The nocebo effect in psychotherapy.

The nocebo effect, negative treatment outcomes arising from patient expectations, therapeutic context, or clinician communication, plays a possibly significant yet often under-estimated role in psychotherapy. Drawing on recent empirical and theoretical contributions, possible mechanisms how nocebo effects occur and can be attenuated in psychotherapeutic practice are discussed. Nocebo effects may arise from therapist communication, previous treatment failures, adverse therapeutic dynamics, poorly managed expectations, social influences outside the therapy, or context-factor elements such as waiting lists. Strategies for mitigating such effects include, for example, empathic engagement, expectation management, and reconditioning of previous negative treatment experiences in clinical settings.