Nocebo effect: “the placebo effect’s evil twin”

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Dr Rebecca Webster, Durham University graduate and lecturer in Psychology at the University of Sheffield, has been recently recognised by Forbes 30 under 30 Science and Healthcare list for her research into the ‘nocebo’ effect and its relevance to health behaviours during the Covid-19 pandemic.

Durham graduate to Forbes success

When Webster found out that she had made the 30 under 30 list, she was in disbelief. “Of course, I am hugely honoured. I could not have done it without the support of my colleagues and supervisors who enabled this research to happen, so this achievement is a definite reflection of their hard work too.”

She explains how she came to be noticed by Forbes. “After the research I did at the beginning of the Covid-19 pandemic, my husband nominated me – although he didn’t tell me at the time – since he thought I would be a strong candidate.”

Webster met her husband, David, during her time at Durham, affirming the rumoured statistic that 70% of Durham graduates go on to marry a fellow alum. “I met him whilst I was on the Durham Divas Cheerleading Squad. He was a Durham Saints American footballer, and I a cheerleader – cliché I know!”

Before delving into the complexities of her research, Webster reminisces warmly about her days at Durham, from which she graduated in 2013.

“I had a fantastic three years at Durham and always look back on my time with fond memories. In particular the formals, sunny days by the river, and competing with the Durham Divas, where I was Vice Captain in my final year.

He was an American footballer, and I a cheerleader – cliché I know!

“It is such a picturesque place to study in, and kept me very fit having to walk up Cardiac Hill every week to lectures.”

It wasn’t until Webster’s third year at Durham that she discovered an interest in health psychology. She credits this to the breadth of the psychology course at the university: “It gives you exposure to so many parts of Psychology and really allowed me to find out what I was most passionate about.”

In pursuit of this newfound passion, Webster went on to complete an MSc in Health Psychology at King’s College London. “I had a fantastic year learning about all the research going on in the department, and in the field from guest lecturers, as well as running my own research project. It was at this point that I decided to pursue a career in academia. I went on to complete my PhD at KCL too.”

The nocebo effect

The core of Webster’s research is the ‘nocebo’ effect – which she terms “the placebo effect’s evil twin”. She further explains, “I research how negative expectations can contribute to the experience of medication side-effects and explore strategies to reduce nocebo effects whilst still upholding informed consent.”

“I have been working in the area of nocebo effects for 7 years now, since I started my PhD in 2014. This work actually came about as a result of the last pandemic (Swine flu), when people were reporting more side-effects to Tamiflu, the prophylaxis – a treatment taken to prevent a disease – than was expected from the clinical trial data. It was thought that the negative media coverage of Tamiflu was contributing to this.”

We led research into the psychological impacts of quarantine

Now, the word ‘pandemic’ has inescapable connotations with Covid-19. Webster’s research has been invaluable to the UK government in informing their pandemic response over the last couple of years. “My colleagues and I led research into the psychological impacts of quarantine and how to improve adherence to quarantine measures which the government were starting to bring into forced to stop Covid-19 transmission.”

“Although mainly researching within the area of nocebo effects, at the start of the pandemic I was working in the NIHR Health Protection Unit in Emergency Preparedness and Response. As a team we have expertise in conducting research to minimise the impact of emergencies.”

Almost two years on, Webster reflects on the extent of her achievements during the pandemic. “Summaries and published papers from my research were communicated in meetings with the Scientific Advisory Group for Emergencies and the Scientific Pandemic Insights Group on Behaviours.

“This informed the government on strategies to reduce psychological impacts and how to encourage adherence to the measures. This work received extensive international press coverage and was included as essential references in the WHO’s 2019 novel Coronavirus Research Roadmap.”

Next steps

Now, moving into the future, Webster is confident that her research will be vital if the world ever faces a similar public health crisis again. “At the time when we did the research we were just at the start of the pandemic, so no studies had been carried out in relation to quarantine and Covid-19.

“As such we used a systematic review method, drawing on studies that had been carried out in previous pandemics, epidemics, or infectious disease outbreaks in order to inform the current situation,” she continued.

I plan to investigate how the nocebo effect could contribute to the spread of information about side-effects to vaccinations

“Of course, now there have been many studies conducted which build on our findings and apply them to the Covid-19 pandemic. This will all help to inform public health strategies and minimise the impact of any future pandemics.”

Webster has recently started her first lectureship position at the University of Sheffield and is continuing her ongoing work on the nocebo effect. She says, “In particular I plan to investigate how the nocebo effect could contribute to the spread of information about side-effects to vaccinations via the media, as well as racial or ethnic disparities in health outcomes. I have also become interested in infectious illness presenteeism (going to work while sick with a cold or flu) – something which has gained increased attention as a result of Covid-19.”

Finally, Webster sets out her personal plan for the future. “Aside from building up my academic profile at Sheffield, on a more personal note, my wider goals include making the most of being back up North and closer to family after having lived in London for seven years.”

Covid-19 has, for the moment, made this endeavour difficult, but hopefully Webster’s research will continue to aid the UK government’s pandemic response and help us to move towards a safer future for all.

Image: Nathan Clarke Photography

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