The following is adapted from Called to Care.
Revisiting an often misunderstood and underappreciated topic: the clinical implications of placebo and nocebo effects. These concepts aren’t inherently good or bad but can be powerful tools in patient care when used correctly. Let’s dive in!
In a study, a group of medical students was given either one or two blue or red tablets, purportedly a tranquilizer and a stimulant. Unbeknownst to them, the tablets were inert. Despite this, the students reported that the red tablets acted as stimulants while the blue ones acted as depressants. This reaction wasn’t due to the tablets themselves but to the placebo/nocebo effect — the phenomenon where patients experience real effects from inactive substances in a clinical trial. Placebos generate positive outcomes, while nocebos yield harmful effects.
The students’ responses were influenced by the association of red with “up” or “hot” and blue with “down,” “cool,” or “quiet.” This isn’t just psychological; these perceptions can create real physiological changes.
Understanding and harnessing the placebo and nocebo effects can significantly enhance patient care. Here are seven strategies to help you maximize the positive outcomes of placebo while minimizing nocebo effects:
1. Positive Framing
Imagine getting a flu shot and the nurse says, “Most people tolerate this well and have no ill effects.” Now, imagine the nurse saying, “This might cause a headache, you might miss a day of work, and you might get a fever.” The second scenario often leads to more reported side effects. Always frame information positively. For instance, say, “Most patients respond well to this treatment,” instead of emphasizing the small percentage who experience severe side effects.
2. Shape Expectations
Ask your patients, “What is your expectation?” Shaping expectations is crucial for positive outcomes. Understanding and clarifying patient expectations builds clarity, confidence, and understanding, which are key to successful treatment.
3. Leverage a Collaborative Model of Shared Decision-Making
When patients are involved in decision-making, they feel a sense of control and ownership over their treatment, fostering a stronger therapeutic alliance and improving adherence and engagement.
4. Follow Patient Preferences
Patient preferences can be as influential as placebos. If a patient strongly prefers a certain technique and it’s not harmful, consider accommodating their preference. This approach supports patient-centered care and can positively impact outcomes.
5. Encourage Adherence
Taking medicine consistently sends a positive signal to the body. Emphasize the importance of adherence while reassuring patients that occasional missed doses won’t negate the treatment’s effectiveness.
6. Avoid Using Negative Words
Negative language can heighten anxiety and pain. For example, saying, “We’re going to give you a local anesthetic that will make you comfortable during the procedure,” is better than, “You’re going to feel a big bee sting; this is the worst part of the procedure.” Positive language can significantly reduce perceived pain and anxiety.
7. Take Gender into Account
Men and women respond differently to placebos. Women are more influenced by conditioning, while men are more influenced by shaped expectations. Tailor your approach accordingly to enhance treatment outcomes.
Embrace the Effects
By understanding and embracing the science of placebo and nocebo, healthcare professionals can help patients recover faster. Use positive framing, patient communication, and adherence strategies to harness the power of placebo and mitigate nocebo effects.
Many of us already use some of these techniques without realizing the science behind them. Expanding our knowledge can help us better employ these strategies to promote positive patient outcomes through the placebo effect.
For a deeper dive, check out Called to Care which this was adapted.
larry
@physicaltherapy
For more advice on the placebo and nocebo effects, you can find Called to Care on Amazon.
