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Comment author: Shield 28 September 2013 11:22:18AM 6 points [-]

Are you sure that "anti placebo effect" is a good name though? The placebo effect refers exclusively to medical treatment if I'm not entirely mistaken, and this seems to have much broader implications in basically any sort of training. It's still basically the same effect if someone refuses to notice the progress they made with say tutoring, but it has nothing to do with medicine or treatment.

Seems a bit misleading.

Comment author: ShannonFriedman 30 September 2013 06:37:53AM -1 points [-]
Comment author: EvelynM 30 September 2013 02:28:55AM 1 point [-]

This effect isn't limited to people with anxiety and depression. People losing weight also experience it: http://www.3fatchicks.com/forum/metabolic-research-center/146593-paper-towel-theory.html

It's hard to be objective about yourself. Using tools to gain objectivity is a good thing.

I agree anti-placebo isn't a a good name. It's more like a distorted or cloudy mirror (don't see yourself clearly). but that doesn't capture the difficulty of remembering precisely how you were a long time before, to capture changes that happen at a slow rate.

Having a good name for this, will help people to pass along the idea. Thanks Shannon.

Comment author: ShannonFriedman 30 September 2013 04:19:39AM *  1 point [-]

The way that I came up with the name, was that someone was suggesting that my taking metrics might create a placebo effect, where people would believe that they were doing better than they actually were.

So, my response to this was that I was not trying to create a placebo effect, but rather, to avoid a placebo effect in the opposite direction.

So while I agree with you that this effect is not an opposite (why I referred to it as related instead of reverse), I do think that it is the opposite of what a lot of people fear - that they are experiencing a placebo effect.

In short, people being afraid of having a placebo effect is often how this effect comes to be - they don't want to create false hope and then have it dissipate, so instead they refuse to believe or acknowledge real positive results when they see them.

So, I would say that the title is reasonable regarding people's expectations, but not in the precise using of the term placebo sense. Personally, I think that expectations are more important for titling. Fewer people will pay attention to a precisely named definition that they know nothing about, whereas calling it the anti-placebo effect grabs attention - specifically the attention of people who have this bias.

Comment author: hyporational 29 September 2013 09:58:01AM *  0 points [-]

Edited the original to clarify. The video link didn't work, it's here, pretty descriptive of the basic attitudes. Changing attitudes to me feels like changing beliefs, you can't simply choose them by tricks of imagination. Medication helped with that. These days my problem is more simple avolition than depression, any non pharma tips on that? (I'm a physician.)

It would be nice to know how much of imagined SSRI poop out doesn't actually happen. Unfortunately there aren't similar tracking tools in finnish to give to my patients. Maybe pen and paper should suffice.

Comment author: ShannonFriedman 29 September 2013 02:47:57PM -1 points [-]

Yes, a lot of it has do to with having the parts of your mind that are action oriented not in alignment with the ones that want to have fun. If you're in that state for a long time, or in any way that ingrains the patterns hard, eventually you get to more extreme states like lack of interest in anything.

I use non-medication techniques to get people out of these states as my profession. You might find this audio helpful.

Comment author: hyporational 28 September 2013 06:12:56AM *  4 points [-]

I've had personal experience with this phenomenom, but never associated it with the hedonic treadmill.

I think this has also something to do with you current emotional state determining which episodic memories you recall. When you feel good, you remember all the good stuff, when you feel bad, all the bad things pile up. I've found it's really difficult to remember what it was like being depressed when I'm well. That has lead to stupidly quitting medication a couple of times. Is there a name for this effect?

EDIT: In my case the improvement with medication was dramatic, so it wasn't just a case of not noticing slow progress. My point was the anti-placebo effect probably consists of many different kinds of known cognitive failure modes, and it might be helpful to recognize them. In the problem that I describe, the difficulty is in retrieving memories that don't fit the emotional context. The hedonic treadmill effect is another type of an effect that fits the category.

Comment author: ShannonFriedman 28 September 2013 08:22:44PM *  1 point [-]

What you're describing sounds like the results from the anti-placebo effect, although I didn't go so far as naming that. Basically, you don't realize its working (anti-placebo effect), and then you stop and regress (what you're pointing to). Since you've figured this out, you should have a much easier time avoiding it with the next intervention you try, especially if you track the metrics you're most interested in seeing changes in.

One place that things get tricky is that your negative reinforcement loops can get started while you're still tracking metrics - as an example, perhaps you're doing great, and then you have one bad day, and then you make the false assumption that the bad day means that you will continue having bad days and that none of the other progress is real. If you adopt that belief, then even your mood tracking will decline, so its important to be reality checking as much as possible along the way, and to remind yourself that one bad day is not as big a deal as weeks of good days, and that will help you stay on track. Here's a video of me role playing the two attitudes that might be helpful.

Not quite on topic, but same principle - replace getting the work task done with having succeeded in improving on the metric you've been tracking for several consecutive weeks, and imagine how the optimistic person would respond to a down day, with that attitude, v.s. the overwhelmed/depressed role play person.

Comment author: RolfAndreassen 28 September 2013 06:17:07PM 3 points [-]

people suffering from anxiety from my personal client tracking.

This phrase probably does not carry the intended meaning.

Comment author: ShannonFriedman 28 September 2013 08:14:34PM -1 points [-]

LOL, indeed :)

Comment author: RomeoStevens 28 September 2013 08:38:05AM 0 points [-]

I have been supplementing rhodiola rosea and your example is the exact thing it promises, a halving of depressive symptoms along with other benefits. I'm not sure if it's working.

Comment author: ShannonFriedman 28 September 2013 03:23:58PM *  0 points [-]

Yeah, hard to know in retrospect, I would love to hear more about your results in as much as you can tell. For future such attempts where you're trying something like this, I recommend taking a baseline on a mood tracking site for a week or two before starting, if you can manage it, and then tracking for at least however long they claim it takes to get results. I also recommend just generally taking baselines, maybe every couple to few months - that way, even if you don't want to mood track all the time, you at least have some reasonable random sampling to look back on to see how you're doing over time. When you track, its ideal if you find a way to have uniform bias - so always take the test at the same time each day for example, or randomize the time if you're doing many data points and can handle noise - one problem with mood tracking is that people tend to take it when they are feeling especially good or especially bad or generally motivated by extreme mood, so its good if you can find a way to minimize that particular bias.

The Anti-Placebo Effect

39 ShannonFriedman 28 September 2013 05:44AM

Just about everyone is familiar with the placebo effect at this point.  What I've discovered through my personal studies working with people suffering from anxiety and depression is that there is actually a significant related effect, which I have dubbed the anti-placebo effect.  

Google says: pla·ce·bo ef·fect 



a beneficial effect, produced by a placebo drug or treatment, that cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient's belief in that treatment.

I say: anti·pla·ce·bo ef·fect 



  1. a beneficial effect, produced by a treatment, that is not attributed to treatment itself or has stopped being noticed, and thus the patient does not believe in that treatment as effective.

Its easy to miss treatment working.  For example, as a kid grows up, its easy to miss how their vocabulary is growing, but for someone who doesn't seem them every day, it may be immediately obvious "my how they're talking more!"  In other words, an anti-placebo effect is what happens when someone is having an intervention that is causing their life to improve, but the person does not believe that they are improving.  

This effect is most common with people who suffer from depression, who have biases for sad [1] and otherwise negative stimuli compared to the general population, and is also true of people suffering from anxiety from my personal client tracking.  Its also important to note that this bias persists after the recovery of the depressive episode.

The reason that this is important is that those recovering from anxiety and depression have a tendency to believe that they are not doing as well as they are - due to this cognitive bias creating an anti-placebo effect for them, which results in their giving up too soon on interventions which are effective and thus not getting better and regressing to old unpleasant patterns.  

It has been interesting since tracking results of my own clients [2] - I have all of them track scores at the beginning of their sessions on the site moodscope.com at the beginning of their sessions, so that we can see their progress over time with a consistent bias of the time of tracking being start of session (as opposed to other random biases such as wanting to take the quiz when in an especially good or bad mood).  I also take extensive notes and track other metrics of progress.  

What I've found, is that many clients hit a point after a few weeks or months, where they are questioning if they have made any progress.  Because I take metrics to prepare for this, I am able to point my clients at their metrics, and say for example, that according to their self reports, their mood has increased by 50% and their productivity has doubled.  What typically happens when I review score + notes with the client in question is that once they look back at how things were before compared to how they are now, they realize that they actually have made progress, and this is often followed with additional forward progress.  

It is interesting to put this in perspective with the hedonic treadmill [3].  The hedonic treadmill is the supposed tendency of humans to quickly return to a relatively stable level of happiness despite major positive or negative events or life changes.  What I'm finding with my studies is that it is often true for people recovering from depression when they take an overall evaluation (go meta), especially from a low point, but that when they look back at the factors that have changed, and they take the mood score test looking at different aspects of their experience on moodscope.com, they actually do have a more positive life experience when measured this way.  When I point out the inconsistency, people generally determine that the moodscope.com reported experience is more accurate (especially when supplemented by going over session notes) and over time, most clients do get off the hedonic treadmill and proceed to having the meta level catch up with moodscope.com.  

The good news about this for people suffering from anxiety and depression at large:  If you are aware of the negative cognitive bias and anti-placebo effect, you can take steps to account for and correct this bias.  One of the best ways to do this is by taking metrics along with notes that you can look at later.  When you look back, look at what your overall trend is, and try to focus on that more than if you happened to have a bad day or week.  If you have been progressing with a good linear regression, odds are that if you don't give up the new better patterns and habits you have created, they will continue to serve you. Although external factors to the one variable you are studying do complicate this and need to be taken into account.  


[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847035/

[2] http://www.depressiontoproductivity.com/your-clients-really-improve/

[3] http://en.wikipedia.org/wiki/Hedonic_treadmill


Comment author: JenniferRM 18 July 2013 12:10:00AM 1 point [-]

Responding (as sort of requested) almost a year later now...

The total outcome of the comments seems to have been educational, with a number of people learning and Zvi raising issues with Kelly that I hadn't already noticed and helping to educate me, but the ostensible purpose was to "get emails from someone" and so far no one has contacted me by outside channels on the basis of having made the grand parent comment. The lack of networking success on the basis of this comment doesn't seem like a particularly bad outcome to me in that my goal was mostly to cause education to happen that pays dividends for LWers in general in the semi-long-run :-)

Comment author: ShannonFriedman 30 July 2013 04:12:11PM *  0 points [-]

I appreciate your follow up. I couple of things did happen with other projects too:

  • one is that one of the better versions of Anki did get created - you can see up in the newer comments somewhere, where it was linked by hacker news.

  • Peter is also collaborating with someone working on his version, although I don't know whether or not this post had a impact on their collaboration.

  • I worked for awhile with one of the people Eliezer mentioned.

  • The backwards kickstarter folks were talking for awhile, and someone ended up working on a similar project with another group - I haven't followed up with them.

I think its likely that other stuff happened - I only found out about the better-Anki program because I ran into the guy who was behind it at a party. Likewise with my post about starting group houses - I know of several group houses that started that used it as part of their process, but I think only one commented. The co-working post has also been very successful, although not in the way I had anticipated - I don't know of much in the way of individual partnerships created, but the study hall that started is still going and populated almost 24/7, several months later.

Comment author: RichardKennaway 13 June 2013 03:35:45PM 5 points [-]

I notice that after the first few most recent of her comments, which have not yet received any votes either way, almost all the rest of the first page of her comments have received exactly one downvote, but varying numbers of upvotes. I suspect the downvotes are all due to one person, who has decided to object to whatever she posts. Perhaps the same person who has been downvoting everything that ialdabaoth posts.

Comment author: ShannonFriedman 17 June 2013 05:16:15AM -1 points [-]

I just re-read this and realized the important information I completely glossed over, and that this totally changes my analysis.

That said, I recall thinking that the comments had gone up and down many times when showing 50%, and that perhaps either it was a case that numbers were just more even since they were smaller, or that the calculation was done differently with the comments than the post. I don't feel up for doing the math to check this with so many comments, but if I had infinite time and energy it would be interesting.

Comment author: RichardKennaway 13 June 2013 03:35:45PM 5 points [-]

I notice that after the first few most recent of her comments, which have not yet received any votes either way, almost all the rest of the first page of her comments have received exactly one downvote, but varying numbers of upvotes. I suspect the downvotes are all due to one person, who has decided to object to whatever she posts. Perhaps the same person who has been downvoting everything that ialdabaoth posts.

Comment author: ShannonFriedman 16 June 2013 03:53:59AM 0 points [-]

In addition to whatever other voting is going on, my guess is that there is either one person doing this with multiple accounts, or several who have been going down the line and down voting the majority of my comments.

During the day that I was watching the patterns frequently, my karma would stay relatively stable with slow fluctuations most of the time, and the maybe around 5 times would quickly drop 10-20 or so points. I haven't been writing much lately and am pretty sure I was at 0 for monthly karma before this post, so my current score reflects specifically these ups and downs. For anyone who wants to do math, he post was on main for about half a day before it was moved, and I believe it was at -2 when it was transferred. (up from hovering around -4 most of the day)

Speaking of the math, would you mind giving the formula you used to calculate the range of +/-'s?

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