Department of Pain and Translational Symptom Science, University of Maryland Baltimore School of Nursing, Baltimore, Maryland, USA.
Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Clin Pharmacol Ther. 2019 Dec;106(6):1246-1252. doi: 10.1002/cpt.1587. Epub 2019 Sep 10.
Positive and negative expectancies drive behavioral and neurobiological placebo and nocebo effects, which in turn can have profound effects on patient improvement or worsening. However, expectations of events and outcomes are often not met in daily life and clinical practice. It is currently unknown how this affects placebo and nocebo effects. We have demonstrated that the violation of expectancies, such as when there is a discrepancy between what is expected and what is actually presented, reduces both placebo and nocebo effects while causing an extinction of placebo effects. The reduction of placebo and nocebo effects was paralleled by an activation of the left inferior parietal cortex, a brain region that redirects attention when discrepancies between sensory and cognitive events occur. Our findings highlight the importance of expectancy violation in shaping placebo and nocebo effects and open up new avenues for managing positive and negative expectations in clinical trials and practices.
积极和消极的期望会导致行为和神经生物学的安慰剂和反安慰剂效应，而这些效应反过来又会对患者的改善或恶化产生深远的影响。然而，在日常生活和临床实践中，人们的期望往往无法得到满足。目前尚不清楚这将如何影响安慰剂和反安慰剂效应。我们已经证明，期望的违背，例如当预期的和实际呈现的之间存在差异时，会降低安慰剂和反安慰剂效应，同时导致安慰剂效应的消退。安慰剂和反安慰剂效应的降低伴随着左下顶叶皮层的激活，当感知和认知事件之间出现差异时，该大脑区域会重新引导注意力。我们的研究结果强调了期望违背在塑造安慰剂和反安慰剂效应中的重要性，并为在临床试验和实践中管理积极和消极期望开辟了新的途径。
