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The Placebo & Nocebo Effect

Written by

Deborah & Sabrina Freudenmann

Placebo and nocebo effects are powerful and pervasive in any health coaching or clinical practice. Placebo effects are the expectation of a positive outcome and can indeed trigger beneficial results. Compared to nocebo effect which is the negative expectation of an outcome. This negative expectation can undeniably cause harmful outcomes or lead to the worsening of a symptom.

Variation in the ways that client’s respond to a therapeutic relationship, treatments and experience their health is partly attributed to these effects.

In a study with 200 patients, some of the participants were given a diagnosis and told they would feel better in a few days of which 64% did. Out of those participants who were told their diagnosis was uncertain or unclear only 39% noticed improvements a few days later.
This indicates that 50% of improvements are based on the confidence and clarity provided by a practitioner/coach or individual. Now, this isn’t just between a coach/practitioner or client but also between friends, families, children, strangers… your words have immense power.

In another clinical study, real acupuncture was compared to sham acupuncture. The patients were asked which group they believe they belonged to – either real treatment or placebo. Those who believed they belonged to the real treatment group experienced far larger improvements compared to those who believed they belonged to placebo.

Another example is post-operative anxiety and the use of diazepam prescription. There is clear evidence that anxiety decreases in patients who receive overt administration of diazepam. However, when diazepam is given secretly (without the patient’s knowledge) it is completely ineffective at reducing anxiety levels. Crazy right?
Similarly, anxiety increases significantly after 4–8 hours when diazepam is interrupted overtly, whereas its hidden interruption does not change anxiety scores. Therefore, the anxiety relapse after the expected (open) interruption of diazepam is attributable to the negative expectation of anxiety relapse (nocebo effect).

Nocebo effects are also important in aspects such as physical performance. For example, in a 30 m repeat-sprint, placebo capsules combined with different positive or negative instructions lead to increased and decreased speed, respectively. It is possible to negatively affect the performance of various exercises by employing negative conditioning and discouraging suggestions.

However, the placebo effect also has a darker side. The same mind body power that can help you heal can also help cause harm. Patients partaking in these clinical trials are given the list of side effects that the real drug could cause even if they are given a placebo. Some of the patients which received the placebo, a sugar pill often reported taste disturbances, memory disturbance, fatigue, muscle weakness, vomiting other discomforts and symptoms that a sugar pill wouldn’t cause.

Overall, this suggests that the social environment and your role as a health coach/practitioner has an important contribution to health and emphasizes how expectations, both positive and negative can impact the outcome to an illness.

Every time a person whether that’s a friend or health specialist tells you that you have an “incurable” disease, that you will always suffer with a condition, or that you will never get off a medication for the rest of your life… they are essentially hexing you! Remember this isn’t about blaming, more often than not, these statements are said because people think you deserve to know and it comes from a place of good intention.
Yet when those words are said, they instill in your conscious and subconscious mind a belief that you won’t get well, and as long as the mind holds this negative belief, it becomes a self-fulfilling prophecy. If you believe you’ll never recover, you won’t.

Are you promoting strong belief in the body’s ability to heal itself? Faith? Empowerment? Or are you promoting fear?
Do you believe you’ll be on medication for the rest of your life?
Are you resigned to the prognosis your doctor gave you?
Or are you motivated to try to activate your body’s innate self-repair mechanisms by shifting your beliefs from negative ones to positive ones?

Food for thought!

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    2 Responses

    1. What a great article! Thank you 🙂

      1. Deborah Freudenmann says:

        Appreciate it Zoe!

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