Think yourself sick – Nocebo Effect

By David Joel Miller.

The Nocebo Effect.

Did you know that thinking you will get sick, can make it so? Most of us are familiar with the Placebo effect in which someone who thinks they are taking powerful medication will get better even if the pill has nothing in it. There is an opposite but not so equal effect called the Nocebo effect in which we can make ourselves sick when the risk factors say we should not have gotten ill.

In one study of women with a family history of heart disease, women who expected to have heart problems – eventually developed them.  Thinking they were prone to heart disease made them four times more likely to develop the disease than those who did not think they would get it. That difference persisted even when we compared the results of diet, exercise, weight, blood pressure and cholesterol.

This does not mean you should give up efforts to control your weight or improve your health. What it does tell us is that while positive thoughts can make you happier, negative thoughts can kill you.

Doctors have known about the existence of the Nocebo effect for a long time. Surgeons know that people who do not expect to survive an operation are much more likely to die. If the patient has had a loved one who died recently and they want to be with that loved one, the risk of death increases dramatically even when the operation is not that risky. Still, it is hard to measure something that makes the body sick but is centered in the mind, not the body.

Is this a new idea? No, not really. We have all talked or thought about someone who “makes me sick.” Brian Reid wrote an interesting article called The Nocebo Effect: Placebo’s Evil Twin for The Washington Post on April 30, 2002. He is not the only one to tackle this subject. Penny Sarchet discussed research on the ‘Nocebo’ effect in her winning essay for the Wellcome Trust science writing prize in November of 2001. There have been lots of other references to this phenomenon but it hasn’t been widely noticed.

One reason is that we like to give people credit for healing themselves through their beliefs or positive thinking but we are reluctant to criticize someone for having negative thoughts. Depressed people, for example, can’t be positive. Acknowledging the Nocebo effect feels like blaming the victim.

Many of the side-effects reported for medications may be the result of Nocebo effects. Burns, Meichenbaum, and others have talked about the way in which beliefs about the effectiveness of a medication or negative beliefs about the med can change the results of studies even when there are no active ingredients in the pill. For example, always buy multi-colored capsules if you can; they work better than white tablets regardless of what is in them.

Reid also pointed out in his article that doctors don’t like to warn patients about potential side effects because telling the patient about that side-effect makes the patient much more likely to have that side effect.

We know that thoughts are transmitted in the brain chemically. Now with various sorts of brain scans, we can see what happens in the brain. Tell someone that the medication they are taking will have a painful effect and the parts of the brain that process pain will light up.

We also know that what you are thinking, good or bad has an effect not just on your thoughts and mood but also on the production of chemicals that make you better or worse.

Have you ever awakened one morning and thought you were going to have a bad day? Have you known someone who was always negative and expected the worst? How does it usually turn out? Expecting the worst increases the chances that you will experience it.

Thinking is not a substitute for proper medical treatment, but your attitude towards that treatment may influence the effectiveness of the treatment no matter what your doctor does. Your thoughts can influence the results.

So how do you banish Nocebo?

Try to keep your thoughts positive. Read inspirational books. Spend time with friends. Having positive people around you can make you more positive. If you don’t have a positive support system, develop one. Go to religious services, do hobbies and activities where you might see people and make friends. Having good friends can lengthen your life.

Pay more attention to the benefits of things than the negative. Whatever you focus on you will get more of. Constantly worrying about side effects will make them larger. Focusing on any progress no matter how small will magnify that progress.

If something is concerning you, capture that thought, write it down, type it on the computer whatever it takes to get it recorded and then out of your head. Trying to remember for a month all the things you need to discuss with your doctor will keep you focused on your pain and symptoms. Writing it down gets the disturbing thought out of your head and gives you something to take with you when you talk to your provider.

Work with a counselor or therapist on improving your outlook. Self-help groups, religious leaders, and trustworthy friends can also be helpful in banishing negative thoughts.

Be aware of the Nocebo effect and don’t become its next victim.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at A list of books I have read and can recommend is over at Recommended Books


5 thoughts on “Think yourself sick – Nocebo Effect

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