Over the years, research has stated that those who have a positive approach to their treatment plan have lower rates of rehospitalization and better quality of life than those who may have developed an unconscious negative view of their treatment plan. The power of positive thinking and acceptance contributes to the placebo effect – the belief that a treatment will help – which can be as effective as medical intervention. Interestingly, we are learning that the opposite can also be true, coined as the “nocebo effect”.
Nocebo Effect [no·ce·bo ef·fect]
The nocebo effect is described as a phenomenon “causing patients to develop side effects or unwanted symptoms, or reject treatment, due to the belief that the medical intervention will cause harm.” In other words, an individual’s pre-existing experiences and beliefs, including the environmental influences they are exposed to, can influence their outcomes.
For example, there were a huge number of media reports on the effects of COVID-19 vaccination to trigger unknown side effects, including conspiracy theories about why vaccination was being encouraged were circulating. Therefore, some people were unwilling to be vaccinated. Now, if a patient was advised to be vaccinated, the patient would unconsciously search for experiences and feedback gathered over time when making a decision. In this instance, they may decide against receiving the vaccine because they are concerned about the side effects but have not done any research personally; the decision is purely based on environmental influences.
Both examples are important when understanding the nocebo effect – rejecting treatment and advice because of significant concerns that the treatment will do harm, not good. As stated, this can be influenced by environmental/early experiences and an individual’s psychological mindset.
Clinicians can unintentionally trigger the nocebo effect during medical appointments or when obtaining informed consent, discussing potential adverse effects, outlining patient expectations, or responding to questions about the treatment or trial
Another example relates to a case of a patient who had been recently diagnosed with a rare cancer that require immediate surgery to remove the cancer cells. However, her reluctance to go ahead with the operation was based on environmental “noise” informing her that the surgery would trigger the cancer to spread, leaving her with a difficult dilemma. She was “rejecting” treatment because of her concerns that the treatment would do more harm – otherwise defined as the nocebo effect.