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Yıl:2007; Cilt: 10; Sayı: 19>> Özet
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Türk Psikoloji Yazıları; 2007;10(19):33-54
Plasebo Etkisi: Kuramsal Yaklaşımlar ve Fizyolojik, Nörolojik ve Psikolojik Bozuklukların Tedavisindeki Rolü
HB Ayvaşık, O Yorulmaz
Orta Doğu Teknik Üniversitesi, Ankara
Plasebo, aktif maddenin (örn., ilacın) ya da işlemin etkisini karşılaştırmak için katılımcılara (hastalara) verilen ya da uygulanan aktif olmayan madde ya da işlemdir. Plasebo şekerli tablet, serum fizyolojik gibi farmakolojik bir madde olabileceği gibi fiziksel (örn., yapmacık elektriksel uyarım) ya da psikolojik (örn., hasta ile sohbet) bir müdahele de olabilir. Plasebo uygulanan hastada gözlenen fizyolojik ya da psikolojik etkiye ise “plasebo etkisi” adı verilir. Plasebo etkisi acı/ağrı, ülser, astım, Parkinson hastalığı ve depresyon gibi pek çok rahatsızlığın tedavisinde gösterilmiştir. Plasebo etkisine ilişkin kuramsal yaklaşımlar arasında beklenti kuramı ve klasik koşullama yaklaşımı, literatürde en popüler olan yaklaşımlardır. Beklenti kuramına göre, kişinin uygulanan tedavinin etkisine ilişkin beklentisi, bazı fizyolojik değişikliklere neden olmaktadır. Kişi plasebo alsa bile uygulanan tedavinin onu iyileştireceğini düşünüyorsa, plasebo etkisi ortaya çıkmaktadır. Klasik koşullama yaklaşımına göre ise ilacın yarattığı etki koşulsuz tepki, ilacın uygulandığı bağlamdaki uyarıcılar (örn., nesneler ya da insanlar) öncelikle nötr uyarıcı olmakta; bu uyarıcılar ilaç ile eşleştiğinde ise koşullu uyarıcı özelliği kazanmakta ve ilacın etkisine benzer etkiler ortaya çıkarmaktadır. Plasebo etkisinin nörobiyolojik temelleri ile ilgili çalışmalar, özellikle endojen opioid sistemi ve dopamin mekanizmalarına odaklanmıştır. Acı/ağrı, Parkinson hastalığı ve depresyonun tedavisinde, plasebo etkisine hem psikolojik hem de biyolojik etmenlerin ve bunların etkileşiminin aracılık ettiği gösterilmiştir. Ancak, plasebo etkisinin ölçülmesindeki yöntemsel sorunlar ve çözüm önerileri halen tartışılmaktadır.
Placebo Effect: Theoretical Approaches and the Role of Placebo Effect on the Treatment of Physiological, Neurological and Psychological Diseases
Placebo is an inert substance or procedure that is administered to the subjects (patients) to compare the effectiveness of the active agent (i.e., drug) or procedure. A placebo might be a pharmacological agent such as sugar pill and saline as well as physical (i.e., shame electrical stimulation) and psychological (i.e., conversation with the patient) interventions. Placebo effect is the physiological or psychological changes occur in the patient after the administration of a placebo. Placebo effects are well established in a variety of diseases including pain, ulcer, asthma, Parkinson’s disease and depression. Among the theories proposed to explain the placebo effect, there are two well-known approaches in the literature: expectancy theory and classical conditioning approach. According to the expectancy theory, expectancies about the effects of the treatment or interventions might result in some physical or physiological changes in the person. If the person believes that the treatment will result in beneficial effect even s/he takes a placebo, this expectancy leads to placebo effect. According to the conditioning approach, an unconditioned response (i.e., pharmacological effect of a drug) elicited by an unconditioned stimulus (i.e., drug) becomes a conditioned response due to the repeated pairing of a conditioned stimulus (i.e., placebo) and unconditioned stimulus. Studies on the neurobiological basis of placebo effect have been especially focused on endogenous opioid system and dopamine pathways in the brain. Both psychological and physiological basis of the placebo effect are especially demonstrated in pain, Parkinson’s disease and depression. However, the methodological problems in measuring placebo effect and suggestions to solve the problem have been still a debate in the related literature.

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