Who responds to placebos? Considering the "placebo personality" via a transactional model
Who responds to placebos? Considering the "placebo personality" via a transactional model
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DOI：
10.1080/13548506.2014.936885
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发表时间：
2015-04-03
影响因子：
3.8
通讯作者：
Consedine, Nathan S.
中科院分区：
文献类型：
--
作者：
Darragh, Margot;Booth, Roger J.;Consedine, Nathan S.
安慰剂效应现在被认为是一种真正的心理生物学现象。然而，如何系统地利用它来改善健康结果的问题尚不清楚。一个尚未解决的问题是为什么有些人对安慰剂有反应而另一些人则没有。许多特征与反应有关，但研究结果分散。在扩展先前的工作时，本文提出了三个考虑因素。首先，尝试通过单一人格特征来描述安慰剂应答者可能是有限的。迄今为止的研究结果表明，安慰剂反应可能反映了两个方面的结构，“内向”和“外向”方向代表了安慰剂反应不同但相关的方面。其次，缺乏理论驱动的研究可能会阻碍进展。人格测量而不是人格理论似乎正在推动研究，而高阶特征是描述性工具，在预测行为方面用途有限。基于生物学的刺激-反应人格模型考虑了个体如何对某些环境线索做出反应，可能更合适。第三，提出了安慰剂反应的交易模型，其中性格特征与环境意外事件相互作用。反应性可能会在安慰剂环境中显现出来，其中个体的生物特征样反应系统与环境意外事件之间存在匹配。这种类型的模型可能在研究和临床环境中都有用。系统地考虑不同个体对不同安慰剂环境的反应可能有助于识别预测反应的稳定个体特征。确定谁对安慰剂治疗有反应以及在什么情况下有反应的能力可以使个体与治疗相匹配，从而最大限度地提高治疗的有效性并最大限度地减少可能的医源性伤害。在负担日益沉重的现代医疗保健行业中，非药物治疗替代方案至关重要。
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 suggests 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 minimising possible iatrogenic harm. In the increasingly overtaxed modern health care industry, non-pharmacological treatment alternatives are of critical importance.