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      The neuroscience of placebo effects: connecting context, learning and health

      research-article
      1 , 2
      Nature reviews. Neuroscience

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          Abstract

          Placebo effects are beneficial effects that are attributable to the brain–mind responses to the context in which a treatment is delivered rather than to the specific actions of the drug. They are mediated by diverse processes — including learning, expectations and social cognition — and can influence various clinical and physiological outcomes related to health. Emerging neuroscience evidence implicates multiple brain systems and neurochemical mediators, including opioids and dopamine. We present an empirical review of the brain systems that are involved in placebo effects, focusing on placebo analgesia, and a conceptual framework linking these findings to the mind–brain processes that mediate them. This framework suggests that the neuropsychological processes that mediate placebo effects may be crucial for a wide array of therapeutic approaches, including many drugs.

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          Most cited references152

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          The brain basis of emotion: a meta-analytic review.

          Researchers have wondered how the brain creates emotions since the early days of psychological science. With a surge of studies in affective neuroscience in recent decades, scientists are poised to answer this question. In this target article, we present a meta-analytic summary of the neuroimaging literature on human emotion. We compare the locationist approach (i.e., the hypothesis that discrete emotion categories consistently and specifically correspond to distinct brain regions) with the psychological constructionist approach (i.e., the hypothesis that discrete emotion categories are constructed of more general brain networks not specific to those categories) to better understand the brain basis of emotion. We review both locationist and psychological constructionist hypotheses of brain-emotion correspondence and report meta-analytic findings bearing on these hypotheses. Overall, we found little evidence that discrete emotion categories can be consistently and specifically localized to distinct brain regions. Instead, we found evidence that is consistent with a psychological constructionist approach to the mind: A set of interacting brain regions commonly involved in basic psychological operations of both an emotional and non-emotional nature are active during emotion experience and perception across a range of discrete emotion categories.
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            Self-control in decision-making involves modulation of the vmPFC valuation system.

            Every day, individuals make dozens of choices between an alternative with higher overall value and a more tempting but ultimately inferior option. Optimal decision-making requires self-control. We propose two hypotheses about the neurobiology of self-control: (i) Goal-directed decisions have their basis in a common value signal encoded in ventromedial prefrontal cortex (vmPFC), and (ii) exercising self-control involves the modulation of this value signal by dorsolateral prefrontal cortex (DLPFC). We used functional magnetic resonance imaging to monitor brain activity while dieters engaged in real decisions about food consumption. Activity in vmPFC was correlated with goal values regardless of the amount of self-control. It incorporated both taste and health in self-controllers but only taste in non-self-controllers. Activity in DLPFC increased when subjects exercised self-control and correlated with activity in vmPFC.
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              Ventromedial prefrontal-subcortical systems and the generation of affective meaning.

              The ventromedial prefrontal cortex (vmPFC) comprises a set of interconnected regions that integrate information from affective sensory and social cues, long-term memory, and representations of the 'self'. Alhough the vmPFC is implicated in a variety of seemingly disparate processes, these processes are organized around a common theme. The vmPFC is not necessary for affective responses per se, but is critical when affective responses are shaped by conceptual information about specific outcomes. The vmPFC thus functions as a hub that links concepts with brainstem systems capable of coordinating organism-wide emotional behavior, a process we describe in terms of the generation of affective meaning, and which could explain the common role played by the vmPFC in a range of experimental paradigms. Copyright © 2012 Elsevier Ltd. All rights reserved.

                Author and article information

                Journal
                100962781
                22270
                Nat Rev Neurosci
                Nat. Rev. Neurosci.
                Nature reviews. Neuroscience
                1471-003X
                1471-0048
                7 June 2018
                July 2015
                21 June 2018
                : 16
                : 7
                : 403-418
                Affiliations
                [1 ]Department of Psychology and Neuroscience, University of Colorado, Boulder, 345 UCB, Boulder, Colorado 80309, USA.
                [2 ]National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland 20982, USA.
                Author notes
                Correspondence to T.D.W. Tor.Wager@ 123456Colorado.edu
                Article
                PMC6013051 PMC6013051 6013051 nihpa969556
                10.1038/nrn3976
                6013051
                26087681
                75d99708-de7e-4a49-afde-e003666932dd
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