UNDERSTANDING PLACEBO, NOCEBO and IMMUNITY
Imagine for a moment being that person with all the high risk factors that we have heard about ad nauseam, and you now test positive for Covid-19. Whether exhibiting symptoms or not, it must undoubtedly be a terrifying moment. An instant triggering of stress hormones causing shock to the body with nowhere to run, except into your mind which has been primed for weeks now to panic at this news. There is pounding in your chest and you feel immediately and severely ill and over the next few days your imagination runs wild, finding scenarios that fill you with horror and dread. Your friends and family are not allowed to come near you, and the look in your doctors’ eyes peering at you over a mask, through a shield and gloved up to the eye balls, confirms your worst nightmare…, Enough to tip anyone over the edge?
TWO REASONS TO STAY CALM AND KEEP A HEALTHY PERSPECTIVE
1.Stress and fear trigger immune suppressing reactions in the body.
2.The nocebo response which is as real as the more well known placebo effect but in a negative way.
PLACEBO: Many therapies are dismissed as being purely placebo but it is this very placebo effect that fascinates anyone interested in healing. Hypnotherapists are especially aware of the effects of the subconscious mind on our physiology.
For the Placebo effect three things are deemed necessary:
1. The patient believes in the doctor (white coat effect and good rapport adds to the positive expectation and belief.)
2. There is a ritual (take pill or injection or even undergo surgery; this is classic behavioural conditioning i.e Pavlov’s dog story.)
3. The doctor believes in the ritual.
Even when a person is told they are part of the placebo group in a study, they still experience relief of symptoms especially if led to believe that many others have found relief from the same sugar pills. Knowing that others have benefited from any therapy will enhance success!
Culture also plays a role – if you belong to a culture where a particular treatment is accepted, that treatment will be more effective for you. For example, acupuncture has been found to be more effective the closer a person is to China.
And media – the more widely a product or drug is advertised, the more people believe in it, the more powerful the placebo effect. In other words the more successful the advertising, the better the treatment works.
Doctors all over are mystified by how placebo works but are finding complex neurobiological proof that it is not merely “in the head”. In fact it has physical consequences such as an increase in feel good neurotransmitters (endorphins and dopamine) and activation of certain parts of the brain which can be seen on MRI.
Even more fascinating is the NOCEBO EFFECT which causes similar physical consequences but in a destructive way. This lesser known dark side of placebo is responsible for unpleasant symptoms and negative outcomes due to fear and negative expectations..
Researchers have observed that in drug studies up to 65% of the placebo group can manifest negative side effects i.e. the nocebo response. For example when they are testing chemotherapeutics this group will report vomiting, diarrhea, nausea and some of them actually abandon the study because the physical symptoms are unbearable…all caused by the inert sugar pill!
This nocebo response puts doctors in a quandary every day because they are ethically bound to give patients the full story regarding possible side effects of treatments and surgeries while knowing that certain patients will actually then manifest these deleterious symptoms and could experience delayed healing post surgery. The harmful nocebo response appears to be greater in people that are already anxious and depressed and who tend towards catastrophizing and neuroticism.
The more a patient has heard about bad outcomes of treatments or surgeries from other people, the more likely that patient is to experience a similar negative outcome – sometimes referred to as contagious rumour. The higher the negative expectation, the more harmful the nocebo response.
How does what we know about NOCEBO relate to CORONA? Applying this principle of negative expectation to Covid-19, it is not rocket science to see how fear and anxiety, brought on by a continuous stream of scary statistics, could be making many of us more susceptible to the virus in the same way that students are more susceptible to viruses during exams. A small amount of fear is protective in that it may encourage crowd avoidance and responsible behaviours but fear in excess becomes destructive, irrational and immune suppressing, almost a self fulfilling prophecy.
And fear is certainly contagious – when catching up on news it is easy to hear which journalists have caught the fear and feel compelled to share it. We are flooded with (often out of context) numbers of deaths, hospital admissions and new infections with little emphasis on recoveries and other feel good stories. The fact that most of us will either be asymptomatic or have very mild symptoms seems to have been lost in the fear.
There are already plenty of articles written regarding the nocebo as well as emotional contagion in the context of this Corona virus panic. Please see below for more fascinating articles on all the above.
The picture that starts to emerge is that when people test positive for corona and they believe that their odds of survival are good, their experience of the infection and their outcome will be far more favourable. This is especially true when they know that many people with the same comorbidities have in fact fully recovered.
Awareness is often the best form of defense so I am hoping that by reading this blog it can help you choose mindfully what you let into your consciousness and which rabbit hole you allow your thoughts to run around in. Fear and hysteria are counterproductive to staying healthy. Our thoughts have physical consequences especially when accompanied by a strong emotion such as fear. And imagination is all powerful in this regard- just think of how you felt last time you consulted Dr Google on a mysterious symptom in the middle of the night.
Finally, please know that there are many ways you can support yourself and those around you to remain healthy at this time. Self care rituals have been shown to have powerful placebo effects. Similarly any perceived attention or care from another is shown to boost immunity and feelings of well-being. In this time when suicides are on the rise, reaching out to someone else could literally save a life. Do what makes you feel good and do it often because feeling good supports a healthy immune system.
For some of us, supporting a healthy immune system could be as simple as steering clear of contagious viral media. For others, loving, kindness and feeling loved creates a dopamine upsurge which is immune boosting. Exercise, time in nature, sunshine and any spiritual practice will have similar effects. Simply thinking, day dreaming or reminiscing about good things can boost your health.
If coming out of lockdown feels scary, be gentle with yourself and imagine good things to come. Spend some time planning the next outing/holiday/quality social get together so you have something to look forward to. Spread positivity and focus on the world being a better place when this is all in the past, while appreciating moments in time, right now.
Please contact me if you would like to experience how using your imagination can boost your immune system, especially if you have perhaps received some bad news regarding your viral status and need to stay calm. Online sessions are proving to be very effective.
“Each patient carries his own doctor inside him. They come to us not knowing that truth. We are at our best when we give the doctor who resides within each patient a chance to go to work.”—Albert Schweitzer