Placebos reduce feelings of guilt – even when people know they’re taking one

Guilt is a double-edged sword. It can be a reminder to improve and a motivation to apologize. It can also lead to pathological perfectionism and stress and is also closely associated with depression and post-traumatic stress disorder.

Unfortunately, both good and bad guilt are common, and there are few proven treatments to reduce unhealthy guilt.

To help address the problem of too much guilt, a recent study published in Nature found that placebos can reduce feelings of guilt, even when the person taking them knows they are receiving placebos.

In the study, 112 healthy volunteers between the ages of 18 and 40 participated. Their guilt was measured at baseline using questionnaires including the State Shame and Guilt Scale (SSGS). This questionnaire asks people if they feel remorse or malice about something they have done. Then the participants did an exercise designed to make them feel more guilty. The exercise was to write a story about a time when they treated someone they loved unfairly.

The participants were then divided into three groups. One group was given a “misleading placebo”: a blue pill that they were told was real medicine. Specifically, they were told the pill contained phytopharmacon, a substance designed to reduce feelings of guilt by calming the taker.

Another group received an “open placebo” – the same blue pill, but this group was told it was a placebo. They were told that placebos benefit many people through mind-body self-healing mechanisms.

The third group received no treatment. This was the “control” group.

After receiving the treatment, feelings of guilt were measured using the same questionnaires to see if the deceptive placebo or the open placebo was more effective than no treatment.

The main outcome reported in the study was that the deceptive placebo and the open placebo combined were more effective in reducing guilt than no treatment.

Overcoming the placebo paradox

Open-label placebos are important because they overcome the “placebo paradox”. The paradox is that on the one hand placebos have effects, in particular on pain, and we know how they work. Physicians are ethically bound to help their patients and this ethical force drives them to prescribe placebos.

In contrast, traditional placebos are misleading (patients think they are, or could be, a real treatment). Doctors are also ethically bound to avoid misleading patients (usually) and this ethical force keeps them away from prescribing placebos (although it seems most doctors have prescribed placebos at least once). Because open-label placebos do not involve deception, they overcome the paradox and pave the way for ethical (open-label) placebos to help patients when needed.

If the novelty of this study is to be applauded, it is not without weaknesses.

First, the participants were healthy volunteers. They did not suffer from guilt before the experiment. It is unclear whether research in healthy volunteers translates to people in actual clinical practice. Furthermore, guilt measurements were not taken until 15 minutes after administration of the placebos. The long-term effects (and real-life usefulness) of placebos are therefore not known.

A bigger problem was that it lumped together the effects of deceptive and open-label placebos. The novelty of the study is that it uses open-label placebos, so pooling their effects with those of misleading placebos dilutes the novelty. This was rather odd because when I dug into the additional material it was clear that the open-ended placebos only were more effective than no treatment in reducing guilt. It’s a pity that this is not the flagship result.


The fact that open-label placebos can reduce pathological guilt by even a tiny amount is encouraging because they can be used ethically in cases where better treatments do not exist. Future studies should examine the effects of open-label placebos in real patients and follow them longer.

It’s also a small leap from the promising results of this study to believe that if open-label placebos work, we might be able to “placebo” ourselves by giving ourselves positive suggestions that make us feel better.The conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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