Minimizing nocebo effects by conditioning with verbal suggestion: A randomized clinical trial in healthy humans.

Nocebo effects, i.e., adverse treatment effects which are induced by patients' expectations, are known to contribute to the experience of physical symptoms such as pain and itch. A better understanding of how to minimize nocebo responses might eventually contribute to enhanced treatment effects...

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Main Authors: Danielle J P Bartels, Antoinette I M van Laarhoven, Michiel Stroo, Kim Hijne, Kaya J Peerdeman, A Rogier T Donders, Peter C M van de Kerkhof, Andrea W M Evers
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2017-01-01
Series:PLoS ONE
Online Access:http://europepmc.org/articles/PMC5598922?pdf=render
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author Danielle J P Bartels
Antoinette I M van Laarhoven
Michiel Stroo
Kim Hijne
Kaya J Peerdeman
A Rogier T Donders
Peter C M van de Kerkhof
Andrea W M Evers
author_facet Danielle J P Bartels
Antoinette I M van Laarhoven
Michiel Stroo
Kim Hijne
Kaya J Peerdeman
A Rogier T Donders
Peter C M van de Kerkhof
Andrea W M Evers
author_sort Danielle J P Bartels
collection DOAJ
description Nocebo effects, i.e., adverse treatment effects which are induced by patients' expectations, are known to contribute to the experience of physical symptoms such as pain and itch. A better understanding of how to minimize nocebo responses might eventually contribute to enhanced treatment effects. However, little is known about how to reduce nocebo effects. In the current randomized controlled study, we tested whether nocebo effects can be minimized by positive expectation induction with respect to electrical and histaminic itch stimuli. First, negative expectations about electrical itch stimuli were induced by verbal suggestion and conditioning (part 1: induction of nocebo effect). Second, participants were randomized to either the experimental group or one of the control groups (part 2: reversing nocebo effect). In the experimental group, positive expectations were induced by conditioning with verbal suggestion. In the control groups either the negative expectation induction was continued or an extinction procedure was applied. Afterwards, a histamine application test was conducted. Positive expectation induction resulted in a significantly smaller nocebo effect in comparison with both control groups. Mean change itch NRS scores showed that the nocebo effect was even reversed, indicating a placebo effect. Comparable effects were also found for histamine application. This study is the first to demonstrate that nocebo effects can be minimized and even reversed by conditioning with verbal suggestion. The results of the current study indicate that learning via counterconditioning and verbal suggestion represents a promising strategy for diminishing nocebo responses.
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spelling doaj.art-b195122ccd1f42c08d4cbf9bbeee51702022-12-21T19:06:05ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01129e018295910.1371/journal.pone.0182959Minimizing nocebo effects by conditioning with verbal suggestion: A randomized clinical trial in healthy humans.Danielle J P BartelsAntoinette I M van LaarhovenMichiel StrooKim HijneKaya J PeerdemanA Rogier T DondersPeter C M van de KerkhofAndrea W M EversNocebo effects, i.e., adverse treatment effects which are induced by patients' expectations, are known to contribute to the experience of physical symptoms such as pain and itch. A better understanding of how to minimize nocebo responses might eventually contribute to enhanced treatment effects. However, little is known about how to reduce nocebo effects. In the current randomized controlled study, we tested whether nocebo effects can be minimized by positive expectation induction with respect to electrical and histaminic itch stimuli. First, negative expectations about electrical itch stimuli were induced by verbal suggestion and conditioning (part 1: induction of nocebo effect). Second, participants were randomized to either the experimental group or one of the control groups (part 2: reversing nocebo effect). In the experimental group, positive expectations were induced by conditioning with verbal suggestion. In the control groups either the negative expectation induction was continued or an extinction procedure was applied. Afterwards, a histamine application test was conducted. Positive expectation induction resulted in a significantly smaller nocebo effect in comparison with both control groups. Mean change itch NRS scores showed that the nocebo effect was even reversed, indicating a placebo effect. Comparable effects were also found for histamine application. This study is the first to demonstrate that nocebo effects can be minimized and even reversed by conditioning with verbal suggestion. The results of the current study indicate that learning via counterconditioning and verbal suggestion represents a promising strategy for diminishing nocebo responses.http://europepmc.org/articles/PMC5598922?pdf=render
spellingShingle Danielle J P Bartels
Antoinette I M van Laarhoven
Michiel Stroo
Kim Hijne
Kaya J Peerdeman
A Rogier T Donders
Peter C M van de Kerkhof
Andrea W M Evers
Minimizing nocebo effects by conditioning with verbal suggestion: A randomized clinical trial in healthy humans.
PLoS ONE
title Minimizing nocebo effects by conditioning with verbal suggestion: A randomized clinical trial in healthy humans.
title_full Minimizing nocebo effects by conditioning with verbal suggestion: A randomized clinical trial in healthy humans.
title_fullStr Minimizing nocebo effects by conditioning with verbal suggestion: A randomized clinical trial in healthy humans.
title_full_unstemmed Minimizing nocebo effects by conditioning with verbal suggestion: A randomized clinical trial in healthy humans.
title_short Minimizing nocebo effects by conditioning with verbal suggestion: A randomized clinical trial in healthy humans.
title_sort minimizing nocebo effects by conditioning with verbal suggestion a randomized clinical trial in healthy humans
url http://europepmc.org/articles/PMC5598922?pdf=render
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