What If the Most Powerful Part of Your Treatment Has Nothing to Do with the Medicine?

The science of healing has been measuring the wrong thing. It’s time to pay attention to everything else.

By Marybeth Missenda, MS RPh

You’ve been dealing with chronic lower back pain for months. Your physician spends seven minutes with you, types into the computer while you talk, and sends you out with a prescription. A week later, you see a massage therapist. She spends ten minutes just asking about your life before she touches you. The room is warm. She explains what she’s going to do and why. You walk out of both appointments having received a legitimate treatment—but something about the second one felt different. Not just emotionally different. Physically different.

Most people chalk this up to preference, or personality, or the vague idea that “it’s nice to feel heard.” But what if the difference you felt wasn’t vague at all? What if it was measurable, neurobiological, and one of the most under-discussed forces in all of healthcare?
Thanks for reading Integrative Health Insights by Marybeth! Subscribe for free to receive new posts and support my work.

The Thing Nobody Trained You to See

Healthcare education teaches providers to focus on the specific treatment: the drug, the technique, the procedure. Everything else—the way you greet a patient, the warmth of the room, how you explain the diagnosis, whether you make eye contact—gets filed under “bedside manner.” Nice to have. Not clinically significant.

Except it is clinically significant. A growing body of research shows that the entire context surrounding a treatment—the clinician’s behavior, the patient’s expectations, the therapeutic relationship, the setting, even the ritual of care itself—produces real physiological changes in the patient’s body. These aren’t just feelings. They involve the release of neurotransmitters like endogenous opioids, cannabinoids, and dopamine, and they activate specific brain regions including the prefrontal cortex and periaqueductal gray. Researchers call this the context effect. And it operates in every clinical encounter, whether or not anyone is paying attention to it.

A positive context—an empathetic provider, a clear explanation, a sense of safety—can reduce pain and improve outcomes by triggering what researchers describe as placebo effects. A negative context—a rushed visit, dismissive language, a cold clinical environment—can worsen symptoms through nocebo effects. The treatment stays the same. The context changes everything.

More Than Placebo, More Than Bedside Manner

If you’re a clinician, you might be thinking: “Isn’t this just the placebo effect with a new name?” It’s a fair question, and the answer matters.
The context effect is related to placebo research, but it’s broader and more clinically relevant. A placebo is a specific intervention—a sugar pill, a sham procedure—used in controlled trials. The context effect describes something that happens in every real-world clinical encounter, whether or not a placebo is involved. It’s not about giving patients fake treatments. It’s about recognizing that how care is delivered is, itself, a form of treatment.

In 2023, an international panel of researchers produced the first consensus definition of contextual factors, describing them as “components of all therapeutic encounters” that include patient characteristics, clinician characteristics, the patient-clinician relationship, treatment features, and the environment of the encounter. This was significant because, until that point, there was no agreed-upon cross-discipline definition. Clinicians and researchers were talking about the same phenomenon using different language—and often talking past each other entirely.

The context effect is also not the same as “good bedside manner,” though bedside manner is one piece of it. Bedside manner implies a soft skill, an interpersonal nicety. The context effect is a neurobiological mechanism. When a provider communicates with empathy and warmth, the patient’s nervous system responds—literally. Research suggests that the healing relationship combats loneliness, increases the patient’s expectation of relief, and helps co-regulate emotions and physiological arousal. These aren’t abstract benefits. They are measurable changes that influence clinical outcomes.

Context Effects Are Woven into Complementary Practice

If you’re a practitioner trained in a complementary or traditional discipline, you may be reading this and thinking: “We’ve always known this.” You’re right. And that’s precisely the point.

James Snow, a faculty member at NDMU’s School of Integrative Health, made this argument in a 2016 paper in the journal Explore, examining how context effects operate within Western herbal medicine (WHM). Snow’s central thesis is striking: context effects are not incidental to herbal practice—they are woven into its very fabric and may be fundamental to its overall effectiveness.

Consider what a typical herbal medicine visit looks like. Initial consultations run at least 60 minutes. The practitioner engages with the patient’s full life story, not just their symptoms. Treatment is individualized—not a standardized pill off a shelf, but a compounded formula made for that specific person. And the medicine itself retains the distinctive smell and taste of whole herbs, unlike the anonymous tablets that dominate the retail supplement market.

Each of these elements, Snow argues, activates context effects through well-documented mechanisms. The sensory properties of herbal preparations—their bitterness, their pungency, their aroma—create powerful expectations of healing and may trigger conditioned physiological responses. The individualized nature of the formula communicates respect for the whole person. The collaborative patient-herbalist relationship, characterized in qualitative research as a “connected relationship” built on mutual trust and shared authority, fosters the kind of narrative concordance that research links to improved health outcomes. Even the physical environment—the sight and smell of herbal medicines, live plants on the windowsill, natural light through a window—contributes to what researchers describe as an optimal healing environment.

As one patient in a qualitative study put it, comparing her herbalist’s office to conventional clinical settings: the herbal practice felt like “a healing place,” while conventional offices felt “sterile…there’s nothing that makes a sick person feel good.” That difference isn’t cosmetic. It’s therapeutic.

The Evidence That Changed the Conversation

The broader research confirms what complementary practitioners experience daily. Ted Kaptchuk, a researcher at Harvard Medical School who trained as a traditional Chinese medicine practitioner before entering academic research, has spent decades studying what happens when you strip away the specific treatment and focus on the context of care.

In a series of randomized controlled trials, Kaptchuk and colleagues found that patients who knew they were taking placebos still experienced significant clinical improvement. In one trial, cancer survivors taking open-label placebos reported meaningful improvement in fatigue severity compared to those receiving treatment as usual. The patients knew the pills were inert. They improved anyway. Why? Because the ritual of care—the act of taking something, the relationship with a provider who explained and encouraged, the structured attention to their experience—activated the body’s own healing responses.

A 2023 survey of healthcare providers across multiple professions found that clinicians already sense this importance—estimating that contextual effects contribute to roughly half of the overall therapeutic effect in their practice. But the same survey found no consensus among providers about how to think about, teach, or ethically apply this knowledge.

In other words, practitioners across the healthcare spectrum recognize that context matters. They just haven’t been given a shared framework for doing anything about it.

The Gap Between Two Kinds of Knowing

This is where the conversation gets interesting—and where integrative health becomes essential.
Conventional medicine has the neuroscience. It can explain the opioid, dopaminergic, and endocannabinoid pathways through which context effects operate. It can point to fMRI studies showing brain activation patterns during placebo responses. But conventional training rarely teaches practitioners how to deliberately optimize these effects in practice.

Complementary traditions have the practice. Herbalists, acupuncturists, yoga therapists, and health coaches have developed centuries of wisdom about how to create healing contexts—through relationship, through ritual, through individualized care, through attention to the whole person. But they haven’t always had the scientific language to articulate why these approaches work.

As Snow writes, if context effects are truly fundamental to the overall effectiveness of herbal treatment, then any changes to prescribing practices, patient-practitioner interactions, or the physical environment of care “need to be undertaken with care.” The modern evidence base, he suggests, may be best used to inform personalized treatment—not replace it.

What’s needed are practitioners who can hold both perspectives. People who understand the neuroscience of contextual healing and the traditional wisdom of how to create it. People who can translate between paradigms and advocate for care that takes the full therapeutic encounter seriously.

Training the Practitioners Who Bridge the Gap

That’s what we do at NDMU’s School of Integrative Health. Our Integrative Health Studies program trains practitioners who develop research literacy across traditions—the ability to evaluate evidence from conventional biomedical research and from complementary and traditional practices, and to understand where they converge. The context effect is one of the most powerful convergence points in all of healthcare.

Since our merger with Notre Dame of Maryland University in Fall 2025, our students have the opportunity to learn alongside future nurses, pharmacists, physician assistants, and occupational therapists, as well as yoga therapists, herbalists, health and wellness coaches, and nutritionists. That interprofessional environment is where students practice exactly what context effect research
calls for: learning to recognize how different practitioners create different therapeutic contexts, and how to consciously optimize those contexts in service of the whole person.

The context effect isn’t a reason to abandon evidence-based medicine. It’s a reason to expand what we mean by evidence-based practice—to include the growing science of how the encounter itself heals.

Every clinical encounter is already producing contextual effects, for better or worse. The question isn’t whether context matters. The question is whether anyone on the care team has been trained to understand it, name it, and bridge the gap between the traditions that have always known it and the science that is finally proving it.
And as Snow reminds us—regardless of the clinical setting where practitioners and patients find themselves, there should always be room for a rosemary plant on the windowsill.

Your patients don’t just need the right treatment. They need the right context for healing. We’re training the practitioners who understand both.

Cited Sources

1. Cook CE, Bailliard A, Bent JA, et al. An international consensus definition for contextual factors: findings from a nominal group technique. Frontiers in Psychology 14:1178560 (2023).

2. Rossettini G, Carlino E, Testa M. Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain. BMC Musculoskeletal Disorders 19:27 (2018).

3. Wampold BE. Healing in a Social Context: The Importance of Clinician and Patient Relationship. Frontiers in Pain Research 3:684768 (2022).

4. Snow J. Context Effects in Western Herbal Medicine: Fundamental to Effectiveness? Explore 12(1):55-62 (2016).

5. Kaptchuk TJ, Miller FG. Open label placebo: can honestly prescribed placebos evoke meaningful therapeutic benefits? BMJ 363:k3889 (2018).

6. Hoenemeyer TW, Kaptchuk TJ, Mehta TS, Fontaine KR. Open-Label Placebo Treatment for Cancer-Related Fatigue: A Randomized-Controlled Clinical Trial. Scientific Reports 8:2784 (2018). \

7. Druart L, et al. Using contextual factors to elicit placebo and nocebo effects: An online survey of healthcare providers’ practice. PLOS ONE (2023).