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The influence of message framing on nocebo headaches: Findings from a randomized laboratory design

Abstract

Attribute framing presents an ethically sound approach for reducing adverse nocebo effects. In past studies, however, attribute framing has not always decreased nocebo effects. The present study used a sham tDCS procedure to induce nocebo headaches to explore factors that may contribute to the efficacy of attribute framing. Participants (N = 174) were randomized to one of three between-subject conditions: a no-headache instruction (control) condition and two conditions in which headaches were described as either 70% likely (negative framing) to occur or 30% unlikely (positive framing) to occur. Results revealed nocebo headaches in both framing conditions, as compared to the control condition. Attribute framing did not influence headache measures recorded during the sham tDCS task, but framing did have a modest influence on one of two headache items completed after the task. Results suggest that attribute framing could have a stronger influence on delayed nocebo effect measures or retrospective symptom reports; a finding that may explain inconsistencies in the existing framing-nocebo effect literature. Exploratory analyses also revealed that low negative affect was associated with stronger nocebo and attribute framing effects, although these effects were found on only a few headache measures. It is concluded that researchers should further investigate the influence of attribute framing on nocebo headaches as a function of both timing and emotional factors.

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Availability of data and materials

Data will be available on the Open Science Framework. All materials are available upon request from the corresponding author.

References

  • Aiken, L. S., & West, S. (1991). Multiple regression: Testing and interpreting interactions. Sage.

  • Aslaksen, P. M., & Lyby, P. S. (2015). Fear of pain potentiates nocebo hyperalgesia. Journal of Pain Research, 8, 703–710.

    PubMed  PubMed Central  Article  Google Scholar 

  • Aslaksen, P. M., Zwarg, M. L., Eilertsen, H., Gorecka, M., & Bjøkedal, E. (2015). Opposite effects of the same drug: Reversal of topical analgesia by nocebo information. Pain, 156, 39–46.

    PubMed  Article  Google Scholar 

  • Barnes, K., Faasse, K., Geers, A., Helfer, S., Sharpe, L., Colloca, L., & Colagiuri, B. (2019). Can positive framing reduce nocebo side effects? Current evidence and recommendation for future research. Frontiers in Pharmacology, 10, 167.

    PubMed  PubMed Central  Article  Google Scholar 

  • Baumeister, R. F., Bratslavsky, E., Finkenauer, C., & Vohs, K. D. (2001). Bad is stronger than good. Review of General Psychology, 5, 323–370.

    Article  Google Scholar 

  • Benedetti, F. (2015). Placebo effects. Understanding the mechanisms in health and disease. Oxford University Press.

  • Benedetti, F., Amanzio, M., Vighetti, S., & Asteggiano, G. (2006). The biochemical and neuroendocrine bases of the hyperalgesic nocebo effect. Journal of Neuroscience, 26, 12014–12022.

    CAS  PubMed  Article  Google Scholar 

  • Bigman, C., Cappella, J., & Hornik, R. (2010). Effective or ineffective: Attribute framing and the human papillomavirus (HPV) vaccine. Patient Education and Counseling, 81, S70–S76.

    PubMed  Article  Google Scholar 

  • Caplandies, F. C., Colagiuri, B., Helfer, S. G., & Geers, A. L. (2017). Effect type but not attribute framing alters nocebo headaches in an experimental paradigm. Psychology of Consciousness: Theory, Research, and Practice, 4, 259–273.

    Google Scholar 

  • Cesario, J. (2014). Priming, replication, and the hardest science. Perspectives on Psychological Science, 9, 40–48.

    PubMed  Article  Google Scholar 

  • Charlesworth, J. E., Petkovic, G., Kelley, J. M., Hunter, M., Onakpoya, I., Roberts, N., Miller, F. G., & Howick, J. (2017). Effects of placebos without deception compared with no treatment: A systematic review and meta-analysis. Journal of Evidence-Based Medicine, 10, 97–107.

    PubMed  Article  Google Scholar 

  • Clore, G. L., & Huntsinger, J. R. (2007). How emotions inform judgment and regulate thought. Trends in Cognitive Science, 11, 393–399.

    Article  Google Scholar 

  • Colagiuri, B., Schenk, L. A., Kessler, M. D., Dorsey, S. G., & Colloca, L. (2015). The placebo effect: From concepts to genes. Neuroscience, 307, 171–190.

    CAS  PubMed  Article  Google Scholar 

  • Colloca, L., Flaten, M. A., & Meissner, K. (2013). Placebo and pain: From bench to bedside. Academic Press.

  • Colloca, L. (2016). Nocebo effects: The dilemma of disclosing adverse events. In D. Strech & M. Mertz (Eds.), Ethics and governance of biomedical research (pp. 47–55). Springer International Publishing.

    Google Scholar 

  • Colloca, L., & Benedetti, F. (2007). Nocebo hyperalgesia: How anxiety is turned into pain. Current Opinion in Anesthesiology, 20, 435–439.

    PubMed  Article  Google Scholar 

  • Colloca, L., Enck, P., & DeGrazia, D. (2016). Relieving pain using dose-extending placebos: A scoping review. Pain, 157, 1590.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  • Devlin, E. J., Whitford, H. S., & Denson, L. A. (2019). The impact of valence framing on response expectancies of side effects and subsequent experiences: A randomised controlled trial. Psychology & Health, 34, 1358–1377.

    Article  Google Scholar 

  • Evers, A. W. M., Colloca, L., Blease, C., Annoni, M., Atlas, L. Y., Benedetti, F., Bingel, U., Büchel, C., Carvalho, C., Colagiuri, B., Crum, A. J., Enck, P., Gaab, J., Geers, A. L., Howick, J., Jensen, K. B., Kirsch, I., Meissner, K., Napadow, V., et al. (2018). Implications of placebo and nocebo effects for clinical practice: Expert consensus. Psychotherapy and Psychosomatics, 87, 204–210.

    PubMed  Article  Google Scholar 

  • Faasse, K., Helfer, S. G., Barnes, K., Colagiuri, B., & Geers, A. L. (2019a). Experimental assessment of nocebo effects and nocebo side effects: Definitions, study design, and implications for psychiatry and beyond. Frontiers in Psychiatry, 10, e396.

  • Faasse, K. (2019). Nocebo effects in health psychology. Australian Psychologist, 54, 453–465.

    Article  Google Scholar 

  • Faasse, K., Huynh, A., Pearson, S., Geers, A. L., Helfer, S. G., & Colagiuri, B. (2019b). The influence of side effect information framing on nocebo effects. Annals of Behavioral Medicine, 53, 621–629.

    PubMed  Article  Google Scholar 

  • Faasse, K., Martin, L. R., Grey, A., Gamble, G., & Petrie, K. J. (2016). Impact of brand or generic labeling on medication effectiveness and side effects. Health Psychology, 35, 187–190.

    PubMed  Article  Google Scholar 

  • Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191.

    PubMed  Article  Google Scholar 

  • Fischhoff, B. (2011). Applying the science of communication to the communication of science. Climatic Change, 108, 701–705.

    Article  Google Scholar 

  • Flaten, M. A., Simonsen, T., & Olsen, H. (1999). Drug-related information generates placebo and nocebo responses that modify the drug response. Psychosomatic Medicine, 61, 250–255.

    CAS  PubMed  Article  Google Scholar 

  • Fregni, F., & Pascual-Leone, A. (2007). Technology insight: Noninvasive brain stimulation in neurology—perspectives on the therapeutic potential of rTMS and tDCS. Nature Clinical Practice Neurology, 3, 383–393.

    PubMed  Article  Google Scholar 

  • Gallagher, K. M., & Updegraff, J. A. (2012). Health message framing effects on attitudes, intentions, and behavior: A meta-analytic review. Annals of Behavioral Medicine, 43, 101–116.

    PubMed  Article  Google Scholar 

  • Garcia-Retamero, R., & Cokely, E. T. (2011). Effective communication of risks to young adults: Using message framing and visual aids to increase condom use and STD screening. Journal of Experimental Psychology: Applied, 17, 270–287.

    PubMed  Google Scholar 

  • Gasteiger, C., Jones, A. S., Kleinstäuber, M., Lobo, M., Horne, R., Dalbeth, N., & Petrie, K. J. (2020). Effects of message framing on patients’ perceptions and willingness to change to a biosimilar in a hypothetical drug switch. Arthritis Care & Research, 72, 1323–1330.

    Article  Google Scholar 

  • Geers, A. L., Fowler, S. L., Helfer, S. G., & Murray, A. B. (2019b). Test of psychological and electrodermal changes immediately following the delivery of three analgesic treatment messages. Pain Reports, 4 e693.

  • Geers, A. L., Faasse, K., Guevarra, D. A., Clemens, K. S., Helfer, S. G., & Colagiuri, B. (2020). Affect and emotions in placebo and nocebo effects: What do we know so far? Social and Personality Psychology Compass, e12575.

  • Geers, A. L., Close, S. R., Caplandies, F., & Vase, L. (2019a). A positive mood induction for reducing the formation of nocebo effects from side effect information. Annals of Behavioral Medicine, 53, 999–1008.

    PubMed  Article  Google Scholar 

  • Hilarius, D. L., Kloeg, P. H., Van Der Wall, E., Van Den Heuvel, J. J. G., Gundy, C. M., & Aaronson, N. K. (2012). Chemotherapy-induced nausea and vomiting in daily clinical practice: A community hospital-based study. Supportive Care in Cancer, 20, 107–117.

    PubMed  Article  Google Scholar 

  • Hirt, E., R., Lynn, S. J., Payne, D. G., Krackow E., & McCrea, S. M. Expectancies and memory: Inferring the past from what must have been. In I. Kirsch (Ed.), How expectancies shape experience (pp. 93–124). American Psychological Association, Washington D.C., U.S.

  • Hoch, S. J., & Ha, Y. W. (1986). Consumer learning: Advertising and the ambiguity of product experience. Journal of Consumer Research, 13, 221–233.

    Article  Google Scholar 

  • Horvath, J. C., Forte, J. D., & Carter, O. (2015). Quantitative review finds no evidence of cognitive effects in healthy populations from single-session transcranial direct current stimulation (tDCS). Brain Stimulation, 8, 535–550.

    PubMed  Article  Google Scholar 

  • Inglis, S., & Farnill, D. (1993). The effects of providing preoperative statistical anaesthetic- risk information. Anaesthesia & Intensive Care, 21, 799–805.

  • Isaac, M. S., & Poor, M. (2016). The sleeper framing effect: The influence of frame valence on immediate and retrospective judgments. Journal of Consumer Psychology, 26, 53–65.

    Article  Google Scholar 

  • Kaptchuk, T. J., & Miller, F. G. (2018). Open label placebo: Can honestly prescribed placebos evoke meaningful therapeutic benefits? BMJ, 363, k3889.

  • Keller, P. A., Lipkus, I. M., & Rimer, B. K. (2003). Affect, framing, and persuasion. Journal of Marketing Research, 40(1), 54–64.

    Article  Google Scholar 

  • Leventhal, E. A., Hansell, S., Diefenbach, M., Leventhal, H., & Glass, D. C. (1996). Negative affect and self-report of physical symptoms: Two longitudinal studies of older adults. Health Psychology, 15, 193–199.

    CAS  PubMed  Article  Google Scholar 

  • Levin, I. P., & Gaeth, G. J. (1988). How consumers are affected by the framing of attribute information before and after consuming the product. Journal of Consumer Research, 15(3), 374–378.

    Article  Google Scholar 

  • Levin, I. P., Schneider, S. L., & Gaeth, G. J. (1998). All frames are not created equal: A typology and critical analysis of framing effects. Organizational Behavior and Human Decision Processes, 76, 149–188.

    CAS  PubMed  Article  Google Scholar 

  • Mao, A., Barnes, K., Sharpe, L., Geers, A. L., Helfer, S. G., Faasse, K., & Colagiuri, B. (in press). Using Positive Attribute Framing to Attenuate Nocebo Side Effects: A Cybersickness Study. Annals of Behavioral Medicine.

  • Mayer, J. D., & Gaschke, Y. N. (1988). The experience and meta-experience of mood. Journal of Personality and Social Psychology, 55, 102–111.

    CAS  PubMed  Article  Google Scholar 

  • Mayer, J. D., McCormick, L. J., & Strong, S. E. (1995). Mood-congruent memory and natural mood: New evidence. Personality and Social Psychology Bulletin, 21, 736–746.

    Article  Google Scholar 

  • Nosek, B. A., Aarts, A. A., Anderson, C. J., Anderson, J. E., Kappes, H. B., & Open Science Collaboration. (2015). Estimating the reproducibility of psychological science. Science, 349, aac4716-aac4716.

  • O’Connor, A. M., Pennie, R. A., & Dales, R. E. (1996). Framing effects on expectations, decisions, and side effects experienced: The case of influenza immunization. Journal of Clinical Epidemiology, 49, 1271–1276.

    CAS  PubMed  Article  Google Scholar 

  • Peters, E. (2012). Beyond comprehension the role ofnumeracy in judgments and decisions. Current Directions in Psychological Science, 21, 31–35. https://doi.org/10.1177/0963721411429960

    Article  Google Scholar 

  • Petty, R. E., & Briñol, P. (2015). Emotion and persuasion: Cognitive and meta-cognitive processes impact attitudes. Cognition and Emotion, 29, 1–26.

    PubMed  Article  Google Scholar 

  • Robinson, M. D., & Clore, G. L. (2002). Belief and feeling: Evidence for an accessibility model of emotional self-report. Psychological Bulletin, 128, 934–960.

    PubMed  Article  Google Scholar 

  • Rose, J. P., Geers, A. L., France, C. R., & France, J. L. (2014). Norm perception and communication for vasovagal symptoms in blood donation. Transfusion, 54, 2258–2266.

    PubMed  Article  Google Scholar 

  • Salovey, P., & Birnbaum, D. (1989). Influence of mood on health-related cognitions. Journal of Personality and Social Psychology, 57, 539–551.

    CAS  PubMed  Article  Google Scholar 

  • Seta, J. J., Seta, C. E., & McCormick, M. (2017). Commonalities and differences among frames: A unification model. Journal of Behavioral Decision Making, 30, 1113–1130.

    Article  Google Scholar 

  • Tversky, A., & Kahneman, D. (1981). The framing of decisions and the psychology of choice. Science, 211, 453–458.

    CAS  PubMed  Article  Google Scholar 

  • Updegraff, J. A., & Rothman, A. J. (2013). Health message framing: Moderators, mediators, and mysteries. Social and Personality Psychology Compass, 7, 668–679.

    Article  Google Scholar 

  • Uygunoglu, U., & Siva, A. (2016). Epidemiology of headache. In D. D. Mitsikostas & K. Peameleire (Eds.), Pharmacological management of headaches (pp. 7–18). Springer International Publishing.

    Chapter  Google Scholar 

  • Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress, and distress: Exploring the central role of negative affectivity. Psychological Review, 96, 234–254.

    CAS  PubMed  Article  Google Scholar 

  • Webster, R. K., Weinman, J., & Rubin, G. J. (2018). Positively framed risk information in patient information leaflets reduces side effect reporting: A double-blind randomized controlled trial. Annals of Behavioral Medicine, 52, 920–929.

    PubMed  Article  Google Scholar 

  • Wells, R. E., & Kaptchuk, T. J. (2012). To tell the truth, the whole truth, may do patients harm: The problem of the nocebo effect for informed consent. The American Journal of Bioethics, 12(3), 22–29.

    PubMed  PubMed Central  Article  Google Scholar 

  • Wilhelm, M., Rief, W., & Doering, B. K. (2018). Decreasing the burden of side effects through positive message framing: An experimental proof-of concept study. International Journal of Behavioral Medicine., 25, 381–389.

    PubMed  Article  Google Scholar 

  • Wilson, D. K., Kaplan, R. M., & Schneiderman, L. J. (1987). Framing of decisions and selections of alternatives in health care. Social Behaviour, 2, 51–59.

    Google Scholar 

  • Yan, C., Dillard, J. P., & Shen, F. (2010). The effects of mood, message framing, and behavioral advocacy on persuasion. Journal of Communication, 60, 344–363.

    Article  Google Scholar 

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Funding

This research was supported by Australian Research Council Grant DP200101748, to Dr. Ben Colagiuri.

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SH, BC, KF and AG were involved in study design, data analysis, data interpretation, and writing. KC was involved in data analysis, interpretation, and writing. FC was involved in study design, development of materials, and writing.

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Correspondence to Andrew L. Geers.

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This research was approved in advance by the Institutional Review Board at the University of Toledo, Toledo, Ohio USA.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Helfer, S.G., Colagiuri, B., Faasse, K. et al. The influence of message framing on nocebo headaches: Findings from a randomized laboratory design. J Behav Med 45, 438–450 (2022). https://doi.org/10.1007/s10865-022-00294-6

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Keywords

  • Placebo
  • Nocebo
  • Headache
  • Framing
  • Communication
  • Expectation