Neural mechanisms of placebo anxiolysis
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Neural mechanisms of placebo anxiolysis. / Meyer, Benjamin; Yuen, Kenneth S L; Ertl, Matthias; Polomac, Nenad; Mulert, Christoph; Büchel, Christian; Kalisch, Raffael.
In: J NEUROSCI, Vol. 35, No. 19, 13.05.2015, p. 7365-73.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Neural mechanisms of placebo anxiolysis
AU - Meyer, Benjamin
AU - Yuen, Kenneth S L
AU - Ertl, Matthias
AU - Polomac, Nenad
AU - Mulert, Christoph
AU - Büchel, Christian
AU - Kalisch, Raffael
N1 - Copyright © 2015 the authors 0270-6474/15/357365-09$15.00/0.
PY - 2015/5/13
Y1 - 2015/5/13
N2 - The beneficial effects of placebo treatments on fear and anxiety (placebo anxiolysis) are well known from clinical practice, and there is strong evidence indicating a contribution of treatment expectations to the efficacy of anxiolytic drugs. Although clinically highly relevant, the neural mechanisms underlying placebo anxiolysis are poorly understood. In two studies in humans, we tested whether the administration of an inactive treatment along with verbal suggestions of anxiolysis can attenuate experimentally induced states of phasic fear and/or sustained anxiety. Phasic fear is the response to a well defined threat and includes attentional focusing on the source of threat and concomitant phasic increases of autonomic arousal, whereas in sustained states of anxiety potential and unclear danger requires vigilant scanning of the environment and elevated tonic arousal levels. Our placebo manipulation consistently reduced vigilance measured in terms of undifferentiated reactivity to salient cues (indexed by subjective ratings, skin conductance responses and EEG event-related potentials) and tonic arousal [indexed by cue-unrelated skin conductance levels and enhanced EEG alpha (8-12 Hz) activity], indicating a downregulation of sustained anxiety rather than phasic fear. We also observed a placebo-dependent sustained increase of frontal midline EEG theta (4-7 Hz) power and frontoposterior theta coupling, suggesting the recruitment of frontally based cognitive control functions. Our results thus support the crucial role of treatment expectations in placebo anxiolysis and provide insight into the underlying neural mechanisms.
AB - The beneficial effects of placebo treatments on fear and anxiety (placebo anxiolysis) are well known from clinical practice, and there is strong evidence indicating a contribution of treatment expectations to the efficacy of anxiolytic drugs. Although clinically highly relevant, the neural mechanisms underlying placebo anxiolysis are poorly understood. In two studies in humans, we tested whether the administration of an inactive treatment along with verbal suggestions of anxiolysis can attenuate experimentally induced states of phasic fear and/or sustained anxiety. Phasic fear is the response to a well defined threat and includes attentional focusing on the source of threat and concomitant phasic increases of autonomic arousal, whereas in sustained states of anxiety potential and unclear danger requires vigilant scanning of the environment and elevated tonic arousal levels. Our placebo manipulation consistently reduced vigilance measured in terms of undifferentiated reactivity to salient cues (indexed by subjective ratings, skin conductance responses and EEG event-related potentials) and tonic arousal [indexed by cue-unrelated skin conductance levels and enhanced EEG alpha (8-12 Hz) activity], indicating a downregulation of sustained anxiety rather than phasic fear. We also observed a placebo-dependent sustained increase of frontal midline EEG theta (4-7 Hz) power and frontoposterior theta coupling, suggesting the recruitment of frontally based cognitive control functions. Our results thus support the crucial role of treatment expectations in placebo anxiolysis and provide insight into the underlying neural mechanisms.
KW - Adult
KW - Anxiety
KW - Brain
KW - Brain Mapping
KW - Cues
KW - Electric Stimulation
KW - Electroencephalography
KW - Fear
KW - Female
KW - Galvanic Skin Response
KW - Healthy Volunteers
KW - Humans
KW - Male
KW - Middle Aged
KW - Pain
KW - Pain Measurement
KW - Placebo Effect
KW - Placebos
KW - Time Factors
KW - Young Adult
U2 - 10.1523/JNEUROSCI.4793-14.2015
DO - 10.1523/JNEUROSCI.4793-14.2015
M3 - SCORING: Journal article
C2 - 25972166
VL - 35
SP - 7365
EP - 7373
JO - J NEUROSCI
JF - J NEUROSCI
SN - 0270-6474
IS - 19
ER -