Understanding placebo, nocebo, and iatrogenic treatment effects

Richard R. Bootzin, Elaine T. Bailey

Research output: Contribution to journalReview articlepeer-review

73 Scopus citations


Placebo and nonplacebo treatments have both positive and negative effects on patient outcomes. To better understand the patterning of treatment effects, three specific interventions will be discussed that are reported to produce more harm than benefit: critical incident stress debriefing, group therapy for adolescents with conduct disorders, and psychotherapy for dissociative identity disorder. In each case, there is an interaction between mechanisms thought to underlie both placebo and specific treatment effects. Mechanisms hypothesized to underlie placebo and nocebo effects include patient expectancy, self-focused attention to symptoms, motivation to change, and sociocultural role-enactment cues. In the three treatments discussed, specific mechanisms interact with nonspecific mechanisms to produce iatrogenic effects. To advance knowledge, it is important both to specify the theory of treatment and its expected outcomes and to put the theory to test. Only with attention to the empirical findings from programmatic research of specific and nonspecific effects and their interaction is it possible to improve the outcomes of treatment beyond the status quo.

Original languageEnglish (US)
Pages (from-to)871-880
Number of pages10
JournalJournal of Clinical Psychology
Issue number7
StatePublished - Jul 2005


  • Iatrogenic effects
  • Nocebo
  • Placebo
  • Specific and nonspecific effects

ASJC Scopus subject areas

  • Clinical Psychology
  • Arts and Humanities (miscellaneous)


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