Side Effects May Depend on the Framing of a Warning: But Does this Framing Effect Depend on Absolute Risk?
Access status:
Open Access
Type
ThesisThesis type
HonoursAuthor/s
Clark, BrodieAbstract
Side effect warnings contribute directly to the burden of side effects. This occurs via the nocebo effect whereby negative outcomes are shaped by features of the treatment context, beyond the direct actions of the active treatment. Some studies have found that positive framing of ...
See moreSide effect warnings contribute directly to the burden of side effects. This occurs via the nocebo effect whereby negative outcomes are shaped by features of the treatment context, beyond the direct actions of the active treatment. Some studies have found that positive framing of warnings – stating the proportion of people who will not experience the side effect – reduces side effects compared to the more common-place negative framing – stating the proportion who will experience the side effect. However, findings have been mixed. It appears that the absolute risk ascribed to the side effect may determine the effect of framing, however this has not been tested. The current study employed a 2x2+1 between-subjects design to test the impact of both absolute risk and framing of a warning – as well as the inclusion of any statistical warning at all - on side effects. This was done in a model of virtual reality (VR)-induced nausea, with 130 healthy volunteers. Expectancy, anxiety and attentional bias were also measured as they have been proposed as mechanisms of framing and nocebo effects, but scantly - or in the case of attentional bias, never – previously empirically investigated. In this study, VR-induced nausea was not affected by framing or absolute risk of the warning. However, nausea was greater for participants who received no statistical warning. Relative to other groups, these participants also showed elevated anxiety – although not expectancy or attentional bias. These findings indicate that future studies and clinical practices must consider the effects of general, non-statistical warnings on nocebo side effects as they are potentially even more deleterious than more extensive, statistical warnings. These findings are also the first outside of pain studies to support a role for anxiety in nocebo effects, thereby shaping current understanding and future investigations of the poorly understood mechanisms of nocebo effects.
See less
See moreSide effect warnings contribute directly to the burden of side effects. This occurs via the nocebo effect whereby negative outcomes are shaped by features of the treatment context, beyond the direct actions of the active treatment. Some studies have found that positive framing of warnings – stating the proportion of people who will not experience the side effect – reduces side effects compared to the more common-place negative framing – stating the proportion who will experience the side effect. However, findings have been mixed. It appears that the absolute risk ascribed to the side effect may determine the effect of framing, however this has not been tested. The current study employed a 2x2+1 between-subjects design to test the impact of both absolute risk and framing of a warning – as well as the inclusion of any statistical warning at all - on side effects. This was done in a model of virtual reality (VR)-induced nausea, with 130 healthy volunteers. Expectancy, anxiety and attentional bias were also measured as they have been proposed as mechanisms of framing and nocebo effects, but scantly - or in the case of attentional bias, never – previously empirically investigated. In this study, VR-induced nausea was not affected by framing or absolute risk of the warning. However, nausea was greater for participants who received no statistical warning. Relative to other groups, these participants also showed elevated anxiety – although not expectancy or attentional bias. These findings indicate that future studies and clinical practices must consider the effects of general, non-statistical warnings on nocebo side effects as they are potentially even more deleterious than more extensive, statistical warnings. These findings are also the first outside of pain studies to support a role for anxiety in nocebo effects, thereby shaping current understanding and future investigations of the poorly understood mechanisms of nocebo effects.
See less
Date
2019Licence
OtherRights statement
The author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.Faculty/School
Faculty of Science, School of PsychologyShare