Interview with Pim Cuijpers, professor of clinical psychology

Pim Cuijpers is a clinical psychologist but only came to VU Amsterdam when he was 48. Before that, he worked for 15 years in mental health care where he was mainly involved in prevention projects. During his time in mental health care, he obtained his PhD at the Radboud University in Nijmegen for research about support groups for elderly people with dementia. After that he worked for 8 years at the Trimbos Institute where, in addition to various implementation projects and setting up training courses, he also did research.

After his period at the Trimbos Institute, he started at VU Amsterdam where he led the Department of Clinical, Neuro- and Developmental Psychology for 15 years. Within the field of psychology and psychiatry, Cuijpers is the most cited scientist in academic publications on psychological treatments. In addition, he is the creator of the internationally renowned database Metapsy.org with information about research into psychological treatments and has supported students in their psychological well-being with the establishment of the Caring Universities platform.

What kind of projects were you involved in mental health care?
I mainly did prevention projects, support groups for caregivers of people with dementia, groups for survivors of suicide, courses dealing with depression, and all kinds of other projects. Then the vacancy for an endowed chair at the VU Amsterdam came my way, and I applied for it. At the same time, the department needed a new department head. Then someone else was appointed professor and I was appointed head of the department of clinical psychology, because I also had a management position at the GGZ and the Trimbos Institute. Then I started raising research money and recruiting people again. That was in 2005.

What did you discover in your time in practice?
I’ve noticed that I am good at doing research. The crazy thing is that I don't feel like an academic at all, because I have a completely different way of leading and looking at research. For me, the most important thing is that you do research that benefits patients. Nevertheless, the step to VU Amsterdam has been good for me. As a clinical psychologist from practice, I have a completely different background. Moreover, I’ve always had to work very hard to get the things I wanted to do done. It never happened by itself and that shaped me.

Do you remember what attracted you to the vacancy of professor by special appointment?
At the Trimbos Institute I discovered that I enjoyed doing research and I was good at it. So that's why it was a logical step to go to the university. Compared to my colleagues, I started an academic career much later. But in the number of papers and studies, I've pretty much caught up with everyone.

Did you feel like you had to catch up?
No, it doesn't. But of course I had to build up the clinical psychology department, do my own research and teach. And that was not nothing. There were many students, but a small department and the research branch was mostly missing, So I built it up. In the academic year 2014/2015, clinical psychology merged with neuropsychology and developmental psychology. I stepped down as head of that department a few years ago.

When could you pay more attention to the research?
(Jokingly) In the evenings? Because I had a full management position, but the core of the research mainly concerns prevention, which I did a lot at the GGZ and the Trimbos Institute. In addition to prevention, minimal interventions are also an important focus within my research. That's what I started doing when I got into mental health care. When I joined VU Amsterdam, there was already research into digital interventions. I then continued with this and prevention and interventions have always remained the major themes in my research work.

In addition to prevention and interventions, I have also started doing more and more research into psychological treatments. These are actually still the three topics I'm working on. The overarching theme is what you can do in addition to conventional standard treatment to reduce the burden of depression at the population level. What else can you do against depression, except what you do live in the treatment room. These are also the themes that I want to discuss in the online lectures.

What can you do with all that knowledge about psychological treatments?
Over the past few years, we have mapped all this out in the database Metapsy.org that is accessible free of charge. We've brought together everything we know from randomized effect studies on treatments worldwide. That has now become a huge domain, especially with regard to depression but lately also for all kinds of other mental illnesses. You can ask me anything about psychological treatments. And that is also the objective of the database (https://www.metapsy.org/): what do we know, and what do we not yet know. And how can you change things, minimize them, offer them differently or, for example, make alternative treatments. Then you first have to know what we know now.

When did you start using that database?
I started the database around 2006. Since then, we have kept track of which new studies have been done every four months. We added that to the database, and we have made it completely open source via the website. Everyone can make use of this and get answers to questions such as: Does cognitive behavioral therapy also work in the elderly? Can you apply group therapy for perinatal depression? Does interpersonal psychotherapy also work if you have a physical illness in addition? You can ask all those kinds of questions endlessly. And if you ask such a question, the database will come up with a meta-analysis. Such as what are the effects, what is the quality of the studies, how many people do you need to treat to have one more positive outcome. Everything that is in a normal meta-analysis is done online, within 2 minutes.

And what do the users do with the data?
The intention is that the data will become available and, an important secondary goal is that people no longer do unnecessary small meta-analyses. Now you have a lot of researchers asking small questions and writing a paper about them that gets published when none of that is necessary. Because you can get the results directly from our database. And we don't make any money from it. It is completely open source.

The main users are researchers, and in addition, important users are the developers of treatment guidelines. For example, at the moment people are working on an update of the Dutch directive, they also use our data. And the World Health Organization (WHO), which has been working on an update to their treatment guidelines for mental health problems, also uses papers based on our data.

You have been working with the WHO for some time. What exactly does that mean?
At the WHO I am an advisor on many projects and I am also director of the WHO collaborating center on psychological interventions, together with my colleague Marit Sijbrandij, who has developed a whole line of research on global mental health. The database is also part of the collaborating center. And the WHO is now funding a database for psychological treatment of psychotic disorders. The current database is mainly about depression. But we have also collected research data on disorders such as panic, generalized anxiety, social phobia, insomnia, and borderline. It's a bit technical, because they're meta-analyses, so not readable by laypeople, but we've also started to see if we can't also translate the outcomes for clinicians and patients so that they can use them. It is just very important that there is a place where you can find information about psychological treatments for mental health problems.

In addition to the database, you have also developed many digital interventions. Do they make healthcare cheaper?
That is not the main goal. You have a lot of people who have depression, but are not treated. If you're going to spend a lot of money on one treatment, you can't spend that money on other people who need it too. So if you can do it minimally, then you can help more people with the same money. Especially in a time with so many and long waiting lists, digital interventions are a good alternative. By the way, a lot is already being done with digital help. The GGZ does that and there are already digital clinics. The Netherlands is also ahead of other countries in this respect. My colleague, Heleen Riper also has a long and extensive line of research on digital interventions.

Can you also see what the state of mental health is in the Netherlands?
No, we can't see that, because we're only looking at treatment studies. We can't see what's happening in society. We can look at the effects over time. For example, we know that the placebo effect of antidepressants increases over time. We cannot look at what is happening in the population.

Around your retirement you will give four lectures, what do they mean?
The lectures are about the areas I have been involved in in my working life, such as prevention. For example, I have done a lot of research into whether you can prevent the development of depression. We now know that it is possible, but it is complicated to prevent depression. I have also developed all kinds of methodologies for this in recent times and I think that in the past 25 years we have taken great steps in this.

A second domain is digital intervention. A stormy development over the past 25 years. In 1998 I received the first grant to do research into digital interventions. A lot has happened between then and now and we have achieved a great deal. One of those things I want to show in the lecture is that the digital interventions are just as effective as face-to-face treatments. But what we should not forget, and I will also discuss this in the lecture, is that if you look at the whole world, 80% of the world's population with a mental health problem still lives mainly in the countries with lower incomes, and therefore hardly has access to evidence-based aid.

In India, for example, there are more people with depression than the entire population of Spain combined. So if you have an intervention in those countries with a small effect, but you make sure that it can be used by a lot of people, you can have a huge impact.

In general, we in the West try to develop digital treatments that are as effective as face-to-face treatments, but if you have an intervention with a very small effect, which you can have used by a country like India, then the impact is enormous. That is a challenge that interests me enormously. And there you can also work with unaccompanied digital interventions, then it doesn't matter so much that those effects are smaller, as long as you can offer it on a large scale.

We have already started to do that, such as with Syrian refugees in Turkey and Lebanon, where we have offered a digital intervention on the smartphone and to other people living in Lebanon, and it shows that these interventions work. I do this together with Marit Sijbrandij, who has set up a whole research group around this.

You have to officially retire, but from the sounds of it, that's not possible at all!
Indeed, I am far from finished. Furthermore, in the lectures I will talk about where the possibilities lie to improve treatments. We have a lot of treatments, but we don't really know which treatments are best for whom. And what about antidepressants? How can you do that better? What works in the long run? Does that also work for specific target groups, such as children? In the fourth webinar, I am going to talk about general recommendations for future research. We have the standard treatments, but what else can we do?

The latter is the main subject of the research question that Cuijpers often asks himself: What else can we do? The online lectures will be published weekly on YouTube in September.