Exploring the Potential of Positive Attribute Framing to Reduce Observational Learning of Nocebo Side Effects

Abstract

Warnings about and observation of others’ adverse experiences can trigger such outcomes via the nocebo effect. Emerging evidence suggests that positively framing side effect information to highlight the probability side effects will not occur reduces nocebo side effects relative to standard negative framing, which highlights the probability side effects will occur, but it is unclear whether this extends to observationally induced nocebo side effects. The current study used a model of virtual reality (VR) induced cybersickness to investigate this. Before viewing a VR video, 202 healthy volunteers were randomly assigned to receive a positively framed (“7 out of 10 people will not experience cybersickness”), negatively framed (“3 out of 10 people will experience cybersickness”), or no side effect warning, and to either witness a confederate model cybersickness symptoms (observational learning [OL]), or to not witness such modelling (no OL). Framing and OL did not affect composite VR-induced cybersickness scores. However, OL elevated VR-induced nausea specifically, and anxiety and expectancy, though no framing effects were found on these outcomes. Expectancy and anxiety predicted VR-induced cybersickness and nausea with mediation analysis indicating that expectancy completely mediated the effect of OL on VR-induced nausea – suggesting causal influence – but that anxiety did not. The current findings uniquely demonstrate OL-induced nocebo side effects in an online environment and indicate that media platforms should consider the unnecessary harm that can arise – via the nocebo effect – from simply observing other’s negative experiences. The current study provided no evidence that positive framing can attenuate OL-induced nocebo side effects. Future studies should therefore explore alternative methods to reduce OL of nocebo side effects; these should specifically target expectancy given the current evidence that it mediates the effect of OL on nausea.