Sunday, April 03, 2011

Placebo effect and Nocebo effect: how could this impact your fertility?

Can what you believe about your treatment have an effect on its outcome? Sounds strange but more and more studies are showing this could be true. Your expectations may actually influence the result of your treatment.

You may have heard of the placebo response, where a person believes that something is good for them and it actually makes a difference physiologically in the body. For example someone is given a sugar pill instead of an antidepressant for example and they feel better because they believe the antidepressant is working for them (they weren't told they received the sugar pill). That is the placebo effect. But there is a less talked about response that I would also like to discuss. It is called the nocebo response.

The nocebo response is the exact opposite to the placebo response. And it could be significantly impacting your situation.

To understand the nocebo response and how it may impact your fertility let's first review a little bit more about the power of the placebo response, the opposite of the nocebo response. The placebo response refers to health benefits that are the result of something that should not have had any significant physiological response. It could be a pill or it could be a surgery, for example. One of the most amazing reports about the placebo response was referred to in a study on patients who had Parkinson's disease. The patients had brain surgery that was supposed to assist with decreasing the symptoms of Parkinson's disease. All of the patients had holes drilled in their skull, however some had the real treatment and some only had the hole drilled in their skull, no real treatment.

Based on perceived treatment, or treatment patients thought they received, there were numerous differences and changes over time. In all cases, those who thought they received the transplant reported better scores re symptoms whether they actually had the treatment or not. Arch Gen Psychiatry. 2004 Jun;61(6):627.

In other words, if they thought they had the treatment, whether they actually had it or not, they noticed significant improvement for at least a year later. It was the belief that they had the actual treatment that seemed to affect the results, not the actual treatment. Amazing!

Now the nocebo effect is just the opposite. When patients truly believe something will go wrong, there is more likely a chance that it will. For example, in one study, women who believed that they were prone to heart disease were nearly four times as likely to die as women with similar risk factors who didn't hold such beliefs.

"They're convinced that something is going to go wrong, and it's a self-fulfilling prophecy" said Arthur Barsky, a psychiatrist at Boston's Brigham and Women's Hospital who published an article in the Journal of the American Medical Association beseeching his peers to pay closer attention to the nocebo effect. "From a clinical point of view, this is by no means peripheral or irrelevant."

Dr. Bruce Lipton ( a research scientist and medical school lecturer has said this about the nocebo effect. "This is when a negative thought or belief is used to shape our biology. For example, if a professional person, a medical doctor or specialist, says you are going to die in three months and you believe him, then you may set this date into your perceptual clock, start to disentangle yourself from your life and actually die in three months.

Sound a bit crazy? Here's another example of the nocebo effect from an article written in the Washington Post in 2004.

Researchers at three medical centers undertook a study of aspirin and another blood thinner in heart patients and came up with an unexpected result that said little about the heart and much about the brain. At two locations, patients were warned of possible gastrointestinal problems, one of the most common side effects of repeated use of aspirin. At the other location, patients received no such caution.

When researchers reviewed the data, they found a striking result: Those warned about the gastrointestinal problems were almost three times as likely to have the side effect. Though the evidence of actual stomach damage such as ulcers was the same for all three groups, those with the most information about the prospect of minor problems were the most likely to experience the pain.

So what does this nocebo response have to do with your fertility?

Well what has the media, your doctor, your naturopath or anyone or anything you consult re your fertility issues say about your situation? What in the media have you heard that could be influencing your fertility? Or what have you heard from a prestigious person in your life that you have taken on as a belief for yourself about your fertility?

In my opinion this is such an important consideration for couples dealing with fertility issues because you are constantly bombarded by comments such as "your eggs are too old";"you don't have much time", "your only option is IVF", and many, many more. You are shown charts and graphs representing percentages that show a significant drop in fertility rates after 35. (which by the way are based on data more than 15 years old). You are told to hurry up or even asked why you waited so long.

Are you creating your own placebo or nocebo effect by taking on certain beliefs about your fertility?

Addressing these beliefs may significantly impact your fertility. For example, a small study of women who hadn't been ovulating received cognitive behavioral therapy and the results were that 80% of women in the study began to ovulate after receiving the therapy. Cognitive behavioral therapy works on your beliefs, your thoughts, your values, which in turn can help to decrease the stress on your body. So by addressing the way they were thinking they were actually able to affect their reproductive cycle.

What are you thinking about that is effecting your fertility? Do you focus on the percentage of people not getting pregnant or the percentage of people that do? Which group do you see yourself in?

Our Fertile Mind Fertile Body workshops and CD set help individuals or couples figure out whether they are contributing to a placebo or nocebo effect. You learn techniques about how to get off the emotional rollercoaster that is causing more stress in your life and get rid of beliefs that are not supporting you.

What can you do to become more congruent with the current path that you are on regarding your fertility to initiate a move towards optimising your fertility?

Our creation story this week is short and sweet.

A couple who had been on our herbs for 6 months decided to attend our workshop. After doing so they decided to concentrate on their emotional wellbeing and their relationship. She felt she was letting him down because she was the one with the diagnosis. Her partner let her know that he married her because he loved her not due to whether or not she could have children. Children, he said, would be a bonus. She believed him, and started to let go of all of the destructive emotions and beliefs she held and within 6 months of the workshop they were pregnant, even though she had PCOS and was told she would likely never become pregnant naturally. Now, from a natural pregnancy, they have a beautiful baby girl and have defied the odds according to their doctors.