Nocebo Education to Reduce the Potential Unintended Harms of Mental Health Awareness

Rates of mental health problems have risen dramatically in North America and around the world. The high rates of mental health problems led to more mental health awareness efforts on university campuses, in the workplaces, and online. These efforts have greatly destigmatised mental health and increased help seeking across all ages, but may also induce the nocebo effect: it may create negative expectations about one's mental health status and thus paradoxically worsen the very symptoms they try to prevent. Nocebo effect is well known to cause various negative outcomes in medicine, such as worse medication side effects. For instance, when the person takes the drug, she can have negative expectations about having side effects and experience them due to misinterpreting normal but ambiguous physical sensations as the relevant side effects. Mental health awareness campaigns may follow the same pattern: they may reframe normal difficulties that are typical of emerging adulthood as early symptoms of psychiatric disorders, thus exacerbating mental health concerns. Experts are now calling for more balanced approaches to mental health awareness that provide necessary information without causing unintended harms.

This will be a randomized controlled trial designed to evaluate whether mental health awareness induces worsening of symptoms (unintended harms) and whether nocebo education can reduce or inoculate against these. Participants in this study will be recruited from the University of Toronto community and complete the study in small to medium sized groups.

Groups of participants will be assigned to one of the three conditions using block randomisation (in a 1:1:1 ratio). The three conditions will include two experimental conditions and an active control: ADHD information workshop, ADHD information with nocebo education workshop, or a control sleep education workshop. Participants will report their ADHD symptoms and rates of self-diagnosis prior to participating in the workshop, immediately after (self-diagnosis), and at one-week follow-up (both).

Inclusion criteria

• No existing diagnosis of ADHD, or history/current diagnosis of any other neurological/psychiatric disorder.
• Score below 18 on the Adult ADHD Self-Reported Symptom (ASRS) Checklist Screener.
• No current intake of medication to treat a psychiatric disorder (e.g., antidepressants)
• Fluent in English;
• Access to a computer, tablet, or smartphone with internet capability;
• Normal or corrected-to-normal vision and hearing.

Exclusion criteria

• Diagnosis of ADHD or any other neurological/psychiatric disorder.
• Active intake of medication.