A systematic review of factors that contribute to nocebo effects
Open accessAbstract
OBJECTIVES: Medication side effects are common, often leading to reduced quality of life, nonadherence, and financial costs for health services. Many side effects are the result of a psychologically mediated "nocebo effect." This review identifies the risk factors involved in the development of nocebo effects. METHOD: Web of Science, Scopus, MEDLINE, PsycINFO, Journals@Ovid full text, and Global Health were searched using the terms "nocebo" and "placebo effect." To be included, studies must have exposed people to an inert substance and have assessed 1 or more baseline or experimental factor(s) on its ability to predict symptom development in response to the inert exposure. RESULTS: Eighty-nine studies were included; 70 used an experimental design and 19 used a prospective design, identifying 14 different categories of risk factor. The strongest predictors of nocebo effects were a higher perceived dose of exposure, explicit suggestions that the exposure triggers arousal or symptoms, observing people experiencing symptoms from the exposure, and higher expectations of symptoms. CONCLUSIONS: To reduce nocebo induced symptoms associated with medication or other interventions clinicians could reduce expectations of symptoms, limit suggestions of symptoms, correct unrealistic dose perceptions, and reduce exposure to people experiencing side effects. There is some evidence that we should do this especially for persons with at-risk personality types, though exactly which personality types these are requires further research. These suggestions have a downside in terms of consent and paternalism, but there is scope to develop innovative ways to reduce nocebo effects without withholding information. (PsycINFO Database Record
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The basic psychological mechanisms underlying the formation of negative expectations and nocebo effects are anticipation of and information about negative outcomes, prior lack of therapeutic effectiveness, and observation of other patients' pain worsening.
“The basic psychological mechanisms underlying the formation of negative expectations and thus, nocebo effects, are anticipation of and information about negative outcomes,34,76 prior lack of therapeutic effectiveness,33,34 and observation of other patients' pain worsening.42,60,74,77,78”
From Nocebo and pain: an overview of the psychoneurobiological mechanisms (2017) · cites this paper as [76]
Negative verbal suggestions designed to induce higher expectations for itch or pain led to higher reports of both itch and pain, with stronger effects for itch compared to pain.
“In the study by van Laarhoven et al, negative verbal suggestions were designed to induce higher expectations for itch or pain, and it was revealed that higher itch and pain expectancies led to higher reports of both events. Evaluation of both nocebo effects revealed stronger effects for itch when compared to pain.8,76”
From Nocebo and pain: an overview of the psychoneurobiological mechanisms (2017) · cites this paper as [76]
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The effects of messaging on long COVID expectations: An online experiment.
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Self-citation
- Authors
- Webster, R. K., Weinman, J., & Rubin, G. J.
- Affiliations
- University of London (GB)
- Corresponding author
- Webster, Rebecca K.
- Venue
- Health Psychology
- Published
- 2016-12
- Volume
- 35
- Issue
- 12
- Pages
- 1334-1355
- ISSN
- 0278-6133 (ISSN-L)
- 1930-7810
- OpenAlex
- W2517898512
- Cited by
- 172
- References
- 132
- Citations by year
- 2026: 15 · 2025: 22 · 2024: 15 · 2023: 14 · 2022: 19 · 2021: 10 · 2020: 18 · 2019: 24 · 2018: 19 · 2017: 14 · 2016: 2
- FWCI
- 2.07
- Type
- journal article
- Language
- en
- Open access
- green
- kclpure.kcl.ac.uk
- Licence
- other-oa
- Locations
- Health Psychology (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- National Institute for Health Research
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- nocebo effect, placebo effect, risk factors, adverse drug reactions, symptom observation, psychological mediation
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Prospective Studies, Quality of Life, Risk Factors, Drug-Related Side Effects and Adverse Reactions, Nocebo Effect
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