Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
Department of Psychology, Università degli Studi di Milano-Bicocca, Milan, Italy.
Ann Behav Med. 2024 Oct 16;58(10):635-644. doi: 10.1093/abm/kaae038.
Although some existing models propose that attention may be crucially implicated in placebo/nocebo effects, empirical research on this aspect remains limited and scattered.
This systematic review aims to provide an inclusive overview of studies that have either directly manipulated or assessed attention within the context of placebo and nocebo procedures so to gain a synthetized picture of the role of this variable in placebo/nocebo effects. Importantly, only studies in which attention represented a mechanism or mediator of the placebo/nocebo response, and not a primary outcome, were included.
A systematic search was conducted across multiple databases, including PubMed, Scopus, PsycINFO, Web of Science, and Embase, to identify peer-reviewed studies. These studies were subjected to methodological evaluation and eligibility criteria for inclusion.
We identified and classified 12 studies into three categories based on their focus: (i) those that directly assessed attention, (ii) those that directly manipulated participants' attention, and (iii) those that combined both a direct manipulation and assessment of attention. In all selected studies attention acted as a mechanism or mediator of the placebo/nocebo response, and was not considered a primary outcome of the placebo/nocebo manipulation.
The synthesis of the included studies reveals that the role of attention in placebo and nocebo effects is still a topic of debate, marked by variations in how attention is conceptualized and measured. Results suggest that attention has significant clinical implications, particularly in optimizing therapeutic efficacy by directing patients' focus toward signs of healing and away from indicators of illness or distress. To advance our understanding, future research should explore these attentional mechanisms, in conjunction with neurophysiological correlates.
尽管一些现有的模型提出，注意力可能在安慰剂/反安慰剂效应中起着至关重要的作用，但关于这方面的实证研究仍然有限且分散。
本系统综述旨在提供一个综合的概述，对在安慰剂和反安慰剂程序中直接操纵或评估注意力的研究进行综述，以综合了解该变量在安慰剂/反安慰剂效应中的作用。重要的是，只包括注意力是安慰剂/反安慰剂反应的机制或中介，而不是主要结果的研究。
通过对多个数据库（包括 PubMed、Scopus、PsycINFO、Web of Science 和 Embase）进行系统搜索，确定同行评审的研究。对这些研究进行了方法学评估和纳入标准的评估。
我们根据研究的重点将 12 项研究分为三类：（i）直接评估注意力的研究，（ii）直接操纵参与者注意力的研究，以及（iii）同时直接操纵和评估注意力的研究。在所有入选的研究中，注意力是安慰剂/反安慰剂反应的机制或中介，而不是安慰剂/反安慰剂操纵的主要结果。
纳入研究的综合分析表明，注意力在安慰剂和反安慰剂效应中的作用仍然是一个有争议的话题，这表现在如何概念化和测量注意力方面存在差异。结果表明，注意力具有重要的临床意义，特别是通过引导患者关注愈合迹象，远离疾病或痛苦的指标，从而优化治疗效果。为了深入了解这一问题，未来的研究应该探索这些注意力机制，并结合神经生理学相关因素进行研究。
