Nondeceptive placebo has demonstrated its efficiency in clinical practice. Although the underlying mechanisms are still unclear, nondeceptive placebo effect and nondeceptive nocebo effect may be mediated by expectation. To examine the extent to which expectation influences these effects, the present study compared nondeceptive placebo and nocebo effects with different expectation levels. Seventy-two healthy female participants underwent a standard conditioning procedure to establish placebo and nocebo effects. Sequentially, participants were randomized to one of the four experimental groups—baseline (BL), no expectation intervention (NoEI), expectation increasing (EI), and expectation decreasing (ED) groups, to receive either no intervention or interventions through different verbal suggestions that modulated their expectation. Placebo and nocebo effects were established in all four groups after the conditioning phase. However, after disclosing the placebo and nocebo, the analgesic and the hyperalgesic effects only persisted in the EI group, when compared with the BL group. Our results provide evidence highlighting the critical role of increased expectation in nondeceptive placebo and nocebo effects. The finding suggests that open-label placebo or nocebo per se might be insufficient to induce strong analgesic or hyperalgesic response and sheds insights into administrating open-label placebo and avoiding open-label nocebo in clinical practice.

Objective: The percentage of adolescents with test anxiety is increasing rapidly. Working memory (WM) training has been demonstrated to reduce anxiety levels and enhance attentional control in individuals. Therefore, we investigated whether adaptive dual n-back WM training could lower test anxiety level and improve attentional control in adolescents. Methods: Forty adolescents were allocated to either adaptive dual n-back WM training (n = 21) or non-adaptive dual 1-back WM training (n = 19) for 10 days. The Test Anxiety Scale was applied to measure individuals’ test anxiety symptoms. The Attentional Control Scale (ACS), the flanker task, and the Go/Nogo task were used to measure attentional control. Results: Compared with the control group, the training group reported significantly relief of test anxiety symptoms; however, there were no significant differences between the two groups in pre-to-post changes in ACS scores or performance on the flanker task and Go/Nogo task. Conclusion: In sum, adaptive dual n-back WM training effectively reduced adolescents’ level of test anxiety but did not improve their attentional control.

Attentional control theory suggests that test anxiety hinders individuals' attentional control, aiding our understanding of how test anxiety may impair cognitive function. However, various methods used to assess attentional control have yielded inconsistent findings. Moreover, past studies, especially on adolescents, that examine the distinct impacts of worry and the emotional components of test anxiety on individuals' attentional control capacity are scarce. This study, using self-report, behavioral, and resting-state EEG measures, explores how worry and emotionality, impact attentional control in adolescents. It enhances our understanding of the link between test anxiety and cognitive function. Referring to the effect size from prior studies, a total of 42 adolescents took part in the study. We used the Test Anxiety Inventory, due to it can assess worry and emotionality components. We employed three widely-utilized measures of attentional control: the Attentional Control Scale (ACS), the Go/Nogo task, and resting-state electroencephalography measures (alpha oscillation and the theta/beta power ratio). Both worry and emotionality components were significantly and negatively correlated with the ACS scores. Unlike worry, emotionality demonstrated a significant positive correlation with response times for the Go trials and alpha power in the parietal cortex. These results suggest that, emotionality, but not worry, is highly correlated with attentional control deficits in adolescents. This study underscores the significance of distinguishing between the components of test anxiety, which aids in comprehending the negative impacts of test anxiety on adolescents' academic performance.

Test anxiety impairs attentional control and negatively affects working memory (WM). According to Attentional Control Theory (ACT), individuals with high test anxiety (HTA) exhibit impaired attentional control compared to those with low test anxiety (LTA), with these deficits becoming more pronounced in high cognitive load and test-related threat conditions. This study used the Test Anxiety Scale (TAS) to group participants and combined the Sternberg WM task with EEG to investigate emotional WM processing differences between HTA (n = 43) and LTA (n = 45) individuals in high and low cognitive loads, with exposure to neutral and test-related threat stimuli. During the high-load WM encoding phase, HTA individuals showed enhanced theta power compared to LTA individuals specifically under neutral stimuli, while LTA individuals exhibited increased theta power for threat versus neutral stimuli-a pattern absent in HTA individuals. No significant theta differences emerged during maintenance. Alpha power did not differ between groups during encoding, but HTA individuals demonstrated significantly elevated alpha power than LTA individuals during the maintenance phase. These findings indicate that HTA individuals exhibit WM deficits. While they demonstrate flexible allocation of attentional resources for neutral stimuli under high-load encoding condition, their theta modulation capacity fails to show significant enhancement when processing test-related threat stimuli compared to neutral stimuli, reflecting a compromised ability to meet elevated cognitive demands. Moreover, during the maintenance phase, HTA individuals require greater attentional control resources than LTA individuals to suppress irrelevant information.