Virtual As If Approach

in relation to PLACEBO issues

Roel Gaymans MD PhD

EXPECTATION

ExpectationConditioningSuggestionEmpathic encounterContextual factorsSymbolic meaning of treatment, other than farmalogical content are important factors in elliciting placebo response in Medical setting

PROBLEM to be solved

Expectation in the patient isnot formulated in language

poorly defined,hard to measure/evaluate

seldom registereddifficult to increase or deminish

The virtual mind set expectationis not just a promoting factor

but the ignition of the Placebo Action.

It is not going to produce a “cascade”; it is part of the cascade already.

Expectation and recognised experienceare part of the placebo action.

Expectation can be defined as the virtual mind set which

formulates a future situationAS IF that situation will be met.

The formulation of the expectancyIs based on organic experience and AS IF that experience is recognised

to be put into action.

AS IF

With AS IF mechanismis meant:

the capacity of an organismto produce

the most appropriate actionin a situation when

limited or possibly deceiving information is presented.

AS IF MECHANISMSare present in

very many fields of Human behaviorand culture:

Evolutionary biologyGames

ArtsPolitics

PsychologySociology

Neuroscience

AS IF CONSTRUCTS are at the

very base of our* biological, * individual, *

language , *

cognitive and , *

cultural development.Both conscious and

subconscious

Virtual As If ConstructIs a affordance of the organism

to translate an undefined information

into a defined action

by comparing it

with an available solution.

PLACEBO

STATEMENT:

Placebo Actionsshare a basic element ofVirtual As If Constructs.

:Language gamesthat are useful to us

Virtual AS IF constructsNot just apply to the “patient”

but also to the treatment procedure

andto the doctor’s

pesentation/behavior

SO WHAT ?If we consider Placebo as

a Virtual AS IF Construct

It is one of the evolutiomary adaptive tools in our own health maintenance

; and must be appreciated

as such.

Anticipation Expectation Conditioning

Suggestion All are

usefull toolsand parts of

effective As If constructs in placebo response

DEFINITION

Placebo Response uses an autonomous virtual AS IF action of the organism, that is triggered by a treatment construct, with an outcome,appropriate to actual need of the patient, and comparable to the culturally accepted solution for that need.

Upgrading the Expectation (that can be met) means

upgrading the placebo response.Adding cues that

link the expectation with the experience

promotes the desired activation of the available body systems.

Research goalThe upgrading of Expectation byverbal cues to the patient*Mentioning one’s own repair and healing capacities.*Remembering previous succesful healing situations.*Remembering/mentioning previoussuccesful treatment procedures.

Exact formulation depends of the general procedure of theVerum condition to be studied

What is this all about: Enhance

Patient’s Placebo capacities

byspecific verbal cues

containing virtual AS

IF terminology

Suggested terminology

So WHAT?

As if mechanism can be enhanced and made useful

To induce placebo andnatural healing

SO WHAT ?

In a treatment situation both “patient” and “doctor” must aim at a similar,

synergistic As If based terminology

and expectancy.

PD Wall:

Placebo is an appropriate action, which experience has taught us to give

relief of the “need”

Placebo analgesia studies show that the organism can make appropriate use of

the endogenous opioïd , DOPAminesystem, and other

repair systems

in case of a pain(ful) need.

Clinical trials :

Does inactive method with AS IF terminology show rACC activation?

AS IF terminology group versus “inactive substance”group

AS IF one fourth effective versus Active analgesic

AS IF trial with “same effect as previously”

AS IF suggestion “Your own analgesic capacity comes into action”

AS IF suggestion “Your body knows what it needs as painkiller”

AdditionalINFORMATION

AS IF CONSTRUCTSin other foelds

Medieval Funeral Singers“Placebo Domino in regione vivantes”

acted AS IF

they were pleasing the Lord.By doing this they gained respect and possibly reward from the deceased–s family.

Dissociation between “word” I will please and itspsychofysiological meaning limits the correct understanding and acceptation of the fenomenon

What next ?

The: “I will please” approach of

PLACEBO can be converted to act Virtual

AS IF.

The German Philosopher Hans Vaihinger

had a term for beliefs that we know that are not true, but still come in handyHe called them useful fictions.You act AS IF something were true if it is beneficial to You.

Dutch Historian Johan Huizinga:

In Homo Ludens defines Play as basic element in cultural development.

Playing as if is present everywhere in our society

Evolutionary biologist Tijs Goldschmidt describes

Acting as if is an important capacity in evulutionary biology

Sociologist Roger Caillois

analyses various forms of play. As If is important social factor: by cognitive processing of imitation and simulation

Neuroscientist Antonio R.Damasio

names the As If loop as an active tool in the composition structure of the fenomenon-emotion-feeling- consciousness complex

Physician and linguist Klaus Schonauer defines the placebo problem : the specific meaning of something that isfarmacologically aspecific. Solution is found in Modelling for Similarity

Klaus Schonauer :In case of placebo response Simulation Affirmation Gratification Lead to “Structural gain” for the patient

Psychiatrist G.A.Kelly published thePersonal Construct Psychology. in which the Acting as If technique is effectively applied in psychotherapy