The Nocebo Effect

by Farzana Rahman

So far we’ve talked about the Placebo effect, namely how positive beliefs can have a positive effect on symptoms. But what about negative believes?


Medical Student Syndrome

As medical students, one of the most common afflictions to befall a studious group of obsessive types is medical student syndrome. This is not a rare infectious disease but a phenomenon common in medical students around the world.

It’s when students perceive themselves to be experiencing symptoms of a disease they are studying. In the third year of medical school , my friends and I were convinced that I had myasthenia gravis, a rare auto-immunological condition.  This was based on nothing more than slightly droopy eyelids. Needless to say I did not have my myasthenia gravis. 


Negativity and the Nocebo Effect

There have been some great studies looking at this.

In 1978, Gryll & Katahn gave sugar pills before a dental injection telling patients that they were effective for pain relief.  They were either handed out with an enthusiastic positive message talking about their benefits or a negative message playing down their effects. Even though the pills had no intrinsic effect, those patients who were given them with an enthusiastic positive message experienced less pain and anxiety.

In a study by Schweiger & Parducci (1981), more than two-thirds of an 34 college students reported mild headaches when told that an electric current was passing through their heads. Yep, you’ve guessed it, there was no electric current. 

A study by Dworkin et al (1983) gave subjects Nitrous Oxide, otherwise known as laughing gas. They were told this would cause pain and indeed many felt pain. The only problem with this was laughing gas is in fact a painkiller.


Thinking Yourself to Death

Phillips et al (1993) explored the idea that beliefs about life and death impacted survival. They looked at the mortality data for 28,000 adult Chinese-Americans and matched this with Caucasian Americans.  They found that  Chinese-Americans died significantly earlier when they their year of birth was one which Chinese astrology consider ill-fated.  They found a link between how strongly the Chinese Americans were attached to Chinese traditions and the life years lost. The researchers concluded that this was at least partly  due to psychosomatic processes; namely the belief that they would die earlier seemed to have an effect on the length of their life.   

The power of  belief has been linked to conditions such as depression and pain. it Some researchers have asserted that many of the benefits of anti-depressants are attributable to the placebo effect (Kirsch, 2014; Kirsch & Sapirstein, 1998).  There has also been considerable research demonstrating that placebos have a significant effect on the treatment of pain (Finnerup et al., 2015, Turner et al 1994).

We’re going to talk about our beliefs and attitudes and how they affect our health in upcoming posts. Subscribe to stay upto date.


Gryll, S. L., & Katahn, M. (1978). Situational factors contributing to the placebo effect. Psychopharmacology, 57(3), 253–261.

Schweiger, A., & Parducci, A. (1981). Nocebo: the psychologic induction of pain. The Pavlovian Journal of Biological Science: Official Journal of the Pavlovian, 16(3), 140–143.

Dworkin, S. F., Chen, A. C., LeResche, L., & Clark, D. W. (1983). Cognitive reversal of expected nitrous oxide analgesia for acute pain. Anesthesia and Analgesia, 62(12), 1073–1077

Phillips, D. P., Ruth, T. E., & Wagner, L. M. (1993). Psychology and survival. The Lancet, 342(8880), 1142–1145

Kirsch, I. (2014). Antidepressants and the placebo effect. Zeitschrift Fur Psychologie / Journal of Psychology, 222(3), 128–134.

Finnerup, N. B., Attal, N., Haroutounian, S., McNicol, E., Baron, R., Dworkin, R. H., … Wallace, M. (2015). Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology, 14(2), 162–173.