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Ben Colagiuri
Associate Professor in the School of Psychology, University of Sydney, Australia.

What’s in a frame? Using positive attribute framing to inhibit nocebo side effects.

Side effect warnings are essential for informed consent. Yet, these warnings often lead to poorer patient outcomes via the nocebo effect. Communication strategies that impede the development of nocebo effects whilst providing accurate side effect information are critical for addressing this paradox. Positive framing is one such promising technique. Side effect information typically has a negative attribute frame, with the likelihood presented to patients as the risk of experiencing the side effect (e.g. 30% of patients will experience nausea). Positive attribute framing involves presenting the inverse likelihood, i.e. that of not experiencing the side effect (e.g. 70% of patients will not experience nausea). Critically, both frames provide statistically equivalent information, thus maintaining informed consent. Across a series of experiments, we found that positive framing was capable of reducing nocebo side effects. Importantly, this was when compared with both negative and generally framed side effect warnings and appropriate natural history controls. Interestingly, however, there was no evidence that expectancy mediated the framing effect, suggesting that other factors must underlie its efficacy. Irrespective of the mechanisms/s at play, the findings are encouraging and suggest that positive attribute framing may be an ethical and cost-effective method of reducing the burden of nocebo side effects in clinical settings.

 

Biosketch

Ben Colagiuri is an Associate Professor in the School of Psychology, University of Sydney. He received his PhD in Psychology in 2010 from the same School. His research aims to understand how expectancies shape health outcomes via placebo and nocebo effects. To date, he has developed a number of novel experimental models to uncover the mechanisms of placebo and nocebo effects for pain, sleep, nausea, and related conditions. He has been awarded multiple Australian Research Council Discovery Grants, published over 60 scientific papers, and received national and international recognition for his research, including the Australian Psychological Society Early Career Research Award 2014 and the International Society for Behavioural Medicine Early Career Award 2016. His current research is exploring how knowledge about placebo and nocebo effects could be used ethically to improve patient outcomes.