Episode 8 – The ‘nocebo’ effect: just as important as the placebo effect?

Janine and Aleena kick off by summarising the well-established ‘placebo’ effect, before focusing in on the lesser-known ‘nocebo’ effect. What’s the difference? How might these affects play a big role in treatment effectiveness? Can these effects be minimised? Janine also confesses to sub-par performance on a university assignment and Aleena shares some long-overdue pool noodle wisdom.

Mastering of this episode, plus intro and outro music, by the ever-talented Dr Adrian Diery.

Recap of the placebo effect

Most people are aware of the placebo effect. This is one of the reasons why we need control groups in many studies. A well-designed study into the effectiveness of a new drug, for example, should recruit participants to be slotted into either the treatment group or the control group. If we are testing the effect of a new drug, those in the treatment group will get the drug and those in the control group will usually get a placebo – for example sugar pills. And in the best studies, this should be carried out in a way that is “double blind” – this means neither the participants nor the people administering the treatment knows who is getting real drugs versus placebo sugar pills.

The placebo effect is a real phenomenon where people in the control group experience and report improvements in symptoms, even though no real drug was administered. The belief that may have been given the drug leads to real and measurable changes in symptoms.

So what’s the ‘nocebo’ effect then?

Good question! While the placebo effect leads to positive benefits – maybe a lifting of troubling symptoms – the nocebo effect is where receiving negative information about a treatment, usually in terms of side-effects, leads to negative effects. Like the placebo effect, the nocebo effect is not due to the treatment being administered; it’s due to the belief that you may experience side-effects. And this belief triggers real and measurable symptoms in the body.

Can the nocebo effect be minimised?

A study on cybersickness during virtual reality experiences confirmed that providing side-effect information to participants via “positive framing” (i.e., being told “70% of participants DO NOT experience nausea”) effectively abolished the nocebo effect, when compared to providing no information. When the information was “negatively framed” (i.e., participants were told “30% of participants DO experience nausea”), obvious nocebo effects were seen. So the way in which we convey side-effect information to people really matters.

Mao, A. et al. (2021). Using Positive Attribute Framing to Attenuate Nocebo Side Effects: A Cybersickness Study, Annals of Behavioral Medicine: XX:1–10.

Do you suffer from cybersickness?

Why not watch Avatar in 3D and see if you can get through it without any nausea? Janine certainly could not!

Increased nocebo effects due to Covid-19?

There’s no experiment here, but the authors of this perspective review suspect all the psychological distress and lack of control brought on by the Covid-19 pandemic makes for fertile ground for strong nocebo effects. They share some cool past research, including brain imaging studies, to make their argument. If Covid-19 really is ‘the perfect storm’ for nocebo effects, then reducing psychological distress through balanced news and other media could be one way to combat this. Lots to think about and plenty of science to test in the coming years…

Amanzio, M, et al. (2020). How do nocebo phenomena provide a theoretical framework for the COVID-19 pandemic? Frontiers in Psychology, 11: 589884.

We also saw that covid led to loads of conspiracy theories, including a $15,000 “biocharger” (a.k.a. “load of crap!”) that could maybe, possibly, sorta help with covid… ish… hmmm…

What brought out our inner square?

Janine shared some assignment feedback from her university days. She got only 60% on an evolution assignment and was just gutted as it was her favourite subject and she really did work hard at it. The written feedback was brutal. Many years on, Janine confesses that the grade and feedback was spot on – turns out that the assignment just wasn’t very good. Moral of the story: be persistent with whatever skills you want to improve – time and perseverance will do the trick!

Aleena follows-up Janine’s inspirational story with some slightly less important pool noodle tid bits. She thought she knew all there was to know about pool noodles until she saw their myriad uses around the home and even with covid-19 infection control. Check out these pool noodles hats to keep people out of your bubble. Also if you fancy some pool-noodle inspired craft and hacks, check this out.

Photo by Christina Victoria Craft on Unsplash

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