Objective: Investigate if placebo effects can be separated into assessment/observation, therapeutic ritual (placebo treatment), and patient-practitioner relationship. Participants: 262 adults with IBS randomized to waiting list (WL), placebo acupuncture alone (LIM), or placebo acupuncture with an “augmented” patient-practitioner relationship (AUG). Outcome measures: Global improvement scale (GIS), adequate relief of symptoms (AR), symptom severity score (SSS), and quality of life (QOL). Results: At 3 weeks, GIS scores were 3.8 for WL, 4.3 for LIM and 5.0 for AUG (P<0.001 trend). Proportions reporting AR (28%, 44%, and 62%), SSS (30, 42, 82) and QOL (3.6, 4.1, 9.3) had similar patterns (each P<0.001). Conclusion: Components of the placebo effect can be progressively combined in a manner resembling dose escalation. This has implications for patient care and trial design.