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.
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Data availability
All behavioral data and the VR video footage we created for this study are available upon request to the corresponding author.
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Acknowledgements
The authors acknowledge the support of the National Institute of Dental and Craniofacial Research Helping to End Addiction Long-term (NIDCR HEAL) Initiative (1R21 DE032532-01, Dorsey/Colloca; J. White), the University of Maryland Baltimore’s Institute for Translational and Clinical Research (5TL1TR003100-05, L. Watson) and the National Center for Complementary and Integrative Health (R01AT010333 and R01AT011347, L. Colloca). The funding source was not involved in this work. The authors would like to thank Nandini Raghuraman for helping with the procedure setup and Yavin Shaham for feedback on the manuscript.
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J.N.W. and L.C. conceived and designed the study. J.N.W., L.W., R.S., J.M.H., S.L., and B.B. contributed to data collection and preprocessing. J.N.W. and L.W. performed initial data analysis. A.V. provided expertise and oversight on virtual reality design and implementation. L.C. supervised the study and secured funding. G.C., Y.W., and C.-É.B.-R conducted intendent analyses of the data collected and helped interpret the findings. J.N.W., L.W., and C.-É.B.-R drafted the manuscript. L.C. and C.-É.B.-R. reviewed and approved the final version of the manuscript. All authors contributed to manuscript revisions and approved the final version for submission.
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White, J.N., Watson, L., Wang, Y. et al. Context-dependent placebo hypoalgesia through observational learning: the role of empathy in immersive and non-immersive environments. npj Digit. Med. (2026). https://doi.org/10.1038/s41746-026-02373-3
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DOI: https://doi.org/10.1038/s41746-026-02373-3
