安慰剂效应的心理机制及临床应用

Placebo Effects:Psychological Mechanisms and Clinical Applications

安慰剂效应在临床治疗中发挥着重要作用,如缓解患者的疼痛及促进患者运动功能康复等。由于临床环境的复杂性,安慰剂效应的产生涉及到患者、医护人员和医疗环境等复杂的心理社会因素。为综合调节这些因素使得安慰剂效应最大化,有效提高整体治疗效果,本研究系统总结了安慰剂效应产生的心理机制,包括预期、条件化、社会观察学习和个体因素的作用;讨论了安慰剂在临床镇痛中的有效性;从患者、医护人员和治疗环境等方面探讨了影响临床中安慰剂效应的因素及相应的调节策略;最后,针对当前安慰剂相关的基础研究向临床转化中所面临的问题提出了可能的解决方案。

To promote the translation of basic findings into clinical practice and to optimize placebo effect in clinical ap- plications, psychological mechanisms and clinical applications of placebo effects were comprehensively reviewed in the present study. We firstly summarized the involvement of expectancy, classical conditioning, social learning, and individual factors in the generation of placebo effects. The interactions among expectancy, conditioning, motivation（e.g., desire for relief）, cognition（e.g., somatic focus）, and individual factors（e.g., emotional state and personality trait） were highlighted. Then, we discussed evidence demonstrating placebo induced analgesic effects for relieving various types of pain in the clinical practice. Furthermore, we discussed possible factors with potential to influence placebo effects in the clinical practice from several perspectives： patients, healthcare workers, and medical environment. And we proposed several strategies to optimize placebo effects in the clinical practice from different perspectives. From patients＇ perspective, they should keep positive and optimistic attitudes to the medical treatment, with their expectancy for rehabilitation regulated in a median and reasonable level and their negative emotions well controlled. From heahhcare workers＇ perspective, they should be patient-centered, establish a harmonious doctor--patient relationship, and deliver positive expectancy to patients through proper instructions and behaviors. From the medical environment perspective, the multi-dimensional information （e.g., vision, touch, and taste） of therapy-related medicine or instruments should be presented to patients, with highlight on their clinical efficacy and value. In the end, we discussed several issues that could hamper the translation of basic research findings relevant to placebo effects into their clinical applications, and the possible solutions for future studies.