There are always news to report: the participating teams of the SFB/TRR 289 are looking for collaborators and study participants, deliver talks, and publish their results. You can take part in the scientific as well as public discourse. From open study calls and reports in the media to scientific publications - here you can discover what is currently happening at the Collaborative Research Center "Treatment Expectation".
How can we optimize the expectations of patients in order to increase the success of therapies? Prof. Dr. Johannes Laferton is investigating this question. He also works with teams from our CRC—and is therefore very welcome as a new associate member of our research network. In this interview, he explains his current projects.
Expectations are an essential mechanism of placebo and nocebo effects and thus a widely documented influencing factor for the success of medical treatments. Prof. Dr. Johannes Laferton, professor of medical psychology and psychological psychotherapist at the HMU Health and Medical University Potsdam since 2020, has long been researching how to optimize patient expectations.
In June 2025, Laferton initiated a joint, highly acclaimed article with Prof. Meike Shedden Mora and Prof. Winfried Rief from SFB 289 “Treatment Expectation” for the Journal of the American Medical Association (JAMA). As part of the series “JAMA Insights – Communicating Medicine,” the three researchers explain four evidence-based communication strategies that practitioners can use to specifically promote positive expectation effects.
Prof. Laferton is a new associate member of SFB 289. His research has several points of contact with existing SFB 289 projects, such as projects A09 and A15 on antidepressant treatments and A13 on hip surgery.
How do patients' expectations influence the success of antidepressant treatments or the recovery process after knee surgery? How do therapies in turn affect expectations? And how can practitioners strengthen positive expectations in order to increase the chances of success of therapies? Johannes Laferton is conducting research at the HMU Health and Medical University Potsdam, exploring the tension between these questions.
Professor Laferton, where does your interest in the complex field of “expectation optimization” come from?
For me, one of the central questions is how we as therapists can help patients develop more positive expectations. I previously worked on the PSY-Heart study with Prof. Winfried Rief in Marburg. There, we were able to demonstrate that simple psychological interventions can optimize expectations in patients prior to heart surgery, thereby further increasing the success of treatment. Back in 2017, this was already a good example of the significant impact that addressing individual treatment expectations can have on patients.
You won a poster award at SIPS in Krakow for your project “Dynamics of patient expectations in antidepressant treatment.” What is the key aspect?
In the past, expectations in the context of antidepressant treatment were almost exclusively surveyed in randomized controlled studies. Often, expectations were only asked about once, at the beginning or end of treatment. As a result, it is still difficult today to determine, first, the exact interaction between antidepressant treatment and expectations and, second, the exact interaction between antidepressant treatment and expectations.
The aim of our new study is to repeatedly record aspects of antidepressant treatment such as symptom change, side effects, interaction with practitioners, and treatment expectations over the course of treatment, thereby gaining a more precise understanding of their mutual dynamics.
Do you have a hypothesis?
Hypothesis 1 is: There is a correlation between changing expectations and the progression of depressive symptoms and side effects in the context of antidepressant treatment. Hypothesis 2 is: There is a correlation between the progression of depressive symptoms and side effects and changing expectations in the context of antidepressant treatment. And hypothesis 3 is: Positive therapist-patient interaction is related to expectations and the course of depressive symptoms and side effects in the context of antidepressant treatment.
That sounds complicated. Is this a chicken-and-egg question?
Yes, essentially. Are there changes in expectations from day to day, and are these changes related to therapeutic improvements or symptom worsening? Or are they related to communication between therapists and patients? There is still very little research on this interaction in normal routine care for antidepressant treatment. We use a mobile phone app for this purpose, in which patients answer questions about their expectations, depressive symptoms, and side effects every evening in two to three minutes. Around 100 patients are involved in this study.
What consequences could your findings have?
If we can better understand the precise relationship between expectations, treatment success, and side effects in antidepressant treatment, it would help us to use interventions for expectation optimization in a more targeted manner. Either by suggesting specific communication strategies for expectation optimization to the treating physician or by attempting to address patients' expectations directly, for example via digital health applications.
In a new project that is currently getting started, you are examining different patient groups prior to knee replacement surgery. What exactly do you aim to find out?
We want to know how different techniques can be used to optimize treatment expectations for knee replacement surgery. Before any therapy, patients consider: Is this the right therapy for me, how will it work for me, will I have side effects, how quickly will I get better? This applies to mental health issues as well as primarily physical complaints.
Knee replacement surgery is one of the most common surgical procedures worldwide. Many patients feel significantly better after the operation, but 10 to 20 percent of those who undergo surgery are not satisfied with the results or continue to experience chronic pain even after the operation. Previous studies have shown that patients' expectations prior to knee surgery are related to the success of the operation: people with positive expectations also have better surgical outcomes.
Our question now is: Can these expectations be specifically addressed before knee surgery in order to further improve the outcome of the surgery? To this end, we first want to test suitable communication strategies. In a feasibility study, patients who are scheduled for knee surgery will receive our workbook “My Surgery Coach,” which provides them with information to help them develop realistic, positive expectations about the surgery and their life afterward. In addition, following each of the three chapters in the workbook, we will conduct a 30-minute conversation via (video) call to develop personalized, realistic and positive expectations together with the patients. We expect results in 2026. If patients find expectation optimization helpful, we want to conduct a larger study to investigate whether it can also further improve surgical outcomes.
Link to the JAMA publication:
Laferton JAC, Rief W, Shedden-Mora M. Improving Patients’ Treatment Expectations. JAMA. Published online June 04, 2025. doi:10.1001/jama.2025.6261
https://jamanetwork.com/journals/jama/article-abstract/2834861
You can find out more details in the podcast with Prof. Johannes Laferton:
JAMA Podcast Clinical Reviews – Prof. Laferton in conversation
https://jamanetwork.com/journals/jama/pages/jama-clinical-reviews
A chronic burning, stinging, or itching sensation in the vulva area with no clear cause – lasting for months, often even years: vulvodynia is extremely distressing. The Collaborative Research Center 289 “Treatment Expectation” is committed to better informing the public about this disease – and making therapies more effective for those affected.
Between five and ten percent of all women suffer from unbearable pain in the external genital area during their lifetime. For many of them, even everyday activities such as riding a bike become impossible. In Germany, vulvodynia often remains undiagnosed for years. Those affected experience not only physical but also psychosocial stress. This condition is largely unknown to the general public, and those affected struggle for recognition and adequate support.
When the diagnosis is finally made, many of those affected are faced with the task of thoroughly informing themselves about the condition, as they are often left to their own devices on their path to recovery. Although a multimodal treatment approach exists, its effectiveness is so individual that it remains unclear what ultimately provides relief. Such a situation can promote negative expectations—and thus complicate attempts at therapy.
Photographer Celia Joy Homann has set herself the goal of raising public awareness of chronic pain in the genital area. As part of her Bachelor thesis, she has designed an exhibition that aims to break the taboo surrounding vulvodynia and offers suggestions for improving communication between healthcare professionals and patients. Her artistic photographic approach describes a new dimension in conveying information about chronic pain and promotes education about chronic pain in the genital area.
The CRC supports Homann's photography project, which was on display as an exhibition in Dortmund in August 2025. A photo book with interviews with those affected and contributions from doctors from various therapeutic fields will be published to accompany the exhibition.
In her photographic work, Celia Joy Homann focuses on the still barely-known diagnosis of vulvodynia. Her images make pain visible that is rarely talked about in our society. Intimate portraits and atmospheric imagery create a visual space in which the invisible takes on a tangible form. The aim of the work is to raise awareness and break the taboo surrounding chronic pain in the genital area.
Ms. Homann, what prompted you to address the topic of vulvodynia?
The idea to create a project about vulvodynia arose from a desire to open up the topic and make it more visible. I was shocked to learn that vulvodynia exists, that so many women are affected by it—and yet so little is known about it. Even though topics related to the vulva are now being discussed more openly and many people are informed about vaginism or endometriosis, hardly anyone knew what vulvodynia was—myself included.
What was your initial impulse for the artistic realization?
When you search for information about vulvodynia online, you almost always come across articles with a similar image as the lead. Most of these images show women holding their stomachs and grimacing in pain – as if they were nauseous. I found this type of representation inappropriate. Because the pain is not located in the abdomen, but in the vulva – on the outside, as well as in the entrance area.
I wanted to find imagery that more accurately and tangibly describes how this pain manifests itself. A visual language that boldly shows the problem – without slipping into vulgarity or shame. A language that does justice to the experiences and in which those affected can see themselves reflected.
The lack of such forms of representation of female pain gave rise to my initial impulse: to develop a new visual world that not only “shows” but also allows people to “feel.”
What did you take away from your conversations with those affected?
Many women have endured a long and lonely journey before finding help and words to describe their pain. Most were fed up with the fact that no one knew anything about vulvodynia—and wanted to share their stories to raise awareness and help others. It became clear that every woman affected experiences the pain differently, has her own way of dealing with it, and has an individual progression of when and how it gets better. A key message from the conversations was: “Be good to yourself. Treat yourself with love.” Relaxation—both physically and in everyday life—plays an important role for many. And several interviewees find that taking probiotics helps.
What would you like to see in terms of how this issue is dealt with – socially and medically?
More visibility and openness. Pain in the vulva should not be a taboo subject. I want to open up the discourse on vulvodynia and make the word “vulvodynia” more widely known. Everyone should know what it is so that they can take those affected seriously, listen to them, and respond appropriately. We need open spaces for discussion of this topic—including in gynecological practices. I would like to see those affected receive help more quickly and be listened to more attentively. They should not have to feel alone—instead, they should find ways to network and exchange ideas.
It is well known that placebo effects can alleviate symptoms of illness: for this reason, new drugs, for example, should always be tested in comparison with a placebo treatment in order to determine their actual effectiveness. However, even a known effective therapy can be improved if the treating physicians additionally increase positive expectations regarding the active ingredient. Researchers from the SFB/TRR 289 “Treatment Expectation” have demonstrated this in an experimental study.
A total of 124 healthy volunteers received either ibuprofen treatment or a placebo in the experiment, combined with either a positive or neutral explanation from the treating physician. All participants were then injected with the substance lipopolysaccharide, which causes inflammation-related disease symptoms. Up to six hours after the injection, the researchers measured several inflammation markers and recorded the physical symptoms of the participants, such as pain or swelling, as well as psychological symptoms such as feeling low or feeling ill.
Positive expectations alleviated the symptoms of illness – and enhanced the effect of ibuprofen
The result: As expected, those treated with ibuprofen showed fewer symptoms of inflammation than those in the placebo group. However, even a placebo treatment alone was able to alleviate the symptoms – when combined with a positive explanation from the doctor. And the effect of ibuprofen was significantly greater when the doctor had previously raised positive expectations of the medication.
These improvements were particularly noticeable in symptoms reported by the participants themselves, especially so-called affective or psychological symptoms. In contrast, the doctor's explanation had no influence on the physiological markers of inflammation – an indication that expectation effects work in a different way than directly influencing the immune response.
This study, in which our projects A04, A10, and A11 participated, shows for the first time that placebo effects can also increase the benefits of active ingredients in cases of inflammation. This is an important finding for healthcare professionals: even small changes in the way patients are addressed give a positive connotation to a therapeutic measure, which can significantly increase the success of the therapy.
Original work:
Schmidt, J., Reinold, J., Rohn, H., Schedlowski, M., Engler, H., Elsenbruch, S., & Benson, S. (2025). Placebo effects improve sickness symptoms and drug efficacy during systemic inflammation: a randomized controlled trial in human experimental endotoxemia. BMC medicine, 23(1), 455. https://doi.org/10.1186/s12916-025-04292-8
"Ibuprofen works even better with the right words" – Foto: freepik
How would you like your placebo?
Once a day as a white pill, please.
Representatives of patient organizations present their participation in research on placebo and nocebo effects for the first time at a SIPS conference. As part of the Collaborative Research Center 289 “Treatment Expectation,” a Patient Advisory Board (PAB), consisting of 16 members, was established in 2024. This board has the task of accompanying and enriching the CRC's research projects from the perspective of those affected.
Prof. Ulrike Bingel, spokesperson for SFB 289 “Treatment Expectation,” welcomes the members of the patient advisory board at the opening event of the SIPS Conference 2025. From left to right: Prof. Ulrike Bingel, Dorothea Fell from the German Rheumatism League, Sonja Arens from the Bundesarbeitsgemeinschaft Selbsthilfe, and Oliver Vorthmann from the German Depression League. On the right is Anna Borgmann from the Medical School Hamburg, psychologist and coordinator of the PAB.
At the 5th SIPS conference in Krakow from June 15th-18th, 2025, Dorothea Fell from the German Rheumatism League, Sonja Arens from the Federal Working Group for Self-Help, and Oliver Vorthmann from the German Depression League explained their wishes and tasks as members of the PAB to researchers at the poster session.
As a member of the board of the Federal Working Group for Self-Help for people with disabilities, chronic illnesses, and their families, Sonja Arens brings the perspective of 119 self-help associations and 13 state working groups to the CRC. “I think this is a wealth of knowledge that can help shape research on treatment expectations in a meaningful way,” she says, explaining her commitment. “In addition, the conference gives me the opportunity to network and gain insights into international placebo research, while at the same time explaining in discussions how important the participatory involvement of patients and the research of this topic is.”
Dorothea Fell from the German Rheumatism League emphasizes, in view of the diverse topics covered at the SIPS conference, "how important it is to ask the right questions when it comes to treatment expectations: How do I formulate a question to get to the heart of the problem in this very complex placebo research? And how can we succeed in understanding the person as a whole?" Oliver Vorthmann from the German Depression League is also enthusiastic because Krakow and the SIPS conference have exceeded his expectations.
At the poster session of SIPS 2025 in Krakow, the patient advisory board of SFB 289 explains its work. From left to right: Oliver Vorthmann from the German Depression League, Prof. Ulrike Bingel from the University of Duisburg-Essen, Sonja Arens from the Bundesarbeitsgemeinschaft Selbsthilfe, Dorothea Fell from the German Rheumatism League, Anna Borgmann from the Medical School Hamburg, and Prof. Winfried Rief from Philipps University Marburg
Prof. Ulrike Bingel, spokesperson for CRC/TRR 289, met the three PAB members at the conference and introduced them to some colleagues. “As crazy as it may sound, even though individual biographies and experiences are central to treatment expectations and individual preferences should definitely be taken into account when specifically optimizing expectations, patients were not involved in the development and interpretation of our research for a long time,” she recalls. This realization motivated the professor at the University of Duisburg-Essen to make the PAB relevant and significant in research and for patients. “The participation of the PAB here in Krakow was a highlight and has gained international visibility. I am proud of that,” explains Prof. Bingel, thanking Prof. Meike Shedden-Mora and Anna Borgmann “for their great work in integrating the PAB into the CRC.”
Open, creative, appreciative: this is how the Volkswagen Foundation and “Die Junge Akademie” want the research environment for scientists in the early and middle stages of their careers to be. That is why they announced the award for the “Best Research Environment” for the first time in 2024. On June 7, 2025, the 24 shortlisted teams from a total of 300 applications were honored in Berlin – including the Bingellab team from the Department of Neurology at Essen University Hospital.
Dr. Livia Asan and Dr. Ezgi Arikan from Bingellab accepted the certificate. For neurologist Dr. Asan, the decisive factor at Bingellab is: “For me, the great research environment is characterized by good leadership. As young scientists, we are recognized, encouraged, empowered, supported, and challenged, and we have a really strong mentor at our side.”
Under the direction of Prof. Ulrike Bingel, the Bingellab researches the perception, modulation, and chronicity of pain as well as cognitive influences on treatments, especially placebo and nocebo effects. The interdisciplinary, diverse, and dynamic team works with a variety of approaches—from functional magnetic resonance imaging and pharmacological studies to controlled clinical trials—and in close collaboration with strong national and international partners. The Bingellab is significantly involved in several subprojects of the CRC/TRR 289.
“A good research environment promotes good science by bringing out individual strengths and combining them into a greater whole that benefits everyone,” says Prof. Bingel. Important factors for her team include space to think outside the box, inspiration at the interfaces between disciplines and research fields, and, above all, a positive, family-friendly working atmosphere.
What factors make work at the Bingellab so exciting? "Support and mentoring are very important here. In the working group, student assistants and medical doctoral students play just as important a role as PhD students and postdocs. Everyone works together in a spirit of mutual respect to produce high-quality research,“ explains psychologist Dr. Helena Hartmann. As a project leader, psychologist Dr. Katharina Schmidt emphasizes: ”I particularly appreciate the interdisciplinary exchange because it often leads to faster problem solving, but above all, it gives rise to exciting new creative research questions that one might never have come up with by oneself."
The award emphasizes the importance of a good research environment for scientific performance and the appreciation of each individual scientist, and recognizes the contribution of every member of the research community to scientific progress. It is intended to create an incentive to establish the quality of the research environment as a central quality feature for scientific organizations and to engage in the conscious design of this environment.
Patients' expectations of treatment influence the success of a therapy: positive expectations increase the chances of a therapy succeeding, while negative expectations can reduce its success and increase the risk of side effects. In the Journal of the American Medical Association (JAMA), Prof. Meike Shedden Mora, Prof. Winfried Rief, and Prof. Johannes Laferton present four evidence-based communication strategies that practitioners can use to specifically promote positive expectations.
The authors (from left to right): Johannes Laferton, Professor of Medical Psychology at HMU Health and Medical University Potsdam; Winfried Rief, Professor of Clinical Psychology and Psychotherapy at Philipps University Marburg; Meike Shedden Mora, Professor of Clinical Psychology and Psychotherapy at Medical School Hamburg
Their four strategies, which the three researchers explain in the “JAMA Insights” series, are aimed at everyone working in the healthcare sector. The goal is to improve communication by focusing on the treatment expectations of those affected, thereby increasing the chances of successful therapy and reducing the risk of unwanted side effects:
For their practical suggestions, psychologists Prof. Meike Shedden Mora (Medical School Hamburg), Prof. Winfried Rief (Clinical Psychology and Psychotherapy, University of Marburg), and Prof. Johannes Laferton (Health and Medical University, Potsdam) extracted the decisive factors from various studies on placebo effects. An essential basis for this is provided by work from the Collaborative Research Center 289 “Treatment Expectation,” in which Shedden Mora and Rief lead key subprojects as principal investigators.
Positive and negative expectations, as well as fear of side effects, can independently influence the success of treatment, as shown by a comprehensive analysis of six studies with a total of 748 participants. Even if a person expects to benefit greatly from treatment, they may at the same time be concerned about experiencing unpleasant side effects. Therefore, healthcare professionals should ask their patients specific questions about
“We encourage everyone who is in contact with patients to ask these questions, because this is the only way to ensure that individualized therapy and supportive communication tailored to individual fears and needs can be used successfully,” advises psychologist and psychotherapist Prof. Shedden Mora.
When doctors demonstrate competence and empathy toward their patients, it influences the success of the treatment. Nonverbal signals such as eye contact or an affirmative nod, as well as well-structured and understandable communication, create trust:
“If you are concerned about side effects, let's think together about what we can do if side effects occur.”
A study involving 262 patients with irritable bowel syndrome showed that significantly more patients benefited from (placebo) acupuncture treatment when their doctor radiated warmth and empathy rather than when the contact was more factual and distant.
“Asking open questions, listening, and emphasizing your own experience as a doctor can be an important factor in the success of the treatment. Every doctor, psychologist, and physical therapist should be aware of the impact of their communication,” emphasizes psychologist and psychotherapist Prof. Winfried Rief.
Every patient has expectations about an upcoming treatment. Positive expectations can increase the chances of success of the therapy, while negative ones can decrease them. To support positive assumptions and a confident outlook among those affected, caregivers can realistically reinforce the individual's personal goals:
“After the operation, you want to go hiking with your family again. I am confident that you will be able to take short walks within the first six weeks and manage moderate hikes again after three months.”
Studies of people who have undergone heart surgery and abdominal surgery show that a personal recovery plan promotes recovery. After heart surgery, patients were able to be discharged from hospital up to 4.5 days earlier, and after abdominal surgery, they resumed their normal daily activities around five days earlier. “When developing such a recovery plan with the help of psychological intervention, it is important that the goals are realistic and have personal significance, for example, being able to walk the dog again after bypass surgery,” confirms psychologist and psychotherapist Prof. Johannes Laferton.
It is well documented that patients often overestimate the risk of adverse side effects, but underestimate the benefits of therapy. How medical staff explain possible side effects has a significant impact on the frequency of side effects. Balanced information provided in a positive context, where benefits are also emphasized and explained, reduces the burden of side effects.
In a clinical study, people who received methotrexate for inflammatory rheumatism reported significantly fewer side effects when these were explained to them as a positive sign that the drug was working in their bodies. Patients who received such a positive explanation for side effects were significantly less likely to discontinue treatment.
“We are very pleased that JAMA is publishing these findings and recommendations, as our research network has been contributing substantially to the evidence for these effects for many years,” says Prof. Ulrike Bingel, spokesperson for the Collaborative Research Center “Treatment Expectation.” "The positive significance of communication in the therapeutic field of all disciplines cannot be overestimated. At the same time, we still have a lot to learn that will allow us to use expectation effects in a personalized, context-specific, and comprehensive way in daily practice, for the benefit of patients," says Bingel. She is a neurologist, the head of the Center for Pain Medicine at Essen University Hospital and has been conducting intensive research into placebo and nocebo effects in medicine for decades.
Original work:
Laferton JAC, Rief W, Shedden-Mora M. Improving Patients’ Treatment Expectations. JAMA. Published online June 04, 2025. doi:10.1001/jama.2025.6261
https://jamanetwork.com/journals/jama/article-abstract/2834861
Negative previous experiences and expectations are associated with greater pain-related disability
A new study from our Collaborative Research Center shows: Negative expectations have a stronger effect and last longer than positive ones. This result is of great importance for communication between doctors and their patients.
It's a kind of self-fulfilling prophecy: if we truly believe that a treatment will help, it is more likely to work. Conversely, if we fear that the treatment will be ineffective and cause unpleasant side effects, this is often exactly what happens.
This phenomenon is particularly common and well-studied in the case of pain: positive expectations can alleviate pain and increase the effect of a painkiller – this is the placebo effect. Negative expectations, on the other hand, often intensify the pain and can nullify the effect of even highly potent painkillers – this is known as the nocebo effect.
In experiments, nocebo effects are stronger than placebo effects
But which of these effects is stronger? Unfortunately, it is probably the nocebo effect, as a study from projekt A01 of our CRR 289 shows. In an experiment, a research team led by Prof. Ulrike Bingel at the University of Duisburg-Essen exposed 104 healthy volunteers to short-term heat pain. The researchers specifically influenced the participants' expectations and treatment experiences of a sham nerve stimulation and then investigated how strongly these affected subsequent test phases on the same day and after one week. In these test phases, all participants received equally strong pain stimuli - but associated with different expectations: positive, negative or neutral. The pain stimuli were rated on a scale of 0–100.
The exciting result: negative expectations had a stronger and more lasting influence on the sensation of pain than positive ones. On average, those with negative expectations rated subsequent pain around 11 points higher than those with no specific expectations. A positive expectation, on the other hand, only reduced the pain rating by around 4 points. (Here is the link to the original publication.)
The effect of negative expectations is greater - even in the long term
The effect of negative expectations was twice as strong as that of positive expectations - even though the pain induced was the same for all participants. Only the expectations were different. But how long does this effect last?
To test this, all participants received the same pain stimulus again in the second session one week later. The effect remained similar: the nocebo effect meant that the people with negative expectations rated the pain about 9 points higher than those in the control group without expectations. The placebo effect, on the other hand, resulted in the pain being perceived as 4.6 points lower.
"Better safe than sorry": Why do people expect the worst?
“People apparently tend to expect the worst - and this is also reflected in the way they process pain,” explains Prof. Dr. Ulrike Bingel, neurologist and head of the Interdisciplinary Center for Pain Medicine at Essen University Hospital. The reason for this could lie in human evolution, suspects Dr. Katharina Schmidt from Bingel's team, who was also involved in the study: “This behavior corresponds to a ‘better safe than sorry’ strategy.” It is possible that humans have evolved to be better prepared for potential threats - and therefore give more weight to negative expectations.
“This is very important for clinical practice,” explains neurologist Bingel. In everyday life, doctors often focus on promoting positive expectations. "However, our study shows that it is at least as important to avoid unintended negative expectations," says Bingel. Healthcare professionals should be aware that the way they provide information about treatments can strongly influence patients' reactions to them – in both a positive and negative sense.
“Nocebo effects can be prevented by simple and effective strategies to improve communication between patients and doctors,” adds Bingel: "Positive wording, avoiding unnecessary emphasis on side effects and building a trusting relationship can reduce the risk of nocebo reactions. At a time when cost efficiency in healthcare is critical, avoiding nocebo effects should be a key strategy to improve treatment outcomes."
Foto: SFB/TRR 289
"This study marks a significant milestone in the study of placebo effects in severe somatic diseases such as psoriasis. It reveals possibilities and limitations, as well as raising important questions for future research,” says Prof. Ulrike Bingel, spokesperson of SFB/TRR 289, in her assessment of the research. In this interview, Prof. Sondermann explains how patient and doctor expectations influence the success of psoriasis therapy.
Happy winners of the German Psoriasis Prize 2025: Prof. Wiebke Sondermann with members of her research team from project A12. From left to right: Dr. Frederik Krefting, Prof. Wiebke Sondermann, Senta Mühlhaus and Daniela Bese
Ms. Sondermann, for which aspect of your research have you receied the DDG prize?
The prize was awarded to me for the publication of the data from our main study from sub-project A12 from the first funding period of the SFB/TRR “Treatment Expectation”. Using the targeted modulation of positive expectations, we wanted to see whether the effect of secukinumab can be influenced. This is a human monoclonal antibody that acts specifically on the pro-inflammatory protein interleukin-17A. Our study showed that verbal expectation modulation alone only has a limited influence on the course of the disease. Therefore, in the second funding period, we want to examine the effect of unconscious learning mechanisms in the context of expectation modulation.
Having dealt with the psychological factors influencing psoriasis, why not move on to new medications?
We now have a wide range of medications that can effectively treat psoriasis. For most patients, we can now improve the skin condition by 90 percent. However, these very good results are achieved with using drugs called biologics, which include secukinumab, the drug used in our study. Biologics are expensive and can be associated with side effects, so we believe it makes sense to investigate whether part of the dose could be saved by using psychological factors, such as expectation effects, in our specific study.
An older study with psoriasis patients has already shown that the effect of corticosteroid-containing creams is maintained when the full dose is alternated with a placebo.
Is the pharmaceutical industry interested in this research?
Fortunately, yes. For example, Novartis provided us with logistical support to obtain a certain formulation of the biologic secukinumab, enabling us to work more easily with the lower dosage of the preparation. Above all, however, we would like to thank the German Research Foundation, which supports the 'Treatment Expectation' Collaborative Research Center and thus our research.
Is there a need to improve care for psoriasis patients?
Yes, definitely. That was the exact title of my habilitation thesis. Many patients are still undertreated, particularly worldwide, because not everyone has access to highly effective medication.
How do you assess new therapies with biologics?
Biologic therapies have been available for psoriasis for around 20 years. Our growing understanding of the inflammatory processes underlying psoriasis has continually driven the development and refinement of biologics. The modern biologics currently used for psoriasis specifically block two inflammatory messengers that play a central role in the condition: Interleukin 17 and Interleukin 23. By specifically blocking inflammatory messengers that are present in excessive amounts in psoriasis, we achieve very high response rates. As the immune system is no longer broadly suppressed as it was during past treatments, the side effect profile has also improved. Unfortunately, due to the high costs of biologics therapy, too few patients are still receiving this type of modern treatment.
Do biosimilars work just as well?
Biosimilars are copycat products of biologics whose patent protection has expired. They are already available for older biologics. One advantage of biosimilars is that they are significantly cheaper than the original preparations. Studies show that biosimilars are actually just as effective as the original preparations. However, discontinuation rates following a switch from the original preparation to a biosimilar are above average, which is attributed to the nocebo effect. Biosimilar quotas exist, particularly in the private practice sector, meaning that a certain percentage of patients must be prescribed biosimilars instead of biologics. Education and effective communication between doctors and patients are therefore crucial in order to prevent discontinuation.
This inflammatory chronic skin disease affects two to three percent of the population. Is your work of great clinical relevance?
Yes, psoriasis is actually one of the most common inflammatory skin diseases in the western world, affecting two to three percent of the population. Around 20 to 30 percent of all patients suffer from a moderate to severe form of the disease, which requires systemic therapy, i.e. treatment from the inside. Early treatment can probably have a positive effect on the overall course of the disease and may even prevent the onset of psoriatic arthritis to some extent. “Hit smart and early” is therefore the order of the day. This is precisely where our research comes in, making it of great clinical relevance for many patients.
What connections and interactions exist between the skin, the immune system and the psyche?
These three systems are connected via a complex network and influence each other. The skin is not only a physical barrier, but also an active immune organ.
What goes wrong in the brain-skin axis in psoriasis?
In chronic inflammatory diseases such as psoriasis, the immune system in the skin is overactive. This leads to redness, scaling and itching. Stress, anxiety and depression can in turn dysregulate the immune system, further exacerbating the skin disease. Among other things, the stress hormone cortisol and the autonomic nervous system are involved. Stress causes the body to release stress hormones such as cortisol and adrenaline. At the same time, the immune system is activated - but this can backfire, especially in the case of inflammatory diseases such as psoriasis: The immune response becomes overactive, the inflammatory processes increase and flare-ups can be triggered or intensified. Recent research also shows that the nervous system communicates directly with the immune system. Visible skin changes can lead to feelings of shame, stigmatisation, social withdrawal, anxiety and depression. These psychological burdens can increase the stress experienced by patients, exacerbating the disease. It's a classic vicious circle. I am glad that the subjective stress experienced by patients can now be accurately assessed using various questionnaires, and that individual suffering is increasingly being considered in therapy guidelines.
Imagine a scale from 0 to 10: 0 means you know very little about the correlations and 10 means you know everything. Where does psoriasis research stand on this scale?
I would estimate five. There is still a lot to do because the mutual influences are extremely complex, as is the research.
What do you consider to be the best evidence that placebo effects work?
In my opinion, one of the most convincing proofs of the effectiveness of placebo effects is the fact that they are measured in randomized, double-blind clinical trials. In a meta-analysis of 34 randomized clinical trials with patients suffering from psoriasis, atopic dermatitis, chronic spontaneous urticaria, it was shown in 2015, for example, that placebos could significantly, i.e. considerably and not by chance, reduce itching - by an average of 24 percent.
Does this also apply to nocebo effects?
Various studies have shown that patients who are informed prior to therapy that a drug could have certain side effects are significantly more likely to report these side effects, even if they have only received a placebo. Furthermore, studies in dermatology have shown that verbal suggestions or information about an allergen-containing solution, even when it is only water, can significantly increase perceived itching. If you tell a study participant, 'This is going to itch a lot', it is very likely that it will.
How can expectations be used specifically to improve the treatment of psoriasis?
Expectations can amplify the psychological effects of therapies in many clinical cases. However, in the first funding period of our project, we found that positive expectations induced verbally alone only have a limited influence on the objective course of the disease. In the second funding period, we are therefore expanding our approach by using reinforcement learning through pharmacological conditioning to optimise treatment. This principle is based on the observation that, in certain cases, the body remembers the effect of a drug and can partially replicate it itself. In our CRC project A12, we are investigating whether this is also possible with systemic biologic treatment: If successful, this approach could reduce side effects and make treatment more cost-effective.
What advice would you give to colleagues in practice?
If we utilise expectation effects effectively, we can enhance the efficacy of medication, mitigate inflammatory activity, and elevate the quality of life for individuals with psoriasis. Specifically, using appreciative and affectionate language in doctor-patient consultations builds trust and strengthens the placebo effect.
And what can patients do themselves?
Many patients suffering from psoriasis are depressed and skeptical about new therapeutic approaches after years of inadequate treatment attempts. Nevertheless, it makes sense for patients to be optimistic about new therapies. Study data also show that confidence in the therapy - and therefore also its effectiveness - increases if the patient is involved in shared decision-making together with the doctor. Maintain your optimism and don't let yourself be disheartened!
Original publikcation:
Hölsken S., Krefting F., Mühlhaus S., et al. and Sondermann W. Shaping Treatment Expectation to Optimize Efficacy of Interleukin 17A Antagonist Secukinumab in Psoriasis Patients. Psoriasis (Auckl). 2025 Jan 10;15:9-22.
https://doi.org/10.2147/PTT.S486338
New publication: How Placebo Effects in Emotion Processing Depend on Cognitive Resources
Also this year, we are continuing our popular webinar series on treatment expectations: until September, four renowned scientists will shed light on important facets of our field of research in exciting online lectures.
Prof. Christian Bellebaum from Heinrich Heine University Düsseldorf will kick things off on April 1, 2025 at 4 pm. His webinar will focus on “Effects of Expectancy in the Processing of Actions and their Outcomes". Later this year, we will also be welcoming Prof. Andreas Olsson from the Karolinska Institutet in Stockholm, Prof. Thomas Graven-Nielsen from Aalborg Universitet sowie Dr. Nathan Huneke from the University of Southampton.
The webinars in the “Treatment Expectation” series are aimed at a scientific audience and will be held in English. Participation is free of charge, but the number of participants is limited. We therefore ask you to register early.
If you would like to attend individual webinars or the full program, please register at
We would be very pleased if you could write a few words about your scientific background and why you would like to attend the webinars.
10 steps to a successful publication: Dr. Helena Hartmann presents the ARIADNE Navigator
Felgenhauer Research Prize 2024 for Dr. Livia Asan
Dr. Helena Hartmann und Dr. Julian Packheiser receive the Pain Research Award 2024
Sintetica Research Fellowship 2024 for Dr. Jana Aulenkamp
"More effektive fake medicine": IG Nobel Prize for the research of Lieven A. Schenk, Tahmine Fadai and Christian Büchel
“Fake medicine that causes painful side effects can be more effective than fake medicine that does not cause painful side effects": The jury found this research result astonishing and amusing enough to award the “IG Nobel Prize” for Medicine 2024 to Dr. Lieven Schenk, Dr. Tahmine Fadai and Prof. Christian Büchel from Project A02 of the SFB/TRR 289. As is so often the case with this award, which only seems absurd at first glance, there is an important finding behind it - in this case with major implications for patients.
A bizarre ceremony, a worthless prize: the scientific community celebrates its freedom at the award ceremony for the “IG Nobel Prizes”. And it shows that research can often be hilarious at first glance - and thought-provoking at second glance.
“How side effects can improve treatment efficacy: a randomized trial” is the title of the publication in the journal Brain, which was ‘honored’ with the IG Nobel Prize (to the publication). In the article, Schenk, Fadai and Büchel describe their observation that the effect of a medical treatment can be enhanced if people experience mild side effects.
To demonstrate this, the researchers administered a nasal spray to volunteers that supposedly contained either a painkiller or a placebo. The test participants were then asked to assess how strong a heat stimulus was on their arm. The trick was that all the nasal sprays actually contained a placebo substance. In some cases, however, the heat stimulus was reduced in order to simulate an effect; and for some participants, capsaine was also mixed into the spray, which causes a slight burning sensation in the nose. The result: when there was a burning sensation in the nose, the heat stimulus on the arm felt less painful for the test subjects - even though no painkiller was administered at all. It was therefore the supposed side effect that had reduced the pain.
Prof. Katja Wiech, Dr. Helena Hartmann and Prof. Ulrike Bingel comment on the very serious and important implications of these results for medicine and clinical research in the same issue of the journal. They explain that this effect is a problem for clinical studies: if side effects increase the effect of a test substance, it can no longer be compared with a placebo without side effects - and can therefore no longer be measured correctly.
In therapy, on the other hand, noticeable side effects could possibly not only be a burden, but even a therapeutic opportunity. However, only under certain circumstances, the scientists write: For example, this presumably only applies to mild side effects that are not perceived as threatening by the individuals. And the individual expectations and previous experiences of those affected certainly also play a role.
In any case, the results give reason to re-evaluate side effects - and to investigate whether they can be useful for patients not only experimentally, but also as part of a therapy. In the spirit of the “IG Nobel Prizes”, which are awarded by the US journal “Annals of Improbable Research” for research that “first makes you laugh and then makes you think”. (Here is the link to this year's ceremony.)
Frontiers in Psychiatry
Deutsche Gesellschaft für Psychologische Schmerztherapie und -Forschung DGPSF e.V.
New publication: Transtheoretical Psychological Therapy – New Perspectives for Clinical Training and Practice
Accompanying the SFB/TRR 289, we again offer a webinar series with scientific lectures by internationally renowned researchers.
All lectures will be given online and participation is free. The talks are geared towards a scientific audience and will be held in English.
If you would like to attend individual webinars or the full program, please register at
We would be very pleased if you could write a few words about your scientific background and why you would like to attend the webinars.
At the Science Slam of the SIPS Conference 2023 in Duisburg, young researchers explained their science as creatively and entertainingly as possible for a broad audience, moderated by Dr. Helena Hartmann (picture below). High praise for two SFB researchers from the University Hospital Essen: Elif Buse Caliskan (picture left) from the Bingel Laboratory and Stefanie Hölsken (picture right) from the Institute of Medical Psychology and Behavioral Immunology won at the Science Slam! Rewatch this great event here.
Elif Buse Caliskan (picture below) explained in four minutes what placebo effects have to do with the perception of wine. Did you know that the label, the price, the shape of the glass, and even the ambience of the environment affect how we perceive wine quality?
Stefanie Hölsken (picture below) took us into the world of dermatology and reported how allergy symptoms can be alleviated there with the help of classical conditioning and green strawberry milk. Without any real anti-allergy medication, but through expectations!
Three CRC/TRR 289 teams (A04, A10 and A11) jointly investigated the interaction of inflammation or depressed mood and the expectations with and experiences of visceral pain in healthy subjects.
The results of the study were published recently in the journal Brain Behavior and Immunity under the title "Amplified gut feelings under inflammation and depressed mood: A randomized fMRI trial on interoceptive pain in healthy volunteers."
You can read the full publication ScienceDirect.
Positive influence on the perioperative well-being of patients through the preoperative administration of open-label placebos
In the approved clinical project, the perioperative well-being of patients will be positively influenced by open-label placebo administration before an upcoming surgery. Additionally, it will be investigated whether these effects can be enhanced by observational learning. As target parameters, effects on anxiety and well-being as well as the postoperative experience, especially postoperative pain and its effects, will be analyzed. This prospective, randomized, controlled study will be conducted in patients with planned laparoscopy at the University Hospitals of Essen and Hamburg.
Congratulations to Jana Aulenkamp and Johannes Wessels for this great project and good luck for its implementation!
As part of SFB/TRR 289, we offer a virtual webinar series with scientific talks by internationally recognized researchers.
Many of the past lectures can now be found on our YouTube channel!
All lectures are given online and participation is free. The talks are aimed at a scientific audience and are given in English. If you would like to attend individual webinars or the entire program, please register at
If you have any questions or requests, please send us an email at
Three early career researchers from the Department of Neurology at the University Medical Center Essen received awards for pain research. The three innovative projects focus on expectancy and learning mechanisms in the perception and processing of pain, both in healthy individuals and in patients. Congratulations to Frederik Schlitt* for the 2nd prize in the category Clinical Research on his work in pain-related learning mechanisms in patients with chronic back pain. Dr. Laura Ricarda Lanters** accepted the 2nd prize in the Basic Research category for her work on the specificity of conditioned nocebo effects in visceral interoceptive pain. The prizes were awarded by the German Pain Society and the donor Grünenthal GmbH. Livia Asan*** can be excited the 1st place of the Young Investigator Award for Pain. She wants to investigate how adverse effects after lumbar puncture can be avoided.
"We are very proud that this year scientists from the University Medical Center Essen were represented in every category of the highest award for pain research in Germany. Their work confirms the success of the interdisciplinary, cross-project collaboration in the Translational Pain Research Unit at the Center for Translational Neuro- and Behavioral Sciences," said Prof. Ulrike Bingel, head of the Center for University Pain Medicine and spokesperson of the SFB/TRR 289 Treatment Expectation.
*Frederik Schlitt, Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medical Center Essen, received the 2nd prize in the Clinical Research category for his research on pain-related learning mechanisms in chronic back pain. Pain-related learning mechanisms seem to play a key role in the development and maintenance of chronic pain. Initial studies have been able to show impairments in pain-related learning in patients with chronic pain. However, the results are not consistent. Frederik Schlitt investigated pain-related learning and unlearning of visual cues that announced a painful heat stimulus or predicted its absence - in patients with nonspecific chronic back pain and healthy subjects. In patients with chronic back pain, reduced pain-related learning was observed both from cue stimuli that announced a heat pain stimulus and from those cue stimuli that predicted its absence. The data provide preliminary evidence for more diminished learning of cue stimuli that announce a heat pain stimulus with increasing clinical pain duration. Given the high prevalence of chronic low back pain in the general population, as well as the challenges that arise in its treatment, this work highlights the high clinical relevance of altered pain-related learning in this patient population. If the ability to discriminate between cues that announce a pain stimulus and cues that predict its absence is impaired, this may lead to ambiguity in the emotional appraisal of these stimuli and, subsequently, to overprotective behavior, which could contribute to the development and maintenance of chronic pain. The project was funded by the Collaborative Research Center 1280 "Extinction Learning".
**Dr. Laura Ricarda Lanters, Department of Neurology, Associate of the Translational Pain Research Unit led by Prof. Dr. Ulrike Bingel, demonstrated the relevance and specificity of visceral pain across methods in her work. In two consecutive but independently conducted fMRI studies, the team was able to show that interoceptive visceral stimuli are rated as more aversive compared to different exteroceptive stimuli by healthy subjects, even if both stimuli were perceived intraindividually as initially comparably unpleasant or painful. In both studies, cue stimuli announcing interoceptive visceral stimuli were found to be prioritized for learning, storage, and recall in healthy subjects compared with exteroceptive cue stimuli, accompanied by greater involvement of the insula and cingulate cortex for the visceral modality. The prioritization of learning processes with respect to negative expectation of clinically-relevant interoceptive compared to exteroceptive stimuli represents an addition to the understanding of conditioned nocebo effects for the development and maintenance of chronic pain and thus has high relevance for further research and, prospectively, therapy of functional and inflammatory diseases along the brain-gut axis. "In our understanding, the studies presented in the submitted work have a particular clinical validity due to the pain models used - e.g., rectal distensions for the visceral stimuli versus thermal stimuli on the skin- and thus, from a translational perspective, probably represent an interface between basic research conducted in healthy subjects and clinically oriented research with the aim of deepening the understanding of the underlying mechanisms of visceral pain along the brain-gut axis," explains Dr. Lanters. The work originated as a collaboration between two projects in the SFB 1280 "Extinction Learning" under the project leadership of Prof. Sigrid Elsenbruch (A10) and Prof. Harald Engler (A12) at the Institute of Medical Psychology and Behavioral Immunology in close collaboration with the Department of Neurology, Translational Pain Research Unit and the Institute of Diagnostic and Interventional Radiology and Neuroradiology, which are united under the umbrella of the C-TNBS.
*** Livia Asan, assistant physician and researcher at the Department of Neurology and C-TNBS, Unversitätsmedizin Essen, received the German Pain Society's Young Investigator Award for Pain (1st place). The award-winning project aims to investigate how adverse effects following lumbar puncture can be avoided. During lumbar puncture, a few milliliters of nerve fluid are extracted from the spinal canal and then analyzed. Nerve water analysis has a high value in neurological diagnostics for a wide range of diseases and is therefore performed in many of our patients. Although lumbar puncture is a very safe and low-risk procedure, patients sometimes complain of mostly harmless but nonetheless limiting side effects such as headache. There has been evidence in previous studies that the rate of post-puncture headache is significantly dependent on prior education in this regard. Ms. Asan would now like to test whether some of these complaints can be reduced by optimizing the positive design of the physician's risk information.
Clinical Psychological Science
This month, we will be addressing the topic of back pain in the Patient Forum on Neurology. Prof. Dr. Ulrike Bingel, Head of University Pain Medicine, and her team of experts invite you to join them on July 21 from 5:30 pm.
This time, patients, relatives and interested parties can find out about topics such as "The cross with the cross - widespread disease chronic back pain", "Why movement is so important and there is no wrong movement in chronic back pain" and "The interaction of pain and psyche".
Of course, there will be plenty of time for questions this time as well.
You can find the link to the registration Azum Zoom-Meeting here or send an e-mail to:
Mr. Schmidt has been suffering from strong back pain for a long time and has almost given up hope of relief after several attempts at therapy. Then his neighbor tells him about a new doctor and a very good therapy offer. This had helped her husband wonderfully. Mr. Schmidt is hopeful.
And indeed, the treatment helps him, too. But the success is not only based on the professional individual treatment, but also on Mr. Schmidt's positive expectations. He simply believed that he could be helped after all.
But how can such a positive expectation promote the success of the therapy? What happens in the brain and body? Our new film from the Collaborative Research Center SFB/TRR289 explains this in an understandable and competent way. You can also watch this film on YouTube.
A research group associated with the SFB/TRR 289 investigated the effects of placebos in the area of sadness.
The result of the study was published in the Journal of Affective Disorders on May 1, 2022,under the title "Even when you know it is a placebo, you experience less sadness: First evidence from an experimental open-label placebo investigation".
You can read the full publication on ScienceDirect.
Members of the SFB/TRR 289 have published a research paper about the Impact of a 12-week open-label placebo treatment on headache days in episodic and chronic migraine. The first authors Dr. Katharina Schmidt and Dr. Julian Kleine-Borgmann belong to the project team of Prof. Ulrike Bingel in Essen.
The publication can be downloaded here or read directly on the BMJ Open site.
Effects of open-label placebo on pain and functional disability in patients with chronic back pain: A 3-year follow-up study
How Do Expectations Influence Treatment Outcome?
Patients’ expectations are important modulators of pain and analgesic treatment outcomes. As best illustrated in experimental and clinical placebo studies, an individual’s expectation can substantially shape the perception and neural processing of acute and chronic pain. Treatment expectation is not only the key determinant of placebo analgesia, but is also increasingly recognized to modulate the efficacy and tolerability of pharmacological and non-pharmacological treatments for pain and other acute and chronic conditions.
Recent insights into the psychological and neurobiological mechanisms underlying the clinically relevant effects of treatment expectations call for their systematic integration and utilization into standard treatment regiments. Such strategy promises to optimize analgesic treatment outcomes and to prevent or reduce the burden of unwanted side effects and misuse of analgesics, particularly of opioids. In this lecture Prof. Ulrike Bingel highlights current concepts, recent achievements but also challenges and key open research questions that need be addressed to improve (analgesic) treatment outcomes in a personalized manner and to use our knowledge to inform the designing and outcome interpretation of clinical trials.
Learning objective 1 :
be aware of the impact of expectation on (analgesic) treatment outcomes.
Learning objective 2 :
define key psychological and neurobiological mechanisms underlyind expectation effects.
Learning objective 3 :
outline implications for clinical routine and clinical trials as well as key-open questions and challenges.
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If you are interested in the above exciting topic, watch the full lecture of Prof. Ulrike Bingel on June 16th at 10:30 a.m. EST at IASP 2021 VIRTUAL WORLD CONGRESS ON PAIN.
The full program of the event can be viewed here.
To view the above lecture or the full program, you must register here.
Prof. Yvonne Nestoriuc, one Leader of the project A15, has published a new paper about the hypothesis, that understanding patients's informational needs and adapting drug-related information are the prerequisites for a contextualized informed consent. Current information practices might rather harm by inducing nocebo effects.
You can read the complete publication on frontiers in Psychiatry or download it here.
The formation and fulfillment of expectations play an important role in positive subjective treatment outcomes. Julia Stuhlreyer (Project Regine Klinger, A13) discovered that patients receiving a combination of a digital health app and patient-oriented physician visits postoperatively were more likely to rate their treatment as successful, based on their stated preoperative treatment expectations. This also leads to significant reduced postoperative pain and opioid consumption.
More information about DGAI is available here.
Prof. Winfried Rief has studied the fear towards Covid-19 vaccinations and the influence of our society.
The full result of his reflections on this topic can be downloaded here or read directly on the JAMA website.
Medicine also lives from stories. Medicine is also shaped by people’s stories. This is why we’re gathering patients’ diverse experiences regarding their own expectations for the Collaborative Research Centre “Treatment Expectation”. Almost everyone has experienced a positive placebo or negative nocebo effect.
This virtual lecture incorporates a discussion on improving research transparency and robustness by exploring the necessity of preregistrations and registered reports.
New study gives the most detailed look yet at the neuroscience of placebo effects, which was published by Prof. Ulrike Bingel and Dr. Tamas Spisak from our project Z03.
eLive has published a research paper about the temporal and spectral characteristics of expectations and prediction errors in pain and thermoception. The first author Andreas Strube works as a PhD Student closely with the project leaders Prof. Christian Büchel and Prof. Michael Rose from the SFB/TRR 289.
The publication can be downloaded here or read directly on the eLife site.
Scientific Reports has recently published our research about the impact of Open-Label Placebos on test performance and well-being in acutely stressed students. Dr. Julian Kleine-Borgmann is corresponding author and happy to answer comments!
The CRC/TRR 289 receives one of the highly competitive grants from the German Research Foundation (DFG).
