Positive Health Online

Vikki Rimmer, writer, NLP coach and hypnotherapist speaks with Dr Phil Parker PhD, Professor Irving Kirsch and Dr David Hamilton PhD about how the power of belief is integral to effective pain relief.

For many in the world of neuroscience, the humble placebo has shone a light on a new pathway out of pain for patients who had previously given up hope.

The placebo effect used to be an annoyance to many in the field of medical research.  Years ago, it was just something that had to be accounted for and recorded.  However, over the last decade, pioneers in the field of neuroscience and the mind-body connection have embraced the work of Professor Irving Kirsch and colleagues, whose work strives to understand the very nature of the placebo effect and the expectation response.

The Emperor's New Drugs: Exploding the Antidepressant Myth
by Prof Irving Kirsch

Professor Kirsch, lecturer at Harvard, has spent the last 50 years investigating the placebo effect itself.  In contrast to many in the 1970s, he embraced the placebo and used its very existence in order to examine exactly what was going on in a person’s physiology when the act of drinking sugar water could reduce pain, or an injection of saline could enable the body to manage symptoms.

The placebo effect in thousands of studies has shown that expectancy plays a crucial role in recovery and can have as much power as a medicinal or surgical intervention.  When a person believes they’re receiving a pain killer (but it’s really a sugar tablet) their brain will produce its own natural version of endogenous opiates (originating from within) to deliver the result they were expecting. 

This response suggests that having positive beliefs about a treatment helps produce the result they want/expect to happen.

And while at the start of his career, Professor Kirsch’s research may have seemed on the fringes of science, he has since time authored 10 books and over 250 scientific journal articles and his analysis of this influenced official guidelines for the treatment of depression in the United Kingdom.[1]

Understanding the mechanisms and the physiological effects of the placebo has enabled clinicians to educate their patients and to then teach them how it’s possible to produce their own natural version of a drug, a pain killer, or an anti-depressant with the power of the mind, and to alleviate their symptoms.

Placebo and understanding the body’s response to pain (and how it has very little to do with the state of the body’s tissues) has led to placebo being examined as a potential future treatment for pain relief.

New training programmes to help patients ‘think’ their way out of pain have proved popular over the last few years, including The Lightning Process, designed by Dr Phil Parker, researcher and lecturer at the London Metropolitan  University and author of 4 books on wellbeing and health.

Mind-Body Connection with Dr Phil Parker

Response Expectancy

At the heart of Professor Kirsch’s work was the idea of ‘response expectancy’. Kirsch says: “it was an idea I invented back in the 1970s to explain what is going on when a patient takes a placebo.[2]  It essentially looks at the role of expectancy or belief when it comes to treating pain or anxiety.  We looked at non-volitional response and how if a person believes they are going to experience something different - more pain, less pain, more anxiety less anxiety - this can be increased, decreased, or generated by the experience of taking a placebo (sugar water or chalk tablets).  Ultimately it shows that patients have it within them to change their experience independently of what's out there.  If there is a stimulus causing you to feel pain, you can modulate it dependent on your beliefs.”

Agreeing with this definition of the placebo effect, Dr Phil Parker adds;  “the psychology of it will have a physiological effect - there will be changes in neurotransmitters, blood pressure etc. There is some great research on how the words we use affect the brain”.[3] The expectancy itself is not only a subjective event therefore, it’s also a physiological event.

Prove It

Skepticism about this connection between the mind and the body persisted for most of the latter part of the twentieth century, but Dr Phil Parker posits that this has now changed and due to the body of research evidence on the mind influencing the body (and vice versa), the idea that they are interconnected and that there is in fact no divide is now well accepted.[4]

Over twenty years ago now, Dr Parker developed the Lightning Process, a 3-day training programme, that teaches clients who suffer from chronic pain conditions, anxiety and depression, to utilize imaging, self-coaching techniques, and body movement, based on this mind-body research, to make change in their physical and mental health. He says: “Kirsch’s expectancy model is a good way of viewing why people have some extraordinary responses to The Lightning Process and mind-body approaches in general. We explain to our clients how some of the research into placebos shows that you can affect your body and make beneficial changes”.[5]

Despite a wealth of research identifying benefits for those with chronic health conditions and resolving pain to return to normal life, some still are skeptical of change that doesn’t involve pharmaceutical products.

Dr Phil Parker says:  “Despite the evidence, there is still resistance in some communities to the idea that the mind and body are interconnected. It’s obvious to many though that the two cannot be separated.  Blushing is a very obvious example of the mind body connection.  An external stimulus, a thought or embarrassment will create a physical response and it would be hard to go through your life without having some such experience. I often use this example to show how there is no break, or distinction between the mind and the body - they influence each other and are never apart.”

David R Hamilton PhD

Dr David Hamilton, former pharmacologist and author of How Your Mind Can Heal Your Body agrees that there can be no differentiation between the two.  He says “each are always affecting the other - it’s like time and space, they’re really the same thing. The mind, to us in our everyday experience, feels distinct, but may be they’re just two different expressions of the same thing, and are ultimately much more entangled than our everyday experience will have us believe.”

How Do You Harness the Placebo Effect and Switch It On?

If it is possible to generate your own dopamine,[6] cortisol, or oxytocin, how can you do it at will?  Dr Phil Parker has trained thousands of people to access this and says “Initially it surprised me to see such changes- but having seen people make incredible long term changes to their physical conditions, resolving chronic pain and achieving results they couldn’t previously imagine, I don’t question it any anymore.”

Agreeing with Dr Phil Parker, Dr Hamilton suggests : “one way to trigger your own personal pain killer is to think warm and affectionate thoughts about people.  Oxytocin is the ‘kindness hormone’ for me. The effects of kindness are in many ways the physiological opposite to stress.  Think of someone you love and care about, a time that was well-spent, maybe they did something really kind for you and you feel gratitude for that, you will generate oxytocin.  Any way you can access that feeling is one of the best ways to generate it.”

Dr Parker adds “In the same way as producing stress hormones has a physiological effect on our body, accessing feel-good memories will have a profoundly positive effect on the body.” 

It would appear that mentally practising a movement, or a feeling can have a profound physiological change on the body, akin to placebo.[7]

The benefits of mental imagery or rehearsal has been studied a lot over the last few years and how this can have the effect of ‘re-wiring the brain’.  A modest study conducted by Neuroscientist Alvaro Pascual-Leone at Harvard in 2007[8] showed that the mental practice of a piano piece by volunteers who imagined practising the piano, generated the same development in the brain as the volunteers in the study who undertook the actual physical practice of the very same piano piece. The results of his study showed that mental training had the power to change the physical structure of the brain.

Pascual-Leon’s piano study has more recently supported by other researchers who have found how the repeated mental practice and imaging of the perfect golf swing, or the perfect tennis serve, helps improve the physical one.  If the brain can utilize imaging in this way for improved physical action, the applications for pain are exciting.

Dr Parker says though, the three rules of achieving success with this are “practice, practice, practice” or “repeat, repeat, repeat”.  He adds: “when working with the neuro plasticity of the brain, or as some people refer to it ‘the re-wiring process’ it doesn’t actually take long for the practice and repetition to become absorbed unconsciously and for the brain and body to integrate this new behaviour as the dominant one.  The same can be true for the placebo response with pain.  In Kaptchuk’s famous placebo study,[9] some of the respondents asked to carry on taking the placebo when the study has ended - they know that the drug is not an active medication, but they had experienced repeated benefits by taking it and wanted to continue to remain pain free.”

Education seems to be a key part of utilizing the placebo response for good, as is the way the placebo is delivered. If it delivered with an expectancy of change or relief, then results will be forthcoming.[10]

Dr Parker concludes: “It’s our job as clinicians to educate patients to the power of their response expectancy and to provide them with the tools to effectively harness this placebo effect, or as Prof Luana Colloca likes to call it ‘the internal pharmacy’, going forward, without the need to take sugar water or ingest a chalk pill.”

References

1.  Kirsch and Depression: (Jakobsen et al., 2019) Jakobsen, J. C., Gluud, C., & Kirsch, I. (2019). Should antidepressants be used for major depressive disorder? BMJ Evidence-Based Medicine, bmjebm-2019-111238. https://doi.org/10.1136/bmjebm-2019-111238 2019.

2. Vickery & Kirsch Response Expectancy (1985) further racing here: https://pdfs.semanticscholar.org/8069/13ae06f9d23b06f4759d2c6c2e3a829ffd4f.pdf

3. Straube, T., Sauer, A., & Miltner, W. H. R. (2011). Brain activation during direct and indirect processing of positive and negative words. Behavioural Brain Research, 222(1), 66–72. https://doi.org/10.1016/j.bbr.2011.03.037 2011.

4. Benedetti et al., 2007; Straube et al., 2011 Benedetti, F., Lanotte, M., Lopiano, L., & Colloca, L. (2007). When words are painful: Unraveling the mechanisms of the nocebo effect. Neuroscience, 147(2), 260–271. https://doi.org/10.1016/j.neuroscience.2007.02.020 . 2011.

5. Parker, P., Aston, J., & Finch, F. (2018). Understanding the Lightning Process approach to CFS/ME; a review of the disease process and the approach. Journal of Experiential Psychotherapy, 21(2), 8. https://jep.ro/images/pdf/cuprins_reviste/82_art_2.pdf . 2018.

6. Parkinson’s studies; placebo cause dopamine production(Lidstone et al., 2010) Lidstone, S. C., Schulzer, M., Dinelle, K., Mak, E., Sossi, V., Ruth, T. J., de la Fuente-Fernández, R., Phillips, A. G., & Stoessl, A. J. (2010). Effects of Expectation on Placebo-Induced Dopamine Release in Parkinson Disease. Archives of General Psychiatry, 67(8), 857. https://doi.org/10.1001/archgenpsychiatry.2010.88  2010.

7. How recalling positive images reduces stress response (Speer & Delgado, 2017) Speer, M. E., & Delgado, M. R. (2017). Reminiscing about positive memories buffers acute stress responses. Nature Human Behaviour, 1(5), s41562-017-0093–017. https://doi.org/10.1038/s41562-017-0093 . 2017.

8. Piano study: (Pascual-Leone et al., 1995) Pascual-Leone, A., Nguyet, D., Cohen, L. G., Brasil-Neto, J. P., Cammarota, A., & Hallett, M. (1995). Modulation of muscle responses evoked by transcranial magnetic stimulation during the acquisition of new fine motor skills. Journal of Neurophysiology, 74(3), 1037–1045. https://doi.org/10.1152/jn.1995.74.3.1037 . 1995.

9. Study of open label placebos with Kirsch: (Kaptchuk et al., 2010) Kaptchuk, T. J., Friedlander, E., Kelley, J. M., Sanchez, M. N., Kokkotou, E., Singer, J. P., Kowalczykowski, M., Miller, F. G., Kirsch, I., & Lembo, A. J. (2010). Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome. PLoS ONE, 5(12), e15591. https://doi.org/10.1371/journal.pone.0015591  2010.

10. Good overview of placebo studies: (Oken, 2008) Oken, B. S. (2008). Placebo effects: Clinical aspects and neurobiology. Brain, 131(11), 2812–2823. https://doi.org/10.1093/brain/awn116  2008.