Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Aug 22;15(1):30851.
doi: 10.1038/s41598-025-14118-5.

Investigating whether socially acquired nocebo effects can spread to other treatments

Cosette Saunders  1 , Winston Tan  2 , Kirsten Barnes  3 , Nicolas McNair  2 , Ben Colagiuri  2
Affiliations
Randomized Controlled Trial

Investigating whether socially acquired nocebo effects can spread to other treatments

Cosette Saunders et al. Sci Rep. .

Abstract

Observation of another's treatment side effects can elicit side effects in the observer, even when the treatment is a placebo. This study investigated whether these socially acquired side effects can generalise to similar treatments. Healthy volunteers (N = 120) participated in a study ostensibly comparing the effect of two cognitive enhancers (placebos). Participants were randomised to one of four experimental groups. The three treatment groups comprised: social modelling of side effects associated with the same treatment; social modelling of side effects associated with the different treatment; and a verbal suggestion only group (i.e., no social modelling). The fourth group was a no-treatment control group. The primary outcome was severity of side effects reported. Groups that received placebos reported increased symptom severity, i.e., showed a nocebo effect. Surprisingly, primary outcome analysis revealed no significant enhancement of the nocebo effect due to social modelling. However, there was an additive effect of social modelling on general side effects (planned secondary outcome) and specifically for headaches and dizziness (exploratory analysis), both of which generalised across treatments. Therefore, preliminary findings suggest that socially induced nocebo side effects may not always occur, but when they do, they can generalise beyond identical treatments. This warrants replication and raises significant concern given the widespread sharing of treatment-related information, potentially contributing to the societal burden of nocebo effects.

Keywords: Generalisation; Nocebo; Observational learning; Side effects; Social modelling; Symptoms.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study procedure.
Fig. 2
Fig. 2
Pre-registered analyses. Note. From left to right, Mean baseline adjusted Target, Non-Target and General Symptom scores by group. Natural History (NH), No Social Modelling (No SM), Social Modelling Consistent (SM C) and Social Modelling Inconsistent (SM I). All error bars are ± 1 SEM.
Fig. 3
Fig. 3
Exploratory analyses. Note. From left to right, mean Target Symptoms of headache/dizziness warned participants only; mean Target Symptoms of nausea/stomach discomfort warned participants only. Mean headache/dizziness for all participants. All error bars are ± 1 SEM.
See this image and copyright information in PMC

References

    1. Bagaric, B., Jokic-Begic, N. & Sangster, J. C. The nocebo effect: A review of contemporary experimental research. Int. J. Behav. Med.29(3), 255–265 (2022). - PubMed
    1. Mitsikostas, D. D. et al. European headache federation recommendations for placebo and nocebo terminology. J. Headache Pain21(1), 117 (2020). - PMC - PubMed
    1. Saunders, C., Tan, W., Faasse, K., Colagiuri, B., Sharpe, L., Barnes, K. The effect of social learning on the nocebo effect: A systematic review and meta-analysis with recommendations for the future. Health Psychol. Rev. 1–20 (2024). - PubMed
    1. Vögtle, E., Barke, A. & Kröner-Herwig, B. Nocebo hyperalgesia induced by social observational learning. Pain154(8), 1427–1433 (2013). - PubMed
    1. Papoiu, A. D., Wang, H., Coghill, R. C., Chan, Y. H. & Yosipovitch, G. Contagious itch in humans: A study of visual ‘transmission’ of itch in atopic dermatitis and healthy subjects. Br. J. Dermatol.164(6), 1299–1303 (2011). - PMC - PubMed

Publication types

LinkOut - more resources