Kelsey Wallach

Reading Response #8
11.23.2013
Job et al.s study on self-regulation highlighted the impressive influence of peoples
beliefs on ego depletion. Their conclusions led me to wonder about just how powerful a belief
can be and, in accordance to what seem to be a reoccurring fascination for me, the extent to
which it could affect physiological processes.
Often flung around at parties to justify silly behavior after consuming just a weak drink
or two, the term placebo effect is quite familiar to the average college student. However I also
know that placebo treatments have shown significant efficacy in treating a wide range of medical
problems. How is it that by simply holding a certain belief-a false belief mind you- that we are
able to trick our bodies into thinking we are tipsy or suddenly free from pain?
Multiple research studies on analgesic placebo effect by Wager et al. (2004, 2005)
suggest that placebos cause an increase in neural activity in expectancy and appraisal centers as
well as down-regulate activity in pain-responsive areas in the brain. Wager et al. (2005) suggest
that placebos determine a framework that shape the appraisals of the pain-predicting cue and thus
create a positive expectancy when the cues that signal immanent pain are perceived. From a
neurobiological perspective expectancies, which are also influenced by past experiences and
attitudes, play a critical role in the process of pain perception. When presented with cues that
signal impending pain, relevant memories are recalled and processed in the orbitofrontal cortex
(which updates the emotional values of cues) to form an expectation about how severe the pain
will be. These expectations are preserved in the dorsolateral and ventrolateral prefrontal cortices,
areas of the brain which store context information for working memory (Wager 2005).

fMRI imaging revealed that subjects who were given a placebo had higher levels of
orbitofrontal cortex and dorsolateral prefrontal cortex activity when anticipating pain than the
control. In fact, the larger the increase in neural activity in these brain areas the more painreduction was reported by the subject who had received placebos (Wager 2005). Some research
suggests that activation of the orbitofrontal and dorsolateral prefrontal cortex trigger opioid
release in the midbrain, which would act as a top-down control to mediate feelings of pain
(Wager 2004). It seems that the increased brain activity in these centers a result of the positive
expectancy that comes with the belief of being treated, and not the treatment drug itself, may
result in the same beneficial opioid release typically produced by pharmaceutical analgesics.
It has also been suggested that placebos can reduce activity in areas of the brain that
perceive pain. Experiments with shock and heat pain demonstrated a correlation between the
magnitude of reported pain and brain activity in placebo and control groups. Subjects that were
given a placebo were observed to have significant reductions of neural activity in the
contralateral thalamus, anterior insula and anterior cingulate cortex. Analysis of the fMRI scans
as well as the subjects reported perceptions of pain revealed a distinct correlation between low
brain activity in these areas and reduced pain level.
I find the placebo effect to be one of the most interesting and puzzling topics that I have
explored this quarter. It was comforting to find a neurobiological basis to this phenomenon, but it
is still hard for me to grasp how holding a belief can have an almost deceitful impact on your
bodys biological processes. I see real value in continuing research on this effect and the
potential that such research holds towards how we approach physical health. I have come to
realize that we have much more control over our physical well-being than we think, and I wish
that everyone would take the time to read some this impactful research. The ties between

physical and mental health are much closer and much more important than what is commonly
emphasized in both society and the medical field. I would like to see much more integration and
education in schools and medical facilities about just how influential our mental health is to our
entire well-being, both psychologically and physically.

Wager, T. et al. (2004). Placebo-induced changes in fmri in the anticipation and experience of
pain. Science,303(1162), doi: 10.1126/science.1093065
Wager, T. (2005). The neural basis of placebo effects in pain. Current Directions in
Psychological Science, 14(4), 175-179. Retrieved from in
ewww.columbia.edu/cu/psychology/tor/Papers/Wager_2005_CDIR_placebo.pdf