Senior manager's note: The IASP Early Career Research Grant facilitates the development of young researchers just starting their careers as independent investigators. Here, we interview Kaya Peerdeman, one of the winners of the 2021 grant. (See our interview with Sarah Luthy, the other grant winner, here.)
Peerdeman is a postdoctoral researcher and assistant professor at the Health, Medical, and Neuropsychology unit of Leiden University, the Netherlands. Her research focuses on enhancing understanding of the mechanisms of expectancy, placebo, and nocebo effects on pain and other physical symptoms. Experimental studies bridging fundamental and applied research are key to her work, and she aims to contribute to improving clinical care and patients’ well-being through harnessing expectancy effects. In this interview, Peerdeman speaks with PRF Correspondent Manasi M. Mittinty, MD PhD, a lecturer at the University of Sydney, Australia, to discuss her career and research. What follows is an edited transcript of the conversation.
First off, a big congratulations on your IASP Early Career Research Grant. How does it feel to have won this year's grant?
Very, very good – I was excited to hear about it. It's very motivating, and it's about a project I'm particularly enthusiastic about. It gives me a push and spikes my enthusiasm to pursue this project with great energy.
Before we talk more about the grant project, let's start from the beginning: Can you tell me a little bit about your journey in the field of psychology, and what really inspired you to go in that direction?
I think, quite naively, that I got into psychology because I wanted to understand people – I wanted to better understand people close to me and other people in the world, and to try to find ways in which I could help people in need. I was particularly interested in psychopathology back then, and in trying to figure out how one could live life well, most happily and healthy.
At what point did you think of combining your interest in psychology with the study of pain?
That was when I was completing my master's degree. I was looking around for a PhD position and here, in the Netherlands, it's quite common to apply for a position for an existing project. On a national website where academic job vacancies are posted, I saw a PhD project about placebo effects on pain, itch, and fatigue. What really struck me was the phenomena of placebo effects and the mind-body interaction; I found it interesting to explore how the mind influences the body and how they interact with each other.
How do you define placebo and nocebo effects?
The first thing that you think about with placebo effects is a sugar pill that makes you feel better; it can relieve your pain. With nocebo effects, that sugar pill will make your pain worse or give you other harmful side effects. But what makes these phenomena highly interesting is that they are very relevant to many if not all medical treatments that we provide – the same mechanisms are at play – and this will have a significant influence on outcomes.
When we think about placebo effects, we think about effects of treatments that cannot be ascribed to the active ingredients of the treatment, but are rather due to other elements, such as the expectations that people have about the treatment and other factors. The nocebo effect is kind of the opposite of the placebo effect, where instead of having positive outcomes, there are negative outcomes due to expectations. For example, it could be that because you expect a treatment to make you nauseated, you actually become nauseated.
Which specific studies from your PhD research speak to the role of expectations?
Maybe the one that does it the best is a meta-analysis I did during my PhD, in which we looked at expectation interventions in patients with pain. We tried to see if verbal suggestions, conditioning procedures, or mental imagery could relieve pain, and if they could, we asked if they do so via the expectations they induce. What we saw is that verbal suggestions, which are basically short instructions such as “this treatment will relieve your pain,” are often studied and found to be effective, particularly for relieving acute pain.
For chronic pain, the effects are different – it seems to be less malleable via verbal suggestions. That makes sense, of course, because people with chronic pain have had many experiences with many treatments that were not effective for them.
So then we would think more about conditioning procedures. When we talk about conditioning, it's really having that personal experience that a treatment is effective, and you can manipulate it in the lab. There is extensive experimental evidence that conditioning can shape expectations and relieve people's pain, but the evidence for these effects in patients, in clinical settings, is still quite limited.
And what about mental imagery?
In our meta-analysis, we found that the evidence for mental imagery is also relatively limited. We had wondered if mental imagery – for example, imagining pain relief with, say, an image of warmth like a warm blanket or glove – would relieve pain. We thought that might actually be more powerful than verbal suggestions of pain relief because people are actively involved in mental imagery. But what we saw in the meta-analysis is that while mental imagery can be effective, it's not as effective as instructions.
What future research plans are you most excited about?
What I'm most excited about is the research project for which I received the IASP Early Career Research Grant.
Has your research for that grant started yet?
Yes. The idea there is that we look at the strength and the precision of expectations and how they shape pain experiences. What we see is that expectations tend to work as a self-fulfilling prophecy: If you expect pain to worsen, it will worsen, and if you expect pain relief, then you'll get pain relief. That's what you see in placebo research, and I think it's generally true. However, I always felt that this is too simple; there must be something more to it.
I've gotten really interested in the boundaries of expectations. Could it be that if you expect too much, it will work against you? Could it be that you actually experience more pain when you didn't expect any pain at all than when you were prepared for pain? In this research we will examine how the strength of the expectation, not just the valence – positive or negative – affects pain experience.
I'm also interested in the certainty of expectation. If you're highly certain that something will happen, the general idea is that this will have a larger impact on your pain experience. However, how certain can you really be in clinical practice? Physicians commonly prescribe analgesic treatments, but can they predict if it will improve an individual patient’s pain from a 9 to a 1, or from a 9 to a 5? You really can't make very precise predictions.
So I'm trying to learn: What are the optimal expectations for pain? Can it be helpful to be mildly positive, or highly positive? Or maybe it's even good to be a bit negative? Or should people simply be realistic, allowing also for uncertainty? Also, we should not just examine how intense the pain is that patients experience, but also their emotional responses, as these are important aspects of a patient's full experience. For example, how satisfied is the person with what happened, and how anxious are they?
Switching gears, are there any specific strategies that help you to be more focused and creative in your own work?
What helps me be more focused is to do one thing at a time – and that's something I am not always good at. I tend to want to do everything at the same time, and I tend to be distracted easily, if only by my own thoughts. But sitting down and focusing on one thing at a time is very helpful for me. For creativity, I think it's a little bit of a mixture: I need sufficient quiet time, but on the other hand, I have also noticed that the buzz of everyday life and particularly the buzz and activity that go with discussing things with people at conferences, or with colleagues in the hallway, or in scheduled meetings can be really inspiring and get me to be creative.
Have there been any challenging decisions that you have had to make along the course of your career so far? Any lessons from those experiences?
The most challenging decision was back when I had to choose what to focus my PhD on and who I would work with. I'm very happy with how that panned out. But there are smaller and larger challenging decisions to make on a daily basis. As an academic, you run into problems that need fixing every day, like when deciding upon a study design or analysis technique, or on how to communicate your thoughts.
What I've learned is that there's always a solution. It might not always be the best solution out there, or you might realize along the way that it comes with new challenges, but you'll find your way. So I have gained a certain go-with-the-flow attitude that helps me deal with all the challenges that come with our work.
What keeps you motivated?
Generally, I don't do anything consciously to keep me motivated, because I enjoy my job and the many different aspects of it, from the discussions to the writing to the analyses. Of course, sometimes you enjoy it more than at other times, and sometimes it’s just plain frustrating.
But what keeps me motivated is the idea, or maybe it’s just the hope, that what I'm doing is meaningful, that the research I do, even if it's just a tiny little bit, will contribute to improvements in clinical practice or to improvements in how people deal with their pain or with other symptoms.
Shifting gears again, what are your thoughts about writing a grant application? Do you have a process? Any advice?
I don't think there's a set process. But for me, what I do is just sit down and try to think, okay, what do I want to know? What do I think is meaningful? What might people want to know? And what can help move the field forward? Then I try to write that down.
And then, of course, I read the application over again and again, trying to see if the argumentation is clear and if other people would understand it. I recommend having other people read it because what's obvious to you might not be so obvious to others.
What I enjoy most about writing a grant is that it really gets you to dive into a new idea and forces you to really think it through – to really think about the value of it and what you can truly contribute to the literature and daily life.
In the end, if you look at grant writing, the odds are against you, right? Not so much in the writing but whether you get the grant or not. So even if this one grant doesn't work out, maybe you can use the idea somewhere else, for another project.
What is the best career advice you ever received?
Over the years, I've received advice from different people saying something that boils down to this: Do what suits you best, and do what you find important and meaningful. That's advice I've gotten from my parents and from people around me. It is helpful during the times when you have to choose what you’ll study in university, when you have to choose what you want to focus your research on, or when considering whether you even want to do research in the first place. Do what suits you.
Thank you so much, Kaya, for taking the time to chat with me today. I'm sure many readers will benefit from your insights on research and careers. Best of luck for your future projects, and I look forward to learning about what findings emerge from your research.
Thank you Manasi; that's so kind of you.
PRF Correspondent Manasi M. Mittinty, MD PhD, is a lecturer at the University of Sydney, Australia.