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Imaging the placebo response: a neurofunctional review
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
2008 (English)In: European Neuropsychopharmacology, ISSN 0924-977X, E-ISSN 1873-7862, Vol. 18, no 7, 473-485 p.Article, review/survey (Refereed) Published
Abstract [en]

An emerging literature has started to document the neuronal changes associated with the placebo phenomenon. This has altered placebo from being considered a nuisance factor in clinical research to a target of scientific investigation per se. This paper reviews the neuroimaging literature on the placebo effect, and illustrates how imaging tools can improve current understanding of brain mechanisms underlying the placebo response. Imaging studies provide evidence of specific, predictable and replicable patterns of neural changes associated with placebo administration. In general, placebo responses seem mediated by "top-down" processes dependent on frontal cortical areas that generate and maintain cognitive expectancies. Dopaminergic reward pathways may underlie these expectancies. Placebo-induced clinical benefits also involve disorder-specific neuronal responses, yielding neurofunctional or neurochemical alterations similar to those produced by pharmacological treatments.

Place, publisher, year, edition, pages
2008. Vol. 18, no 7, 473-485 p.
Keyword [en]
Functional magnetic resonance imaging, Neuroimaging, Placebo effect, Positron emission tomography, Review
National Category
Psychology
Identifiers
URN: urn:nbn:se:uu:diva-125736DOI: 10.1016/j.euroneuro.2008.03.002ISI: 000257347500001PubMedID: 18495442OAI: oai:DiVA.org:uu-125736DiVA: diva2:320834
Available from: 2010-05-27 Created: 2010-05-27 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Mind really does matter: The Neurobiology of Placebo-induced Anxiety Relief in Social Anxiety Disorder
Open this publication in new window or tab >>Mind really does matter: The Neurobiology of Placebo-induced Anxiety Relief in Social Anxiety Disorder
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The placebo effect, a beneficial effect attributable to a treatment containing no specific properties for the condition being treated, has been demonstrated in a variety of medical conditions. This thesis includes four studies aimed at increasing our knowledge on the neurobiology of placebo. Study I, a review of the placebo neuroimaging literature, suggested that the anterior cingulate cortex (ACC) may be a common site of action for placebo responses. However, because placebo neuroimaging studies in clinical disorders are largely lacking, the clinical relevance of this needs further clarification. The subsequent three empirical studies were thus designed from a clinical perspective. Using positron emission tomography (PET) these studies investigated the underlying neurobiology of sustained placebo responses in patients with social anxiety disorder (SAD), a disabling psychiatric condition that nonetheless may be mitigated by placebo interventions. Study II demonstrated that serotonergic gene polymorphisms affect anxiety-induced neural activity and the resultant placebo phenotype. In particular, anxiety reduction resulting from placebo treatment was tied to the attenuating effects of the TPH2 G-703T polymorphism on amygdala activity. Study III further compared the neural response profile of placebo with selective serotonin reuptake inhibitors (SSRIs), i.e the first-line pharmacological treatment for SAD. A similar anxiety reduction was noted in responders of both treatments. PET-data further revealed that placebo and SSRI responders had similar decreases of the neural response in amygdala subregions including the left basomedial/basolateral (BM/BLA) and the right ventrolateral (VLA) sections. To clarify whether successful placebo and SSRI treatments operate via similar or distinct neuromodulatory pathways, study IV focused on the connectivity patterns between the amygdala and prefrontal cortex that may be crucial for normal emotion regulation. In responders of both treatment modalities, the left amygdala (BM/BLA) exhibited negative coupling with the dorsolateral prefrontal cortex and the rostral ACC as well as a shared positive coupling with the dorsal ACC. This may represent shared treatment mechanisms involving improved emotion regulation and decreased rumination. This thesis constitutes a first step towards better understanding of the neurobiology of placebo in the treatment of anxiety, including the neural mechanisms that unite and segregate placebo and SSRI treatment.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 92 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 82
Keyword
Placebo effect, anxiolysis, SAD, PET, TPH2 G-703T polymorphism, SSRIs, amygdala subregions, prefrontal cortex.
National Category
Humanities
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-181548 (URN)978-91-554-8478-1 (ISBN)
Public defence
2012-11-09, Auditorium Minus, Gustavianum, Akademigatan 3, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2012-10-19 Created: 2012-09-25 Last updated: 2013-01-23Bibliographically approved

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Faria, VandaFredrikson, MatsFurmark, Tomas

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