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Can Nocebo Effects Be Reduced via Open- and Closed-Label Counterconditioning?
Simone Meijer1,2,3, Andrea W M Evers1,2,3,4, Kaya J Peerdeman1,2,3
1Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands.
European Journal of Pain (London, England)
|March 13, 2026
Summary
Open-label counterconditioning effectively reduces nocebo effects on pain, even without deception. This learning-based approach offers a promising, ethical strategy for managing pain and other conditions influenced by negative expectations.
Area of Science:
- Psychology
- Pain Research
- Behavioral Medicine
Background:
- Nocebo effects negatively impact physical symptoms like pain.
- Strategies to reduce nocebo effects are crucial.
- Open-label counterconditioning shows promise but needs comparison to closed-label methods.
Purpose of the Study:
- To investigate if open-label counterconditioning reduces nocebo effects on pressure pain.
- To compare open-label counterconditioning with closed-label counterconditioning and extinction.
- To assess the role of placebo expectancies in these interventions.
Main Methods:
- Randomized controlled trial with 66 healthy female participants.
- Investigated open-label counterconditioning, closed-label counterconditioning, and extinction.
- Measured reduction of conditioned nocebo effects on pressure pain.
Main Results:
- Open-label counterconditioning significantly reduced nocebo effects (d=1.13).
- Open-label counterconditioning was more effective than extinction (d=0.85) and induced placebo effects.
- Closed-label counterconditioning also reduced nocebo effects, particularly in responders.
Conclusions:
- Open-label counterconditioning is a highly effective, non-deceptive method for modulating nocebo effects on pain.
- This approach holds promise for developing ethical, learning-based treatments for various patient groups, including chronic pain.
- Results support the use of open-label counterconditioning as an alternative to deceptive strategies.
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