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Understanding placebo, nocebo, and iatrogenic treatment effects
Author(s) -
Bootzin Richard R.,
Bailey Elaine T.
Publication year - 2005
Publication title -
journal of clinical psychology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.124
H-Index - 119
eISSN - 1097-4679
pISSN - 0021-9762
DOI - 10.1002/jclp.20131
Subject(s) - expectancy theory , psychology , nocebo , placebo , nocebo effect , debriefing , psychotherapist , clinical psychology , psychological intervention , psychiatry , medicine , social psychology , alternative medicine , pathology
Abstract Placebo and nonplacebo treatments have both positive and negative effects on patient outcomes. To better understand the patterning of treatment effects, three specific interventions will be discussed that are reported to produce more harm than benefit: critical incident stress debriefing, group therapy for adolescents with conduct disorders, and psychotherapy for dissociative identity disorder. In each case, there is an interaction between mechanisms thought to underlie both placebo and specific treatment effects. Mechanisms hypothesized to underlie placebo and nocebo effects include patient expectancy, self‐focused attention to symptoms, motivation to change, and sociocultural role‐enactment cues. In the three treatments discussed, specific mechanisms interact with nonspecific mechanisms to produce iatrogenic effects. To advance knowledge, it is important both to specify the theory of treatment and its expected outcomes and to put the theory to test. Only with attention to the empirical findings from programmatic research of specific and nonspecific effects and their interaction is it possible to improve the outcomes of treatment beyond the status quo. © 2005 Wiley Periodicals, Inc. J Clin Psychol 61: 871–880, 2005.