Koban Leonie, Kross Ethan, Woo Choong-Wan, Ruzic Luka, Wager Tor D
Institute of Cognitive Science and
Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado 80309.
J Neurosci. 2017 Mar 29;37(13):3621-3631. doi: 10.1523/JNEUROSCI.2658-16.2017. Epub 2017 Mar 6.
Placebo treatments can strongly affect clinical outcomes, but research on how they shape other life experiences and emotional well-being is in its infancy. We used fMRI in humans to examine placebo effects on a particularly impactful life experience, social pain elicited by a recent romantic rejection. We compared these effects with placebo effects on physical (heat) pain, which are thought to depend on pathways connecting prefrontal cortex and periaqueductal gray (PAG). Placebo treatment, compared with control, reduced both social and physical pain, and increased activity in the dorsolateral prefrontal cortex (dlPFC) in both modalities. Placebo further altered the relationship between affect and both dlPFC and PAG activity during social pain, and effects on behavior were mediated by a pathway connecting dlPFC to the PAG, building on recent work implicating opioidergic PAG activity in the regulation of social pain. These findings suggest that placebo treatments reduce emotional distress by altering affective representations in frontal-brainstem systems. Placebo effects are improvements due to expectations and the socio-medical context in which treatment takes place. Whereas they have been extensively studied in the context of somatic conditions such as pain, much less is known of how treatment expectations shape the emotional experience of other important stressors and life events. Here, we use brain imaging to show that placebo treatment reduces the painful feelings associated with a recent romantic rejection by recruiting a prefrontal-brainstem network and by shifting the relationship between brain activity and affect. Our findings suggest that this brain network may be important for nonspecific treatment effects across a wide range of therapeutic approaches and mental health conditions.
安慰剂治疗可强烈影响临床结果，但关于其如何塑造其他生活经历和情绪幸福感的研究尚处于起步阶段。我们对人类使用功能磁共振成像（fMRI）来研究安慰剂对一种特别有影响力的生活经历——近期浪漫关系被拒引发的社交疼痛——的影响。我们将这些影响与安慰剂对身体（热）痛的影响进行了比较，后者被认为依赖于连接前额叶皮质和导水管周围灰质（PAG）的通路。与对照相比，安慰剂治疗减轻了社交疼痛和身体疼痛，并在两种模式下均增加了背外侧前额叶皮质（dlPFC）的活动。安慰剂进一步改变了社交疼痛期间情感与dlPFC及PAG活动之间的关系，并且对行为的影响是由一条连接dlPFC与PAG的通路介导的，这是基于近期有关阿片能PAG活动参与社交疼痛调节的研究。这些发现表明，安慰剂治疗通过改变额叶 - 脑干系统中的情感表征来减轻情绪困扰。安慰剂效应是由于期望以及治疗所处的社会医疗背景而产生的改善。尽管它们在诸如疼痛等躯体疾病的背景下已得到广泛研究，但对于治疗期望如何塑造其他重要应激源和生活事件的情感体验却知之甚少。在此，我们使用脑成像表明，安慰剂治疗通过招募前额叶 - 脑干网络并改变大脑活动与情感之间的关系，减轻了与近期浪漫关系被拒相关的痛苦感受。我们的发现表明，这个脑网络可能对于广泛的治疗方法和心理健康状况中的非特异性治疗效果很重要。
