Capitalizing on the placebo component of treatments

A placebo treatment is traditionally administered in a double-blind, randomized controlled trial to control for the ‘real’ effects of the treatment under investigation. In the present paper a broader view of the placebo is proposed, one in which the idea of a potentially ‘useable’ placebo component of a sports or exercise medicine treatment is presented. It is argued that many interventions in sport and exercise psychology might contain a placebo component that could be capitalized upon by practitioners, through processes often as simple as communicating positive expectations of a treatment to clients. Research findings relating to factors that might influence an individual’s response to a placebo, such as personality, situation and genetics, are briefly addressed. Ethical considerations for practice and future research are discussed

Is there a role for implicit and explicit information about placebo and nocebo effects in reducing the use of drugs in sport?

Background: The gateway hypothesis posits that the use of sport supplements by athletes can lead to the use of banned and possibly harmful performance-enhancing drugs. Previous data suggest that athletes implicitly exposed to a placebo intervention and/or explicitly informed about the role of placebo effects in sport may be less likely to use sports supplements, and therefore - in line with the gateway hypothesis - less likely to progress to drugs. Methods: Participants (n=629) completed the Sports Supplements Beliefs Scale (SSBS), Performance Enhancement Attitude Scale (PEAS) and a Likert-type scale measuring intention to use sports supplements. They were then randomised to Placebo (n=263), Nocebo (n=209) and Control (n=157). All participants completed a performance trial (see Hurst et al., this conference). Placebo and Nocebo participants subsequently received the results of the trial as well as a brief educational session describing the role of placebo/nocebo effects in sports performance. Controls received no information. All participants re-completed the questionnaires. Results: Analyses indicated that following the intervention, beliefs (P=0.009, Cohens d [d]=0.43), attitudes (P=0.047, d=0.29) and intentions (P=0.020, d=0.33) relating to the use of drugs and sport supplements were significantly lower in the Placebo and Nocebo group compared to Controls. Conclusions: Implicit exposure to a placebo/nocebo intervention and explicit exposure to a brief educational intervention about placebo effects influenced athlete’s beliefs, attitudes and intentions about drugs and sport supplements. Given the gateway hypothesis, experience of, or education about the placebo and nocebo effect may prevent athletes transitioning towards doping

An educational placebo effect intervention reduces the likelihood of athletes using performance enhancing drugs

Background Recent research has reported that placebo effects can significantly improve sport performance. However, while research has generated knowledge about placebo effects on sport performance, there is limited research devoted to how this can support applied practice. In light of this, it has been suggested that placebo effect research could be harnessed and used as a tool to prevent drug use in sport. The aim of this study was to investigate the effect of an educational placebo effect intervention on an athlete’s decision to use performance enhancing drugs. Method Elite athletes (N=169; 56% male, age=18.2±0.4yrs) attended a one-hour educational placebo effect intervention. The session was delivered by a facilitator using Power-point in a university classroom. The session introduced participants to placebo effects, the role expectations and prior experiences can have on the effectiveness of performance enhancing drugs and placebo effect research on sport performance. Throughout the session, participants were encouraged to critically examine the need to use performance enhancing drugs and to consider the role of placebo effects. Participants completed measures of performance enhancing drug use pre and one-week post intervention. Results Data indicated that participants were less likely to use performance enhancing drugs following the intervention (p<.001, d=0.42). Conclusion The results of this study provide novel evidence to suggest that an educational placebo effect intervention may be an effective in preventing drug use in sport. Future research should aim to harness knowledge of placebo effects to prevent other drug use behaviours

Is the intention to use sport supplements a predictor of placebo and nocebo responding among athletes?

Background: Placebo and nocebo effects have been observed in relation to many interventions in sport. Given variance in response, a key question is whether individual difference variables identify likely ‘responders.’ Hypothetically, such a variable might be the person’s intention to use the intervention. We aimed to explore relationships between athletes' intention to use sport supplements and their responses to a placebo/nocebo intervention. Methods: Participants completed a single-item measure of intention to use sport supplements (‘intending’, ‘undecided’ or ‘not intending’) prior to 5×20-m sprints. Participants were then randomised to Placebo (n=219), Nocebo (n=168) and Control (n = 134) conditions. Participants in Placebo and Nocebo conditions were administered a capsule deceptively presented as a sport supplement that would have a positive (Placebo) or negative (Nocebo) effect on performance. Controls were provided with no instructions and received no capsule. After 20 minutes, all participants completed another set of 5×20-m sprints. Results: Among ‘intending to use’ participants, the Placebo treatment was associated with faster times than the Nocebo treatment (P=0.023, Cohen’s d [d]=0.34). In the Placebo treatment, ‘intending to use’ participants were significantly faster than ‘not intending to use’ participants (P=0.004, d=0.49), as were ‘intending to use’ participants in relation to ‘undecided’ participants in the Nocebo treatment (P=0.044, d=0.44). No significant differences in performance by intention were observed in the Control condition. Conclusions: Placebo and nocebo responses appear to be mediated by the participant’s intention to use supplements. These findings have value in explaining placebo/nocebo responses, and should be tested in clinical medical settings

Development and validation of the Sports Supplements Beliefs Scale

It has been proposed that the use of sports supplements by athletes might lead to the use of banned substances. This has been termed the gateway hypothesis. Given this hypothesis, if we accept that athletes use non-banned sports supplements because they believe that they will be effective, a measure of athletes’ beliefs about supplements might allow practitioners to identify athletes at risk of doping. We report the five-stage development of the Sports Supplements Beliefs Scale (SSBS). In study 1 we evaluated athletes’ beliefs about sports supplements by conducting semi-structured interviews on 16 athletes. Inductive and deductive analyses resulted in a pool of 26 items. In study 2 we recruited a panel of experts and athletes to evaluate the content validity of the 26 items. 15 items were eliminated at this stage. In study 3 we subjected the responses of 171 athletes to exploratory factor analysis to determine the factor structure of the scale. A two-factor model emerged, with one strong six-item factor, a less coherent four-item factor, and one item that cross loaded. In study 4, responses of a sample of 412 team sports athletes were subjected to confirmatory factor analysis. Of three competing models tested, a six-item single-factor model demonstrated best model fit (χ2/df = 2.894, RMSEA = 0.068; 90% CI = 0.038 to 0.099, P = 0.146, SRMR = 0.0246, CFI = 0.987, TLI = 0.978, AIC = 50.045, EVCI = 0.122). Factor loadings ranged from 0.4 and 0.9. All t-values were statistically significant (P <0.001) and ranged from 10.3 to 13.3. In study 5 we examined relationships between scores on the six-item scale and supplement use. Linear regression indicated that higher scores were significantly associated with the use of a greater number of supplements (β = 0.534, P <0.001, r2 = 0.285) and higher frequency of supplement use (β = -0.517, P <0.001, r2 = 0.267). Scores of users and non-users of supplements differed significantly (mean differences = 6.37 ± 0.56, U = 8,357, P <0.001), with discriminant function analysis indicating that scores correctly predicted 76% of sport supplement users and 66% of non-users (Wilks Lambda = 0.760 χ2 = 110.988, P <0.001). Whilst future research will be required to demonstrate its predictive validity, the SSBS has utility in the assessment of athletes’ beliefs about sports supplements. In the context of the gateway hypothesis, SSBS scores might play a meaningful role in identifying at risk athletes and in evaluating interventions

On the attitudinal consequences of being mindful: Links between mindfulness and attitudinal ambivalence

ArticleThis is the author accepted manuscript. The final version is available from SAGE Publications via the DOI in this record.A series of studies examined whether mindfulness is associated with the experience of attitudinal ambivalence. Studies 1A and 1B found that mindful individuals expressed greater comfort holding ambivalent views and reported feeling ambivalent less often. More mindful individuals also responded more positively to feelings of uncertainty (as assessed in Study 1B). Study 2 replicated these effects and demonstrated that mindful individuals had lower objective and subjective ambivalence across a range of attitude objects but did not differ in attitude valence, extremity, positivity/negativity, strength, or the need to evaluate. Study 3 showed that the link between greater ambivalence and negative affect was buffered by mindfulness, such that there was no link between the amount of ambivalence and negative affect among more mindful individuals. The results are discussed with respect to the benefits of mindfulness in relation to ambivalence and affect.Parts of this article were funded by a Leverhulme Trust Research Project Grant awarded to the first author

Enhancing the lateral-flow immunoassay for viral detection using an aqueous two-phase micellar system

Availability of a rapid, accurate, and reliable point-of-care (POC) device for detection of infectious agents and pandemic pathogens, such as swine-origin influenza A (H1N1) virus, is crucial for effective patient management and outbreak prevention. Due to its ease of use, rapid processing, and minimal power and laboratory equipment requirements, the lateral-flow (immuno)assay (LFA) has gained much attention in recent years as a possible solution. However, since the sensitivity of LFA has been shown to be inferior to that of the gold standards of pathogen detection, namely cell culture and real-time PCR, LFA remains an ineffective POC assay for preventing pandemic outbreaks. A practical solution for increasing the sensitivity of LFA is to concentrate the target agent in a solution prior to the detection step. In this study, an aqueous two-phase micellar system comprised of the nonionic surfactant Triton X-114 was investigated for concentrating a model virus, namely bacteriophage M13 (M13), prior to LFA. The volume ratio of the two coexisting micellar phases was manipulated to concentrate M13 in the top, micelle-poor phase. The concentration step effectively improved the M13 detection limit of the assay by tenfold from 5 × 108 plaque forming units (pfu)/mL to 5 × 107 pfu/mL. In the future, the volume ratio can be further manipulated to yield a greater concentration of a target virus and further decrease the detection limits of the LFA. Figure A schematic representation of concentrating viruses with an aqueous two-phase micellar system containing Triton X-114 surfactant prior to the detection of the virus through the lateral-flow immunoassa