Just Say No! to Nocebos

By Susan Haines, MFA, NCPT, NKT, FRC

There’s a good chance that you have experienced the “nocebo effect” from a teacher, friend, parent, or even a well-intentioned stranger! Nocebo is a funny word that is used to describe the opposite of the placebo effect. The placebo effect is a well-known phenomenon; defined as “a beneficial effect produced by a placebo drug or treatment, which cannot be attributed to the properties of the placebo itself and must therefore be due to the patient's belief in that treatment.” Placebo is a word that comes from Latin that is defined as “I shall please”, while its opposite, nocebo, means, ‘I will be harmful’. Dr. Bhavya Chhabra writes about the effects of placebos and nocebos during athletic performance: “Placebo and nocebo effects mirror the remarkable power of the human mind to shape future outcomes. In this regard, the placebo effect can enhance performance by creating positive expectations, while, on the other hand, the nocebo effect would hinder one’s performance through negative expectations. These effects have been studied in medicine for over five decades for their notable neurobiological and psychological effects.” 

Dancers receive detailed feedback on their technique, strength, stamina, minor injuries, and overall physical performance quite frequently. If the dancer is injured, this feedback is coming from physical therapists, orthopedic surgeons, teachers, and well-meaning family members. These words, especially coming from someone in a position of authority that the dancer holds in high esteem, can result in a beneficial or detrimental effect on a dancer’s physical performance. 

The placebo effect from dance teachers can be something as simple as telling a dancer that they are ‘a good jumper’ or they have ‘a strong center for balancing.’ These positive suggestions can offer confidence and neurobiological effects that keep the dancer focused on improving their physical skills. And yet, it is all too common for teachers to give their classes the nocebo effect that will foster the negative. Here's an example: a class is half-heartedly completing a core workout in class and the teacher calls out a rallying cry that goes something like this: “C’mon class, are your abs not strong enough to get to the end of this series?” or “Let’s go! You’re not strong enough to audition if you can’t get through this!” Comments like these come from the desire to motivate a group—but for some dancers the suggestion that their teacher believes their abs are “not strong”, which very quickly translates into “weak abs” in a concerned dancer’s mind, can be enough to create some worry about their physical strength that stays with them as they take class and perform, altering how they approach challenging movements.

A more serious example is when the nocebo comes from a doctor or physical therapist. It is all too common for injured dancers to hear statements like, “Your lumbar spine is unstable. That’s why you are feeling that pain.” Or “You have no core strength! That’s probably why you fell.”  The dancer is left with a clear proclamation by a credentialed medical expert who just told them their low back is unstable. Sure, they were given some exercises to help correct this, and maybe their pain is feeling better, but…every time they land a big leap or lift a leg up to arabesque…that phrase “lumbar spine is UNSTABLE” has been embedded as a nocebo that may cause them to hesitate just a little in every big movement they attempt. And telling a dancer they have NO core strength? That’s quite a powerful nocebo, negatively affecting dancers in everything from standing alignment to landing jumps and leaps. 

Injured dancers are especially vulnerable to the nocebo effect as well meaning teachers, family, and friends try to share information that could help with a diagnosis. You know how it goes: “Pain in your foot?! WELL…my cousins’ brothers’ auntie’s neighbor had a pain in her foot right there and it ended up being a torn/broken/stress fractured/sprained/parasitic infection/infected cut that took 2/3/5/6/9 days/weeks/years to finally get betterl!!”  All the stories shared in hopes of offering empathy and care are about the same—they are tales of woe cloaked in the drama and mystery of trying to help with an unknown pain or injury.  The important thing to remember is NONE of them are YOUR story. 

Dancers, your challenge is to own your own story as you navigate aches and pains. Is it sore muscles? Is it an injury? Honor what your body is telling you and seek medical care from a dance specific practitioner at the first sign of an injury. And say No! to nocebos that come your way. If the nocebo comes from a PT or a dance teacher, ask for more information. You can respectfully ask what is it that makes you think I have no core strength? Empower yourself by questioning the word choice of weak, unstable, no strength, failing, and more. Bodies deserve specificity, not dramatics. Dance teachers, physical therapists, and medical professionals, your challenge is to offer advice and information in a way that empowers the dancer for the best possible outcome for recovery. Words and phrases coming from a medical professional that create the nocebo effect can negatively impact a dancers’ performance long after the injury has healed. Let’s all say No to the nocebo effect and shift to a more positive approach that supports dancers’ mental and physical performance outcomes.

References

Chhabra, B.; Szabo, A (2024) Placebo and Nocebo Effects on Sports and Exercise Performance: A Systematic Literature Review Update Nutrients, 16(13); https://doi.org/10.3390/nu16131975

Petrie KJ et al. (2019). Psychobiological mechanisms of placebo and nocebo effects: pathways to improve treatments and reduce side effects. Annual Review of Psychology, 70(1), 599-625. https://doi. org/10.1146/annurev-psych-010418-102907

Raglin, J.; Szabo, A.; Lindheimer, J.B.; Beedie, C.(2020) Understanding Placebo and Nocebo Effects in the Context of Sport: A Psychological Perspective. Eur. J. Sport Sci, 20, 293–301

*Susan Haines is a dance science expert, bringing the latest research in dance medicine directly into technique classes to prevent injury and build dancer specific strength. Susan works with the causes of dysfunctional movement in the motor control center with NeuroKinetic Therapy. She created Dance Conditioning Technique to bridge research in neuroscience and fascia into dance training. She is the Director of Dance at Western Washington University and has presented her research at conferences nationwide. She has studied fascial movement patterning and taping and holds certifications in NKT, NCPT Pilates, Yoga, FRC,  FMT Mobility Specialist, and IASTM. Dancer specific training available at www.danceconditioningtechnique.com  @danceconditioningtechnique