Chic conferences, polished presentations and glossy journals. The scientific world seems like one big success story. “Seems”, because reality, of course, is different. In this series, Observant will look for the mistakes, the setbacks, the slip-ups, the unexpected turns. Because those too, or maybe even especially, are science. Today: Anita Jansen, professor of clinical psychology.
Do patients with bulimia nervosa, who go through cycles of binge eating and purging, recover if therapy helps them overcome their distorted thoughts? Examples include “I’m so fat”, “I’m worthless”, “I must finish all the food on my plate”. Or is challenging these kinds of cognitive distortions only half the battle? Do patients need more than just talk therapy? Should they also go out and expose themselves to the situations they fear? Like going to a party without make-up, or looking at the “ugly” parts of their bodies in the mirror?
Those are the questions it all started with, back in 2013, says Professor Anita Jansen. “I had no funding for this project, as funders tend to spend their money on more common disorders like depression and anxiety. Eating disorders only affect about 5 per cent of the population. But no money means no researcher taking the reins, so I decided to do it myself.”
While working on other things, like leading a VICI-funded project, Jansen applied for a medical ethics review, wrote the research and treatment protocol and trained seven therapists, all affiliated with mental healthcare facility Riagg in Maastricht.
The Faculty of Psychology and Neuroscience had been working closely with this facility across from the train station since the 1980s, within the context of a national project to academicise mental health care. UM psychologists conducted research and treated patients at the facility, while Riagg therapists taught psychology students, who greatly appreciated this. The aim of the project was to improve the quality of research, education and health care.
The sudden end
Not long after the study began, it encountered its first obstacle in 2015. The Riagg facility in Maastricht, one of the last remaining independent Riagg locations in the Netherlands, ran into financial trouble and decided to merge with private healthcare provider Virenze. “Fortunately, neither the academicisation project nor our research was at risk. We were running a total of forty studies there at the time.”
By this point, Jansen had passed the experiment on to someone else, as she was appointed dean of the Faculty of Psychology and Neuroscience in 2016. Young researcher Lotte Lemmens took over from her.
This kind of clinical study is very labour-intensive, says Jansen. “Sixteen weekly therapy sessions for each patient, extensive data collection before, during and after, and therapists who are also treating other patients. So we only collected data from fifteen patients per year. With some patients we would only challenge their cognitive distortions, whereas others would also engage in real-life confrontations, also known as exposure therapy. At the same time, we were trying to find out what exactly the active ingredients of effective therapy are. And whether exposure was needed for better results.”
The years passed and the study progressed steadily, until the curtain finally fell on Virenze Riagg: the organisation went bankrupt at the end of 2017. It didn’t come as a surprise, says Jansen. “They had already been experiencing financial problems and some health professionals had already left, including some of our therapists. That moment marked the sudden end of our experiment as well.”
MET ggz, another private healthcare organisation, took over the facility on Parallelweg. “But ‘my’ therapists, who had been so carefully trained, and the research assistants who knew exactly what to do… You can’t just replace those.”
It was a bitter disappointment for Jansen as both a researcher and a dean, as the bankruptcy simultaneously dealt a death blow to the academicisation project. Not just her study, but also the faculty’s other 39 studies came to a standstill. MET ggz was not interested in collaborating with the university at first.
“I was fed up. I thought, ‘We should just set up our own mental healthcare facility.’ I envisioned a university centre in Randwijck where patients would be treated and participate in research into more effective treatments. Nothing too experimental, of course, as everything always has to be approved by a medical ethics committee. Colleagues loved the plan and had already come up with a name: Psymosa.”
Jansen took the plan to the hospital and the Faculty of Health, Medicine & Life Sciences, who thought it was a good idea. “But despite all our efforts, we haven’t got it off the ground yet. It's still hanging in the air, even though it’s incredibly important. Also for our own students and staff, some of whom have psychological problems, especially now. There are just so many good reasons for such a facility to exist. Think of it as a university hospital, but for mental health care. On a smaller scale, of course.”
Running your own facility means not being at the mercy of a healthcare provider for whom research will never be a priority, says Jansen.
If it has so many advantages, how come it hasn’t got off the ground yet? “The health insurance company that has to pay for the treatments isn’t exactly enthusiastic about the idea of yet another facility in South Limburg, where many small healthcare providers are already active. Although they’ve told us they are very interested in an academicised facility. Our current dean Harald Merckelbach also recognises the great importance of this. So it isn’t a matter of if, but when the facility will be established.”
And how about the research? “I thought we would establish Psymosa within a year and pick our study up again, but that wasn’t the case. But everything is ready, so we can continue right away. We will have to train all the therapists and research assistants again, though. A bigger problem is the fact that we have no follow-up data from our previous participants, but we’ll make it work.”
Jansen is determined to complete the study. It’s still relevant to research the question of cognitive distortions and exposure. Jokingly, she adds, “And by now it has cost so much money it’s beginning to resemble the Betuweroute construction project.”
Journal of “failed” science
Many things go wrong in science, as they do everywhere. But why are the failures, setbacks or dead ends in research rarely exposed? Is it because of the tremendous amount of pressure on researchers to be successful? Is that why failure is a taboo in science?
“We have unrealistically high expectations of researchers”, says recently graduated historian of science Martijn van der Meer. “If failure was a little more accepted in the scientific world, the work environment would immediately be a lot healthier and more pleasant. Sometimes failure is necessary to achieve something beautiful.”
Van der Meer is one of the master’s students from Utrecht University who founded the Journal of Trial and Error (JOTE). This open-access journal embraces negative, non-significant results rather than shying away from them.
The point of the journal, which first appeared in November, isn’t to glorify “sloppy science”, says Van der Meer. Papers with incorrect statistics, improper data collection or sloppy writing are rejected. All articles go through a rigorous peer-review process and first appear online in preprint.
The journal isn’t receiving a lot of submissions yet. “People have plenty of articles in their desk drawers”, suspects Van der Meer, “but they have to be brave enough to submit them. Some might be worried that being published in a journal of “failed” science wouldn’t look good on their CV.” And that’s exactly the problem JOTE aims to address. (HOP)