Virtual As I f Approach in relation to PLACEBO issues Roel Gaymans MD PhD

1. Virtual As If Approach in relation to PLACEBO issues Roel Gaymans MD PhD

2. EXPECTATION

3. Expectation Conditioning Suggestion Empathic encounter Contextual factors Symbolic meaning of treatment, other than farmalogical content are important factors in elliciting placebo response in Medical setting

4. PROBLEM to be solved Expectation in the patient is not formulated in language poorly defined, hard to measure/evaluate seldom registered difficult to increase or deminish

5. The virtual mind set expectation is 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 experience are part of the placebo action.

6. Expectation can be defined as the virtual mind set which formulates a future situation AS IF that situation will be met. The formulation of the expectancy Is based on organic experience and AS IF that experience is recognised to be put into action.

7. AS IF

8. With AS IF mechanism is meant: the capacity of an organism to produce the most appropriate action in a situation when limited or possibly deceiving information is presented.

9. AS IF MECHANISMS are present in very many fields of Human behavior and culture: Evolutionary biology Games Arts Politics Psychology Sociology Neuroscience

10. AS IF CONSTRUCTS are at the very base of our * biological, * individual, * language , * cognitive and , * cultural development. Both conscious and subconscious

12. Virtual As If Construct Is a affordance of the organism to translate an undefined information into a defined action by comparing it with an available solution.

13. PLACEBO

14. STATEMENT: Placebo Actions share a basic element of Virtual As If Constructs. :Language games that are useful to us

15. Virtual AS IF constructs Not just apply to the “patient” but also to the treatment procedure and to the doctor’s pesentation/behavior

16. 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.

17. Anticipation Expectation Conditioning Suggestion All are usefull tools and parts of effective As If constructs in placebo response

18. DEFINITION

19. 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.

20. 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.

21. Research goal The upgrading of Expectation by verbal cues to the patient *Mentioning one’s own repair and healing capacities. *Remembering previous succesful healing situations. *Remembering/mentioning previous succesful treatment procedures. Exact formulation depends of the general procedure of the Verum condition to be studied

22. What is this all about: Enhance Patient’s Placebo capacities by specific verbal cues containing virtual AS IF terminology

23. Suggested terminology

24. So WHAT? As if mechanism can be enhanced and made useful To induce placebo and natural healing

25. SO WHAT? In a treatment situation both “patient” and “doctor” must aim at a similar, synergistic As If based terminology and expectancy.

26. PD Wall: Placebo is an appropriate action, which experience has taught us to give relief of the “need”

27. 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.

28. 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”

29. Additional INFORMATION AS IF CONSTRUCTSin other foelds

30. 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.

31. Dissociation between “word” I will please and its psychofysiological meaning limits the correct understanding and acceptation of the fenomenon

32. What next ? The: “I will please” approach of PLACEBO can be converted to act Virtual AS IF.

33. The German Philosopher Hans Vaihinger had a term for beliefs that we know that are nottrue, but still come in handy He called them useful fictions. You act AS IF something were true if it is beneficial to You.

35. Dutch Historian Johan Huizinga: In Homo Ludens defines Play as basic element in cultural development. Playing as if is present everywhere in our society

36. Evolutionary biologist Tijs Goldschmidt describes Acting as if is an important capacity in evulutionary biology

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

38. Neuroscientist Antonio R.Damasio names the As If loop as an active tool in the composition structure of the fenomenon-emotion-feeling- consciousness complex

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

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

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