Key themes with underlying categories.

Background The efficacy of open-label placebos (OLPs) has been increasingly demonstrated and their use holds promise for applications compatible with basic ethical principles. Taking this concept one step further an imaginary pill (IP) intervention without the use of a physical pill was developed and tested in a randomized controlled trial (RCT). To explore participants’ experiences and views, we conducted the first qualitative study in the field of IPs. Methods A reflexive thematic analysis (RTA) of semi-structured interviews with test anxious students (N = 20) was nested in an RCT investigating an IP and OLP intervention. In addition, open-ended questions from the RCT were evaluated (N = 114) to corroborate the RTA and pill characteristics were included to more accurately capture the IP experience. Results Four key themes were identified: (1) attitude towards the intervention, (2) applicability of the intervention, (3) experience of effects, and (4) characteristics of the imagination. The IP intervention was well-accepted, easily applicable, and various effects, pill characteristics and appearances were described. While many participants did not desire a physical pill, either due to the absence of the imagination component or aversion to pills, the approach was considered to be cognitively and time demanding, which in turn, however, encouraged the establishment of a therapeutic ritual that protected against the increase in test anxiety during the preparation phase. OLP findings were comparable, and especially the importance of a treatment rationale was stressed in both groups, counteracting an initial ambivalent attitude. The RTA findings were supported by the open-ended questions of the RCT. Conclusion IPs appear to be a well-accepted and easily applicable intervention producing a variety of beneficial effects. Thus, the IP approach might serve as an imaginary based alternative to OLPs warranting further investigations on its application to harness placebo effects without a physical pill.研究背景：开放标签安慰剂（open-label placebos）的疗效已得到越来越多的实证支持，其应用契合基本伦理原则，具备良好的应用前景。基于此概念进一步拓展，本研究开发了无需实体药片的假想药片（imaginary pill，IP）干预方案，并在随机对照试验（randomized controlled trial，RCT）中开展测试。为探究参与者的体验与看法，我们完成了该领域内首项关于假想药片的质性研究。 研究方法：本研究将针对20名考试焦虑学生的半结构化访谈进行反身主题分析（reflexive thematic analysis，RTA），该访谈嵌套于一项探究假想药片与开放标签安慰剂干预的随机对照试验中。此外，本研究还对随机对照试验中收集的114份开放式问卷结果进行分析，以佐证反身主题分析的结论，并纳入药片特征维度以更精准地捕捉参与者的假想药片体验。 研究结果：本研究共识别出四大核心主题：（1）对干预方案的态度；（2）干预方案的适用性；（3）干预效果体验；（4）想象活动的特征。结果显示，假想药片干预方案接受度良好、易于实施，参与者还描述了多样化的干预效果、药片特征与外观表现。尽管部分参与者因缺乏想象环节或抵触实体药片而不愿使用实体药片，但该干预方案被认为会带来一定的认知与时间投入，不过这反而促成了治疗仪式的建立，有助于在准备阶段缓解考试焦虑的加剧。开放标签安慰剂的研究结果与之相似，两组参与者均强调治疗依据的重要性，这抵消了初始的矛盾态度。随机对照试验的开放式问卷结果进一步佐证了反身主题分析的发现。 研究结论：假想药片干预方案接受度良好且易于实施，可产生多种有益效果。因此，假想药片方案或可作为无需实体药片、基于想象的开放标签安慰剂替代方案，值得开展进一步研究以挖掘其在利用安慰剂效应方面的应用潜力。