Bad is More Powerful Than Good: The Nocebo Response in Medical Consultations
Bad is More Powerful Than Good: The Nocebo Response in Medical Consultations
SOURCE: Am J Med. 2015 (Feb); 128 (2): 126–9
Maddy Greville-Harris, PhD, Paul Dieppe, MD
School of Psychology,
University of Southampton,
United Kingdom.
Although there has been a lot of research looking at the placebo response, nocebo responses in the healthcare setting have been largely overlooked. This article explores the potential role of negative patient-doctor communication in facilitating nocebo responses in the medical consultation. We suggest that invalidation, that is, communicating a lack of understanding and acceptance to the patient (albeit unintentionally), is a key factor in understanding the nocebo response. This article reviews evidence from the experimental and healthcare setting, which suggests that the negative effects of invalidation may be stronger than we think.
KEYWORDS: Communicating understanding; Doctor–patient interaction; Health communication; Invalidation; Nocebo response; Placebo response; Validation
Much attention has been given to the so-called placebo response, that is, people getting better in response to sham or dummy treatments that contain no active ingredient. [1] The opposite nocebo response, that is, people getting worse in response to sham interventions, has also been recognized for a long time, but has resulted in less attention from health researchers, [2, 3] who often focus on the ethical concerns around knowingly inducing such responses. [4–6]
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