Getting to grips with the digital placebo effect

Source: IPU Berlin / Fabian Eggert
Copyright: IPU Berlin / Fabian Eggert
License: Creative Commons Attribution + NoDerivatives (CC-BY-ND)

Sharing information about the expected effect of a health app before its use and providing positive feedback regarding its effectiveness after its use have the potential to strengthen the placebo effect. This is suggested by a randomized controlled trial, conducted by scientists from the International Psychoanalytic University (IPU) Berlin, in cooperation with colleagues from the University of Basel and RWTH Aachen, just published in the open-access journal JMIR mHealth and uHealth. The results provide the basis for using the placebo effect in the context of digital mental health applications.

Placebo effects when using health apps largely understudied
Although placebo effects have been studied in classical treatment settings for decades, the “digital placebo effect” when using digital health applications is still largely unexplored. To better understand the mechanisms underlying the digital placebo effect, Prof. Dr. Gunther Meinlschmidt, Esther Stalujanis, and other colleagues at IPU Berlin, the University of Basel, and RWTH Aachen conducted a randomized controlled trial to find answers to the questions: How stable are the anticipated effects of smartphone-based health apps and are they modifiable?

To this end, they examined the expected effects of a smartphone app, programmed specifically for this study, over the course of 3 weeks. They assigned 132 healthy subjects to four groups. The first group was only informed before using the app that an effect was expected, and the second group was only informed in retrospect that the app had shown an effect. In the third group, both types of information were combined, and the fourth group did not receive any such information.

The results show: “If information about the effect of a smartphone app is provided both before and after its use, the expected effectiveness and credibility of digital health applications could become more sustainable,” says Meinlschmidt, Professor of Clinical Psychology at IPU Berlin and Head of Research at the Department of Psycho-somatic Medicine at University Hospital and the University of Basel. This could, for example, prevent patients from quickly ceasing to use apps, which is a major challenge for digital mental health applications.

Current relevance through prescriptible digital health applications
Not only the active ingredient of a medication but also the expectation that a therapy can help boost the effects of a treatment can improve patient outcomes. This common phenomenon, also known as the placebo effect, can be found, for example, in pharmaceutical treatments for depression, pain, and Parkinson’s disease, as well as in non-pharmaceutical treatments such as psychotherapy. One can make use of the placebo effect in a variety of ways. In randomized controlled studies examining the efficacy of a specific treatment, it is a common aim to minimize placebo effects. However, in regular health service contexts, when applying medication or psychotherapy, a large placebo will improve the outcome of a treatment.

Digital applications in the area of mental health are increasing in relevance, especially in the times of the global COVID-19 pandemic. It has only been since October 2020 that physicians in Germany have been able to prescribe digital health interventions to be covered by public health insurances. The first examples are apps for the treatment of obesity, tinnitus, anxiety disorders, depressive disorders, and sleep disorders.

“The use of the digital placebo effect in therapy contexts is also challenging from an ethical perspective,” says Meinlschmidt. Better understanding of the underlying mechanisms may pave the way for promoting patient health in a more targeted way.

Original article
Stalujanis E, Neufeld J, Glaus Stalder M, Belardi A, Tegethoff M, Meinlschmidt G
Induction of Efficacy Expectancies in an Ambulatory Smartphone-Based Digital Placebo Mental Health Intervention: Randomized Controlled Trial
JMIR Mhealth Uhealth 2021;9(2):e20329
DOI: 10.2196/20329

Gunther Meinlschmidt

Esther Stalujanis

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