Skepticism
calmness, OLP
SAID
Many participants in the IP group reported that they felt skeptical or doubtful about the intervention, especially in the beginning. While some participants expressed insecurities towards an unknown method, others mentioned doubts regarding the required resources (e.g., time, cognitive capacities). Comparably many OLP participants expressed initial skepticism.When asked about the other group’s intervention, a majority of IP participants preferred taking a pill the imaginative way. A physical component was not wished for, either due to the absence of the imagination component (which they liked), or because of a reluctance to taking real pills. Further, two IP participants expressed that the imagination was satisfactory and helpful, thus not wishing anything to be different:"So, it did help me, the imaginary pill, so I don’t know if a real placebo would have helped more than this." (IP; Subject 18)[about whether OLP would have been better]”I don’t think so, because then the imagination would have disappeared. I don’t know what would have happened if I had taken a Tic Tac […] but ehm, I think the pure imagination that I needed for it, would then have vanished. And that’s why I found it really cool that it is all about imagination, yes.” (IP; Subject 16)However, feedback from six IP participants indicated that the imaginative method is cognitively taxing and requires concentration and calmness. Three of those interviewees thus expressed that, even though the IP worked for them, taking a physical pill might have been easier and less tiring. On the other hand, eight participants in the OLP group expressed openness and interest toward an IP intervention, yet, assumed that an imagination might be more challenging. In this context, three participants also stated that they preferred taking a physical pill.[about taking an IP] “Yes, I mean the critical part in me says: […] ‘I need a physical correlation here, something that someone sends me, what someone has packed, what is produced […] It would probably be more difficult for me to believe in it.’ […] And then there’s another part in me saying: ‘Mind over matter.’ […] Just because you can touch it […] doesn’t really make any difference." (OLP; Subject 1)The treatment session where participants received the intervention reduced skepticism and strengthened the trust in the intervention. Almost all IP participants reported that–besides the explanation–the joint IP intake was helpful, fostered trust, and countered their initial skepticism. The comments of the IP participants showed that the single practice with the provider within the RCT was enough to gain security to continue the practice independently.“This exercise that was done together with the pill taking was kind of really cool, because I had this feeling of ‘huh that really works?’ […] I wouldn’t have expected that before.” (IP; Subject 12)Along these lines, almost all OLP interviewees were convinced by the rationale, which helped to reduce skepticism at the beginning and during the intervention. The most memorable and convincing discussion points in the treatment rationale were that the effects can occur even with a skeptical attitude (n = 5) and that a possible mechanism is assumed to be conditioning (n = 2), which can be explained by an automatic biological mechanism (n = 1).“So, the biological [discussion point] made sense for me, with the neurotransmitters, I think that’s the one that kind of sold me the most and that’s also the one that I thought about the most during the study as well.” (OLP; Subject 5)“I believe that an additional thing was that it was said that placebos also work, even if you don’t believe in it. Simply taking the pills can help. And I think that was something that was most notably decisive.” (OLP; Subject 6)