Placebo Leadership

For her Brain Science podcast, Dr. Ginger Campbell interviewed Dr. Fabrizio Benedetti, author of 'Placebo Effects'  ... what they discussed provides information that threatens to make people better leaders.

Dr. Benedetti explains that in a 1960's study entitled 'Biology of the Placebo Effect in the Rat', experimenters introduced a pharmacological agent to the rodents which upset their balance and motor control, seeing them fall over etc., which was apparent and measured through various tests.

After a few repetitions of this process, the agent (drug) was replaced with a placebo, a saline solution ...  but someone forgot to tell the rats! Having been ill informed, they went through the same process and demonstrated the same results! i.e. They kept falling over; without any drugs in their system!!

Anyone who has ever heard of Pavlov will recognise this as 'Classical Conditioning', i.e. the capacity for a mammalian brain to learn to respond to a pattern of events with a pattern of behaviour, (often irrespective of the detail where pre-conditioning has occurred). e.g. if you get angry at people who cut you off when you're driving, you'll probably react with anger in all similar situations ... even when it may have been your fault ... (Admit it - we've all done this ... haven't we ...No! Just me then, lol?).

All joking aside, such experiments allow us to get a little specific and link this kind of clinical activity to some everyday language.

When it comes to a mammalian brain responding to stimulus (and yes! that includes you and me), we have 'mechanisms' in the brain which are activated. Two major mechanisms we can think of as 'Conscious' and 'Unconscious'. Where we consider a conscious placebo response we might talk about  the mammalian brain having 'Expectations'. When we are talking about classical (Pavlovian) conditioning (as described above with the rats), we are talking about unconscious placebo responses.

And as most of us go through life on auto-pilot (especially at work), it's most certainly those unconscious responses which we are able to provoke in people, (in-line with their prior experience), that we might want to concern ourselves with ... because, at that level, verbally communicated expectations play second fiddle to learned behaviour - BIG TIME!
That becomes incredibly important where you want your employees to act differently ... for better organisational results... and yet you communicate through words and e-mail rather than through action and example.

Dr. Benedetti gives the example of an Aspirin to help explain the principles behind placebo effects further ... An aspirin has an active ingredient, a pharmacological agent, but it also has a psycho-social context. i.e. it has size, shape, colour ... it normally comes in a blister pack, so the patient has to go through the ritual of opening the packet, popping the pill from the foil, getting a glass of water, placing the 'round', 'white' pill in the mouth to swallow it.
Once this has been repeated a number of times throughout life and the pain for which the pill is taken has been reduced or eradicated each time, the act of takingany 'round' 'white' pill will have the same effect ... that's right, irrespective of there being no active ingredient, the round white pill can be a placebo and it will still work!

On the strength of such findings, it can generally be said that conscious expectations are important for conscious physiological functions, like pain and motor performance; on the other hand we can say unconscious classical conditioning is more important for unconscious physiological functions like hormone secretion or the activation of immune mediators. That sounds technical, What does it mean?

It means, if you tell a patient 'I'm administering a drug that will increase your Growth Hormone levels' and then administer an inert agent (e.g. a saline solution), there will be no effect. The power of suggestion alone is not enough to provoke an unconscious response.
However, if you tell the patient you are going to administer a drug which increases growth hormone (GH) levels (and you give them the real drug), then show them the results of the drug ... then repeat for one or two days ... on the third day, you can administer a saline solution and you will still get the increase in GH. You can even tell the patient that you expect a decrease on the 3rd day (and give some reason why) and you will see the same level increase as you got from the previous two days and the real GH increasing drug.

The verbal communication is not enough to have an effect within the patient. However, the pre-conditioning activity is strong enough and it causes an effect irrespective of the expectations communicated verbally.

To spell it out - just telling someone something at work is not enough to counter imprinted / conditioned behavioural responses ... you have to lead by example and lead consistently if you want the automatic response to be in line with your expectations.

In relation to the findings from the clinical trials, it turns out that the way in which you respond becomes a completely unconscious function, what you expect doesn't matter, what matters is your previous conditioning.

This has been proven in trials with Morphine. One trial demonstrated it was possible to reduce the use of Morphine by 30% with patients who had been put through such 'Drug-Drug-Placebo' pre-conditioning activities.

On the strength of this knowledge, some hospitals are using the capabilities of the brain to great effect. The idea of the conscious mechanism being enhanced when rituals are apparent is directing nurses to develop standard operating procedures in which they ensure they explain the medicine, the expected outcomes of administering the medicine, how long the effects will last etc. to ensure the patient is 'primed' to get the best results. This conscious act of communication ensures the process stimulates the reward circuitry and ensure positive results ... but the positive impact is often enough to catch even the nurses out sometimes, many have questioned how their patients are able to report the effects of the medicine much faster than is biologically possible - the answer is 'the placebo effect'.

Another example to wrap things up is in relation to Deep Brain Stimulation (DBS) for those suffering with Parkinson's Disease. In these tests, sufferers of the neural condition, which see's them unable to stop their limbs from shaking, have a low voltage electrical probe introduced into their brain which, when turned on, interrupts the signals to the muscles and stops the shaking. In tests, such patients have been told the probe is activated when it's not, leading to their shaking reducing in-line with previous experience of the probe being switched on. They have also been told the probe is off when it's on, seeing the shaking increase in-line with prior experience. 

And finally, for anyone failing to make the connection to leadership and conduct in the workplace... let me put it like this.

Some of you may have heard about Maslows self-fulfilling prophecy. What it basically states is this;

• If I assume you are an idiot, I will treat you in-line with my assumption.
• My treatment of you will provoke a non-representative response.
• I will interpret your 'strange' responses as confirmation of my assumption.

Now, given the impact of expectation (Conscious mechanism placebo response) and the profound effect of conditioning (Unconscious mechanism placebo response), it's pretty safe to say that any 'consistent' treatment of people based on an assumption (that they are an idiot) is likely to ensure they will act in-line with their previous actions in the face of similar treatment.

Now consider the default 'attitude and assumptions' found in leaders at work in productive countries like Germany and compare them to the default stance taken by those in your own country.

In Germany, the assumption ... the 'expectation' is... 'People will do the right things well ... and we will provide them systems to support and enable them'. In other countries, the assumption / expectation is, 'People will do the wrong things, and anything right they do will be done poorly ... so we will use systems to control them'.

Now lets consider all of this in terms of organisational performance, 'Change' and perhaps most importantly 'sustainability'.
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What this latest look into the complexities of the human brain is telling us, is that you can introduce I.T. solutions, tools, techniques and processes till the cows come home, but if your leaders mindset and attitude is fundamentally premised on an assumption, that people need to be controlled rather than be given control, the culture those leaders create will never lead to maximised performance, because their very assumptions and resultant attitudes will pre-condition their employees to make mistakes and fail to take responsibility. 

So to draw to a close, what is starting to become too much writing for one thought process, let's say this.

Understanding the principles behind 'Placebo leadership' is just the tip of the iceberg. Today we can help leaders better understand Motivation, Anxiety, Social learning, reward mechanisms ... and how these issues can be considered consciously in the design of your organisations and systems ... just as it's the key for neuroscientists like Dr. Benedetti, understanding the human brain is also the key for Leaders in organisations ... we must increase the rate at which we come to know 'How the brain works' and I hope my musings above give you a taste of what is in store for those wanting to know more.

​We will expect your call :-)