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1

PLACEBO - FROM AN EVOLUTIONARY POINT OF VIEW

100%
Koteles F., Bardos G.
Magyar Pszichologiai Szemle (Hungarian Psychological Review)
|
2007
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vol. 62
|
issue 2
239-252
EN
The main goal of our theoretical work has been critically summarizing the previous theories about the adaptivity of the placebo-phenomenon and synthetizing them. From the biological point of view, the phenomenon in itself is not unambiguously adaptive thus its evolution cannot be fully explained by direct selection. After overviewing the underlying biological and psychological mechanisms, the authors consider the human placebo-phenomenon as an evolutionary by-product, that had originally emerged from interaction of other adaptive characteristics (such as sociability, learning, consciousness, theory of mind). On the other hand, the placebo-phenomenon is culturally determined hence it goes beyond the frames of Darwinian evolution. Due to its cultural embeddedness and to the increasing number of disorders of partially psychic origin, the importance of placebo is growing in our age. As the representation of the environment had become more and more complex, the importance of mind-visceral connections also increased. Perhaps the placebo can be the tool which should be able to activate the biological self-healing mechanisms repressed by our modern culture - even within the frames of the contemporary medicine that in many ways is symptom-oriented, overspecialized, rigid and non-personal. This is why the authors consider the human placebo-phenomenon as culturally potentially adaptive.
2

NIL NOCERE? THE NOCEBO PHENOMENON (Nil nocere? A nocebo-jelenseg)

100%
Koteles F., Bardos G.
Magyar Pszichologiai Szemle (Hungarian Psychological Review)
|
2009
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vol. 64
|
issue 4
697-727
EN
The aim of the authors' review was a comprehensive summary of the nocebo-phenomenon and a brief comparison of three phenomena (nocebo, symptom reports of healthy persons and medically unexplained symptoms) that are usually considered as distinct. According to their approach, these phenomena are so closely related in terms of triggering and maintaining mechanisms that they suggest to classify them together in an integrated conception (non-specific health problems). To confirm their hypothesis, the potential psychophysiological mechanisms (different types of expectations; classical conditioning; social learning; stress, anxiety, depression; somatisation; contents of pills; symptoms of physical illnesses) and the motivational background (need of control and misattribution; measuring of the effectiveness of drugs; resistance to therapy; guilt and self; punishment phenomena; secondary gains; conscious simulation) of these phenomena as well as the related dispositional personality factors (female gender; neuroticism; increased monitoring of bodily processes) are discussed. After comparing the nocebo with the placebo, the authors are against the widespread view that treats them as crowd mirror images of each other. Based on the literature, the possible interventions for attenuating the nocebo-effect are summarised and discussed as well.
3

PACKAGE INFORMATION LEAFLETS AS POTENTIAL CONTRIBUTORS TO THE CURATIVE EFFECT (A betegtajekoztatok mint a gyogyhatas lehetseges osszetevoi)

81%
Komsa I., Koteles F., Bardos G.
Magyar Pszichologiai Szemle (Hungarian Psychological Review)
|
2009
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vol. 64
|
issue 4
629-642
EN
The effect of description of curative effects (e.g.: What is XXX and what is it used for?) in package information leaflets (PILs) upon patient's choice was examined. Sections describing the curative effects from PILs of 15 frequently used, freely accessible (OTC) NSAID drugs were extracted and were evaluated in a paper-and-pencil study by 200 university students (38% male; mean age = 19.76, SD = 1.495). Two independent aspects were considered: a) how understandable the given description is, and b) how attractive the drug seems to be based on the description (what would be the chance of choosing it when needed). Using mixed model ANOVA-s, significant differences among the ratings of leaflets both in terms of understandability and attractivity, but no gender main effects and leaflet x gender interactions were found. According to the results of content analysis, the length of the descriptions and the number of effects enumerated were the main sources of the differences. The understandability and attractivity ratings correlated very strongly (r = 0,938, p lower than 0,01). Understandability and content of practical information were the most important factors of choice. The most attractive descriptions were longer than average and listed more effects and symptoms for which the curative can be used. Patient Information Leaflets (PILs) can make benefits (placebo-effect: providing information) and harms (nocebo-effect: descripting side-effects) either. As part of a new approach called intelligent medicine designing, in addition to the side-effects, description of the curative effects as well as positive suggestions should be given to enhance beneficial outcomes and to promote safe and effective use of medicines.
4

NON-SPECIFIC SYMPTOMS ATTRIBUTED TO ENVIRONMENTAL ELECTROMAGNETIC LOAD AND THE PSYCHOLOGICAL BACKGROUND OF SYMPTOM PRODUCTION (Hungarian title - below)

81%
Szemerszky R., Koteles F., Bardos G.
Magyar Pszichologiai Szemle (Hungarian Psychological Review)
|
2009
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vol. 64
|
issue 3
553-571
EN
(Title in Hungarian - 'A kornyezeti elektromagneses terheles hatasanak tulajdonitott nem specifikus tunetek es a tunetkepzes pszichologiai hattertenyezoi'). Although there are no clear evidences that non-ionizing electromagnetic fields (NI-EMFs) undermine health, non-specific symptoms attributed to electromagnetic exposition are frequent in the general population. These complaints might be traced back to negative expectations determined by the cultural or social environment and to certain predisposing personality features, respectively. In the authors' study, 185 undergraduate student participants were asked to select those items of 15 non-favorable and 7 favorable symptoms evoked by electromagnetic fields which they believed they had experienced earlier. In addition, they completed psychological questionnaires (trait anxiety - STAI-T, perception of bodily symptoms/somatisation - PHQ-15, satisfaction with life - SWLS), and had also to estimate the degree of their computer and mobile phone exposition. The aim was to determine the quantitative and qualitative relationship among the measured psychological variables and the complaints attributed to EMF. Far more participants judged the effects of the electromagnetic fields unfavorable than favorable, especially regarding central nervous system symptoms. Amount of the complaints was directly predicted only by the frequency of computer use and by the perception of bodily symptoms (PHQ-15), whereas indirectly, via bodily symptoms, trait anxiety and gender also influenced the number of non-specific symptoms. It seems that information given about the potential damages caused by electromagnetic fields that is originally aimed to protect the public and to strengthen awareness, may also elicit negative expectations that - if predisposing personality factors are present - may lead to non-specific health problems. The authors suggest that public communication about the effects of EMFs should take this into account and should be far more objective.
5

ETHICAL PROBLEMS IN THE THERAPEUTIC USE OF PLACEBO

81%
Koteles F., Fodor D., Cziboly A., Bardos G.
Magyar Pszichologiai Szemle (Hungarian Psychological Review)
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2007
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vol. 62
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issue 4
429-448
EN
The authors summarize the different approaches, arguments, and implicit beliefs for and against the therapeutic usage of placebo. The previous investigations, proposed solutions and ideas are also reviewed and evaluated. As the therapeutic effectivity of placebo is proven regarding both subjective and objective symptoms in many diseases and disorders, the complete denial of possible usage is not acceptable any more. Observing the recommended rules and guidelines (e.g. proven effectivity for the given symptoms, informed consent, as adjuvant therapy, etc.) the placebo would be already usable as a therapy, and the underlying psychological (primarily cognitive) and psychophysiological mechanisms could also be discovered and understood with more research. The usage of the placebo does not mean deception and limiting of autonomy under any circumstances. In the appropriate context it can help patients participating actively in their own recovering and can give them the opportunity of further personality development.
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