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When I read about studies like these I always wonder how the placebo is done. Here it is actually stated: "sham meditation" and petroleum jelly cream. One of

by chvid 11y ago

When I read about studies like these I always wonder how the placebo is done. Here it is actually stated: "sham meditation" and petroleum jelly cream. One of the problems with this is that the experimentors would know who got the placebo and who did not. I don't think it is far fetched than a subject would sense whether they were being taught mindfulness mediation which the experimentor perceived as being genuine or "sham meditation" which the experimentor knew to be false. Whether a subject perceives she is undergoing an effective treatment obviously will effect the placebo effect and probably also show on brain scans.

PhasmaFelis 11y ago
Hm. Double-blind studies are supposed to measure whether a medical effect is real or all in your head. But meditation is, in a sense, "all in your head" either way. If a patient who genuinely believes that they are doing pain-relieving mindfulness meditation enters a mental state in which pain is relieved, does it matter if that state is "real" mindful meditation or not?
- austinjp 11y ago
  Everything you will ever experience is all in your head. No snark intended. This is a potent insight in pain science.
  - lisper 11y ago
    It's not all in your head. If I hit you on the head with a sledgehammer, the pain you will feel will in some sense be "all in your head." But the sledgehammer, which is not in your head (unless I hit you really, really hard!), still had something to do with it.
    - DanBC 11y ago
      But some people esperience pain without the external cause. No sledge hammers, no cancer, no disease, but pain is present.
      - lisper 11y ago
        Yes, of course, but so what? It is still not true that "Everything you will ever experience is all in your head."
        deleted 11y ago
        [deleted]
        bcook 11y ago
        It is correct, from my perspective. Pain is just the interpretation of signals from sensory organs. Our brain could just as easily interpret it as something else or disregard it.
        lisper 11y ago
        Not really. Try this experiment: hit yourself on the head with a sledgehammer and then try to "interpret" the pain as something else (eating chocolate, say) or just "disregard" it. You'll find it's not so easy. In fact, you already know that I'm right about this. You are in fact so convinced that I am right that you will not try this experiment. How do I know this? Because millions of years of evolution has hard-wired this understanding of pain into your brain. Anyone who doesn't have this understanding hard-wired into their brains tends not to survive because they end up doing stupid things like hitting themselves on the head with sledgehammers just to see what will happen. In fact, there are a very few people who can't feel pain. It's a very serious problem. They have to be extremely careful because they can easily sustain life-threatening injuries and not realize it.
        DanBC 11y ago
        But you're being a bit dogmatic. We use psychological techniques to reduce pain in, for example, cancer patients. You're reducing pain to some reaction to the physical world, but we see that some people have pain with no physical stimulus; and we some people who can reduce their pain even though there are physical stimuli present. When you properly control a study on pain meds you see such a strong placebo response that it's hard to justify using the meds: https://news.ycombinator.com/item?id=10351230 https://news.ycombinator.com/item?id=10351230 http://www.nature.com/news/strong-placebo-response-thwarts-painkiller-trials-1.18511 http://www.nature.com/news/strong-placebo-response-thwarts-p...
    - austinjp 11y ago
      It's odd, I know, but entirely factual. All sensation, all your experience of anything ever is a processing output of your brain. Certainly if you hit my hand with a sledgehammer i will scream about my hand hurting. But what has happened? Nerves depolarise, synapses communicate, a pattern of activity emerges in my brain. And as the conscious entity experiencing that pattern, i experience pain. If my spinal cord is severed (and i survive otherwise intact) those signals never reach my brain, and i experience no pain. No physical pain as a direct result of your actions, anyway. I may still be annoyed :) Your experience is 100% dependant on and exclusive to your brain, sledgehammer or no.
      - lisper 11y ago
        Yes, your subjective experience has its locus in your brain, but that is not at all the same thing as "Everything you will ever experience is all in your head." There is an external reality that is separate from your brain. Some of the things you experience (like getting hit on the head with a sledgehammer) involve processes that operate in this external reality, and others (like dreams or psychosomatic pain) don't. This is a salient and useful distinction which "Everything you will ever experience is all in your head" only serves to obscure.
        austinjp 11y ago
        Okay so this may feel like splitting hairs, but... You're talking about input, I'm talking about output. Experience is influenced (to varying extent) on sensory input, but they're not the same thing. Sensory input of course influences experience, I'm not going to deny a sledgehammer to the hand. While you feel that the distinctions drawn above serve only to obscure things, in fact the reverse may be true. The Cartesian perspective that "output is nothing but a response to input" has been pretty much discarded in modern research into pain, neurology, consciousness, psychiatry, and so on. So i don't deny the role of sensory input. I'm just pointing out that input is distinct from output; they're not the same thing.
        ZeroFries 11y ago
        There is no clear line which makes a sensation external or internally based. It's a messy abstraction, but there's some meaning behind it, because things can at least be relatively sorted by how external or internally based they are. For example, you may see a spider which 99.99% of sighted individuals would also see and agree there was a spider there, or you can hallucinate one, where only you would agree about a spider being present. Clearly the first is MORE externally based than the latter.
- austinjp 11y ago
  The "all in your head" element is always present. Trials seek to discover an effect beyond this, not instead of it.
jhdevos 11y ago
True - which is why they did the cream as well. At the very least, this study tells us that the mindfulness meditation is a 'more effective' placebo than the cream. It's very hard do really do in a 'double blind' way - I would not be able to think of something that is to all appearances equal to the real mindfulness mediation, but actually only a fake. There's no substance to it. Do you have any suggestions to do it better?
- austinjp 11y ago
  This is why trials designs other than RCT can be appropriate. For example, one group could be randomised to receive meditation therapy now, and another group would receive it later. Ethically this is more comfortable too, since neither group is denied a potentially effective treatment. I wonder if there is a well tested, robust placebo for meditation. Time to trawl the literature for protocols and designs.
- lisper 11y ago
  Use an activity-based sham therapy as the control, and have it administered by someone who believes it works. Waving magnets over the subject's body, for example.
- nroets 11y ago
  Some meditation teachers concentrate on Buddhist teachings that's not part of mindfullness. They believe those teachings to be more important than mindfullness. If the experimentors ask one of those teachers to teach the patients to meditate, the meditation will be "fake".
  - stone-monkey 11y ago
    Can that really substitute as a placebo, though? I'd imagine you'd have to first verify that those teachings are no more effective than a placebo, which runs into the same problem as the original purpose of finding a proper placebo comparison. Edit: Sorry, I misunderstood your comment. However, if they're testing the effectiveness of the meditation technique, then the teacher's belief in the method shouldn't affect the outcome of the result, assuming the technique is the same in both cases.

by chvid 11y ago

PhasmaFelis 11y ago

Hm. Double-blind studies are supposed to measure whether a medical effect is real or all in your head. But meditation is, in a sense, "all in your head" either way. If a patient who genuinely believes that they are doing pain-relieving mindfulness meditation enters a mental state in which pain is relieved, does it matter if that state is "real" mindful meditation or not?

austinjp 11y ago
Everything you will ever experience is all in your head. No snark intended. This is a potent insight in pain science.
- lisper 11y ago
  It's not all in your head. If I hit you on the head with a sledgehammer, the pain you will feel will in some sense be "all in your head." But the sledgehammer, which is not in your head (unless I hit you really, really hard!), still had something to do with it.
  - DanBC 11y ago
    But some people esperience pain without the external cause. No sledge hammers, no cancer, no disease, but pain is present.
    - lisper 11y ago
      Yes, of course, but so what? It is still not true that "Everything you will ever experience is all in your head."
      - deleted 11y ago
        [deleted]
      - bcook 11y ago
        It is correct, from my perspective. Pain is just the interpretation of signals from sensory organs. Our brain could just as easily interpret it as something else or disregard it.
        lisper 11y ago
        Not really. Try this experiment: hit yourself on the head with a sledgehammer and then try to "interpret" the pain as something else (eating chocolate, say) or just "disregard" it. You'll find it's not so easy. In fact, you already know that I'm right about this. You are in fact so convinced that I am right that you will not try this experiment. How do I know this? Because millions of years of evolution has hard-wired this understanding of pain into your brain. Anyone who doesn't have this understanding hard-wired into their brains tends not to survive because they end up doing stupid things like hitting themselves on the head with sledgehammers just to see what will happen. In fact, there are a very few people who can't feel pain. It's a very serious problem. They have to be extremely careful because they can easily sustain life-threatening injuries and not realize it.
        DanBC 11y ago
        But you're being a bit dogmatic. We use psychological techniques to reduce pain in, for example, cancer patients. You're reducing pain to some reaction to the physical world, but we see that some people have pain with no physical stimulus; and we some people who can reduce their pain even though there are physical stimuli present. When you properly control a study on pain meds you see such a strong placebo response that it's hard to justify using the meds: https://news.ycombinator.com/item?id=10351230 https://news.ycombinator.com/item?id=10351230 http://www.nature.com/news/strong-placebo-response-thwarts-painkiller-trials-1.18511 http://www.nature.com/news/strong-placebo-response-thwarts-p...
  - austinjp 11y ago
    It's odd, I know, but entirely factual. All sensation, all your experience of anything ever is a processing output of your brain. Certainly if you hit my hand with a sledgehammer i will scream about my hand hurting. But what has happened? Nerves depolarise, synapses communicate, a pattern of activity emerges in my brain. And as the conscious entity experiencing that pattern, i experience pain. If my spinal cord is severed (and i survive otherwise intact) those signals never reach my brain, and i experience no pain. No physical pain as a direct result of your actions, anyway. I may still be annoyed :) Your experience is 100% dependant on and exclusive to your brain, sledgehammer or no.
    - lisper 11y ago
      Yes, your subjective experience has its locus in your brain, but that is not at all the same thing as "Everything you will ever experience is all in your head." There is an external reality that is separate from your brain. Some of the things you experience (like getting hit on the head with a sledgehammer) involve processes that operate in this external reality, and others (like dreams or psychosomatic pain) don't. This is a salient and useful distinction which "Everything you will ever experience is all in your head" only serves to obscure.
      - austinjp 11y ago
        Okay so this may feel like splitting hairs, but... You're talking about input, I'm talking about output. Experience is influenced (to varying extent) on sensory input, but they're not the same thing. Sensory input of course influences experience, I'm not going to deny a sledgehammer to the hand. While you feel that the distinctions drawn above serve only to obscure things, in fact the reverse may be true. The Cartesian perspective that "output is nothing but a response to input" has been pretty much discarded in modern research into pain, neurology, consciousness, psychiatry, and so on. So i don't deny the role of sensory input. I'm just pointing out that input is distinct from output; they're not the same thing.
        ZeroFries 11y ago
        There is no clear line which makes a sensation external or internally based. It's a messy abstraction, but there's some meaning behind it, because things can at least be relatively sorted by how external or internally based they are. For example, you may see a spider which 99.99% of sighted individuals would also see and agree there was a spider there, or you can hallucinate one, where only you would agree about a spider being present. Clearly the first is MORE externally based than the latter.
austinjp 11y ago
The "all in your head" element is always present. Trials seek to discover an effect beyond this, not instead of it.

jhdevos 11y ago

True - which is why they did the cream as well. At the very least, this study tells us that the mindfulness meditation is a 'more effective' placebo than the cream. It's very hard do really do in a 'double blind' way - I would not be able to think of something that is to all appearances equal to the real mindfulness mediation, but actually only a fake. There's no substance to it. Do you have any suggestions to do it better?

austinjp 11y ago
This is why trials designs other than RCT can be appropriate. For example, one group could be randomised to receive meditation therapy now, and another group would receive it later. Ethically this is more comfortable too, since neither group is denied a potentially effective treatment. I wonder if there is a well tested, robust placebo for meditation. Time to trawl the literature for protocols and designs.
lisper 11y ago
Use an activity-based sham therapy as the control, and have it administered by someone who believes it works. Waving magnets over the subject's body, for example.
nroets 11y ago
Some meditation teachers concentrate on Buddhist teachings that's not part of mindfullness. They believe those teachings to be more important than mindfullness. If the experimentors ask one of those teachers to teach the patients to meditate, the meditation will be "fake".
- stone-monkey 11y ago
  Can that really substitute as a placebo, though? I'd imagine you'd have to first verify that those teachings are no more effective than a placebo, which runs into the same problem as the original purpose of finding a proper placebo comparison. Edit: Sorry, I misunderstood your comment. However, if they're testing the effectiveness of the meditation technique, then the teacher's belief in the method shouldn't affect the outcome of the result, assuming the technique is the same in both cases.