The Power of Ritual

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I met Jessica Parilla about two years ago in Elizabeth Rowan‘s yoga immersion as we dove deep into the yoga philosophy module. Jessica, in addition to having the greatest sense of humor, teaches science (specifically microbiology and virology) at GSU.  So when she casually mentioned that she wanted to bridge the gap between science and the wellness community I jumped at the chance to ask her to write a blog post for Dirty South Yoga.

You see while I love yoga, crystals and ritual, I also think that it is equally important to visit the doctor when I have an injury, to take antibiotics if I have an infection and not to take for granted the incredible scientific advances that have allowed us to live longer than ever before. 

Sometimes we can get caught up in this either/or mentality that prevents us from being able to receive all that is available to us from both spirituality and science. So when we find incredible unicorns like Jessica who can bridge the gap for us, I want to soak up all the knowledge she can share to help us to see how they work in alignment with each other.  I mentioned the idea of the placebo effect (because sometimes I feel like everything in my life is one big placebo) and well… Jessica brought home for us beautifully.

The Power of Ritual

by Jessica Parilla

The placebo (Latin for “I shall please”) effect is the idea that a sham treatment like a sugar pill or fake treatment is enough to alleviate a person’s symptoms.  It has been observed in medical trials for decades, but only just recently has it been given more attention.  Studies on the placebo effect have been rather fascinating, and controversial.  It doesn’t seem to happen to everyone, and women seem to be more affected by it than men.  Even though a sham pill can’t cure a disease, regulate your blood sugar or resolve an infection, they do seem to alleviate subjective symptoms (anxiety, pain, nausea, fatigue, sleep quality) in some people.

In the past, placebos were defined as a fake treatment, like a sugar pill or an injection of saline.  More recent studies indicate that the placebo effect may have something to do with going through the routine of medical treatment.  Being seen by a health care provider, actually sitting in a treatment room, talking about your illness, being in a healing environment– sometimes that alone is enough to elicit the effect.  It seems as if the “ritual” of treatment can actually alleviate a person’s symptoms, without even having to take any medicine at all.

The symptom relief that a patient might feel as they go through the healing routine could be the result of something similar to classical conditioning (Pavlovian response).  Just as animals can be conditioned to respond to a sound, the brain can actually respond positively to the sights, sounds, and smells of the medical routine.  It expects to feel relief when it encounters a doctor or healer, and so it does.  It may be an unconscious response that the patient is not aware is happening.

The next explanation of the placebo effect is much more conscious.  As a patient experiences the medical intervention, they start to feel better because they feel like something is being done about the problem.  They are taking control of their illness, or they trust that their health care provider is going to do a good job and make them better.  They expect that this is the first step to their recovery, and that fact alone begins to give them relief.  This is very evident for patients that are in pain, or for those patients who are addicted to pain medication.  The feelings of pain or withdrawal start to diminish even before the pain medication is administered.  Some patients report feeling better as soon as they see the medicine, the needles, or even if they know that the drug is being administered soon.  The anticipation is enough to bring relief.  This last example indicates that the placebo effect may have something to do with the reward system in the brain.  Dopamine or opioid-like chemicals are released when the reward system is activated, and these feel-good chemicals can have pleasurable, or pain-numbing effects.  In this explanation, the placebo effect is the result of the brain releasing its own pain-relieving chemicals.

To take this a step further, studies were done where the patients actually knew they were receiving a sham medication.  Studies in patients with back pain or irritable bowel syndrome showed that many participants reported relief from their symptoms even when they knew from the start of the treatment that they were receiving placebos.  Some patients even asked to be given more fake pills to continue to take.  This particular study compared two groups of IBS sufferers, one who were taking fake pills (and knew they were fake) and another that took no pills at all.  Both groups had similar warm and supportive interactions with their medical care providers.  So, this study at least indicates that the actual act of taking a pill was what was causing the symptom relief.  Perhaps the brain is used to feeling better after taking a pill; the mere act of it alone is enough.

Placebo effects vary from person to person.  Some studies show that there are gender differences in the strength of the placebo effect, with women experiencing more effect, especially when being given the hormone vasopressin.  Vasopressin did not boost the placebo effect similarly in men.  Optimistic people seem to experience the placebo effect more strongly than those that are pessimistic about their medical experiences.  In fact, a pessimistic attitude may even bring about the much more mysterious “nocebo” (Latin for “I shall harm”) effect in which the sham medication makes their symptoms worse.

Placebo effects seem very similar to the emotional and psychological effects that rituals can have on a person.  Rituals are as old as humanity itself because it brings a person into a specific state of mind.  Many people report feelings of reverence to come over them just stepping into a house of worship.  Putting on a uniform, a revered article of clothing or priestess’ cloak can cause a person to mentally step into the role they are about to serve.  For me, the feeling of “yoga” begins as soon as I unroll the mat.  Something about that act alone is enough to bring me into the mental space that yoga opens up for me.  My brain knows what’s coming, and it goes ahead and steps into that direction.  The brain expects to be pleased by what’s about to happen, and it releases chemicals to facilitate that pleasure.

Benedetti, F. and Amanzio, M.  The placebo response: how words and rituals change the patient’s brain. Patient Education and Counseling. 2011. 84, 413-419

Colagiuri, B.; Schenk, L.; Kessler, M.; Dorsey, S. Colloca, L. The placebo effect:  from concept to genes.  Neuroscience.  2015.  307, 171-190

Colloca, L. ; Pine, D.; Ernst, M.; Miller, F.; Grillon, C.  Vasopressin Boosts Placebo Analgesic Effects in Women:  A Randomized Trial.  Biol. Psychiatry.  2016, 79(10), 794-802.

Gino, F and Norton, M.  Why Rituals Work.  Scientific American.  May 14, 2013.  https://www.scientificamerican.com/article/why-rituals-work/

Kaptchuk, T.; Friedlander, E.; Kelley, J.; Sanchez, M.; Kokkotou, E.; Singer, J.; Kowalczykowski, M.; Miller, F.; Kirsch, I.; Lembo, A.  Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome.  PLoS One.  2010. 5(12)  https://doi.org/10.1371/journal.pone.0015591

Vance, E.  The Placebo Effect’s Role in Healing, Explained.  PBS.  April 11, 2018.  https://www.pbs.org/newshour/science/the-placebo-effects-role-in-healing-explained

 

 

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