Tutorial 10: Nocebo response

Question 1

Nocebo effect

Answer 1

Adverse consequences (side effects or worsening of symptoms) experienced from taking an inert OR active treatment (which are not brought about by any component of the treatment)

Negative expectations cause the treatment to have a worse effect

Question 2

Main psychological mechanisms of nocebo response

Answer 2

Misattribution
Expectations
Classical conditoning
Anxiety

Question 3

Factors which influence the nocebo effect

Answer 3

• Describing/framing information
• Social modelling
• Expectations
• Choice of treatment

Question 4

Clinical implications of the nocebo effect

Answer 4

Inert AND active treatments can cause nocebo effects

• Distress
• Adds to burden of illness
• Increase costs of care
• Intentional non-adherence
• Physician may try to treat side effects with additional drugs
• Fosters distrust in treatment and healthcare

Question 5

Reducing nocebo effect

Answer 5

• Withhold side effect information (deception)
• Statistical framing of information:
• positive and negative framing
• Psychoeducation
• Patient choice

(POSITIVE SOCIAL MODELLING)