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. 2025 Sep 26;20(1):nsaf100. doi: 10.1093/scan/nsaf100

A simple alternative to nondeceptive placebos for reducing emotional distress: encouragement

Anne Schienle 1,✉, Wolfgang Kogler 2, Albert Wabnegger 3
PMCID: PMC12584057  PMID: 41002219

Abstract

Although numerous studies have shown that nondeceptive placebos (NDPs) can reduce emotional distress, research on their neurobiological effects remains limited. Furthermore, administering NDPs is time-consuming, as their effectiveness relies on providing detailed explanations of the concept and presumed mechanisms. This functional magnetic resonance imaging (fMRI) study investigated whether an encouragement-based intervention could serve as an alternative to NDPs. Three groups of female participants (total n = 151) took part in an fMRI study in which they viewed both disgusting and neutral images. Prior to this, one group received an NDP capsule for oral intake, while another received a small figurine accompanied by an encouraging written message. Both interventions were framed as tools to support emotion regulation. A third group passively viewed the images. NDP and encouragement elicited similar, modest reductions in reported disgust. However, the two interventions were linked to distinct patterns of brain activity and connectivity, involving the putamen, hippocampus, and ventrolateral prefrontal cortex. Since participants perceived encouragement as a more credible and effective means of reducing emotional distress, it may serve as a simple and practical alternative to NDP pills.

Keywords: nondeceptive placebo, encouragement, emotion regulation, disgust, fMRI

Introduction

Nondeceptive placebos (NDPs) are interventions administered with full transparency, meaning recipients are explicitly informed that the treatment contains no active pharmacological ingredients (e.g. inert pills, cremes, nasal sprays; Colloca and Howick 2018). Evidence indicates that NDPs can produce therapeutic benefits in patients with various physical and psychological conditions, as well as in nonclinical contexts (for meta-analyses, see Buergler et al. 2023, Spille et al. 2023). In particular, NDPs have been shown to support emotion regulation and reduce negative affective states in healthy individuals, such as anxiety (Schaefer et al. 2019), sadness (Friehs et al. 2022), guilt (Sezer et al. 2022), social pain (Stumpp et al. 2023), and disgust (Schienle et al. 2023). The specific feeling states were predominantly elicited via visual stimuli (e.g. images, movies, video games).

The mechanisms underlying the effects of NDPs are multifactorial, involving the retrieval of pharmacological memories, (subconscious) conditioning, and conscious expectancy (Colloca and Howick 2018). These positive expectancies may promote attentional disengagement from negative stimuli and activate self-regulatory processes—for instance, by facilitating the reinterpretation of emotional states as less threatening and/or more manageable (e.g. Shafir et al. 2023, Schienle et al. 2024).

To elicit such positive effects through NDPs, this form of treatment must be adequately introduced to the recipients. This typically involves imparting basic knowledge about placebos and their effects. For instance, Locher et al. (2017) acquainted participants in an NDP study on pain with information regarding the efficacy of placebos for specific symptoms and disorders (e.g. pain, depression), the role of classical conditioning in placebo responses, the beneficial effects of culturally ingrained rituals, and self-healing processes before commencing the placebo treatment. Whereas the informed group reported a reduction in pain attributed to the NDP, this was not the case in the comparison group that received only a brief definition of a placebo. In other NDP studies aimed at reducing emotional distress (Guevarra et al. 2020, Schienle et al. 2022), participants read scientific articles on placebo research and viewed presentations on the topic. This was followed by instructions about the specific placebo used in the study and its administration mode (e.g. a nasal spray) as well as a positive verbal suggestion. Only after this extended procedure did the experiment with emotion induction begin.

It has been shown that providing individuals with information about NDPs is essential, as it influences the perceived plausibility of the treatment and fosters positive treatment expectations among recipients (Buergler et al. 2023). A network meta-analysis, encompassing data from both clinical and nonclinical samples, revealed that NDP interventions that did not establish at least minimal treatment expectations beforehand were not effective (Buergler et al. 2023). Other studies found that the plausibility of the NDP approach for the recipient was positively associated with both the anticipated and the perceived effectiveness of the placebo treatment and the willingness to take an NDP (Schienle et al. 2023, 2024).

As outlined above, the concept of NDPs, which may be unfamiliar to many, requires clarification. Explaining it can be time-consuming, potentially hindering its integration into clinical practice. Consequently, it becomes imperative to ascertain its efficacy compared to alternative more time-efficient methodologies to support emotion regulation. One simple strategy that also leverages affective control is encouragement. Wong (2015) defines encouragement as the ‘expression of affirmation through language or other symbolic representations to instil courage, perseverance, confidence, inspiration, or hope in a person within the context of addressing a challenging situation or realizing a potential’ (p. 180). In the present investigation, participants received a symbolic representation of encouragement in the form of a small crocheted figurine (‘a positive pickle’) with an uplifting message (‘I may be a tiny pickle, but I believe in you. You can do it.’). The intuitive nature of this approach obviates the need for elaborate explanations. Moreover, there is empirical evidence that encouragement can help to manage emotional distress (see review by Marroquín 2011). It has been suggested that encouragement can support cognitive reframing/reappraisal (i.e. shifting the interpretation of a situation from threatening to manageable), boost motivation and self-efficacy (i.e. restoring confidence in one’s abilities), and induce positive emotions (e.g. optimism; see Marroquín 2011). The proposed mechanisms of encouragement partially overlap with those of NDPs (Colloca and Howick 2018).

The underlying neurobiological processes by which both NDPs and encouragement reduce negative emotions remain poorly understood. Concerning NDPs, previous studies with functional magnetic resonance imaging (fMRI) have demonstrated that this type of placebo treatment can alter activity in various brain regions during the presentation of distressing images. The NDP treatment was associated with activation changes in the hippocampus, anterior cingulate cortex (ACC), ventrolateral prefrontal cortex (VLPFC), putamen, and pallidum (Schaefer et al. 2023; Schienle et al. 2023, 2024). These brain regions are involved in the contextual and motivational modulation of emotional responses, and thereby contribute to emotion regulation (Uddin 2015).

In the present fMRI study, participants were randomly allocated to one of three groups (NDP, Encouragement, No Treatment) that were presented with repulsive and neutral images. It was hypothesized that both treatments would reduce self-reported feelings of disgust. For the analysis of the brain imaging data, regions of interests (ROIs) were selected based on previous fMRI-NDP studies on emotion regulation. These studies indicated that the reduction of negative feeling states was accompanied by increased activity in the hippocampus and ACC (Schaefer et al. 2023) as well as VLPFC (Schienle et al. 2023). Reduced activity was expected for the putamen and pallidum (Schienle et al. 2024). The insula was included as an additional ROI given its central role in interoception, a key process in disgust processing (Uddin 2015). Successful disgust regulation has previously been associated with reduced insular activity (e.g. Ochsner et al. 2004, Schienle et al. 2017).

Analyses for encouragement followed an exploratory approach due to the absence of prior studies on this topic. Additionally, an exploratory comparison of functional connectivity was conducted between the two treatment conditions. Previous research has shown that different interventions, such as deceptive placebo (DP) treatment and cognitive reappraisal (CR), can both effectively reduce visually induced disgust, yet they are associated with opposing patterns of connectivity within a network involving the insula and prefrontal cortex, highlighting their neurocognitive specificity (Schienle et al. 2017).

To the best of our knowledge, this is the first fMRI study to directly compare an NDP and an encouragement intervention regarding their behavioural and neural effects on emotion regulation.

Materials and methods

Participants

A total of 151 females (mean age = 23.57 years, SD = 5.30) participated in this study. Participants were recruited through announcements on the university campus and via social media. The inclusion criteria required participants to be at least 18 years old and female. To minimize sex-related variance in placebo reactivity (Enck and Klosterhalfen 2019) and disgust propensity (Schienle et al. 2022), only female participants were recruited. Exclusion criteria were reported diagnoses of mental disorders, neurological disorders, intake of psychotropic medication, and fMRI contraindications (e.g. pregnancy, metal implants).

Participants were randomly allocated (random number table) to one of three groups: (i) oral intake of an oval NDP capsule (1 cm-long, filled with 0.8 g dextrose) (NDP; n = 51), (ii) receiving a small oval figurine (Figure S1, see online supplementary material for a colour version of this figure) holding a sign stating ‘I may be a little pickle, but I believe in you. You can do it!’ (Encouragement: n = 53), or (iii) passive viewing (PV) of the pictures (n = 47). The three groups did not differ in mean age (F(2,148) = 0.28, P = .76) and scores on the brief Disgust Propensity Scale (Schienle et al. 2022; F(2,148) = 0.25, P = .78).

Written informed consent was obtained from each participant before participation in the study. The Ethics Committee of the University of Graz approved the study (GZ. 39/144/63 ex 2023/24), which was carried out following the current version of the Declaration of Helsinki. The study was preregistered on the German Clinical Trials Register DRKS00034210, June 3rd, 2024).

Procedure

Participants were invited to an fMRI study on affective processing. In the lab, all groups first viewed a presentation consisting of 14 PowerPoint slides (containing a comparable number of figures and words, without audio), each slide shown for 30 s. The content covered either placebos (NDP group), encouragement/self-affirmation (Encouragement group), or affective neuroscience without any mention of placebos or encouragement (PV group). We kept the presentation length constant across groups to avoid timing confounds. At the end of the presentation, the NDP/Encouragement groups rated their expectations concerning the effectiveness of the intervention (1 = not effective; 9 = very effective). Then they received the treatment (NDP capsule for oral intake or figurine that was brought into the scanner room.) We used the same capsule as in an earlier OLP study (Schienle et al. 2023) to ensure methodological comparability and to match the oval shape of the figurine. Participants kept the figurine in their trouser pocket throughout the study. Thus, they were not distracted by it. Directly before the scanning, the following instructions were given:

NDP: You will now receive a so-called NDP that does not contain any active substances. This placebo is meant to help reduce emotional reactions to the negative images that will be shown to you. Scientific studies have demonstrated that placebos (even if you know they are placebos) can reduce negative emotions. You will now be given a glass of water and a placebo capsule for oral intake. This capsule is filled with sugar (dextrose). The placebo can support you so that the pictures are less negative for you.

Encouragement: You will now receive a so-called ‘Positive Pickle’, which is meant to help reduce emotional reactions to the negative images that will be shown to you. The pickle holds a message card that reads: ‘I may be small, but I believe in you. You can do it!’ Scientific studies have shown that such encouraging messages can effectively alleviate negative emotions. You may take the pickle with you into the scanner room so that it remains beside you during the measurements. This source of encouragement can support you so that the pictures are less negative for you.

Passive viewing: You will now receive a pill to improve the MRI recordings. fMRI is used to assess metabolic activity in the brain. It measures the oxygen content in the blood, which increases when neurons in the brain are activated. You will now receive a glass of water and a capsule for oral intake. This capsule is filled with dextrose (sugar). The substance slightly increases metabolism and thus improves the MRI signal-to-noise ratio. (A similar control instruction referring to the improvement of psychophysiological recordings has been used in previous NDP studies).

During the fMRI session, pictures were presented (30 validated disgusting and 30 neutral (pixelated) images; Schienle et al. 2017). The disgust pictures depicted elicitors of core disgust, such as rotten food, and body secretions. The pictures were presented for 5 s each, in blocks of three pictures of the same type (Disgust or Neutral). Then, a fixation cross was shown (variable interval: 2–4 s), which was followed by ratings for the intensity of experienced disgust (1 = very low, 9 = very strong). Participants gave the rating verbally using the intercom system. After each rating, the trial ended with a 15-s resting period during which a fixation cross was shown. The experiment consisted of 10 disgust blocks (30 images) and 10 neutral blocks (30 images). The sequence of blocks was randomized, with the only restriction that a maximum of two blocks of the same type could be shown consecutively.

At the end of the experiment, the NDP/Encouragement groups rated the perceived effectiveness and plausibility of the treatment (1 = not effective/plausible; 9 = very effective/plausible). All participants completed the experiment (no dropouts, see CONSORT diagram Figure S2).

Statistical analysis of self-report data

A mixed-measures analysis of variance (ANOVA) investigated the effects of GROUP (NDP, Encouragement, PV) and PICTURE CATEGORY (Disgust, Neutral) on disgust ratings. An additional ANOVA compared effectivity ratings given before and after the experiment (TIME) between GROUPs. Significant effects were followed up with independent samples t-tests. For all post-hoc analyses, results were considered statistically significant when the observed P-value was below the critical Bonferroni-Holm level (p(Holm)). We report partial eta squared and Cohen’s d as effect size measures.

Plausibility ratings were compared between the two intervention groups via an independent samples t-test. All statistical analyses were conducted with JAMOVI (version: 2.3.21).

fMRI recordings and analysis

The MRI session was conducted with a 3 T scanner (Vida, Siemens, Erlangen, Germany) with a 64-channel head coil. Functional runs were acquired using a T2*-weighted multiband EPI protocol (number of slices: 58, interleaved, flip angle = 82°, slice thickness: 2.5 mm; slice spacing: 2.5 mm; TE = 0.03; TR = 1800 ms; multi-band accel. factor = 2; acquisition matrix: 88; in-plane resolution = 2.5 × 2.5 × 2.5 mm).

Preprocessing of the fMRI data was performed using fMRIPrep 22.0.1 (Esteban et al. 2019; RRID: SCR_016216), which is based on Nipype 1.8.4 (Gorgolewski et al. 2018; RRID: SCR_002502). The pipeline included skull-stripping, tissue segmentation, susceptibility distortion correction, slice-timing correction, motion correction, and normalization to MNI152NLin2009cAsym space. A detailed description of the preprocessing workflow is provided in Supplementary Materials (S2). Smoothing and first- and second-level analyses were conducted with SPM12 (7487) implemented in MATLAB R2019b.

The first-level analysis followed a previous NDP study on disgust processing (Schienle et al. 2023). Before conducting the first-level analyses, functional image quality metrics were evaluated using MRIQC (Esteban et al. 2017). Substantial deviations in various quality-related metrics, such as signal-to-noise ratio and motion outliers, led to the exclusion of five participants (NDP: 2; PV: 1; Encouragement: 2) from further analyses. The preprocessed images were then used for the first-level analyses, which involved convolving event-related responses for the image categories (Disgust, Neutral), and rating scales with the hemodynamic response function. We defined the contrast of interest as Disgust minus Neutral. To account for motion-induced variance, we used the six motion parameters and their first derivative as regressors of no interest. Volumes with a framewise displacement exceeding the predefined threshold of 0.5 mm were excluded from further analyses. The data were high-pass filtered at a frequency of 180 s, and serial correlations were addressed by using an autoregressive AR(1) model.

In the second-level analysis, we compared groups (contrast Disgust—Neutral) regarding activity in ROI derived from previous studies (Schaefer et al. 2023, Schienle et al. 2023: insula, putamen, pallidum, hippocampus, VLPFC, ACC) via independent t-tests.

Furthermore, we conducted exploratory generalized psychophysiological interaction (gPPI; McLaren et al. 2012) analyses to examine functional connectivity between regions and contrasts that reached statistical significance in the group comparisons. While conventional fMRI analyses identify localized alterations in brain function, they do not capture how such regions interact within distributed networks. To address this, subject-specific connectivity maps for the Disgust—Neutral contrast were entered into two-sample t-tests to compare the groups. ROIs were identical to those used in the BOLD contrast analyses.

For all analyses, statistical significance was determined based on a family-wise error corrected (FWE) P-value for voxel-peaks that was below .05 (small volume correction).

Results

Disgust ratings

The computed ANOVA revealed significant effects for PICTURE CATEGORY (F(1,148) = 1376.26, P < .001, partial eta2 = .90), GROUP (F(2,148) = 3.79, p = .025, partial eta2 = .05), and the interaction GROUP X PICTURE CATEGORY (F(2,148) = 3.84, p = .024, partial eta2 = .06). Compared to the PV group, the NDP group (t(96) = 2.27, p = .026, Cohen’s d = 0.46) and the Encouragement group (t(98) = 2.80, p = .006, d = 0.56) reported less intense disgust in response to the disgust images (Fig. 1). NDP and Encouragement did not differ from each other (p = .642). The groups also did not differ in their disgust ratings for the neutral images (all p > .14).

Figure 1.

Figure 1.

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Disgust ratings and standard errors for the images per group.

Efficacy and plausibility ratings

The ANOVA for the efficacy ratings (expected, perceived) revealed significant main effects for GROUP (F(1,98) = 20.46, p < .001, partial eta2 = .173) and TIME (F(1,98) = 10.23, p = .002, partial eta2 = .094). The interaction was not significant (p = .33, partial eta2 = .001). The Encouragement group rated the intervention as more effective (M = 6.10, SD = 1.45) than the NDP group (M = 4.80, SD = 1.60; t(102) = 4.35, p < .001, d = .85), and overall, the expected efficacy of the interventions (M = 5.70, SD = 1.68) was higher than the perceived efficacy (M = 5.15, SD = 2.04, t(99) = 3.20, p = .002, d = .32).

The Encouragement group gave higher ratings for the plausibility of the intervention than the NDP group (t(88.18) = 2.36, p = .020, d = .47; Table 1).

Table 1.

Ratings for efficacy (expected, perceived) and plausibility of the interventions.

Nondeceptive placebo Encouragement
(n = 51) (n = 53)
Expected efficacy 5.10 (1.64) 6.30 (1.50)
Perceived efficacy 4.38 (1.88) 5.92 (1.90)
Plausibility 6.35 (2.25) 7.25 (1.53)
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Ratings: 1 = low; 9 = high.

Brain activity

As a manipulation check, we first analysed ROI activity to disgust images (compared with neutral images) across groups (Table 2). Statistically significant activity was identified in all selected ROIs (insula, putamen, pallidum, VLPFC, ACC, hippocampus). On the whole-brain level, significant activation for the contrast Disgust—Neutral was observed in the left fusiform gyrus (MNI coordinates x, y, z: −39, −53, −16; t = 35.82, p < .0001).

Table 2.

Activity in regions of interest (ROI) for the contrast Disgust > Neutral.

ROI H
 X
 Y Z T p(FWE)
Effects across groups
Insula L −37 5 −14 19.21 <.0001
Insula R 36 8 −14 18.95 <.0001
Hippocampus L −29 −25 −19 22.58 <.0001
Hippocampus R 36 −25 −16 20.27 <.0001
Putamen L −29 −13 −11 21.65 <.0001
Putamen R 19 5 −11 17.28 <.0001
Pallidum L −22 −10 −6 16.80 <.0001
Pallidum R 14 −5 −6 15.11 <.0001
VLPFC L −52 15 −1 14.09 <.0001
VLPFC R 51 15 27 10.26 <.0001
ACC R 6 18 34 15.38 <.0001
Nondeceptive placebo—encouragement
Hippocampus L −19 −35 −6 3.70 .009
Hippocampus R 24 −28 −11 3.63 .012
Putamen L −24 13 2 3.33 .029
Passive viewing—encouragement
Hippocampus L −19 −35 −6 3.14 .046
Nondeceptive placebo—passive viewing
VLPFC R 56 33 7 2.86 .024
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H: hemisphere; MNI coordinates x, y, z, p corrected for family-wise error (FWE); VLPFC: ventrolateral prefrontal cortex; ACC: anterior cingulate cortex.

We then focused on group-specific effects. Relative to the PV of the images (contrast: Disgust—Neutral), the NDP increased activity in the right VLPFC, whereas Encouragement reduced activity in the left hippocampus. Encouragement was associated with reduced activity in the bilateral hippocampus and the left putamen when compared with the NDP (Fig. 2).

Figure 2.

Figure 2.

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Group comparisons in brain activity (threshold at p < .05 uncorrected, for visualization purposes only): (a) nondeceptive placebo (NDP)—encouragement, (b) passive viewing (PV)—encouragement, (v) NDP—PV.

Functional connectivity: comparison of encouragement and nondeceptive placebo

Encouragement (relative to NDP) was associated with increased coupling between the left putamen (seed) and the right VLPFC (MNI coordinates x, y, z: 59, 18, 22, t = 3.17, p = .018). NDP (relative to Encouragement) was associated with increased coupling between the left hippocampus (seed) and the left pallidum (MNI coordinates x, y, z: −14, 3, 2, t = 2.99, p = .035) as well as between the right hippocampus (seed) and the left hippocampus (x, y, z: −22, −23, −14, t = 3.78, p = .008). All other comparisons were statistically non-significant.

Discussion

The present fMRI study compared the effects of an NDP and an encouragement-based intervention on the reduction of visually induced disgust. Both treatments produced a comparable decrease in experienced disgust intensity relative to no-treatment (PV), with medium-sized effects observed. Specifically, the NDP condition produced an effect size of d = 0.46, closely aligning with the effect size reported for self-reported outcomes in a meta-analysis of experimental studies with non-clinical populations (d = 0.43; Spille et al. 2023).

The observed reductions in disgust for both the NDP and encouragement conditions included an average decrease of −0.7 points on a 1–9 scale with one-point increments. This is modest, particularly when compared to prior studies utilizing alternative regulation strategies, such as deceptive placebo (DP) treatment and cognitive reappraisal (CR). For instance, in an fMRI study employing a within-subjects design (Schienle et al. 2017), participants underwent three conditions: receiving a DP pill presented as an anti-nausea medication, engaging in CR, or passively viewing disgusting and neutral images (the images were the same as in the present study). Compared to a no-treatment/PV condition, both DP and CR resulted in significantly lower disgust ratings (M(DP) = −2.96; M(CR) = −3.77 on a 1–9 scale).

The brain-imaging findings of the present study indicated differential effects of Encouragement and the NDP. Relative to PV, the NDP was associated with increased VLPFC activity. This region has been repeatedly found to be involved in cognitive emotion regulation (e.g. Kohn et al. 2014). The Encouragement group compared to PV showed lower hippocampus activity. The direct comparison of the interventions indicated that Encouragement reduced activity in the hippocampus and putamen relative to NDP. The putamen has been consistently activated in response to disgusting stimuli, including unpleasant odours, tastes, and images (Calder et al. 2007, Thielscher and Pessoa 2007), whereas the hippocampus plays a crucial role in avoidance (Revest et al. 2009, Felix-Ortiz et al. 2013) and approach–avoidance conflicts (O’Neil et al. 2015, Loh et al. 2017, Schumacher et al. 2018, Zhu et al. 2019). The hippocampus is also involved in emotional memory recall and regulation (Schumacher et al. 2018).

It can be concluded that both interventions improved participants’ internal attempts to regulate disgust; however, they appeared to do so via different neurocognitive mechanisms, as reflected in the observed activity and connectivity patterns. Encouragement was found to increase functional connectivity between the VLPFC and the putamen, potentially reflecting cognitive (re)appraisal processes (Rota et al. 2009, Li et al. 2022). The positive verbal cue embedded in the encouragement symbol (‘you can do it’), represented in the VLPFC, may have modulated activity in the putamen, a region associated with the negative emotional valence of the images. Furthermore, Encouragement was linked to reduced connectivity between the hippocampi and between the hippocampus and the pallidum, highlighting the hippocampus’s role as a key hub within the paralimbic system (Eichert et al. 2024).

Viewed in a broader context, the NDP capsule and the figurine may even be conceptualized as two distinct types of placebos. Both are inert, oval-shaped objects lacking inherent disgust-reducing properties, yet each is accompanied by distinct verbal suggestions aimed at facilitating emotion regulation. A comparable conceptual framework was employed by Shafir et al. (2023), who explored another emotion regulation strategy: distraction. In their study, electrocutaneous stimulation was paired either with a distraction task introduced through a positive verbal suggestion (‘placebo distraction’) or without such a suggestion (‘control distraction’). The placebo distraction condition elicited significantly greater reductions in self-reported fear of pain.

Importantly, treatment acceptance plays a critical role in achieving such outcomes. In the current study, participants expected and perceived stronger effects from Encouragement (large effect size) and also rated it as more plausible than the NDP (medium effect size), despite reporting similar levels of disgust reduction from both interventions. From a practical perspective, symbolic encouragement may represent a promising alternative to NDP pills for mitigating emotional distress, offering a more time-efficient and intuitive approach.

Several limitations of the present study should be acknowledged. First, the sample consisted exclusively of healthy female participants, which limits the generalizability of the findings to other gender groups. Second, the two treatments differed not only in terms of verbal suggestions but also in their sensory characteristics, such as size and colour. These features may influence placebo-related expectations (Khan et al. 2010). However, during the fMRI session, the capsule was ingested while the positive figurine was kept in the participants’ trouser pockets, thereby minimizing potential sensory distractions. Third, some of the predicted NDP-related changes in brain activity (e.g. in the ACC) were not observed. This may be due to differences in the verbal suggestions and visual stimulus materials used across studies. Fourth, the observed effects—both in self-reports and neural responses—were modest. Given that previous studies have reported polarized attitudes towards NDPs (Haas et al. 2021, Schienle and Seibel 2024), it is essential to identify individuals who are responsive to either NDPs or symbolic encouragement before implementing such interventions. Future research should therefore aim to identify relevant predictors of individual responsiveness to optimize the effectiveness of these emotion regulation strategies.

Conclusion

In conclusion, this fMRI study demonstrated that both interventions (NDP and encouragement) were similarly effective in reducing disgust but were perceived differently in terms of effectiveness and plausibility. The distinct patterns of brain activity and connectivity suggest that the two treatments engage different neurocognitive processes.

Supplementary Material

nsaf100_Supplementary_Data
nsaf100_supplementary_data.zip (370.4KB, zip)

Contributor Information

Anne Schienle, Department of Clinical Psychology, BioTechMed, University of Graz, Graz, 8010, Austria.

Wolfgang Kogler, Department of Clinical Psychology, BioTechMed, University of Graz, Graz, 8010, Austria.

Albert Wabnegger, Department of Clinical Psychology, BioTechMed, University of Graz, Graz, 8010, Austria.

Author contributions

Anne Schienle (Conceptualization [lead], Writing—original draft [lead]), Wolfgnag Kogler (Data curation [equal], Writing—review & editing [equal]), and Alberrt Wabnegger (Formal analysis [equal], Writing—review & editing [equal])

Supplementary data

Supplementary data are available at SCAN online.

Conflict of interest: None declared.

Funding

The university of Graz supported open-access publication.

Data availability

Data are available from the first author upon request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

nsaf100_Supplementary_Data
nsaf100_supplementary_data.zip (370.4KB, zip)

Data Availability Statement

Data are available from the first author upon request.

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