Does Adding Nocebo Avoidance Strategies Increase the Strength of Nocebo Education?

Abstract: Background: Medication side effects are common and sometimes result from the nocebo effect – when expectations or anxiety exacerbate side effect experience. Nocebo education is a health communication intervention for minimizing nocebo effects in which individuals learn about the nocebo effect. Aims: We suggest that nocebo education interventions can be improved by also describing cognitive and behavioral strategies by which patients can actively minimize their own nocebo effects. Method: In an online preregistered cross-sectional study, participants ( N = 436) were randomly assigned to one of three conditions: Conventional Nocebo Education (CNE), Nocebo Education supplemented with Avoidance Tactics (NEAT), or a control condition (health behavior education). Following the manipulation, participants read about a statin medication and completed a broad palette of nocebo-relevant psychological outcomes. Results: CNE elevated perceived side effect control, tolerance, and intentions to avoid side effect information and decreased side effect information seeking intentions as compared to controls. The NEAT intervention surpassed the CNE intervention, further increasing control and information avoidance intentions, while decreasing global side effect expectations, side effect worry, information seeking intentions, and discontinuation intentions. Limitations: This study assessed only immediate psychological changes, so future work is needed with side effect reports and longitudinal designs to understand the applicability of the intervention. Conclusion: We conclude that supplementing nocebo education with specific actionable reduction strategies increases its psychological impact, providing a valuable future direction for nocebo reduction research.