675: When TikTok teaches pain: testing observationally induced nocebo effects and their temporal dynamics

Topic: Experimental (Non-clinical) Human Studies
Subtopic: Non -specific to any diagnosis, Psychology, Placebo/Nocebo

Background and Aims: Nocebo hyperalgesia, an increase in pain following an inert intervention, can be acquired through observational learning [1]. Previous studies demonstrate that symbolic modeling (observing a model in a video) induces nocebo hyperalgesia under laboratory conditions [2]. It remains unclear, however, whether similar responses can be triggered by social media, such as TikTok, which frequently spreads treatment-related expectancies, including negative ones [3]. Furthermore, the reversibility of observationally acquired nocebo effects through direct experience is largely unknown. This study aims to test TikTok-based induction of nocebo hyperalgesia, compare it with standard symbolic modeling, and examine modification of these effects by classical conditioning.

Methods: Participants are randomized to four groups: TikTok symbolic modeling, standard symbolic modeling, and two control. The experiment consists of four phases: Induction, Testing 1, Modification, and Testing 2. During Induction, experimental groups observe a model reporting higher pain with a placebo (TikTok-style or standard video), while control groups receive no manipulation. The placebo is a non-active TENS electrode. Testing 1 delivers moderate pain with and without a placebo. During Modification, lower pain is paired with a placebo in experimental groups and in one control group, while the other receives no intervention. Testing 2 repeats Testing 1.

Results: In Testing 1, no significant effects were observed for pain (all p⩾.727). Significant main effect of trial was found for expectancies [F(3, 57)=8.782, p=.004] : participants expected higher pain with placebo (M=4.57; SE=0.37) than without (M=3.52; SE=0.37). Trend towards significance was observed in symbolic modeling and control groups (both p=.08). In Testing 2, significant trial x group interaction emerged for pain ratings [F(3, 61)=3.247, p=.028]: participants in symbolic modeling group experienced higher pain with placebo (M=4.68; SE=0.4) than without (M=4.29; SE=0.39). No significant effects were found for expectancies in Testing 2 (all p⩾.38).

Conclusions: Observational learning did not induce nocebo hyperalgesia in Testing 1, although participants reported higher pain expectancies when the placebo device was allegedly activated. Following the Modification phase, nocebo hyperalgesia occurred in the symbolic modeling group in Testing 2, suggesting that its development may be delayed. Given the small pilot sample (N=64), further testing is needed to draw more precise conclusions. Data collection is ongoing, and final results will be presented at the conference.

References: [1] Bajcar, E. A., & Bąbel, P. (2024). Social Learning of Placebo Effects in Pain: A Critical Review of the Literature and a Proposed Revised Model. The Journal of Pain, 25(9), 104585. https://doi.org/10.1016/j.jpain.2024.104585

[2] Meeuwis, S. H., Wasylewski, M. T., Bajcar, E. A., Bieniek, H., Adamczyk, W. M., Honcharova, S., Di Nardo, M., Mazzoni, G., & Bąbel, P. (2023). Learning pain from others: A systematic review and meta-analysis of studies on placebo hypoalgesia and nocebo hyperalgesia induced by observational learning. Pain, 164(11), 2383–2396. https://doi.org/10.1097/j.pain.0000000000002943

[3] Olvera, C., Stebbins, G. T., Goetz, C. G., & Kompoliti, K. (2021). TikTok Tics: A Pandemic Within a Pandemic. Movement disorders clinical practice, 8(8), 1200–1205. https://doi.org/10.1002/mdc3.13316

Presenting Author: Daryna Rubanets
Submitting Author: Daryna Rubanets

Senior Author: Elżbieta A. Bajcar

IASP 2026 Global Year theme of Neuropathic Pain: No

• Izabela A. Łaska: MSc - Jagiellonian University, Institute of Psychology; Jagiellonian University, Doctoral School of Social Sciences
• Joanna Kłosowska: PhD - Jagiellonian University, Institute of Psychology
• Przemysław Bąbel: PhD - Jagiellonian University, Institute of Psychology