Health Psychology : a Textbook

The cognitive dissonance theory of placebos, however, developed by Totman (1976,

1987), attempted to remove patient expectations from the placebo equation and

emphasized justification and dissonance.

FOCUS ON RESEARCH 13.1: TESTING A THEORY –

‘DOING AS YOU’RE TOLD’ AS A PLACEBO

A study to examine the role of adhering to medical treatment in predicting

recovery from a heart attack – taking pills (whether active or not) as a placebo

(Horwitz et al. 1990).

For a long time, medicine has regarded adherence (compliance) with medical recom-

mendations to be important for recovery: ‘take these drugs and you will get better’.

However, this study suggests that simply adhering to medical recommendations to take

pills may be beneficial to recovery following a heart attack, regardless of whether the

pills taken are active pills or placebo pills. This has implications for understanding

the relationship between the mind and body (‘I believe that I have taken my medication’

is related to actually getting better) and for understanding the central role of beliefs and

expectations in health and illness.

Background

Random controlled trials (RCTs) have been used since the 1940s to assess the effective-

ness of drugs compared with placebos. For these trials, subjects are randomly allocated

to either the experimental condition (and receive the real drug) or the control condition

(and receive the placebo drug). Placebo drugs are used as a comparison point in order

to distinguish the ‘real’ effects of the chemically active drug from both the ‘placebo

effects’ and changes that may spontaneously happen over time. The RCT methodology

Fig. 13-1 The central role of patient expectations in placebo effects

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