Emily Bilodeau, LMT (207) 779-6671

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The Nocebo Effect

"This is the worst _____ that I have ever seen."

"You have the _____ of an eighty-year-old."

Neck. Wrist. Plantar Fasciitis. Sacroiliac dysfunction. Hamstring tear. Fibromyalgia. Fill in the blank with your own particular malady.

I wish that my colleagues wouldn't say this to people. It's important to acknowledge and respect the injury and pain that our clients present with, but the extremity of these statements can trigger something detrimental to our clients' progress: the nocebo effect.

We're all familiar with the placebo effect, when a medication or intervention works simply because we believe it's working. It's why some parents give kids a sugar tablet for a tummy ache--believing  that you are going to feel better can cause you to feel better.

The nocebo effect is the opposite of placebo;
in the nocebo effect, you get sick because you believe you're going to get sick. In massage therapy, this means you don't get better because you believe that you are beyond help. When we believe that our pain is too extreme or too stubborn, we can become resistant to treatment, face more discomfort, and the nocebo effect strengthens. It's not that the pain is all in our head, it's that our heads need some recalibration in order to help our bodies.

For me, it means that I have to phrase everything carefully or else I can affect my client's outcomes. If I find a particularly tense area, instead of saying, "Wow, this is really tight!" I'll ask, "Is this where you're feeling it?" The first statement sets up a belief that something is wrong with my client, but the second gives them a chance to describe their experience. Sometimes, this is exactly where the pain is, but I haven't set any kind of nocebic expectation; I just asked a clarifying question. Sometimes, people don't hurt in these tense places. By asking instead of describing, I get the feedback I need to make my work more effective and I avoid implying that there's something else wrong with somebody.


Our mind-body connection is powerful. It can set us up for some incredibly healing experiences, but it can also block our progress. I do my best to stay positive, supportive and encouraging in my office because working through the nocebo effect is tougher than any muscle knot you can throw at me.
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