In countless studies, treatments are tested against sham treatments. It’s important to test a promising treatment against a “fake” treatment for one reason—the placebo effect. There’s also a nocebo effect, and we’ll get to that soon.
Even if the real treatment shows better results, validating its efficacy, the placebo group usually shows a benefit as well! That’s where we get the idea of beating the placebo. Because if not set against a control, almost every treatment could claim to be effective because of the placebo effect.
It would seem that belief is the main driver of the placebo effect, because people believe they’re taking real medicine. But interestingly enough, it’s not just belief at work. For example, a 2014 study found that a pill labeled “placebo” was 50% as effective as medication in managing pain from a migraine attack. The patients knew it was a placebo, but it still helped!
“Even if they know it’s not medicine, the action itself can stimulate the brain into thinking the body is being healed.”
~ Ted Kaptchuk
The mind is powerful. But like all power, its use isn’t always positive.
The Nocebo Effect
The opposite of the placebo effect is called the nocebo effect. Whereas the anticipation of a positive outcome can provide benefit, the anticipation of a negative outcome can also bring that to fruition.
This is particularly relevant for anyone taking medication. Whereas one person might anticipate the benefit of a medication, another might worry about the side effects of it (very much a glass half full or half empty kind of situation). It turns out, that choice probably matters, because the nocebo effect is very real.
An article by Paul Enck and Winfried Häuser in the New York Times gives some fascinating examples of the nocebo effect. Here are two:
“We found that 11 percent of people in fibromyalgia drug trials who were taking fake medication dropped out of the studies because of side effects like dizziness or nausea.”
“In one remarkable case, a participant in an antidepressant drug trial was given placebo tablets — and then swallowed 26 of them in a suicide attempt. Even though the tablets were harmless, the participant’s blood pressure dropped perilously low.”
It seems that any pill—even one without effect—can be used by the mind as a symbol or trigger to cause significant internal changes, for better or for worse.
I’ve experienced the nocebo effect in my own life.
About 10 years ago, I was bitten by a spider. I woke up with a very itchy spot on my chest. I saw fang marks. Soon after, I was convulsing from neurotoxic venom on the way to the ER. The experience shocked me, as I had been in perfect health my whole life up until that point, and suddenly I felt very vulnerable.
Following that experience, I fell into a hypochondriac spiral. I worried about everything and everything. Every sensation concerned me. The butterflies in the stomach feeling that used to be reserved for seeing my crush was now happening dozens of times a day. It reached the point where breathing was no longer autonomous! I would have trouble staying asleep because I would hold my breath.
I experienced terrible symptoms for an entire year, some due to chronic tension in my body, and some due to the scary power of the nocebo effect. It was as if I were trying to fist fight a ghost. I had no actual medical issues other than the ones I was manifesting for myself out of thin air.
I know firsthand the power of the nocebo effect. It ruined a year of my life. While it is less known than the placebo effect, I think it’s just as important.
The first thing I wanted to accomplish with this article is to raise your awareness of the two sides of this mind-power coin. Do your best to be on the placebo side!
Expecting a positive or negative outcome does in fact make it more likely to happen. Of course, don’t ignore real health problems and symptoms in the name of positivity. But when it comes to your health, I think it goes a long way to expect good things and not worry too much about what might happen to you. That may be easier said than done, but considering where I came from and am now (much better!), I believe anyone can do it.
Placebo and Nocebo: Outside of Medicine
There already exists concepts such as “The Power of Positive Thinking” and even the “Law of Attraction” that claim the power of belief to create superior outcomes. But I think the placebo angle provides a slightly different idea because it is about your thoughts after an action, not before it.
After you do something, such as exercising or eating good food, visualize all the good things it’s going to do for your physical and mental health. Celebrate it. Not only will you feel a greater benefit due to the placebo effect, but it will compound. Since you’re making it an encouraging and positive experience, you’re more likely to repeat that healthy behavior in the future.
Exercise with a smile, not a frown. Be curious, not jaded. Look for and expect a benefit in whatever you’re doing.
A caveat: If tragedy strikes you, don’t force yourself to “find the positive” in it (which is often not a genuine or accurate process). I believe that some things in life are just tragic and terrible, and it’s okay to recognize that. We don’t need to sugarcoat tragedy and pretend it’s somehow good. That’s more harmful than helpful because it delays acceptance and the natural process of grief.
We can, however, envision ourselves coming out of these situations stronger and more determined than ever. We can use negative events to fuel positive change. And if we take that approach, we can accept reality and still benefit from the placebo effect.
Your mind can create or change momentum. It can even affect you physiologically. Don’t underestimate the power of your thoughts, and you can use them to your advantage.
