I Believe in the Placebo Effect

“Kenneth Nowack, Ph.D.


In a recent study, 61.3% of the public and 20.2% of professionals believe that a miracle can a save person in a persistent vegetative state and 57.4% of the public said divine intervention can save a person when doctors think treatment just isn’t going to work, compared with just 19.5% of trauma professionals according to Lenworth Jacobs, M.D., of Hartford Hospital and colleagues. (Jacobs LM et al. “Trauma Death: Views of the Public and Trauma Professionals on Death and Dying From Injuries.” Arch Surg. 2008; 143(8): 730-735).

For the study, Jacobs and his colleagues conducted a random-digit-dialing telephone survey of 1,006 Americans over the age of 18 (margin of error was plus or minus 3.2 percentage points). They also surveyed a convenience sample of medical personnel involved in trauma care, including medical directors of trauma units, trauma nurses, and emergency services personnel.

Well, the power of belief is truly amazing:

In a study of 256 patients with chronic arm pain (rating of at least 3 on a 10-point pain scale), 133 were treated with sugar pills (one a day for 8 weeks) and the other with fake acupuncture (twice a week for 6 weeks).

In the study, 25% of the acupuncture group experienced side effects including 19 who felt pain; 31% of the pill group experienced dizziness, restlessness, nausea, dry mouth and fatigue. After 10 weeks, the pill group reported significant decreases in pain (average 1.50 points) and after 8 weeks those receiving fake acupuncture reported a drop of 2.64 points.

The fake acupuncture had greater effects than the placebo pill on self-reported pain (Kaptchuk, et al., 2006. Sham device v inter pill: Randomised controlled trial of two placebo treatments. British Medical Journal).

To investigate the limits of placebo, Ted Kaptchuk of Harvard Medical School’s Osher Research Center divided 80 patients suffering from irritable bowel syndrome (IBS) into two groups: one received no treatment and the other was given dummy pills to take twice a day. The second group was told by the doctors that they would be taking “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS-symptoms through mind-body self-healing processes“.

The results, published in the scientific journal PLoS ONE, showed that the placebo pills were more effective at relieving symptoms compared with doing nothing at all (Kaptchuk TJ, Friedlander E, Kelley JM, Sanchez MN, Kokkotou E, et al. 2010 Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome. PLoS ONE 5(12): e15591. doi:10.1371/journal.pone.0015591). These results suggest that placebos work even when people know they are taking a placebo.

If You Believe You Are Being Prayed for Are You Healthier?

I’ve become a bit more interested in the association between spirituality and religiosity with health (Giesser, B., Coleman, L., Fisher, S., Guttry, M., Herlihy, E., Nonoguch, S., Nowack, D., Roberts, C. & Nowack, K. (2005). Living Well: An integrative approach to wellness with multiple sclerosis. Paper presented at Annual Conference of The American Congress of Rehabilitation Medicine (ACRM) Board/American Society of Neurorehabilitation (ASNR), Chicago, Illinois. UCLA Department of Neurology and National Multiple Sclerosis Society, Southern California Chapter). I’ve wondered about the relationship between being prayed for and recovery from illness.

Recently, a study including 1,802 patients in six hospitals by Benson and his colleagues (Benson H, Dusek JA, Sherwood JB, Lam P, Bethea CF, Carpenter W, Levitsky S, Hill PC, Clem DW Jr, Jain MK, Drumel D, Kopecky SL, Mueller PS, Marek D, Rollins S, Hibberd PL. (2006). Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer. 151(4):934-42) failed to show any impact of remote prayer although there has been some criticism of the study design (e.g., 45% of those invited to participate elected not to be part of the study, intercessors were not allowed to pray their own prayers and it was impossible to limit prayers for those in the “control” group). One interesting finding was that those who knew they were being prayed for actually did worse than the other two groups.

Maybe a bit of deception or ignorance is the best medicine after all….Be well….


Can Hardiness and Resilience Be Enhanced?

Kenneth Nowack, Ph.D.

 Perceptions of stress at work are quite high with several recent studies by Envisia Learning Inc. suggesting that 40% to 65% of all executives and employees rate their jobs as being very or extremely stressful with significant impact on work/family balance and overall health ((Nowack, K. (2000). Occupational stress management: Effective or not? In P. Schnall, K. Belkie, P. Landensbergis, & D. Baker (Eds.), Occupational Medicine: State of the Art Reviews, Hanley and Belfus, Inc., Philadelphia, PA., Vol 15, No. 1, pp. 231-233)).

In a poll by Reston, Virginia based TrueCareers, more than 70% of workers do not think there is a healthy balance between work and their personal lives. More than 50% of the 1,626 respondents reported they are exploring new career opportunities because of the inability to manage both work and family stressors. Not only that, a Monster.com survey found that 79% of all job holders said they had increased their search for new jobs since the economy weakened more than a year and a half ago.

We were interested in seeing whether results from our own personal stress and health risk appraisal called StressScan would help to identify what professional working employees reported being stressed about and why some stay healthy in the face of work and life challenges and stressors. StressScan measures 14 psychosocial scales that have been shown to be associated with diverse individual (e.g., job burnout, depression, physical health) and organizational (e.g., absenteeism) outcomes ((Nowack, K. (2008). Coaching for Stress: StressScan. Psychometrics in Coaching Association for Coaching, UK, pp. 254-274)).

Stress is conceptualized as the experience of major and minor irritants, annoyances, and frustrations (hassles) of daily living over a three-month period. This brief measure of work/life stress was based upon factor analytic research of the original Hassles scale. StressScan measures the extent to which respondents experience daily hassles in six distinct factor areas including: 1) Health; 2) Work; 3) Personal Finances; 4) Family; 5) Social Obligations; and 6) Environmental and World concerns.

We analyzed differences by gender across these six StressScan scales (ANOVA) using requests for free trials for this assessment over the last few years (N=149). In general, women reported significantly higher levels of stress compared to males (mean for woman = 16.48 versus mean for men = 15.35, p < .01). No other significant differences were found across gender for quality/quantity of sleep, social support network (availability, use and satisfaction) or happiness.

We found only two stress categories were rated as significantly more challenging by women compared to their male counterparts (p < .01) using a 1 to 5 scale where 1 = Never, 3 = Sometimes and 5 = Always):

  • Family Stressors (mean for women 3.08/mean for men 2.70)
  • Financial Stressors (mean for women 3.15/mean for men 2.72)

So, why do some talent in the face of work and life stress experience job burnout, depression and physical illness and others remain physically and psychologically healthy? Our research has found three distinct coping patterns in the face of work and life stressors: 1) Hot reactors (those who get sick in the battle of stress, challenge and change); 2) Sustainers (those who get sick after the “letdown” with the battle); and 3) The Hardy (those who are resilient and experience stress and challenge free from illness and distress).

Hot Reactors: About 1 in 5 executives can be described as “hot reactors” on the basis of how they react to stress and the effects on their long term health. Hot reactors are most likely to experience physical illness, job burnout and psychological distress during stressful and challenging projects, assignments and heavy workloads. Behaviorally they are prone to demonstrating impatience, irritability, frustration with incompetence, mood swings and anger. In our research, these hot reactors are highly correlated with typical measures of Type A behavior characterized by a relentless drive for success as well as cynical mistrust of those around them.

Hot reactors seem to be biologically “wired” to react to stress with exaggerated physiological and behavioral responses. These executives are often resistant to changing their basic coping style as most truly believe their ability to work long hours, suppress fatigue and feel energized by stress is a key to his/her career success. Such executives seem to chronically be exhibiting the classic “fight or flight” response almost to the point of exhaustion and burnout. Most are high risk for long term cardiovascular disorders including high blood pressure, high cholesterol and heart disease.

Sustainers: Talent who find themselves feeling the symptoms of a cold coming on right after a big project has been completed or getting away for a much deserved vacation are experiencing the clinical “let down effect.” Such individuals are shifting from a high state of activation to a lower state rapidly making their immune system “let down” from its normal “high stress” protective state and leading to increased vulnerability to get sick in the short term.

Sustainers are used to prolonged periods of high stress states and are able to suppress fatigue and “get up” for the battle in order to succeed. Their vulnerability comes not during the battle but after. By using relaxation strategies to manage the chronic stress response these executives can stay healthy both during stressful times and when things slow down. By recognizing the signs and symptoms of stress, tension and anxiety when they first appear, executives can begin to utilize a wide range of behavioral and cognitive strategies to avoid the chronic “race horse” condition that is characteristic of most “high flyers.” These “sustainers” truly do pay the price of being able to hang in during very stressful situations, challenges and times without breaking down physically or emotionally.

The Hardy: The resilient and hardy talent in our research are the ones who experience high levels of stress, work/life unbalance and critical demands but maintain a high level of physical health and psychological well-being. In our research, these individuals are less likely to report job burnout, absenteeism due to illness, anxiety, sleep problems, and depression.

Resilient talent appear to maintain and practice specific lifestyle behaviors that become part of his/her daily routine and utilize coping habits that help translate stress into positive challenges that energize, rather than, compromise the immune system and well-being ((Nowack, K. (1994). Psychosocial Predictors of Health and Absenteeism: Results of Two Prospective Studies. Paper presented at the American Psychological Association Annual Convention, September 1994, Los Angeles, CA)). We can’t always avoid some chronic (high level of work demands or child care issues) or acute (injury, child illness) stressors but those who are hardy appear to cope and manage them in a manner that minimize negative health outcomes.

Profile of Hardy Talent

  • Experience and report less work and family stress on a daily basis
  • Maintain a high level of physical activity/exercise despite travel and work/family demands (e.g., work out at least 3 days a week for 60 minutes).
  • Maintain heart healthy eating/nutrition habits (e.g., eat breakfast, avoid convenience food, and manage weight).
  • Are non-smokers and drink alcohol in moderation (e.g., no more than 2 alcoholic drinks per day).
  • Consistently maintain an adequate level of sleep and practice sound sleep hygiene (e.g., avoid building a sleep debt and get adequate sleep required to avoid being inappropriate sleepy during the day).
  • Minimize hostile, impatient and aggressive behaviors towards others that are associated with eliciting the “fight or flight” response.
  • Practice some type of daily mental or physical activity that elicits the “relaxation response” (e.g., meditation or yoga) reversing stress activation.
  • Cultivate and utilize a strong social and professional support network by spending time with those who are satisfying to be around and avoiding those who are “energy zappers” in our life.
  • Possess a hardy outlook on life including viewing change as a challenge, identifying and spending time on his/her passions and develop an external set of attributions for failures ((Greene, R. and Nowack, K. (1996). Stress, hardiness and absenteeism: Results of a 3-year longitudinal study. Work and Stress, 9, 448-462)).
  • Identify and emotionally express strong feelings in writing or verbally to others on a daily basis.
  • Stop obsessive thoughts that create tension and explore action plans to resolve the stressor.
  • Minimize the use of defeating and perfectionist “self-talk” (e.g., constantly using the words “must” or “always”).
  • Actively ruminate and express gratitude for his/her life situation
  • Identify and act on his/her signature strengths to maximize career and life satisfaction.

Being resilient isn’t something that we are necessarily born with although there appears to certainly be a genetic predisposition to possessing biological wiring favoring the release of neuropeptide Y and other hormones that may damper the stress response. We have also seen in our own research and others the capacity to develop hardiness or resilience:

Hardy talent appear to develop an ongoing commitment to maintain a lifestyle that enables them to balance the demands at work and home while remaining energized, productive and healthy.

If you are interested in seeing how resilient you are and would like a free trial of StressScan (www.getlifehub.com/stress_scan) just email me at ken@envisiaonline.com and I will be happy to set you up! Be well….