School of Psychology, University of Plymouth, Plymouth PL4 8AA, UK.
Philos Trans R Soc Lond B Biol Sci. 2011 Jun 27;366(1572):1828-37. doi: 10.1098/rstb.2010.0391.
This paper challenges the common assumption that the mechanisms underlying short-term placebo paradigms (where there is no motivation for health improvement) and long-term placebo paradigms (where patients value improvement in their health) are the same. Three types of motivational theory are reviewed: (i) classical placebo motivation theory that the placebo response results from the desire for therapeutic improvement; (ii) goal activation model that expectancy-driven placebo responses are enhanced when the placebo response satisfies an activated goal; and (iii) motivational concordance model that the placebo response is the consequence of concordance between the placebo ritual and significant intrinsic motives. It is suggested that current data are consistent with the following theory: response expectancy, conditioning and goal activation are responsible for short-term placebo effects but long-term therapeutic change is achieved through the effects of goal satisfaction and affect on the inflammatory response system and hypothalamic-pituitary-adrenal axis. Empirical predictions of this new theory are outlined, including ways in which placebo effects can be combined with other psychologically mediated effects on short-term and long-term psychological and physiological state.
本文挑战了一个常见的假设，即短期安慰剂范式（其中没有改善健康的动机）和长期安慰剂范式（患者重视健康改善）背后的机制是相同的。本文回顾了三种动机理论：（i）经典安慰剂动机理论认为，安慰剂反应是出于对治疗改善的渴望；（ii）目标激活模型认为，当安慰剂反应满足激活的目标时，期望驱动的安慰剂反应会增强；（iii）动机一致性模型认为，安慰剂反应是安慰剂仪式与重要内在动机之间一致性的结果。本文提出，现有数据与以下理论一致：反应期望、条件作用和目标激活负责短期安慰剂效应，但长期治疗变化是通过目标满足和对炎症反应系统和下丘脑-垂体-肾上腺轴的影响实现的。本文概述了这一新理论的实证预测，包括如何将安慰剂效应与其他心理介导的短期和长期心理和生理状态的影响结合起来。
