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Psychobiological and Contextual Influences on Treatment Expectations
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Background: Treatment expectations have a significant impact on health interventions and play a pivotal role in placebo and nocebo effects. In the current analysis, we investigated the influence of psycho-biological and contextual factors on treatment expectations in placebo- and nocebo-related intervention studies.
Methods: Data from seven experimental and clinical studies was pooled (n = 173 participants with chronic pain, psoriasis or depression, n = 420 healthy participants). Treatment expectations as well as chronic stress, somatosensory amplification, trait depressive and anxiety symptoms were assessed via self-report. As a measure of hypothalamic-pituitary-adrenal axis functioning, the cortisol awakening response (CAR) was calculated from saliva samples.
Results: Patients in clinical studies reported higher improvement expectations (OR [95% CI] 5.27 [1.20, 23.2]) and side effect expectations (OR [95% CI] = 7.68 [2.16, 27.3]) compared to healthy participants in experimental settings. In the clinical samples, higher levels of stress were associated with higher levels of worsening expectations (OR [95%CI] = 1.88 [1.02, 3.44]). Additionally, previous experience with the intervention was associated with lower side effect expectations (OR [95% CI] = 0.28 [0.11, 0.70]), while somatosensory amplification was associated with higher side effect expectations (OR [95%CI] = 1.28 [1.04, 1.58]). The CAR was not associated with any treatment expectation.
Conclusion: This large-scale analysis identified key correlates of treatment expectations while simultaneously finding no support for an association with the CAR. Clinical samples reported higher improvement and side effect expectations, suggesting that intervention relevance and meaning shape expectations and highlighting the importance of contextual factors in modulating expectations.
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Except where otherwise noted, this item's license is described as Attribution 4.0 International