Research master thesis | Psychology (research) (MSc)
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Background: Between 10-15% of women have a pathological fear of childbirth. An expectation of fear might contribute to an actual fearful childbirth experience, which is known as a nocebo effect....Show moreBackground: Between 10-15% of women have a pathological fear of childbirth. An expectation of fear might contribute to an actual fearful childbirth experience, which is known as a nocebo effect. Likewise, positive thoughts about childbirth may lead to positive experiences, known as a placebo effect. Negative expectations surrounding childbirth mainly occurs in women who are known with anxiety and depression. As a result of these negative expectations, women could have a prolonged labor and obstetric complications which can evoke traumatic symptoms. The purpose of this study was to research whether there is a predictive association between positive or negative expectations surrounding childbirth and the experience of childbirth and whether this differs in women with or without psychiatric problems. This is relevant because most research on women’s expectations of childbirth are focused on fear of childbirth and its potential impact in medical aspects, whereas in this study the focus is on a broader expectation base, including positive expectations and also the subjective experience of childbirth. Methods: In this prospective study we included in total 150 women from both the Psychiatric Obstetric Pediatric (POP) outpatient clinics, a clinic for pregnant women with psychiatric vulnerability, and the general obstetric clinic, between January 2020 and January 2022. All participants filled in the Wijma Delivery Expectancy (version A at T1) and Experience (version B at T2) questionnaire after providing an informed consent. Also, all participants filled in the Hospital Anxiety and Depression scale (HADS) and the PTSS checklist for DSM-5 (PCL-5), to evaluate current psychiatric complaints. Results: The expectation surrounding childbirth was a significant predictor for the childbirth experience after controlling for parity and pain relief, p <.001, whereas positive expectations are related to a positive childbirth experience (placebo effect) and negative expectations are related to a negative childbirth experience (nocebo effect). This was not different for women with or without psychiatric problems, p =.841. Conclusions: Women’s negative and positive expectations of childbirth are related to the childbirth experience, showing indications for both a nocebo and placebo effect. These results can be important for future experimental research to see whether changing the expectation of childbirth in a positive way, could improve the experience of childbirth.Show less
Research master thesis | Psychology (research) (MSc)
closed access
Background: To alleviate side-effect burden in advanced breast cancer, it is necessary to identify at-risk personality types and effective interventions. Previous research indicates that patients’...Show moreBackground: To alleviate side-effect burden in advanced breast cancer, it is necessary to identify at-risk personality types and effective interventions. Previous research indicates that patients’ pessimism and trait anxiety may be risk factors for experiencing side-effects. To reduce their side-effect burden, optimizing patients’ side-effect expectations is suggested as a novel strategy. Doctor-patient communication strategies, such as expressing empathy (i.e. reassurance of nonabandonment) and explaining psychological mechanisms behind side-effects (i.e. a nocebo explanation), are most promising for optimizing patients’ expectations. In this experimental video-vignette study, we aimed to determine (1) whether clinician-expressed empathy and/or a nocebo explanation is effective in reducing expected side-effect burden, (2) whether generalized pessimism and trait anxiety relate to expected side-effect burden, and (3) whether there is an interaction between the effectiveness of these interventions and these personality characteristics. Methods: Using a two-by-two experimental video-vignette design, 159 cancer patients/survivors and healthy women watched one out of four videos with a nocebo explanation (present/absent) and empathy manipulation (present/absent). The effect of the interventions, the personality characteristics, and the interaction between these two were assessed using regression analyses. Differences between specific (e.g. hair loss) and nonspecific side-effects (e.g. fatigue) were investigated. Results: Clinician-expressed empathy, but not the nocebo explanation (p>.025), was successful in reducing expected side-effect occurrence (p=.008) and intensity (p=.003). Next, pessimistic patients expected side-effects to be more intense (p=.010), which was more profound in predicting the intensity of specific (p=.004), rather than nonspecific side-effects (p=.038). Moreover, results indicate an adverse effect of the nocebo explanation for pessimistic patients, as they expected nonspecific side-effects to be more intense after receiving this intervention (p=.014). Anxious patients expected a higher occurrence of nonspecific side-effects (p=.024), but not of specific side-effects (p=.435). No moderating role was found regarding patients’ anxiety and the effectiveness of the interventions. Conclusions: Short expressions of empathy by an oncologist can improve side-effect expectations. Generalized pessimism may cause patients to be vulnerable to expecting more intense side-effects, and to experiencing adverse effects from the nocebo explanation. Clinical follow-up studies need to investigate whether these results hold in clinical practice, and identify interventions for pessimistic cancer patients.Show less
Nocebo effects are harmful treatment effects of an inert agent elicited by the anticipation of negative effects. Limited amount of studies focused on nocebo effects on pain, suggesting nocebo...Show moreNocebo effects are harmful treatment effects of an inert agent elicited by the anticipation of negative effects. Limited amount of studies focused on nocebo effects on pain, suggesting nocebo effects can increase pain sensations. Importantly, a better understanding of nocebo effects in relation to pain is needed due to its clinical relevance. Few studies showed that established nocebo effects can generalize to different stimuli, yet it has not been investigated that nocebo effects can occur from one modality to another within the category of pain sensations. Besides, research suggests personality factors such as anxiety can play a role in these nocebo effects. This study investigates nocebo effects on heat pain, its generalization to different pain stimuli, and as an explorative objective, we investigate the possible moderating role of anxiety in these effects. At first, the STAI-S questionnaire was assessed to measure the levels of anxiety per individual. To induce negative expectations, two nocebo inducing mechanisms were used; first, a conditioning phase related to heat pain was used to acquire an association between the activation of a sham device (ENS) and increased pain stimulation, secondly, verbal suggestion was used by informing participants the ENS will increase pain sensations. Then, heat pain stimuli set at the same temperature were assessed with the supposed activation and deactivation of the ENS. Thereafter, pressure pain stimuli at the same pressure were administered with the supposed activation/deactivation of the ENS. The results showed that participants experienced more heat pain and pressure pain with the supposed activation of the ENS. This demonstrates significant nocebo effect for heat pain, and it shows nocebo effects significantly generalized to pressure pain stimuli. However, for the explorative outcome, the moderation analysis did not find indications that anxiety played a role in these effects. The current findings suggests the important role of negative expectations interfering with pain perception and altering the experience of different pain stimuli. We discuss the importance to understand the less researched nocebo phenomenon and its generalization to effectively reduce nocebo effects in a clinical setting. Also, the need to explore psychological factors in these nocebo effects is emphasized.Show less
