Minimizing nocebo side effects in health care: The unrecognized role of patient involvement.

Abstract

Nocebo side effects occur when patient expectations worsen negative psychological and physiological responses to medical treatments. This phenomenon can significantly impact patient experiences and outcomes across a broad range of health conditions and treatment types. Interventions are necessary to help patients avoid and minimize nocebo side effects, and in this paper, we explore a new direction for such interventions. Current nocebo reduction interventions, such as positive side effect framing, primarily rely on healthcare providers intervening before or during a particular side effect disclosure event. Although valuable, these approaches are limited in disrupting nocebo effects that arise outside the medical context, including those influenced by news reports, social media, or discussions with friends and family. To address this gap, we advocate for the development of nocebo reduction interventions that leverage intrapersonal processes, such as anxiety reduction practices and the deliberate avoidance of unregulated and excessive side effect information from non-reputable sources. We propose that patients can use clear and actionable cognitive, emotional, and behavioral regulation strategies for preventing and diminishing their own nocebo effects. Empowering patients with effective self-regulation tools for nocebo minimization would enable them to take an active role in managing their own nocebo responses. We describe different types of intrapersonal strategies that patients could employ, as well as benefits, challenges, and future research directions for exploring this approach. Intrapersonal nocebo reduction strategies offer a novel and complementary approach to traditional healthcare communication methods for nocebo minimization. Intrapersonal strategies have the potential to empower patients and improve healthcare outcomes.