What is the psychological impact of before and after videos on health and wellness decisions?

The Psychology of Before and After Videos

Before and after videos can significantly harm health and wellness decisions by triggering nocebo effects through social learning mechanisms that are as powerful as personal experience and can override professional medical advice. 1

The Nocebo Effect Through Social Observation

The most critical concern with before and after videos is their ability to induce nocebo effects—negative health outcomes caused by negative expectations formed through observation. Social learning from observing others' experiences (including through videos) produces effects similar in magnitude to classical conditioning from personal experience, and importantly, larger effects than explicit instruction from healthcare professionals. 1 This means anecdotal video evidence can override what medical providers tell patients, representing a serious threat to informed decision-making. 1

Medium-Specific Impact

While face-to-face modeling produces stronger nocebo effects than video-based observation, the sheer volume and accessibility of video content online may rival or exceed the influence of individual face-to-face interactions. 1 The difficulty in processing social cues and non-verbal behaviors in video format somewhat attenuates the effect, but the ubiquity of platforms like TikTok and YouTube enables mass-scale social influence that compensates for this reduced per-video impact. 1

Specific Psychological Harms Documented

Body Image and Appearance Content

Viewing appearance-focused before and after content causes immediate measurable harm to body image satisfaction, increases negative mood, and elevates self-objectification. 2, 3 Research demonstrates that:

• Women exposed to appearance-ideal videos show decreased body image satisfaction and increased internalization of societal beauty standards compared to neutral content 4, 2
• Pro-anorexia TikTok content produces the greatest decrease in body image satisfaction and increases internalization of beauty standards 5
• These effects occur regardless of whether the content is presented as images or videos, though videos perceived as unedited may be more harmful than images 3

The Comparison Trap

Before and after videos trigger upward appearance comparisons and intrusive appearance-related thoughts that persist beyond viewing. 2 Women viewing beauty-focused content report significantly more upward appearance comparisons relative to neutral content, creating a cognitive pattern that undermines self-acceptance. 2

Duration and Exposure Effects

Longer exposure to modeling content produces stronger negative outcomes, though even brief exposure (as short as 1 minute) can induce measurable effects. 1 The relationship between daily time spent viewing such content and development of disordered eating behaviors shows a dose-response pattern, with high and extreme daily users reporting greater disordered eating behaviors. 5

Clinical Implications for Healthcare Providers

Patient Counseling Strategy

When patients present with health decisions influenced by before and after videos:

1. Acknowledge that video-based social learning is neurologically processed as powerfully as personal experience 1—don't dismiss their influence
2. Explicitly address the nocebo mechanism: explain that observing negative outcomes in others can create those same outcomes through expectation alone 1
3. Provide counterconditioning through behavioral techniques (relaxation, guided imagery, conscious breathing) rather than simply providing contradictory information 1

Critical Pitfall to Avoid

Do not rely solely on verbal instruction or written information to counter video-based social learning. 1 Explicit instruction from healthcare professionals produces smaller effects than social learning from videos, meaning simply telling patients "that video is wrong" will likely fail. 1 Instead, use experiential interventions and behavioral techniques that engage the same learning pathways as the videos themselves. 1

Vulnerable Populations

Female patients warrant particular attention, as they demonstrate greater susceptibility to appearance-related video content effects. 4, 5, 2, 3 However, the gender effects in nocebo research show complex patterns that require individualized assessment rather than blanket assumptions. 1

Positive Applications (With Caution)

Videos can serve beneficial educational purposes when designed appropriately:

• Culturally tailored videos with same-ethnicity narrators increase trust and comprehension in underserved populations 1
• Peer modeling videos help adolescents prepare for medical procedures when combined with coping technique instruction 1
• Self-compassion focused videos can increase self-compassion relative to control content 2

However, even neutral or educational video content can decrease body image satisfaction, 4 highlighting that the medium itself carries psychological weight beyond content alone.

Practical Recommendations

Healthcare systems should proactively address video-based social learning in patient education protocols rather than waiting for patients to raise concerns. 1 This includes:

• Screening for recent exposure to health-related before and after videos during intake
• Providing anticipatory guidance about nocebo effects before patients encounter such content
• Developing institutional strategies to minimize the impact of negative social information patients inevitably consume 1

The key insight: before and after videos exploit fundamental social learning mechanisms that bypass rational evaluation, making them particularly dangerous for health decision-making despite—or perhaps because of—their emotional persuasiveness.