Abstract
There is growing interest in interventions that enhance placebo responses in clinical practice, given the possibility that this would lead to better patient health and more effective therapy outcomes. Previous studies suggest that placebo effects can be maximized by optimizing patients’ outcome expectations. However, expectancy interventions are difficult to validate because of methodological challenges, such as reliable blinding of the clinician providing the intervention. Here we propose a novel approach using mobile apps that can provide highly standardized expectancy interventions in a blinded manner, while at the same time assessing data in everyday life using experience sampling methodology (e.g., symptom severity, expectations) and data from smartphone sensors. Methodological advantages include: 1) full standardization; 2) reliable blinding and randomization; 3) disentangling expectation effects from other factors associated with face-to-face interventions; 4) assessing short-term (days), long-term (months), and cumulative effects of expectancy interventions; and 5) investigating possible mechanisms of change. Randomization and expectancy interventions can be realized by the app (e.g., after the clinic/lab visit). As a result, studies can be blinded without the possibility for the clinician to influence study outcomes. Possible app-based expectancy interventions include, for example, verbal suggestions and imagery exercises, although a large number of possible interventions (e.g., hypnosis) could be evaluated using this innovative approach.
Highlights
There is an increased interest in understanding the effects of placebo interventions and the mechanisms underlying these effects
It is not possible to conclude whether the outcomes are due to these nonspecific clinician factors that are a part of how the intervention is delivered, due to experimenter bias, or both [for a review on the effects of nonverbal behaviors of experimenters on placebo effects in research participants, see Ref. [47]]
We propose in this paper that the use of mobile apps can lead to many advantageous developments in both placebo research and clinical practice: i) using smartphones can help to solve problems inherent in validating placebo-boosting interventions such as expectancy manipulations; ii) mobile apps can be used to gain a better understanding of placebo mechanisms in everyday life; and iii) once placebo-boosting interventions have been successfully validated, apps can be used as an effective way to deliver these interventions as an adjunct to therapy sessions or as a stand-alone tool to a large number of people
Summary
There is an increased interest in understanding the effects of placebo interventions and the mechanisms underlying these effects. While basic research has led to a better understanding of psychobiological mechanisms underlying placebo effects by means of strictly controlled experiments [1], applied research has focused on elucidating the factors contributing to placebo effects in clinical practice [2]. Some of these studies have been extensively covered in the media, reflecting the interest in placebo effects among the general public. By delivering expectancy interventions via apps, researchers can disentangle expectancy effects due to the intervention from effects induced by the patient–researcher (or patient–practitioner) interaction, allowing for the control of experimenter bias [7]. Validated apps can be used for treatment delivery to a large number of people
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
