Can conscious guilt feelings incite nocebo pain?

Psychodynamically, chronic pain problems with no organic cause have been conceptualized as a punishment through physical pain for guilt feelings. This study aimed to investigate the effects of conscious guilt feelings on nocebo pain responses and whether the resultant nocebo pain would affect conscious guilt feelings in the form of expiation through the pain.

An experiment was conducted with 100 participants. There were two independent variables, which were guilt induction (guilt-no guilt) and nocebo manipulation (nocebo-no nocebo). Nocebo manipulation was done by telling the participants that they would receive electricity from an EEG cap. In addition, they watched a video in which a confederate imitates having pain during the procedure. There were two dependent variables, guilt feelings, and experienced pain. Guilt feelings were measured using Positive and Negative Affect Scale twice, once after guilt induction and once after nocebo pain manipulation. Subjective pain scores were measured by using a basic 0 to 10 visual pain scale, on which the participants reported how much pain they experienced.

The findings revealed that only the main effect of nocebo was significant.

The participants reported mild headaches in the absence of any physical stimulation after nocebo manipulations. The effect was observed in a standard laboratory environment. Non-physical nocebo pain induction could create pain, but conscious guilt induction did not increase the amount of reported nocebo pain, and resultant pain did not function as a punishment. Limitations and implications of the study were discussed.