背景:尽管一些现有模型提出注意力可能与安慰剂/nocebo效应密切相关,这方面的实证研究仍然有限和分散。
目的:本系统综述旨在提供在安慰剂和nocebo程序中直接操纵或评估注意力的研究的包容性概述,以便综合了解该变量在安慰剂/nocebo效应中的作用。重要的是,只有注意力代表安慰剂/nocebo反应的机制或中介的研究,而不是主要结果,包括在内。
方法:在多个数据库中进行了系统搜索,包括PubMed,Scopus,PsycINFO,WebofScience,和Embase,以确定同行评审的研究。这些研究经过方法学评估和纳入资格标准。
结果:我们根据重点将12项研究分为三类:(i)直接评估注意力的研究,(Ii)那些直接操纵参与者注意力的人,和(Iii)结合了直接操纵和评估注意力的那些。在所有选定的研究中,注意力充当安慰剂/nocebo反应的机制或媒介,并且不被认为是安慰剂/nocebo操纵的主要结局。
结论:纳入的研究的综合显示,注意力在安慰剂和nocebo效应中的作用仍然是一个争论的话题,以注意力概念化和测量方式的变化为标志。结果表明,注意有显著的临床意义,特别是通过引导患者专注于愈合的迹象和远离疾病或痛苦的指标来优化治疗效果。为了增进我们的理解,未来的研究应该探索这些注意机制,与神经生理学相关。
到目前为止,关于注意力在安慰剂/nocebo效应中的作用的实证研究仍然很少且尚无定论。本系统综述的目的是提供直接操纵或评估注意力作为安慰剂/nocebo反应的机制或媒介的研究的概述。同行评审研究经过方法学评估和资格标准,选择了12项研究,并根据其重点分为3类:(i)直接评估注意力的研究,(ii)那些直接操纵参与者注意力的人,和(Iii)结合了直接操纵和评估注意力的那些。纳入研究的综合指出了研究注意力在安慰剂和nocebo效应中的作用的细微差别的方法论方法。以这个变量的概念化和测量方式的变化为标志。总的来说,结果支持安慰剂/nocebo效应并不总是预期的直接副产品,在探索这种关系时,注意力是一个需要考虑的重要因素。特别是,注意力在优化治疗效果方面发挥着重要作用,通过引导患者将注意力转向愈合的迹象,远离疾病或痛苦的指标。
BACKGROUND: Although some existing models propose that attention may be crucially implicated in placebo/nocebo effects, empirical research on this aspect remains limited and scattered.
OBJECTIVE: This systematic review aims to provide an inclusive overview of studies that have either directly manipulated or assessed attention within the context of placebo and nocebo procedures so to gain a synthetized picture of the role of this variable in placebo/nocebo effects. Importantly, only studies in which attention represented a mechanism or mediator of the placebo/nocebo response, and not a primary outcome, were included.
METHODS: A systematic search was conducted across multiple databases, including PubMed, Scopus, PsycINFO, Web of Science, and Embase, to identify peer-reviewed studies. These studies were subjected to methodological evaluation and eligibility criteria for inclusion.
RESULTS: We identified and classified 12 studies into three categories based on their focus: (i) those that directly assessed attention, (ii) those that directly manipulated participants\' attention, and (iii) those that combined both a direct manipulation and assessment of attention. In all selected studies attention acted as a mechanism or mediator of the placebo/nocebo response, and was not considered a primary outcome of the placebo/nocebo manipulation.
CONCLUSIONS: The synthesis of the included studies reveals that the role of attention in placebo and nocebo effects is still a topic of debate, marked by variations in how attention is conceptualized and measured. Results suggest that attention has significant clinical implications, particularly in optimizing therapeutic efficacy by directing patients\' focus toward signs of healing and away from indicators of illness or distress. To advance our understanding, future research should explore these attentional mechanisms, in conjunction with neurophysiological correlates.
To date, empirical research on the role of attention in placebo/nocebo effects remains scarce and inconclusive. The aim of this systematic review is to offer an overview of studies that have either directly manipulated or assessed attention as a mechanism or mediator of placebo/nocebo responses. Peer-review studies were subjected to methodological evaluation and eligibility criteria, and 12 studies were selected and classified into 3 categories based on their focus: (i) those that directly assessed attention, (ii) those that directly manipulated participants’ attention, and (iii) those that combined both a direct manipulation and assessment of attention. The synthesis of the included studies points to the nuanced methodological approaches to the study of the role of attention in placebo and nocebo effects, marked by variations in how this variable is conceptualized and measured. Overall, results support the idea that placebo/nocebo effects are not always a direct byproduct of expectations, with attention acting as an important factor to consider when exploring this relationship. Particularly, attention plays an important role in optimizing therapeutic efficacy by directing patients’ focus toward signs of healing and away from indicators of illness or distress.