The Nocebo in Social Work – what can the COVID vaccine trials tell us about social work practice?

In the COVID Vaccine trails boffins at Oxford gathered 40,000 people (80,0000 arms) and split them into two groups.

One would get the vaccine jab and the other a harmless placebo.

The placebo is used in what is know as a “double blind” trial as it provides the gold standard to set the vaccine against. The placebo has a measurable positive effect that is well established in the scientific literature.

This effect is not caused by the material in the placebo jab but from the psychological expectation of a positive change.  A great example in the literature is knee operations. It was shown that just going through surgery cutting into the knee and doing nothing reduced patients pain and increased mobility (amazing!)

The Placebo has an evil twin the Nocebo. This is where despite a treatment being benign (chemically and medically) there are negative impacts psychologically which cause measurable side effects like nausea, stomach pains, itching, bloating, depression, sleep problems, loss of appetite, sexual dysfunction and severe low blood pressure.

(An interesting side thought is how would anti-vaxers be impacted by the vaccine given their world view is dead set against it, their mind might cause more damage than the vaccine prevents?)

What does this all mean to social work.

I wonder that given we know as social workers that families are often fearful, sceptical and resistance to intervention or change it is possible that our intervention may cause harmful effects, due to the dread and lack of belief.

Example: A mother who is worrying and not sleeping prior to a social work visit, her body physically and mentally braced for a “punch” from a social work Tyson Fury.  Her fight or flight mode (driven by her amygdala) is switched on, her capacity for learning (controlled by her frontal cortex) is switched off, and the body is anxious, inflamed and worn out.

In this scenario the over all impact on the mother health physical and mental may very well be negative, even if the social worker has read every word of Carl Rogers, Community Care magazine and their lecture notes.

How can we beat the NOCEBO. The answer is in its twin the placebo – the power of positivity.

As social workers we have to be the most positive and hopeful person in the room. We have to ‘defrost’ problems and open up a new path for families.

In short, if we don’t feel enthused, or don’t feel confident in the effectiveness of our models’ the families certainly wont. And given their worries about our intervention we may be doing harm. I feel this may be particularly true in cases where there has been repeated failed interventions over the year, as why would you have positive expectations of your 5th Single assessment?

Food for thought.

George Bull

George is a Social Worker at the Connected Carers Team South Tyneside. He has been a social worker for 10 years working mainly in child protection and Early Help. He has lectured with Jamie Scorer at New College Durham, University of Sunderland and University of Northumbria in solution focused practice.

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