The Psychological Record, 1972, 22, 113-119.

AN ANALYSIS OF EXPERIMENTAL COMPONENTS

IN A PLACEBO EFFECT

L. W. BUCKALEWl
University of Southern Mississippi

The study, directed toward clarification and quantification of

a placebo effect, assessed the effects of 3 independent variables on
the dependent variable of reaction time (RT) in a test-retest situ-
ation. The independent variables were: a lactose capsule (pla-
cebo), suggestion that the capsule would speed-up RTs, <lnd
statements that RTs were faster (reinforcement). Analysis of
covariance revealed significant group differences, compared to un-
treated controls, in RT reduction. The placebo effect manifested
entailed (in order of contribution lo RT reduction): ({/) reinforce-
ment (slight inßuence), (b) suggestion (major inHuence), and
( c) an interaction effect (large inßuence).

Psychologieal, psychiatrie, and medical investigations have awarded

increasing importance to psychological and physiological effeets of
placebos. The history of medical and psychiatrie in te rest in the placebo
effeet was traced by Shapiro (1960), who concluded that the potency,
widespread use, and therapeutic potentials of placebos failed to gain
recognition until recently. Barber (1959) suggested that placebo re-
search is still in its infancy, and it has only been within the last decade
that psychological and physiological effeets of placebos have been ack-
nowledged and investigated to any great extent (Brodeur, 1965; Leh-
mann & Knight, 1960). Buckalew (1969) summarized research inter-
est in the placebo effect during the past decade.
The placebo has most often been associated with drug studies as
a control agent. However, as pointed out by Lehmann & Knight (1960),
every effect of an active drug always constitutes a composite of pharma-
cological and placebo effects. Shapiro (1960) stated that clarification of
the placebo e!fect required a distinction be made between methodolo-
gical variables, the placebo itself, and the placebo effect as an uncon-
trolled variable. The placebo reaction or effeet has conventionally been
defined as the physiological and psychological reaetion to administration
and acceptance of the placebo. Distinction must be made between the
inert drug (placebo), suggestions that it will have a certain effect, and
the effect on some dependent variable of the placebo plus suggestions.
A majority of research needs in the field concern methodological and
definition problems (Buckalew, 1968; 1969), with emphasis placed on

1 Now at South Carolina Stute College, Orangeburg. Reprint requests should be addressed to the
author, Department of Psychology, South Carolina Stute College, Orangeburg, South Carolina
29115.
114 BUCKALEW

gaining a dearer understanding of phenomenon composition, favorable

conditions for achievement, and potentials. Adequacy of the placebo as
a control (Wolf, 1959; Gelfand, Ullmann, & Krasner, 1963) prompted
Liberman (1962) to note pointedly the serious Haw in research design
which failed to indude no-treatment control groups. Barber (1959)
noted problems of stating placebo effects in too general terms and failing
to report specific physiological measures, while Duke (1963) pointed
out the need for direct and objective measures of the phenomenon. De-
velopment of methodology and controlled experimentation for study of
the placebo effect, according to Shapiro (1964), may well be recorded
as the major advance in medicine made in the last decade.
Clarification of the placebo effect has assumed eminen ce in stated
research needs. Conceptualization of the placebo response must be
broadened to indude not only the inert chemical stimulus, but the entire
social inHuence situation surrounding placebo administration (Muller,
1965). Liberman (1962) suggested:
An inclusive study of the placebo phenomenon requires the break-
ing up of the total situation into its component parts . . . char-
acterized and defined according to their relative contributions to
the total effect: this is thc basis of variable-controlled experimenta-
tion. Failure to appreciate the distorting effect of uncontrolled
studies has led to confusion and uncertainty over the placebo
response [po 7641-
Tbe present study focused on darification and quantification of a
placebo effect. To overcome problems of experimental controls, nature
of measurements, and specific statements of variables and effects, em-
phasis was placed on operationally defining the effect, isolation of pri-
mary causative variables, and use of an appropriate control group. Re-
action time (RT) served as the dependent variable due to its ex-
perimental simplicity, ease of accessibility, and reliability. A placebo
effect was considered operative in any group manifesting a significant re-
duction in RT, using an untreated control group as a standard of com-
parison. The effect was analysed in terms of quantifiable components
enumerated by proportional contribution to RT reduction. Definition
of the placebo effect in terms of alterations of a basic sensory-motor
response became an important goal. Treatment variables induded
the placebo itself (lactose capsule), suggestion (the capsule would
speed up RT), and reinforcement (statements that RT was faster). Re-
search has suggested these variables as primary to a placebo effect (Buck·
alew, 1968). Tbe hypotheses were:
1. Suggestion (S) facilitates a major proportion of RT reduction
for a placebo effect.
2. Reinforcement (R) facilitates a minor but essential proportion
of RT reduction for a placebo effect.
3. The order of treatment groups in amount of RT reduction is,
from least to greatest:
a. placebo (P)
b. placebo-reinforcement (PR)
c. placebo-suggestion (PS)
d. placebo-suggestion-reinforcement (PSR)
 PLACEBO EFFECT 115

METHOD
Sub;ects
Introductory psychology classes provided 25 males and 25 females,
all of whom received extra credit for participation.
Apparatus
A multi-choice re action tim er was used which activated a chronome-
ter when a green or red light stimulus was presented and deactivated
it when S pushed a button or depressed a foot pedal. Chronometer read-
ings reHected RT. Placebos of multi-colored gelatin capsules containing
lactose were given to each S of Groups P, PR, PS, and PSR. "Ampheta-
mine" and "stimulant" appeared on the container label, viewed only by
Groups PS and PSR. A recorder was used to convey information and in·
structions to Ss.
Procedure
All Ss were tested individually in a laboratory setting, with chron-
ometer readings concealed from Ss. For each S, a test-retest situation
was instituted, with 20 min. of isolation intervening. In Phase 1, the
stimulus was a green light and response required pressing a foot pedal,
while in Phase 2, the stimulus was a red light and response involved
pushing a button. The Ss were instructed to use the preferred foot
(Phase 1) or hand (Phase 2) in responding. In both phases, three an-
nounced practice trials were pravided Ss. A randomized foreperiod (1-5
sec.) was used for each stimulus presentation, with a verbalized "ready"
by E signifying start of the foreperiod. The Ss were instructed to depress
the pedal (or button) as quickly as possible upon noting the stimulus.
Ten-sec. rest periods followed each RT trial. Procedures in Phase 1 were
identical for aIl Ss.
Immediately after Phase 1 trials, Ss of groups P and PR were given
a capsule of undivulged contents and assured that the capsule was not
harmfuI. The Ss of groups PS and PSR were given identical capsules,
though told they contained a powerful short-term stimulant which would
significantly speed up RTs. The contral group received no capsules. Fol-
lowing isolation, Phase 2 trials were run. In these trials, Groups C, P,
and PS received no differential treatment, while Groups PR and PSR
were told after each practice trial that their RT was faster.

RESULTS
Average RTs were computed for Ss in Phases 1 and 2, using trials
4 through 13 (initial and final three trials eliminated to avoid warm-up
and end spurt effects). Phase 1 RT served as the covariate (X), while
Phase 2 RT was the dependent variable (Y). Phase 1 RTs were inde-
pendent of Phase 2 RTs, which reHected treatment effects, and signi-
ficance of differences between Phase 2 treatment groups and the con-
tral group was of primary statistical interest. Analysis of covariance
116 BUCKALEW

randomized groups design was applied to the adjusted treatment mean

square and is summarized in Table 1.

TABLE 1
Summary Analysis of Covariance
for Phase 2 Reaction Time Measures

Source of Sum of Variance

Variation Squares df Estimate F

Treatments (b) 53.50 4 13.38 5.48·

Error (w) 107.32 44 2.44
Total (t) 160.82 48

"p < .01

The significant F ratio verified a placebo effect: operationally a
significant reduction in RT in a treatment group, using the control group
as a standard of comparison. To evaluate the first two hypotheses, in-
dividual group means on Y were adjusted for variation in X, and differ-
ences between treatment group means and the control group were
tested using Duncan's New Multiple Range Test. Table 2 presents this
application, with the significance of group difference set at the .01 level
of prob ability. Any two-treatment means not underscored by the same
line are significantly different.

TABLE 2
Duncan's New Multiple Range Test
Applied to Differences Between
Adjusted Phase 2 Treatment Means'

PSR PS PR C p Shortest
Significant
Ranges
Means 20.45 21.57 22.48 22.62 23.48
PSR 20.45 1.12 2.03 2.17 3.03 R2 1.87
PS 21.57 .91 1.05 1.91 Ra 1.95
PR 22.48 .14 1.00 R4 2.01
C 22.62 .86 R5 2.05
• All figures re/lect lOOths of a second.

Reduction in RT of each group, using the untreated control group

as a standard of comparison, may be noted from Table 2. The unique
contribution of each variable to total RT reduction of the effect
(.0217 sec. of group PSR) is presented in Table 3. Since Group P failed
 PLACEBO EFFECT 117

to. sho.w RT reductio.n, the variable o.f P was assigned a neutral value
(+0).

TABLE 3
Component (Treatment Variable)
Proportional Contributions to RT
Reduction in a Placebo Effect

Component Derivation Contribution

. Proportion

p C-P - .86 0
R C-PR + .14 71
S C-PS +1.05 481
SR (C-PSR) - (R+S) + .98 451
• All figures reHect lOOths of a second.

DISCUSSION
The F o.f Table 1 warranted the co.nclusio.n o.f significant differences
between groups in RT after treatment. These differences reflected the
quantitative effects o.f manipulating variables o.f the placebo., suggestio.n,
and reinfürcement. Statistical co.mpariso.n üf adjusted group means, as
seen in Table 2, indicated that o.nly the PSR group signincantly differed
früm the cüntrül gro.up in RT-by definitio.n, a placebo. effect.
The predictiün that suggestio.n was the majür cüntributo.r tü RT re-
ductiün was upheld by the pro.pürtiünal analysis o.f Table 3. Indispensa-
bility üf suggestiün tü a placebo. effect was suppürted by the placebo.
effect grüup (PSR) inco.rpo.rating the variable üf suggestiün. The secünd
hypüthesis, predicting that reinfürcement facilitated a minür tho.ugh
essential pro.pürtiün üf RT reductio.n in the placebo. effect, was cünnrmed
by finding that Gro.up PS did nüt manifest the effect while Grüup PSR
did. Analysis o.f Table 2 data suppürted the third hypüthesis, which pre-
dicted the relative ürder o.f treatment grüups in amo.unt o.f RT reductiün.
Buckalew (1968) also. repo.rted signincant differences between similar
groups in RT. In this study the PSR gro.up had a 10% RT reductiün when
cümpared with the cüntro.l grüup. Results o.f the present study stro.ngly
suppürt these findings (9.6% reductio.n für Gro.up PSR).
The placebo. variable cünsisted o.f capsules and their administratio.n
and acceptance. Since Grüups P and PR were nüt shüwn the cüntainer
label, Ss were free tü fürm persünal expectancies as to. nature and in-
Huence üf the capsules. Unstructured administratiün appears to. cün-
tribute tü interaperso.nal cünfusio.n in expectancy and subsequent re-
spünse diso.rganizatio.n, as Group P perfo.rmance in Phase 2 reflected
high within-grüup variatiün and o.ver-all decline in respo.nse emciency.
Lehmann and Knight (1960) investigated effects üf placebo. adminis-
tratiün ün a range üf psycho.physical and psycho.mo.tür tests, including
audito.ry RT, and co.ncluded that the müre basic and primitive the
118 BUCKALEW

function tested, the more likely are results to be free from placebo
effects. Using nondirective instructions concerning the nature and in-
fluence of the placebo, Ross, Krugman, Lyerly, and Clyde (1962 )
failed to find a placebo effect for the H-bar and tapping test. This
treatment was similar to that of Groups P and PR of the present study,
in which little change in RT was noted. Tables 2 and 3 reflect no signi-
fkant alteration of visual RT for either group.
The contributions of suggestion and reinforcement were easily iso-
lated from Groups PR and PS. Since the placebo variable increased RT,
it received no allotment as a proportional contributor to the placebo
effect as defined. Analvsis of Table 3 indicates that addition of reinforce-
ment to placebo administration overcame the depressive effect on RT
associated with placebo treatment. Although Group PR manifested little
RT improvement, reinforcement was an essential component in the
placebo effect (Group PSR), but alone (Group PR) was not sufficient
to induce the effect. Whitehorn (1958) suggested that reinforcement,
as a determinant of placebo effects, was a common denominator for all
snccessful psychotherapy.
Frankenhaeuser, Jarpe, Svan, and Wrangsjo (1963), using placebos
introduced either as a stimulant or depressant drug, found objective
auditory RT significantly affected in the suggested direction by both
treatments, with approximately a 6% RT reduction for the stimulant
treatment. Lyerly, Ross, Krugman, and Clyde (1964) found that ex-
pectations induced by instructions affected performance measures in
placebo groups. Brodeur (1965) investigated the effects of placebos
identified as amphetamine Or meprobamate on pulse rate and concluded
that effects of both stimulation and sedation can be induced by means
of a pill and knowledge suggesting specific effects. A majority of studies,
including the present, support Tibbetts and Hawkings (1956), who feel
it inescapable that the placebo reaction must be a manifestation of
suggestion. Confirrnation of the first and third hypothesis of the present
study warranted the conclusion that suggestion is indispensable to a
placebo effect and that groups incorporating this variable manifest the
greatest RT reduction.
Group PSR contributed additive effects of these variables as weIl
as the effect of combination; the unique contribution of Group PSR
to RT reduction involved an interaction effect between suggestion and
reinforcement. The variable of suggestion was the primary contributor:
48% of the RT reduction. As noted in Table 3, summation of independent
treatment variables accounted for only 55% of total RT reduction. The
remaining 45% was attributed to this interaction effect, which essentially
involved reinforcement of suggestion. In quantitative terms the placebo
effect of the present study was the result of placebo administration,
supported by directive suggestion (48%), reinforcement (7%), which
was contingent on expectancies, and inter action of these variables (45%).
Interpreted in a medical or psychotherapeutic framework, this effect
 PLACEBO EFFECT 119

could be correlated with giving a patient or client information, direction,

and support or confirrnation of predicted results. Certainly the potential
of this effect and its versatility of influence cannot be suppressed by
ethical cries of "dishonesty" if the foremost concern is for improvement.
The placebo effect is a phenomenon demanding recognition as a power-
ful, promising, and widely applicable modifier of behavior.

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