Conditioning effects
Traditional conditioning theories have also been used to explain placebo effects (Wickra-
masekera 1980). It is suggested that patients associate certain factors with recovery and
an improvement in their symptoms. For example, the presence of doctors, white coats,
pills, injections and surgery are associated with improvement, recovery, and with effective
treatment. According to conditioning theory, the unconditioned stimulus (treatment)
would usually be associated with an unconditioned response (recovery). However, if this
unconditioned stimulus (treatment) is paired with a conditioned stimulus (e.g. hospital, a
white coat), the conditioned stimulus can itself elicit a conditioned response (recovery,
the placebo effect). The conditioned stimulus might be comprised of a number of factors,
including the appearance of the doctor, the environment, the actual site of the treatment
or simply taking a pill. This stimulus may then elicit placebo recovery. For example, people
often comment that they feel better as soon as they get into a doctor’s waiting room, that
their headache gets better before they have had time to digest a pill, that symptoms
disappear when a doctor appears. According to conditioning theory, these changes would
be examples of placebo recovery. Several reports provide support for conditioning theory.
For example, research suggests that taking a placebo drug is more effective in a hospital
setting when given by a doctor, than if taken at home given by someone who is not
associated with the medical profession. This suggests that placebo effects require an
interaction between the patient and their environment. In addition, placebo pain reduc-
tion is more effective with clinical and real pain than with experimentally created pain.
This suggests that experimentally created pain does not elicit the association with the
treatment environment, whereas the real pain has the effect of eliciting memories of
previous experiences of treatment, making it more responsive to placebo intervention.Anxiety reduction
Placebos have also been explained in terms of anxiety reduction. Downing and Rickles
(1983) argued that placebos decrease anxiety, thus helping the patient to recover. In
particular, such a decrease in anxiety is effective in causing pain reduction (Sternbach
1978). For example, according to the gate control theory, anxiety reduction may close
the gate and reduce pain, whereas increased anxiety may open the gate and increase
pain (see Chapter 12). Placebos may decrease anxiety by empowering the individual and
encouraging them to feel that they are in control of their pain. This improved sense of
control, may lead to decreased anxiety, which itself reduces the pain experience. Placebos
may be particularly effective in chronic pain by breaking the anxiety–pain cycle (see
Chapter 12). The role of anxiety reduction is supported by reports that placebos are
more effective in reducing real pain than reducing experimental pain, perhaps because
real pain elicits a greater degree of anxiety, which can be alleviated by the placebo,
whereas experimentally induced pain does not make the individual anxious. However,
there are problems with the anxiety reducing theory of placebos. Primarily, there are
many other effects of placebos besides pain reduction. In addition, Butler and Steptoe
(1986) reported that although placebos increased lung function in asthmatics, this
increase was not related to anxiety.314 HEALTH PSYCHOLOGY