“…will break my bones, but names will never harm me!” (an English children’s rhyme)
Wrong! Words and expectations do matter and can actually harm us!
The strange truth about medicine and the brain is that they often interact in completely unpredictable and counterintuitive ways. Nowhere is this truer than with the bewildering phenomenon known as the nocebo effect.
‘The Placebo Effect’ is the healing patients experience in clinical trials when they believe they’re getting a fancy new drug; but are actually getting a fake treatment. The Placebo Effect is real, it’s not just in your head – it actually dilates bronchi, heals ulcers, makes warts disappear, drops your blood pressure, and even helps bald men who think they’re getting Rogaine grow hair!
There is new research on the opposite of the Placebo Effect, known as the Nocebo Effect, in which negative expectations produce bad results. In drug trials, patients who are given dummy pills can have either positive or negative outcomes despite the fact that they were given a fake drug.
The Nocebo Effect has been called the lesser-known “evil twin” of the Placebo Effect. Think of it this way: just as the Placebo Effect creates a positive reaction or healing from an inert or sham treatment, the Nocebo Effect is the negative or harmful reaction from a harmless treatment.
When treated with nothing more than placebos, clients often report fatigue, vomiting, muscle weakness, colds, ringing in the ears, taste disturbances, memory disturbances, and other symptoms that should not result from a sugar pill. Most of the time, they experience these symptoms because they were told to expect these side effects.
Wrong! Words and expectations do matter and can actually harm us!
The strange truth about medicine and the brain is that they often interact in completely unpredictable and counterintuitive ways. Nowhere is this truer than with the bewildering phenomenon known as the nocebo effect.
‘The Placebo Effect’ is the healing patients experience in clinical trials when they believe they’re getting a fancy new drug; but are actually getting a fake treatment. The Placebo Effect is real, it’s not just in your head – it actually dilates bronchi, heals ulcers, makes warts disappear, drops your blood pressure, and even helps bald men who think they’re getting Rogaine grow hair!
There is new research on the opposite of the Placebo Effect, known as the Nocebo Effect, in which negative expectations produce bad results. In drug trials, patients who are given dummy pills can have either positive or negative outcomes despite the fact that they were given a fake drug.
The Nocebo Effect has been called the lesser-known “evil twin” of the Placebo Effect. Think of it this way: just as the Placebo Effect creates a positive reaction or healing from an inert or sham treatment, the Nocebo Effect is the negative or harmful reaction from a harmless treatment.
When treated with nothing more than placebos, clients often report fatigue, vomiting, muscle weakness, colds, ringing in the ears, taste disturbances, memory disturbances, and other symptoms that should not result from a sugar pill. Most of the time, they experience these symptoms because they were told to expect these side effects.
What Causes the Nocebo Effect?
The Nocebo effect can be caused by verbal suggestions, expectations, and past experience. An article in the British Medical Journal illustrates this reaction: Researchers compared two different placebos for arm pain. The first treatment group received a sugar pill and the second group received sham acupuncture with retractable needles. Overall, the group that received the sham acupuncture reported less pain…the Placebo Effect in action.
More interesting: both groups reported side effects from their placebo treatment. A few patients from the group that received the pills reported that they were so sluggish that they couldn’t get out of bed while the group that received the sham acupuncture reported swelling, redness, and extreme pain. These side effects were exactly what the patients were told they might experience!
A New York Times article about the Nocebo Effect stated: “the Placebo Effect, which is based on a person's positive expectation, has been widely studied. Its opposite, the Nocebo Effect, has not. But, clearly a negative expectation can be powerful. Subjects who volunteer for drug trials sometimes drop out because the side effects of the new drug are too severe. This is true even when the side effects are being induced by a sugar pill and not a real drug.”
Another example was a study on lactose intolerance that involved a group of subjects who complained of intestinal problems caused by lactose, the sugar found in milk. Some of these people had been diagnosed with lactose intolerance; others only suspected that they had it. When they were given a fake lactose by the experimenters, "44 percent with known lactose intolerance and 26 percent of those without lactose intolerance complained of gastrointestinal symptoms" - and yet all had actually been given glucose, which does not harm the intestinal tract.
It is important to remember that, despite the fact that there is no "real" drug involved, the actual harmful, undesirable, emotional consequences of the fake drug are very real.
More interesting: both groups reported side effects from their placebo treatment. A few patients from the group that received the pills reported that they were so sluggish that they couldn’t get out of bed while the group that received the sham acupuncture reported swelling, redness, and extreme pain. These side effects were exactly what the patients were told they might experience!
A New York Times article about the Nocebo Effect stated: “the Placebo Effect, which is based on a person's positive expectation, has been widely studied. Its opposite, the Nocebo Effect, has not. But, clearly a negative expectation can be powerful. Subjects who volunteer for drug trials sometimes drop out because the side effects of the new drug are too severe. This is true even when the side effects are being induced by a sugar pill and not a real drug.”
Another example was a study on lactose intolerance that involved a group of subjects who complained of intestinal problems caused by lactose, the sugar found in milk. Some of these people had been diagnosed with lactose intolerance; others only suspected that they had it. When they were given a fake lactose by the experimenters, "44 percent with known lactose intolerance and 26 percent of those without lactose intolerance complained of gastrointestinal symptoms" - and yet all had actually been given glucose, which does not harm the intestinal tract.
It is important to remember that, despite the fact that there is no "real" drug involved, the actual harmful, undesirable, emotional consequences of the fake drug are very real.
Unwanted Side Effects
The Nocebo Effect complaints aren’t random. Sometimes they are in response to the side effects warnings caused by the actual drug or treatment. The mere suggestion that a patient may experience negative symptoms in response to a medication (or a sugar pill) may be a self-fulfilling prophecy. For example, if you tell a patient treated with a placebo, he might experience nausea, he’s likely to feel nauseous. If you suggest that he might get a headache, he may. Patients given nothing but saline, who thought it was chemotherapy, actually threw up
Can Words Harm?
One experiment showed the more frequently the words “sting,” “burn,” “hurt,” “bad” and “pain”, were said, the more discomfort was felt by patients. This research suggests that doctors should consider the Nocebo Effect when dealing with pain to avoid magnifying side effects.
Of course, trying to avoid this sort of scenario puts a doctor in a dilemma—limiting the patient’s discomfort could be at odds with keeping them informed about the procedure. To navigate this tension, the study’s authors advise doctors to emphasize positives (re-framing warnings into phrases such as “the majority of patients tolerate this well”) and, in some cases, actually getting permission from patients to keep them in the dark about certain mild side effects.
Addressing how to manage patients’ fears and anxieties can be just as important as fighting the real disease. A surprising conclusion you might come to after learning about the Nocebo Effect is: What you don’t know can’t hurt you.
Every time a doctor tells a patient that you have an “incurable” illness or that you’ll be on medication for the rest of your life or that you have a 5% five-year survival expectation, they’re essentially creating a ‘nocebo effect’. These predictions can be self-fulfilling.
The question arises: “Does the ‘Nocebo Effect’ occur in our everyday relationships?”
How we perceive an event significantly impacts our experience of it. In our everyday lives, it is important that we communicate and interact with others positively, so that people walk away feeling empowered with no fear or apprehension.
How information is exchanged between couples, friends or colleagues — whether with warmth or with negativity — clearly affects outcomes of how you feel when you walk away from the experience. If interactions with friends and loved ones are always pessimistic, it would lead to more negative outcomes for us and them.
Therefore, yes, the “Nocebo Effect” can occur outside clinical trials!
Keeping this in mind shows how we communicate information is just as important as the content of the information. We may create more positive outcomes in our day to day relationships. We know that people who are more positive tend to live longer, healthier lives.
When we read clinical research studies about how optimism and low stress is common among populations who live longer, it further reinforces the idea that a positive attitude — whether it’s communicated or only in our thoughts — generally leads to positive outcomes in health and relationships.
An article in the Journal of American Medical Association (JAMA) suggests, “the ‘Nocebo Effect’ should be taken into consideration in clinical situations. But, as most clinical studies that support optimism as a way to a healthier life suggest, we could all take the concept of ‘Nocebo Effect’ into everyday life and envelop ourselves and others with a positive perspective. This way, maybe we can all see more positive outcomes… not just in clinical environments, but throughout all aspects of our lives as well.”
Yes, words can sometimes be more harmful than “Sticks and Stones”!
References:
https://www.smh.com.au/lifestyle/the-nocebo-effect-can-our-thoughts-kill-us-20150303-13tdjl.html
http://www.huffingtonpost.com/julie-chen-md/nocebo-effect_b_1277841.html
https://www.deepakchopra.com/blog/article/3973
https://www.deepakchopra.com/blog/article/3988
https://www.deepakchopra.com/blog/article/4036
https://www.sciencedaily.com/terms/nocebo.htm
https://www.students4bestevidence.net/the-nocebo-effect/
https://www.health.harvard.edu/newsletter_article/The_nocebo_response
Of course, trying to avoid this sort of scenario puts a doctor in a dilemma—limiting the patient’s discomfort could be at odds with keeping them informed about the procedure. To navigate this tension, the study’s authors advise doctors to emphasize positives (re-framing warnings into phrases such as “the majority of patients tolerate this well”) and, in some cases, actually getting permission from patients to keep them in the dark about certain mild side effects.
Addressing how to manage patients’ fears and anxieties can be just as important as fighting the real disease. A surprising conclusion you might come to after learning about the Nocebo Effect is: What you don’t know can’t hurt you.
Every time a doctor tells a patient that you have an “incurable” illness or that you’ll be on medication for the rest of your life or that you have a 5% five-year survival expectation, they’re essentially creating a ‘nocebo effect’. These predictions can be self-fulfilling.
The question arises: “Does the ‘Nocebo Effect’ occur in our everyday relationships?”
How we perceive an event significantly impacts our experience of it. In our everyday lives, it is important that we communicate and interact with others positively, so that people walk away feeling empowered with no fear or apprehension.
How information is exchanged between couples, friends or colleagues — whether with warmth or with negativity — clearly affects outcomes of how you feel when you walk away from the experience. If interactions with friends and loved ones are always pessimistic, it would lead to more negative outcomes for us and them.
Therefore, yes, the “Nocebo Effect” can occur outside clinical trials!
Keeping this in mind shows how we communicate information is just as important as the content of the information. We may create more positive outcomes in our day to day relationships. We know that people who are more positive tend to live longer, healthier lives.
When we read clinical research studies about how optimism and low stress is common among populations who live longer, it further reinforces the idea that a positive attitude — whether it’s communicated or only in our thoughts — generally leads to positive outcomes in health and relationships.
An article in the Journal of American Medical Association (JAMA) suggests, “the ‘Nocebo Effect’ should be taken into consideration in clinical situations. But, as most clinical studies that support optimism as a way to a healthier life suggest, we could all take the concept of ‘Nocebo Effect’ into everyday life and envelop ourselves and others with a positive perspective. This way, maybe we can all see more positive outcomes… not just in clinical environments, but throughout all aspects of our lives as well.”
Yes, words can sometimes be more harmful than “Sticks and Stones”!
References:
https://www.smh.com.au/lifestyle/the-nocebo-effect-can-our-thoughts-kill-us-20150303-13tdjl.html
http://www.huffingtonpost.com/julie-chen-md/nocebo-effect_b_1277841.html
https://www.deepakchopra.com/blog/article/3973
https://www.deepakchopra.com/blog/article/3988
https://www.deepakchopra.com/blog/article/4036
https://www.sciencedaily.com/terms/nocebo.htm
https://www.students4bestevidence.net/the-nocebo-effect/
https://www.health.harvard.edu/newsletter_article/The_nocebo_response
RSS Feed