迁移性安慰剂效应的多模态机制 ：从痛觉到情绪的行为、ERP和fMRI研究

Although studies on placebo effect proved the placebo expectation established by pain-alleviating treatment could significantly alleviate later pain perception, or the placebo expectation established by anxiety-reducing treatment could significantly reduce the intensity of induced negative feelings, it is still unclear whether or not the placebo effect can occur in a transferable manner. That is, we still don’t know if the placebo expectation derived from pain-alleviating can significantly reduce later negative emotional arousal or not. Experiment 1: We compared the effect of the verbal expectation (purely verbal induction and without pain-alleviating reinforcement) with the reinforced expectation (building the belief in the placebo’s ataractic efficiency on unpleasant picture processing by secret reduction of the intensity of the pain-evoking stimulus) on the negative emotion. The results showed that the expectation, which was reinforced by actual analgesia, was transferable and could produce significant placebo effect on negative emotional arousal. However, the expectation that was merely induced by verbal instruction did not have such power. Experiment 2 both examined the direct analgesic effect of the placebo on the sensory pain (how strong is the pain stimulus) and emotional pain (how disturbing is the pain stimulus) and the transferable ataractic effect of the placebo on the negative emotion (how disturbing is the emotional picture stimulus), and further proved that the placebo expectation that was established from pain-reducing reinforcement not only induced significant placebo effect on pain, but also significant placebo effect on unpleasant feeling. These results support the viewpoint that the reduction of affective pain based on the conditioning mechanism plays an important role in the placebo analgesia, but can’t explain the transferred placebo effect on visual unpleasantness. Experiment 3 continued to use the paradigm of the reinforced expectation group and recorded the EEG activities, the data showed that the transferable placebo treatment was accompanied with decreased P2 amplitude and increased N2 distributed, and significant differences between the transferable placebo condition and the control condition (i.e., P2 and N2) were observed within the first 150-300 ms, a duration brief enough to rule out the possibility that differences between the two conditions merely reflect a bias “to try to please the investigator. In Experiment 4, we selected the placebo responders in the pre-experiment and let them to go through the formal fMRI scan. The results found that the transferable placebo treatment reduced the negative emotional response, emotion-responsive regions such as the amygdala, insula, anterior cingulate cortex and the thalamus showed an attenuated activation. And in the placebo condition, there was an enhanced activation in the subcollosal gyrus, which may be involved in emotional regulation. In conclusion, the transferable placebo treatment induced the reliable placebo effect on the behavior, EEG activity and bold signal, and we attempted to discuss the pychophysiological mechanism based on the positive expectancy.