• Bartels Danielle J P DJP Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands. , van Laarhoven Antoinette I M AIM Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands. , Michiel Stroo, Kim Hijne, Kaya J Peerdeman, Donders A Rogier T ART Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands., van de Kerkhof Peter C M PCM Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands., and Evers Andrea W M AWM Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands. .
• Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands.

AbstractNocebo effects, i.e., adverse treatment effects which are induced by patients' expectations, are known to contribute to the experience of physical symptoms such as pain and itch. A better understanding of how to minimize nocebo responses might eventually contribute to enhanced treatment effects. However, little is known about how to reduce nocebo effects. In the current randomized controlled study, we tested whether nocebo effects can be minimized by positive expectation induction with respect to electrical and histaminic itch stimuli. First, negative expectations about electrical itch stimuli were induced by verbal suggestion and conditioning (part 1: induction of nocebo effect). Second, participants were randomized to either the experimental group or one of the control groups (part 2: reversing nocebo effect). In the experimental group, positive expectations were induced by conditioning with verbal suggestion. In the control groups either the negative expectation induction was continued or an extinction procedure was applied. Afterwards, a histamine application test was conducted. Positive expectation induction resulted in a significantly smaller nocebo effect in comparison with both control groups. Mean change itch NRS scores showed that the nocebo effect was even reversed, indicating a placebo effect. Comparable effects were also found for histamine application. This study is the first to demonstrate that nocebo effects can be minimized and even reversed by conditioning with verbal suggestion. The results of the current study indicate that learning via counterconditioning and verbal suggestion represents a promising strategy for diminishing nocebo responses.

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