The Nocebo Effect

Why We Don't Like Negativity, and What to Do About It

By Cyndi Dale
[Energy Work]

Who wants to think about negativity? We get enough of it watching television and reading the newspaper. However, as practitioners, it’s important we understand that negativity may affect a client’s health. Equally vital is to know how to decrease these side effects and boost a client’s optimism—the antidote to negativity.
We’ve all heard that believing in a treatment supports a positive outcome. This statement is the sales point for the placebo effect, which has been often studied. Placebos are substances that yield beneficial outcomes, despite the absence of medicinal properties. Basically, the subject is told that the placebo will be helpful. During a study, subjects are usually given a sugar pill, a benign shot, or some other inert substance. Another group of subjects is given a medicinal product.
The studies are illuminating, demonstrating that placebos (actually the mind-set that change is possible) create positive effects in conditions, such as depression, pain, sleep disorders, menopause, and irritable bowel syndrome.1 Placebos have also been shown to dilate the bronchi, heal ulcers, and even make bald men think they can grow hair. In general, it seems the placebo effect encourages clear-cut positive shifts between 18 and 80 percent of the time; the mere suggestion of a positive outcome causing the body to produce the chemicals needed to generate change.2
The opposite is also true, however. Through an interaction called the nocebo effect, people given a harmless substance or treatment, but informed of negative side effects, will experience unpleasant symptoms. For instance, brain imaging studies have revealed that pain is more intense in patients who expect pain than in those who don’t.3 In fact, according to a study at Oxford University, poor expectations of a treatment can override the strongest of opioids, even while positive expectations can double the biochemical effect of the opioids.4 In yet another study, patients were told that they were given chemotherapy. Saline water was actually administered, but some subjects still vomited and lost their hair.5 As well, patients told they would have sexual side effects following a drug treatment were three times more likely to experience these symptoms as those not informed about this reaction.6

Pretty Water
As an energy practitioner, I became aware of the two-sided, body-mind connection—placebo and nocebo—when a friend relayed a story. He was a medical doctor who frequently volunteered for Catholic medical mission trips. During one mission, the team ran out of medicine. A few of the nuns on the team grabbed bottled water, colored it, and passed it out as medicine. Nearly all of the villagers who drank the water reported transformative healing. (My friend wasn’t informed of their activity until it was actually done.)
Later, the real medicine, little white pills, was delivered and dispensed. The villagers insisted that the pills made them feel bad and that they wanted the “pretty water” again. My friend was amazed at the power of perception to harm and heal.
My friend’s experience intrigued me, and I decided to learn more about the nocebo side of the placebo effect. Over time, I arrived at the following conclusions:
• My attitudes toward a client can influence the outcome, which means that my own negativity can potentially create negative results or side effects.
• The more faith I hold in a client’s progress, the more likely they are to progress.
• The above two statements are also true about a client. Their own positivity or negativity can affect them.

Energy is Shareable
As a subtle energy practitioner, I believe the impact of negative and positive perceptions can be at least partially explained through an understanding of energy. Energy is information that moves. While physical or measurable energy is certainly powerful, it’s the subtle energy, the invisible and inaudible stuff of the universe, that steers the physical world. Change the subtle energies—which are directed through beliefs, consciousness, emotion, and mood, among other factors—and you alter physical reality.
If subtle energy is anything, it’s incredibly shareable. In the snap of a finger, perceptions can fly from us to a client—and vice versa. Our negative impressions can pass from us into a client as easily as our positive valuations. Along the same line, our client’s fears can transfer into us, stimulating negative perceptions about their condition. As practitioners, we hold the power to help determine how much negativity versus positivity spreads between us and a client.
Of course, we’re only human. It’s pretty difficult to monitor and control our negative perceptions. Humans think around 60,000 thoughts a day. About 95 percent of these are repeated day after day. Of these, around 80 percent are negative.7 Of course, this figure only constitutes our measurable thoughts. Who among us could ever count how many subtle thoughts we formulate per day? Bottom line, we must wonder how we can even hope to control our negativity or help a client do the same.
The truth is, we can’t. Neither do we have to.
Another set of studies shed a clue on what we can do to protect our clients from our negative perceptions, stave off the harmful attitudes we might pick up from them, and help them shift their own negativity. These studies were performed by Ted Kaptchuk, MD, an associate professor of medicine at Harvard Medical School, who relays that it’s as important to analyze the nocebo effect as it is to understand the placebo effect.
Kaptchuk’s work revealed that both placebos and nocebos affect the brain areas that modulate pain reception. Nocebo effects, however, also activate the hippocampus, which is linked with anxiety. Rituals, such as healing rites, as well as overt care, impact the same pathways. In fact, the clients who had the best outcomes during his studies were those who participated in the most empathic interactions with a practitioner. According to Kaptchuk, healing interactions nudge patients toward altering the perceptions of their problems and symptoms. The more empathy, kindness, and overt care provided by the caregiver, the better the client did. In other words, either outcome—placebo or nocebo—can depend on the nature of the engagement between a client and a practitioner.8

Maximizing the Power of Positivity
How can we promote these types of positive interactions, given how much hidden information flows between us and a client? Based on years of research and practical experience, I recommend establishing protocol in the following areas:
1. Carefully Disclose Information
Certainly, we must let our clients know if our treatment could produce discomfort or side effects. I’ve had my fair share of bodywork that has left me tired or even sore. But we can carefully explain any uncomfortable side effects. For instance, how about tying a positive to the pain? If the client is experiencing pain while we work, we can say something like this: “I know that this is uncomfortable, but think of how much better you will feel when we’re done.” When dealing with anticipatory announcements, such as delayed side effects like soreness or achiness, we might make a statement like this: “It is possible you might feel some aftereffects. I also want you to pay attention to how much better you’ll feel.”
2. Use Positive Rituals
Clients find healing rituals very reassuring. Think about how you can best insert supportive and comforting rituals into your interactions. Is there music in your waiting room? Do you start each session with a positive statement? Are clients encouraged to share the gains they have achieved since the last session? We can use physical props such as fountains and affirmative posters, as well as interactive questions to build a positive environment.
3. Reframe Complaints
Whether we’re thinking negative thoughts or dealing with a pessimistic attitude in a client, we can always pull the silver lining out of the dark cloud. If you don’t like a client’s pessimism or negative trait, perceive it differently. For instance, if a client is stubborn, label them as passionate instead of stubborn. If a client can only see the downside of their challenge, point out how patient or strong they are being. Many psychological experts believe it takes three positives to neutralize a negative.9 Keep this in mind and aim for a three-to-one ratio for statements you make internally or aloud during a session.
4. Focus on Meaning
Spiritual qualities can help us make meaning out of the stormy events of life. Instead of speaking only to the dark sides of the clients’ challenges, see if it’s possible to reflect on a quality that adds meaning. For instance, does the situation call for acceptance, appreciation, faith, gratitude, hopefulness, love, peacefulness, relief, serenity, or some other meaningful perception? If it’s not appropriate to speak about these traits to a client, hold them in your own mind when interacting.
5. Show Compassion
Our humanity is actually an asset, not a detractor in working with clients. It’s OK to be empathic and compassionate. Simply saying something like, “I’d find that difficult, too,” or, “I’m so proud of you,” can go a long way.
Chuck Norris got it right: “A lot of times people look at the negative side of what they feel they can’t do. I always look on the positive side of what I can do.”

1. “What is the Placebo Effect?” WebMD, accessed September 2016,
2. Lissa Rankin, “The Nocebo Effect: Negative Thoughts Can Harm Your Health,” August 6, 2013, Psychology Today online, accessed September 2016,
3. “Placebo Effect,” American Cancer Society, accessed September 2016,
4. University of Oxford, “Placebo Effect Works Both Ways,” February 27, 2011, published in Science News in Science Daily online, accessed September 2016,
5. Lissa Rankin, “The Nocebo Effect: Negative Thoughts Can Harm Your Health.”
6. Ted J. Kaptchuk and Franklin G. Miller, “Placebo Effects in Medicine,” The New England Journal of Medicine 373 (July 2, 2015): 8–9, accessed September 2016,
7. The Miracle Zone, “80% of Thoughts Are Negative … 95% are Repetitive,” March 2, 2012, accessed September 2016,
8. Kaptchuk and Miller, “Placebo Effects in Medicine”; Cara Feinberg, “The Placebo Phenomenon,” Harvard Magazine online, January–February 2013, accessed September 2016,
9. Steph Fontane Pennock, “Why We Need Negative and Positive Emotions,” Positive Psychology Program, January 23, 2014, accessed September 2016,

Cyndi Dale is an internationally renowned author, speaker, and intuitive consultant. Her books include the bestselling The Subtle Body: An Encyclopedia of Your Energetic Anatomy (Sounds True, 2009), The Complete Book of Chakra Healing (Llewellyn Publications, 2009), and Advanced Chakra Healing (Crossing Press, 2005). To learn more about Dale and her products, services, and classes, please visit