse events.
Most of the available evidence regarding the efficacy and safety of BFRs has a high risk of bias. We conclude that, based on the reported adverse events in these six trials, BFRs are probably safe. Few controlled prospective trials of BFRs for psychological problems and pain exist. Our analysis of the four controlled trials of BFRs for examination anxiety and ADHD indicates that there is no evidence of benefit compared with a placebo intervention.
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 (beta=.35, P=.01) and expectancy (beta=.25, P=.03) independently predicted outcome. When flower essences were presented as an affirmation (i.e., nonspiritual) therapy, then spirituality negatively (beta=-.27, P=.03) and expectancy (beta=.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 nonenhanced ritual group. The results suggest that motivational concordance is an important therapeutic mechanism for real-life placebos.
The aim of this article is to assess and compare three classification statistical techniques--logistic regression, discriminant analysis and classification trees--to identify the personality characteristics associated with the risk of suffering from ischemic cardiovascular acute episodes (ICAE). The sample comprised 313 participants, men and women, aged from 36 to 80. Participants were divided into two groups: a clinical group of patients (n = 143) who were diagnosed as suffering from ICAE, and a control group (n = 170). Both groups were equated in gender, age, socio-economic and educational level. In view of the comparative study of the analytical procedures, we recommend classification trees as the best choice, as it was the most accurate for the individuals in the clinical group, a simple data analysis and a meaningful clinical interpretation. The predictive validity analysis of the MCMI-II allowed the construction of a reduced version made up of 9 personality scales from the 22 scales in the original version. Thus, we could identify the patients with a higher probability of suffering from ICAE, and additionally, generate an empirical model comprising seven and five personality profiles associated, respectively, with the increase and the decrease of the probability of suffering from ICAE.
Research on dispositional optimism as assessed by the Life Orientation Test (Scheier & Carver, 1985) has been challenged on the grounds that effects attributed to optimism are indistinguishable from those of unmeasured third variables, most notably, neuroticism. Data from 4,309 subjects show that associations between optimism and both depression and aspects of coping remain significant even when the effects of neuroticism, as well as the effects of trait anxiety, self-mastery, and self-esteem, are statistically controlled. Thus, the Life Orientation Test does appear to possess adequate predictive and discriminant validity. Examination of the scale on somewhat different grounds, however, does suggest that future applications can benefit from its revision. Thus, we also describe a minor modification to the Life Orientation Test, along with data bearing on the revised scale's psychometric properties.
The aim of this study was to determine whether absorption and spirituality predict the placebo response independently of expectancy.
This was an open study of self-treatment with self-selected Bach flower essences. Participants' expectancy of the effect of flower essences, attitudes to complementary medicine, holistic health beliefs, absorption, and spirituality were measured prior to treatment. One month after the start of treatment, participants responded to an e-mail enquiry about symptom change using a single seven-point change scale.
One hundred sixteen participants (97 university undergraduates and 19 staff) completed all assessments. Spirituality and absorption together predicted additional variance compared with a cluster of expectancy measures comprising expectancy, attitude to complementary medicine, and holistic beliefs (increment in R(2)=.042, P=.032), and spirituality alone (but not absorption alone) predicted more additional variance than did the expectancy cluster (increment in R(2)=.043, P=.014).
Our data are inconsistent with conventional explanations for the placebo effect. The mechanism underlying the placebo response is not fully understood.
The aim of this study was to test a motivational interpretation of placebo responding using two different types of placebo therapy, one using flower essences and the other a nonspecific psychological therapy. The motivational concordance interpretation is that therapeutic rituals that are consistent with self-defining or self-actualizing goals have a nonspecific therapeutic benefit independently of expectancy.
Study 1 was a replication of an earlier flower essence outcome study but with additional outcome and predictor variables: 167 people completed questionnaires in return for free flower essence treatment. Predictor variables consisted of two measures of spirituality, optimism, expectancy, and attitudes and beliefs to complementary medicine. Outcome was assessed after 3 weeks. In Study 2, 90 people took part in "gratitude therapy" for improved sleep quality over one night in return for questionnaire completion (trait gratitude, spirituality, and expectancy).
Study 1 confirmed previous research: Trait spirituality predicted perceived improvement. This improvement was independent of optimism (P<.001), cannot be explained by acquiescence or social desirability, and was independent of a highly conservative test of expectancy (P=.02). In Study 2, trait gratitude predicted perceived sleep improvement independently of expectancy (P=.01): Spirituality did not correlate with improvement.
These data suggest that in addition to expectations, degree of engagement in a positive, therapeutic ritual determines the extent of the placebo response. The placebo response depends in part on the interaction (i.e., the degree of concordance) between the type of therapy and the participant's personality: Dispositional predictors vary with the type of placebo therapy.
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Introduction: No term has probably been as misused and has caused so much confusion as the term 'placebo'. Its effects have strengthened medical treatments throughout history without receiving due recognition. Understood as events attributable to the significance acquired by an intervention in a given therapeutic context, it takes on a new dimension, detaching from the prevailing tautological definitions. Objective: Analyze the challenges posed by this theoretical stand, as well as its potential for research and clinical practice. Method: An analysis is conducted of the limitations of its use in randomized clinical trials, among them the efficacyparadox paradox. A contrast is made of evidence of its effectiveness generated in various contexts. A description is provided of placebos available in clinical practice and situations of use, as well as doctors' and patients' opinions. Its effect is presented from a biopsychosocial perspective, within the framework of Lifestyle Medicine. An outline is provided of the factors preventing alternative medicines from being «better than a placebo». Finally, its place in clinical practice is identified and exemplified. Conclusions: The placebo effect should be understood as an effect from the context, structured on the basis of the individual significance assigned to the intervention by a specific culture and historical development, which is significant for a large number of diseases, through the activation and modification of psychological and physiological variables. Conceived of as an Optimal Healing Environment, it acquires the «active principle» required to act by itself (when the alternative is doing nothing), or strengthen the effect of conventional treatments.
We examined the hypothesis that a tendency to experience the world in terms of a sense of `special' connection is responsible for the self-transcendent value dimension identified by multi-dimensional scaling and constitutes a common factor for different religious and non-religious interpretations of spirituality. Eight different groups were studied including: (a) six different types of faith leaders in India and the UK, (b) people who self-rated as spiritual but not religious, and (c) those self-rating as neither spiritual nor religious. They completed a questionnaire that assessed (a) the strength of their spirituality irrespective of type (self-perceived spirituality) and (b) the experience of special connection to the following categories: people, nature, places and the universe, with and without using the term spiritual. For all eight samples the different types of connection were highly inter-correlated, and self-perceived spirituality correlated with the sum of connection items irrespective of whether items included the term spiritual or not. Variation between groups in the size of the latter correlation was consistent with different interpretations of spirituality in those groups. Although the meaning of spirituality is socially constructed, variability within faith leader groups suggests that its interpretation is also affected by personality.
A placebo by proxy effect occurs when a patient's response to therapy, assessed either objectively or subjectively, is affected by the behavior of other people who know that the patient is undergoing therapy. We recruited 58 children aged 2-5 years who reported frequent tantrums and examined the effect of a pharmacologically inert substance (flower essence) that is purported by the manufacturers to reduce temper tantrums. Tantrum frequency, tantrum severity, and parental mood were measured on 5 occasions over 8 days before treatment and on a further 5 occasions over 10 days after the start of treatment. Compared to the period before treatment, there was a continuing reduction in tantrum frequency (p = .002) and severity (p = .003) over the 8 days of placebo treatment. There were significant day-to-day correlations between parents' mood and tantrum frequency (r = .23) and severity (r = .19). Children's response to treatment for tantrums is associated with the beliefs and mood of the adult carer. We cannot say whether tantrum reduction was due to objective changes in child behavior, changes in parental perception, or both, but both are clinically important changes.
To determine whether spiritual and religious identities predict complementary and alternative medicine (CAM) use above and beyond other known influences such as gender, region of residence, social status, personality, health, and access to conventional medicine.
Analyzing data from the 1995-1996 National Survey of Midlife Development in the United States (n=3032), this study examines the correlations between four aspects of spirituality/religiousness-i.e., spiritual only, religious only, both spiritual and religious, and neither spiritual nor religious-and six measures of CAM.
Compared with spiritual only persons, the odds of using energy therapies are 86% lower for spiritual and religious persons, 65% lower for religious only persons, and 52% lower for neither spiritual nor religious persons. Compared to spiritual only persons, spiritual and religious individuals are 43% more likely to use body-mind therapies in general; however, when this category does not contain prayer, meditation, or spiritual healing, they are 44% less likely. Religious only individuals are disinclined toward CAM use.
After controlling for established predictors including educational attainment, personality, social support, and access to conventional medicine, the present study demonstrates that spirituality and religiousness are associated, in unique ways, with CAM use. Additional research on this topic is clearly warranted.
Homeopathy and Bach Flower Remedies (BFRs), historically-related complementary healing modalities classified as prescription/nonprescription drugs and over-the-counter homeopathic nutritional supplements, respectively, are compared with respect to indications, dosage philosophies, associated procedures, reported outcomes, safety profiles, and the possible operation of the placebo effect.
Original data and published research reports, including case studies, retrospective meta-analyses, and double-blind clinical trials are compiled and evaluated for both healing systems.
Homeopathy and BFR therapy both feature highly diluted natural medicinal substances, flexible dosage schedules tailored to individual patients, and energy-based healing action. They differ with respect to practitioner training and certification, number and types of medicinal source materials, remedy combinations and applications, and potential toxicity or other side-effects.
Extensive testing has produced mixed or equivocal results regarding the efficacy of both of these health care systems. While a variety of positive outcomes have been frequently recorded with Homoeopathy and BFR treatments, it is likely that the placebo effect operates to a significant extent in both approaches.
Pharmacists need to know about complementary therapies so they can advise patients on their suitability, and also their compatibility with conventional drugs. This article discusses, from a pharmaceutical perspective, the types of therapies available, their applications and indications, and issues surrounding the placebo effect.
A common sense view in psychotherapy holds that there are individual differences in response to different treatments. However, despite considerable effort, no clear rationale exists to guide the selection of therapy for individual patients.
Rather than focusing on specific components of therapy as a basis to predict interactions between patients and treatments, we draw on motivational concordance theory and a contextual model of psychotherapy to test whether, in an analogue study, perceived effectiveness of different therapy vignettes is related to human values.
Two samples (undergraduates and members of the public) read short vignettes, informed by six therapies for depression (cognitive behaviour therapy, client-centred therapy, antidepressant medication, existential psychotherapy, psychodynamic psychotherapy, and a complementary medicine: Bach flower essences), provided ratings of perceived effectiveness, and completed questionnaire measures of dispositional motivations (Schwartz Values Scale and the Spiritual Connection Questionnaire-14). Responses were analysed using multidimensional scaling (MDS).
In both samples, expectancy for the cognitive behavioural-informed vignette was related to Self-direction and Stimulation, and was opposed to Tradition, Conformity and Security. Expectancies for the Drug vignette were associated with Power and Security.
People perceive therapies as more effective if the therapy is congruent with their values. These preliminary data suggest motivational concordance is a useful framework for predicting client-treatment interactions.
The motivations of cancer patients in seeking complementary therapies are, fundamentally, self-healing motivations which, when engaged appropriately, can contribute to the patient's psychological and physical well being. In this paper, we apply a theoretical model, the Risk Adaptation Model, to furthering the clinical understanding of the motivations of cancer patients in seeking complementary therapies. The model identifies six discrete cognitive processes which, in combination, are hypothesized to play a central role in therapy seeking. Emphasis in this model is placed on the patient's need to maintain positive expectancies (optimism) when faced with the risk and uncertainty of cancer. This understanding of complementary-therapy seeking is grounded in the perspective that clinicians must respect the autonomy of cancer patients in their quest for appropriate therapies, and assist rather than direct their process of therapy-seeking.
This paper explores the potentiality of Bach flower remedies as a means of pain relief through a retrospective case-study analysis to establish how clients suffering with painful conditions responded to the therapy.
Of 384 subjects, 41 suffered pain. Of these, 46% felt treatment had relieved their pain; in 49% the physical outcome was unknown. About 88% of all subjects reported an improvement in their emotional outlook.
The role of placebo and its influence on the study's key features: focus shift from physical pain to emotional outlook, and the importance of the client-practitioner relationship and belief in the therapy.
The use of Bach flower remedies has brought about positive emotional changes in the majority of clients in this study. Whilst it is difficult to draw a definitive conclusion as to significance of the therapeutic value of these remedies in relation to pain above that of a placebo, the results are encouraging. In particular, relief of negative emotions and promotion of positive thought including how clients opened up about, and dealt with, emotional issues. The indication is that potential for Bach flower remedies as a therapeutic agent in the relief of pain does exist and is worthy of further qualitative and quantitative investigation through robust, purpose-designed studies to replicate and progress the results shown here.
The Rational-Experiential Inventory (REI) and Tellegen Absorption questionnaire were completed by 131 undergraduate students who also completed a scale measuring complementary medicine use (with separate entries for practitioner and self-delivered use) and vitamin/mineral use. Less rationality and greater absorption predicted greater use of practitioner-delivered and self-delivered complementary medicine, and vitamin/mineral use. Logistic regression showed that rationality and absorption were independent predictors of these behaviours. In addition to confirming previous research, this is the first demonstration that complementary medicine and vitamin/mineral use are predicted by the same variables, including less rationality.
- M Linderman
M. Linderman, Biases in intuitive reasoning and belief in complementary and
alternative medicine, Psychol. Health 26 (3) (2011) 371e382.
Bach Flower Remedies: Form and Function
- J Barnard
J. Barnard, Bach Flower Remedies: Form and Function, Lindisfarne Books,
Great Barringtong, MA, 2004.