Understanding The 'Nocebo' Effect

Psychology's well-known placebo effect has an eerie doppelganger: the nocebo effect.

By Mark Travers, Ph.D. | January 17, 2024

Our mind wields a remarkable influence over our well-being. Its ability to shape our health outcomes through belief alone is evident in the much-celebrated placebo effect, one of the strongest testaments to the mind’s power. While much attention has been devoted to the positive impact of belief on health, there exists a shadowy counterpart that has often been overlooked.

Just as the mind can convince the body of positive outcomes with a mere placebo, it also has the capacity to evoke negative consequences through a phenomenon known as the “nocebo effect.” This intriguing and somewhat ominous aspect of the mind-body connection is now the focus of psychologists seeking to unravel its mysteries.

What Is The Nocebo Effect?

The placebo effect, a well-documented phenomenon, demonstrates the incredible power of the mind in influencing health outcomes through belief. Initially discovered as a curious response to inert substances during clinical trials, the placebo effect sparked a revolution in understanding the mind’s role in healing. However, within the realms of this fascinating psychological phenomenon lies its darker counterpart. 

The nocebo effect, simply put, is the exact opposite of the placebo effect, wherein negative outcomes are induced by the belief in their likelihood. A study published in Pharmacology Research and Perspectives explores the underlying mechanisms of the nocebo.

These mechanisms, rooted in both psychology and neurobiology, involve conditioning, negative expectations and the roles of cholecystokinin, endogenous opioids and dopamine—powerful neurotransmitters. Moreover, the unintentional negative suggestions in the verbal and nonverbal communications of physicians can trigger a nocebo response. Most concerningly, the nocebo effect can occur in the presence of either an inert or an active substance. 

The nocebo effect reveals the powerful influence our thoughts can have on our health. In essence, if you expect a negative outcome, your mind might actually make it happen, regardless of whether or not the medication, therapy or intervention works. The effect is like a simultaneous self-sabotaging and self-fulfilling prophecy, grounded in our minds and neurochemicals.

Consider a scenario where your doctor, with all good intentions, unknowingly communicates negative expectations regarding your medication or treatment (like unpleasant side effects or unexplained ineffectiveness). This unintentional messaging becomes a subtle suggestion that your mind and neurotransmitters interpret as a cue to manifest unpleasant symptoms. The same can occur if you maintain negative expectations regarding your health outcomes yourself; this highlights the need for a positive mindset in healthcare endeavors, as well as the dangers of a negative mindset.

Who Does It Affect? And Can It Be Avoided?

The impact of the nocebo effect is not uniform across individuals, and certain practices and personality types may be more susceptible to its influence. Interestingly, research from the Australian and New Zealand Journal of Psychiatry suggests that individuals with certain personality traits—particularly neuroticism, pessimism and Type A personalities—may be more prone to the nocebo effect, indicating the need for personalized approaches to healthcare and related communications. 

Navigating your health can be a challenging journey, and can be even trickier for those predisposed to worry, stress or negativity. A pessimistic outlook can be unknowingly detrimental to your health outcomes, as personalities predisposed to negativity may experience the nocebo effect more acutely. The mind can unwittingly mold our health outcomes based on our expectations. However, understanding our negative tendencies opens a gateway to actively shape a more positive and resilient narrative while looking after our health.

For those with neurotic tendencies:

• Embrace open communication. Share your concerns and fears with your healthcare provider openly. Don’t hesitate to ask questions; it’s your health, and you have the right to know.
• Seek reassurance. Focus on the positive aspects of your treatment. Remember, many side effects are manageable, and your healthcare team is there to support you.
• Build a support network. Surround yourself with a supportive network of friends and family. Having people who understand and encourage you can make a significant difference.

For those with pessimistic tendencies:

• Set realistic expectations. Approach your treatment with a balanced perspective. Gather information, but try not to dwell on worst-case scenarios. Many people have positive experiences with similar treatments.
• Look for success stories. Seek out positive stories from others who have undergone similar treatments. Hearing about positive outcomes can shift your perspective and provide hope.
• Explore mental health resources. Consider exploring counseling or support groups to manage pessimistic tendencies and navigate the emotional challenges associated with your health journey.

For Type A personalities:

• Focus on what you can control. Identify aspects of your treatment that you can actively manage. Creating a sense of control can positively impact your overall experience.
• Dive into details. Learn as much as you can about your treatment plan. Detailed information can help alleviate uncertainties and contribute to a more organized approach to your health.
• Create structured routines. Develop routines that align with your treatment plan. Structure can provide a sense of organization and predictability, helping you feel more in control.

Your mindset and approach to your health journey matter. By actively participating in your care and adopting strategies that align with your personality, you can contribute to a more positive and effective healthcare experience.

Conclusion

Regardless of your personality type, maintaining a positive approach is crucial in your health journey, especially considering the influence of the nocebo effect. Be an active participant in your healthcare, asking questions to understand your treatment plan and reduce the risk of nocebo-induced negative effects. When seeking information, choose wisely by avoiding overly negative sources that could amplify your anxiety. Curiosity, discernment and a positive mindset can make all the difference in your healthcare journey—not only in your outlook, but in actively avoiding the pitfalls of the nocebo effect.

A similar version of this article can also be found on Forbes.com, here.