Abstract
Although there has been a lot of research looking at the placebo response, nocebo
responses in the healthcare setting have been largely overlooked. This article explores
the potential role of negative patient–doctor communication in facilitating nocebo
responses in the medical consultation. We suggest that invalidation, that is, communicating
a lack of understanding and acceptance to the patient (albeit unintentionally), is
a key factor in understanding the nocebo response. This article reviews evidence from
the experimental and healthcare setting, which suggests that the negative effects
of invalidation may be stronger than we think.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Placebo and nocebo in cardiovascular health implications for healthcare, research, and the doctor-patient relationship.J Am Coll Cardiol. 2007; 49: 415-421
- The role of learning in nocebo and placebo effects.Pain. 2008; 136: 211-218
- Nocebo phenomena in medicine: their relevance in everyday clinical practice.Dtsch Arztebl Int. 2012; 109: 459-465
- When words are painful: unraveling the mechanisms of the nocebo effect.Neuroscience. 2007; 147: 260-271
- Nocebo hyperalgesia: how anxiety is turned into pain.Curr Opin Anaesthesiol. 2007; 20: 435-439
- New insights into the placebo and nocebo responses.Neuron. 2008; 59: 195-206
- Nonconscious activation of placebo and nocebo pain responses.Proc Natl Acad Sci U S A. 2012; 109: 15959-15964
- Preventing motor training through nocebo suggestions.Eur J Appl Physiol. 2012; 112: 3893-3903
- Induction of nocebo and placebo effects on itch and pain by verbal suggestions.Pain. 2011; 152: 1486-1494
- Conscious expectation and unconscious conditioning in analgesic, motor, and hormonal placebo/nocebo responses.J Neurosci. 2003; 23: 4315-4323
- Nocebo effects, patient-clinician communication, and therapeutic outcomes.JAMA. 2012; 307: 567-568
- The nocebo effect and its relevance for clinical practice.Psychosom Med. 2011; 73: 598-603
- Nonspecific side effects of oral contraceptives: nocebo or noise?.Contraception. 2011; 83: 5-9
- To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed consent.Am J Bioeth. 2012; 12: 22-29
- Nonspecific medication side effects and the nocebo phenomenon.JAMA. 2002; 287: 622-627
- Validation and psychotherapy.in: Bohart A. Greenberg L. Empathy Reconsidered: New Directions in Psychotherapy. American Psychological Association, Washington, DC1997: 353-392
- Accurate expression and validating responses: a transactional model for understanding individual and relationship distress.in: Sullivan K. Davila J. Support Processes in Intimate Relationships. Oxford Press, New York2010: 121-152
- The impact of validating and invalidating responses on emotional reactivity.J Soc Clin Psychol. 2011; 30: 163-183
- Painfully reassuring? The effects of validation on emotions and adherence in a pain test.Eur J Pain. 2011; 16: 592-599
- The effect of validating and invalidating communication on satisfaction, pain and affect in nurses suffering from low back pain during a semi-structured interview.Eur J Pain. 2012; 16: 239-246
- The necessary and sufficient conditions of therapeutic personality change.J Consult Psychol. 1957; 21: 95-103
- Introducing compassion-focused therapy.Adv Psychiatr Treat. 2009; 15: 199-208
- Bad is stronger than good.Rev Gen Psychol. 2001; 5: 323-370
- Development and validation of brief measures of positive and negative affect: the PANAS scales.J Pers Soc Psychol. 1988; 54: 1063-1070
- Does Feeling Understood Matter? The Effects of Validating and Invalidating Interactions.([doctoral thesis]) University of Exeter Medical School, Exeter, UK2013
- It is hard work behaving as a credible patient: encounters between women with chronic pain and their doctors.Soc Sci Med. 2003; 57: 1409-1419
- Living with low back pain- stories of hope and despair.Soc Sci Med. 2007; 65: 1584-1594
- Patient–provider interactions in the management of chronic pain: current findings within the context of shared medical decision making.Pain Med. 2007; 8: 25-35
- Patients' and professionals' understandings of the causes of chronic pain: blame, responsibility and identity protection.Soc Sci Med. 1997; 456: 699-709
- Medically unexplained symptoms–GPs' attitudes towards their cause and management.Fam Pract. 2001; 18: 519-523
- Telling patients there is nothing wrong.Br Med J. 1996; 313: 311-312
- Medically unexplained symptoms and the problem of power in the primary care consultation: a qualitative study.Fam Pract. 2002; 19: 178-182
- The harmful consequences of elevating the doctor-patient relationship to be a primary goal of the general practice consultation.Fam Pract. 2004; 21: 229-231
- Reassurance: help or hinder in the treatment of pain.Pain. 2008; 134: 5-8
Article Info
Publication History
Published online: September 15, 2014
Footnotes
Funding: Peninsula College of Medicine and Dentistry .
Conflict of Interest: None.
Authorship: Both authors had access to the data and played a role in writing this manuscript.
Identification
Copyright
© 2015 Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- The Good, the Bad, and the…EmpathicThe American Journal of MedicineVol. 128Issue 8

