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Neuroplasticity is a term indicating structural and functional changes in the brain through the lifespan. In the present study, differences in the functional cortical activations between the musical talents and non-talents were investigated after a short-term practice of the visuomotor and auditory tasks. Visuomotor task consisted of the finger tapping sequences, while auditory task consisted of passive listening to the classical music excerpts. Non-talents were divided in two groups: trained non-talents who practiced the task prior to scanning and untrained non-talents who did not practice the task. Functional activations were obtained by the functional magnetic resonance imaging (fMRI) in a 1.5T Scanner. It was hypothesized that talents would exhibit different functional activations from non-talents in both tasks as a result of the long-term music practice, which would account for the brain plasticity. Decreased activation of the same areas in talents in respect to the non-talents as well as the activation of different areas between the talents and non-talents was hypothesized. In addition due to a plethora of previous studies showing increased activations in the primary motor cortex (M1) in musicians, as well as left inferior frontal gyrus (lIFG), increased activation of the M1 and lIFG in talents were hypothesized. Behavioral results did not reveal differences in performance among the three groups of subjects (talents, non-talents who practiced the task, and non-talents who did not practice the task). The main findings from imaging results of the visuomotor task confirmed the hypothesis of the increased activation in the M1 in talents. Region of interest analyses of the lIFG revealed the highest activation in the untrained non-talents, lower activation in talents, and least activation in the trained non-talents. Posthoc imaging analyses revealed higher activations in the cerebella of subjects who practiced the visuomotor task. For the auditory task, the effect of auditory practice was observed in the right inferior frontal gyrus (rIFG). These results should be interpreted with caution due to the absence of behavioral differences among the groups.
Maladaptive coping mechanisms influence health-related quality of life (HRQoL) of individuals facing acute and chronic stress. Trait emotional intelligence (EI) may provide a protective shield against the debilitating effects of maladaptive coping thus contributing to maintained HRQoL. Low trait EI, on the other hand, may predispose individuals to apply maladaptive coping, consequently resulting in lower HRQoL. The current research is comprised of two studies. Study 1 was designed to investigate the protective effects of trait EI and its utility for efficient coping in dealing with the stress caused by chronic heart failure (CHF) in a cross-cultural setting (Pakistan vs Germany). N = 200 CHF patients were recruited at cardiology institutes of Multan, Pakistan and Würzburg as well as Brandenburg, Germany. Path analysis confirmed the expected relation between low trait EI and low HRQoL and revealed that this association was mediated by maladaptive metacognitions and negative coping strategies in Pakistani but not German CHF patients. Interestingly, also the specific coping strategies were culture-specific. The Pakistani sample considered religious coping to be highly important, whereas the German sample was focused on adopting a healthy lifestyle such as doing exercise. These findings are in line with cultural characteristics suggesting that German CHF patients have an internal locus of control as compared to an external locus of control in Pakistani CHF patients. Finally, the findings from study 1 corroborate the culture-independent validity of the metacognitive model of generalized anxiety disorder.
In addition to low trait EI, high interoception accuracy (IA) may predispose individuals to interpret cardiac symptoms as threatening, thus leading to anxiety. To examine this proposition, Study 2 compared individuals with high vs low IA in dealing with a psychosocial stressor (public speaking) in an experimental lab study. In addition, a novel physiological intervention named transcutaneous vagus nerve stimulation (t-VNS) and cognitive reappraisal (CR) were applied during and after the anticipation of the speech in order to facilitate coping with stress. N= 99 healthy volunteers participated in the study. Results showed interesting descriptive results that only reached trend level. They suggested a tendency of high IA individuals to perceive the situation as more threatening as indicated by increased heart rate and reduced heart rate variability in the high-frequency spectrum as well as high subjective anxiety during anticipation of and actual performance of the speech. This suggests a potential vulnerability of high IA individuals for developing anxiety disorders, specifically social anxiety disorder, in case negative self-focused attention and negative evaluation is applied to the (more prominently perceived) increased cardiac responding during anticipation of and the actual presentation of the public speech. The study did not reveal any significant protective effects of t-VNS and CR.
In summary, the current research suggested that low trait EI and high IA predicted worse psychological adjustment to chronic and acute distress. Low trait EI facilitated maladaptive metacognitive processes resulting in the use of negative coping strategies in Study 1; however, increased IA regarding cardioceptions predicted high physiological arousal in study 2. Finally, the German vs. the Pakistani culture greatly affected the preference for specific coping strategies. These findings have implications for caregivers to provide culture-specific treatments on the one hand. On the other hand, they highlight high IA as a possible vulnerability to be targeted for the prevention of (social) anxiety.
Social life is organized around rules and norms. The present experiments investigate the cognitive architecture of rule violations. To do so, a setting with arbitrary rules that had to be followed or broken was developed, and breaking these rules did not have any negative consequences. Removed from any social influences that might further encourage or hinder the rule breaker, results suggest that simply labeling a behavior as a rule violation comes with specific costs: They are more difficult to plan and come with specific behavioral markers during execution. In essence, rule violations resemble rule negations, but they also trigger additional processes.
The question of what makes rule violations more difficult than rule inversions is the major focus of the remaining experiments. These experiments revealed negative affective consequences of rule violation and rule inversions alike, while rule violations additionally prime authority-related concepts, thus sensitizing towards authority related stimuli.
Next, the question how these burdens of non-conformity can be mitigated was investigated, and the influence of having executed the behavior in question frequently and recently was tested in both negations and rule violations. The burdens of non-conformity can best be reduced by a combination of having violated/negated a rule very frequently and very recently. Transfer from another task, however, could not be identified.
To conclude, a model that accounts for the data that is currently presented is proposed. As a variant of a task switching model, it describes the cognitive processes that were investigated and highlights unique processing steps that rule violations seem to require.
Conflict Management
(2014)
Humans have a remarkable ability to plan ahead, set goals for the future and then to act accordingly. Unfortunately, this is not always the case. Everybody has experienced situations in which motivational urges like a tendency to drink another beer, or over-learned behavioral routines like driving on the right side of the road collide with ones´ goals. This tug of war between impulsive or habitual action tendencies and goal-directed actions is called a conflict.
Conflict is ubiquitous and comes in many different ways. Not surprisingly, the means to control conflict are diverse, too. Clearly, people can manage conflict in multiple ways: When expecting a conflict situation to occur in the future, one can recruit more effort to resolve the conflict, for instance by inhibiting unwanted urges or habits. Alternatively one can avoid the conflict situation and thereby circumvent possible failures to control habits and impulses. Furthermore, when currently facing a conflict, people can mobilize more effort to overcome the conflict. Alternatively they can withdraw from the conflict situation to minimize the risk of indulging in their impulses and habits.
To account for these different ways to master a conflict, the present thesis takes an initial step towards a characterization of the variability of control. To this aim, two dimensions of control will be identified that result from partially incompatible constraints on action control. These dimensions depict a trade-off between flexibility and stability and between anticipatory early selection and reactive late correction of control parameters. To describe how these control trade-offs interact and to explain how conflict is handled to ensure adaptation behavior, the conflict management framework is proposed. A corollary of this framework suggests that one strategy to control conflict comprises of a tendency to withdraw from a conflict situation.
The empirical part probed this behavioral response to conflict and tested whether participants withdraw from conflict situations. To approach this hypothesis, three series of experiments are presented that employ free choice paradigms, speeded response classification tasks and continuous movement tracking tasks to reveal withdrawal from conflict. Results show that conflict caused motivational avoidance tendencies (Experiment 1 &2), biased decision making away from conflict tasks (Experiment 3 & 5) and affected the execution of more complex courses of action (Experiment 6 & 7).
The results lend support for the proposed conflict management framework and provide the ground for a more thorough treatment of how the different conflict strategies can be integrated. As a first step, a connectionist model is presented that accounts for the simultaneous implementation of two conflict strategies observed in Experiments 3 – 5. The remainder of the present thesis analyses failures to integrate different conflict strategies. It is discussed how the conflict management framework can shed light on selected psychopathologies, inter-individual differences in control and break-downs of self-control.
In three studies, we investigated, if and how different modes of presentation - written, auditory, audiovisual (auditory combined with pictures) - affect comprehension of semantically identical materials. Children, beginning from the age of 7, and adults were included into the studies. A vast amount of studies have shown that pictures can facilitate text comprehension (e.g. Carney & Levin, 2002).
Other than the majority of these previous studies, we assessed text comprehension with methods that we assume to allow more differentiated insights into the cognitive processes that - according to current theories - underlie text comprehension. Text comprehension involves at least three levels of mental representations (see Kintsch, 1998). Moreover, text comprehension means constructing a locally and globally coherent mental representation of the text content.
Using a sentence recognition task (see Schmalhofer & Glavanov, 1986), we examined whether the memory of the text surface, the text base, and the situation model differs between written, auditory, and audiovisual text presentation in a sample of 103 8- and 10-year-olds and adults (Study I), and between auditory and audiovisual text presentation in a sample of 106 7-, 9-, and 11-year-olds (Study II). Furthermore, we examined with 155 9- and 11-year-olds, whether the ability to draw inferences to establish local and global coherence differs between written, auditory, and audiovisual text presentation. These inferences were indicated by reaction times to words associated with a protagonist's super- (global) or subordinate (local) goal.
Overall, the results of these three studies taken together, indicate that children up to age 11 do not only have better memory of not only the text surface, but also of the situation model when pictures are added to an auditory text. This effect became apparent in comparison with both auditory and written texts. For the adults, in contrast, we did not find an effect of the presentation mode. Furthermore, both 9- and 11-year-olds were better at establishing global coherence at audiovisual compared to auditory text presentation. Written presentation turned out to be superior to auditory presentation in terms of both local and global coherence.
The present thesis addresses cognitive processing of voice information. Based on general theoretical concepts regarding mental processes it will differentiate between modular, abstract information processing approaches to cognition and interactive, embodied ideas of mental processing. These general concepts will then be transferred to the context of processing voice-related information in the context of parallel face-related processing streams. One central issue here is whether and to what extent cognitive voice processing can occur independently, that is, encapsulated from the simultaneous processing of visual person-related information (and vice versa). In Study 1 (Huestegge & Raettig, in press), participants are presented with audio-visual stimuli displaying faces uttering digits.
Audiovisual gender congruency was manipulated: There were male and female faces, each uttering digits with either a male or female voice (all stimuli were AV- synchronized). Participants were asked to categorize the gender of either the face or the voice by pressing one of two keys in each trial. A central result was that audio-visual gender congruency affected performance: Incongruent stimuli were categorized slower and more error-prone, suggesting a strong cross-modal interaction of the underlying visual and auditory processing routes. Additionally, the effect of incongruent visual information on auditory classification was stronger than the effect of incongruent auditory information on visual categorization, suggesting visual dominance over auditory processing in the context of gender classification. A gender congruency effect was also present under high cognitive load. Study 2 (Huestegge, Raettig, & Huestegge, in press) utilized the same (gender-congruent and -incongruent) stimuli, but different tasks for the participants, namely categorizing the spoken digits (into odd/even or smaller/larger than 5). This should effectively direct attention away from gender information, which was no longer task-relevant. Nevertheless, congruency effects were still observed in this study. This suggests a relatively automatic processing of cross-modal gender information, which
eventually affects basic speech-based information processing. Study 3 (Huestegge, subm.) focused on the ability of participants to match unfamiliar voices to (either static or dynamic) faces. One result was that participants were indeed able to match voices to faces. Moreover, there was no evidence for any performance increase when dynamic (vs. mere static) faces had to be matched to concurrent voices. The results support the idea that common person-related source information affects both vocal and facial features, and implicit corresponding knowledge appears to be used by participants to successfully complete face-voice matching. Taken together, the three studies (Huestegge, subm.; Huestegge & Raettig, in press; Huestegge et al., in press) provided information to further develop current theories of voice processing (in the context of face processing). On a general level, the results of all three studies are not in line with an abstract, modular view of cognition, but rather lend further support to interactive, embodied accounts of mental processing.
The perception of pain can be modulated by a variety of factors such as biological/pharmacological treatments as well as potent cognitive and emotional manipulations. Placebo and nocebo effects are among the most prominent examples for such manipulations. Placebo and nocebo manipulations cause reliable psychological and physiological changes, although the administered agent or treatment is inert. The present dissertation aimed at investigating the role of cognitive and emotional influences in the generation of placebo and nocebo effects on pain perception. In addition, the feasibility of solely psychological placebo manipulations to alter the perception of pain was tested.
Two commonly discussed preconditions for the generation of placebo and nocebo effects are prior experiences (i.e., past encounter of drug effects) and expectations (i.e., positive or negative attitudes towards an intervention). So far, research on placebo and nocebo effects relied on the administration of sham interventions, which resembled medical treatments like inert pills, creams or injections. However, such experimental procedures deal with confounds due to earlier experiences and expectations resulting from the individual’s history with medical interventions. Accordingly, the implementation of a placebo manipulation that is completely new to an individual, seems necessary to disentangle the contribution of experience and expectation for the induction of placebo and nocebo effects.
To this end, in Experiment 1 the level of experience and expectation regarding a placebo-nocebo treatment was stepwise manipulated across three different experimental groups. To avoid any resemblances to earlier experiences and individual expectations, a mere psychological placebo-nocebo treatment was chosen that was new to all participants. They were instructed that visual black and white stripe patterns had been found to reliably alter the perception of pain. One group of participants received only the placebo-nocebo instruction (expectation), a second group experienced a placebo-nocebo treatment within a conditioning phase (experience) but no instruction, and a third group received the combination of both that is a placebo-nocebo instruction and a placebo-nocebo conditioning (experience + expectation).
It was shown that only the experience + expectation group revealed significantly higher pain ratings and physiological responses during nocebo, compared to placebo trials of the succeeding test phase. These findings demonstrate that the induction of a mere psychological placebo-nocebo effect on pain is in principle possible. Most important, results indicate that such effects most likely rely on both, a positive treatment experience, due to the encounter of an effective intervention (placebo conditioning), and a positive expectation about the intervention (placebo instruction).Besides experience and expectation, the current mood state has been shown to modulate pain and to impact the induction of placebo and nocebo effects. In this vein it has been demonstrated that placebo effects come along with positive affect, while nocebo effects often occur together with elevated feelings of anxiety. To clarify the interaction of emotions and placebo-nocebo manipulations on pain perception, in Experiment 2 the paradigm of Experiment 1 was modified. Instead of black and white stripe patterns, positive and negative emotional pictures were presented, which either cued pain increase (nocebo) or pain decrease (placebo). Two experimental groups were compared, which differed with regard to the instructed contingency of positive pictures serving as placebo and negative pictures serving as nocebo cues or vice versa (congruent vs. incongruent). Results indicate that the differentiation of placebo and nocebo trials (behaviorally and physiologically) was more pronounced for the congruent compared to the incongruent group. However, in the incongruent group, affective pain ratings were also significantly higher for nocebo (positive pictures) than placebo (negative pictures) trials, similar to the congruent group. These findings demonstrate that a placebo-nocebo manipulation is capable to dampen and even reverse the originally pain augmenting effect of negative emotions.
The results of Experiment 2 were further corroborated in Experiment 3, when the design was adapted to the fMRI scanner, and again a congruent and an incongruent experimental group were compared. Behavioral, physiological and neurophysiological markers of pain processing revealed a differentiation between nocebo and placebo conditions that was present irrespective of the experimental group. In addition, the fMRI analysis revealed an increased engagement of prefrontal areas for the incongruent group only, supposedly reflecting the reinterpretation or appraisal process when positive pictures were cueing negative outcomes.
Taken together, the results of the present studies showed (a) that it is possible to induce a placebo-nocebo effect on pain solely by a psychological manipulation, (b) that both, prior experiences and positive expectation, are necessary preconditions for this placebo-nocebo effect, (c) that the impact of negative emotion on pain can be dampened and even reversed by placebo-nocebo manipulations, and (d) that most likely a cognitive top-down process is crucial for the induction of (psychological) placebo-nocebo effects.
These results significantly enhance our understanding of psychological mechanisms involved in the induction of placebo-nocebo effects. Further, a fruitful foundation for future studies is provided, which will need to determine the contributions of primarily nocebo or placebo responses mediating the effects as demonstrated in the present studies. In a long-term perspective, the present findings may also help to exploit placebo effects and prevent from nocebo effect in clinical contexts by further elucidating crucial psychological factors that contribute to the placebo and nocebo response.
This doctoral thesis is part of a research project on the development of the cognitive compre-hension of film at Würzburg University that was funded by the German Research Foundation (Deutsche Forschungsgemeinschaft) between 2013 and 2019 and awarded to Gerhild Nied-ing. That project examined children’s comprehension of narrative text and its development in illustrated versus non-illustrated formats. For this purpose, van Dijk and Kintsch’s (1983) tri-partite model was used, according to which text recipients form text surface and textbase rep-resentations and construct a situation model. In particular, predictions referring to the influ-ence of illustrations on these three levels of text representation were derived from the inte-grated model of text and picture comprehension (ITPC; Schnotz, 2014), which holds that text-picture units are processed on both text-based (descriptive) and picture-based (depictive) paths. Accordingly, illustrations support the construction of a situation model. Moreover, in line with the embodied cognition account (e.g., Barsalou, 1999), it was assumed that the situa-tion model is grounded in perception and action; text recipients mentally simulate the situation addressed in the text through their neural systems related to perception (perceptual simulation) and action (motor resonance). Therefore, the thesis also examines whether perceptual simula-tion takes place during story reception, whether it improves the comprehension of illustrated stories, and whether motor resonance is related to the comprehension of text accompanied by dynamic illustrations. Finally, predictions concerning the development of comprehending illus-trated text were made in line with Springer’s (2001) hypotheses according to which younger children, compared with older children and adults, focus more on illustrations during text comprehension (perceptual boundedness) and use illustrations for the development of cogni-tive skills (perceptual support).
The first research question sought to validate the tripartite model in the context of children’s comprehension of narrative text, so Hypothesis 1 predicted that children yield representations of the text surface, the textbase, and the situation model during text reception. The second research question comprised the assumptions regarding the impact of illustrations on text comprehension. Accordingly, it was expected that illustrations improve the situation model (Hypothesis 2a), especially when they are processed before their corresponding text passages (Hypothesis 2b). Both hypotheses were derived from the ITPC and the assumption that per-ceptual simulation supports the situation model. It was further predicted that dynamic illustra-tions evoke more accurate situation models than static ones (Hypothesis 2c); this followed from the assumption that motor resonance supports the situation model. In line with the ITPC, it was assumed that illustrations impair the textbase (Hypothesis 2d), especially when they are presented after their corresponding text passages (Hypothesis 2e). In accordance with earlier results, it was posited that illustrations have a beneficial effect for the text surface (Hypothesis 2f). The third research question addressed the embodied approach to the situation model. Here, it was assumed that perceptual simulation takes place during text reception (Hypothesis 3a) and that it is more pronounced in illustrated than in non-illustrated text (Hypothesis 3b); the latter hypothesis was related to a necessary premise of the assumption that perceptual sim-ulation improves the comprehension of illustrated text. The fourth research question was relat-ed to perceptual boundedness and perceptual support and predicted age-related differences; younger children were expected to benefit more from illustrations regarding the situation model (Hypothesis 4a) and to simulate vertical object movements in a more pronounced fash-ion (Hypothesis 4b) than older children. In addition, Hypothesis 4c held that perceptual simu-lation is more pronounced in younger children particularly when illustrations are present.
Three experiments were conducted to investigate these hypotheses. Experiment 1 (Seger, Wannagat, & Nieding, submitted).compared the tripartite representations of written text without illustrations, with illustrations presented first, and with illustrations presented after their corresponding sentences. Students between 7 and 13 years old (N = 146) took part. Ex-periment 2 (Seger, Wannagat, & Nieding, 2019) investigated the tripartite representations of auditory text, audiovisual text with static illustrations, and audiovisual text with dynamic il-lustrations among children in the same age range (N = 108). In both experiments, a sentence recognition method similar to that introduced by Schmalhofer and Glavanov (1986) was em-ployed. This method enables the simultaneous measurement of all three text representations. Experiment 3 (Seger, Hauf, & Nieding, 2020) determined the perceptual simulation of vertical object movements during the reception of auditory and audiovisual narrative text among chil-dren between 5 and 11 years old and among adults (N = 190). For this experiment, a picture verification task based on Stanfield and Zwaan’s (2001) paradigm and adapted from Hauf (2016) was used.
The first two experiments confirmed Hypothesis 1, indicating that the tripartite model is appli-cable to the comprehension of auditory and written narrative text among children. A benefi-cial effect of illustrations to the situation model was observed when they were presented syn-chronously with auditory text (Hypotheses 2a), but not when presented asynchronously with written text (Hypothesis 2b), so the ITPC is partly supported on this point. Hypothesis 2c was rejected, indicating that motor resonance does not make an additional contribution to the comprehension of narrative text with dynamic illustrations. Regarding the textbase, a general negative effect of illustrations was not observed (Hypothesis 2d), but a specific negative effect of illustrations that follow their corresponding text passages was seen (Hypothesis 2e); the latter result is also in line with the ITPC. The text surface (Hypothesis 2f) appears to benefit from illustrations in auditory but not written text. The results obtained in Experiment 3 sug-gest that children and adults perceptually simulate vertical object movements (Hypothesis 3a), but there appears to be no difference between auditory and audiovisual text (Hypothesis 3b), so there is no support for a functional relationship between perceptual simulation and the situ-ation model in illustrated text. Hypotheses 4a–4c were investigated in all three experiments and did not receive support in any of them, which indicates that representations of illustrated and non-illustrated narrative text remain stable within the age range examined here.
This dissertation contributes to deepen our understanding of constructs that play a key role in individuals’ vocational career construction. In this regard, many previous studies have focused exclusively on a specific phase of an individual’s career. Yet, modern societies
require continuous investments in one’s career to adapt to changing Environments throughout the life span. Consequently, this dissertation takes a broad approach to capture a wide spectrum of career construction processes.
According to Super’s (1990) developmental stage framework, individuals have to manage vocational developmental tasks corresponding to each of the developmental life stages in order to be career mature across the life span. As the two stages exploration and
maintenance set the stage for individuals’ future career pathways, they are especially important in individuals’ vocational career construction. Therefore, both of them are addressed in this dissertation.
By answering open research questions relevant to career choice in early career stages and to career development in later career stages, this dissertation contributes to the overarching goal of shedding more light on constructs relevant to individuals’ vocational career construction processes across the life span. Beyond the results presented within each study’s horizon, this dissertation aimed at offering practical guidance to career counselors,
trainees, and training and development (T&D) professionals. Career counselors and T&D professionals are involved in guiding vocational career construction processes of individuals across the life span. Thus, on the one hand, this dissertation supports career counselors’ work so that they can help deliberating individuals make optimal and effective career choices. On
the other hand, this dissertation facilitates T&D professionals’ work so that they can effectively design and evaluate e‐learning and classroom trainings in corporate educational settings. Identifying individuals’ vocational interests combined with cognitive abilities through adequate test measures and maximizing success of learning and success of transfer through fostering evidence‐based transfer support actions will help individuals adapt quickly to the changing nature of work environments in the 21st century and to continue to successfully construct careers across the life span.
The incidence of cancer cases is rising steadily, while improved early detection and new cancer-specific therapies are reducing the mortality rate. In addition to curing cancer or prolonging life, increasing the quality of life is thus an important goal of oncology, which is why the burdens of cancer and treatment are becoming more important. A common side effect of cancer and its therapy is cancer-related fatigue, a tiredness that manifests itself on physical, emotional and cognitive levels and is not in proportion to previous physical efforts. Since the etiology of fatigue has not yet been fully clarified, symptom-oriented therapy is preferable to cause-specific therapy. In addition to activity management, sleep hygiene, and cognitive behavioral therapy, mind-body interventions such as yoga are recommended for reducing fatigue.
Previous studies with small sample sizes were able to examine the efficacy of yoga regarding fatigue predominantly in patients with breast cancer. Long-term effects of yoga have rarely been studied and there have been no attempts to increase long-term effects through interventions such as reminder e-mails. This dissertation takes a closer look at these mentioned aspects of the study sample and long-term effects. An 8-week randomized controlled yoga intervention was conducted, including patients with different cancer types reporting mild to severe fatigue. Following the 8-week yoga therapy, a randomized group of participants received weekly reminder e-mails for 6 months for regular yoga practice, whereas the control group did not receive reminder e-mails.
The first paper is a protocol article, which addresses the design and planned implementation of the research project this dissertation is based upon. This serves to ensure better replicability and comparability with other yoga studies. Due to a very low consent rate of patients in the pilot phase, it was necessary to deviate from the protocol article in the actual implementation and the planned inclusion criterion of fatigue >5 was reduced to fatigue >1.
The second paper examines the efficacy of the eight-week yoga intervention. Patients in the intervention group who participated in the yoga classes seven times or more showed a significantly greater reduction in general and physical fatigue than those who participated less often. The efficacy of yoga was related to the number of attended yoga sessions. Women with breast cancer who participated in yoga reported greater reductions in fatigue than women with other cancer types. There was also an improvement for depression and quality of life after eight weeks of yoga therapy compared to no yoga therapy. These results imply that yoga is helpful in reducing depression and cancer-related fatigue, especially in terms of physical aspects and improving quality of life.
The third paper focuses on the efficacy of reminder e-mails in terms of fatigue and practice frequency. Patients who received reminder e-mails reported greater reductions in general and emotional fatigue, as well as significant increases in practice frequency, compared to patients who did not receive reminder e-mails. Compared to fatigue scores before yoga, significantly lower fatigue and depression scores and higher quality of life were reported after yoga therapy and at follow-up six months later. Weekly e-mail reminders after yoga therapy may have positive effects on 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 improvement in physical fatigue as found in Paper 2. This may indicate other factors that influence the efficacy of yoga practice on physical fatigue, such as mindfulness or side effects of therapy.
This research project provides insight into the efficacy of yoga therapy for oncology patients with fatigue. It is important that such interventions be offered early, while fatigue symptoms are not too severe. Regular guided yoga practice can reduce physical fatigue, but subsequent yoga practice at home does not further reduce physical fatigue. Reminder emails after completed yoga therapy could only reduce patients' emotional fatigue. It may be that physical fatigue was reduced as much as possible by the previous yoga therapy and that there was a floor effect, or it may be that reminder emails are not suitable as an intervention to reduce physical fatigue at all. Further research is needed to examine the mechanisms of the different interventions in more detail and to find appropriate interventions that reduce all levels of fatigue equally.