Abstract
Fatigue is one of the most common and burdensome symptoms for people living with chronic diseases such as breast cancer or chronic kidney disease. This is not just “being tired”: patients describe it as an overwhelming exhaustion that does not improve with rest and severely limits daily life. Despite its impact, effective treatments are scarce, and fatigue symptoms are often under-recognised in healthcare. Some therapies, such as exercise programs and cognitive behavioural therapy, can help reduce fatigue. However, these approaches mainly target conscious thoughts and behaviours. This PhD project explored a different approach: cognitive bias modification (CBM). CBM is an eHealth training that focuses on automatic processes outside of our awareness – unconscious patterns that may keep fatigue going, such as paying more attention to tiredness or identifying strongly with fatigue.
Two new CBM applications were developed together with patients and healthcare professionals:
•IVY, a smartphone app for people with breast cancer, designed to strengthen positive links between self-image and vitality rather than fatigue.
•VitalMe, a computer-based training for people with chronic kidney disease, which trained both attention and self-image towards vitality.
Both applications were evaluated and tested in explorative studies with patients. Overall, the training paradigms were found easy to use and well-accepted. Beneficial effects were observed on automatic thinking patterns, but no convincing improvements were found on self-reported fatigue, vitality, or fatigue-related behaviours yet. The findings show that CBM is promising as a low-effort and user-friendly approach but also underline the challenge that clear effects on fatigue are still to be demonstrated. Because CBM requires little effort and is easy to offer as an online option that patients could use at their own convenience, it has potential to become a valuable addition to healthcare in the future. By exploring this novel approach, the research takes an important step towards understanding how automatic thinking patterns contribute to fatigue, and how CBM-based digital training could help people with chronic illness move towards more vitality in their daily lives.
Two new CBM applications were developed together with patients and healthcare professionals:
•IVY, a smartphone app for people with breast cancer, designed to strengthen positive links between self-image and vitality rather than fatigue.
•VitalMe, a computer-based training for people with chronic kidney disease, which trained both attention and self-image towards vitality.
Both applications were evaluated and tested in explorative studies with patients. Overall, the training paradigms were found easy to use and well-accepted. Beneficial effects were observed on automatic thinking patterns, but no convincing improvements were found on self-reported fatigue, vitality, or fatigue-related behaviours yet. The findings show that CBM is promising as a low-effort and user-friendly approach but also underline the challenge that clear effects on fatigue are still to be demonstrated. Because CBM requires little effort and is easy to offer as an online option that patients could use at their own convenience, it has potential to become a valuable addition to healthcare in the future. By exploring this novel approach, the research takes an important step towards understanding how automatic thinking patterns contribute to fatigue, and how CBM-based digital training could help people with chronic illness move towards more vitality in their daily lives.
| Original language | English |
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| Qualification | Doctor of Philosophy |
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| Award date | 29 Oct 2025 |
| Place of Publication | Enschede |
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| Print ISBNs | 978-90-365-6853-1 |
| Electronic ISBNs | 978-90-365-6854-8 |
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| Publication status | Published - 29 Oct 2025 |
