MID-TERM SELF-EVALUATION REPORT:
CoRPS - Center of Research on Psychology
in Somatic diseases
2008-2010
Tilburg University
School of Social and Behavioral Sciences
April, 2011
Introduction
Despite the commonly held belief that psychological stress has a negative impact on health,
this relationship is often considered to be merely folklore within the medical community. In recent
years, accumulating evidence suggests that people differ in their level of vulnerability to stress-related
medical conditions. Depression, anxiety and distressed personality have been shown to have a
negative impact on the clinical course of these conditions. Changes in the immune, endocrine and
nervous systems can partly explain these adverse effects on health. In addition, psychological factors
should not be ignored in the medical context because patients themselves play an increasingly
important role in the optimal care for their medical condition. Given the chronic nature of conditions
such as heart disease, hypertension, diabetes or cancer survivorship, psychological factors are
becoming increasingly important in today’s health care.
However, it is not clear yet how person-related differences in vulnerability to chronic
medical conditions can be best understood, indicating the need for interdisciplinary research at the
interface between mind and body. In 2007, the Tilburg research program on the importance of
psychological factors in patients with cardiac conditions was honored the national “Science and
Society Award” by the Royal Netherlands Academy of Arts and Sciences as a token of its high
relevance to society. Eventually, this relevance to patients and to the international community
prompted the start of a new interdisciplinary research center at Tilburg University in 2008.
The Center of Research on Psychology in Somatic diseases (CoRPS) of Tilburg University
addresses the growing need for research at the interface of mind and body. CoRPS is an initiative of
the School of Social and Behavioral Sciences and the executive board of Tilburg University, in close
collaboration with the St. Elisabeth and TweeSteden teaching hospitals (Tilburg), the Cancer Registry
South (Eindhoven, NL) and the primary care organization POZOB (Veldhoven, NL). The CoRPS
program was designed to investigate under which conditions psychological factors may interact with
the clinical course of chronic diseases, to better understand these interactions, and to influence these
interactions for the benefit of the patient. This research crosses traditional borders between
scientific disciplines, and should offer new perspectives on the risk-stratification and optimal
treatment of patients with chronic conditions.
Admittedly, this is an ambitious agenda that requires high-quality studies including longterm follow-up, behavioral intervention, experimental study designs, and close collaboration across
different areas of methodological and clinical expertise. This report on the initial phase of the
research center (2008-2010) evaluates the extent to which CoRPS has been successful in initiating
research projects, acquiring funding and reporting findings that address this agenda.
Prof. dr. Johan Denollet,
Academic director CoRPS
TABLE OF CONTENTS
1.
Tilburg University & School of Social and Behavioral Sciences ......................................... 1
2.
CoRPS research program ................................................................................................................. 4
2.1 Mission statement of CoRPS .............................................................................................................4
2.2 Objectives of CoRPS: Innovation through interdisciplinary research .............................4
2.3 Thematic areas of research & target groups..............................................................................4
3.
Organization & funding .................................................................................................................... 7
3.1 Governance ..............................................................................................................................................7
3.2 Academic staff ........................................................................................................................................7
3.3 Partner organizations..........................................................................................................................8
3.4 Funding .................................................................................................................................................. 10
4.
Research environment and SWOT analysis............................................................................ 12
4.1 International position ...................................................................................................................... 12
4.2 Network ................................................................................................................................................. 12
4.3 Criteria and quality control for international collaborations .......................................... 13
4.4 SWOT Analysis: Strengths, Weaknesses, Opportunities and Threats .......................... 13
5.
Output, quality & relevance ......................................................................................................... 17
5.1 Publications on risk stratification and outcome assessment........................................... 17
5.2 Publications on mediating mechanisms ................................................................................... 18
5.3 Publications on clinical care and behavioral intervention................................................ 19
5.4 Publications on methodology and medical statistics .......................................................... 19
5.5 Editorial comments, meta-analyses, and review papers ................................................... 20
5.6 Book chapters and professional publications ........................................................................ 21
5.7 Societal relevance .............................................................................................................................. 21
6.
Research training............................................................................................................................. 23
7.
Strategy................................................................................................................................................ 24
7.1 Opportunities for future research ............................................................................................... 24
7.2 Looking into the future: What is most important on the agenda? ................................. 24
Appendices
1. Evaluation criteria and deliverables
2. Publications in target journals (2008-2010)
3. External funding
4. Acquired grants for participating centers
5. Completed PhD projects
6. Current PhD projects
7. Organization chart
8. H-Index & Citationscore
9. Affiliates
10. Organization of Academic meetings
11. Visibility: Keynotes, invited lectures and presentations
12. Media appearances (2010)
13. Academic reputation senior research staff
14. CoRPUS magazine
1. TILBURG UNIVERSITY & SCHOOL OF SOCIAL AND BEHAVIORAL SCIENCES
Tilburg University
Research and education at Tilburg University is organized in 5 schools:
1.
2.
3.
4.
5.
Economics and Management
Social and Behavioral Sciences
Law
Humanities (Communication, Culture, Philosophy and Religion)
(Catholic) Theology
In addition to these schools, Tilburg University has a number of well-established research
centers and graduate schools and a TiasNimbas Business School.
At the university approximately 1700 people are employed, 990 of which as scientific staff. The
number of students is about 12700; 3500 of them are first year students.
School of Social and Behavioral Sciences
In its research and educational programs, the Tilburg School of Social and Behavioral Sciences
focuses on issues of both an intra-individual and an extra-individual nature. Social, cultural, and
behavioral phenomena are prominent. This means that both individual persons, social
aggregates of persons, and social systems (groups, networks, organizations, and societies) are
examined. The mission of the Tilburg School of Social and Behavioral Sciences is to become not
only an up-market player in academic education and research in the social and behavioral
sciences in the Netherlands, but also a full-fledged competitor in the international academic
arena in certain core areas.
The Tilburg School of Social and Behavioral Sciences offers bachelor and master programs in the
following areas:
•
•
•
•
•
Psychology
Sociology
Organization Studies
Human Resource Studies
Leisure Studies
The school was founded in 1963. At present, the number of new students is about 550 and the
total number of bachelor and master students is about 2500. The school counts 40 full
professors and the total number of employees is 430. Among these are 100 contract PhD
students. The number of PhD-theses defended in 2010 is 48.
Research is organized in 12 research programs (incl. program director):
1.
2.
3.
4.
5.
6.
7.
Medical Psychology (Prof. Johan Denollet)
Conscious and Unconscious Processing (Cognitive Neurosciences) (Prof. Jean Vroomen,
Prof. Bea de Gelder)
Attachment, Emotion Regulation and Psychopathology (Clinical Psychology) (Prof. Marrie
Bekker)
Developmental Psychology (Prof. Bea van de Bergh)
Social Decision Making (Social Psychology) (Prof. Marcel Zeelenberg)
Behavior in Cultural Context (Cross-Cultural Psychology) (Prof. Fons van de Vijver)
Social and Cultural Dynamics (Sociology) (Prof. Matthijs Kalmijn)
1
8.
Relational perspectives on adaptive organizations (Organization Studies)
(Prof. Marius Meeus)
9. Human Resource Management and Performance: In search of balance (Prof. Jaap Paauwe)
10. Leisure Studies (Prof. Greg Richards)
11. Tranzo (Transformation of the nature and quality of care and welfare) (Prof. Henk
Garretsen)
12. Latent variable models for complex data from comparative research (Prof. Jeroen
Vermunt)
In 2008, researchers of the groups in Medical Psychology, Cognitive Neurosciences and
Methodology and Statistics joined forces with medical institutions in the interdisciplinary
research center of CoRPS. There is also a growing and intensive cooperation with the Tilburg
School of Economics and Business Administration. Researchers from the Tilburg School of Social
and Behavioral Sciences in the field of Social Psychology have established joint projects with
researchers in the field of Marketing and Experimental Economics. The foundation of the
interdisciplinary research institute Tiber has been one of the consequences of these joint
interests.
Next to CoRPS and Tiber, other local collaborations exist. The Tilburg School of Social and
Behavioral Sciences has joined forces with the School of Humanities in the interfaculty research
institute Babylon, the Centre for Studies of the Multicultural Society. In 2008, researchers from
the department of Organization Studies together with their colleagues from the Department of
Strategy and Organization from Economics started to participate in the new Center for
Innovation Research (CIR). Together with researchers from the Tilburg Law School, researchers
from Clinical Psychology and Developmental psychology have been undertaken some projects
within Intervict. This center focuses on research on victims and Forensic psychology. Finally, the
Tilburg School of Social and Behavioral Sciences participates in the new Netspar initiative.
Netspar is a new high-profile network for research and education in the field of saving, pensions,
aging, and retirement. This institute is chaired by the Tilburg School of Economics and Business
Administration.
Oldendorff Research Institute
The Oldendorff Research Institute (ORI), founded in 2001, is the home to all fundamental
research activities of the School and to the (local) Graduate School. The main functions of the
institute are as follows:
1.
2.
3.
4.
Preparation of research policy (e.g., initiating external and mid-term evaluations and
preparing (and disseminating) information about the output quantification, laboratory
facilities, and requests for ad-hoc funding or projects);
Graduate School: Monitoring for contract PhD’s (mainly process oriented, together with
supervisors within the departments who take care of the substantive supervision) and
providing support for extramural promotions;
Maintaining regular contacts with program leaders on program, research policy, research
calls (EU, NWO, or other institutions), etc. and
Management of research output database.
Strategy and Growth
The objective of the Tilburg School of Social and Behavioral Sciences’ research policy has been to
considerably improve the quality of research while retaining a high level of productivity.
Strategic plans of the Tilburg School of Social and Behavioral Sciences and Tilburg University
2
have invariably emphasized the need for a strong research focus of the school and to bring or
maintain the research groups at an internationally recognized level.
The Tilburg School of Social and Behavioral Sciences has been very successful in improving the
quality of research. In all external evaluations of the last four years, research programs of the
Tilburg School of Social and Behavioral Sciences received grades for “quality” and “productivity”
between 4 and 5. Furthermore, a large number of grants were received by its researchers. One
of the consequences of these successes was that the number of research staff increased from
66 fte (=full-time equivalent) in 2003 to over 130 fte in 2010. The number of PhD students
increased from 50 in 2003 to 100 in 2010.
3
2. CORPS RESEARCH PROGRAM
2.1
Mission statement of CoRPS
According to the mission statement of CoRPS, optimal health care for patients with chronic
conditions should identify patients at risk, monitor health outcomes that are immediately relevant
for patients, and intervene with programs of care that enhance patients’ quality of life and selfmanagement of their condition. Therefore, the mission of CoRPS is straightforward: To further
uncover the complex nature of the interface between the human mind and body.
2.2
Objectives of CoRPS: Innovation through interdisciplinary research
CoRPS has the ambition of becoming a leading research institute in Europe in the area of psychology
and somatic disease. To enhance innovative research at the interface between mind and body, CoRPS
consists of a young, dynamic and motivated group of researchers who collaborate with researchers
from other academic centers in the Netherlands (Rotterdam, Utrecht, Groningen and Maastricht),
Europe and the United States. CoRPS is unique for a number of reasons, such as its interdisciplinary
mix of researchers from psychology, medicine and biology, and the integration of the CoRPS research
program in the training of psychology students who enroll in the 2-year Master program on Medical
Psychology at Tilburg University. Given the mission statement of the research institute and its focus
on research on the interface between medicine and psychology, a multidisciplinary approach that
involves expertise from other health-related scientific disciplines is pivotal. This includes a close
collaboration with medical specialists, biologists and other bio-medically oriented disciplines.
2.3
Thematic areas of research & target groups
To achieve its ambitions, the CoRPS research program focuses on four groups of patients with
chronic medical conditions (cardiovascular disorders, diabetes and hypertension, cancer & cancer
survivorship, neurological disorders). Criteria for selecting these conditions include the following: (a)
high level of disease burden in terms of frequency and impact of the medical condition; (b) relevance
to the medical profession as expressed by both general practitioner and medical specialists; (c)
feasibility of psychological research in terms of screening, intervention, and detection of disease
mechanisms; (d) scientific merit both in the national and international context; (e) expertise of the
researchers from Tilburg University and the hospitals participating in the research institute. Co
morbidity between the various conditions is an explicit subject of study. Other groups of patients can
be studied when there is sufficient connection to the researcher’s expertise and when high level
research results can be expected. Next to this more clinical research, CoRPS staff is also involved in
more fundamental research. In the Department of Medical Psychology and Neuropsychology,
researchers in the area of cognitive neurosciences have state-of-art knowledge of cognitive processes
in the brain, and are specialized in the use and interpretation of techniques of neuro-imaging (fMRI
research).
Research focuses on a central issue that is timely and of immediate relevance to the medical
community. Eventually, the insights gathered by the research program of CoRPS will have to
contribute to a significantly better disease management care for the medical conditions under study.
4
The following areas of research fields are covered by the CoRPS research program:
A. Risk stratification and outcome assessment
The central research question in this thematic area is:
“How can we best establish which medical patients are at an increased risk for poor health outcomes,
despite state-of-the-art medical treatment?”
This research focuses on risk stratification and outcome assessment. Important examples of risk
stratification are the diagnosis of depression and the assessment of emotional distress, because
emotions are known to play a role in the clinical course of chronic conditions and non-adherence to
medical treatment. Outcome assessment not only refers to somatic recovery and prognosis, but also
to patient-reported outcomes, including health-related quality of life and self-reported symptoms in
particular. Patient-reported outcomes have become an important focus of attention in the optimal
care in many chronic somatic diseases.
Examples of recent CoRPS publications on risk stratification and outcome assessment include the
importance of anxiety for the incidence (Roest et al., Journal of the American College of Cardiology,
2010) and progression (Martens et al., Archives of General Psychiatry, 2010) of coronary heart disease,
the association between depression and vascular co-morbidities in diabetes patients (Koopmans et
al., Diabetologia, 2009), patient-reported outcomes among melanoma survivors (Mols et al., European
Journal of Cancer,2010) and post-myocardial infarction patients (Mols et al., Heart,2010), and the
incremental predictive value of the distressed personality type (Denollet & Pedersen, Archives of
Internal Medicine, 2008).
B. Mediating mechanisms
While the first area of research addresses the question which patients may be at an increased risk for
poor health outcomes, the second thematic area of research focuses on how we can conceptualize
and understand the mediating mechanisms that may explain the fact that some patients are at higher
risk for poor health outcomes as compared to others. Hence, the central research question in this
thematic area is:
“Which biological and behavioral mechanisms can explain why many patients do not respond optimally
to state-of-the-art medical treatment?”
Some examples of CoRPS publications on biological mechanisms include the importance of
depression and anxiety as predictors of decreased heart rate variability after myocardial infarction
(Martens et al., Psychological Medicine, 2008), the role of ventricular arrhythmia after implantable
defibrillator treatment in anxious Type D patients (van den Broek et al., JACC, 2009), the association
between depression and markers of inflammation in fibrosis (Kop et al., Brain, Behavior and
Immunity, 2010) and increased cardiovascular mortality (Kop et al., Psychosomatic Medicine 2010),
the relationship between hostility and T-cell cytokines (Mommersteeg et al.,
Psychoneuroendocrinology,2008), the importance of proinflammatory cytokines in health related
quality of life among patients with chronic heart failure (Mommersteeg et al., Brain, Behavior and
Immunity, 2010), and the association between the distressed personality type and inflammatory
activation (Denollet et al., American Journal of Cardiology,2009) and oxidative stress (Kupper et al.,
Psychosomatic Medicine,2009) in patients with chronic heart failure.
C. Clinical care and behavioral intervention
The third thematic area of research addresses the aim of CoRPS to contribute to a better disease
management care for patients with chronic medical conditions. The researchers of CoRPS work
closely together with clinical practitioners to examine the effects of different treatment modalities. In
addition, some of the members of the CoRPS staff have already been involved in clinical training and
combine scientific work at the university with a professional career in the clinical setting. For
example, Dr. Sitskoorn has been appointed as a professor in clinical neuropsychology, and is involved
5
in clinically-oriented research about the plasticity of the human brain, which is of high relevance in
the treatment neurological degradation.
Accordingly, the central research question in this thematic area is:
“What kind of biomedical and behavioral interventions are successful at improving prognosis,
enhancing quality of life, and preventing disease onset?”
Examples of CoRPS publications on clinical care and behavioral intervention include the importance
of financial concerns and health care insurance on delays to hospital presentation in acute
myocardial infarction (Smolderen et al., Journal of the American Medical Association, 2010), the
psychological outcome of a second operation in breast cancer patients (den Oudsten, International
Journal of Cancer, 2010), antidepressant treatment in patients with diabetes mellitus (Bot et al.,
Journal of Affective Disorders, 2010), cognitive rehabilitation in patients with brain tumors (Gehring
et al., Lancet Neurology, 2008; Journal of Clinical Oncology, 2009), and the effect of internet-based
cognitive behavioral therapy on sub threshold depression in middle-aged individuals (Spek et al.,
Psychological Medicine, 2008) and on anxiety and device concerns in cardioverter defibrillator
patients (Pedersen et al., Trials, 2009) .
D. Methodology and medical statistics
The fourth thematic area of research focuses on the enhancement of methodological and
statistical approaches in the medical context. The complex nature of studies with a longitudinal
design, repeated measurement, or experimental manipulation requires substantial
methodological and statistical expertise. Therefore, researchers from the Department of
Methodology and Statistics participate in CoRPS to enhance the methodological quality of
studies. This includes the application of new methods for analyzing measurement scales as well
as categorical and continuous data from longitudinal, experimental and biological research in
the medical context.
The central research question in this thematic area is:
“How can we best study and analyze the complex nature of the interface between the human body
and mind?”
6
3. ORGANIZATION & FUNDING
3.1
Governance
CoRPS has a board of directors, consisting of the academic director and the managing director. The
board is appointed by the dean of the Tilburg School of Social and Behavioral Sciences. The academic
director Prof. dr. Johan Denollet bears the final responsibility for the overall research program. The
academic director ensures that the quality of this research program adheres to high scientific
standards. The managing director Ms. Kitty Boermans is responsible for the internal organization,
human resource management, the budget, communication with partners, and external relations.
The board of directors has appointed a number of program coordinators who act as key advisors
across the various research domains. The program coordinators supervise the researchers and PhD
students of CoRPS who are working in a particular area of research, and contribute to the scientific
vision and research agenda of CoRPS. Progress in the performance of the research programs and,
progress of CoRPS in general, is regularly discussed between the board of directors and the program
coordinators.
At the start in 2008, the institute planned to establish an Advisory board. This board would advise
the board of directors and the dean of the Tilburg School of Social and Behavioral Sciences, solicited
and unsolicited, on the composition and aims of its research program, the evaluation of its activities,
the determination of its policy and budget, as well as the joining of new partners of CoRPS. Also a
Scientific council would be established. This council should consist of renowned international
scholars with expertise in the research area of CoRPS. Its task would be to advise the board of
directors, solicited and unsolicited, on the aims of the research programs and the evaluation of the
activities. The scientific council should assure that CoRPS operates in accordance with its aims and
the members of the scientific council should also promote CoRPS in the international academic arena.
So far, both the Advisory board and the Scientific council have not been established yet. Since the
institute is quite young, much time was invested on setting up the various research programs. Should
the mid-term review lead to a positive outcome, the board of directors aims to approach people for
both counseling bodies, in consultation with the program coordinators.
Both researchers from the Academic Staff of the Tilburg School of Social and Behavioral Sciences and
researchers from associated partner organizations participate in the research program. The profile of
Academic staff, participating external institutes will be briefly discussed. Next, information will be
provided on the funding of CoRPS by direct funding and the acquisition of external research funding.
Appendix 7 provides more detailed information on the CoRPS organization.
3.2
Academic staff
The academic staff of CoRPS includes both Tenured (Full, Associate, and Assistant professors) and
Non-Tenured (Assistant professors, Post-doc researchers, PhD students) staff. An overview of the
staff is presented in Table 1. Appendix 13 provides more background information on the academic
reputation of the senior research staff of the CoRPS research institute. People of the academic staff
have published in a large number of high-quality journals, have been awarded a number of prizes and
grants, and have actively participated in professional associations, journal boards and the
organization of international scientific meetings. As of January 2011, one of the senior staff members
of CoRPS, Prof. W.J. Kop, has been appointed as the new Editor-in-Chief of ‘Psychosomatic Medicine’,
the official journal of the American Psychosomatic Society.
The H-Index and citation scores of the CoRPS senior staff members are presented in Appendix 8. As
shown in this Appendix, a number of tenured staff members has an H-Index >20 and a total number
of citations >1,000. Given the recent start of the CoRPS research program, these figures are projected
to further increase substantially in the next couple of years.
7
Tenured staff
(in fte’s)
Non-tenured
staff
(in fte’s)
Full professors
Associate professors, incl. senior lecturers (uhd) and senior
researchers
Assistant professors, incl. lecturer (ud) and researchers
Total tenured staff
Assistant professors, incl. lecturer (ud) and researchers
Researchers
1
Phd students
Total non-tenured staff
Total staff
Table 1 Research staff
2008
3.01
1.90
2009
4.15
1.55
2010
3.88
2.05
2.76
7.67
3.16
8.86
2.75
8.68
1.50
3.99
16.00
21.49
2.45
4.43
26.00
32.88
1.80
5.45
29.00
36.25
29.16
41.74
44.93
At the start of CoRPS, the university’s Executive Board pointed out the limited amount of senior staff,
compared to the ambition to attract a large number of PhD’s and postdoctoral fellows in 2008-2012.
Partly due to this, the board of directors of CoRPS has strengthened the institute’s senior capacity,
and thus the supervising capacity, by appointing a fulltime professor (Dr. Kop) in 2010, and two parttime professors (Drs. De Jonge and Sitskoorn), a part-time associate professor (Dr. Van de Poll) and a
full-time associate professor (Dr. Pouwer) in 2008. These developments have led to the broadening
of the research scope from cardiovascular conditions to include research programs in oncology and
cancer survivorship, diabetes, clinical neuropsychology and basic research that are headed by wellestablished researchers.
The number of researchers participating in CoRPS has substantially increased in the last couple of
years. Next to appointing these senior staff members, between 2008 and 2010, 25 PhD’s and 12
postdoctoral fellows have been appointed since 2008. As a result, there is a slight imbalance between
the large number of junior researchers as compared to the number of senior staff. In the near future,
a number of associate professors will be promoted to (part-time) full professors, and will act as
research directors of specific interest groups (e.g., psycho-oncology, device therapy, experimental
research, etc.) that address the research activities of non-tenured staff. Once a year, the professional
activities and progress of each of the academic staff members are formally evaluated by their
immediate supervisor. The professional activities of the full professors are evaluated by the academic
director of the CoRPS research institute.
Once a week, all researchers participate in the CoRPS research meeting. During this meeting,
research plans and projects are presented and discussed by junior and senior researchers from
CoRPS. Once a month, there is a journal club were recent publications in the scientific literature are
being presented and discussed, and there also is a research colloquium with an external expert
presenting his/her research in medical psychology or neuropsychology. Each of the PhD students is
being supervised by an advisor and a promoter who meet with the PhD student on a regular basis.
Finally, motivated students from the Bachelor and Master programs of the department of Medical
Psychology and Neuropsychology are invited to participate as voluntary research assistant in
ongoing CoRPS research projects of both junior and senior staff members.
3.3
Partner organizations
Given the mission statement of the research institute and its focus on research on the interface
between medicine and psychology, a multidisciplinary approach that involves expertise from other
health-related scientific disciplines is pivotal. This includes close collaboration with medical
specialists, biologists and other biomedical disciplines. In order to achieve this aim, the departments
of Medical Psychology, Cognitive Neurosciences and Methodology and Statistics of Tilburg University
1
1,0 fte per PhD student
8
have to rely on a solid strategic alliance with partners from the medical community that have an
excellent clinical profile and an established scientific expertise.
In line with naturally evolving processes in the research collaborations over the past few years, the
CoRPS research institute started with an institutional embedment in Tilburg University and the St.
Elisabeth and TweeSteden teaching hospitals in Tilburg. The Department of Medical Psychology at
Tilburg University has developed close relationships in research with both hospitals over the past
few years. The ongoing collaboration with the St. Elisabeth hospital resulted in a comprehensive
agreement on cooperation in terms of research and education in 2003. As from this time, a member
of the Department of Medical Psychology acts as a research officer, bringing in methodologicalepidemiological support. Specialists and psychologists from the St. Elisabeth hospital also participate
in the 2-year Master program of Medical Psychology. In 2006, the St. Elisabeth hospital sponsored the
foundation of a shared chair in Quality of Life in the Medical Setting, held by Dr. Jan Anne Roukema
(surgeon) and Dr. Jolanda de Vries (psychologist) who were also appointed to intensify their joint
research program on psycho-oncology.
As of January 2007, the TweeSteden hospital also decided to anchor its scientific collaboration with
the Department of Medical Psychology in the context of a more comprehensive covenant. The
TweeSteden hospital and the department have been working together for several years on research
projects on cardiovascular disorders, and in the internship of students from the Master Medical
Psychology. They also have the intention to extend this collaboration to other relevant fields of
medical expertise. A staff member of the department started in January 2007 as a research officer in
this teaching hospital.
These close collaborations offer the researchers the necessary access to data (since the research
program focuses on patients with chronic disease) and infrastructure. Financially, both hospitals
contribute €625.000 each to the CoRPS budget in the period 2008-2012. There is a proper
deliberation with the Executive Boards of these hospitals on the spinoff of their contribution to
CoRPS on their own ambitions in the area of care, research and education.
In 2008 (the year CoRPS was initiated) two new partners joined the research center. The ongoing
research collaboration with the Cancer Registry South (Integraal Kankercentrum Zuid or IKZ) was
converted into a structural partnership. Arrangements have been made about the access to the IKZexpertise and infrastructure and the sponsoring of two PhD positions.
A similar construction was made with the POZOB collaboration of general practitioners
(Praktijkondersteuning Zuid-Oost Brabant). CoRPS gains access to data and infrastructure of POZOB
and receives direct funding. This collaboration has led to the start of 8 PhD projects.
With the research and education centers of the Catharina Hospital Eindhoven and the Amphia
Hospital Breda, agreements exist about seconding of CoRPS postdocs who act as research
coordinators within these large teaching hospitals.
9
3.4
Funding
The sources and amount of direct and external funding of CoRPS during the first three years are
summarized in the table below.
Department of Medical Psychology and
Neuropsychology
Tilburg School of Social and Behavioral Sciences
Tilburg University
Oldendorff Research Institute (funding for contract
PhD’s)
Total 1st money stream
2008
€ 75,000
€
2009
75,000
€
2010
75,000
€ 75,000
€ 333,000
€ 75,000
€ 267,000
€
7,000
€ 75,000
€ 200,000
€
9,000
€ 483,000
€ 424,000
€ 359,000
€ 150,000
€ 184,000
€ 60,000
€ 603,000
St. Elisabeth Hospital, TweeSteden Hospital, IKZ
POZOB (Collaboration General Practitioners)
Total direct funding
€ 633,000
€ 155,000
€ 55,000
€ 634,000
Research grants (NWO and ZonMw)
Contract research (Philips, KWF, Diabetesfonds)
2
Total external funding
€ 19,000
€ 19,000
€ 380,000
€ 148,000
€ 528,000
€ 1099,000
€ 273,000
€ 1372,000
Total direct and external funding
€ 652,000 € 1,162,000
Table 2 Funding of CoRPS across the initial 3 years of the research center.
€ 1,975,000
According to the Evaluation Criteria and Deliverables (please see Appendix 1), the institute should
demonstrate its ability to receive sufficient funding from NWO and other scientific organizations over
a five year period of time (2008-2012). After three years, it is already clear that CoRPS not only will
meet these targets, but rather lives up to the financial agreement as stated in the CoRPS regulations
by far and large. In the first three year of its existence, CoRPS has acquired a total of
€ 3,789,000,- of direct and external funding. To Dutch standards, this represents a very substantial
amount of funding.
2008 2009 2010
Direct funding
97%
55%
31%
External funding
3%
45%
69%
Total funding
100% 100% 100%
Table 3 Percentage of direct and external funding of CoRPS.
Moreover, as shown in Table 3, there is a gradual increase in the proportion of external funding as
compared to direct funding across the years. As a result, the initial 5-year target of € 1,500,000
external funding (which equals the funding of Tilburg University across the 5-year time period), has
already been exceeded by € 419,000 at the midterm review of the initial 3 years (€ 1,919,000
external funding between 2008 and 2010).
Researchers from CoRPS have been successful in acquiring external research funds and personal
grants. Because of this success in generating external funding, a large number of PhD projects have
been initiated in the past three years. Below is a brief overview of a number of these grants. A more
detailed overview of these and other acquired research grants is provided in Appendix 3 and 4.
Dr. Pouwer was awarded a research grant by NWO - the Netherlands Organisation for Scientific
Research (€ 459,681) for his research proposal on disease management of primary care patients
with type 2 diabetes and/or chronic obstructive pulmonary disease and co-morbid depression. Drs.
Sitskoorn and van Boxtel received a grant by Philips industries (€ 320,000) for their research
2
Total of assets received from subsidizing organisations in a financial year.
10
program on the effects of neurofeedback. In the area of cancer, several CoRPS researchers were
supported by several research grants from the Dutch Cancer foundation: Dr. Gehring for her research
on treatment of cognitive deficits in patient with primary brain tumors (€ 277,500), Dr. Den Oudsten
for her research on the sexual functioning after treatment of colorectal cancer (€ 258,000) and Drs.
De Vries and Roukema for their research on the effects of chemotherapy and cognitive functioning in
breast cancer patients (€ 113,400). Dr. Van de Poll-Franse was awarded a € 599,000 grant (NWO the Netherlands Organisation for Scientific Research) and a € 356,500 grant (Dutch Cancer Fund) to
examine patient-reported outcomes and the effects of medical treatment among long-term cancer
survivors. Dr. Pedersen was awarded a € 459,999 research grant for her research on the effects of a
web-based distress management program for patients with an implantable cardioverter defibrillator.
Researchers from CoRPS have also been honored with innovation research grants (VENI – VIDI – VICI
program) by the Netherlands Organisation for Scientific Research. In the category of young highpotental researchers, both Dr. Mols and Dr. Smolderen were awarded a VENI research grant
(€ 250,000 each) for their innovative research on Type D personality in colorectal cancer patients
and on patient reported outcomes in patients with peripheral arterial disease, respectively.
Dr. Keetels also received a VENI research grant (€ 208,000) for her innovative basic research on
brain adaptation processes to temporal disturbances in this chain of motor-sensor events that can
occur in medical situations such as telesurgery. Dr. Tamietto was awarded with a VENI research
grant (€ 250,000 each) for his research on the neurobiology of emotional communication with multidimensional imaging techniques in both healthy subjects and brain-damaged patients.
In the future, more PhD students will be encouraged to submit a proposal for a VENI grant by their
program supervisor. As an established researcher, Dr. Pedersen received a prestigious VIDI grant (€
800,000) for her innovative research on the psychological impact of device therapy for the treatment
of heart disease. Dr. Denollet was awarded a VICI grant (€ 1,250,000) for research on personality and
cardiovascular disease from 2005 to 2010. Eventually, this VICI program prompted the start of the
CoRPS research center in 2008 with support of the executive board of Tilburg University.
11
4. RESEARCH ENVIRONMENT AND SWOT ANALYSIS
4.1
International position
The CoRPS faculty is internationally recognized for its scientific contributions to the interdisciplinary
fields of medical psychology and neuropsychology. In addition, multiple international collaborations
have been developed as evidenced by joint publications and active exchange of CoRPS PhD students
and post-doctoral Fellows to renowned universities and research institutes in the United States and
Europe. PhD students and post-doctoral Fellows from CoRPS have conducted research at various
institutions in the USA and Europe, including the University of California at San Francisco,
Washington University School of Medicine, MD Anderson Cancer Center, and the University of
Maryland. These “outreach” collaborations are complemented by several visiting professorships of
internationally recognized scholars to the CoRPS facilities (see Table below).
Regarding international reputation, innovative research findings from CoRPS-based projects have
been published in premier medical and psychology journals. A systematic summary of the CoRPS
scientific productivity is provided in Chapter 5 with substantial contributions in cardiovascular
diseases, diabetes, cancer, and neurological disorders. In addition to these prominent publications,
CoRPS faculty is actively involved in the leading academic societies of medical psychology and
neuropsychology, including the American Psychosomatic Society.
At the National level, recognition of CoRPS is reflected by the high success rate of securing research
funding for junior as well as senior faculty. In addition, CoRPS faculty actively participate in the
scientific review centers of the Netherlands Organisation for Scientific Research (Nederlandse
Organisatie voor Wetenschappelijk Onderzoek: NWO) and key foundations such as the Dutch Heart
Foundation.
4.2
Network
CoRPS members work closely together with researchers from the partner organizations. In addition,
the network of affiliated researchers reaches far beyond the local collaborators. Regular
collaborations on research projects exist with a large number of national and international
researchers within various disciplines. An overview of these affiliates is presented in Appendix 9.
From 2008-2010, CoRPS has welcomed several visiting scholars in various capacities (see below).
Dr. Jens Brock
Johansen MD
Prof. Samuel Sears
Dr. Willem Kop
Prof. John Spertus
MD
Phil Tully
Erla Alft Svansdottír
Kenneth Freedland
PhD
Prof. Matthew Burg
Prof. Karl-Heinz
Ladwig
Dr. Julian Thayer
Table 4 Visitors
Dep. of Cardiology, University Hospital Odense, Denmark
18 – 20 Mar. 2010
Dep. of Psychology, East Carolina University, USA
University of Maryland, School of Medicine, Department of
Cardiology, Baltimore, USA
Professor of Medicine, University of Missouri, Kansas City, and
Director of Outcomes Research, Mid America Heart Institute
PhD student Flinders Medical Center, Dept. Cardiac and
Thoracic Surgery / School of Psychology, University of Adelaide,
Australia.
Chartered psychologist, University of Iceland, PhD student
CoRPS.
Washington University in St. Louis, School of Medicine, Dep. of
Psychiatry, St. Louis, Missouri, USA
Columbia University of Medicine, Yale University, Section of
Cardiovascular Medicine, New Haven, Connecticut, USA
Institute of Epidemiology, Helmholtz Zentrum München,
German Research Center for Environmental Health GmbH
Ohio State University
17 – 20 Mar. 2010
Oct. 2009
19-23 Oct. 2009
May-Jun. 2009
Feb -May 2009
Sep- Nov. 2008
Nov. 2008
Sep. 2008 and Nov.
2008
Sep. 2008
Jan. 2008
12
In addition, CoRPS co-sponsors a monthly lecture series for the Department of Medical Psychology
and Neuropsychology with nationally recognized faculty from universities in the Netherlands and
Belgium.
4.3
Criteria and quality control for international collaborations
Selection of foreign institutions at which our junior faculty and PhD students conduct research
internships is based on specific criteria. All these extended international visits have to be approved in
advance by the CoRPS leadership and are evaluated using the following criteria:
-
-
A designated mentor is available with expertise in the CoRPS member’s research area (based
on publications and international scientific reputation)
This mentor will have weekly meetings with the CoRPS visitor
Availability of ongoing research projects from which the CoRPS member can learn
Availability of local office space for the CoRPS visitor
Assistance from the guest institution with finding housing and visa arrangements
It is preferred but not required that the visit will lead to a joint scientific publication
Funding for the visit is arranged in advance and can be obtained from three general sources:
extramural grant, intra-mural grant (from CoRPS or University of Tilburg), or a grant from
the foreign institution)
The CoRPS visitor reports back on a monthly basis to his/her supervisor in Tilburg with a
brief progress report (alternative reporting schedules can be arranged for extended visits)
For visiting scholars who are invited to Tilburg and collaborate with CoRPS faculty, the following
criteria are used:
-
4.4
The visiting scholar has expertise in a research area relevant to CoRPS
The quality of the visiting scholar should be high, based on publications and international
scientific reputation
The visiting scholar will give at least one presentation for CoRPS members and will be
available for individual meetings with CoRPS faculty and students
CoRPS will assist the visitor with travel arrangements and local accommodation
Funding for the visit is arranged in advance and can be obtained from three general sources:
extramural grant, intra-mural grant (from CoRPS or University of Tilburg), or a grant from
the foreign institution)
SWOT Analysis: Strengths, Weaknesses, Opportunities and Threats
4.4.1 Strengths
Advantages of CoRPS compared to other national and international research groups are related to
the quality of the academic staff, collaborations, the impact of the scientific work, new areas of
cutting-edge research, the embedment in a 2-year Master program in Medical Psychology, and the
location of the research center.
a.
Members: The CoRPS faculty and students are well-trained, motivated and productive
i.
ii.
iii.
iv.
High quality (virtually all have a MSc and PhD/MD)
Diverse background (psychology, biology, health sciences, medicine, etc.)
The CoRPS group size large enough for specialization and collaboration
Many CoRPS members are early in their career, which helps long-term growth within
CoRPS and future collaborations for those who take leadership positions outside of
CoRPS
13
b.
Collaborations: Local, National and International
i.
ii.
iii.
iv.
Tilburg University (Departments of Methodology and Clinical Psychology)
Local area hospitals and clinics (most Noord-Brabant hospitals collaborate with CoRPS)
National Academic Medical Centers (Rotterdam, Groningen, Utrecht, Maastricht)
International Academic Centers (Belgium, Denmark, Germany, Iceland, UK, USA)
c.
Impact of CoRPS research on the progress in medical psychology/neuropsychology
i.
ii.
iii.
High productivity (e.g., approximately 40 peer-reviewed publications in 2009)
High-impact journals; JAMA, Circulation, JACC, Psychosomatic Medicine
CoRPS members publish well-cited review articles in addition to original research
d.
New research areas: Because of our large and dynamic group, we conduct cutting-edge
research on clinical topics. New areas include:
i.
ii.
iii.
iv.
Peripheral artery disease,
Cardiac Resynchronization Therapy
Web-based interventions
Internet-based psychological assessments in cancer survivors
e.
Excellent 2-year Master Program in Medical Psychology
i.
The program is 2-years (following a 3-year Bachelor program), which is unique in the
Netherlands (commonly only 1 year)
New funding-lines will specifically target Master’s students
CoRPS can select new talent from our own students and send other talented students out
which can facilitate future collaborations
ii.
iii.
f.
Location of Noord-Brabant
i.
ii,
Less crowding than in other areas in the Netherlands
Less competition in hospitals from competing studies
Relevant resources to accomplish our activities include the following:
a.
b.
c.
d.
e.
Funding through CoRPS participating hospitals (pilot projects)
Excellent extra-mural funding acquisition (“tweede en derde geldstroom”)
Presence of our staff in local hospitals for statistical and methodological consultation
Unique 2-year Master’s program
Active participation of physicians in the teaching mission of the 2-year Master program
4.4.2. Weaknesses
The weaknesses of the CoRPS program lie largely in the fast growth of the institute, causing a slight
imbalance between junior staff and the senior staff that need to supervise the work. Next to that,
CoRPS researchers have to invest extra time in excellent relationships with medical research groups
outside the university.
a.
Embedment of junior staff within CoRPS
i.
The career policy of the School of Social and Behavioral Sciences puts equal importance on
research and on education. This leads to limited possibilities to retain junior researchers
in CoRPS, since they are less involved in teaching.
ii.
There is some imbalance in the CoRPS scientific staff, which is “top heavy” (full professors)
combined with “bottom heavy” (Masters and PhD students). This can be explained by the
14
very rapid growth of the CoRPS research program and its success in acquiring external
funding.
iii.
Many of the full Professors are actively involved in ongoing research programs in external
medical research groups. This implies that a number of their research activities take place
outside the university. CoRPS should monitor that sufficient time and attention is paid to the
supervision of our junior staff.
b.
Conducting medical research in a non-medical environment
i.
At the start of CoRPS, a deliberate choice was made to work within a university with a
specific focus on social and behavioral sciences. One of the consequences of this choice is a
lack of direct and easy access to high-end equipment such as fMRIresearch; equipment for
biological and genetic assays. Therefore, the institute is more dependent on national and
international collaborations with medical research groups to accomplish research in these
domains. The goal is to keep investing in relationships that can provide necessary resources
for these objectives.
ii.
Collaborating physicians do generally not have sufficient time allocated for research as their
primary duties pertain to clinical care
Based on these weaknesses we aim to execute the following activities:
a.
b.
c.
CoRPS should initiate collaborations with physician colleagues who are willing to spend
sufficient time and resources to invest in high quality research
Research proposals should be realistic in terms of opportunities within CoRPS and
Tilburg University
New research should not require more PhD students than we can manage. Special attention will
be given to this issue in monitoring the PhD training
4.4.3. Opportunities
Interesting trends in research and application for CoRPS
a.
b.
c.
d.
e.
Internationalization
The University has increasing interests in internationalization. CoRPS has excellent
international collaborations, which can be expanded to include a teaching component for
Master’s students
Valorization
The University is interested in promoting the translation of research into practical
applications. One entity within the university (TRANZO) already conducts research in this
area, but this is generally not linked to direct medical care.
Use of novel technologies
New technological developments will enable to promote cutting-edge research in the
biomedical area. Ambulatory methodologies are of particular interest as those are readily
applicable in the present medical settings.
Collaborations
CoRPS has the opportunity to develop collaborations with academic medical centers to
initiate collaborative efforts in which they can provide high-end technical equipment and
CoRPS can facilitate patient-based data.
Interventions
Given recent developments in the literature, the time is right for the development of
intervention studies. Those can be large-scale web-based interventions and/or smaller scale
mind-body interventions (stress reduction, mindfulness, psychotherapy, self-management
strategies)
15
f.
g.
Funding
CoRPS is in an excellent position to successfully apply for National and International
(particularly European) grants. We have a strong track record at the national level and are
therefore well equipped for this next step. Additional funding from industry, insurance
companies and other external sources will be beneficial in securing funds for tenured and
non-tenured researchers
Public awareness and public relations
CoRPS should allocate resources to promote public awareness (both locally and nationally)
of its activities and accomplishments.
Health in minority populations becomes increasingly important and CoRPS can expand its
research activities to include topics related to minority health.
CoRPS could play a leadership role in the development of international data bases relevant to
the interplay between psychological factors and adverse health outcomes.
4.4.4. Threats
The main threats for CoRPS are the recent reductions in the University’s budget as well as lower
average chances of securing extramural funding, the lack of a medical academic center needed for the
research in our area, and the fast growth of CoRPS and retention of junior faculty .
a.
Funding
i.
CoRPS is dependent on local hospitals for funding for some of its activities.
Constant efforts need to be made to retain these funding sources and to make CoRPS a useful
collaborator for these institutions
CoRPS members need to be more involved in the review boards of national and
international funding organizations. An active plan to take such positions needs to be
developed, as we are outperformed by our competitors on this domain
CoRPS does not have a systematic funding acquisition strategy, or a mechanism to
oversee quality and success of its funding applications. The newly developed
Scientific council may serve an important role in these activities
ii.
iii.
b.
Conducting research in medical patients in a non-medical academic center
i.
ii.
CoRPS needs to find collaborating institutions to conduct our research, particularly those
studies that require technological and/or biological measures that do not fall within the
typical research domains of Tilburg University. Existing collaborations exist but need to be
further consolidated and expanded. There are no national funding opportunities that directly
facilitate such collaborations and we need to spend time and resources to develop a strategy
to further develop such collaborations
Compensation and other incentives for participating physicians need to be developed
c.
Retention of junior scholars and communication in the fast growing CoRPS group
i.
Continued efforts need to be made to create new tenure track positions at the Departmental
level. A strategy plan to accomplish this needs to be developed.
ii.
CoRPS needs to work on additional systematic training models for its PhD students and postdoctoral Fellows. This may increase retention and help motivation. Education should only be
partly mandatory and largely individually-tailored on the student.
iii.
CoRPS needs to develop promising career tracks within the Dutch labor law restrictions.
Other venues are needed to retain talented faculty beyond the six-year limit of temporary
employment and a funding structure needs to be developed to make this possible.
16
5. OUTPUT, QUALITY & RELEVANCE
Innovative research findings from CoRPS -based projects have been published in premier medical
journals such as the Journal of the American Medical Association (Smolderen et al., 2010), Lancet
Neurology (Gehring et al., 2008) and top journals in general sciences such as Nature Reviews
Neurosciences (Tamietto & de Gelder, 2010), Nature Reviews Endocrinology (Pouwer, 2009) and the
Proceedings for the National Academy of Sciences (de Gelder (senior author) et al. 2009). In addition,
our work is published in journals with high impact factors in medical specialties (e.g., Circulation, the
Journal of the American College of Cardiology, Diabetes Care, European Journal of Cancer), basic
neuroscience (e.g., Journal of Cognitive Neuroscience), and medical psychology (e.g., Psychosomatic
Medicine, Brain, Behavior and Immunity).
The scientific output of CoRPS in the period from 2008 to 2010 stratified by type is displayed in Table
5. The primary output has been as scientific articles in international, peer-reviewed journals with a
mean of 108 publications per year.
Refereed articles (ISI)
Other refereed
Books
Book chapters
PhD-theses
Professional publications
2008
105
13
1
9
9
6
2009
115
13
0
4
8
3
2010
104
9
1
8
6
6
Table 5 Total research output
Based on the list of CoRPS target journals as presented in Appendix 2, divided into the fields of
Medical Psychology, Medical Specialties (i.e., Cardiology, Oncology, Diabetes, Neurology), Medicine, and
Basic Science, members of CoRPS have published 102 articles in target journals during the 3-year
period from 2008 to 2010. CoRPS researchers published in these journals as lead author (61 times),
as senior or second author (25 times), and as other author (16 times). These target journals serve as
a benchmark for evaluating the quality of CoRPS publications. In addition to these target journals,
CoRPS researchers published a large number of articles in other international, peer-reviewed
journals of high quality. For a complete list of all CoRPS publications, see website
http://www.tilburguniversity.edu/qualityassessment/corps/
A systematic overview of a number of these CoRPS publications is provided in the following
paragraphs, with substantial contributions in the four main areas of risk stratification, mediating
mechanisms, clinical care/intervention, and methodology/medical statistics. The publications listed
under the following subheading are not exhaustive but rather represent relevant illustrations of
ongoing CoRPS research in each of these different areas. For each of the thematic areas, 10
publications are listed as a prototypical example of the output of CoRPS (2008-2010).
5.1
Publications on risk stratification and outcome assessment
As previously described in the research program of CoRPS (Chapter 2), the central issue in this
thematic area is how can we best identify medical patients who are at an increased risk for poor
health outcomes, despite state-of-the-art medical treatment. Please find below a few examples of
recent CoRPS publications on risk stratification and outcome assessment (CoRPS researchers are
presented in boldface; IF= the most recent impact factor):
-
Roest, A.M., Martens, E.J., de Jonge, P., & Denollet, J. (2010). Anxiety and risk of incident coronary heart
disease: A meta-analysis. Journal of the American College of Cardiology, 56(1), 38-46. (IF=12.535)
-
Denollet, J. & Pedersen, S.S. (2009). Anger, depression, and anxiety in cardiac patients: The complexity of
individual differences in risk. Journal of the American College of Cardiology, 53(11), 947-949. (IF=12.535)
17
-
Martens, E.J., de Jonge, P., Na, B., Cohen, B.E., Lett, H., & Whooley, M.A. (2010). Scared to death? Generalized
anxiety disorder and cardiovascular events in patients with stable coronary heart disease: The Heart and Soul
Study. Archives of General Psychiatry, 67(7), 750-758. (IF=12.257)
-
Denollet, J., & Pedersen, S.S. (2008). Prognostic value of Type D Personality compared with depressive
symptoms. Archives of Internal Medicine, 168(4), 431-432. (IF= 9.813)
-
Koopmans, B., Pouwer, F., Bie, R.A., Leusink, G.L., Denollet, J. & Pop, V.J. (2009). Associations between vascular
co-morbidities and depression in insulin-naive diabetes patients: The DIAZOB Primary Care Diabetes study.
Diabetologia, 52(10), 2056-2063. (IF= 6.551)
-
Mols, F., Martens, E.J., & Denollet, J. (2010). Type D personality and depressive symptoms are independent
predictors of impaired health status following acute myocardial infarction. Heart, 96(1), 30-35. (IF= 5.385)
-
Martens, E.J., Mols, F., Burg, M.M. & Denollet, J. (2010). Type D personality and disease severity independently
predict clinical events after myocardial infarction. Journal of Clinical Psychiatry, 71(6), 778-783. (IF= 5.218)
-
Schiffer, A.A., Pelle, A.J., Smith, O.R., Widdershoven, J.W., Hendriks, E.H. & Pedersen, S.S. (2009). Somatic
versus cognitive symptoms of depression as predictors of mortality and health status in chronic heart failure.
Journal of Clinical Psychiatry, 70(12), 1667-1673. (IF= 5.218)
-
Martens, E.J., Hoen, P.W., Mittelhaëuser, M., de Jonge, P., & Denollet, J. (2010). Symptom dimensions of postmyocardial infarction depression, disease severity and cardiac prognosis. Psychological Medicine, 40(5), 807-814.
(IF= 5.012)
-
Mols, F., Holterhues, C., Nijsten, T. & van de Poll-Franse, L.V. (2010). Personality is associated with the health
status and impact of cancer among melanoma survivors. European Journal of Cancer, 46(3), 573-380. (IF= 4.121)
5.2
Publications on mediating mechanisms
The second thematic area of research of CoRPS focuses on how we can conceptualize and understand
the mechanisms that may explain the fact that some patients with chronic medical conditions are at
higher risk for poor health outcomes as compared to other patients. Hence, the central research
question here is which biological and behavioral mechanisms can explain why many patients do not
respond optimally to state-of-the-art medical treatment. Some examples of CoRPS publications on
these potential mediating mechanisms include:
-
van den Broek, K.C., Nyklicek, I., Voort, P.H. van der, Alings, M., Meijer, A. & Denollet, J. (2009). Risk of
ventricular arrhythmia after implantable defibrillator treatment in anxious Type D patients. Journal of the
American College of Cardiology, 54(6), 531-537. (IF=12.535)
-
De Jonge, P., Rosmalen, J.G., Kema, I.P., Doornbos, B., van Melle, J.P., Pouwer, F., & Kupper, N. (2010).
Psychophysiological biomarkers explaining the association between depression and prognosis in coronary artery
patients: a critical review of the literature. Neuroscience and Biobehavioral Reviews, 35(1), 84-90. (IF=7.791)
-
Kop, W.J., Kuhl, E.A., Bararsh, E., Jenny, N.S., Gottlieb, S.S. & Gottdiener, J.S. (2010). Association between
depressive symptoms and fibrosis markers: The Cardiovascular Health Study. Brain, Behavior and Immunity,
24(2), 229-235. (IF= 5.061)
-
Mommersteeg, P.M., Kupper, N., Schoormans, D., Emons, W.H. & Pedersen, S.S. (2010). Health related quality
of life is related to cytokine levels at 12 months in patients with chronic heart failure. Brain, Behavior and
Immunity, 24(4), 615-622. (IF= 5.061)
-
Denollet, J., Vrints, C.J., & Conraads, V.M. (2008). Comparing Type D personality and older age as correlates of
tumor necrosis factor-α dysregulation in chronic heart failure. Brain, Behavior and Immunity, 22, 736-743. (IF=
5.061)
-
Martens, E.J., Nyklicek, I., Szabó, B.M. & Kupper, N. (2008). Depression and anxiety as predictors of heart rate
variability after myocardial. Psychological Medicine, 38(3), 375-383. (IF= 5.012)
-
Kop, W.J., Stein, P.K., Tracy, R.P., Barzilay, J.L., Schulz, R. & Gottdiener, J.S. (2010). Autonomic nervous system
dysfunction and inflammation in the increased cardiovascular mortality risk associated with depression: The
Cardiovascular Health Study. Psychosomatic Medicine, 72(2), 626-635. (IF= 4.236)
18
-
Kupper, N., Gidron, Y.Y., Winter, J.B. & Denollet, J. (2009). Association between Type D personality, depression,
and oxidative stress in patients with chronic heart failure. Psychosomatic Medicine, 71(9), 973-980. (IF= 4.236)
-
Mommersteeg, P.M., Vermetten, E., Kavelaars, A., Geuze, E. & Heijnen, C.J. (2008). Hostility is related to clusters
of T-cell cytokines and chemokines in healthy men. Psychoneuroendocrinology, 33(8), 1041-1050. (IF= 4.194)
-
Denollet, J., Schiffer, A.A., Kwaijtaal, M., Hooijkaas, H., Hendriks, E.H., Widdershoven, J.W. & Kupper, N. (2009).
Usefulness of Type D personality and kidney dysfunction as predictors of interpatient variability in inflammatory
activation in chronic heart failure. American Journal of Cardiology, 103(3), 399-404. (IF= 3.575)
5.3
Publications on clinical care and behavioral intervention
The third thematic area of the CoRPS research program addresses how disease management care for
patients with chronic medical conditions can be improved. The central research question here is
what kind of interventions could improve prognosis or patient-reported outcomes. Examples of
CoRPS publications on clinical care and behavioral intervention include:
-
Smolderen, K.G., Spertus, J.A., Nallamothu, B.K., Krumholz, H.M., Tang, F., Ross, J.S., Ting, H.H., Alexander, K.,
Rathore, S.S. & Chan, P.S. (2010). Health care insurance, financial concerns in accessing care, and delays to
hospital presentation in acute myocardial infarction. JAMA. The Journal of the American Medical Association,
303(14), 1392-1400. (IF=28.899)
-
Gehring, K., Sitskoorn, M.M., Aaronson, N.K. & Taphoorn, M.J.B. (2008). Interventions for cognitive deficits in
adults with brain tumors. Lancet Neurology, 7(6), 548-560. (IF=18.126)
-
Gehring, K., Sitskoorn, M.M., Gundy, C.M., Sikkes, S.A., Klein, M., Postma, T.J., van den Bent, M.J., Beute, G.N.,
Enting, R.H., Kappelle, A.C., Boogerd, W., Veninga, T., Twijnstra, A., Boerman, D.H., Taphoorn, M.J., & Aaronson N.K.
(2009). Cognitive rehabilitation in patients with gliomas: a randomized, controlled trial. Journal of Clinical
Oncology, 27(22), :3712-3722. (IF=17.793)
-
Spek, V.R., Cuijpers, P., Nyklicek, I., Smits, N., Riper, H., Keyzer, J.J. & Pop, V.J. (2008). One-year follow-up results
of a randomized controlled clinical trial on internet-based cognitive behavioural therapy for subthreshold
depression in people over 50 years. Psychological Medicine, 38(5), 635-639. (IF= 5.012)
-
Denollet, J., de Jonge, P., Kuyper, A., Schene, A.H., Melle, J.P. van, Ormel, J. & Honig, A. (2009). Depression and
Type D personality represent different forms of distress in the Myocardial INfarction and Depression
Intervention Trial (MIND-IT). Psychological Medicine, 39(5), 749-756. (IF= 5.012)
-
den Oudsten, B.L., van Heck, G.L., van der Steeg, A.F., Roukema, J.A. & de Vries, J. (2010). Second operation is
not related to psychological outcome in breast cancer patients. International Journal of Cancer, 126(6), 14871493. (IF= 4.722)
-
Bot, M., Pouwer, F., Assies, J., Jansen, E.H., Diamant, M., Snoek, F.J., Beekman, A.T. & de Jonge, P. (2010).
Eicosapentaenoic acid as an add-on to antidepressant medication for co-morbid major depression in patients
with diabetes mellitus: A randomized, double-blind placebo-controlled study. Journal of Affective Disorders,
126(1-2), 282-286. (IF= 3.763)
-
5.4
Pedersen, S.S., Spek, V., Theuns, D.A., Alings, M., van der Voort, P., Jordaens, L., Cuijpers, P., Denollet, J., & van
den Broek, K.C. (2009). Rationale and design of WEBCARE: a randomized, controlled, web-based behavioral
intervention trial in cardioverter-defibrillator patients to reduce anxiety and device concerns and enhance
quality of life. Trials, 10, 120. (IF= 2.020)
Publications on methodology and medical statistics
This thematic area of research focuses on the enhancement of methodological and statistical
approaches in the medical context. The central research question in this thematic area is how we can
best study and analyze the complex nature of the interface between the human body and mind. Some
examples of CoRPS publications on methodology and medical statistics include:
-
Spek, V.R., Nyklicek, I., Cuijpers, P. & Pop, V.J. (2008). Internet administration of the Edinburgh Depression
Scale. Journal of Affective Disorders, 106(3), 301-305. (IF= 3.763)
19
-
Denollet, J., Martens, E.J., Smith, O.R. & Burg, M.M. (2010). Efficient assessment of depressive symptoms and
their prognostic value in myocardial infarction patients. Journal of Affective Disorders, 120(1), 105-111. (IF=
3.763)
-
Smith, O.R., Kupper, N., de Jonge, P., & Denollet, J. (2010). Distinct trajectories of fatigue in chronic heart
failure and their association with prognosis. European Journal of Heart Failure, 12(8), 841-848. (IF= 3.706)
-
Emons, W.H., Meijer, R.R., & Denollet, J. (2007). Negative affectivity and social inhibition in cardiovascular
disease: Evaluating Type D personality and its assessment using Item Response Theory. Journal of Psychosomatic
Research, 63(1), 27-39. (IF= 2.908)
-
Vermunt, J.K. (2008). Latent class and finite mixture models for multilevel data sets. Statistical Methods in
Medical Research, 17(1), 33-51. (IF= 2.569)
-
Sijtsma, K., Emons, W.H., Bouwmeester, S., Nyklícek, I., & Roorda, L.D. (2008). Nonparametric IRT analysis of
quality-of-life scales and its application to the World Health Organization Quality-of-Life Scale (WHOQOL-Bref).
Quality of Life Research, 17(2), 275-290. (IF= 2.376)
-
Emons, W.H., Sijtsma, K., & Pedersen, S.S. (2010). Dimensionality of the Hospital Anxiety and Depression Scale
(HADS) in cardiac patients: Comparison of Mokken scale analysis and factor analysis. Assessment, October 14,
2010 [Epub ahead of print]. (IF= 1.974)
-
Sijtsma, K. (2009). On the use, the misuse, and the very limited usefulness of Cronbach's alpha. Psychometrika,
74(1), 107-120. (IF= 1.205)
-
Sijtsma, K. (2009). Reliability beyond theory and into practice. Psychometrika, 74(1), 169-173. (IF= 1.205)
-
Vermunt, J.K., Van Ginkel, J.R., van der Ark, L.A., & Sijtsma, K. (2008). Multiple imputation of incomplete
categorical data using latent class analysis. Sociological Methodology, 38(1), 369-397. (IF= 1.000)
5.5
Editorial comments, meta-analyses, and review papers
Between 2008 and 2010, researchers from CoRPS have also written a number of meta-analytic
studies, review papers and invited editorial comments. These publications reflect an overview of
accumulating empirical evidence, provide a critical analysis of where the field is going, and indicate
the scientific expertise and reputation of the CoRPS staff in these areas of research.
As an example of these state-of-the-art papers, a number of publications focused on the role of
anxiety, depression and Type D personality in the clinical course of coronary heart disease (Denollet,
2008; Denollet & Pedersen, 2009; Denollet et al., 2010; Roest et al., 2010a & 2010b), chronic heart
failure (Pelle et al., 2008) and heart transplantation (Kop, 2010). The meta-analysis of Roest et al.
(2010a) was the first to clearly establish anxiety as a potential risk factor for the development of
coronary heart disease. In addition, review papers in cardiovascular populations focused on the
clinical importance of patient-reported health status (Mommersteeg et al., 2009) and
psychophysiological biomarkers (De Jonge et al., 2010). The role of emotional distress, health-related
quality of life and fatigue was also highlighted in other chronic medical conditions such as diabetes
mellitus (Pouwer, 2009; Pouwer & Hermanns, 2009) and sarcoidosis (De Kleijn et al., 2009). Regarding
brain-body medicine, CoRPS publications highlighted the neural bases of emotion perception and
regulation in the healthy brain (Tamietto & de Gelder, 2010), as well as the occurrence of cognitive
dysfunction in cancer patients with brain tumors (Gehring et al., 2008) or breast tumors (Pullens et
al., 2010). The findings and conclusions of these review activities have been published in the
following peer-reviewed articles:
De Jonge, P., Rosmalen, J.G., Kema, I.P., Doornbos, B., van Melle, J.P., Pouwer, F., & Kupper, N. (2010).
Psychophysiological biomarkers explaining the association between depression and prognosis in
coronary artery patients: a critical review of the literature. Neuroscience and Biobehavioral Reviews, 35(1),
84-90. (IF=7.791) - De Kleijn, W.P., De Vries, J., Lower, E.E., Elfferich, M.D., Baughman, R.P., & Drent, M.
(2009). Fatigue in sarcoidosis: a systematic review. Current Opinion in Pulmonary Medicine, 15(5), 499506. (IF= 2.697) - Denollet, J. (2008). Depression, anxiety, and trait negative affect as predictors of
cardiac events: Ten years after. Psychosomatic Medicine, 70(8), 949-951. (IF=4.236) - Denollet, J. &
20
Pedersen, S.S. (2009). Anger, depression, and anxiety in cardiac patients: The complexity of individual
differences in risk. Journal of the American College of Cardiology, 53(11), 947-949. (IF=12.535) - Denollet,
J., Schiffer, A.A., & Spek, V.R. (2010). A general propensity to psychological distress affects cardiovascular
outcomes. Evidence from research on the Type D (Distressed) Personality Profile. Circulation:
Cardiovascular Quality and Outcomes, 3, 546-557. - Gehring, K., Sitskoorn, M.M., Aaronson, N.K. &
Taphoorn, M.J.B. (2008). Interventions for cognitive deficits in adults with brain tumors. Lancet Neurology,
7(6), 548-560. (IF=18.126) - Kop, W.J. (2010). The role of psychological factors in the clinical course of
heart transplant patients. The Journal of Heart and Lung Transplantation, 29(3), 257-260. (IF=3.541) Mommersteeg, P.M., Denollet, J., Spertus, J.A., & Pedersen, S.S. (2009). Health status as a risk factor in
cardiovascular disease: a systematic review of current evidence. American Heart Journal, 157(2), 208-218.
(IF= 4.357) - Pelle, AJ, Gidron, YY, Szabó, BM, & Denollet, J. (2008). Psychological predictors of prognosis
in chronic heart failure. Journal of Cardiac Failure, 14(4), 341-350. (IF=3.254) - Pouwer, F. (2009).
Should we screen for emotional distress in type 2 diabetes mellitus? Nature Reviews Endocrinology, 5(12),
665-671. - Pouwer, F. & Hermanns, N. (2009). Insulin therapy and quality of life. A review. Diabetes:
Metabolism Research and Reviews, 25, 4-10. (IF=2.762) - Pullens, M.J., De Vries, J., & Roukema, J.A.
(2010). Subjective cognitive dysfunction in breast cancer patients: a systematic review. Psycho-Oncology,
19(11), 1127-1138. (IF=2.684) - Roest, A.M., Martens, E.J., de Jonge, P., & Denollet, J. (2010a). Anxiety
and risk of incident coronary heart disease: A meta-analysis. Journal of the American College of Cardiology,
56(1), 38-46. (IF=12.535) - Roest, A.M., Martens, E.J., Denollet, J. & de Jonge, P. (2010b). Prognostic
association of anxiety post myocardial infarction with mortality and new cardiac events: A meta-analysis.
Psychosomatic Medicine, 72, 563-569. (IF=4.236) - Tamietto, M. & de Gelder, B. (2010). Neural bases of
the non-conscious perception of emotional signals. Nature Reviews Neuroscience, 11, 697-709. (IF=26.483)
These references represent the endeavor of CoRPS researchers to aggregate and understand
accumulating findings across a number of medical conditions. This list is not exhaustive, and other
review and point-of-view papers can be found at the CoRPS publications website.
5.6
Book chapters and professional publications
In addition to a large number of peer-reviewed international publications, the scientific output of
CoRPS also includes a number of book chapters and scientific publications. Of the book chapters, the
chapter in the European Society of Cardiology (ESC) TEXTBOOK OF CARDIOVASCULAR MEDICINE
(Chapter 37, 2nd edition) by Pedersen, Kupper & Denollet J, entitled “Psychological factors and heart
disease” [In J Camm, T Lüscher, & P Serruys (eds): Oxford University Press, 2009] deserves special
mentioning, as it serves as a reference work for every cardiology trainee, general cardiologist and
specialist cardiologist across Europe. The textbook is based on the Core Curriculum of the European
Society of Cardiology, and reflects ESC guidelines, Task Force reports and Scientific statements, in aid
of providing the most compelling and relevant evidence-base available. It is the first time that a
chapter on psychological factors and heart disease appears in this widely-used textbook of
cardiovascular medicine.
Dissemination of empirical evidence to other health care professionals and laymen, including
patients, is an important objective of the CoRPS research program. The number of professional
publications counts a total of 15 with a mean of 5 per year (Table 5).
5.7
Societal relevance
Given the chronic nature of medical conditions such as heart disease, hypertension, diabetes or
cancer survivorship, psychological factors are becoming important in today’s health care. Depression,
anxiety and personality factors have been shown to have a negative impact on the clinical course of
these conditions. Changes in the immune, endocrine and nervous systems can partly explain these
adverse affects on health. In addition, psychological factors should not be ignored, because patients
themselves are playing an increasingly important role in the optimal care of their chronic medical
condition.
21
The importance of psychological factors in health and disease is becoming increasingly relevant not
only because of the chronic nature of most diseases, but also because of the ageing of the general
population, the increasing socio-cultural diversity of the population in Europe, and the increased
survival rate of medical conditions such as cardiovascular disease and cancer.
The goal of CoRPS is to investigate observable and thus measurable psychosocial factors, medical
outcomes, and mediating health behaviors (e.g. diet, physical activity, smoking, medication
adherence) and biological processes. With this integrative and multidisciplinary approach we aim to
promote health and reduce disease burden in patients with chronic medical conditions. This also
implies translating insights from clinical research to the general public and integrating scientific
knowledge into the field of education. Hence, researchers from CoRPS also participate in the 2-year
Master program in Medical Psychology that was specifically designed to train psychologists that can
contribute to an integrative approach to a continuously developing health care system (see Chapter 6
on ‘Research training’).
Because of the societal relevance of CoRPS research, the measurable output is not limited to
(scientific) publications and completed PhD projects only. The institute also organizes symposia,
conferences and lunch colloquia with national and international participants to discuss the latest
insights. Also CoRPS researchers actively participate in a number of (inter)national meetings for
scientists and/or health care professionals. And finally, CoRPS researchers regularly generate media
attention to their research. Appendices 10, 11, 12 and 14 provide more detailed information on the
dissemination of research findings from CoRPS.
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6. RESEARCH TRAINING
The research of the CoRPS institute is directly linked to the education of students at the Tilburg
School of Social and Behavioral Sciences. Education in the Master Medical Psychology focuses on
psychology within the medical context, including hospitals. In 2010, an external committee has
evaluated the program according to the NVAO3-framework and concluded that the program
meets the required quality aspects.
Starting year
Enrolment
Graduated
M F
Total
4
2005
1
3
4
4
2006
0
0
0
0
2007
0
1
1
0
2008
0
8
8
1
2009
1 11
12
2
2010
0
9
9
0
Table 6 Enrolment of PhD candidates
Not yet
finished
0
0
1
8
10
9
Dis
continued
0
0
0
0
1
0
During the period from 2008-2010, 29 new PhD students started their 4-year degree at CoRPS.
Currently, we have 32 PhD students within CoRPS.
The PhD-training is tailored to the individual needs of the student. This depends on the educational
background of the PhD-student as well as the specific demands of the project. Therefore, a training
and supervision plan is composed by the supervisors and the PhD-student which is updated every
year. PhD-students can take part in general courses such as ‘Academic writing’ or ‘Presentation skills’
at Tilburg University’s Career Centre. Also, workshops on methodology are organized by the
Graduate School. PhD-students are expected to attend and actively participate in international
conferences.
The progress of the PhD-projects is continuously monitored by the PhD-coordinator of the Graduate
School and twice per year more formally in a performance assessment interview, one of these
interviews is also attended by the supervisor(s). Due to this system of intensive monitoring, possible
difficulties are observed in time. Excellent PhD-students may get an offer for a postdoc position upon
completion of their PhD thesis.
In the two-year Master’s program in Medical Psychology, the first year of the program consists of 10
courses (60 ECTS) in three clinical specializations: ‘Medical psychology (adults)’, ‘Pediatric
psychology’, and ‘Clinical neuropsychology’. A more to basic science-oriented fourth track (‘Biological
Psychology’) will start in 2011-2012. The Master thesis is embedded in ongoing research projects of
CoRPS Staff, and is written in English in a format that is ready for submission to one of the
international research journals.
More information regarding the master’s program is presented on the secluded website
www.tilburguniversity.edu/qualityassessment/corps/
3
4
Accreditation Organisation of the Netherlands and Flanders (In Dutch: Nederlands Vlaamse Accreditatie Organisatie).
Even though CoRPS started in 2008, the projects that started in 2005-2007 are perceived as PhD projects of the institute
23
7. STRATEGY
During the initial three years of its existence, the CoRPS research institute has been highly productive
in terms of new PhD projects, number of publications overall, publications in high-impact journals,
publications of well-cited review articles, invited lectures at international meetings, and acquisition
of very substantial extra-mural funding.
7.1
Opportunities for future research
Brain body medicine
During the last decade, research has uncovered a number of potential biological pathways that may
help to explain the adverse effect of psychological risk factors on adverse health outcomes. A number
of these pathways involve dysfunction of the autonomic nervous and immune systems that may
promote the progression of chronic medical conditions. Research in this field requires specific
expertise and facilities. For this reason, CoRPS has hired staff with a thorough knowledge of biology,
physiology and psychoneuroimmunology. A next step would involve a more active cooperation with
senior staff from the Department of Medical Psychology and Neuropsychology who are experts in
cognitive neurosciences, and who do research on the neural bases of emotion processing and
multisensory information processing in the brain. Research in brain-body medicine is needed to
improve our understanding of emotion-regulation processes in the brain that may affect autonomic,
immune and stress mechanisms and could explain the adverse effects of depression, anxiety and
stress on health outcomes.
Patient self-management
Recently, Ralph Brindis, president of The American College of Cardiology, argued in an editorial that
team-based care is a solution for health care delivery challenges in the years to come. Optimal day-today management of chronic medical conditions implies the active involvement of patients
themselves. Self-management is a complex process that incorporates psychological adjustment to
living with a chronic condition, managing disease symptoms, healthy lifestyle changes (diet, exercise)
and adhering to treatment. While emotional stability promotes patients’ willingness to take an active
role in the treatment of their condition, emotional distress may contribute to poor self-management,
non-adherence to treatment and, eventually, poor disease control. In addition, some patients may
delay medical consultation despite the fact that timely diagnosis of increased disease activity is
essential for the successful treatment of chronic conditions. Hence, the CoRPS research program
needs to further uncover behavioral mechanisms that can explain inadequate self-management and
needs to investigate intervention strategies to target high-risk patients, improve their selfmanagement strategies, and enhance their health-related quality of life.
7.2
Looking into the future: What is most important on the agenda?
In the years to come, the mission of the CoRPS institute is to further conduct excellent research that
promotes a better understanding of the complex interaction of biobehavioral factors in patients with
chronic conditions, and to publish these findings in premier medical and psychological journals. The
ultimate goal is to improve long-term health care of patients with life-threatening and disabling
conditions. In order to meet the objective of this ambitious research agenda, it is important that the
following goals will be met:
(1) Center of Excellence. Further embedment at the institutional level is of pivotal importance. This
implies that, eventually, CoRPS aims for acquiring the status of “Center of Excellence” at Tilburg
University.
(2) Further improving the internal organization. CoRPS is very successful in the training of
Master’s students, PhD students and post-docs. The transition from these junior stages to early
career faculty (Assistant Professor) needs to be facilitated for excellent junior faculty.
24
A research institute like CoRPS requires adequate management of substantial financial and human
resources. Therefore, we need to find lasting solutions to assure these important management tasks.
In terms of governance, the board of directors will approach people for both the Advisory board and
Scientific council (as mentioned in paragraph 3.1,) should the mid-term review lead to a positive
outcome.
(3) Further securing of grant funding. In the past three years, CoRPS has acquired substantial
extra-mural funding. In addition to NWO, other grant providers are now supporting CoRPS, including
the Netherlands Organization for Health Research and Development (ZonMW), the Netherlands
Heart Foundation, the Dutch Cancer Society and the Dutch Diabetes Foundation. Other ways to
acquire funding need to be explored, both at the regional and at the national/international level.
CoRPS is in an excellent position to successfully apply for National and International (particularly
European) grants. CoRPS has a strong track record at the national level and is therefore well
equipped for this next step. Additional funding from industry, insurance companies and other
external sources will be beneficial in securing funds for tenured and non-tenured researchers.
(4) Strategic alliances at the international level. The University has increasing interests in
internationalization. CoRPS has excellent international collaborations, which can be expanded to
include a teaching component for Masters and PhD students. CoRPS will need to establish a formal
network of collaboration with excellent international research groups.
(5) Relevance for society. CoRPS needs to promote translation of research into practical
applications in the daily clinical practice of medical care. This translational research will enhance
further optimal care for a constantly growing number of individuals with chronic conditions. Hence,
the research program aims to contribute to the training of excellent behavioral researchers and
clinicians that have the capacity to actively participate in optimal care for patients with chronic
conditions.
(6) Continued investment in research alliances. One of the outcomes of the SWOT analysis
(paragraph 4.4) is that CoRPS will be actively engaged in retaining good working relationships to
achieve its research goals.
(7) And finally … To continue what CoRPS has been doing for the past 3 years: to thrive on the
ambition and motivation of both the junior and senior CoRPS staff to initiate, conduct and report the
very best research at the interface of mind and body.
To be continued …
____________
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