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On May 18, 2021, at 11:30. This session consists of three small talks:
Izar Agirresarobe-Pineda (EHU/UPV) and Iñigo R. Arandia (EHU/UPV)
- “Placebo, addictions, and the interplay between pre-reflective and reflective activity”
Background: Placebo and addictive phenomena share a controversy between reflective volition and uncontrollable bodily responses. Motivated by the conscious/nonconscious divide, they also share explanations in terms of (conscious) expectations and (nonconscious) conditioning. However, this dichotomy is problematic: it assumes a passive mechanistic account of bodies difficult to extrapolate beyond controlled experimental settings, and it renders the nonconscious as an almost inaccessible black-box.
Methods: We assess empirical evidence and theoretical explanations on placebo and addictive phenomena employing the dynamic interplay between pre-reflective (more implicit and automatized) and reflective (more explicit and controllable) aspects of agency derived from embodied cognitive science. We take the intersubjective domain as constitutive of experience, following the notion of “ontological intimacy” developed by philosopher Kym Maclaren.
Results: The pre-reflective/reflective interplay allows to investigate the influence of habits and other interrelated behavioral patterns, personal narratives, and a variety of tacit interactive elements (body language, speech tone, moods, atmospheres) that are fundamental to understand placebo phenomena and addictive behavior. Social interactions, including therapeutic encounters, cannot be reduced to exchanges of information that shape expectations only in a reflective manner. Social encounters always affect (positively or negatively) the ongoing constitution of our personhood in pre-reflective and reflective ways.
Conclusions: We suggest placebo and addictive phenomena should be investigated as meaningful interactive experiences involving a dynamic interplay between pre-reflective and reflective activity. This interplay, capturing essential sensorimotor and intersubjective influences, offers more flexibility than the conscious/nonconscious dichotomy. These categories might also provide insights for other conditions such as phobias or traumas.
Iñigo R. Arandia (UPV/EHU)
2. “Placebo from an Enactive Perspective”
Background: A set of problematic assumptions pervades research into placebo effects. These include various kinds of dualisms (physiology/psychology, object/subject, known/knower), and tendencies towards reductive explanations based on passive individuals and mechanistic conceptions of the body.
Methods: We review an alternative theoretical framework in embodied cognitive science that rejects these assumptions—the enactive approach to life and mind—and evaluate the conceptual tools it offers for placebo research. We overview enactive concepts such as dimensions of embodiment, agency, and sense-making. We also introduce the ontology of individuation developed by Gilbert Simondon to offer a processual account of placebo phenomena.
Results: Based on empirical evidence, we interpret placebo interventions not as originating causal chains, but as triggers in the regulation of existing tensions between bodily and interpersonal processes. These processes involve looping effects through three intertwined dimensions of embodiment: organic, sensorimotor, and intersubjective. From this perspective, placebo responses are individuation processes triggered to regulate ongoing tensions in biopsychosocial processes. We defend the need to investigate therapeutic interactions in terms of participatory sense-making, going beyond the identification of individual social traits that modulate placebo effects to the investigation of patterns and kinds of social interaction.
Conclusions: We offer enactive proposals to overcome limiting assumptions common in placebo research and clinical practice, and discuss their resonances and differences with traditional explanations in terms of expectations and conditioning, and other approaches based on meaning responses and phenomenological/ecological ideas.
Iñigo R. Arandia (UPV/EHU)
3. “Social Interaction and Not Just Social Skills Affect Placebo Phenomena”
Background: Placebo effects are not predictable nor easily manipulable at an individual level. We suggest that a poor understanding of individual experiences and of social interactions contributes to discrepancies between placebo as robust group effects, and individual variability. Social influences on placebo are considered as external factors to be controlled for. The focus is on individual social traits, reducing the complex interactive experience to personal expectations, personality traits, motivational goals, or beliefs, downplaying interactive aspects such as patterns of coordination, asymmetries, and dissonances.
Methods: Following the enactive concept of participatory sense-making, we propose that a kind of interactive autonomy emerges in the therapeutic encounter, constituting a third element that depends on both patient and practitioner but is not controllable by either. Social interaction cannot be reduced to information transmission shaped by individual characteristics (empathy, trust, warmth).
Results: A successful encounter demands the capacity of relatedness from both sides in order to construct shared meaning and adequately modulate hopes and expectations. The few studies that gather data about interaction dynamics support the hypothesis that engaged forms of participation correlate with placebo effects. This perspective is compatible with the ‘placebo by proxy’ hypothesis and can account for evidence showing the impact of parental expectations on placebo effects in children.
Conclusions: Looking at phenomenological, anthropological and biomedical research, we show the necessity to investigate concrete situated and interactive experiences to gain generalization ability. Enactive theory bridges the gap between placebo effects measured at the group level and variability at the individual level.