💊 Take This Placebo to Make You Happier

How a DIY placebo may just put a smile on your face

Apr 03, 2022

Many people think of a placebo as a “sham treatment” or “a drug that doesn’t work”. But placebos are interesting because they work. You can give people a pill containing nothing but sugar and yet their symptoms improve.

The placebo effect is useful as a control condition in efficacy trials for new drugs. It helps researchers to identify whether the benefits of a new drug are caused purely by people’s expectations or by active ingredients in the new drug. If a new drug improves people’s symptoms but doesn’t perform better than a placebo, we generally discard it.

There’s a good amount of evidence on how placebos affect pain and other physical symptoms, but there’s less on how they affect psychological symptoms. Psychology is complicated, and it’s also the mechanism through which the placebo effect works in the first place. So how do you come up with good placebo conditions for psychological interventions?

The whole point of a placebo is that the person taking it can’t distinguish it from an active treatment. For a pill, this is easy to design: if you have a red, tasteless pill as your active treatment, just create the same pill for your placebo but surreptitiously remove the active ingredient.

For a behavioral or cognitive intervention, this is more difficult. You can’t simply remove all the “psychology” in a psychological intervention because everything you do affects your psychology in some way. When you’re developing a cognitive intervention, how are you supposed to decide when the “placebo effect” part of it stops and the “real effect” part of it begins?

I often faced this challenge when I worked in the world of cognitive training games. Training games contain a set of mechanics that make them mentally challenging and fun to play. But as soon as you remove or edit these “active psychological ingredients” in an effort to create a placebo version for scientific trials, you’re left with a completely different task that’s no longer comparable to the original game.

The problem is there isn’t a single placebo effect; it’s an effect with many dimensions. The size, color, or context of a placebo can change the effects it has on a person. Since some placebos work better than others, placebo design is not trivial when it comes to testing how well a psychological therapy works. If you compare a treatment to a weak placebo, it will make your treatment look better. And if you compare to a strong and closely-matched placebo, your placebo may do some of the same things your psychological treatment is supposed to do, leaving your treatment looking weak in comparison.

In other words, the whole thing is quite confusing. At the very least, we need more research on how placebos affect our psychology and how deep those effects go. Do they simply change how we think about our health and happiness or do they also change our deeper and more automatic emotional reactions? Here’s some new evidence to help answer this question.

🎭 Placebo-induced happiness

In a study published in March 2022, researchers in Germany recruited 44 people and tested them on two separate days one week apart. On each day, participants completed a task in which they had to classify a series of emotional facial expressions on a computer screen as fearful, neutral, or happy. Before starting the task, they absorbed a few puffs in each nostril from a nasal spray.

On both days, the nasal spray was just a saline solution containing no active ingredient that could affect emotions or emotion recognition. But on one of the days, each participant was told that the nasal spray contained oxytocin. This is a hormone that plays an important role in childbirth, and it’s often referred to as the “love hormone”. Participants also watched a 5-minute documentary explaining that oxytocin affects your mood and changes how you perceive emotions, just to make sure they had the right expectations during testing.

After taking the fake oxytocin nasal spray, people felt happier than they did after taking the non-placebo spray (i.e. the one they were told contained no oxytocin). People took an identical saltwater spray each time, but their expectations impacted how they felt. When you believe saltwater is going to make you happy, saltwater makes you happy.

The researchers then analyzed how people performed in the emotion classification task. These kinds of tasks tap into automatic biases that affect how you perceive and recognize emotions. Although the instruction is always to identify the emotion you’re seeing on a person’s face, biases in how you feel can change how you read subtler expressions. On a good day, you might read a slight smile on a person’s face as happiness. On a bad day, you might read it as a neutral or even unfriendly smirk.

After a placebo oxytocin spray—compared to the non-placebo spray—participants were more likely to view ambiguous facial expressions as happy. There was no difference between the placebo spray and non-placebo spray when it came to recognizing faces as fearful. The effect was limited to exactly the expectations that the placebo was designed to manipulate: the amount of happiness people felt and how much happiness they perceived in others.

Expectations were the real driving force in the effect. The more happiness people expected to feel following the placebo spray, the stronger their positivity bias was in the emotion recognition task.

In clear-cut cases, like when someone has a beaming smile on their face, your expectations aren’t likely to change whether you believe someone is happy or sad. But life is full of gray areas, ambiguous information, and mixed emotions. In these prevalent real-life scenarios, your expectations matter enormously. If you want to see positivity and happiness in the world, you’re likely to find just that.

Make your own peppy placebo: The potency of the placebo effect shows just how much your mindset can change your view of the world and ultimately your mental health. I’ve previously written about how your emotional expectations dictate your behavior. Cultivate positive expectations each day by creating your own happy placebo. You might do a few jumping jacks to get your blood flowing, read a few inspiring quotes to start your day, or take a quick walk through your local park. As I explained in my introduction, there’s a fine line between “placebo effect” and “real effect” when it comes to psychological interventions. If jumping jacks make you happy, is it because they’re a placebo or because they “actively” make you happier? Should you care? In my opinion, not really. Any uplifting and easy-to-do activity with no downside should be at the top of your daily to-do list. Find something that gives you a burst of happy energy, condense it to five minutes, and take it once a day every morning.
The placebo effect is real: We need a new language for the placebo effect. If your doctor is setting up a treatment plan for you and adding some contextual placebos that boost how well the treatment works, it feels as though the doctor is tricking you. But why wouldn’t you want to maximize the positive impacts of your treatment? Negative perceptions are caused by seeing the placebo as a sham rather than seeing it as a kind of baseline cognitive treatment. We can always aim higher than a placebo effect, but that doesn’t mean the placebo effect is useless. So let’s embrace it as the first step in any good treatment.
Pseudoscience is still pseudoscience: I’m naturally a skeptical person and don’t buy into many popular alternative medicines like acupuncture, homeopathy, and reflexology—there’s no good evidence that they work via the mechanisms that their practitioners claim. But of course, the placebo effect gives them some efficacy. And if someone feels that a particular treatment works well for them, then who am I to say they should quit? Some placebos work better than others, and one type of placebo may work well for one person and not at all for another. There’s nothing wrong with people practicing alternative techniques that make them feel healthy, but of course, that’s not the same as arguing there’s a place for pseudoscience in our evidence-based healthcare systems.