Healing Thyself: Does Psychedelic Therapy Exploit the Placebo Effect?

The following is an excerpt. The full text of the article can be accessed online at http://www.scientificamerican.com/blog/post.cfm?id=healing-thyself-does-psychedelic-th-2010-12-07. My last post talked about the depressing lack of progress in treatments for depression and other common psychological disorders. Talking cures and antidepressants alike are subject to the “dodo effect,” which decrees that all therapies are roughly as effective—or ineffective—as one another. The dodo effect implies that treatments harness the placebo effect, the patient’s expectation of improvement. Claims that one therapy beats all the others often reflect researchers’ favoritism, called the “allegiance effect”. After reading the post one of my smart-ass students asked, “What about psychedelic therapies? Are those subject to the dodo and allegiance effects, too?” Good questions. He knew that, although bashing conventional psycho-treatments, I’ve written positively about psychedelics’ therapeutic potential. Does my reporting reflect countercultural allegiance to psychedelics and distrust of clinical psychology, psychiatry and Big Pharma? Maybe a little. But I’ve also pointed out the risks of drugs such as DMT and LSD as well as the role of suggestion in shaping psychedelic trips. Psychedelics clearly exploit the placebo effect, but in complicated ways. To make clinical trials of a drug more rigorous, researchers sometimes give subjects in the control group an “active placebo,” which unlike a sugar pill has discernible physiological or mental effects, so subjects can’t easily tell whether they are in the control group. If psychedelics are placebos, they should perhaps be called hyperactive placebos, because their psychotropic effects are so dramatic. The question of the placebo effect is an important one, especially in the field of clinical psychedelic research. As this article correctly points out, simply believing that a therapy will work will often lead to significant improvements in health. Because psychedelics have such rapid and dramatic effects on consciousness compared to antidepressants and other currently legal treatments, determining whether it was the drug or the drug-therapy combination or the placebo effect that led to patients’ recovery is particularly difficult. As a result, the development of innovative experimental techniques–such as the active placebo–is extremely important. The real value of psychedelic therapy is not due the drug alone, but rather due to a careful balance of drug and therapeutic setting, as well as the expectations of both therapist and patient.