Verbal modeling, counterconditioning, and operant conditioning are effective in nocebo hyperalgesia attenuation

Nocebo hyperalgesia, the increased pain following inert interventions, is frequently observed in clinical practice. This study investigates whether nocebo hyperalgesia can be reduced through counterconditioning, verbal modeling, and operant conditioning. Healthy volunteers (N = 168) were randomly allocated to 3 experimental and 2 control groups. In the experimental groups, nocebo hyperalgesia was induced through classical conditioning by applying high-intensity pain stimuli with a placebo and low-intensity pain stimuli without a placebo. In the control groups, sham conditioning was implemented (the relation between pain intensity and placebo was noncontingent). Nocebo hyperalgesia was then attenuated by (1) counterconditioning (low-intensity pain stimuli with a placebo, and high-intensity pain stimuli without a placebo); (2) verbal modeling (moderate pain stimuli with and without a placebo, with pain ratings provided by others suggesting less pain with placebo); (3) operant conditioning (moderate pain stimuli with and without a placebo, and participants were rewarded when experiencing less pain with placebo). In one control group, sham conditioning was continued; the other group received no manipulation. Classical conditioning induced nocebo hyperalgesia. All 3 learning procedures effectively attenuated the nocebo effect with no difference in their effectiveness. The induction of nocebo hyperalgesia was fully mediated by expectancies, whereas the attenuation of this effect was mediated by expectancies only when elicited through operant conditioning. This study demonstrates that nocebo hyperalgesia can be attenuated by verbal modeling, counterconditioning, and operant conditioning. Our findings suggest that healthcare workers may have flexibility in selecting nocebo-attenuating procedures when considering the treatment context or patient preferences.