Table 2.

Scenarios for patient groups

Scenario	Aspect that might enhance placebo responding
Scenario 1: ‘Withholding side effects’ You visit your GP because you have noticed new or worsened symptoms. Your GP examines you, asks you about your symptoms, gives you a diagnosis and decides to prescribe medication. Your GP knows that if she provides you with positive information about the medication you are more likely to notice a benefit. So to make you feel hopeful about your treatment she tells you, truthfully, that research has shown that the majority of patients taking this medication notice a big improvement in their symptoms, and that you too, should notice a big improvement. The medication might have side effects, but your GP does not tell you about these. This is because she knows that if she does tell you about the possible side effects then you will be more likely to suffer from them.	Giving a positive message may enhance patients’ response expectancy; withholding information about medication side-effects may reduce the chances of the patient developing them via nocebo mechanisms.
Scenario 2: ‘Monitoring’ You visit your GP because you have noticed new or worsened symptoms. Your GP advises you to continue with your usual treatment but requests that you attend the surgery more frequently for ongoing review and monitoring of your condition. She also asks you to monitor your symptoms on a daily basis and report back to her at your next visit. She provides you with a special symptom-monitoring diary to help you to do this.	The use of regular monitoring and review may increase awareness of symptom changes and potentially motivate behavioural changes.
Scenario 3: ‘GP endorsement’ You visit your GP because you have noticed new or worsened symptoms. Your GP examines you, asks you about your symptoms, gives you a diagnosis and offers to prescribe a particular medication. You have heard of this medication and are not sure how effective it will be and ask if there are any other treatments you could try instead. Your GP says that there are but that he strongly believes (based on his experience with other patients and from published research) that the medication he wants to prescribe provides absolutely the best chance of reducing your symptoms in the shortest time.	Conveying the clinicians’ strong personal beliefs about a particular medication may enhance patients’ response expectancy.
Scenario 4: ‘Idealised consultation ’ You visit your GP because you have noticed new or worsened symptoms. Your appointment is with the same GP you always see. He greets you warmly and seems pleased to see you. He turns away from his computer screen and gives you his full attention. He is very interested and concerned about what you tell him. He asks you many detailed questions about how the symptoms started and how they are now affecting your daily life. He thoroughly examines you. He genuinely seems to be interested in you as a person and not as just a collection of symptoms. He allows you time to ask questions and even though he does not know all of the answers he provides as much information as he can and says he will try to find out more and will get back to you later in the day by telephone. He tells you that he would prefer it if you continue to make your appointments with him in future.	Enhanced attention, more time, warm and empathic and collaborative style may enhance perception of empathy, validation and response expectancy.
Scenario 5: ‘Deceptive placebo pills’ You attend your GP surgery because you have noticed new or worsened symptoms. Your GP examines you, asks you about your symptoms, gives you a diagnosis and recommends a prescription for medication. She tells you that research has shown that by taking this medication three times a day for at least a week, your symptoms will get better. What she does not tell you is that the medication she will be prescribing is actually a ‘placebo’ pill that contains no real medicine.	Prescribing a placebo medication deceptively may enhance response expectancy and engender a conditioned response to pill taking.
Scenario 6: ‘Open-label placebo pills’ You attend your GP surgery because you have noticed new or worsened symptoms. Your GP examines you, asks you about your symptoms, gives you a diagnosis and recommends a prescription for medication. She tells you that research has shown that by taking this medication three times a day for at least a week, your symptoms will get better. What she does tell you is that the medication she will be prescribing is actually a ‘placebo‘ pill that contains no real medicine.	Prescribing a placebo medication openly may enhance response expectancy and engender a conditioned response to pill taking.

GP, general practitioner.