Words that Hurt: Identifying Modality-Specific Linguistic Triggers of the Nocebo Effect in Parents.

Summary

In pain psychology, the nocebo effect—the phenomenon where negative expectations lead to poorer outcomes—is well-established across various research protocols involving pain induction or measurement (Bagarić et al., 2022; Reicherts et al., 2016).

This effect is primarily triggered when a participant is conditioned, socially or experimentally, to anticipate pain (Bagarić et al., 2022).

While the clinical implications are vast—ranging from reduced medication adherence to increased anxiety—the "Ethical Paradox" remains; researchers must accurately describe painful stimuli to ensure informed consent without inadvertently triggering a nocebo response through the power of suggestion.

Despite the necessity of describing pain components (e.g., experimental manipulations) in Participant Information Sheets (PIS), there is currently no consensus on the specific language that should be used to minimize threat.

This research gap is particularly acute in paediatric research, where parents significantly influence a child’s perception and description of pain (Boerner et al., 2017).

This project expands upon previous work identifying "threat-value" in descriptions of von Frey hairs by including three other common induction modalities: pressure pain algometry, cold pressor, and thermal heat induction.

While a von Frey hair may feel like a "child’s hairbrush" or "spaghetti noodle," its visual appearance can trigger a naturally occurring nocebo response. Similarly, descriptions of "burning" heat or "aching" cold may evoke distinct anticipatory fears.

By conducting a systematic review and experimental evaluation across these three modalities, this study will investigate how specific terminology interacts with parental psychological traits, such as fear of their child’s pain and response to their child’s symptoms.

The ultimate goal is to move beyond modality-specific observations toward a generalised framework and "Language Toolkit" for paediatric pain research.

Objectives of the research:

1. To systematically review existing literature and current institutional PIS for paediatric pain research to identify the range of terminology used to describe mechanical (von Frey and algometry), thermal (heat), and cold (cold pressor) pain induction.
2. To identify and compare specific terminology within PIS for von Frey, cold pressor, and thermal induction tasks that significantly heightens parental "threat value" or nocebo expectations.
3. To investigate how parental fear of pain, anxiety sensitivity, and response to symptoms moderate the impact of specific PIS wording on the formation of nocebo expectations.
4. To synthesise findings from the systematic review and experimental data into a set of evidence-based guidelines for researchers, focusing on "neutral-descriptive" language that maintains ethical transparency without inducing unnecessary nocebo effects.

Methods to be used:

The first phase involves a systematic review of the literature to identify the diversity of language currently used in PIS for paediatric pain research [objective 1].

The second phase will evaluate how these identified terms influence parental expectations and nocebo responses [objective 2]. Participants (parents) will be presented with image-based stimuli showing the four pain induction/pain sensory tools in a laboratory context. Each image will be paired with different linguistic descriptions (e.g., describing a von Frey hair as a "medical filament" vs. “flexible nylon hair").

Participants will also complete a survey to evaluate their fear of pain, anxiety sensitivity and response to their child’s symptoms [objective 3]. Data from this questionnaire will be examined alongside performance on the experiment to determine if any of these factors moderate the relationship between PIS wording and nocebo [objective 3].

Findings from this study will be synthesised into a set of evidence-based guidelines for researchers, focusing on "neutral-descriptive" language that maintains ethical transparency without inducing unnecessary nocebo effects [objective 4].

External partner: Dr David Moore and Dr Charlotte Krahe SomAffect Lab, Department of Psychology, Liverpool John Moores University (they will provide us with images of the sensation and pain induction techniques for use in the experiment)

Skills required of applicant:

• A strong undergraduate degree in Psychology or a closely related discipline.
• Demonstrated understanding of quantitative data analysis (e.g., SPSS) through either conducting a previous research project or completing relevant coursework or both.
• Previous experience in designing or conducting psychological experiments—particularly those involving human participants or sensory stimuli—is highly desirable.

Essential criteria

Applicants should hold, or expect to obtain, a First or Upper Second Class Honours Degree in a subject relevant to the proposed area of study.

We may also consider applications from those who hold equivalent qualifications, for example, a Lower Second Class Honours Degree plus a Master’s Degree with Distinction.

In exceptional circumstances, the University may consider a portfolio of evidence from applicants who have appropriate professional experience which is equivalent to the learning outcomes of an Honours degree in lieu of academic qualifications.

Equal Opportunities

The University is an equal opportunities employer and welcomes applicants from all sections of the community, particularly from those with disabilities.

Appointment will be made on merit.

Funding and eligibility

This opportunity is open to all applicants.

The tuition fee for international and EU (excluding ROI) candidates is £19,040 for 2026/27.

Studentship funding is available to UK and ROI applicants, as follows:

• MRes studentships will be available to top ranked candidates to cover tuition fees and a Research Training Support Grant of £900.
• All applicants to the project will be considered automatically for an MRes studentship.
• Applicants who do not receive a studentship but meet admission requirements may be offered admission on a self-funded basis.
• Applicants who already hold an MRes or a doctoral degree or who have been registered on a programme of research leading to the award of an MRes or doctoral degree are NOT eligible to apply for funding.
• Applicants who hold or who are registered on a taught Master’s degree are eligible to apply.