Comparing the effects of message framing and nocebo education on psychological outcomes

Nocebo effects from side effect disclosure are an unfortunate yet common occurrence in health care. Two prominent methods proposed for reducing nocebo effects from side effect disclosure are positive framing and nocebo education.

The present study examined the unique and combined effects of these two intervention approaches on an array of nocebo-relevant psychological outcomes.

In an online pre-registered experiment, community participants (N = 210) learned about a symptomatic treatment for COVID-19 along with the potential treatment side effects. Participants were randomly assigned in a 2 (side effect attribute framing: positive or negative) × 2 -(education: nocebo education video or a common health problems control video) between-subjects design.

Both positive framing and nocebo education altered psychological outcomes related to nocebo effects. Importantly, nocebo education and positive framing affected entirely different outcomes, with positive framing reducing global side effect expectations and worry about side effects, and nocebo education improving perceptions of side effect control, tolerance, and decreasing side effect information-seeking intentions. Side effect avoidance intentions, treatment adherence intentions, and specific side effect expectations were not altered by either intervention. Interestingly, nocebo education and positive framing did not significantly interact on any outcome measure in this study.

The present results are consistent with the view that the most commonly proposed interventions for reducing nocebo effects from side effect disclosure, nocebo education and positive framing, operate through different psychological mechanisms.