Can a Brief Psychoeducational Intervention Reduce Nocebo Responding in Clinical Settings? An Exploratory Trial in Two Patient Samples

Abstract

Side effects are a substantial issue in clinical settings and occur more commonly if patients are anxious or have expectations about experiencing side effects. This phenomenon, known as the nocebo effect, is inadvertently strengthened by processes within standard clinical practice (e.g. the informed consent process). The current study aimed to investigate whether explaining the nocebo effect during the informed consent process, as a brief psychoeducational intervention, could reduce patient symptom reporting and perceived side effects. Eighty patients scheduled for colonoscopy and seventy-nine patients scheduled for intravenous iron infusion were randomised to receive either the intervention or standard preparation information alone before their respective procedure. The intervention was effective in reducing symptom reporting three days following the procedure for colonoscopy patients. Participants in the colonoscopy sample who received the intervention had a significantly smaller increase in symptom reporting between post-colonoscopy and three day follow-up than those in the control group (p < .05). The intervention was particularly effective for colonoscopy patients high in anxiety; those in the top 50% of anxiety scores reported significantly fewer symptoms (p < .05) and attributed significantly fewer symptoms as potential side effects of the procedure (p < .05) if they received the intervention than if they received standard information alone. Conversely, the intervention was not found to have an effect on symptom reporting or perceived side effects in the intravenous iron infusion sample. This may have been due to different contextual factors associated with this procedure, or methodological inconsistencies between samples. Overall, the findings highlight the potential for providing patients with an explanation of the nocebo effect as a brief, preventative intervention to minimise nocebo responding in certain clinical contexts. Before this approach is implemented into standard clinical practice, further trials are necessary to (a) examine the efficacy of this intervention in other clinical contexts, (b) better understand the psychological mechanisms involved, and (c) refine the intervention and mitigate any unintended negative consequences.