THE NOCEBO EFFECT: THE POWER OF EXPECTATIONS AND OUTLOOK

The nocebo effect is the opposite of a placebo effect, so it is a negative response to a sham treatment where the person believes that they are getting the treatment but actually are not. What is amazing is how powerful expectations and outlook are as the placebo response is often close to that for those who actually received the treatment.  This has been true for studies of antidepressants used for depression. This has led some researchers to conclude that the antidepressants are not effective because the placebo response is so strong. What seems to be not understood is that for a placebo response to occur people have to believe they are getting the treatment. So, you can only have a placebo or a nocebo response if there is also treatment occuring.  

What is critical is to understand what happens in our brains when we have either a placebo or a nocebo response.  Nocebo responses are especially concerning. To understand these reponses researchers have looked at expectations and beliefs and their impact on treatment responses and overall health. Years ago a large study by the National Heart Association was conducted in Framingham, Massachusetts on 5290 men and women ages 30-62. They found that women who thought that they were "prone" to heart disease were four times more likely to die from heart disease than those women who did not feel that they were at risk for heart disease. So, is it possible that feeling prone to heart disease can kill you? It seems like it. It is as if we can create our own reality regarding our health in amazing and potentially frightening ways.

There is plenty of evidence from research that chronic stress increases negative outcomes for illnesses that we might have. Stress does not create illnesses such as heart disease or cancer but will make them worse and make for a worse prognosis. This reflects increased negative health outcomes related to the impact of chronic stress as this stress contributed to both a negative outlook and a feeling of hopelessness. This makes it similar to a nocebo effect. Turning to a positive outcome, a study by Crestwell in 2007 showed that breast cancer survivors who wrote affirming statements about their life had fewer side-effects and better overall outcomes compared to those who wrote negative statements. So, a more positive outlook as demonstrated by more positive statements without any prompts, leads to better outcomes. 

Since what we believe and expect can have significant impact on our lives why not be positive and hopeful?