Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland.
Eur J Pain. 2020 May;24(5):902-908. doi: 10.1002/ejp.1544. Epub 2020 Feb 28.
Placebo effects are considered to be learning phenomena. There is a growing body of evidence supporting the role of both classical conditioning and observational learning in the induction of placebo effects. However, the third basic learning process, operant conditioning, was not considered as a mechanism of placebo effects until very recently. Unlike classically conditioned responses, which are induced by stimuli that precede the behaviour, operant behaviours are shaped and maintained by their consequences. Thus, placebo effects may not only result from pairing an active intervention with the stimuli that accompany its administration (placebo) but also positive (e.g. the ability to perform a desired activity) or negative reinforcement (e.g. pain relief) of placebo administration may increase the frequency of taking placebos in the future. The paper reviews the evidence supporting the idea of operant conditioning as a mechanism of placebo effects and discusses it in the context of the general principles of operant conditioning, the operant conditioning account of pain modulation and research findings on the role of operant conditioning in pain modulation.
This is a narrative review.
Seven lines of research are proposed to study the role of operant conditioning in producing placebo effects.
Operant conditioning account of placebo effects has practical implications both for routine clinical practice and the placebo arms of randomized controlled trials.
The operant conditioning account of placebo effects is discussed from the theoretical perspective of the general principles of operant conditioning and the operant conditioning account of pain modulation. The paper identifies seven lines of research on the role of operant conditioning in producing placebo effects, and highlights the practical implications of the operant conditioning account of placebo effects both for routine clinical practice and the placebo arms of randomized controlled trials.
安慰剂效应被认为是学习现象。越来越多的证据支持经典条件作用和观察学习在诱导安慰剂效应中的作用。然而，直到最近，操作性条件作用才被认为是安慰剂效应的第三种基本学习过程。与经典条件反射不同，经典条件反射是由在行为之前出现的刺激引起的，操作性行为是由其后果塑造和维持的。因此，安慰剂效应不仅可能源于将积极干预与伴随其给药的刺激（安慰剂）配对，而且积极（例如执行期望活动的能力）或消极强化（例如缓解疼痛）的安慰剂给药也可能增加未来服用安慰剂的频率。本文回顾了支持操作性条件作用作为安慰剂效应机制的证据，并在操作性条件作用的一般原则、操作性条件作用对疼痛调节的解释以及操作性条件作用在疼痛调节中的作用研究结果的背景下对其进行了讨论。
这是一篇叙述性综述。
提出了七种研究方法来研究操作性条件作用在产生安慰剂效应中的作用。
安慰剂效应的操作性条件作用解释既有临床实践的实际意义，也有随机对照试验安慰剂组的实际意义。
从操作性条件作用的一般原则和操作性条件作用对疼痛调节的解释的理论角度讨论了安慰剂效应的操作性条件作用解释。本文确定了七种关于操作性条件作用在产生安慰剂效应中的作用的研究方法，并强调了安慰剂效应的操作性条件作用解释在常规临床实践和随机对照试验安慰剂组中的实际意义。
