Context-dependent placebo hypoalgesia through observational learning: the role of empathy in immersive and non-immersive environments

Jewel N White; Lakota Watson; Yang Wang; Giancarlo Colloca; Jonathan Michael Heagerty; Sida Li; Barbara Brawn; Amitabh Varshney; Roni Shafir; Carmen-Édith Belleï-Rodriguez; Luana Colloca

doi:10.1038/s41746-026-02373-3

Context-dependent placebo hypoalgesia through observational learning: the role of empathy in immersive and non-immersive environments

NPJ Digit Med. 2026 Jan 27;9(1):192. doi: 10.1038/s41746-026-02373-3.

Authors

Jewel N White^{1

2

3

4}, Lakota Watson⁴, Yang Wang^{1

2}, Giancarlo Colloca⁵, Jonathan Michael Heagerty⁶, Sida Li⁶, Barbara Brawn⁶, Amitabh Varshney⁶, Roni Shafir^{1

2}, Carmen-Édith Belleï-Rodriguez^{1

2

7}, Luana Colloca^{8

9

10}

Affiliations

¹ Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA.
² Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, MD, USA.
³ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
⁴ Graduate Program in Life Sciences, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD, USA.
⁵ Information Technology PhD Program, Towson University, Towson, MD, USA.
⁶ College of Computer, Mathematical, and Natural Sciences, University of Maryland College Park, College Park, MD, USA.
⁷ Faculty of Nursing, University of Montreal, Montreal, QC, Canada.
⁸ Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA. colloca@umaryland.edu.
⁹ Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, MD, USA. colloca@umaryland.edu.
¹⁰ College of Computer, Mathematical, and Natural Sciences, University of Maryland College Park, College Park, MD, USA. colloca@umaryland.edu.

Abstract

Digital environments are increasingly used to study social and pain-related behaviors. Empathy and contextual factors influence observationally induced placebo analgesia. We tested whether state empathy (i.e., immediate affective and cognitive responses to another's experience) differs when observing a demonstrator in immersive VR versus 2D video, and whether this modulation affects placebo hypoalgesia. Forty-seven participants observed a human or avatar demonstrator receiving painful stimulation with or without placebo, then experienced the same stimulations. Observation induced significant placebo hypoalgesia for pain intensity and unpleasantness. Human demonstrators evoked greater cognitive empathy, while placebo treatments reduced empathy across contexts. Analgesic effects were stronger in 2D after observing humans, but in VR, avatars induced greater placebo effects. Placebo responsiveness was related to trait empathy in the VR-Human condition; however, state empathy did not mediate the effect. Our findings highlight that demonstrator characteristics and immersion critically shape the social transfer of placebo effects.

Grants and funding

5TL1TR003100/TR/NCATS NIH HHS/United States