I Will Harm - The Power of Expectations

Most people are familiar with the concept of the placebo effect but you may not be aware of its lesser known brother and black sheep of the Cebo family; the Nocebo effect. Literally meaning “I will harm” in Latin, the Nocebo effect is a phenomenon where one experiences detrimental effects from an innocuous or even beneficial treatment, based largely on their perceived expectations.

Similar to placebos, the nocebo effect is commonly associated with medications and other medical or health related treatments. Although the physical mechanism behind the phenomenon is still being studied, it is widely accepted that an individual’s negative expectations drive the process. In its simplest form, a nocebo effect can be induced by receiving a treatment, whether pharmaceutical or physical, with the belief that it will cause a negative outcome. Regardless of the truth behind this claim, the recipient of the treatment will be more likely to experience the detrimental outcome.

Thankfully, intentionally causing harm isn’t a common goal in the medical community but there are still situations where the nocebo effect should be acknowledged. Side effects of medications are a good example. Studies have found that people who are given placebo drugs, expecting a positive outcome, are more susceptible to experiencing the negative side effects associated with the same drug. The power of nocebo can extend even further than just producing negative effects from sham treatments. Another study looked at the effectiveness of a real pain-relieving cream but told participants that the use of the cream would increase the pain intensity. Sure enough, the subjects who were expecting to feel an increase in pain reported that they did, despite using a proven pain killing medication. This suggests that expectations have the power to not only influence outcomes of inert treatments but actually reverse the effects of a real intervention.

The nocebo effect isn’t limited to the medical setting and can come from more subtle sources. Media portrayal of disease and treatment can have substantial impact on your understanding of conditions and future expectations. Something as simple as the words we use can have an influence on our assumptions. Words like “degeneration”, “disc bulge”, and “impingement” can all carry strong negative connotations but in many cases are normal and misunderstood issues. These negative associations can stimulate the nocebo effect and/or result in altered behaviours, both of which can produce negative physical outcomes.

I hope this article has started to highlight the important role expectations can play in relation to your health. But what can you do to manage those expectations? The most important component is having a thorough understanding of your diagnosis and treatment! Don’t be afraid to ask questions if you don’t fully understand what you’ve been told about your body. An L4/5 disc bulge might sound like a life sentence of crippling pain and an inevitable trip to the operating theater. In reality, 30% of 20 year olds are walking around with a disc bulge right now but don’t even know it. Most of these will resolve naturally and never cause a problem. Any that do become symptomatic can usually be treated through non-surgical options. A simple misinterpretation could be the difference between a quick, easy recovery and falling victim to unfounded negative expectations that could delay the process. Likewise, it’s just as important to understand the rationale behind the treatment you are receiving and the expected results. If you’re not sure why someone is sticking needles in you, why you’re doing core exercises for your injured shoulder, or why you’re hopping around like a fool on your injured ankle, ASK! I promise there is a method to our madness and a sound rationale behind our treatments but that knowledge doesn’t do YOU any good in OUR heads.

Take home message: Your expectations can influence your outcomes, so stay positive! At best, you might benefit from some placebo effect and at worst you’ll help to stave off the nasty nocebo! If you have doubts or questions make sure you get them clarified by a qualified professional to alleviate your apprehension!

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