Evers is an international expert in the area of placebo effects in physical symptoms. She combines discoveries from various disciplines, such as psychobiology, psychopathology, biomedical sciences and neurosciences, into new insights and then translates these insights into self-help tools that are available online and through apps. Evers uses these tools at the new Leiden Expert and Treatment Centre (LUBEC). Subsequently, she established the “Benefit for all” consortium to reach an even wider target group with the methods she developed in her team. Scientists, health professionals, civil society and private partners work together in this consortium. Strategies for a healthy lifestyle are rewarded and are made attractive to encourage a long-term healthy lifestyle. She has also established various other strategic alliances with academic and private partners, knowledge platforms and networks. She has published various therapeutic guidelines for health practitioners as well as screening and self-help tools for patients.
Considerable influence on medical practice
According to the Stevin Prize selection committee, her research has had a considerable influence on medical professional practice. It has increased our understanding of the importance of good communication between doctor and patient, in which the doctor clearly responds to the patient's expectations. Evers has demonstrated that the way the doctor communicates with the patient, the explanation he or she provides, whether he or she listens and whether the patient trusts him or her are vital aspects. For example, if someone does not trust a doctor or is convinced that a treatment will not work anyway, then this considerably reduces the chances of success. Her research results provide opportunities to change the attitude and behaviour of doctors and consequently to make a real difference in patients’ lives. According to the committee, her work has also led to better insights into the sometimes variable results of clinical trials.
Evers’ academic career has received a lot of recognition. She obtained her doctorate cum laude for her study into the psychological determinants and treatments for rheumatoid arthritis and has received numerous renowned prizes and grants. She was a member of the Young Academy from 2013 to 2018, and in 2019, she became a member of the Royal Netherlands Academy of Arts and Sciences. She is highly successful at acquiring indirect government and private funding, which has enabled her to build up a research group of international repute. She attracts young talent and is known as an inspiring, effective mentor. Colleagues state she has an exceptionally active and energetic personality.
Evers is unique in her ability to develop and share knowledge through her numerous publications, lectures and frequent appearances in the media, from the Dutch TV news programmes EenVandaag and RTL Nieuws to Dutch national newspapers like de Volkskrant, NRC Handelsblad and Trouw. She is a passionate researcher who wants to make a difference in society, and she is a natural communicator too.
I'm a bridge builder between psychology and medicine
Interview | Health psychology focusses on the relationship between mind and body
Andrea Evers leads an innovative, groundbreaking research programme into the influence of psychological factors on physical symptoms and disorders. Evers is a world expert in the area of placebo effects and translates new scientific insights into self-help tools, which enable people to better deal with a disorder or to live a healthier life. She is Professor of Health Psychology at Leiden University. In 2019, she received the Stevin Prize of 2.5 million euros.
You were born in Germany. How did you end up in the Netherlands?
‘I was visiting Amsterdam and entered the beautiful Felix Meritis building. I instantly felt that it would be a fantastic place to study; a place where old knowledge and traditions were combined with an innovative learning environment. I was also really impressed by the approach and international orientation of Dutch research. Funnily enough, my great grandmother moved from Amsterdam to Germany, but I only discovered that later.’
Why do you find health psychology so fascinating?
‘I've always been fascinated by the interaction between psychology and medicine. Our thoughts, feelings and behaviour constantly influence our body. Conversely, our body exerts a large influence on how we feel. At first, I did not know whether I wanted to study medicine or psychology because it was that interaction that interested me so much. So I asked myself: which is worse, losing a leg or not being able to cope with a lost leg? With that in mind, I chose psychology, but always with the approach of unravelling the interactions between the mind and the human body.’
‘A second important motivation was the desire to implement my insights in practice. So it is really helpful that everybody finds my discipline about the relationship between mind and body so interesting. Every journalist and person who visits our department starts talking about their own experiences or those of somebody in their family within ten minutes, and there is so much recognition for what we do. I also get many reactions at the lectures I give to professionals. But having said that, many challenges remain. Psychology and medicine often still work independently of each other.’
So there is still a lot of ground to gain?
‘Yes, there is. Simply looking beyond the boundaries of one’s own discipline can have a considerable impact. Within medicine, there is all too often still an overemphasis on prescribing pills. A treatment's success is frequently put down entirely to the drug, even though research has revealed that for many drugs, such as antidepressants, that is only true for a limited part of the drug effects. A patient's expectations and the trust in his or her doctor play a crucial role in this.’
How do placebos influence the body?
‘A placebo effect can elicit a wide range of physical changes. We now know far more about the underlying neurobiological mechanisms. In the professional literature, placebos appear to play a role in nearly all treatments, and some placebo operations have been described too, for example, for people with knee osteoarthritis. In half of the study subjects, no intervention took place. Nevertheless, these patients recovered just as well as people who had undergone the operation. Conversely, people who receive information about the possible side effects of chemotherapy or other medicines can actually experience physical symptoms from only being informed about these side effects. We refer to that as the nocebo effect.’
‘In 2017, in my capacity as chair of the Society in Placebo Studies (SIPS), I organised a world conference in Leiden about placebo treatments, and in July of this year, we will hold the next conference on this subject. Together with the best international researchers in this field, we held an expert meeting during which guidelines were developed for how medical practitioners can best deal with placebo and nocebo effects in practice. This year we will continue on this process in a second expert meeting.‘
What will the guidelines look like?
‘We must ensure that health practitioners are better informed about the existence of these effects and about how these can best be used. It should be investigated whether patients actually support the treatment prescribed. Do they really understand the purpose of the treatment, how it works and why something has been prescribed? What are their long-term expectations? Can the practitioner optimise those expectations in an ethical way? Are they scared of risks and side effects, and can the health practitioner remove those anxieties by providing a more detailed explanation? Optimising placebo and decreasing nocebo effects can make a huge difference to the treatment outcome.’
‘We now know that the patient does not remember most of the conversation in the consultation room. Communication training courses could help doctors and other care providers. Why does someone want to undergo this treatment? Not because their doctor tells them to, but because they want to be able to play with their grandchildren later in life! If there is not enough time during the consultation to properly motivate people, then perhaps nurses could play an additional role in this. For a small group of particularly worried patients, we could always call upon the services of a medical psychologist. Making optimal use of placebo effects yields a health benefit.’
‘Furthermore, I see highly promising opportunities to optimise treatments with drugs. The most important principle for placebo effects is conditioning. That conditioning principle can be applied to the drug dosage. Research has revealed that various physiological systems in the body, such as the immune system or the production of certain hormones, can be conditioned so that the body produces the substances administered. That could eventually lead to a lower dosage being administered. Several studies provide cautious indications that this approach could be highly promising.’
You develop apps and E-health applications. Do you expect a lot from these?
‘Yes, I do. I am not just a researcher, but also a clinical psychologist, and I have developed many treatments that we offer at our Leiden University Treatment Centre (LUBEC). Besides cognitive behavioural therapies to teach patients how to cope with physical disorders, I have focused on digital methods. E-health fits in our current culture and has also proven to be effective at influencing conscious and subconscious behaviour. It also appeals to younger people. We use e-coaching and serious gaming to enable people to deal with the symptoms of disorders as well as possible, especially in the case of chronic illnesses, but also to encourage a healthy lifestyle. Oddly enough, standard healthcare is not particularly focused on empowerment and prevention, even though people really want this. That is what makes this research so fantastic and gratifying: it puts people first.’
You took the initiative to realise a large consortium in which care providers, civil society partners and researchers jointly work for a healthy lifestyle. How do you tackle that?
‘In our national consortium “Benefit for all”, people are rewarded for healthy behaviour. In our society, but also in how we are raised as children, we are strongly trained and conditioned to find unhealthy things pleasant. There is an incredible supply of unhealthy food, and from a biological and evolutionary perspective, our bodies are also designed to eat as much as possible. Merely looking at tasty food stimulates the reward systems in our brain. So whoever wants to live healthily could do with a bit of support. That is why we developed tools. Until recently, encouraging a healthy lifestyle was mainly about discipline. But in the long-term, particularly in stressful situations, this approach is not in the slightest bit appealing. A far better approach is to make healthy living fun. We must literally reward people for every type of healthy behaviour. Not just the outcome but simply for the fact that they are acting healthily and doing their best. Feedback by a coach or earning points for keeping a food diary or using a activity meter are just some of the many possibilities how people can be motivated.’
‘In the consortium, we are working together with organisations in the field of cardiovascular diseases, but we want to roll out the programme in far more areas. A lot of research is still needed into what works for whom. What works for an academic might not work for people with fewer qualifications. As a researcher, you can best consult the users: what do they experience as a reward? Behavioural changes are complex, but the interest in this has increased considerably in a short space of time, and my research fits perfectly within this.’
What do you plan to do with the Stevin Prize?
‘I've always wondered how you can make a real difference with your research by making new connections. And that is precisely what the Stevin Prize is about. So I will use the prize to make new connections. For example, I would like to encourage interdisciplinary research with a clear emphasis on connecting fundamental research with clinical applications. I'm also convinced that we can mainly generate impact by collaborating with other parties outside of science, which is what our consortium for healthy living does. I hope that receiving the Stevin Prize will make a real difference in this regard. I find it enormously encouraging that I can now continue to work at twice the pace on making new connections between science disciplines but also with society and arts. I think that I am a genuine lifelong bridge builder.’
Text: Marion de Boo, photography: Studio Oostrum/Hollandse Hoogte
Who is Andrea Evers?
1967 born on 7 February in Arnsberg (Germany) 1994
graduated from Bielefeld University (Germany) and the University of Amsterdam in clinical psychology and methods for behavioural change
became a junior researcher at the University of Amsterdam and subsequently a PhD student at Radboud University in Nijmegen where she also trained as a therapist
registered as a health psychologist
obtained her doctorate cum laude from Radboud University for her study into psychological determinants and treatments for rheumatoid arthritis. Received various prizes for this study
received a Veni grant from NWO. Completed her training as a cognitive behavioural therapist and psychotherapist
registered in the Netherlands as a clinical psychologist
received a Vidi grant from NWO for research into placebo effects and their counterparts, nocebo effects (negative expectations)
received NWO Aspasia grant for top female scientists
appointed Professor of Psychobiology of Somatic Disorders at Radboud University Nijmegen. Investigated placebo effects in chronic physical conditions and developed internet therapies (e-coaching)
appointed Professor of Health Psychology at Leiden University. Elected member of the Young Academy
received ERC Consolidator Grant for research into the influence of placebo effects on the immune and endocrine systems
received ERC Proof of Concept grant for the development of training courses for maximising placebo effects
received Vici grant from NWO for research into the influence of nocebo effects and became project leader of a large-scale national consortium to increase the attractiveness of healthy living
elected a member of the Royal Netherlands Academy of Arts and Sciences