What is the nocebo effect and why it can harm

What is the nocebo effect

This is when a harmless treatment causesNocebo / National Cancer Institute Dictionaries a person's condition worsens. The nocebo effect can work if the patient believes the therapy is dangerous.

For example, in the United States, a 26-year-old man who was undergoing experimental psychotherapy tookR. R. Reeves, M. E. Ladner, R. H. Hart. Nocebo effects with antidepressant clinical drug trial placebos / General Hospital Psychiatry 29 capsules of a prescribed antidepressant after having a falling out with a girl. The young man's heart rate increased and fell pressure, and he himself was in a semi-faint. Doctors took urgent measures to stabilize the patient's condition. However, almost immediately it turned out that the pills were a dummy, issued as part of the experiment. Upon learning of this, the man quickly came to his senses.

Because of what the nocebo effect appears

Our thoughts can greatly influence how we feel. For example, fear of pain only intensifiesU. Bingel, V. Wanigasekera, K. Wiech et al. The Effect of Treatment Expectation on Drug Efficacy: Imaging the Analgesic Benefit of the Opioid Remifentanil / Science Translational Medicine her. That is, the brain is capable of creating false sensations that we cannot distinguish from real ones. Therefore, negative expectations are consideredC. Locher, H. Koechlin, J. Gaab et al. The Other Side of the Coin: Nocebo Effects and Psychotherapy / Frontiers in Psychiatry one of the main reasons for the emergence of nocebo.

Their appearance can be influenced by a variety of factors: from how confidentlyS. Planès, C. Villier, M. Mallaret. The nocebo effect of drugs / Pharmacology Research & Perspectives the doctor behaves, up to colorA. J. de Craen, P. J. Roos, A. L. de Vries. Effect of color of drugs: systematic review of perceived effect of drugs and of their effectiveness / BMJ and pricesL. Colloca. Nocebo effects can make you feel pain / Science tablets.

According to one version, the effect of nocebo is associated with the hormone cholecystokinin. It is produced in the intestines, is responsible for feelings of fullness, and can also cause anxiety, anxiety, and hallucinations. Italian scientists in 1997 establishedF. Benedetti, M. Amanzio, C. Martinaa et al. Blockade of nocebo hyperalgesia by the cholecystokinin antagonist proglumide / Painthat when taking drugs that block cholecystokinin, pain caused by nocebo is reduced.

The work of the Italian colleagues was continued by American scientists. By analyzing the MRI data of the brains of people in pain, the researchers cameJ. Kong, R L. Gollub, G. Polich et al. A Functional Magnetic Resonance Imaging Study on the Neural Mechanisms of Hyperalgesic Nocebo Effect / Journal of Neuroscience to the conclusion that the nocebo effect is observed when the hippocampus is active. This area of ​​the brain that is associated with anxiety and corticoid hormones, is stimulated by the negative expectations of the person.

Who is most affected by the nocebo effect?

There are several groups of people who may experience nocebo more often than others.

People prone to anxiety and depression

Doctors from Switzerland analyzedA. Kerna, C. Kramma, C. M. Witt et al. The influence of personality traits on the placebo / nocebo response: A systematic review / Journal of Psychosomatic Research 407 scientific papers on nocebos from 1997 to 2018 and concluded that the effect may be exacerbated by increased anxiety. Depression and negative thinking also increase susceptibility to nocebos.

People with chronic illnesses

The effect of the effect may be more susceptibleC. Locher, H. Koechlin, J. Gaab et al. The Other Side of the Coin: Nocebo Effects and Psychotherapy / Frontiers in Psychiatry people with chronic pain as well as diseasesV. Napadow, A. Li, M. L. Loggia et al. The imagined itch: brain circuitry supporting nocebo-induced itch in atopic dermatitis patients / Allergy itchy skin. Problems like these become constant factors of stress and discomfort. As a result, a person is always alarmed and waits for a deterioration in health.

Those who have had treatment failure

For example, if the therapy was chosen incorrectly or the doctor was behaving unethically. During treatment, such people could feel pain or discomfort and then involuntarilyL. Colloca, F. G. Miller. The nocebo effect and its relevance for clinical practice / Psychosomatic medicine project your fears into any medical intervention.

Why the nocebo effect is dangerous

For several reasons at once.

Causes psychosomatic reactions

For example, a belief in the dangers of a drug leads to the fact that a person really feels a negative impact. In 2015, scientists conducted an experimentV. Napadow, A. Li, M. L. Loggia et al. The imagined itch: brain circuitry supporting nocebo-induced itch in atopic dermatitis patients / Allergy, which confirms this thesis. Two groups of volunteers were injected with saline and a compound that causes an allergic reaction. Those who believed they had received the allergen experienced itchingeven if in fact the doctors gave them a pacifier.

Makes pain and side effects more acute

Because of nocebo, a person may be prone to side effects, even if there is no reason for it, and more acuteM. Pfingsten, E. Leibing, W. Harter et al. Fear-Avoidance Behavior and Anticipation of Pain in Patients With Chronic Low Back Pain: A Randomized Controlled Study / Pain Medicine to feel pain.

So, in people who took not medications for migraines, but a placebo, were recordedM. Amanzio, L. L. Corazzini, L. Vase, et al. A systematic review of adverse events in placebo groups of anti-migraine clinical trials. Pain the same undesirable effects as when taking these drugs. For example, a decrease in blood pressure and an increase in heart rate. And anorexia and memory problems were recorded only in those who took pacifiers. This is because the possibility of such problems was reported before the experiments.

Transmitted from person to person

In November 1998, a Tennessee schoolteacher feltT. F. Jones, A. S. Craig, D. Hoy et al. Mass Psychogenic Illness Attributed to Toxic Exposure at a High School / The New England Journal of Medicine the smell of gasoline in the classroom. Soon the woman became ill: she was tormented by a headache, dyspnea and dizziness. Following the teacher, more than a hundred students and employees of the institution asked for medical help, and 38 people were even hospitalized.

A subsequent inspection did not reveal any traces of poisoning either in the school or in the analysis of the victims. It turned out that those who saw the "sick" or heard that a strange smell had appeared in the school were mainly complaining about poor health. This case was called an example of a massive psychogenic illness.

How to deal with the nocebo effect

Most of the research provides advice on how to overcome nocebos for doctors, but there are a few things you can do yourself.

Check if you are at risk

First you need to defineS. Planès, C. Villier, M. Mallaret. The nocebo effect of drugs / Pharmacology Research & Perspectiveshow susceptible you are to the nocebo effect. A tendency to anxiety and depression, negative treatment experiences, negative attitudes and skepticism are the most characteristic signs.

Don't forget about the danger of self-hypnosis

Unmotivated side effects can be easily avoided by simply warning yourself that nocebo may cause such effects. After all, it is self-hypnosis that often leads to a negative result.

Think positively

CostsL. Colloca, F. G. Miller. Harnessing the placebo effect: the need for translational research / Philosophical transactions of the Royal Society of London. Series B, Biological sciences focus on the positive rather than negative effects of drugs. In other words, the fact that the vast majority of people are helped by treatment is more important than the occurrence of side effects in 5% of patients.

The likelihood of being among the few people who will have problems is extremely small, but our brain clings to this thought and so only hurts. Therefore, you should try to look at everything optimistically.

Find a good doctor

If you are undergoing treatment with a real specialist, then, most likely, you will trust him and will not doubt his methods. It is also important that the doctor is tactful and appliesR. E. Wells, T. J. Kaptchuk. To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed consent / The American journal of bioethics: AJOB individual approach. Especially if the patient is anxious.

Show initiative

Talk with your doctor more often about how your treatment is going. It will give you a sense of control.R. E. Wells, T. J. Kaptchuk. To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed consent / The American journal of bioethics: AJOB over the situation and will reduce the degree of mistrust. Here, again, the professional and human ethics of the doctor is important, who should treat your questions and clarifications with understanding.

See a psychotherapist

If the nocebo is caused by a negative experience of past treatment, with this it mayC. Locher, H. Koechlin, J. Gaab et al. The Other Side of the Coin: Nocebo Effects and Psychotherapy / Frontiers in Psychiatry to help psychotherapy.