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Beyond expectation: a case for nonpersonal contextual factors in a more comprehensive approach to the placebo effect and the contribution of environmental psychology

Authors Sütterlin S, Egner L, Lugo R, Wojniusz S

Received 5 July 2015

Accepted for publication 21 September 2015

Published 30 October 2015 Volume 2015:8 Pages 259—262

DOI https://doi.org/10.2147/PRBM.S91774

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Igor Elman


Stefan Sütterlin,1,2 Lars E Egner,1 Ricardo G Lugo,1 Slawomir Wojniusz2,3

1Section of Psychology, Lillehammer University College, Lillehammer, 2Department of Psychosomatic Medicine, Division of Surgery and Clinical Neuroscience, Oslo University Hospital – Rikshospitalet, Oslo, 3Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway

Abstract: Creating an optimized health care environment to maximize the probability and magnitude of placebo effects draws on a number of well-researched mechanisms such as the patient's positive expectation toward treatment outcome. Patient-centered communication styles influence expectations and can thus be considered as a form of supplemental treatment. Unconsciously processed contextual triggering and facilitating placebo effects are omnipresent in clinical settings as well as in all other social and physical environments. Contextual cues in both the social and physical domain exert influences on the recipient's emotional state and recreational experiences. While the majority of research focuses on improving the patients' expectations, classical conditioning effects of nonsocial contextual factors have been largely neglected in discussions on practical implementation of placebo-enhancing environments. Built on the empirically well-supported argument that conditioning processes act as a powerful tool to mobilize self-healing resources just as verbally induced expectations do, we argue for a stronger consideration of the effects of permanent, nonsocial and nonverbal environmental contexts. Environmental psychology is a new field of research within the psychological domain and offers a toolbox of opportunities for medical psychological research and health care practitioners to improve the treatment outcomes and benefits of health care environments.

Keywords: placebo, expectation, conditioning, environmental psychology

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