Nondeceptive placebos effective, easy to use for patients with COVID-19-related stress

Key takeaways:

• Nondeceptive placebos effectively helped people manage prolonged stress.
• Anxiety and depression also improved with nondeceptive placebos.
• Participants found the placebos easy to use and feasible.

Placebos administered without deception, or nondeceptive placebos, may offer an alternative and effective way to help people manage prolonged stress, according to a study published in Applied Psychology: Health and Well-Being.

“Exposure to long-term stress can impair a person’s ability to manage emotions and cause significant mental health problems long-term, so we’re excited to see that an intervention that takes minimal effort can still lead to significant benefits,” Jason Moser, PhD, study co-author and professor in the department of psychiatry at Michigan State University, said in a press release. “This minimal burden makes nondeceptive placebos an attractive intervention for those with significant stress, anxiety and depression.”

To examine the efficacy of nondeceptive placebos administered remotely online in reducing COVID-19-related stress, overall stress, anxiety and depression, Moser and colleagues conducted a 2-week randomized controlled trial of 61 Michigan residents aged 18 to 30 years (90.2% women; 67.2% white; mean age, 21.13 years) who reported experiencing moderate stress from the COVID-19 pandemic.

The researchers divided the study into four virtual sessions over Zoom: enrollment, baseline, midpoint and endpoint.

During enrollment, the researchers used block randomization in groups of 10 to randomly assign participants to a nondeceptive placebo group (n = 29) or a no-treatment, assessment-only control group (n = 32).

At baseline, all participants completed a survey on stress, anxiety and depression — which was repeated at the midpoint and endpoint — and then received information on the psychological and physical health effects of COVID-19. Those in the nondeceptive placebo group also watched educational videos on the placebo effect and instructions to take placebo pills daily for 2 weeks.

The researchers observed a significant decrease in both COVID-19-related stress and overall stress among the nondeceptive placebo group from baseline to midpoint and from baseline to endpoint (P < .001 for all).

Although the control group did not show a significant decrease in COVID-19-related or overall stress from baseline to midpoint, it showed significant reductions from baseline to endpoint for both COVID-19-related stress (P = .002) and overall stress (P = .015).

The nondeceptive placebo group showed a significant decrease in anxiety from baseline to midpoint and baseline to endpoint (P < .001 for both), as well as in depression from baseline to midpoint (P = .001) and baseline to endpoint (P < .001), whereas the control group showed no reductions in anxiety or depression symptoms over time.

Still, participants reported less benefit from the nondeceptive placebos than they expected (P = .005).

Participants also significantly expected no harm from taking nondeceptive placebo pills (P < .001).

“The low expectation of harm is promising because expectations of harm may negatively impact treatment adherence, which can be a significant barrier to psychological and medical interventions,” Moser and colleagues wrote.

Additionally, participants reported that it was relatively easy to take their pills, with a mean adherence of 92.5%.

Participants rated the nondeceptive placebos as highly feasible and easy to use (P < .001), acceptable and appealing (P < .001), and appropriate and fitting for their concerns (P < .001).

“Taken together, these data suggest that nondeceptive placebos, even when administered remotely online, can help moderately at-risk people manage their psychological health in prolonged stressful situations like the COVID-19 pandemic,” the researchers wrote.

“This ability to administer nondeceptive placebos remotely increases scalability potential dramatically,” Darwin Guevarra, PhD, study co-author and postdoctoral fellow at the University of California, San Francisco, said in the release.

The researchers acknowledged several study limitations, including the small sample that comprised a majority of white, young and female participants.