therapy treatment healing illustration

It did not really matter whether the patients actually received the real or the sham procedure—what mattered was whether they believed in acupuncture and expected a benefit from it.

Benedetti, F. (2014). Placebo Effects: From the Neurobiological Paradigm to Translational Implications. Neuron, Volume 84, Issue 3, Pages 623-637

Koro, the disorder of shrinking penises

Have you ever heard of the syndrome called Koro? In some cultures, there are people suffering from extreme fear from believing that their genitals are shrinking and might possibly disappear – or even cause death by retracting into the body and affecting other organs. Importantly, there is nothing wrong with those people’s genitals, the problem is entirely in their heads. That, however, does not make it any easier for them.

Growing up in Europe, I spent most of my life unaware of any risks of my penis shrinking. Therefore, I could hardly have been panicking for such a reason. Despite the ludicrous nature of this belief, during human history, there were times when rumours were spreading about such a problem, leaving thousands of people terrified and convinced their penises, nipples or breasts are retracting, despite their eyes witnessing no physical change. How is that possible?

People suffering from koro might have been born with some biological predispositions for anxiety, psychotic states or increased sensitivity to stress. To expand, studies have shown that this problem is often preceded by some sexual problems or guilt related to intimacy. Nevertheless, the epidemics happening in certain narrow time windows and locations suggest that none of these factors was key. In fact, the crucial source of this disorder was a piece of information: It was word of mouth which made the disorder (metaphorically) so contagious.

Similar disorders illustrate that it is not only the body, genes and neurons that affect our mental health. The culture we experience also plays a role: our expectations, beliefs, traditions and stories. Regardless of our logical skills, in most situations we are not consciously using our rational thinking and thus we switch to what is innate: learning from random coincidences and from what we see in others. Even some birds are able to learn how to open a can by seeing other individuals of their species doing so, not to mention the learning capabilities of dogs or monkeys.

For us, humans, such a skill is necessary in our everyday activities. When facing a new kind of ticket machine, we mimic what others do without reflecting it consciously. And the same holds true in more complex situations. Are you wondering whether to call in sick to work? Such a choice is rarely rational: rather, you comply with local cultural norms. In other words, you follow the example of others in similar situations before you.

What does this mean for koro? Of course, the poor people suffering from koro did not fake their fears to act as the others did. Rather, they learned the sequence of causes and effects which they had witnessed in the others: the disorder. Once they believed they might get the same disease, they started worrying excessively, which, in turn, made them likely to convince themselves that there is truly something wrong with their genitals.

Now, imagine you have their full and unlimited trust. They don’t believe their own eyes showing them that nothing is happening with their bodies, so despite being trustful, you would hardly be successful when attempting to convince them rationally. But maybe you would find a plant, stone, magical formula or special therapy that might cure the disease. Or perhaps you would simply lie about finding one. In either case, you could effectively help them by applying the trusted but biologically inefficient ointment, cutting off the vicious cycle of worries and distorted self-image. Once they would believe that you have some special power to help them, they would stop worrying which, in turn, would make them realize their genitals are not deformed after all.

Can you see the magic? Rather than the ointment itself, it was the information that cured your patients of their unfounded fears. Welcome to the world of placebo!

On a side note: this does not imply koro would be unreal. All the fear and anxiety are real and genuine, including their neurobiological underpinnings. Although I haven’t seen any research confirming it, I am confident that blood tests would reveal elevated cortisol levels showing increased stress and that brain scans would detect activity characteristic of anxiety. Therefore, your placebo treatment would not only change their mental issue, but also the underlying physiology.

Placebos and treatments often have similar effect sizes. Placebos with comparatively powerful effects can benefit patients either alone or as part of a therapeutic regime.

Howick J, et al. (2013) Are Treatments More Effective than Placebos? A Systematic Review and Meta-Analysis. PLoS ONE 8(5).

Placebo: Treatment with information

Similar effects affect a variety of complaints and diseases, both physical and mental. Placebo is not only about making you believe something, but about exploiting all your expectations and respective neural processes. All the world surrounding us, all the stories, TV shows, rational thoughts, books, you name it – everything connects medicine with healing. It does not require effort from our side, it is one of those connections deep inside us, like the link between a smile and happiness, plants and the color green or heat and summer.

By taking a pill or receiving advice from a trusted clinician, we unconsciously accept some likelihood that we will be healed.

Our neurons then react to such expectation. Therefore, not only does placebo influence your beliefs, it manipulates your brain. And those who control the brain, control the body.

By targeting our brain systems, predominantly those mediated by dopamine, placebo may help with various mental struggles including depression, sleep disorders, and symptoms of Parkinson’s disease. Indirectly, through nerves and hormones, these effects are then spreading further to our immune activity, muscle tension, digestion and many other processes governed by the brain. In the end, placebo is even capable of reducing cardiovascular risks.

It is important to understand, though, that the placebo’s possibilities are limited. The more the brain is in charge, the more the placebo may help. In allergies, for example, the results tend to be significant, because the brain processes responsible for the positive beliefs aid in restoration of the immune equilibrium. However, when it comes to problems more external to the organism, such as infections or tumors, placebo holds very limited power, although it seems that it may support our body fighting the illness by increasing optimism and reducing stress. But considering mental health, the placebo effects tend to be powerful.

Examples that blew me away:

  • One study followed patients after a surgery, comparing effects of analgesic proglumide and placebo saline solution: “Pain intensity was similar in patients receiving no treatment or a hidden injection of saline or proglumide, while it decreased after open injection of saline and even more after proglumide. These results indicate that both saline and proglumide do not have any direct (specific) analgesic effect, but that an overt injection is associated with reduced pain.
  • Another research summed up what we know about diazepam (also named Valium), one of the most potent sleeping pills: “The effectiveness of diazepam, one of the most frequently used benzodiazepines for treating anxiety, is reduced or completely abolished when diazepam is administered unbeknownst to the patient
  • Finally, a study of placebo cell transplantation to the brains of patients with Parkinson’s revealed that placebo was stronger than the effect of the real transplantation. When patients were told that they received the transplants, their health improved and the change was lasting for the whole year after the surgery, even though the whole surgery was fake and in fact, they had not received any real treatment. Plus, the were doing better even compared to those who really received transplants but were told that the surgery was fake.

Of course, across all studies, it was always those who benefited from both, real and placebo treatment, who were helped the most. And that is the point of this article: to recommend some simple ways of improving the true biological effects of light therapy by making sure you exploit placebo as well.

A recent study on obesity showed that improvements in biochemical (fasting glucose, insulin, lipids) and behavioral (sleep duration/quality) parameters occurred between screening and randomization of the patients. These findings are consistent with the Hawthorne effect, which implies that behavior measured in the setting of an experimental study changes in response to the attention received from study investigators.

Benedetti, F. (2014). Placebo Effects: From the Neurobiological Paradigm to Translational Implications. Neuron, Volume 84, Issue 3, Pages 623-637

Honest placebo

Many, if not all cultures noticed the effects of placebo. Homeopathy, acupuncture and various traditional or “alternative” remedies developed complex procedures to exploit these effects as much as possible. Some scientists claim that even many novel products of neuroscientific research like neurofeedback are, in fact, mere sophisticated placebo theatre. But most importantly: placebo is also an important part of any real, evidence-based medicine, in addition to its genuine biological effects.

Using placebo alone is rare in modern medicine. For obvious reasons: medical professionals are not allowed to deceive their patients. There are exceptional cases, such as a friend of mine, a psychotherapist, who recently gave a “magic pill” to a child that immediately cured her enuresis (peeing herself at night). Of course, he did so only once he received consent from her parents.

Nevertheless, today’s clinicians start to appreciate what we call “honest placebo”. There is no deception involved. Doctors and psychologists may for instance explain to their patients the placebo mechanisms and ask them to do their best to exploit them, thus not involving deception. For example, you can be asked not to take your pill every morning mechanically, but always give it a thought, consciously watch the pill before eating and so on, to make sure your brain has time to appreciate the treatment.

Recently, there are even trials administering placebo in an overt way. Giving an “empty pill” to a patient and asking him or her to appreciate the treatment consciously, even though the therapy is only grounded in placebo. No matter how unnatural it may sound, we have seen that placebo is real and has genuine effects on our brains and bodies. Thus, it does not need to be disguised. You may even buy placebo pills yourself, together with an app helping you to achieve and track success.

Advantages of such a honest placebo over regular antidepressants are reaching far behind lack of side-effects. From psychological perspective, the main asset of the placebo pills is your awareness that it is you who makes the difference and heals, rather than some chemicals. Which is important for your coping – and even more important once it comes to discontinuation of the treatment. You can surely buy the pills and give it a try – but for now, let’s get back to the light therapy. Now when you understand the placebo effect, how can you use it to boost the effectiveness of therapy lamps?

There is a crack in everything. That‘s how the light gets in.

Leonard Cohen, Anthem.

Buying a bright light device? Get placebo effect for free!

Throughout our website, we link one thousand and one research studies showing that bright light therapy is stronger than placebo. That is the basis of modern evidence-based medicine: for a treatment to be accepted, its proponents need to prove that in addition to placebo, it also provides genuine biological treatment. And the lamps do. Once you choose a quality device and comply with the treatment schedule, you only need to wait for the effect. But to get even more from your treatment, you can boost the placebo effect.

The task is simple: to make your brain believe that your problem will disappear.

A group of German scientists developed set of recommendations for clinical applications of the placebo effect, which is easily adaptable for the bright light therapy or any other treatment. All you need to do is try to enhance your expectations and your brain’s learning when undergoing the treatment.

Optimizing your expectations

First, it helps if you trust the therapy and expect good results. You should not fool yourself into believing that bright lamps are a panacea – that would only result in disappointment afterwards. However, it might help to understand and appreciate the mechanisms behind their effects. So, the first thing to do is to learn how the light affects your brain and promotes production of the molecules you might lack, or how it restores a healthy rhythm resulting in synchronized bodily processes and ease of falling asleep naturally.

Imagine the light streaming to your brain in the morning, activating little receptors and triggering all its cells. Feel the activation spreading throughout your body, opening your eyes, stretching your muscles, sharpening your mind. And then, in the evening, before going to bed, think about all the lights being shut out, weakening the reactivity of the brain, slowing you down and triggering subtle signs of drowsiness.

Plus, it is always better to truly believe something, compared to mere knowledge of the information. Again, you should not convince yourself that after a few weeks of light therapy you will achieve ultimate happiness. Still, having the knowledge of the mechanisms and evidence behind the treatment allows you to imagine what may happen to you personally. For instance, we know that light therapy relieves depression. Being depressed, you might imagine what it would feel like to let the bright light shine on you: you would feel more energized and… How would it feel in your body? What would you do in the first moment? Whom would you share it with?

Also, you can discuss it with someone, just to remind yourself of the facts you learned and their meaning for you. Further, you can look forward to what it may bring to you and to the people around you. Will you smile more? How would they notice the difference?

In fact, similar exercises are inspired by one school of psychotherapy, so called solution focused therapy. Since mere thinking of the better may often trigger the change, you might think of the light therapy as a boost to your own attempts to heal. Any individual treatment is only a drop in the ocean – but it may well be the last drop that makes the cup run over. Perhaps the light itself would not make you smile or feel happy itself, but would make it easier for you to achieve such a goal. Then you may ask yourself which little improvements might you achieve, provided that the light will induce biological changes improving your health and well-being?

Boosting the learning potential

Our brains are strongly influenced by self-fulfilling prophecies. Do you know of the examples of visual illusions, those pictures showing something or something totally different, based on what the observer expects to see? Their point is that we don’t see the world as it is, instead, we search for things that can confirm or disprove our predictions.

A school mate of mine loved a popular prank: leaving a windshield note on a random car, claiming that some kid had accidentally scratched it with a bicycle and including someone’s phone number. Many owners would indeed find a minor scratch when searching, call the number – and then it was hard to explain that the whole thing was nothing but a joke. Clearly, the fake information that their car was damaged made many people see a scratch, despite no actual damage to their car, demonstrating how easily our perception can be shaped by our expectations.

In a similar fashion, when provided with a “windshield note” that we are going to sleep better or feel better, our brain will do its best to make it reality. As illustrated by the research studies on pain, when we expect the torment to stop, the nerves and brain centres responsible for pain processing indeed reduce their activity. Similarly, a mental “note” saying that tonight, you will fall asleep with ease makes the brain prepare the body for sleep rather than for the stress of endless tossing and turning.

Our brains cannot receive such a note on windshield, but since they are constantly updating their activations, they are constantly learning what to expect from nearly imperceptible cues around. Have you read or heard a story of someone being helped by the bright light therapy? If so, it was a piece of information for the brain, connecting the therapy and relief. Have you read the story twice? Have you spent few moments imagining how well you might feel afterwards? All these activities interconnect the therapy and relief in the brain, thus subtly increasing the chance that the conscious experience of undergoing therapy will trigger change for the better, in addition to the biological treatment.

Most mental struggles are strongly affected by our lifestyle choices: food, sleep, exercise, social gatherings, leisure activities, thought processes and so on. Your conscious effort is even more effective when joint to a new treatment because it can potentiate its effects, in addition to the regular benefits. Therefore, it is recommendable not to wait for the New Year, and start with New Treatment Resolutions instead.

For instance, you may introduce some rest, exercise or another activity you find most beneficial, together with the daily light exposure. For more specific recommendations, you may visit our advice about what to do alongside light therapy of depression or insomnia.

Or ask us for more specific advice. We would love to hear from you!