Placebos reduce feelings of guilt – even when people know they are taking one

Guilt is a double-edged sword. It can be a reminder to get better and a motivation to apologize. It can also lead to pathological perfectionism and stress and is also closely associated with depression and post-traumatic stress disorder.

Unfortunately, both good and bad guilt are common, and there are few proven treatments to reduce unhealthy guilt.

To help address the problem of excess guilt, a recent study published in Nature found that placebos can reduce feelings of guilt, even when the person taking them knows they are receiving placebos.

In the study, 112 healthy volunteers between the ages of 18 and 40 participated. Their guilt was measured at baseline using questionnaires, including the state guilt and shame scale (SSGS). This questionnaire asks people if they feel remorseful or bad about something they’ve done. Next, participants did an exercise designed to make them feel more guilty. The exercise involved writing a story about a time when they treated someone they loved unfairly.

Participants were then divided into three groups. One group was given a “deceptive placebo”: a blue pill that was said to be a real drug. Specifically, they were told that the pill contained phytofarmacon, a substance designed to reduce feelings of guilt, making the person taking it feel calmer.

Another group was given an “open placebo” – the same blue pill, but this group was told it was a placebo. They were told that placebos benefit many people through mind-body self-healing mechanisms.

The third group received no treatment. This was the “control” group.

After receiving the treatment, feelings of guilt were measured using the same questionnaires to see whether the sham or open-label placebo was more effective than no treatment.

The main outcome reported in the study was that the misleading placebo and the open-label Combined were more effective in reducing guilt than no treatment.

Overcoming the placebo paradox

Open-label placebos are important because they overcome the “placebo paradox”. The paradox is that, on the one hand, placebos have effects, especially for pain, and we know how they work. Doctors are ethically obligated to help their patients and this ethical force drives them to prescribe placebos.

On the other hand, traditional placebos are misleading (patients think they are, or could be, a real treatment). Physicians are also ethically obligated to avoid misleading patients (generally) and this ethical force steers them away from prescribing placebos (although it seems that most physicians have prescribed placebos at least once). Because open-label placebos do not involve deception, they overcome the paradox and pave the way for ethical (open-label) placebos to help patients where appropriate.

While the novelty of this study is to be applauded, it is not without its weaknesses.

First, the participants were healthy volunteers. They weren’t suffering from guilt before the experiment. It’s unclear whether the research in healthy volunteers translates to people in actual clinical practice. Furthermore, measures of guilt were only taken up to 15 minutes after administration of placebos. The long-term effects (and real-life usefulness) of placebos, therefore, are not known.

A bigger problem was that he pooled the effects of overt and misleading placebos. The novelty of the study is that it uses open-label placebos, so pooling its effects with those of misleading placebos dilutes the novelty. This was rather odd because when I investigated the supplemental material it became clear that open-label placebos alone were more effective than no treatment in reducing guilt. It is a pity that this was not the result of the headline.


The fact that open-label placebos can reduce pathological guilt even by a small amount is encouraging because they can be ethically used in cases where no better treatments exist. Future studies need to look at the effects of open-label placebos in real patients and follow them longer.

It’s also a small leap from the promising results of this study to believe that if open-label placebos work, we might be able to “placebo” ourselves by giving ourselves positive cues that make us feel better.The conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Leave a Reply

Your email address will not be published. Required fields are marked *