The nocebo effect can bother me. I was watching the program First Dates and in it there was someone who said, "If someone tells me too much information and it's not interesting, I wander off. This is because I have dyspraxia. Then I just can't process that information well, of anything that doesn't interest me."
I did find this interesting, that instead of clearly stating that you just don't find something interesting, you say, "I have dyspraxia, my brain just works differently. Anything that doesn't interest me, I can't process. Isn't because of you though, is just because of my dispersion."
Of course, that does sound much nicer than indicating that you just really don't find someone interesting. That's different, after all.
This made me laugh a lot, so I looked up the term. Then I found out it's a motor development disorder. Still something different than the girl said. It had a little to do with it, but it's more motor. For example, you can't hop, skip, or stay bedridden for a long time. You can't do many motor things well.
Processing information was also one of them, but it still had more to do with motor issues. For example, you don't know where your hands are.
Then again, that may not be pleasant. Hopping and hopscotching I also like. Then I said to myself, "What are you worrying about now, it's not like it's suddenly going to happen."
Let me explain why I started to care. I used to smoke and tried to quit with nicotine gum. That one is not really tasty and my throat was getting sore. Then I thought, yes it will, but still I read the package insert. In it were all the symptoms you could get, such as dizziness, headaches and within no time I had all those symptoms. Then I stopped chewing gum and started smoking again, because at least then I wouldn't have all those complaints.
I later found out that this is the nocebo effect. You have the placebo effect, which is a positive effect on the suggestion that a pill works well for pain. This then works against the pain, when in fact there was nothing in the pill to counteract pain. That the pain becomes less is because of the suggestion that the pill works.
But a nocebo is a negative effect. For example, I read the package insert for a pill. Suddenly the pill then has all the negative properties listed in the package insert. Actually the same effect, but negative. So only I do it myself, in both cases.
So if I really start believing I have dyspraxia, I won't be able to hop, I'll start bedwetting, and I won't know where my hands are. Because I'm quite impressionable with this kind of thing, especially by myself and with suggestions. So I shouldn't do that.
According to scientists, the nocebo effect also occurs more often when someone receives a negative diagnosis. For example, you may start to feel even sicker than you already are. It is also important to have confidence in the therapy or treatment you receive. If this confidence is not there, the nocebo effect can also occur naturally.
The doctor himself also influences the nocebo effect. Suggestions about pain often cause people to feel that pain. This fear created by what a doctor says can even stimulate the production of cholecystokinin in the body[1]. This substance stimulates the transmission of pain sensations in the body.
Not at all convenient.
GPs and countering the nocebo effect
This is also interesting as doctors and counselors start to explain what can go wrong. More can go wrong than just pain, for example. Parkinson's disease, for example, can get worse because of the nocebo effect[2].
People who are sensitive to suggestions then suddenly get worse symptoms or side effects from medication.
Doctors do need to tell the side effects, they cannot lie, and people need to be aware of the risks that can come with medication. It is your body, after all. So how do you solve this as a doctor? If you start then you can say, "There are individuals who are sensitive to this, but there are not that many." And then in doing so you point in a vacuum. Not at your client, but next to it and you also look at where you are pointing.
"And you have individuals who feel very good. They suddenly have no pain. Some people even go through life very happy. This is very special about this pill. It is called antidepressant, but we can also call it happy-joy pill. We see a lot of people become a lot happier. Maybe you do." And then you look and point at your client.
Then you assign all the positive attributes for a placebo effect for the person opposite you and give the side effects to a fictional person; someone who is not there. That way you don't give the nocebo to your client.
I even taught my doctor not to give me nocebo because I am very impressionable. I start thinking about it, I take it home. I protect myself from that by telling my doctor that I'm very sensitive and don't want to hear all that negativity. So then they just have to tell that to a fictional person next to me and all the positives to me though. I tell them how to deal with me.
If you're like this too, it's nice to hear positive things instead of negative things, isn't it? Of course, this is not always possible. You have plenty of people sitting around bitching and then you can move on, but if you're in a waiting room that's not possible.
So let your doctor tell you something in a way that benefits you, rather than hurts you. I want to go home feeling all better, with placebo effects. Instead of feeling that I now "really have something," that is, with nocebo effects.
So take this with you. Also listen to this podcast:
https://www.buzzsprout.com/195236/1369807-het-bijsluiter-effect-ken-je-dat
Therapy and the nocebo effect
It's not just the family doctor who can inadvertently cause a nocebo effect, nor is it linked only to medication. Psychological therapy can also have a nocebo effect, making someone's symptoms worse. For example, when you are dealing with a waiting list, this can make you feel that everything has to get worse first[3] (which is therefore not true, it is okay to remain stable in your symptoms).
In addition, as a therapist, you can also inadvertently trigger the nocebo effect. For example, when you keep your distance during the encounter and do not act empathetically. Previous negative experiences with similar care produce the same effect[4].
So achieving rapport, a good relationship with your client, is incredibly important to minimize or even prevent a nocebo effect. How to achieve rapport or know you have it is something you will learn in training at the HIN.
A mismatch between the story the client tells himself about his problem and how the therapist sees it can also cause miscommunication, which can have a detrimental effect.
If the person you want to help is very focused on language, is anxious and has a pessimistic disposition, the likelihood of a nocebo effect is also higher. Thus, comments such as "You don't have to worry" and "Are you in pain today?" can also trigger the nocebo effect.
People with chronic pain are also often more likely to experience the nocebo effect because of their history with health care providers. For example, people may say, "It's all between the ears." Comments like that then make people feel they are not taken seriously. People then adhere less to advice, which in turn can exacerbate pain symptoms.
Trauma and the nocebo effect
A traumatic event can produce post-traumatic stress disorder (PTSD). Therefore, there has previously been much attention on providing brief treatment on how to cope with trauma immediately after a traumatic event. In this, it was also reported that people could expect negative events because of the trauma. Only research showed that people who received that help were actually more likely to get PTSD than those who did not (source 4). This was because of the suggestion that people could therefore expect those negative events and then they started focusing on negative things.
So giving helpful suggestions and having a good relationship with your client is very important to avoid the nocebo effect. A lot of attention is paid to this in the training of the HIN. If you work with people as a coach, psychologist, doctor or in any other capacity, then knowledge of hypnosis can be a nice addition.
Join the free online master class to learn more about hypnosis.
At a hypnosis seminar, you also get to see demonstrations of hypnosis sessions and learn how to make people feel good with suggestions.
In the HIN's training courses, you will learn more about suggestion, report building and much more.
Also pin this handy infographic as a reminder:
Sources:
[1] https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.208
[2] https://www.sciencedirect.com/science/article/abs/pii/S0306452207001819
[3] https://onlinelibrary.wiley.com/doi/abs/10.1111/acps.12275
[4] https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00555/full
