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7 Ways Your Mind Can Make You Sick

And 12 Ways Caregivers Can Promote the Placebo Effect

by Richard Kradin, MD

Seven Ways Your Mind Can Make You Sick

By Richard Kradin, MD

Your beliefs can make you sick. Doctors have long known about this phenomenon, called the nocebo effect. The nocebo effect is the opposite of the placebo effect. It happens when, for instance, a patient is given a harmless treatment, such as a sugar pill, believes there will be a negative side effect, and then actually experiences the side effect.

Here are seven ways your beliefs, doubts, and fears can produce unpleasant symptoms of illness or slow down the healing process.

1. Making assumptions based on appearance. Studies show that people believe small pills are less effective than large ones, red pills cause more side effects than blue, generic are less effective than brand-name drugs, and oral medication is less potent than injected medication.

2. Having too much information. When patients read and learn about all the side effects from a drug insert in distressing detail, they are more likely to experience those symptoms than patients who were unaware of the side effects.

3. Believing misinformation. So many people believe penicillin allergies are commonplace that a statistically impossible percentage of patients (10 percent) experience symptoms of penicillin allergies, even though less than 3 percent of adults are actually allergic.

4. Scary language. The language adopted to describe side effects of a drug can greatly influence expectancies and outcomes. In one study, instructing subjects to "look for evidence of nasal obstruction" evoked more upper airway symptoms than instructing them to "pay attention to the free passage of air."

5. Incidental environmental cues. Conditional nausea occurs in a full one third of chemotherapy patients and may be triggered by incidental environmental cues, like being in a treatment room the same the color as the last one where a patient felt sick.

6. Fearing the worst. In the Framingham Heart Study, women who feared they were at risk for heart disease were nearly four times more likely to die than women with similar risk factors--obesity, and high levels of cholesterol and blood pressure--who didn't.

7. Hearing the worst. When physicians offer a pessimistic answer to the question, "What can I expect, Doc?" the patient's healing process may sometimes slow down or stop.

* * * * *

12 Ways Caregivers Can Promote the Placebo Effect

A number of studies have shown that the attitudes of caregivers may influence the likelihood of patients¢ developing positive placebo effects. In other words, just going to the doctor may help you feel better and heal quicker.

If you are a doctor, healthcare worker, or even a caregiver for a loved one, here are 12 ways your bedside manner may help patients heal better and faster than with drugs alone.

Be empathic. Empathy is a caregiver trait that has been shown to promote spontaneous healing.

Take a holistic view. Show interest in the whole person, including the patient's attitudes and past and current social situations. Experts theorize this is why psychotherapy has been shown to be so beneficial to some patients.

Get to know them. Knowing the patient over an extended time period inspires more confidence in you, which promote healing.

Be sensitive. Patients respond best when they feel their caregiver is "tuned in" to their emotions.

Be reliable. Showing up on time, getting back to the patient with answers, and being trustworthy promote a sense of calm and can speed the healing process.

Be flexible and open-minded. Be willing to adapt your medical goals to the patient's needs and values. This helps the patient feel as if he or she is part of the process.

Partner. Encourage patient participation in decision making. Studies show that empowered, involved patients have a higher rate of healing success.

Know thyself. Be aware of how both your nonverbal and verbal communication can affect patients. Body language that shows you are fully "there" and not distracted or hurried, for example, can ease a patient's anxiety level and inspire more openness and sharing.

Use personal space wisely. Optimize physical space and patient contact based on verbal cues and body language. Touch, for example, may be very healing--but only if the patient welcomes it.

Take your time. Caregivers with the best records of healing are able to give ample time to each patient.

Be a detective. Be willing to look at all past medical history and early childhood experiences to uncover any circumstances that may impact the patient's symptoms.

Listen up. Be attuned to the way volume, tone, and rhythm effect your verbal communications--and what unconscious messages you may be sending.

* * * * *

Dr. Kradin practices medicine at Massachusetts General Hospital and is an associate professor at Harvard Medical School. He is trained in internal medicine, pathology, immunology, and psychoanalysis, and is one of the country¢s foremost experts in mind-body medicine. His new book is The Placebo Response and the Power of Unconscious Healing (Routledge, 2008).

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