By Tara Petzke
Like many of my fellow ETUDE colleagues, I am an always-curious person who loves travelling and asking annoying questions. My parents are from Germany and Croatia, and we moved to Australia when I was young. I studied psychology in Germany and the Netherlands, where I received a M.Sc. in Clinical and Health Psychology (research) from Leiden University. That probably explains why I wanted to do a program like ETUDE, where I could travel for professional reasons and experience (work) culture across Europe.
My work focusses on somatic symptom perception, and I mainly employ samples from the general population. This allows us to examine symptom perception across the spectrum of everyday symptom burden and can help us explain the experiences of people with ‘mild’ persistent somatic symptoms (PSS) as well as with severe somatic symptom disorders/functional disorders. A useful experimental setup in this area is the affective picture paradigm, which can provoke symptoms in a lab setting by using negative picture stimuli. This effect is especially strong in people who have higher everyday symptom burden [1–3]. Next to negative stimuli and higher symptom burden, factors such as health anxiety and attention towards the body influence this symptom provocation effect. However, if attention towards the body can unfavorably influence symptom perception, how are we supposed to measure symptoms if asking about them might trigger them? To answer this question, my colleagues and I designed an experiment in which we manipulated the frequency of asking for symptoms [4]. Over the course of 20-25 minutes, one group of participants was asked 18 times about their current symptoms – after every block of pictures – while another group was asked only 6 times – after every third block. We knew from more naturalistic studies that prompting people to report symptoms more frequently would increase the number of symptoms reported [5,6], but we were not sure that this would work in a more lab-like setting.
The effects were immediately visible – people in the high frequency condition reported more net symptoms (symptoms after negative pictures minus after neutral pictures) than people in the less frequent condition. Already at the first timepoint, people in the high frequency condition had higher net symptom levels than the low frequency condition ever did, and this level remained stable over the rest of the experiment. The effect was even larger for people with higher everyday symptom burden and with higher health anxiety. This shows that having higher health anxiety, receiving negative stimuli, and being asked very often leads to a strong and unfavorable temporary predisposition to symptom reporting. While one always needs to be careful with the conclusions for clinical practice drawn from lab studies, I think this study gives good evidence that where possible, symptom checklists should be used cautiously and to also have good bilateral relationships with patients, so that they also feel encouraged to report symptoms unprompted.
Behind every fancy award, there is also the untold story of challenges that had to be overcome first. We were blessed with an easy-to-recruit sample and then constructive reviewers. However, using a transdiagnostic, dimensional, and biopsychosocial approach to somatic symptoms means that we often get questions and unsatisfied remarks from colleagues with more traditional approaches. Categorical thinking – having a somatic symptom disorder or not – is useful in clinical practice and has served the research area quite well in the past but has impacted our external validity. In all areas of life, people rarely lie on the ends of a spectrum, and too little is known about what happens between the two extremes. I think it is crucial to examine symptom perception in heterogeneous samples, so that we can truly understand the mechanisms at play. It is also not true that samples from the general population or convenience samples are healthy – the prevalence for a full clinical picture of functional disorder is approximately 8% [7] and especially students are even more affected [8–10]. So, even in non-clinical samples, there are typically numerous people who display functional disorders, and even more who have ‘mild’ PSS. I hope more colleagues will come around to understand that we need these transdiagnostic, dimensional, and biopsychosocial perspectives to advance as a field.
My biggest advice to fellow students is that fortune favors the brave and that you miss 100% of the chances you do not take. I originally did not intend on applying to the young investigator award, simply because my findings did not seem ‘big enough’ to me, and knowing the people who won in recent years, I thought I was still too insignificant to win anything. So, thank you to Judith Rosmalen for encouraging the ETUDE group to apply; I will definitely be braver in the future and try my luck with other awards and grants!
References
