Placebos work, even when patients know they are a sham. One approach to placebo treatments might be the “Side-cebo”.
The way the side-cebo would work is like this. A physician prescribes a beneficial medicine where compliance is somewhat low, such as a statin. When describing the side effects of the medicine, the physician also notes that studies have found that some people who believe that the statin has beneficial effects on eczema actually do get better skin, although this is “generally thought to be a placebo effect.”
I say this being in the weird position of having created a side-cebo for myself. I am supposed to take a statin every day, and I got really bad at it, because of course you don’t see the effects of it. This is ridiculous, because I know taking this single pill reduces all-cause mortality for people in my risk group by the same amount that increasing exercise by 20 minutes a day does. It’s a massive effect.
I also have sleep issues, waking up constantly at 3 a.m. an unable to get back to sleep. I used to take benzodiazapenes for it, but as my tolerance increased I became disturbed about the dangers of them (benzodiazapenes are second only to opiates in drug-related deaths). So I gave up on them and decided just to suffer.
One night I remembered to take my statin pill (which I honestly forget nine out of ten days) and I woke up, weirdly, at 6 a.m. instead of the normal 3 a.m. The next night I took my pill and it happened again. I got excited and got on the internet and looked — was it possible Pravastatin had some effect on sleep inertia? (Sleep inertia is the technical name for my issue — I wake up at 3 a.m. not sleepy, but fully awake, like I’ve had two cups of coffee).
I looked on the internet, and surprise, there was no such side effect. In fact with other statins (although not mine in particular) some people had had sleeplessness.
That’s when, weirdly, I decided not to care. I decided to believe that there was some undiscovered side effect of this pill that helped my sleep. I began to take my pill nightly, dramatically lowering my risk of death. I began to sleep better too — not perfectly, and I still have incidents, but much fewer.
I don’t really understand why it works when I know technically that I am lying to myself. I am a bit worried that writing this long article will somehow strip the side-cebo of its power. But it’s hard to argue with the results, for the first time in my life I am actually taking my statin medication regularly and I am sleeping better.
I wonder if this might have any medical applications, or if the ethics is just too murky on it. In any case, it’s something you can try in your own life — look at the activity you want to make habitual and the issue you want to solve. Pair the two in your mind, and see what happens.
Hugo’s Closet shows another approach to changing behavior, through adding friction to undesired actions.
Sleep Inertia is the sleepiness on waking that helps us fall back to sleep if necessary. I seem to lack it.