# What the Patient Thinks and What the Patient Does: Placebo, Nocebo, and Therapy Adherence in Ulcerative Colitis

## TL;DR

This paper explores how patients' beliefs and emotions affect treatment adherence and outcomes in ulcerative colitis, focusing on placebo and nocebo effects.

## Contribution

The paper provides a narrative review on the interplay between emotional attitudes and therapy adherence in ulcerative colitis.

## Key findings

- Placebo and nocebo effects significantly influence treatment adherence in ulcerative colitis.
- Emotional attitudes and expectations can confound clinical trial outcomes relying on patient-reported data.
- Understanding these effects may help tailor treatment to improve adherence and outcomes.

## Abstract

Patients’ attitude toward therapy and adherence to treatment are central in determining the long-term outcomes of medical treatment in ulcerative colitis. A complex interplay of differing factors modulates the likelihood of persisting in or discontinuing treatment, including patients’ beliefs and concerns about adverse effects of drugs, as well as the interactions with medical staff. Emotional attitude and expectancies are reflected in the so-called placebo and nocebo effects which influence patients’ choices to adhere to or discontinue treatment. They represent important confounding factors in clinical trials and are amplified when the evaluation relies on patient-reported outcomes more than on objective measurements. The therapeutic gain related to placebo effects is likely also relevant in day-to-day practice, but few data are available. The aim of the present narrative review is to provide critical insight into the adherence to therapy in ulcerative colitis and its interaction with the emotional component of the effects of therapy, resulting in the placebo/nocebo effects. Understanding the mechanisms underlying patient behavior may help identify the most appropriate therapeutic approach and treatment schedule to optimize adherence and outcomes in individual patients with UC.