From the Opinon: Letters section of New Scientist magazine.

From Nancy Blake

Helen Pitcher highlights the strength of the nocebo effect, in which negative expectations can produce harmful effects (16 May, p30). A study of the language used in the Milton model of hypnosis could help doctors who wonder how to inform patients of potential side effects without suggesting that they acquire them.

If I ask you not to think of a purple cow, you first have to visualise it, and the image then stays in your mind as you try not to think of it. If you are subsequently asked to visualise a brown cow in some detail, the image of the purple cow disappears.

Similarly, saying to a piano student, ‘This is the hard part of the piece’ will produce negative expectations, raising the student’s anxiety level. Saying instead, ‘This part isn’t easy, yet’ will cause the unconscious, which doesn’t deal well with a negative, to respond to the word ‘easy’.

These quirks of the unconscious mind can be exploited in medical treatment. When prescribing a drug, the doctor could say that in most cases, the patient can expect it to produce a particular improvement, and that they have every reason to believe the patient will respond in that way. The doctor could then go on to explain that occasionally something different might occur, but in such a case it is just a matter of discontinuing the medication and contacting the doctor so that the situation can be sorted out. The emphasis here should be on the process of ‘sorting it out’.

This sets up an expectation of specific improvements: the placebo effect. It builds in a sense of confidence, as the patient knows the doctor is aware that the situation might change and will be able to handle changes accordingly. This should minimise anxiety even if side effects occur, reassuring the patient that things still can go well.

Kingston upon Hull, East Yorkshire, UK”

(New Scientist, 6 June 2009, p26)

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