Hanneke Poort

Adding imagery rescripting during extinction leads to less ABA renewal.

OBJECTIVE Although extinction is highly effective in reducing a conditioned fear response, return of the fear response (renewal) outside the extinction context often occurs. The present study investigated whether US devaluation, through imagery rescripting during extinction, resulted in less renewal than mere extinction. METHOD Seventy psychology students were subjected to a fear conditioning paradigm. During fear acquisition CS+ was always followed by the US, whereas CS- was never followed by the US. For all groups the acquisition phase took place in context A. During extinction both CS+ and CS- were offered, but no US was presented. For three groups extinction was conducted in a different context, context B (ABA groups). The fourth group received extinction in the acquisition context (AAA group) in order to demonstrate that renewal indeed took place. During extinction, participants received either an imagery rescripting (IR) instruction to devaluate the US (ABAir), a US-unrelated imagination instruction to assess the general influence of imagination (ABAcont), or no instruction at all (ABAno and AAAno). Subsequently, testing occurred for all groups in the acquisition context A. RESULTS The results indicated that renewal of the US expectancy ratings was reduced if imagery rescripting (ABAir) was added to mere extinction (ABAno). Next to the reduction in renewal, imagery rescripting (ABAir) also resulted in the devaluation of the US valence, indicating that the mental representation of the US had changed. These findings are not only in line with contemporary conditioning theories, but also suggest that adding imagery rescripting to extinction might be beneficial in the treatment of anxiety problems.

Prevalence, Impact, and Correlates of Severe Fatigue in Patients With Gastrointestinal Stromal Tumors

CONTEXT The introduction of the tyrosine kinase inhibitor (TKI) imatinib in the treatment of gastrointestinal stromal tumor (GIST) in 2000 was the start of a new era of targeted treatment. Since then, the median survival of patients with GIST has substantially increased. Prolonged survival and chronic TKI use are associated with treatment-induced symptoms, such as fatigue, which can compromise quality of life (QoL). OBJECTIVES This study determined the prevalence of severe fatigue in GIST patients compared to matched healthy controls, the impact of fatigue on daily life, and associations between fatigue and current TKI use. METHODS One hundred nineteen patients treated with surgery and/or a TKI for GIST were asked to participate. Participants completed questionnaires including the Checklist Individual Strength-Fatigue Severity scale (CIS-fatigue), Short-Form 36-Item Health Survey, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, Fatigue Catastrophizing Scale, Self-Efficacy Scale, and the Hospital Anxiety and Depression Scale. RESULTS Eighty-nine GIST patients (75%) completed questionnaires, 61 patients (69%) were on a TKI. Prevalence of severe fatigue measured with CIS-fatigue was significantly higher in GIST patients (30%) than in 234 matched healthy controls (15%). The prevalence of severe fatigue did not differ significantly between patients receiving treatment with curative (29%) or palliative intent (36%). Severely fatigued patients reported lower QoL and more impairment on all functional domains. TKI use, more psychological distress, and lower physical functioning were associated with fatigue. CONCLUSION Severe fatigue occurs in 30% of GIST patients and in 33% of GIST patients on a TKI. The fatigue is disabling and is not only associated with current TKI use but also with psychological distress and physical functioning. GIST patients should be informed about these associated factors of fatigue that deserve appropriate management.

One way or another: The opportunities and pitfalls of self-referral and consecutive sampling as recruitment strategies for psycho-oncology intervention trials

Radboud Institute of Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands Department of Public Health, Erasmus MC Rotterdam, Rotterdam, The Netherlands Karify, Utrecht, The Netherlands Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands Academic Medical Center (AMC), University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands Department of Psychosocial Oncology and Palliative Care, Dana‐Farber Cancer Institute, Boston, MA, USA Department of Medical Psychology, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands

Adapting an Evidence-Based Intervention to Address Targeted Therapy-Related Fatigue in Chronic Myeloid Leukemia Patients.

Background: Fatigue is one of the most important quality of life issues experienced by patients being treated with oral targeted therapy for chronic myeloid leukemia (CML). However, no intervention exists that specifically addresses strategies to reduce targeted therapy–related fatigue. Objective: This study adapted an evidence-based clinic-delivered intervention (EBI) “cognitive behavior therapy for post-cancer fatigue” for use in CML patients. The existing EBI was based on 6 established perpetuating factors of fatigue (ie, sleep, activity, helpful thinking, coping with cancer, social support, and fear of disease recurrence). Study aims were to gauge reactions to (1) existing content and (2) a new Internet-assisted intervention delivery format. Methods: Guided by the ADAPT-ITT framework, we used a series of systematic steps and adaptation methodologies, including semistructured interviews with CML patients and providers and feedback from topical experts. Results: Patients were receptive to existing content topics and an Internet-assisted delivery format was acceptable. A key theme reflected the need for a new customized psychoeducational module about CML as a disease and its treatment. Both providers and patients held positive views about the potential of the adapted EBI to improve fatigue. Conclusions: Findings offered essential guidance for the adaptation and reinforced the utility of the adapted intervention. Implications for Practice: Adapting existing EBIs for new audiences contributes to advancing findings of evidence-based research, ultimately providing nurses and other healthcare providers with important referral options to interventions that may provide useful strategies to improve quality of life and reduce targeted therapy–related fatigue.