Enck Paul, Zipfel Stephan
Psychosomatic Medicine and Psychotherapy, Department of Internal Medicine VI, University Hospital Tübingen, Tübingen, Germany.
Front Psychiatry. 2019 Jun 26;10:456. doi: 10.3389/fpsyt.2019.00456. eCollection 2019.
The issue of placebo response and the extent of its effect on psychotherapy is complex for two specific reasons: i) Current standards for drug trials, e.g., true placebo interventions, double-blinding, cannot be applied to most psychotherapy techniques, and ii) some of the "nonspecific effects" in drug therapy have very specific effects in psychotherapy, such as the frequency and intensity of patient-therapist interaction. In addition, different psychotherapy approaches share many such specific effects (the "dodo bird verdict") and lack specificity with respect to therapy outcome. Here, we discuss the placebo effect in psychotherapy under four aspects: a) nonspecific factors shared with drug therapy (context factors); b) nonspecific factors shared among all psychotherapy traditions (common factors); c) specific placebo-controlled options with different psychotherapy modalities; and d) nonspecific control options for the specific placebo effect in psychotherapy. The resulting framework proposes that the exploration and enumeration of context factors, common factors, and specific factors contributes to the placebo effects in psychotherapy.
安慰剂反应及其对心理治疗的影响程度这一问题很复杂，原因有两个：其一，药物试验的现行标准，如真正的安慰剂干预、双盲法，无法应用于大多数心理治疗技术；其二，药物治疗中的一些“非特异性效应”在心理治疗中有非常特殊的作用，比如患者与治疗师互动的频率和强度。此外，不同的心理治疗方法有许多这样的特殊作用（“渡渡鸟裁决”），且在治疗结果方面缺乏特异性。在此，我们从四个方面讨论心理治疗中的安慰剂效应：a）与药物治疗共有的非特异性因素（情境因素）；b）所有心理治疗传统共有的非特异性因素（共同因素）；c）不同心理治疗方式的特定安慰剂对照选项；d）心理治疗中特定安慰剂效应的非特异性对照选项。由此产生的框架表明，对情境因素、共同因素和特定因素的探索与列举有助于心理治疗中的安慰剂效应。
