Verbal conditioning reduces nocebo effects

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Bezug Bartels D, van Laarhoven A, Stroo M, et al. Minimierung von Nocebo-Effekten durch Konditionierung mit verbalen Suggestionen: eine randomisierte klinische Studie an gesunden Menschen. Plus eins. 2017;12(9):e0182959. Zielsetzung Um herauszufinden, ob Nocebo-Effekte reduziert werden können, indem positive Erwartungen durch elektrische und histaminische Juckreize induziert werden. Entwurf Randomisierte, kontrollierte, mehrarmige, einfach verblindete Parallelgruppenstudie Teilnehmer Einhundertneunundzwanzig Teilnehmer niederländischer Nationalität ab 18 Jahren mit einem Durchschnittsalter von 20,25 ± 2,46 Jahren; 78,7 % waren Frauen. Ausschlusskriterien waren schwere körperliche Morbidität, psychiatrische Erkrankungen, chronische Juckreiz- oder Schmerzbeschwerden, Histaminüberempfindlichkeit, regelmäßige Einnahme verschreibungspflichtiger Medikamente in den letzten 3 Monaten, Verwendung von Herzschrittmachern und Farbenblindheit. Studienparameter …
Reference Bartels D, van Laarhoven a, Stroo M, et al. Minimization of nocebo effects through conditioning with verbal suggestions: a randomized clinical study to healthy people. Plus one. 2017; 12 (9): E0182959. Objective to find out whether nocebo effects can be reduced by inducing positive expectations by electrical and histamine itching stimuli. Designed randomized, controlled, multi -armed, simply blinded parallel group study participants one hundred nine and twenty participants of Dutch nationality from the age of 18 with an average age of 20.25 ± 2.46 years; 78.7 % were women. Exclusion criteria were severe physical morbidity, psychiatric diseases, chronic itching or pain complaints, hypersensitivity to histamine, regular use of prescription medication in the past 3 months, use of pacemakers and color blindness. Study parameters ... (Symbolbild/natur.wiki)

reference

Bartels D, van Laarhoven a, Stroo M, et al. Minimization of nocebo effects through conditioning with verbal suggestions: a randomized clinical study to healthy people. plus one . 2017; 12 (9): E0182959.

objective

to find out whether nocebo effects can be reduced by inducing positive expectations by electrical and histamine itching stimuli.

draft

randomized, controlled, multi -armed, simply blinded parallel group study

participant

One hundred nine -nine participants of Dutch nationality from the age of 18 with an average age of 20.25 ± 2.46 years; 78.7 % were women. Exclusion criteria were severe physical morbidity, psychiatric diseases, chronic itching or pain complaints, hypersensitivity to histamine, regular use of prescription medication in the past 3 months, use of pacemakers and color blindness.

study parameters evaluated

Effect of conditioning, counter conditioning and verbal suggestion on nocebo effects of electrical and histamine itching; Influence on psychological characteristics on nocebo effects.

primary result measurements

degrees of the itching, which the participants said orally; Psychological characteristics/personality traits that were raised by questionnaires for self -disclosure.

important knowledge

nocebo effects were significantly lower in the group with positive expectation induction and even vice versa. Psychological characteristics of the participants had no influence on the results.

Study restrictions

The study included only healthy volunteers, only used one session to test the reversal of the nocebo effect, had a small study population and mainly included women.

practice implications

nocebo effects are undesirable effects of treatments that are triggered by negative expectations of the patients. It is a well-known phenomenon of randomized clinical studies: Patients in the placebo group can not only the benefits (placebo effect), but also experience the same improvement of treatment as patients who receive active treatment. 1 Negative expectations can also affect patients who receive active treatment: Patients may not receive the expected Pain relief. 2

nocebo effects can affect a wide range of symptoms, including pain perception, fatigue, nausea, allergic symptoms and itching. Therefore, this can be a very useful clinical tool.

As a clinician, we are responsible for informing our patients about possible side effects, but consent after clarification can unintentionally lead to negative expectations in relation to the proposed treatment intervention.

nocebo and placebo effects have been extensively examined. In psychology, 2 expectation induction procedures are often used: verbal suggestion and conditioning. Verbal suggestion offers oral or written information about possible advantages and side effects. The conditioning uses an independent neutral stimulus (e.g. color or sound), which is coupled with an active stimulus (e.g. induction of pain or itching). Over time, a coupled neutral stimulus (seeing a certain color or listening to the sound) can lead to an increased perception of pain or itching, even if the active stimulus is missing. The present study used both verbal suggestation and conditioning procedures.

The results of the study showed that nocebo effects can be weakened or even reversed by a positive expectation induction. This is an important clinical finding because many patients with often negative expectations come to their providers that could appeal to the treatments. Understanding the sources of the patient expectations can help doctors to comply with their treatment plans and in turn can improve the treatment results. These sources include declarations of consent, previous patient experiences, previous illnesses and non -clinical influences from media and friends.

It is interesting that psychological features of the participants of this study did not affect the results. Another study came to a similar result: personality factors (anxiety, fear) had no direct influence on the level of pain. 5 A systematic review of the literature on the nocebo effect showed that the expectations of humans mainly influenced the placebo reaction, 6 This makes the role of the health service provider in influence as well as the nocebo and placebo effects emphasized more.

The docere (doctor as a teacher) principle is the focus of naturopathic practice. We try to educate our patients and also help them take responsibility for their health. As a clinician, we are responsible for informing our patients about possible side effects, but consent after clarification can unintentionally lead to negative expectations in relation to the proposed treatment intervention.

How do we effectively give information?

Investigations suggest that the way we provide our patients with information makes a difference. In a study by Howe et al. Positive expectations (placebo effect) were reinforced from 2017 when the providers were warm and confident. 7

Other studies have shown that an authentic style of communication that provides adequate information, feedback and evaluations of the fears, concerns and prescriptions of patients, contributes to minimizing nocebo effects of medication. Protect. 10-12

Such approaches ultimately lead to improved patient results and therefore underline the importance of building up a positive relationship and strengthening our patients on their way to better health.

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