Placebos reduce feelings of guilt, even when people know they are taking one RS News

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Guilt is a double-edged sword. It can be a reminder to improve and a motivation to apologize. It can also lead to pathological perfectionism and stress and is also closely associated with depression and post-traumatic stress disorder.

Unfortunately, good guilt and bad guilt are common, and few proven treatments exist to reduce harmful guilt.

To help solve the problem of excess guilt, a recent study published in Nature found that placebos can reduce feelings of guilt, even when the person taking them knows they’re getting placebos.

The study involved 112 healthy volunteers between the ages of 18 and 40. Their guilt was initially measured by questionnaires including the State Shame and Guilt Scale (SSGS). This questionnaire asks people if they feel remorseful or bad about something they have done. Next, the participants performed an exercise designed to make them feel more guilty. The exercise consisted of writing a story about a time they had treated someone they loved unfairly.

The participants were then divided into three groups. One group received a “misleading placebo”: a blue pill that they were told was a real drug. Specifically, they were told that the pill contained phytopharmaceuticals, a substance designed to reduce feelings of guilt by making the user feel calmer.

Another group received an “open-label placebo,” the same blue pill, but this group was told it was a placebo. They were told that placebos benefit many people through mind-body self-healing mechanisms.

The third group received no treatment at all. This was the “control” group.

After receiving the treatment, feelings of guilt were measured using the same questionnaires to see if the deceptive placebo or the open-label placebo were more effective than no treatment.

The main outcome reported in the study was that the misleading placebo and the open-label placebo set were more effective in reducing guilt than no treatment.

A doctor holding a blue pill.
This blue pill will help you reduce your negative feelings of guilt.
Milos Vucicevic/Shutterstock

Overcoming the placebo paradox

Open-label placebos are important because they overcome the “placebo paradox.” The paradox is that, on the one hand, placebos have effects, especially for pain, and we know how they work. Doctors are ethically obligated to help their patients, and this ethical force pushes them to prescribe placebos.

On the other hand, traditional placebos are misleading (patients think they are, or could be, a real treatment). Physicians are also ethically bound to avoid misleading patients (usually) and this ethical force discourages them from prescribing placebos (although it appears that most physicians have prescribed placebos at least once). Because open-label placebos do not involve deception, they overcome the paradox and pave the way for ethical (open-label) placebos to help patients, where appropriate.

While the novelty of this study should be applauded, it is not without its weaknesses.

First, the participants were healthy volunteers. They did not suffer from guilt before the experiment. It is not clear whether research in healthy volunteers translates to people in actual clinical practice. Furthermore, guilt measurements were only taken up to 15 minutes after the placebos were administered. Therefore, the long-term effects (and real-life usefulness) of placebos are unknown.

A bigger problem was that it pooled the effects of misleading and open placebos. The novelty of the study is that it uses open-label placebos, so pooling its effects with those of deceptive placebos dilutes the novelty. This was rather strange because when I dug through the supplementary material, it was clear that open-label placebos only were more effective than no treatment in reducing guilt. It is a pity that this was not the main result.

Encouraging

The fact that open-label placebos can reduce pathological guilt, even by a small amount, is encouraging because they can be used ethically in cases where no better treatment exists. Future studies should look at the effects of open-label placebos in real patients and follow them for longer.

It’s also a small leap from the promising results of this study to believe that if open-label placebos work, we might be able to “pleasure ourselves” by giving ourselves positive suggestions that make us feel better.

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