Placebo and nocebo effects refer to favourable and unfavourable effects of a treatment, respectively, which can arise from other factors than the treatment itself. Examples of these ‘contextual factors’ are: the patient’s expectations, the patient-therapist relationship, (non)verbal communication during a consultation, experiences from the past or fear of side effects.
The consulted experts advise among other things that therapists should try to stimulate placebo-effects, without exaggerating their potential. Creating unrealistic expectations can lead to less faith in treatment, it damages the patient-therapist relationship and often, it also reduces therapy compliance. Additionally, the authors state that it is necessary to be clear: placebo effects can enhance treatment effects, but do not cure a condition or pathology.
The authors stress that nocebos – like frightening metaphors or creating negative expectations – should be avoided as much as possible. However, they do point out that there is tension between avoiding nocebos and the ethical responsibility of therapists: they are obliged to address possible side effects and risks of treatment. The experts advise to avoid creating fear and choosing positive words and an optimistic, open attitude.