“Doing something good together for the faculty,” is what Jansen, professor of Experimental Clinical Psychology, will miss most when she is no longer the dean. As soon as a successor has been found, she will pass on the reins. But in her new role as project leader of the gravitation consortium, she will have plenty of opportunities to work together. Eighteen other scientists, from across the country, are involved in the project.
What will they be researching exactly? At the moment, patients suffering from psychiatric problems, receive a diagnosis and treatment based on that diagnosis. “In practice, however, we see that people with a psychiatric disorder often suffer from other complaints as well.” An anorexia patient may also feel downcast. Or someone with a depression may also suffers from panic attacks.
In the model developed under the leadership of Denny Borsboom, professor of Psychological Methods and Psychometry at the University of Amsterdam, it is no longer about the diagnosis but about the symptoms and how they interrelate. It is this model that the consortium will further research and develop.
“Suppose someone is afraid of getting fat. This leads to eating less and an urge to exercise more, which leads to weight loss. And that in turn leads to an increased fear of becoming fat.” This is a (simplified) example of a symptom network, as it is called in Borsboom's model. A person's symptoms and their interrelationship and interaction are tracked using smart phones and will be mapped out very precisely through special analyses.
Instead of treating the eating disorder with standard methods, the consortium thinks it’s better to treat the most important symptom (for instance the fear of getting fat) within the network. “We are also going to look into the transdiagnostic underlying mechanisms. In this instance, it is fear: fear of getting fat and fear of eating. We will then focus on treating that fear rather than, say, distorted body image.”
The question is also how do those complaints influence each other. How is it possible, for example, that losing weight leads to more anxiety about getting fat? “You would think that if someone loses weight, the fear of getting fat would be reduced. Or why does someone who is feeling bad, eat too much? Often they feel even worse afterwards, so it doesn't work. So why do they do it anyway?”
The examples are from Jansen's own field of expertise: eating disorders. But the consortium's scope is much broader. It includes somatic problems, such as inexplicable pain and the emotional memory. Jansen will work on disordered desires. “When someone is excessive in their need for pleasure or when someone can no longer enjoy anything. The latter, we see in people suffering from depression or anorexia. They have lost interest in anything fun, like eating food. Normally, after not eating for some time, you actually really want to eat, but it appears that their reward system no longer adequately works. It also shows on fMRI scans. That is intriguing. Why does that happen and can we reverse it?”
The research will be carried out in three phases. The first is mapping out the symptom networks and finding out their stability. “Patients will be monitored for some time. They will answer questions on their phone regarding how they are feeling at certain times during the day and we will also keep track of their activity. We will be able to measure stress levels, mood, physical exercise, fatigue, et cetera. All that data will then be analysed and result in a symptom network.” The researchers also have questions related to this. “We think that there are differences between people with the same traditional diagnosis. But how much will their personal networks differ? And how stable are these networks?”
At the same time ‘zooming’ studies will take place, in which we look for the causal relationship between symptoms. And lastly, we have targeting: actually putting the theory into practice and treating people. “For this, we will work together with clinics throughout the country. As soon as patients enter a clinic, they will be asked if they want to take part in the research project. If they agree, they will be placed in one of three groups. They will receive the traditional psychotherapy, or the traditional medication, or the new network treatment. We will instruct practitioners how to discuss the network with the patient and how they can influence the network.”
At the moment, approximately half of the treatments are successful. “That seems like little, but you see the same with serious physical illnesses.” We expect that people with the new network therapy will do better. “We will continue to monitor them for two years.”
Should this model and the accompanying therapy indeed prove successful, this could mean a revolution in the psychological world. “It won't move quickly. That will only be at the end of the research road anyway, in ten years' time. Also, something like that takes time, the same happened with for instance cognitive behavioural therapy. Evidence of its superior effectivity was already available in the nineteen-eighties, but it took twenty years before it became the preferred treatment. People need to get used to something new, so we have to expose them to it intensively. We do so by working together with doctors' practices – we have also included a clinical advisory council in our organisational structure – but also by sharing our views at congresses, in workshops and lectures.”
So, there are exciting times ahead. Just as exciting as her deanship? At the time of her taking office in 2016, Jansen was also interviewed by Observant. She referred to her style at the time as “direct, open, fair, clear, no hidden agendas. What you see is what you get. And I am not afraid, not even of the big bosses.” Did that get her into trouble in the past three years? Laughing: “No, it was always fine. We just have a really good management team (the Executive Board and the deans, ed.). There is mutual respect and we laugh a lot.”
There was also lots of laughter at the faculty itself, and that is something that Jansen is proud of. “When I came, the atmosphere was good and it still very much is. People like working here. Some departments did not always run well. They are now well-oiled machines.” How did that come about? “In principle we trust everyone. Now and again you get a bad apple, but we don't focus on that. Most people do their very best.”
There were two things at the top of her list in 2016: dealing with the high work pressure and securing research funds. Jansen divided up the teaching burden in a different way. This way, the faculty tries to divide the time of its academic staff a bit more fairly between teaching, research and applying for grants, valorisation and leadership. Also those who aspire a teaching career, receive more recognition in this system.
Also, the Robin Hood fund was set up for researchers who want to take on PhD students, but who don't have external subsidies to completely pay for this themselves. The money for the fund is from colleagues who are very successful in securing lots of subsidy. “Because I will be the first to admit that being granted a subsidy in the humanities is a bit of a lottery.”
These measures are no panacea. “The pressure of work among lecturers is still very high. This also has to do with the culture. What people expect from themselves and what they think we expect from them. We did try and put that into perspective. I prefer people to produce good-quality research rather than a lot. But how can you change a culture? It is a complicated process that I as dean would have liked to have put more time into.”
As far as research money is concerned, that continues to be an important issue, certainly with the Van Rijn's Committee plans (more money for science at the expense of the arts and humanities) at the back of one's mind. “My heart is in my mouth, it really gets to me. We are not a rich faculty. We do expensive research with fMRI, EEG and virtual reality, but we are being funded as if we only process questionnaires and talk to people. I have regularly had to say 'no' to great initiatives over the past three years, purely because of the financial aspect. If it is already so difficult now, what will it be like in the future?”
Lastly, what has she learned in the last few years? “I thought it was interesting to realise that a lot had to do with common sense. At home you first look in your purse to see if you can afford something and you are kind and polite to each other. You also learn a lot about the problems in the different departments, the people who work there and what they need. You see a lot more than when you are just a professor. I would like everyone to be a dean for a time.”