You may have heard of the placebo effect, a process in which a person’s health improves after receiving a treatment that has no inherent therapeutic effect. You may be less familiar with the nocebo effect, a phenomenon in which one’s expectations lead to physical changes that worsen their condition. The word nocebo literally means “I will harm” in Latin—an apt description of how this phenomenon works. This powerful example of the mind-body connection is something to be aware of when navigating your own health journey.
What Causes the Nocebo Effect?
The nocebo effect can be triggered by both negative expectations, observations, and experiences. Examples of these can include deliberately ineffective treatments that worsen symptoms, one’s previous treatment expectations and experiences influencing their current condition, both verbal and non-verbal communication by those administering a treatment, and the interaction between a health team and the patient.
The nocebo effect can be instigated not only by individual interactions, but by outside messaging as well. This can happen through negative suggestions prompted by advertisements, social media, or even your friends or family. A negative suggestion could sound like “I experienced a painful side effect, so you will too” or “Everyone who experiences that symptom has had a terrible outcome”. Even observing someone experiencing an unwanted outcome or condition can lead to fear the same will happen to you.
Being aware of the messaging you receive can help you decide if you want that expectation to apply to you. Simply questioning whether or not that information is applicable to you is a way to empower yourself and potentially avoid the nocebo effect.
The Nocebo Effect in the Healthcare System
When you are working with a healthcare provider, it is natural to extend your complete trust to this important authority figure in your life. However, all medical professionals are also people who may bring their own biases or even prejudices into your care.
There are several ways that doctors can introduce negative expectations in their patients, including:
1. Doctors can have a personal history or negative bias about something (for example, if they have suffered from a certain illness themselves), which can affect how they treat you. This does not mean they are intentionally causing harm, in fact, quite the opposite! Health professionals may not realize that their biases could be affecting their treatment of you.
2. Phrases like “when you get worse…” or “I wouldn’t be surprised if this never gets better” can form a strong, if not unshakable, expectation that the negative outcome will happen for you.
3. Sometimes it is what a doctor doesn’t say that can induce the nocebo effect. A lack of communication can create fear or anxiety, which may begin to negatively “fill in the blanks” of what has not been said.
Cultivating trust with your health team is an important aspect of the provider/patient relationship. Remember that you are allowed to speak up for yourself and to have informed consent regarding any choice made about your health.
Expectations have a real physiological impact on our bodies
If the phrase “the mind/body connection” has ever sounded “woo-woo” or made up to you, know that our thoughts, beliefs, and expectations can have a real and measurable physiological effect on our bodies.
This can be seen in stress diminishing white blood cell response to viral infections, the effect of music on exercise performance, the impact of emotions on chronic pain, and more.
Acknowledging the role that your expectations can have on your health is an important step in navigating any wellness journey.
How to Avoid the Nocebo Effect
So now that you know what the nocebo effect is, how you can avoid it?
Start with these three simple steps:
1. Intentionally focus on your desired outcome, not your symptoms. This doesn’t mean ignore your current experience! By not allowing yourself to fixate on unwanted sensations or possibilities, you can expand your expectations to include more positive results.
2. Create a daily relaxation practice. This could include breathwork, meditation or mindfulness exercises like yoga. By shifting your body into a parasympathetic state, you can switch your nervous system into a rest and recovery mode which encourages healing.
3. Listen with awareness. By being aware of what messages you are being presented with, both in your doctor’s office and your daily life, you can consciously navigate any negative expectations that may come your way.