We've all heard of the Placebo effect. But a recent paper by
Zandonai & Chiamulera highlighted the "Ecocebo" effect, where a patient’s
environment, perceived or real, has a measurable impact on drug effectiveness. This
implies that clinical trials should aim for consistency in environment, but
also it may open another aspect of therapy.
What is an Ecocebo?
It could be defined as a placebo-like effect from one's immediate
environment. A variation on this is "neuroarchitecture", the cognitive
and emotional response to the built environment, reviewed in Higuera-Trujillo
et al, (2021).
So, some examples
A pioneering study by Roger Ulrich published in 1984
compared post-surgical outcomes between two groups with a simple difference -
half had windows with natural scenery and light, the other half had windows
facing brick walls. The first group not only recovered better, they took less
strong medication.
Natural light does seem to be an important factor. Walch et
al. (2005) found that spinal surgery patients exposed to high-intensity
sunlight required 22% less pain medication per hour, and had 21% less pain
medication costs, compared to those in low-light conditions.
Beyond this, in general what gives pleasure helps the
patient, and what causes stress does not. But quantifying how to achieve this
is not necessarily easy, although it can be done. To take a specific example,
Bar and Meta (2007) found curved furniture to be preferred to furniture with
sharp corners, and hypothesised this is due to a threat perception as the
amygdala is preferentially stimulated by the presence of sharp edges. However,
it does seem to be a general pattern, Vartanian et al (2013) showed that not
only did subjects prefer curved rooms rather than rectangular rooms with
corners, but the curvilinear rooms preferentially activated the anterior
cingulate cortex, a region associated with the emotional perception of
pain.
Study of the Ecocebo effect - Virtual Reality
Obviously, it is somewhat difficult to build hospital wards
specifically for such a study. However, Zandonai & Chiamulera argue that
improvements in virtual reality (VR) technologies do present an alternative,
being sufficiently "immersive" to fool the brain. Readers have
doubtless seen how even watching a good movie can elicit different emotional
responses.
Mimicking the original study, volunteers suffering chronic
migraines were subjected to a laser pain stimulus when immersed in either a
standard hospital waiting room, or an "ideal" room with a sea view.
Those lucky enough to get the sea view reported less pain (Tommaso et al 2013).
Following on from this, Presti et al (2022) generated a VR
system that presented different architectural features to volunteers, causing
varying emotional responses, and this is just one example.
VR therefore would appear to have possibilities for study of
beneficial medical environments, or indeed as a treatment itself.
Care should be taken with this technique though.
Marín-Morales et al (2021), monitored subjects as they walked through a museum
exhibit on the Holocaust, and an identical VR equivalent. Both groups self
reported very similar emotional responses, but the VR group had considerably
less heart rate variation and vagal stimulation. As Zandonai & Chiamulera
comment, the "sense of presence" is subjective, variable, and
difficult to quantify.
References
Bar, M., Neta, M. (2007). Visual elements of subjective
preference modulate amygdala activation. Neuropsychologia, 45, 2191–2200.
Higuera-Trujillo, J. L., Llinares, C., & Macagno, E.
(2021). The Cognitive-Emotional Design and Study of Architectural Space: A
Scoping Review of Neuroarchitecture and Its Precursor Approaches. Sensors,
21(6), 2193. https://doi.org/10.3390/s21062193.
Marín-Morales J, Higuera-Trujillo JL, Guixeres J, Llinares
C, Alcañiz M, Valenza G. (2021). Heart rate variability analysis for the
assessment of immersive emotional arousal using virtual reality: Comparing real
and virtual scenarios. PLoS One, 16(7):e0254098. doi:
10.1371/journal.pone.0254098.
Presti P, Ruzzon D, Avanzini P, Caruana F, Rizzolatti G,
Vecchiato G. (2022). Measuring arousal and valence generated by the dynamic
experience of architectural forms in virtual environments. Sci Rep., 12(1):13376.
doi: 10.1038/s41598-022-17689-9.
de Tommaso M, Ricci K, Laneve L, Savino N, Antonaci V,
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Ulrich, R.S. (1984). View Through a Window May Influence
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Vartanian, O., Navarrete, G., Chatterjee, A., Fich, L.B.,
Leder, H., Modroño, C., Nadal, M., Rostrup, N., Skov, M. (2013). Impact of
contour on aesthetic judgments and approach-avoidance decisions in
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Walch, J.M., Rabin, B.S., Day, R., Williams, J., Choi, K.,
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Zandonai, T., & Chiamulera, C. (2025). The Interplay
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