4. Automatically fatigued? A user-friendly Cognitive Bias Modification e-Health intervention to minimize fatigue and foster vitality in hemodialysis patients


Fatigue, vitality, cognitive bias modification, self-concept bias, attentional bias


Fatigue is a disabling symptom among hemodialysis and pre-dialysis patients, for which no targeted medical treatment is available. Evidence from studies in renal patients indicates that fatigue has a considerable psychosomatic component. A growing body of research shows that automatic and unconscious mental processes, so-called cognitive biases, play an important causal and perpetuating role in psychosomatic symptoms such as pain and fatigue. Computer-mediated techniques, Cognitive Bias Modification (CBM) that can correct these maladaptive biases with simple repetitive association tasks.

This project targets two complementary cognitive biases related to fatigue: 1) attentional bias, when patients have developed an unconscious preoccupation with fatigue-related signals, and 2) self-identity bias, when fatigue has become mingled with patients’ sense of self.

As this will be the first project to measure and modify cognitive biases in kidney patients, we execute a proof-of-concept study to assess clinical suitability and potential effectiveness of CBM with a computer application combining self-identity (SI-CBM) and attentional (A-CBM) CBM suitable for home use.

A single-case A-B-A series design is employed with multiple measurements during a varying baseline phase, 2 weeks treatment phase, and 3 weeks follow-up on primary and secondary outcomes. The main study will be accompanied by two mixed-method user-centered design studies to ensure usability and acceptability of CBM treatment from patient and health professional perspective.


Ziekenhuis Groep Twente, Isala Zwolle



Contact person(s) in the SMHA lab:

Marcel Pieterse, Christina Bode, Jody Geerts