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Watch out for the nocebo corona effect - Blog by Andrea Evers



We are confronted on a daily basis with news about the Corona virus and its consequences. We read alarming headlines like “Dutch becoming increasingly anxious about Corona virus” (survey by DVE inside, RTL news, 2 April 2020) or “Huge fears and stress about Corona crisis” (study by DirectResearch, Gezondheidsnet.nl, 31 March 2020). In the communication around Corona it’s essential to make citizens aware of the very real danger of Corona and the importance of the preventive measures that are currently restricting our freedom. Anxiety about the Corona virus and its effects is another factor having an enormous impact on daily life. In part, these fears serve a useful purpose. If the fear of contracting the virus can contribute to people maintaining a distance of 1.5 metres from one another, then it’s functional, not only for the individual but also for society. This kind of anxiety is a healthy and natural response to stressful circumstances. The other side of the coin is that anxiety can exacerbate all kinds of physical and psychological complaints, as well as having a negative influence on our behaviour and suppressing our immune system. So, what’s going on here?

How can worries about Corona intensify symptoms?

When negative consequences of treatments and/or disorders are brought on by fears about these same treatments or disorders, we refer to this as the nocebo effect, the negative counterpart of the more familiar placebo effect. The nocebo effect is the result of negative expectations that an individual, patient or practitioner may have about a particular treatment, such as anxiety about the potential risks and side-effects or worries about catching an infection. This response can actually intensify the very symptoms people fear; it works on the basis of the ‘You get what you expect’ principle, and becomes a kind of self-fulfilling prophecy. How does that work?

The most important factor behind the nocebo effect is the constant stream of negative information that we are exposed to every day of our lives. In the case of the Corona pandemic, we are bombarded daily with news about the rate of hospital admissions, the number of deaths, fears about infection or economic disaster scenarios, all of which receive far more attention than more positive issues in society such as our solidarity and resilience. In evolutionary terms, we are primed to prioritise this negative information and to remember the negative much better than the positive. This kind of negative feedback subconsciously triggers a stress reaction that raises our level of alertness and activates our fight-flight response. Information about diseases, risks or side-effects can, through earlier experiences and conditioning (such as nausea caused previously by a medication resulting in these same physiological responses), lead to an increase in the symptoms. To make matters worse, reading an information leaflet can also make people reluctant to take the medication and can result in an increase in the symptoms described.

When stressful events pile up over a longer period of time, such as during the current Corona crisis, earlier experiences and conditioning can play a major role. A person who, for example as a child, had a traumatic experience in hospital, or who has been afraid of germs their whole life and is afraid of viruses is obviously more susceptible to the fear of catching the same virus themselves. These experiences don’t always have to be personal ones. Model behaviour means we also learn from the environment around us, and simply seeing other people having these experiences can cause the same nocebo effects. We know from long-term epidemiological studies that social isolation is a risk factor for greater morbidity and mortality. The current quarantine measures mean that some sections of the population have had social isolation forced upon them, and without social support, most people are more susceptible to such disorders as anxiety and feelings of depression. We know, for example, from research on stress that students are much more susceptible to viruses during exam periods, but also that any cuts and bruises they may have take longer to heal than during holiday periods.

What can we do about it?

The obvious next question is how we can retain the functional aspects of anxiety (being better at keeping to the rules of behaviour, for example, and avoiding unnecessary risks) and at the same time avoid the negative consequences of the Nocebo Corona Effect. Our best option is for all the parties involved (government, the media and the public) to agree the measures we can take to limit the negative aspects of the nocebo effect as much as we can.

1. Inform people about the nocebo effect and help them understand how anxiety about the virus can also be our worst enemy

International research has shown that simply explaining the phenomenon of the nocebo effect can have the effect of reducing symptoms in people who were suffering from unexplained disorders. Simply explaining the nocebo effect can be very effective in helping people to understand that they don’t need to interpret every signal from their body as a warning sign that there is something wrong with them.  

2. Translate negative messages and communication flows into neutral or positive information

The nocebo effect is often prompted by negative triggers in the environment, from the kind of vocabulary or language used around a patient to reading a drug information leaflet or listening to the daily media with its excess of negative news. Finding a good balance can be a delicate matter. Very often we don’t realise how easy it is to modify an instruction or information leaflet to eliminate the nocebo effect, for example by stressing that healthcare workers always do their utmost to make sure people feel comfortable, or by emphasising in the media how many people are cured.

3. Create positive experiences and make sure inputs from other people are positive

Particularly in a period when negative experiences are piling up all around us and people are having to get used to a new, more restricted reality, it’s important to counter these experiences with positive information. One way to do this is by altering the nature of the information. The statement that 90% of people have no side-effects, and a medication is well tolerated by people is experienced as far less threatening and stressful than focusing on the fact that 10% of users experience some negative side-effects.

4. Positive encouragement for a healthy lifestyle

A healthy mind in a healthy body. Knowing that our bodies have lowered immunity in times of stress makes it even more important to have as healthy a lifestyle as possible and to use positive messages to encourage people to live healthily, for example by emphasising the positive effects of a healthy lifestyle.   

Government, the media and the public: let’s together make sure that we also take these consequences of the Corona virus into account and keep the Nocebo Corona Effect to a minimum.



 



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