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

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 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

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

Improved 1000-m running performance and pacing strategy with caffeine and placebo effect: a balanced placebo design study

Purpose: To investigate the placebo effect of caffeine on pacing strategy and performance over 1000-m running time-trials using a balanced placebo design. Methods: Eleven well-trained male middle-distance athletes performed seven 1000-m time-trials (one familiarisation, two baseline and four experimental). Experimental trials consisted of the administration of four treatments: informed caffeine/received caffeine (CC), informed caffeine/received placebo (CP), informed placebo/received caffeine (PC), and informed placebo/received placebo (PP). Treatments were randomized. Split times were recorded at 200-, 400-, 600-, 800- and 1000-m and peak heart rate (HRpeak) and rating of perceived exertion (RPE) were recorded at the completion of the trial. Results: Relative to baseline, participants ran faster during CC (d = 0.42) and CP (d = 0.43). These changes were associated with an increased pace during the first half of the trial. No differences were shown in pacing or performance between baseline and the PC (d = 0.21) and open administration of placebo (d = 0.10). No differences were reported between treatments for HRpeak (η2 = 0.084) and RPE (η2 = 0.009). Conclusions: Our results indicate that the effect of believing to have ingested caffeine improved performance to the same magnitude as actually receiving caffeine. These improvements were associated with an increase in pace during the first half of the time-trial

Considerations of control groups: Comparing active-control with no treatment for examining the effects of brief intervention

© 2021 The Authors. Published by MDPI. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.3390/sports9110156Background: A large-scale online study completed by this research team found that brief psychological interventions were associated with high-intensity pleasant emotions and predicted performance. The present study extends this work using data from participants (n = 3376) who completed all self-report data and engaged in a performance task but who did not engage with an intervention or control condition and therefore present as an opportunistic no-treatment group. Methods: 41,720 participants were selected from the process and outcome focus goals intervention groups, which were the successful interventions (n = 30,096), active-control (n = 3039), and no-treatment (n = 8585). Participants completed a competitive task four times: first as practice, second to establish a baseline, third following an opportunity to complete a brief psychological skills intervention, and lastly following an opportunity to repeat the intervention. Repeated measures MANOVA indicated that over four performance rounds, the intensity of positive emotions increased, performance improved, and the amount of effort participants exerted increased; however, these increases were significantly smaller in the no-treatment group. Conclusions: Findings suggest that not engaging in active training conditions had negative effects. We suggest that these findings have implications for the development and deployment of online interventions.Published versio

Computerised speechreading training for deaf children: A randomised controlled trial

Purpose: We developed and evaluated in a randomised controlled triala computerised speechreading training programme to determine a) whether it is possible to train speechreading in deaf children and b) whether speechreading training results in improvements in phonological and reading skills.Previous studies indicate a relationship between speechreading and reading skill and further suggest this relationshipmay be mediated by improved phonological representations. This is important since many deaf children find learning to read to be very challenging. Method: Sixty-six deaf 5-7 year olds were randomised into speechreading and maths training arms. Each training programme was comprised of10 minutesessionsa day, 4 days a week for 12 weeks. Children were assessed on a battery of language and literacy measures before training, immediately after training, 3 months and 10 months after training. Results: We found no significant benefits for participants who completed the speechreading training, compared to those who completed the maths training, on the speechreading primary outcome measure. However, significantly greater gains were observed in the speechreading training group on one of the secondary measures of speechreading. There was also some evidence of beneficial effects of the speechreading training on phonological representations, however these effects were weaker. No benefits were seen toword reading. Conclusions: Speechreading skill is trainable in deaf children. However, to support early reading, training may need to be longer or embedded in a broader literacy programme. Nevertheless, a training tool that can improve speechreading is likely to be of great interest to professionals working with deaf children