In episode 100, Andrea Evers, Professor of Health Psychology at Leiden University, joins us to discuss her expertise on the placebo effect and its significant relationship to trust in healthcare. Andrea explores how patient expectations and trust can shape surprising medical outcomes and influence trust in doctors and the broader doctor-patient relationship. She explains how the placebo effect is more than just a “sugar pill” and emphasizes the power of positive expectations for enhancing the impact of real medical treatments. Andrea also discusses the important role that communication and the environment of care play in boosting or diminishing these effects.
Listeners will learn how trust, both in past experiences and in current healthcare providers, plays a critical role in how patients respond to treatments. Finally, Andrea touches on future research opportunities, including how the placebo effect can be better integrated into clinical practice to improve patient outcomes and reduce medication use. This insightful conversation offers a deep dive into the psychology of medicine and the vital role trust plays in healing.
The Placebo Effect is a context vector
The placebo effect you could say is a context vector, so is everything what is not the medicine in itself. So all these extra effects like communication from the doctor-patient relationship, your own expectations, your own experience from the past, but also the context factors how the office looks like, how much trust you have in the treatment, so all these factors play a role. And the good thing is for clinical practice that you can influence them also. So we don’t have only the medicine effect, but we have much, much more. The whole context plays a role and that is the patient-doctor communication, your own experience, the experience of the doctor, the experience of the whole hospital. So everything has to be taken into account but can be also be used for interventions.
The whole treatment effect
The whole treatment effect is always a combination of the medicine and the context factors that are influenced by the placebo effect. And that’s a positive expectation of the patient, but also the positive expectations of the doctor. The communication and all these context factors play a role and have to be taken into account. And importantly, this is not only what we call a subjective response to our feelings, we can see indeed these responses in our brains, specific brain areas are activated like reward mechanisms, or in the nocebo conditioning, or the stress mechanisms that play their role, and that they can also induce direct physiological changes, as I explained of our immune system. So that these extra contextual factors are always part of every treatment effects, and that they can
The mother kisses the injured knee of a child
(…) the most well known example of the placebo effect that always works and it’s such a fantastic effect we should always use, of course. And in essence it also works in adults, not only in children of course, perhaps the children might even believe it a little bit more, but it’s the same time, of course so nocebo effects or opposite can also work and can have really very traumatic experiences, as for example in hospitals when children are ill. And the most important difference, of course, between children and adults is then if you have a child who has already a very negative experiences as a child in the hospital or a traumatic experience, it can have long, long life consequences of how you come into the hospital and how much trust you have in medicines or the medical doctor, and so on.
Transcript interview Andrea Evers
Publications Prof. Andrea Evers
See here for a full list of publications by Andrea Evers: