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Objective: To examine the efficacy of reminder e-mails to continue yoga therapy on practice frequency and fatigue in cancer patients and long-term effects of yoga on fatigue, depression, and quality of life. Methodology: One hundred two cancer patients who completed an 8-week yoga therapy were randomly allocated to two groups: reminder (N = 51) vs. no-reminder group (N = 51). After completing yoga therapy, the reminder group received weekly e-mails for 24 weeks, which reminded them of practicing yoga, whereas the no-reminder group did not. Primary outcomes were fatigue and practice frequency, and long-term outcomes were fatigue, depression, and quality of life. Data were assessed using questionnaires after yoga therapy (T1) and 6 months after completing yoga therapy (T2). Result: A significantly stronger reduction of general (p = 0.038, d = 0.42) and emotional fatigue (p = 0.004, d = 0.59) and a higher increase of practice frequency (p = 0.015, d = 0.52) between T1 and T2 were found for the reminder group compared to the no-reminder group. In the mediation model, practice frequency as a mediator partially explained the changes in emotional fatigue (indirect effect B =  − 0.10). Long-term effects of yoga therapy regarding fatigue, depression, and quality of life were found (F > 7.46, p < 0.001, d > 0.54). Conclusion: Weekly reminder e-mails after yoga therapy can positively affect general and emotional fatigue and help cancer patients with fatigue establish a regular yoga practice at home. However, higher practice frequency did not lead to higher physical or cognitive fatigue improvement, suggesting other factors that mediate efficacy on physical or cognitive fatigue, such as mindfulness or side effects of therapy.

Purpose: Examine the effects of an 8-week yoga therapy on fatigue in patients with different types of cancer. Methods: A total of 173 cancer patients suffering from mild to severe fatigue were randomly allocated to yoga intervention (n = 84) (IG) versus waitlist control group (CG) (n = 88). Yoga therapy consisted of eight weekly sessions with 60 min each. The primary outcome was self-reported fatigue symptoms. Secondary outcomes were symptoms of depression and quality of life (QoL). Data were assessed using questionnaires before (T0) and after yoga therapy for IG versus waiting period for CG (T1). Results: A stronger reduction of general fatigue (P = .033), physical fatigue (P = .048), and depression (P < .001) as well as a stronger increase in QoL (P = .002) was found for patients who attended 7 or 8 sessions compared with controls. Within the yoga group, both higher attendance rate and lower T0-fatigue were significant predictors of lower T1-fatigue (P ≤ .001). Exploratory results revealed that women with breast cancer report a higher reduction of fatigue than women with other types of cancer (P = .016) after yoga therapy. Conclusion: The findings support the assumption that yoga therapy is useful to reduce cancer-related fatigue, especially for the physical aspects of fatigue. Women with breast cancer seem to benefit most, and higher attendance rate results in greater reduction of fatigue.

Excessive generalization of safety behavior to innocuous stimuli that resemble a feared stimulus is oftentimes pathological especially with inflicted impairments. Safety behavior is conventionally assessed dichotomously, requiring multiple presentations of each test stimulus for assessing the proportion of safety behavior executed. Thus, the generalization gradient confounds with ongoing extinction learning during non-reinforced test trials. The present study employed a recently developed dimensional measure of avoidance to examine the extent of safety behavior generalization. We found that a dimensional measure of avoidance was able to assess the generalization gradients of safety behavior even when each test stimulus was presented once, thus minimizing the effect of ongoing extinction learning. Of equal importance is whether higher-order cognitive processes shape generalization of safety behavior. We found a range of distinct generalization gradients in safety behavior, which were highly consistent with participants’ verbally reported relational rules. This rule-based generalization parallels to how clinically anxious individuals develop different threat beliefs after trauma exposure, and models how these distinct threat beliefs determine the extent of safety behavior engagement.

Individuals with anxiety disorders typically avoid fear-relevant stimuli even if they miss potential rewards. However, few studies have accounted for such costs of fear-related avoidance in doing so. In this study, 51 spider fearful and 49 non-fearful participants completed the Spider Gambling Task, our modification of the Iowa Gambling Task, to investigate whether fear-relevant stimuli trigger avoidant decisions in the presence of potential rewards. In one version, advantageous choices were associated with pictures of spiders, whereas the same pictures were associated with disadvantageous choices in another version. Fearful participants generally avoided choices associated with pictures of spiders, which resulted in lower overall gains in the version with advantageous spider decks. Although this relative avoidance was sustained, fearful participants progressively approach more advantageous spider choices. These findings demonstrate that phobic fear results in irrational avoidant decisions which can result in considerable cost. Potential long-term rewards for approach may, however, diminish absolute avoidance behavior.

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Exposure is a highly effective treatment for pathological fear and anxiety, but rarely used in routine care. Issues of practicability and lack of therapists in rural areas are main barriers for the dissemination of exposure. Smartglass devices may enable therapists to guide exposure from their own office via real-time feedback and may thereby increase practicability. The present study explored the technological usability and clinical feasibility of Smartglass-guided exposure in a behavioral approach test in spider-fearful individuals (N = 40). Fearful individuals were asked to start the Smartglass themselves and established a connection to a therapist, who guided the exposure test from afar. Clinical severity of spider fear was assessed via questionnaire. Technological usability was assessed with established measures of usability, user experience, and user acceptance. Exploratory, individual characteristics of exposure were collected (e.g., within-session fear reduction, duration, safety behavior). Overall, fearful individuals (94.9%) and therapists (100%) were able to establish a connection. Usability of Smartglass-guided exposure was evaluated as positive. Within-session fear reduction was large (d = 1.91). Adverse events were minimal. There were, however, some associations between exposure characteristics and usability evaluation (e.g., lower user-friendliness and exposure duration). Two case examples further highlight chances and risks of Smartglass-guided exposure. These findings provide first evidence that Smartglass-guided exposure could be useful in exposure therapy. Smartglass-guided exposure may ultimately help to increase practicability of exposure and increase dissemination, also in rural areas. These findings are promising for future research on the long-term outcome of evidence-based exposure in treatment seeking patients.

Exposure-based treatment involves repeated presentation of feared stimuli or situations in the absence of perceived threat (i.e., extinction learning). However, the stimulus or situation of fear acquisition (CS+) is highly unlikely to be replicated and presented during treatment. Thereby, stimuli that resemble the CS+ (generalization stimuli; GSs) are typically presented. Preliminary evidence suggests that depending on how one generalizes fear (i.e., different generalization rules), presenting the same GS in extinction leads to differential effectiveness of extinction learning. The current study aimed to extend this finding to safety behaviors. After differential fear and avoidance conditioning, participants exhibited discrete generalization gradients that were consistent with their reported generalization rules (Similarity vs Linear). The Linear group showed stronger safety behaviors to a selected GS compared to the Similarity group, presumably due to higher threat expectancy. After extinction learning to this GS, the Linear group exhibited stronger reduction in safety behaviors generalization compared to the Similarity group. The results show that identifying distinct generalization rules allows one to predict expectancy violation to the extinction stimulus, in addition to corroborating the idea that strongly violating threat expectancy leads to better extinction learning and its generalization. With regard to clinical implications, identifying one's generalization rule (e.g., threat beliefs) help designing exposure sessions that evoke strong expectancy violation, enhancing the reduction in the generalization of maladaptive safety behaviors.