Nocebo education intervention
Learning about negative expectations and how they can worsen our mental health (known in medicine as the nocebo effect) can reduce false self-diagnosis.
In our research, adding these strategies to mental health awareness content helped reduce false self-diagnosis immediately and eliminate it over time, while still delivering important awareness content (Sandra et al., 2025).
Strategies to reduce false self-diagnosis
Below are the 5 components of the intervention tested in our study (with small changes). The intervention can be used broadly, for example in school interventions, workshops, or campaigns.
1. Normalize distress
Explain that experiencing distress is at times normal, even if it is difficult. Distress is not the same as a mental disorder, and some aspects of experiencing distress can overlap with symptoms of disorders but are not pathological.
Participants who learn about mental disorders as narrow categories are less likely to falsely self-diagnose, for example with having experienced trauma. (Jones & McNally, 2022).
Examples:
1. “A lot of the symptoms of distress can be difficult, but do not mean you have a disorder. Clinical disorders like ADHD, trauma, major depression, or generalized anxiety are quite narrow as categories, with only a small percentage of the population meeting full diagnostic criteria.”
2. “Many mental health questionnaires you see online can measure symptoms, but are mostly not enough on their own for a diagnosis. Someone can have a lot of symptoms but still not have a disorder, because those symptoms fluctuate, are mild, or are due to other causes.”
2. Explain how expectations work
Teach the basics of expectations and nocebo effects:
1) what they are, 2) how real they are (very), 3) how they work, and 4) what can cause them.
Simply learning about the nocebo effect reduces side effects of chemotherapy (Michnevich et al., 2022).
Example:
What nocebo effects are: “Negative expectations that can lead to people developing physical and/or psychological symptoms and self-labeling with a disorder.”
Are they real?: “Across thousands of clinical drug trials, about 50% of participants report side effects from taking a sugar pill (i.e., when being in the placebo group).”
How they work: “The nocebo effects work through misidentifying symptoms (misinterpreting unrelated experiences as relevant symptom) and amplifying symptoms (paying more attention to them over time).”
What can cause them: “Many sources can induce nocebo effects. For example: watching other people's experiences, reading about mental health problems online, learning about them from clinicians, on the internet, social media, friends, or chatbots.”
3. Change the mindset
Change the mindset about psychological symptoms from being signs of an underlying disorder to potentially temporary and context-dependent. This does not mean denying symptoms, but rather inviting the possibility for symptoms to be non-pathological. You can do it verbally, or in writing. In our study, we invited participants to write a reflection using some prompts below.
Changing mindsets about symptoms from negative to positive or neutral can reduce nocebo (expectation-driven) symptoms, like side effects from a drug or a vaccine. (Yielder et al., 2025).
Examples:
1. “Having negative beliefs is normal, but nocebo symptoms may also pass when expectations are adjusted.”
2. “Could your symptoms have another explanation (e.g. stress, poor sleep, phone distractions, temporary distress)?”
3. “How can you use what you learned about the nocebo effects to reduce the possibility of your expectations causing symptoms in the future?”
5. Foster trust and warmth
Aim for a trusted authority figure to deliver the intervention and the mental health content.
Demostrating warmth and competence can reduce anxiety that can lead to nocebo effects, and boost positive expectations (Howe et al., 2017).
Examples:
Clinical psychologist, doctor, teacher, parent.
4. Give examples of other people who had nocebo symptoms
Experiencing nocebo effects is common. Watching others experience nocebo symptoms leads to people experiencing more of them as well (Saunders et al., 2024).
But it works both ways: watching others feel better or talk about not experiencing symptoms reduces symptoms and eliminates them (Saunders et al., 2025).
Ready-to-use examples (or use your own):
Concussion:
“Ana hit her head doing martial arts at school. She got dizzy, a bit nauseous, and shaken up but was otherwise fine. Her friends saw her hit her head and immediately suggested she might have a concussion. Over the next few weeks Ana developed more and more symptoms of dizziness and fatigue, until she went to see a doctor because she was convinced she had a concussion. The doctor assured her that there was no indication that she had actually suffered a head trauma, and her symptoms went away in the next few days.”
Antidepressants:
“Simon gets occasional headaches, like most people he knows. He also gets food cravings, but had never paid much attention to those either. He recently started taking antidepressants, and learned that headaches and food cravings can be common side effects. He started noticing every time he experienced one of these symptoms and started having more of them over time. After he learned about the nocebo effect and that most people did not experience side effects when taking antidepressants, his headaches and food cravings decreased.”