The Effect of Nocebo Education on Socially-Induced Nocebo Cybersickness in Virtual Reality

Abstract

The nocebo effect occurs when aversive physiological symptoms are elicited psychologically, typically via negative health-related expectations. Social modelling is a key mode of inducing nocebo effects. Despite this, there is a paucity of research into interventions to reduce social modelling of negative symptoms. The current study investigated nocebo education as a potential intervention to attenuate socially-induced nocebo cybersickness in a VR paradigm. Nocebo education involves explaining the nocebo effect to participants prior to a treatment or procedure known to cause negative symptoms. Additionally, the effects of social modelling and nocebo education on two proposed mechanisms of the nocebo effect, expectancy and anxiety, were investigated. In line with predictions, social modelling increased cybersickness, an effect that was mediated by increases in expectancy and anxiety. However, contrary to hypotheses, nocebo education had no significant effect on cybersickness. Moreover, nocebo education increased participants’ expectancy and anxiety. This study makes several contributions to the literature. Firstly, the social modelling effect is replicated. Secondly, the role of expectancy and anxiety as key mechanisms underlying social modelling are demonstrated, an area where, despite evidence for these mechanisms in other modes of nocebo induction, research is sparse. Finally, it is demonstrated that nocebo education is not appropriate for inhibiting social modelling of negative symptoms, due both to its lack of effects on cybersickness and its expectancy and anxiety-inducing effects. This is not only empirically significant; it is also pertinent for clinical practice, where nocebo education has been promoted but negative social influences on health are widespread. Recommendations for future research are made. Specifically, other interventions that may be applied to social modelling, such as latent inhibition, are recommended. Moreover, the need to directly compare the relative strength of different modes of nocebo induction, and the respective effects of nocebo education on each, is emphasized.