Understanding the nocebo effect in anxiety
Discover how the nocebo effect contributes to health anxiety and physical symptoms. Learn how evidence-based therapy like CBT and ACT can help break the cycle.
If you're struggling with health anxiety or generalized anxiety, you've probably felt the physical symptoms that come with it—tightness in the chest, headaches, stomach discomfort, or pain. These are real symptoms— and they’re part of the brain-body feedback loop.
One powerful (and often overlooked) part of this loop is the nocebo effect. It’s the lesser-known counterpart to the placebo effect, and it shows how unhelpful thinking and anxiety can lead to real, measurable physical responses—even when there's no medical cause.
What Is the Placebo Effect?
The placebo effect refers to real symptom relief caused by positive expectations. It occurs when a person improves after receiving a treatment that has no active medical ingredients—like a sugar pill—because they believe it will work.
Research shows that the placebo effect can:
Trigger the brain to release endorphins (natural pain relievers)
Calm the nervous system
Improve sleep, pain, and mood
The takeaway? The power of positive expectation can improve both mental and physical well-being.
What Is the Nocebo Effect?
In contrast, the nocebo effect happens when negative expectations lead to real physical or emotional symptoms—even in the absence of any real threat.
Examples include:
Feeling dizzy or nauseated after being warned of side effects—even from a sugar pill
Experiencing tightness or pain after reading about medical conditions online
Interpreting a normal body sensation as dangerous, triggering anxiety and panic
This is especially relevant to those living with health anxiety, where hyper-awareness of bodily sensations and worst-case thinking can cause or intensify physical discomfort.
Placebo vs. Nocebo: Why It Matters for Anxiety
For people with anxiety, especially health anxiety, the nocebo effect creates a feedback loop:
You feel a mild symptom.
Your brain interprets it as dangerous.
Your body reacts with tension or panic.
The symptom worsens or multiplies—reinforcing the fear.
How Evidence-Based Therapy Interrupts the Nocebo Cycle
The good news? This cycle can be broken. Evidence-based therapy for anxiety is specifically designed to help you challenge the thoughts and behaviors that drive the nocebo effect.
✅ CBT for Anxiety and Health Anxiety
Cognitive Behavioral Therapy (CBT) helps you:
Identify distorted thinking (“This sensation means something is wrong”)
Challenge catastrophic thoughts with evidence
Reduce reassurance-seeking and compulsive symptom-checking
Rebuild a sense of safety in your body
CBT is one of the most researched and effective treatments for health anxiety and panic-related symptoms.
✅ ACT (Acceptance and Commitment Therapy)
ACT teaches you to:
Accept anxious thoughts without acting on them
“Unhook” from fear-driven mental stories
Focus on values and meaningful action instead of control and avoidance
This approach is ideal for clients who feel stuck in repetitive fear cycles.
Together, these therapies retrain your brain to respond differently to symptoms—and help you shift from fear to flexibility.
Why This Matters for Long-Term Healing
When you understand the role of the nocebo effect in anxiety, you gain a powerful insight: your brain isn't betraying you—it's trying to protect you. But sometimes it misreads signals and creates more distress in the process.
With the support of an evidence-based therapist, you can learn to:
Break the anxiety-symptom cycle
Trust your body again
Develop a more balanced and resilient mindset
Final Thoughts
The placebo vs. nocebo effect shows us just how deeply our expectations shape our experiences—especially when it comes to anxiety. Negative thinking can make symptoms worse, but that means positive, intentional thinking (supported by therapy) can lead to real relief.
If you’re tired of feeling stuck in your mind or body—and you’re ready for practical, research-backed tools to help—you don’t have to go it alone. I offer evidence-based therapy that’s grounded in compassion and science. Together, we can help you regain peace of mind and feel more at ease in your body.
Managing Holiday Stress
A lot of our stress around the holidays can come from the “shoulds” - unrealistic expectations of what holidays “should” feel like, how we should be feeling, what we should be doing. The word “should” is a type of cognitive distortion - an unhelpful thinking pattern which imposes unrealistic unrealistic expectations on ourselves or others. Cognitive distortions create a sense of guilt or frustration when those expectations aren't met. Remember that “perfect” isn’t possible. Some days are cloudy and come are sunny. If you’re like me, I imagine that you’ll have some frustrating moments over the holidays, and some nice ones. It’s a set up for disappointment if we expect our holidays to look and feel like a Pinterest board because that’s completely unrealistic.
The holidays are here! It’s the time to get cozy, see family, eat good food, hopefully get some time off work. But it’s also a time of high emotions, potential conflict, and lots of potential stressors. Remember, stress can be both positive and negative - it’s anything that challenges your body. Stress can help you prepare logistics for travel or get all your Christmas shopping done but it can also lead to feelings of frustration or irritability, anxiety or difficulty focussing. Stress can also lead to physiological changes in the body, like headaches, muscle tension, fatigue or or digestive issues.
A lot of our stress around the holidays can come from the “shoulds” - unrealistic expectations of what holidays “should” feel like, how we should be feeling, what we should be doing. The word “should” is a type of cognitive distortion - an unhelpful thinking pattern which imposes unrealistic unrealistic expectations on ourselves or others. Cognitive distortions create a sense of guilt or frustration when those expectations aren't met. Remember that “perfect” isn’t possible. Some days are cloudy and come are sunny. If you’re like me, I imagine that you’ll have some frustrating moments over the holidays, and some nice ones. It’s a set up for disappointment if we expect our holidays to look and feel like a Pinterest board. Recognizing our own tendency to compare to an unrealistic ideal, or remembering that most people are having at least some pain and disappointment can help us stay more balanced and realistic. Remember, the holidays are just a day like any others, we just imbue them with significantly more pressure.
Human beings are hardwired to compare ourselves to others - this is why social media is so addictive. We see commercials and movies with perfect families, and wish that our own families were less flawed. Or maybe we feel like our friends are all having better and more perfect holidays than we are. Maybe the holidays remind us of losses, or things that we wish were different. Remind yourself that there really is no such thing as a perfect family, or a perfect holiday. There will be ups and downs. In fact, in general research shows us that the majority of people experience a lot of stress and disappointment around the holidays.
The holidays can often be a trigger for anxiety, stress or even depression. It’s a perfect storm of family dynamics, lots of planning, financial stress etc. Because our stress may already be higher, it’s easy to tip over into irritability, frustration, or even sadness. Factor in a couple gingerbread martinis and we’re even more likely to become dysregulated. Luckily there are some things you can do to help stay as even keel as possible:
Breathe! Just remembering to slow down your breath can be really helpful. When you slow your breath your heart rate slows as well.
Set boundaries: make sure that you carve out time for yourself and your needs. You don’t need to apologize for this - just take it!
Especially if you normally exercise, try to keep it up as much as possible. Movement is a great way to let off steam, reduce adrenaline, and generally manage stress better.
New Years Resolutions are a real set up for most people. We have a tendency to create unrealistic goals and then feel bad about ourselves once we don’t complete them. Try for the 80% rule with goal setting - if you’re not 80% sure that you can complete it, it’s probably not a good goal.
Happy Holidays!