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A systematic review of factors that contribute to nocebo effects.
Health Psychol 2016; 35(12):1334-1355HP

Abstract

OBJECTIVES

Medication side effects are common, often leading to reduced quality of life, nonadherence, and financial costs for health services. Many side effects are the result of a psychologically mediated "nocebo effect." This review identifies the risk factors involved in the development of nocebo effects.

METHOD

Web of Science, Scopus, MEDLINE, PsycINFO, Journals@Ovid full text, and Global Health were searched using the terms "nocebo" and "placebo effect." To be included, studies must have exposed people to an inert substance and have assessed 1 or more baseline or experimental factor(s) on its ability to predict symptom development in response to the inert exposure.

RESULTS

Eighty-nine studies were included; 70 used an experimental design and 19 used a prospective design, identifying 14 different categories of risk factor. The strongest predictors of nocebo effects were a higher perceived dose of exposure, explicit suggestions that the exposure triggers arousal or symptoms, observing people experiencing symptoms from the exposure, and higher expectations of symptoms.

CONCLUSIONS

To reduce nocebo induced symptoms associated with medication or other interventions clinicians could reduce expectations of symptoms, limit suggestions of symptoms, correct unrealistic dose perceptions, and reduce exposure to people experiencing side effects. There is some evidence that we should do this especially for persons with at-risk personality types, though exactly which personality types these are requires further research. These suggestions have a downside in terms of consent and paternalism, but there is scope to develop innovative ways to reduce nocebo effects without withholding information. (PsycINFO Database Record

Authors+Show Affiliations

Department of Psychological Medicine.Institute of Pharmaceutical Science, King's College London.Department of Psychological Medicine.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

27657801

Citation

Webster, Rebecca K., et al. "A Systematic Review of Factors That Contribute to Nocebo Effects." Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association, vol. 35, no. 12, 2016, pp. 1334-1355.
Webster RK, Weinman J, Rubin GJ. A systematic review of factors that contribute to nocebo effects. Health Psychol. 2016;35(12):1334-1355.
Webster, R. K., Weinman, J., & Rubin, G. J. (2016). A systematic review of factors that contribute to nocebo effects. Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association, 35(12), pp. 1334-1355.
Webster RK, Weinman J, Rubin GJ. A Systematic Review of Factors That Contribute to Nocebo Effects. Health Psychol. 2016;35(12):1334-1355. PubMed PMID: 27657801.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A systematic review of factors that contribute to nocebo effects. AU - Webster,Rebecca K, AU - Weinman,John, AU - Rubin,G James, Y1 - 2016/09/22/ PY - 2016/9/23/pubmed PY - 2017/7/14/medline PY - 2016/9/23/entrez SP - 1334 EP - 1355 JF - Health psychology : official journal of the Division of Health Psychology, American Psychological Association JO - Health Psychol VL - 35 IS - 12 N2 - OBJECTIVES: Medication side effects are common, often leading to reduced quality of life, nonadherence, and financial costs for health services. Many side effects are the result of a psychologically mediated "nocebo effect." This review identifies the risk factors involved in the development of nocebo effects. METHOD: Web of Science, Scopus, MEDLINE, PsycINFO, Journals@Ovid full text, and Global Health were searched using the terms "nocebo" and "placebo effect." To be included, studies must have exposed people to an inert substance and have assessed 1 or more baseline or experimental factor(s) on its ability to predict symptom development in response to the inert exposure. RESULTS: Eighty-nine studies were included; 70 used an experimental design and 19 used a prospective design, identifying 14 different categories of risk factor. The strongest predictors of nocebo effects were a higher perceived dose of exposure, explicit suggestions that the exposure triggers arousal or symptoms, observing people experiencing symptoms from the exposure, and higher expectations of symptoms. CONCLUSIONS: To reduce nocebo induced symptoms associated with medication or other interventions clinicians could reduce expectations of symptoms, limit suggestions of symptoms, correct unrealistic dose perceptions, and reduce exposure to people experiencing side effects. There is some evidence that we should do this especially for persons with at-risk personality types, though exactly which personality types these are requires further research. These suggestions have a downside in terms of consent and paternalism, but there is scope to develop innovative ways to reduce nocebo effects without withholding information. (PsycINFO Database Record SN - 1930-7810 UR - https://www.unboundmedicine.com/medline/citation/27657801/A_systematic_review_of_factors_that_contribute_to_nocebo_effects_ L2 - http://content.apa.org/journals/hea/35/12/1334 DB - PRIME DP - Unbound Medicine ER -