Rituals
are a sequence of activities, performed in a sequestered place, and performed
according to set sequence. Rituals are something we all partake in as part of
living in society. We just had the centuries old ritual of going door to door
wearing customs and asking for candy on October 31st. We also saw
the breaking of the 108-year-old ritual of the Chicago Cubs fans saying, “There
is always next year” after not winning the World Series.
Why do we have rituals? From a psychological perspective, we
use this repetitive behavior systematically to help neutralize or prevent
anxiety. It gives a sense of order and predictability in a very chaotic
unpredictable world. (Our nervous system is an intriguing part of our body, it
likes novel new things as long as there isn’t too much uncertainty that goes
with it. Also because it requires a lot of energy to function, it recognizes
that it needs to look for short cuts to run somethings on autopilot. Read Thinking, Fast and
Slow for more on this.) Thus rituals allow us some certainty: when I do
this, and then this, this will be the next thing to occur. Also, over time
these rituals become very ingrained and occur with little to no thought to
conserve energy. This type of ritual response can be part of a conditioned
response (Classic
‘Pavlovian’ Conditioning).
Understanding this concept of the therapeutic ritual and
conditioned responses helps us understand the research the shows significant
pain reduction benefit, even when placebo is revealed. This study showed
that even when patients knew they were receiving a drug that was a placebo they
still had improvements in pain reduction.
One of the researchers, Dr. Kaptchuk reported: “It’s the benefit of being immersed in treatment: interacting with a physician or nurse, taking pills, all the rituals and symbols of our healthcare system. The body responds to that.”
So what should we as clinicians do with this type of
understanding? Be comforted in knowing we can deliver pseudoscientific placebo
interventions ethically? Research shows placebos work even when someone
knows about it. So, ethically all you have to do is keep them informed, right?
I would hope not! I think we need to look carefully at our care we deliver.
Maybe the outcomes I’m getting are not due to specific effects
of my treatment, but just the therapeutic ritual that surrounds it. I need to
understand how to ethically enhance the therapeutic ritual surrounding an
evidence based intervention that does actually have specific effects that helps
individuals. I can Engage,
Empathize, Educate, Enlist, and End as I provide
patient-focused care.
What say you?
via Dr. Kory Zimney, DPT
Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!
Keeping it Eclectic...
Post a Comment
Post a Comment