Is it Ethical to Use this Teaching Tool?

Over the years, I have uncovered dozens (may even hundreds) of effective teaching strategies. But does this one cross your ethical boundaries? It’s highly effective, free, and, yes, fully legal. In fact, you may already be using it without knowing it. But what if it is so controversial that you’d never admit using it to others?

The Research

Let’s begin with the mystery: what is the free, powerful, and “under the radar” tool that some consider unethical? It’s the placebo effect. The word placebo is Latin, meaning “I shall please” (as in offering a positive thing to another). Before the last few decades, placebos were studied from the point of view of a ‘trick’ or even a ‘sham.’ But today we know placebos demonstrate the powerful interaction between the mind and the body.

For the sake of brevity, I’ll define placebo effects as “changes specifically attributable to the placebo expectations, neurobiological and psychological mechanisms” (Evers, et al. 2018). In a word, a placebo “biases” the brain to make a change.

Have you ever taken a drug that you were hoping would be effective? Your beliefs and biases actually can influence the results of that drug. Want proof? In antidepressant clinical trials, the natural history of the disease (an entirely predictable remission) accounts for 24% of the overall effect, the real placebo effect was 51%, and the drug effect for only 25% (Kirsch & Sapirstein, 1998).

Dr. Fabrizio Benedetti is a professor of physiology and neuroscience at the University of Turin Medical School. He is also a highly influential researcher in placebo effects. Recently, he was asked whether placebo research is fueling pseudo-science quackery. After all, placebos can partner with a marginal intervention and co-opt (as in over-represent) its results. Benedetti affirms the answer to that question with a robust “Yes!” What does this have to do with you? Keep reading.

As evidence, Dr. Benedetti showed that placebos could work as well as morphine on many types of inflammation (Benedetti, Pollo & Colloca, 2007). Benedetti gave Parkinson’s patients a placebo, which correlated with a reduction in patients’ muscle rigidity — they moved more easily. No drugs needed.

Placebo research today is widespread. It embraces a complex field of study from psychology to psychophysiology, from pharmacology to neurophysiology, and from cellular/molecular analysis to modern neuroimaging techniques. What neuroscientists have learned is that placebos are not ‘sham’ inert substances. Instead, they are combined with a series of processes (words, displays, rituals, symbols, etc.) which, in turn, can influence the subject’s brain.

Yes, the placebo effect can be pretty powerful. So much so that it is used as the standard comparison for whether a new drug is effective or not. In a new drug trial, if the placebo outperforms the drug, the drug is unlikely to get approved. But could the placebo process apply in a classroom?

Using placebos at school creates a very big and controversial problem for those (like me) who constantly search for and share “evidence-based” tools for learning. “How so?” you ask. Let’s put this in an educational context. As a hypothetical example, let’s say that a classroom intervention has a marginal but positive effect (maybe a 0.2 effect size) on student learning.

Using the additional “placebo effect” with a new classroom strategy can easily “bump up” its effectiveness from a 0.2 marginal effect to a moderate 0.5 effect size. As you may know, a 0.5 works out to a full year of expected learning. While that sounds good, there’s a problem. What’s the real effect of that intervention? Is it the number printed in a book or the effect you or I can get by adding the placebo effect to a substandard strategy? Let’s solve the puzzle.

What factors maximize the placebo effect?
When any approach is used with a student, be it sham or real, it is primarily impacted by context. Maximize the context and you get a stronger impact. Any of these tools below will boost the impact of an intervention you use (Benedetti, 2008). For example, when a placebo experiment is done well, there’s a set of psychosocial stimuli present in which you:

1. Confirm (never assume) by what you do, say, or show that you are an authority figure (class positioning at work, dress, posture, voice, actions, etc.).
2. Orchestrate the location of the intervention (in your classroom, does it look professional, and is it a safe place or not?)
3. Engage a relationship of trust with the student (“I know you can do this, and I’ve got your back 100%.”)
4. Evoke a memory of a successful prior experience to raise confidence. “Share with a neighbor a time when you had a successful new learning.”
5. Mention social confirmation used and you mention that others have also benefitted from this same intervention. “In my class last year, 90% of the students…”
6. Use proven, professional tools (e.g. a digital device, lighting changes, thermometer, flashlight, projector, a commonly accepted food or drink, or a stylus). Maybe you post up positive results of current students on the wall.
7. Expect positive future responses. Say, “The results may mean this may be advantageous and quite helpful for you.” Or, an affirmation is given. “In fact, an improvement will likely happen quite soon.”

While everything in the list above sounds like it is pretty basic, and you could find studies to back them individually in a classroom, there is a problem. Teachers use hundreds of strategies, and some are marginally ineffective. What I am saying is that you can take a marginal strategy and “juice it up” using the context tools from the placebo effect.

And that likely happens (unknowingly) every day in countless classrooms. Depending on whether the placebo effect is added, an average intervention might work really well. By the way, a terrible strategy is still a terrible one, with or without a placebo effect.

Each of the items above matters because context matters most with the placebo effect. Students’ expectations, memories, and where the intervention is done matter. But so does the trusted relationship between the student and teacher (Rossettini, Carlino & Testa, 2018). Let’s take a moment to investigate how just one area can support the placebo learning effect.

Let’s focus on the use of eye contact. Start with a soft, warm gaze. Then follow with your ability to empathize emotionally, sharing the other person’s emotional feelings (“I feel what you feel.”) When you identify with what a student is going through, you infer the mental state of that other person (“I understand what you feel.”), and you connect in another way. These connections can raise the trust levels via oxytocin influence (Ellenbogen, 2018).

Placebos can be an exhausting research model, so let me summarize the results for you. The aggregate of all seven “placebo factors” on the list above is also what you might see in a highly effective teacher. And no one is calling it the placebo effect. According to the research, all highly effective teachers are “juicing up” the value of their strategies with active placebos. And most don’t know it.

The Evidence the 7 Factors Work
Contextual effects (i.e., placebo response) refers to all behavioral changes resulting from administering a purposeful inactive treatment. This meta-research included 186 trials (16,655 subjects). The study examined the average proportion of the overall treatment effect attributable to contextual effects.

In these randomized clinical trials, compared to a control group, the overall treatment effect (i.e., the post-treatment effect in the intervention group) can be regarded as the true effect of the intervention plus the impact of contextual effects.

On average, 54% of the overall treatment effect was attributable to contextual (placebo) effects. Translated, over half of the results among thousands of studies were placebo effects. Their contextual effects were higher for trials with blinded outcome assessors (others did the assessing) and concealed allocation of interventions (Hafliðadóttir et al., 2021).

As we explore all available, quality evidence, it indicates that the placebo effect (and response) is a genuine psychobiological event, and it’s attributable to the overall context for learning (Finniss, Kaptchuk, Miller & Benedetti, 2010).

Let’s review. Staying with the definition of a placebo, its administration is never attributable solely to an inert substance alone (a sugar pill or saline solution) or an action that replaces the real drug or intervention. The placebo engages the human to human therapeutic properties within sensory and social stimuli that says to the subject, “This is beneficial.” The true effect occurs because of the psychosocial context surrounding the inert, pseudo intervention, and the subject. Placebos are much more than a sugar pill.

Practical Applications

Here are two examples of how teachers may have already used this process with students.

First, I recall a highly successful math teacher who used Orange Crush Soda as a reward in his high school class. He touted the drink’s “magical powers” (with a wink), and the kids worked really, really hard to earn a can. By the way, his class scores were through the roof! Placebo effect? Absolutely.

Here’s a strategy I used. “Hey kids, today we are going to do a simple experiment. Some of my colleagues have also found this a great way to focus the brain and remember your learning.”

“First, let’s all stand up. Now, let’s jog in place for 15 seconds. Ready, set, go! Pause… Next, we’ll nose breathe only and slowly inhale and exhale for 15 more seconds. Ready, set, breathe slowly. This oxygen juices up the brain to boost your learning. Finally, have a seat, please. You now have just three minutes to complete our daily retrieval practice.”

“Wait a minute,” you say. “That’s science, not a placebo!” Yes, this quick stress and de-stress activity with a calm-down nasal breathing tool sounds like you could actually call it scientific. But I have never seen peer-reviewed, quality studies that validate that exact process. The ingredients do seem genuine to me. I believe in the science behind this strategy. So, am I using a placebo?

Yes, I am. There you have it; I am guilty. But is it a sham? No, I have never seen this 30″ sequence disproved, and I never falsely quoted that it was hard science. And educators would be crazy to avoid the placebo effect. Though in today’s social media world, you might want to call it “mindset preparation” or “thoughtful teaching.” Time for a few more examples.

Here are three simple “placebo” tools that enhance your effects:

1. Credibility is critical. Students who perceive you are knowledgeable, sharp, and “with it” believe in what you say and that the strategy you suggest will work. Share with your students when you learn new things. Demonstrate to your kids your own passion and energy for ongoing learning; that role models to your students that you have enthusiasm for learning. Also, you can show evidence that what you do works. How? A 5th-grade teacher in a high-poverty elementary school would post up college banners to inspire students. Sounds like a decent idea. But wait… He juiced up the impact by putting the students’ names from his past 5th-grade class who attended that particular university. That’s a powerful credibility statement to his kids! Now they believe that what he says and what he does as a teacher might help them go to college, too. It’s also a placebo effect.

2. Meet and greet students each day. This act engages plenty of mechanisms in the student’s brain responsible for expectations, trust, and hope. This is a great moment to demonstrate or show empathy and compassion. For example, if a student is having a tough day, you might say, “I am so sorry that happened to you. It’s painful to hear that.” or, “I get it. I’ve felt something like that before.” Both of these emotional responses can contribute to the success of your intervention. This suggests that regardless of the intervention’s effectiveness or ineffectiveness, you may trigger favorable placebo responses of trust in students (Benedetti, 2008).

3. Use leading affirmations. There is also compelling evidence that different sentences such as “This may work.” or “Rest assured, this does work.” may lead to higher academic outcomes (Benedetti, 2002). In short, your students are susceptible to subtle cues from a trusted educator (making a specific teaching strategy work better.) Surprisingly, even when students find out that you were bluffing about the intervention working, many subjects will still gain benefits (Schafer, Colloca & Wager, 2015).

That’s it for this month; it’s closing time. Now for my biggest fear. Maybe you still use the ‘time bias.’ Many will read this newsletter and then respond, “I’m just too busy; I’ve got no time for those changes to help me and my students soar like eagles.” If you feel that way, I am sorry; I have failed you. I failed to activate your choice of playing the ‘long game.’ Biases are shortcuts to save time and are often about the ‘short game.’

You see, life goes by so fast that many would say, “Live in the moment, smell the roses, life is short.” And they’re right. Life is about savoring the smell of the flowers, eating a great meal, and enjoying hugs from friends and family.

But most everything in life worth having over a lifetime also requires the ‘the long game.’ At school, it includes building relationships and fostering cognitive capacity. At home, the list includes maintaining relationships, appreciating the daily blessings, and saving for retirement. Choose right now; what have you decided on – long or short? Then begin, right now.

Eric Jensen
CEO, Jensen Learning
Brain-Based Education