Influencing your health with your behaviour and thoughts
Psychological processes have a major effect on the course of a disease and the effects of medical treatment. Researchers in the field of Psychoneurobiology examine the interactions between body and mind. They investigate the effects of stress as well as the effect of placebos and nocebos, which can lead to effective treatments with less medication.
We already know the placebo as a fake pill. You swallow something that the doctor says will help, and that's why it helps, even if you know it's a placebo. The research group headed by Professor of Health Psychology Andrea Evers showed that words can also have a negative effect on someone's complaints or symptoms. It seems that the way a physician communicates a message about a drug is very important. If a doctor lists serious but very uncommon side-effects of a medication when prescribing it, there is a greater chance that the patient will experience these side-effects. This kind of exacerbating factor is called a nocebo. The process can also be seen in the brain on MRI scans.
Conditioning your body
Researchers incorporate a placebo mechanism to improve existing treatments of chronic diseases, for example, in the case of rheumatism where patients would normally take medicines that can cause serious side-effects. In collaboration with the Rheumatology Department of Leiden University Medical Center (LUMC) and other centres, Evers investigates how a placebo or partial placebo can affect people with early rheumatism. The patients are first administered the usual rheumatism medication regimen.
Once their body is used to it, some of the medicine is replaced by a placebo. The purpose of the study is to show that the body can also fight the rheumatism on its own by making optimal use of the placebo effect. Although the effect will always be temporary, it would mean that patients could take a lower dose of medication for a period of time, which could significantly reduce the risk of serious side-effects.
Together with the LUMC, Evers is also implementing an innovative online coaching programme that enhances the quality of life of patients with chronic diseases and reduces their limitations in daily life. People with chronic conditions often experience a lot of pain and/or fatigue, they have frequent hospital appointments and have to take a lot of medication. The coaching programme helps them reduce the limitations they suffer and, if necessary, adjust their lifestyle. Evers: “Patients and doctors are very excited about this programme, and we’re very proud of it.”
The coaching complements the medical treatment well. Evers: “In regular care, an intervention is often either psychological or medical. We look at the total package: the behaviour, the personality, the physical reactions and the treatment – in short, everything. We can significantly contribute to healthcare with this approach.
Patients want more than just a pill. They also want advice on what they can do themselves; they are looking for help addressing problems with their lifestyle and are keen to do everything possible to stay as healthy as possible.”
That interconnection is actually very logical, Evers believes. "We are all somewhere on a spectrum between healthy and ill. In that sense, we are all patients. In the medical field, we can intervene more often in the disease process, even at a stage when people do not feel ill at all. ‘Prevention’ therefore no longer exists.”
Healthy lifestyle for everyone
The advice for both healthy and sick people is the same: better food, more movement. Evers is now applying her psychological insights to support people in adjusting their lifestyles. Punishment does not work; rewards do, and especially rewards in the short term. She is working on a reward system together with the Dutch Heart Foundation in which people save points by doing active sports and buying vegetables, for a discount on fun outings, or on a gym membership. Evers: “Make healthy living fun for everyone and you're there.”