Friday, July 15, 2011

The Placebo Effect and Performance

In the 2006 book Harry Potter and the Half Blood Prince, Ron Weasly was struggling with low self-confidence. Harry then pretends to give Ron felix felicis, a potion that makes one lucky. Believing that he has taken in a dose of liquid luck, Ron performs brilliantly in the day’s Quidditch match. This is a classic example of a placebo effect, an improvement in performance due to expectations or beliefs rather than to biology. In fictional tales (movies and books), placebos are often used to help characters win the day. Could the placebo effect actually impact a player’s performance during a soccer match? Research suggests yes, the placebo effect may be beneficial to sports performance. Also, the use of a "verbal placebo" may already be commonplace among coaches.

The use of placebos is a hotly debated issue in the field of medicine and pain management. Two recent research reviews highlight the effect placebo medications can have on a chronic pain sufferer’s perception of pain (Benedetti, 2011; Pollo et al, 2011). Giving some patients a placebo pill while telling them that it is a drug designed to reduce pain can reduce their pain perception. That is, the patient feels better even though he received no medication. The mere expectation of a positive effect actually elicited one. This concept is called placebo analgesia – reducing pain using a placebo. Clinicians are currently debating the ethics of using deception to reduce the symptoms of a disease. Some argue that it should not be done. Others argue that non-pharmacological treatments for pain management are preferable to drug therapy.

Placebo effects are thought to be “all in your head”. Both articles however, discuss several biological effects that placebos can exert. Brain chemicals, stress hormones as well as the immune system can be affected by the power of suggestion. Placebo effect may be more complex than a simple psychological phenomenon.

As for athletics, the placebo effect can also lead to improved physical performance. For example, one study showed that when subjects were told that they were given a caffeine supplement but were actually given a sugar pill, strength performance improved (Pollo et al., 2008). Another showed that endurance performance was improved when cyclists were told they were provided a carbohydrate supplement during exercise but were actually drinking a placebo  beverage(Clark et al., 2000). In both cases, the athletes were fully aware of how the substances might affect performance. Thus, the expectation that a substance will improve performance actually benefits the athlete.

It should be pointed out that research into placebos and exercise performance is somewhat inconsistent. Not all studies show a clear placebo effect in all subjects. It appears that some are more susceptible to the power of suggestion than are others. Also, the placebo effect may be stronger in some types of activities that others. Nevertheless, there is evidence that the use of placebos may benefit the athlete as demonstrated by Ron Weasly’s match performance.

The discussion on placebo medication, pain and performance is provided to illustrate a point. There is a powerful link between the brain and the body. It is not meant as an endorsement of “performance enhancing” substances. It cannot be emphasized strongly enough – providing young athletes with drugs or even placebo drugs is not an appropriate way to improve performance. No coach, parent or fellow athlete should provide a player any substance (such as caffeine) with the suggestion that it will improve performance. Fostering a dependency on pharmaceuticals or other substances, whether real of imagined, is well beyond the limits of ethical behavior. And, the long-term effects on the athlete’s health can be dangerous.

An alternative to a placebo substance is what researchers call a “verbal placebo”. Many coaches already use the verbal placebo effect to improve their team’s performance. Teams are often faced with a match against a far superior opponent. On paper, there is little hope that the underdog team can prevail. In the days leading up to the match, coaches try to build confidence in their players, individually and as a team. They spend hours trying to build self-efficacy. That is, the players’ belief that they have the skills to compete with and defeat a more talented opponent. Building self-efficacy is simply instilling an expectation that the team can compete without actually improving their skills. In effect, they are trying to elicit a placebo effect.  Coaches are trying to get the team to “play over their heads” and achieve an expectation that, on paper, may not be possible. In essence, the coach is using a verbal placebo to enhance performance.

There is a scientific basis for verbal placebos affecting performance. In an interesting study of naval cadets, researchers experimentally improved self-efficacy by convincing the sailors that they would not experience seasickness on their maiden voyage and if they did, it would not affect performance (Eden & Zuk, 1995). At the end of the cruise, the treated cadets experienced less seasickness and showed better performance than untreated, control sailors. Thus verbally improving self-efficacy prevented seasickness and its adverse effects. To further emphasize that point, a study on exercise training, showed that emphasizing the goals and expected outcomes of the training program resulted in those outcomes being achieved (Desharnias et al. 1993).

Building self-confidence and self-efficacy is a cornerstone of coaching. Research shows that these concepts are integral components of peak performance (Vealey, 2009; Zinsser et al., 1998). Recovering lost confidence after an injury or surgery is also critical in helping the player regain his or her playing form. The mind is a powerful organ. While most training sessions are spent on fitness, technical skills and technical approaches, it seems that training the mind is equally important. To achieve peak performance, superior abilities should be matched with self-confidence.

References:

Benedetti F (2011) Is there a place for placebo analgesia in everyday clinical practice? Pain Management, 1: 211-212.

Clark VR, Hopkins WG, Hawley JA, Burke LM (2000) Placebo effect of carbohydrate feedings during a 40-km cycling time trial. Medicine and Science in Sports and Exercise, 32: 1642-1647.

Desharnias R, John J, Cote C, Levesque L, Godin G (1983) Aerobic exercise and the placebo effect: A controlled study. Psychosomatic Medicine, 55: 149-154.

Eden D, Zuk Y (1995) Seasickness as a self-fulfilling prophecy: Raising self-efficacy to boost performance at sea. Journal of Applied Psychology, 5: 628-635.

Pollo A, Carlino E, Benedetti (2008) The top-down influence of ergogenic placebos on muscle work and fatigue. European Journal of Neuroscience. 28: 379-388.

Pollo A, Carlino E, Benedetti (2011) Placebo mechanisms across different conditions: from the clinical setting to physical performance. Philosophical Transactions of the Royal Society B, 366: 1790-1798.

Vealey, RS (2009) Confidence in Sport. In: Sport Psychology , Ed: BW Brewer), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444303650.ch5

Zinsser, N., Bunker, L., & Williams, J. M. (1998). Cognitive techniques for building confidence and enhancing performance. In: Applied Sport Psychology: Personal Growth to Peak Performance, Ed: JM Williams, pp. 270-295. Mountain View,CA: Mayfield.