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How do different message framing manipulations influence the effects of active placebos?

How does positive and negative message framing affect the placebo effect in a model of active placebos for sleep difficulty? A randomised controlled study in sleep-impaired adults

Status
Terminated
Phases
Unknown
Study type
Interventional
Source
ANZCTR
Registry ID
ACTRN12620000232932
Acronym
Nil known
Enrollment
104
Registered
2020-02-25
Start date
2020-03-09
Completion date
2021-05-13
Last updated
2021-11-15

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

The underlying principle of trials evaluating the effectiveness of pharmacological treatments is to compare a drug against a placebo. The difference in effectiveness is then attributed to the active ingredient of the drug. Typically, placebos are designed to resemble the drug as much as possible, but conventional placebos that only contain lactose fibres (or other inert substances) do not elicit side effects and therefore do not fully resemble all features of the drug. We therefore developed and evaluated an active placebo that elicits side effects but has no other effects on sleep. Prior research has shown that perceived treatment allocation and beliefs about side effects can influence an intervention’s effectiveness. We therefore want to further understand the role of participants beliefs about side effects. The main aim of this study is therefore to test whether framing participants beliefs about side effects influences the efficacy and tolerability of an active placebo. We hypothesise that participants receiving positive framing will demonstrate a larger placebo effect for sleep than a no-framing condition, and that a negative framing condition will show the smallest placebo effect.

Interventions

Participants will be recruited under the guise of a study testing a new formulation of an antihistaminic drug containing beetroot extract as an antioxidant efficacy booster, but no active treatment is actually delivered. Instead, after one week of baseline measures participants will be randomised to one of four groups: three active placebo groups that receive either a positive, negative, or no message framing, or to a no-treatment control group. Message framing is a process whereby communicators

Participants will be recruited under the guise of a study testing a new formulation of an antihistaminic drug containing beetroot extract as an antioxidant efficacy booster, but no active treatment is actually delivered. Instead, after one week of baseline measures participants will be randomised to one of four groups: three active placebo groups that receive either a positive, negative, or no message framing, or to a no-treatment control group. Message framing is a process whereby communicators act to construct a point of view that encourages the facts of a given situation to be interpreted by others in a particular manner. The positive message framing will inform participants that the experience of the target side effect, i.e. red-ish urine means that their body has absorbed and metabolised the medication well and the medication is likely to improve their sleep. The negative message framing will inform participants that the experience of the target side effect, i.e. red-ish urine means that their body has not absorbed and metabolised the medication well and the medication is not likely to improve their sleep. After the randomisation participants in the placebo groups will be handed an information sheet about the new formulation under investigation that will contain the message framing. After participants have read the message framing in the presence of the psychologist conducting the experiment, he will ask if they have any questions, clarify potential questions and repeat the most important parts of the information, verbally repeating the message framing. Participants only receive the message framing on one occasion during the second study visit in written and verbal form, they will not be reexposed to the message framing. Participants randomised to the active placebo groups will be blind towards their framing condition, and told they are receiving an antihistaminic drug. The no-treatment control group will be told that they will not receive treatment and will instead serve as a control group for the natural course of their sleep difficulty and daily symptoms. The placebo capsules will be made of gelatine. The active placebo groups will receive four capsules per day for 7 nights containing each 625 mg of the food colour E 162, i.e. beetroot extract and 125 mg oxalic acid to stabilise and guarantee the absorption of the beetroot extract. The intention of the active placebo is to produce beeturia, i.e. a red-ish colouration of the urine to simulate side effects. Adherence to the capsules will be assessed using a daily participant diary. Additionally, participants will need to return the capsule container containing all capsules they have not taken at the end of the study.

Sponsors

The University of Sydney
Lead SponsorUniversity

Study design

Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject)

Eligibility

Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

(1) at least 18 years of age; (2) threshold score of =10 on the ISI

Exclusion criteria

(1) taking prescription medication (other than the contraceptive pills); (2) pregnancy, trying to conceive, or breastfeeding; (3) received treatment for sleep difficulty in the last three months; (4) antihistamine, beetroot, or lactose allergy, or any other intolerances; (5) abnormal/deficient kidney functioning or any other medical condition; (6) gastric problems or sensitive stomach (e.g. acid reflux)

Outcome results

None listed

Source: ANZCTR · Data processed: Feb 4, 2026