Objectives: Placebo effects can relieve acute and chronic pain in both research and clinical treatments by learning mechanisms. However, the application of placebo-based treatment strategies in routine medical care is questioned. The current study investigated the opinions of patients with fibromyalgia and healthy controls regarding learning of placebo effects and their practical applications. Method: An online survey asked 158 age- and sex-matched adult patients and controls (79 per group) to rate the perceived influence of various placebo learning mechanisms on pain relief, and the acceptability and perceived effectiveness of placebo-based strategies (open-label, closed-label, dose-extending, and treatment-enhancing strategies). Respondents' knowledge about placebo effects was obtained through a 7-item quiz. Results: The groups did not differ in the perceived influence of placebo learning mechanisms on pain relief (p = 0.217). Controls considered closed-label and treatment-enhancing strategies more acceptable than patients (p = 0.003 and p < 0.001), whereas controls perceived all strategies more effective. In both groups, closed-label strategies were significantly less acceptable than any other strategy (p-values < 0.001), and treatment-enhancing or dose-extending strategies were most acceptable. Higher acceptability was predicted by higher perceived effectiveness ratings (p < 0.001). Also, increased placebo knowledge was related to higher acceptability (p = 0.03) and perceived effectiveness (p < 0.001). Discussion: This survey suggests that both the medical history of patients and knowledge about placebo effects affect the acceptability and perceived effectiveness of placebo-based strategies. Furthermore, strategies that are transparent, assumed effective, or combined with existing medical treatments are deemed most acceptable. Keeping these factors in mind is essential for the clinical implementation of placebo-based strategies in routine medical care.

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Background
To improve lifestyle guidance within cardiac rehabilitation (CR), a comprehensive understanding of the motivation and lifestyle-supporting needs of patients with cardiovascular disease (CVD) is required.

Objectives
This study's purpose is to evaluate patients’ lifestyle and their motivation, self-efficacy and social support for change when starting CR.

Methods
1782 CVD patients (69 % male, mean age 62 years) from 7 Dutch outpatient CR centers participated between 2020 and 2022. Modifiable risk factors were assessed with a survey and interviews by healthcare professionals during CR intake.

Results
Most patients exhibited an elevated risk in 3–4 domains. Elevated risks were most prominent in domains of (1) waist circumference and BMI (2) physical exercise (3) healthy foods intake and (4) sleep duration. Most patients chose to focus on increasing physical exercise, but about 20 % also wanted to focus on a healthy diet and/or decrease stress levels. Generally, motivation, self-efficacy and social support to reach new lifestyle goals were high. However, patients with an unfavorable risk profile had lower motivation and self-efficacy to work on lifestyle changes, while patients with lower social support had a higher chance to quit the program prematurely.

Conclusions
Our results underscore the need to begin CR with a comprehensive lifestyle assessment and highlight the importance of offering lifestyle interventions tailored to patients’ specific modifiable risk factors and lifestyle-supporting needs, targeting multiple lifestyle domains. Expanding the current scope of CR programs to address diverse patient needs and strengthening support may enhance motivation and adherence and lead to significant long-term benefits for cardiovascular health.@en

Background: Self-help eHealth interventions provide automated support to change health behaviors without any further human assistance. The main advantage of self-help eHealth interventions is that they have the potential to lower the workload of health care professionals. However, one disadvantage is that they generally have a lower uptake. Possibly, the absence of a relationship with a health care professional (referred to as the working alliance) could lead to negative expectations that hinder the uptake of self-help interventions. The Unified Theory of Acceptance and Use of Technology (UTAUT) identifies which expectations predict use intention. As there has been no previous research exploring how expectations affect the adoption of both self-help and human-supported eHealth interventions, this study is the first to investigate the impact of expectations on the uptake of both kinds of eHealth interventions. Objective: This study investigated the intention to use a self-help eHealth intervention compared to a human-supported eHealth intervention and the expectations that moderate this relationship. Methods: A total of 146 participants were randomly assigned to 1 of 2 conditions (human-supported or self-help eHealth interventions). Participants evaluated screenshots of a human-supported or self-help app–based stress intervention. We measured intention to use the intervention-expected working alliance and the UTAUT constructs: performance expectancy, effort expectancy, and social influence. Results: Use intention did not differ significantly between the 2 conditions (t ₁₄₂=–1.133; P=.26). Performance expectancy (F _1,140=69.269; P<.001), effort expectancy (F _1,140=3.961; P=.049), social influence (F _1,140=90.025; P<.001), and expected working alliance (F _1,140=26.435; P<.001) were positively related to use intention regardless of condition. The interaction analysis showed that performance expectancy (F _1,140=4.363; P=.04) and effort expectancy (F _1,140=4.102; P=.045) more strongly influenced use intention in the self-help condition compared to the human-supported condition. Conclusions: As we found no difference in use intention, our results suggest that we could expect an equal uptake of self-help eHealth interventions and human-supported ones. However, attention should be paid to people who have doubts about the intervention’s helpfulness or ease of use. For those people, providing additional human support would be beneficial to ensure uptake. Screening user expectations could help health care professionals optimize self-help eHealth intervention uptake in practice. Trial Registration: OSF Registries osf.io/n47cz; https://osf.io/n47cz

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Aims
Cardiac rehabilitation (CR) shows lower effectiveness and higher dropouts among people with a low socioeconomic position (SEP) compared to those with a high SEP. This study evaluated an eHealth intervention aimed at supporting patients with a low SEP during their waiting period preceding CR.

Methods and results
Participants with a low SEP in their waiting period before CR were randomized into an intervention group, receiving guidance videos, patient narratives, and practical tips, or into a control group. We evaluated adherence (usage metrics), acceptance (modified Usefulness, Satisfaction, and Ease of use questionnaire), and changes in feelings of certainty and guidance between the waiting period’s start and end. Semi-structured interviews provided complementary insights. The study involved 41 participants [median interquartile range (IQR) age 62 (14) years; 33 males], with 21 participants allocated to the intervention group, using the eHealth intervention for a median (IQR) duration of 16 (10) days, using it on a median (IQR) of 100% (25) of these days, and viewing 88% of the available messages. Key adherence themes were daily routine compatibility and curiosity. Acceptance rates were 86% for usability, 67% for satisfaction, and 43% for usefulness. No significant effects on certainty and guidance were observed, but qualitative data suggested that the intervention helped to inform and set expectations.

Conclusion
The study found the eHealth intervention feasible for cardiac patients with a low SEP, with good adherence, usability, and satisfaction. However, it showed no effect on feelings of certainty and guidance. Through further optimization of its content, the intervention holds promise to improve emotional resilience during the waiting period.

Registration
This trial is registered as follows: ‘Evaluation of a Preparatory eHealth Intervention to Support Cardiac Patients During Their Waiting Period (PReCARE)’ at ClinicalTrials.gov (NCT05698121).@en

Somatic symptoms like pain, itch, and fatigue, can negatively affect daily functioning. In the acute phase, these somatic symptoms are adaptive as they push the body to protect itself from potential bodily threat. However, when these symptoms turn chronic, they may instead cause disability. Pain, itch, and fatigue have been shown to share mechanisms that maintain them towards chronicity and they commonly occur in various medical conditions. For example, pain and fatigue are common co-occurring symptoms in patients with multiple sclerosis, cancer, chronic low back pain, fibromyalgia, and functional neurological disorders (e.g., Eccles and Davies, 2021; Maggio et al., 2020; Mense and Schiltenwolf, 2010; Petersen et al., 2020) and symptoms of itch, pain, and fatigue are often reported in patients with chronic skin diseases and other chronic conditions, such as some forms of cancer or kidney disease (e.g., Verhoeven et al., 2007). Additionally, each of these symptoms have a high prevalence rate (Dahlhamer et al., 2018, Lim et al., 2020, Weisshaar, 2016) and share the same evolutionary function; to protect the body from disease and harm (Boullosa and Nakamura, 2013, Cevikbas and Lerner, 2020, Walters and Williams, 2019). Furthermore, chronic pain, itch, and fatigue cause similar burden to those that experience them. These chronic symptoms can also limit productivity and interfere with daily activities which have been shown to lower quality of life (Cole et al., 2021, Gerbershagen et al., 2002, Van Heck and de Vries, 2002). Moreover, the stigma that may be associated with these symptoms could also contribute to low quality of life (Froehlich et al., 2022, Perugino et al., 2022, Warlich et al., 2015). [...]@en

[...] Psoriasis is associated with a number of comorbidities of which some can be positively influenced by lifestyle changes. It is also known that dietary and relaxation interventions could be promising in improving psoriasis severity and the quality of life of patients with psoriasis. Knowledge on the motivation of psoriasis patients to change lifestyle and on differences in lifestyles of motivated versus unmotivated patients is essential for the development of targeted lifestyle interventions. However, evidence on this topic is scarce. Therefore, we (1) assessed the motivation of psoriasis patients to change their lifestyle and which lifestyle domains they are most willing to adapt, (2) assessed their current lifestyle in six lifestyle domains (physical activity, smoking, alcohol, diet, stress and sleep) and (3) compared the lifestyle of patients who are motivated with patients who are unmotivated or uncertain to change their lifestyle. [...]@en

Medication regimens using conditioning via variable reinforcement have shown similar or improved therapeutic effects as full pharmacological treatment, but evidence in patient populations is scarce. This proof-of-principle double-blind randomized clinical trial examined whether treatment effects in recent-onset rheumatoid arthritis (RA) can be optimized through pharmacological conditioning. After four months of standardized treatment (n = 46), patients in clinical remission (n = 19) were randomized to the Control group (C), continuing standardized treatment (n = 8), or the Pharmacological Conditioning (PC) group, receiving variable treatment according to conditioning principles (n = 11). After eight months, treatment was tapered and discontinued linearly (C) or variably (PC). Standard treatment led to large improvements in disease activity and HRQoL in both groups. The groups did not differ in the percentage of drug-free clinical remission obtained after conditioning or continued standard treatment. The PC group did show a larger decrease in self-reported disease activity (Cohen’s d = 0.9) and a smaller increase in TNF-α levels (Cohen’s d = 0.7) than the C group. During all phases, more differences between groups were found for the patients who followed protocol than for the intention-to-treat sample. Although the results are not conclusive, pharmacological conditioning may have some advantages in terms of disease progression and stability, especially during the conditioning phase, compared with standard clinical treatment. The effects may be particularly beneficial for patients who show a good initial response to increased medication dosages.@en

Stroke is a highly disabling condition, for which music therapy is regularly used in rehabilitation. One possible mechanism for the effects of music therapy is the motivational aspect of music, for example regarding treatment adherence based on improved mood. In this study, changes in motivation related to Neurologic Music Therapy (NMT) techniques during rehabilitation in the subacute phase after stroke will be investigated. Using a randomised within-subjects cross-over design, the effects of two NMT techniques and related motivational indices will be investigated. Data will be collected at three timepoints: baseline (TP1), after being randomised into groups and receiving NMT or standard care (TP2), and then at a third time point after the cross-over and having received both conditions (TP3). This design allows to counteract order effects, time effects due to spontaneous and/or nonlinear recovery, as well as single-subject comparisons in a relatively heterogeneous sample. Twenty adult participants who have experienced a supratentorial ischaemic or haemorrhagic stroke and are experiencing upper-limb impairments and/or cognitive deficits will be included. Behavioural measures of motor function, cognition, and quality of life will be collected, along with self-reported indices of overall motivation. The study outcomes will have implications for the understanding of the underlying mechanisms of music therapy in stroke recovery, more specifically regarding the relevance of motivational states in neurorehabilitation.@en

Objective
Communicating risk information and offering lifestyle advice are important goals in cardiac rehabilitation. However, the most effective way and the most effective source to communicate this information are not yet known. Therefore, we examined the effect of source (cardiologist, physiotherapist) and framing (gain, loss) of brief lifestyle advice on patients’ intention-to-change-lifestyle.

Methods
In an online experimental study, 636 cardiac patients (40% female, 67 (10) yrs.) were randomly assigned to one of four textual vignettes. Effect of source and framing on intention-to-change-lifestyle (assessed using a 5-point Likert scale) was analysed using analysis of covariance (ANCOVA).

Results
Patients expressed positive intention-to-change-lifestyle after receiving advice from the cardiologist (M = 4.1) and physiotherapist (M = 3.9). However, patients showed significantly higher intention-to-change-lifestyle after receiving advice from the cardiologist (0.58 [0.54–0.61]) when compared with the physiotherapist (0.52 [0.48–0.56]), (F[1,609] = 7.06, P = 0.01). Gain-framed and loss-framed advice appeared equally effective. However, communicating risks (loss) was remembered by only 9% of patients, whereas 89% remembered benefits (gain).

Conclusions
Our study shows the value of cardiologists and physiotherapists communicating brief lifestyle advice, as cardiac patients expressed positive intention for lifestyle change after receiving advice, irrespective of framing. Lifestyle advice should include benefits due to better recall.@en

Background: Financial incentives are a promising tool to help people increase their physical activity, but they are expensive to provide. Deposit contracts are a type of financial incentive in which participants pledge their own money. However, low uptake is a crucial obstacle to the large-scale implementation of deposit contracts. Therefore, we investigated whether (1) matching the deposit 1:1 (doubling what is deposited) and (2) allowing for customizable deposit amounts increased the uptake and short term effectiveness of a deposit contract for physical activity. Methods: In this randomized controlled trial, 137 healthy students (age M = 21.6 years) downloaded a smartphone app that provided them with a tailored step goal and then randomized them to one of four experimental conditions. The deposit contract required either a €10 fixed deposit or a customizable deposit with any amount between €1 and €20 upfront. Furthermore, the deposit was either not matched or 1:1 matched (doubled) with a reward provided by the experiment. During 20 intervention days, daily feedback on goal progress and incentive earnings was provided by the app. We investigated effects on the uptake (measured as agreeing to participate and paying the deposit) and effectiveness of behavioral adoption (measured as participant days goal achieved). Findings: Overall, the uptake of deposit contracts was 83.2%, and participants (n = 113) achieved 14.9 out of 20 daily step goals. A binary logistic regression showed that uptake odds were 4.08 times higher when a deposit was matched (p = .010) compared to when it was not matched. Furthermore, uptake odds were 3.53 times higher when a deposit was customizable (p = .022) compared to when it was fixed. Two-way ANCOVA showed that matching (p = .752) and customization (p = .143) did not impact intervention effectiveness. However, we did find a marginally significant interaction effect of deposit matching X deposit customization (p = .063, ηp2 = 0.032). Customization decreased effectiveness when deposits were not matched (p = .033, ηp2 = 0.089), but had no effect when deposits were matched (p = .776, ηp2 = 0.001). Conclusions: We provide the first experimental evidence that both matching and customization increase the uptake of a deposit contract for physical activity. We recommend considering both matching and customization to overcome lack of uptake, with a preference for customization since matching a deposit imposes significant additional costs. However, since we found indications that customizable deposits might reduce effectiveness (when the deposits are not matched), we urge for more research on the effectiveness of customizable deposit contracts. Finally, future research should investigate which participant characteristics are predictive of deposit contract uptake and effectiveness. Pre-registration: OSF Registries, https://osf.io/cgq48.

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Objective: Expectancies are known to shape pain experiences, but it remains unclear how different types of expectancies contribute to daily pain fluctuations in fibromyalgia. This combined experimental and diary study aims to provide insights into how experimentally-derived nocebo hyperalgesia and other, diary-derived, expectancy-related factors are associated with each other and with daily pain in fibromyalgia. Methods: Forty-one female patients with fibromyalgia first participated in a lab procedure measuring nocebo hyperalgesia magnitude, then filled out an electronic diary 3 times a day over 3 weeks regarding the expectancy-related factors of pain expectancy, anxiety, optimism, and pain-catastrophizing thoughts, and current pain intensity. Results: Our results indicate that experimentally-induced nocebo hyperalgesia was not significantly related to diary-assessed expectancy-related factors and did not predict daily fibromyalgia pain. Higher levels of the self-reported expectancy-related factors pain expectancy and pain catastrophizing, but not anxiety and optimism, predicted moment-to-moment pain increases in fibromyalgia, after controlling for current pain, moment-of-day and all other expectancy-related factors. Conclusion: Our exploratory research findings indicate that self-reported expectancy-related factors, particularly pain expectancy and pain catastrophizing, are potentially more relevant for predicting daily pain experience than experimentally-induced nocebo hyperalgesia. Further translation of nocebo hyperalgesia is needed from experimental to Ecological Momentary Assessment research. Our findings imply that targeting the decrease in pain expectancy and catastrophizing thoughts e.g., via Cognitive Behavioral Therapy, have potential for improving daily pain levels in fibromyalgia.

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In this article we describe how designers can apply storytelling to reduce health-related stigmas. Stigma is a pervasive problem for people with illnesses, such as obesity, and it can persistently hinder coping, treatment, recovery, and prevention. Reducing health-related stigma is complex because it is multi-layered and self-perpetuating, leading to intertwined vicious circles. Interactive storytelling environments can break these vicious circles by delimiting the narrative freedom of stigma actors. We theoretically explain the potential of interactive storytelling environments to reduce stigma through the following seven functions: 1) expose participants to other perspectives, 2) provide a protective frame, 3) intervene in daily conversations, 4) persuade all stigma actors, 5) exchange alternative understandings, 6) elicit understanding and support for stigma victims, and 7) support stigma victims to cope with stigmatization. We elaborate on these functions through a demonstration of an interactive storytelling environment against weight stigma. In conclusion, this article is a call on designers for health and wellbeing, scientists, and practitioners from various disciplines to be sensitive to the pervasiveness of stigma and to collaboratively create destigmatizing storytelling environments.@en

Negative expectations can increase pain sensitivity, leading to nocebo hyperalgesia. However, the physiological and psychological factors that predispose individuals to this phenomenon are still not well understood. The present study examined whether stress induced by a social stressor affects nocebo hyperalgesia, and whether this effect is mediated by self-reported and physiological stress responses. We recruited 52 healthy participants (15 men) who were randomly assigned to either the Trier Social Stress Test (TSST) or a control condition (a friendly version of the TSST). Nocebo hyperalgesia was induced using negative suggestions combined with a validated pain conditioning paradigm. We assessed self-reported (anxiety and stress) and physiological (cortisol, alpha-amylase, heart rate, and skin conductance) responses to stress. Both groups exhibited significant nocebo hyperalgesia. The stress group showed higher levels of anxiety, self-reported stress, and cortisol levels compared to the control group while no significant differences were found in other physiological markers. The stress and control groups did not differ in the magnitude of nocebo hyperalgesia, but anxiety levels partially mediated the effects of the stress test on nocebo hyperalgesia. Our findings suggest that an external social stressor does not directly affect nocebo hyperalgesia, but that increased anxiety due to the stressor enhances its magnitude. Thus, it may be worthwhile to investigate whether reducing stress-related anxiety in clinical settings would help alleviate nocebo effects.@en

eHealth lifestyle interventions without human support (self-help interventions) are generally less effective, as they suffer from lower adherence levels. To solve this, we investigated whether (1) using a text-based conversational agent (TCA) and applying human cues contribute to a working alliance with the TCA, and whether (2) adding human cues and establishing a positive working alliance increase intervention adherence. Participants (N = 121) followed a TCA-supported app-based physical activity intervention. We manipulated two types of human cues: visual (ie, message appearance) and relational (ie, message content). We employed a 2 (visual cues: yes, no) x 2 (relational cues: yes, no) between-subjects design, resulting in four experimental groups: (1) visual and relational cues, (2) visual cues only, (3) relational cues only, or (4) no human cues. We measured the working alliance with the Working Alliance Inventory Short Revised form and intervention adherence as the number of days participants responded to the TCA's messages. Contrary to expectations, the working alliance was unaffected by using human cues. Working alliance was positively related to adherence (t(78) = 3.606, p = .001). Furthermore, groups who received visual cues showed lower adherence levels compared to those who received relational cues only or no cues (U = 1140.5, z = −3.520, p < .001). We replicated the finding that establishing a working alliance contributes to intervention adherence, independently of the use of human cues in a TCA. However, we were unable to show that adding human cues impacted the working alliance and increased adherence. The results indicate that adding visual cues to a TCA may even negatively affect adherence, possibly because it may create confusion concerning the true nature of the coach, which may prompt unrealistic expectations.@en

Background: Gamification and deposit contracts (a financial incentive in which participants pledge their own money) can enhance effectiveness of mobile behavior change interventions. However, to assess their potential for improving population health, research should investigate implementation of gamified deposit contracts outside the research setting. Therefore, we analyzed data from StepBet, a smartphone application originally developed by WayBetter, Inc. Objective: To perform a naturalistic evaluation of StepBet gamified deposit contracts, for whom they work best, and under which conditions they are most effective to help increase physical activity. Methods: WayBetter provided data of StepBet participants that participated in a stepcount challenge between 2015 and 2020 (N = 72,974). StepBet challenges were offered on the StepBet smartphone application. The modal challenge consisted of a $40 deposit made prior to a 6-week challenge period during which participants needed to reach daily and weekly step goals in order to regain their deposit. Participants who met their goals also received additional earnings which were paid out from the money lost by those who failed their challenge. Challenge step goals were tailored on a 90-day historic step count retrieval that was also used as the baseline comparison for this study. Primary outcomes were increase in step count (continuous) and challenge success (dichotomous). Results: Overall, average daily step counts increased by 31.2 % (2423 steps, SD = 3462) from 7774 steps (SD = 3112) at baseline to 10,197 steps (SD = 4162) during the challenge. The average challenge success rate was 73 %. Those who succeeded in their challenge (n = 53,281) increased their step count by 44.0 % (3465 steps, SD = 3013), while those who failed their challenge (n = 19,693) decreased their step count by −5.3 % (−398 steps, SD = 3013). Challenges started as a New Year's resolution were slightly more successful (77.7 %) than those started during the rest of the year (72.6 %). Discussion: In a real-world setting, and among a large and diverse sample, participating in a gamified deposit contract challenge was associated with a large increase in step counts. A majority of challenges were successful and succeeding in a challenge was associated with a large and clinically relevant increase in step counts. Based on these findings, we recommend implementing gamified deposit contracts for physical activity where possible. An interesting avenue for future research is to explore possible setback effects among people who fail a challenge, and how setbacks can be mitigated. Pre-registration: Open Science Framework (doi:10.17605/OSF.IO/D237C).

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Background: eHealth interventions have the potential to enhance health outcomes for people with a low socioeconomic position (SEP), but lack of knowledge on how to effectively meet the specific needs of this population can limit their effectiveness and widen the digital divide. Our study aimed to address this issue by developing an online guide for professionals (e.g., researchers and health professionals) to support the development and adaptation of eHealth interventions for people with low SEP. Methods: During the initial phase, we conducted two studies: (1) a Delphi study with professionals, identifying barriers to developing, evaluating, and implementing eHealth interventions (top-down), and (2) a communitybased study with people from low SEP, exploring their perspectives on health, healthcare, and eHealth (bottom-up). In the second phase, an iterative participatory process was used to develop the online guide, involving 11 professionals in think-aloud sessions and interviews to assess content and design acceptance. The presentation focuses on outcomes of this second phase. Findings: Professionals found the online guide to be user-friendly and helpful, particularly the recommendations on barriers, facilitators, and user scenarios. However, they requested more practical examples and engaging content. Discussion: This guide is an important contribution to addressing the knowledge gap in eHealth interventions for people with a low SEP and provides valuable information for professionals, whether they are new to the field or have experience. Future research should focus on enhancing the guide's usability and flexibility for its diverse audience, including healthcare practitioners, and other eHealth professionals working with this population. @en

Aims: Implicit gender biases (IGBs) are unconscious evaluations about a person based on gender. IGBs of healthcare providers may affect medical decision making. This study investigated whether IGBs and genders of patients and general practitioners (GPs) influence diagnostics and treatment decisions in the context of diabetes type 2. Methods: Ninety-nine GPs participated in this randomized online study. Implicit Associations Tasks were used to measure two IGBs, related to lifestyle (women have a healthier lifestyle than men) and communication (men are less communicative than women). Clinical decisions regarding type 2 diabetes were measured with vignettes that included a fictional male or female patient case. Results: Female GPs exhibited a significant lifestyle IGB (p < 0.001). GPs of both genders exhibited a significant communication IGB (p < 0.001). Several associations between IGBs and clinical decisions were found. The gender of the vignette character affected several outcomes, for example GPs were less certain in the diabetes diagnosis when the character was a woman (p < 0.001). Conclusion: We demonstrated that GPs have IGBs and these biases as well as patient's gender affect decisions of GP's when they are solving a diabetes vignette case. Future research is needed to understand the most important consequences of IGBs in the context of type 2 diabetes.

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Nocebo effects on pain are widely thought to be driven by negative expectations. This suggests that anticipatory processing, or some other form of top-down cognitive activity prior to the experience of pain, takes place to form sensory-augmenting expectations. However, little is known about the neural markers of anticipatory processing for nocebo effects. In this event-related potential study on healthy participants (n = 42), we tested whether anticipatory processing for classically conditioned nocebo-augmented pain differed from pain without nocebo augmentation using stimulus preceding negativity (SPN), and Granger Causality (GC). SPN is a slow-wave ERP component thought to measure top-down processing, and GC is a multivariate time series analysis used to measure functional connectivity between brain regions. Fear of pain was assessed with the Fear of Pain Questionnaire-III and tested for correlation with SPN and GC metrics. We found evidence that both anticipatory processing measured with SPN and functional connectivity from frontal to temporoparietal brain regions measured with GC were increased for nocebo pain stimuli relative to control pain stimuli. Other GC node pairs did not yield significant effects, and a lag in the timing of nocebo pain stimuli limited interpretation of the results. No correlations with trait fear of pain measured after the conditioning procedure were detected, indicating that while differences in neural activity could be detected between the anticipation of nocebo and control pain trials, they likely were not related to fear. These results highlight the role that top-down processes play in augmenting sensory perception based on negative expectations before sensation occurs.

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Correction to: Scientific Reports, published online 27 September 2022 The original version of this Article contained errors in the dataset, where one participant was incorrectly labelled as Western immigrant and should have been labelled as Native Dutch. Another participant was incorrectly labelled as Western immigrant and should have been labelled as Non-Western immigrant. As a result, in the Abstract, “Anxiety was not influenced by empathy or information (Stai-state: p = 0.295; p = 0.390, VAS p = 0.399; p = 0.823).” now reads: “Anxiety was not influenced by empathy or information (Stai-state: p = 0.281; p = 0.410, VAS p = 0.387; p = 0.838).” In addition, in the Results section, under the subheading ‘Main and interaction effects of nocebo information and empathy’, under the subheading “Nocebo information”, “As demonstrated in Table 4, in controlled models the nocebo explanation did not influence APs’ anxiety levels (Stai-state: p = 0.390, VAS p = 0.823), or their feelings of satisfaction, trust, and self-efficacy (p > 0.05).” now reads: “As demonstrated in Table 4, in controlled models the nocebo explanation did not influence APs’ anxiety levels (Stai-state: p = 0.410, VAS p = 0.838), or their feelings of satisfaction, trust, and self-efficacy (p > 0.05).” Also in the Results section, under the subheading ‘Main and interaction effects of nocebo information and empathy’, under the subheading “Empathy”, “As demonstrated in Table 4, in controlled models reassurance of continuing support did not influence anxiety levels (Stai-state: p = 0.295, VAS p = 0.399) but did increase feelings of satisfaction, trust, and self-efficacy (p < 0.001).” now reads: “As demonstrated in Table 4, in controlled models reassurance of continuing support did not influence anxiety levels (Stai-state: p = 0.281, VAS p = 0.387) but did increase feelings of satisfaction, trust, and self-efficacy (p < 0.001).” Table 3 contained errors in mean (SD) values for “Migrant background,” “Native Dutch,” “Western immigrant,” “Non-Western immigrant”. Incorrect: (Table presented.) Variables Information−Empathy− N = 43 Information+Empathy+ N = 42 Total N = 160 Mean (SD) Mean (SD) Mean (SD) F (df); (p) Migrant background (Fisher Exact) p = 0.76 Native Dutch 38 (88.4) 33 (78.6) 129 (80.6) Western immigrant 3 (7.0) 5 (11.9) 16 (10.0) Non-Western immigrant 2 (4.7) 4 (9.5) 15 (9.4) Correct: (Table presented.) Variables Information−Empathy− N = 43 Information+Empathy+ N = 42 Total N = 160 Mean (SD) Mean (SD) Mean (SD) F (df); (p) Migrant background (Fisher Exact) p = 0.80 Native Dutch 38 (88.4) 34 (81.0) 130 (81.3) Western immigrant 2 (4.7) 4 (9.5) 14 (8.8) Non-Western immigrant 3 (7.0) 4 (9.5) 16 (10.0) Table 4 contained errors for the “Western migrant vs native Dutch” and “non-Western migrant vs native Dutch”. Adjustments have been made in Table 4. The original Table 4 and accompanying legend appear below. (Table presented.) Main and interaction effects of nocebo information and empathy. Model 1—uncontrolled main effects (+ interaction effect if significant) Nocebo information Empathy Nocebo information × Empathy B p B p B p Anxiety (Stai_state) 0.09 0.260 − 0.03 0.694 Anxiety (VAS) 0.05 0.575 − 0.02 0.816 Probability of specific − 0.06 0.420 − 0.25 Intensity of specific 0.05 0.516 − 0.24 Coping of specific 0.20 0.011 0.03 0.680 0.20 Probability of non-specific − 0.02 0.765 − 0.16 Intensity of non-specific 0.05 0.531 − 0.20 Coping of non-specific 0.09 0.273 0.15 0.057 Probability of partial 0.06 0.426 − 0.17 Intensity of partial 0.09 0.289 − 0.19 Coping of partial 0.12 0.133 0.08 0.295 Satisfaction (VAS)^ − 0.06 0.462 0.26 Trust^ − 0.05 0.492 0.25 Self-efficacy − 0.08 0.324 0.32 Model 2—controlled main effects (+ interaction effect if significant) Nocebo information Empathy Nocebo information x Empathy Migrant background (Western migrant vs native Dutch) Migrant background (non-Western migrant vs native Dutch) Trait anxiety Treatment information need B p B p B p B p B p B p B p Anxiety (Stai_state) 0.06 0.390 − 0.8 0.295 0.13 0.065 − 0.06 0.385 − 0.46 0.01 0.941 Anxiety (VAS) 0.02 0.823 − 0.06 0.399 0.18 0.100 − 0.06 0.379 − 0.46 0.01 0.867 Probability of specific − 0.06 0.459 − 0.22 0.21 0.779 0.10 0.194 0.09 0.263 0.20 0.012 Intensity of specific 0.04 0.591 − 0.23 0.08 0.325 0.14 0.075 − 0.02 0.828 0.13 0.100 Coping of specific 0.20 0.05 0.537 0.19 0.03 0.667 − 0.13 0.109 − 0.14 0.065 0.16 Probability of non-specific − 0.02 0.760 − 0.13 0.092 0.03 0.729 0.19 0.20 0.09 0.256 Intensity of non-specific 0.03 0.669 − 0.19 0.11 0.158 0.30 0.15 0.054 0.03 0.715 Coping of non-specific 0.08 0.329 0.15 0.059 0.08 0.291 − 0.05 0.521 − 0.18 0.09 0.276 Probability of partial 0.07 0.404 − 0.14 0.082 − 0.003 0.968 0.17 0.08 0.319 0.18 Intensity of partial 0.07 0.339 − 0.17 0.10 0.203 0.21 0.07 0.370 0.14 0.069 Coping of partial 0.12 0.122 0.09 0.248 0.03 0.722 − 0.15 0.068 − 0.20 0.13 0.093 Satisfaction (VAS)^ − 0.04 0.612 0.30 − 0.07 0.365 − 0.02 0.781 0.02 0.807 0.21 Trust^ − 0.04 0.604 0.28 − 0.10 0.203 0.01 0.950 − 0.04 0.606 0.17 Self-efficacy − 0.07 0.336 0.33 − 0.04 0.642 0.07 0.387 − 0.03 0.667 0.08 0.316 Significant values are in [bold]. B = standardized beta *p < 0.01 **p < 0.05 (trend significance). Transformation of these negatively skewed variables did not alter the effects, so the non-transformed variables were maintained. The original Article has been corrected.

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