It seems that throughout life, even as we grew up, we heard from our friends and family comments like "If you think bad thoughts, then you'll jinx it" or "If you think the worst, then you'll make it happen." It seems that in clinical research, these sayings actually have a name... and that name is "nocebo effect."
In medicine, when we talk about the "nocebo effect," what we are referring to is the concept that adverse health or clinical events can be produced or influenced by negative expectations. These effects are a direct result of the psychosocial context or therapeutic environment and its impact on a person's mind and body.
It can be produced by various factors, including verbal cues and past experiences. So, if someone has had prior unsuccessful or negative therapeutic experiences or was provided information in a negative light, it may mediate an undesirable outcome to the therapy.
This effect is now widely recognized in medicine, and we know that negative presentation of a clinical event or therapy can potentially lead to more negative outcomes. Therefore, consideration of nocebo effects in the context of patient-clinician communication and disclosure in routine practice may be valuable in both minimizing the nocebo component of a given therapy and improving outcomes.
A recent article in the Journal of American Medical Association (JAMA) discusses the impact of the nocebo effect on therapeutic outcomes, and how clinician-to-patient communication should take this into consideration. As a physician, I am always conscientious about making sure that I paint as accurate of a picture as I can for my patients so that they know what to expect -- both good and bad. But I am also aware of the fact that what I perceive as providing the most accurate picture possible may also be negatively affecting the patient's perception of a treatment. So how can we balance being forthcoming about all potential outcomes while still minimizing this "nocebo effect"?
When I talk to patients about lab results or therapies, or when I am answering their questions, I take on the perspective of talking to a family member or a friend... I also will think about how I might want the information caringly delivered to me. Frequently, physicians have busy clinic schedules and need to make sure that they get the information to the patients as succinctly and accurately as possible. But I believe that when physicians take the time to provide the information as though they are giving that information delicately to a loved one, they are better able to prepare patients for the worst -- and the best -- while still delivering that information with a level of warmth that might ensure more of a positive outcome instead of a negative one.
This concept that what occurs in our mind and perception may affect the ultimate outcome should also be taken into consideration for everyday life and interactions with other people. Have you ever had similar interactions with two different people in relatively similar settings but left one interlude feeling happy and positive, while leaving the other feeling upset and unsettled?
How information is exchanged between couples, friends or colleagues -- whether with warmth or with negativity -- clearly affects outcomes of how you feel when you walk away from the experience. If our interactions with ourselves and loved ones are always pessimistic, this potentially leads to more negative outcomes for us and our relationships. So this "nocebo effect" occurs in daily life as well as in the clinical setting.
When we keep that in mind, it helps us to realize that how we deliver any given information is just as important, if not more so, than the content of the information. By keeping this in mind, we may all create more positive outcomes, both in clinical situations and in day to day life. Furthermore, the positive outcome is not just limited to the person receiving the information but also to the person delivering the information. In various studies, it is seen that people who are more positive tend to be healthier and live longer.
When we hear about epidemiological studies about how optimism is common in those populations who live longer, it further reinforces the idea that positivity -- whether it's delivered in the form of information or whether it's only in our thoughts -- generally leads to positive outcomes, whether in health, therapies or relationships.
How we perceive an event does significantly impact our experience of it. Therefore, as this article suggests, it behooves us all to always deliver information and interact with others with a level of positivity such that people can walk away from the encounter feeling informed, empowered and without significant fear or apprehension.
Sometimes we ignore how important our mind's perspective on an event is, and how our perception will affect the outcome of things we do and encounter. What I see time and time again in clinics and hospitals is that when patients walk away from an encounter feeling like they were provided with both the good and the bad potential outcomes, but with warmth and understanding, the outcomes are usually positive.
So as the JAMA article suggests, the "nocebo effect" should be taken into consideration in clinical situations... But as most epidemiological studies that support optimism as a way to a healthier life suggest, we could all take the concept of "nocebo effect" into everyday life and envelop ourselves and others with a positive perspective and light instead of a negative one. This way, maybe we can all see more positive outcomes, not just in clinical environments, but throughout out all aspects of our lives as well.
For more by Julie Chen, M.D., click here.
For more on mindfulness, click here.
For more on new research, click here.
 Colloca, L, et al. "Nocebo Effects, Patient-Clinician Communication, and Therapeutic Outcomes." JAMA. 2012;307(6):567-568. doi: 10.1001/jama.2012.115
 Tindle, H, et al. "Optimism, Cynical Hostility, and Incident Coronary Heart Disease and Mortality in the Women's Health Initiative." Circulation. 2009 August 25; 120(8): 656-662.
Flickr photo by ar-pics
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