FOR 1328:  Expectation and Conditioning as Basic Processes of the Placebo and Nocebo Response

• Subject Area: Social and Behavioural Sciences ; Medicine
• Term: from 2010 to 2021
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 138279939

In many clinical studies, about 50-70 percent of the positive effects of a medical intervention are already reported for the placebo condition (“placebo effect”). Vice versa, many patients report “medication-induced” side effects, although they received a placebo pill (“nocebo effects”). As central psychological mechanisms for these placebo and nocebo reactions, expectation and conditioning have been identified.
During the last decade, first neurobiological pathways for expectation and conditioning in the clinical context have been detected. These results confirmed that placebo reactions frequently mimick the activity of neurobiological pathways that were described for the clinical intervention. Further investigation of these placebo- and nocebo-reactions does not only offer new treatment approaches, but offer a new model for the understanding of symptom development and symptom control.
This Research Unit presents a translational approach bridging the gap between neurobiological basic approaches and clinical applications of placebo and nocebo effects. All subprojects manipulate expectation and/or conditioning effects in the clinical context. Neurophysiological pathways and circuits are investigated using brain imaging techniques (fMRI).
Immunological, gastrointestinal and pain-relevant systems are manipulated by means of expectation and conditioning paradigms. Dopaminergic, serotonergic and opioidergic neurotransmitter systems are involved. Clinical applications are tested with patients suffering from Parkinson disease receiving deep brain stimulation, but also in patients with low back pain, gastrointestinal disorders or patients from cardiac surgery units. We postulate that the systematic application of expectation and conditioning in clinical conditions offers new and unexpectedly efficient treatment options.

• DFG Programme: Research Units

Projects

• Central tasks of all subprojects of the Research Unit (Applicant Rief, Ph.D., Winfried )
• Clinical application of nocebo research: Optimizing breast cancer patient´s expectations to prevent side effects and decreased quality of life during endocrine therapy (Applicant Nestoriuc, Yvonne )
• Clinical applications of placebo research II: Conditioning of pharmacological responses in sleep patterns in mild to moderate insomnia (Applicant Rief, Ph.D., Winfried )
• Clinical Applications of Placebo Research: Optimizing Expectation Effects in Cardiac Surgery Patients (Applicant Rief, Ph.D., Winfried )
• Clinical implications and applications of placebo effects: potential for post-operative pain management (Applicant Klinger, Regine )
• Effects of emotional context and tactile stimulation on the placebo response in a nausea model (Applicant Meißner, Karin )
• Effects of emotional context on placebo analgesia and nocebo hyperalgesia in a visceral pain model (Applicant Elsenbruch, Sigrid )
• Exploiting learning mechanisms to maximize analgesic treatment outcome (Applicant Bingel, Ulrike )
• Neurobehavioral mechanisms of learned immunosuppressive placebo responses: from basics towards clinical application (Applicant Schedlowski, Manfred )
• The influence of variability of prior experience and pain on placebo responses (Applicant Büchel, Christian )
• The role of expectation and conditioning for motor and cognitive effects in subthalamic deep brain stimulation of Parkinson's disease (Applicant Schnitzler, Alfons )
• The role of serotonin in visceral and somatic placebo analgesia (Applicant Enck, Paul )

• Spokesperson: Professor Dr. Winfried Rief, Ph.D.
• Deputies: Professorin Dr. Ulrike Bingel; Professor Dr. Paul Enck; Professor Dr. Manfred Schedlowski