The Expectancy Protocol

The mechanism that multiplies every row: positive-expectation messaging (SMD 0.43) and clinician empathy (SMD −0.18 on pain/anxiety) are free, universal, and evidence-backed (Howick, J R Soc Med 2018). Never deceptive — the protocol is honest framing, not false promises.

1 · Frame the plan, not the pill

"We have seventeen different directions we can take this — today we chose the three with the best evidence for you, and we set the exact date we will know if each is working."

Why: choice + measurement framing engages agency and expectancy without a single overclaim.

2 · The honest-tier script

Evidenced: "This has real trials behind it." · Transposed: "Proven in a related condition — we borrow it honestly and measure." · Hypothesis: "Early science, honestly labeled — we try it with a stop date." · Contested: "Studies disagree; if it does not earn its place by day X, we stop."

The tier vocabulary IS the expectancy tool: honesty builds the credibility that makes positive framing believable.

3 · Ritual and attention

Sit. Eye contact. Say the read-date out loud and write it down in front of the patient. Empathy statements are an active ingredient (measured), not bedside garnish.

4 · Never

Never promise elimination. Never let marketing language outrun a row's tier. Never use expectancy to paper over a failing treatment past its read date — the stop IS the credibility.

5 · Open-label placebo (separate, gated)

OLP is contested (short-term positive, independent long-term replication null) and sits as its own Y1 row in the psych column — it is NOT this protocol. This protocol is simply how we talk.