Latent Inhibition Reduces Nocebo Nausea, Even Without Deception
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ORIGINAL ARTICLE
Latent Inhibition Reduces Nocebo Nausea, Even Without Deception V. F. Quinn, PhD 1 & E. J. Livesey, PhD 1 & B. Colagiuri, PhD 1
# The Society of Behavioral Medicine 2016
Abstract Background Nocebo nausea is a debilitating and prevalent side effect that can develop after conditioning occurs between cues present in the treatment context and the experience of nausea. Interventions that retard conditioning may therefore be able to reduce nocebo nausea. Purpose To test whether ‘latent inhibition’, where preexposing cues in the absence of an outcome retards subsequent learning about those cues, could reduce nocebo nausea in healthy adults. Methods We examined this possibility using a Galvanic Vestibular Stimulation (GVS) model of nausea in healthy participants, with pre-exposure to the treatment cues achieved using a placebo version of GVS. Results In Experiment 1 we found clear evidence of conditioned nocebo nausea that was eradicated by latent inhibition following pre-exposure to placebo stimulation. Experiment 2 tested whether deception, which may be unethical in clinical settings, was necessary to produce latent inhibition by including an open pre-exposure group informed they were preexposed to placebo stimulation. Experiment 2 replicated the latent inhibition effect on nocebo nausea following deceptive pre-exposure from Experiment 1 and found that open preexposure was just as effective for reducing nocebo nausea. In both experiments, there was an interesting discrepancy found in expectancy ratings whereby expectations appeared to drive the development of conditioned nocebo nausea, but
* V. F. Quinn [email protected]
1
School of Psychology, A18, The University of Sydney, Sydney, NSW 2006, Australia
were not responsible for its suppression through latent inhibition. Conclusions These findings have significant clinical implications. Applying open pre-exposure in clinical settings may effectively and ethically reduce the development of nocebo effects for nausea and other conditions via latent inhibition. Keywords Placebo . Nocebo . Nausea . Conditioning . Latent inhibition
Introduction Nausea is a pervasive problem in both clinical (e.g. chemotherapy and anaesthesia) and non-clinical settings (e.g. aviation and maritime). In its extreme, it impairs quality of life [1–3] and can lead to malnutrition and food aversions [4]. Even in its moderate form, it is inherently unpleasant and can interfere with daily functioning. Importantly, evidence indicates that non-pharmacological factors can significantly contribute to nausea via the nocebo effect (see [5, 6] for reviews). Yet, there have been surprisingly few attempts to date to develop interventions to reduce nocebo nausea. The nocebo effect is when treatment cues, in and of themselves, lead to adverse outcomes, and has been used to explain why so-called non-specific side effects occur in many patients, i.e. adverse effects which are not a direct result of the pharmacological action of a drug [7]. Classical conditioning is a key source of th
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