Nocebo The bad twin of placebo

Nocebo effect causes physical discomfort due to negative expectations

09/05/2014

While the placebo effect is widely known as a positive therapeutic effect, based solely on the assumption that treatment may have occurred, the nocebo effect remains unknown to most people today. It is the ominous counterpart to the placebo effect and causes physical discomfort and illnesses only due to negative expectations. For example, reading the leaflets with numerous side effects can significantly increase the likelihood of side effects through the nocebo effect.

The nocebo effect is so strong that even superstition can lead to the onset of physical symptoms, possibly leading to puzzling mass phenomena in some regions of the world. Across from „Focus Online“ explained the director of the pain ambulance at the University Hospital Essen, Prof. Ulrike Bingel, that the „Nocebo effects negative psychological or physical reactions“ as the new onset of symptoms or symptom exacerbations describe, „which are triggered by negative expectations, negative beliefs or negative experience and fear.“

Conditioning and expectation responsible for the nocebo effect
The Nocebo effect works according to the statement of the psychologist Professor Dr. Paul Enck from the Medical Clinic, Psychosomatic Medicine and Psychotherapy at the University Hospital Tübingen using the same principle as the placebo effect, except that the expectation and thus the physical response is different. „By conditioning (learning), in which an earlier, positive as well as negative experience with medication plays a role, and by current expectations, which patients have and which are nourished by suggestive information, as they are for example on instruction leaflets“, the effects are caused according to Prof. Enck.

Massive physical discomfort due to the expectation
To the intensity of the physical discomfort that can be caused by the nocebo effect, reports a study by the US psychiatrist Roy Reeves of the University of Mississippi in Jackson, which in 2007 in the journal „General Hospital Psychiatry“ has been published. Here, a young participant in the antidepressant study has tried to take his life with the given psychotropic drugs. With severe physical symptoms and a drastic sagging blood pressure, the subject was admitted to the emergency room. In the further course it turned out, however, that the 26-year-old counted to the placebo group, so had received no drug. As soon as the doctors opened it to him, the symptoms immediately went down.

Read leaflets as a risk factor for side effects?
Less obvious, but still clearly recognizable, is the nocebo effect in numerous other studies, where participants complained, for example, of massive side effects, although they did not actually receive any medicine. In view of the influence that the nocebo effect can have on the treatment, the question arises to what extent the information provided by the physician and the information on the package leaflet regarding the threatening side effects may hinder or jeopardize the success of therapy. (Fp)