Original articleWell-being in patients with chronic fatigue syndrome: The role of acceptance
Introduction
Chronic fatigue syndrome (CFS) is a severe and invalidating experience of fatigue, which lasts for at least 6 months [1]. Most patients report a low ability in somatic, psychological, cognitive, and social functioning, which often leads to professional difficulties [2], [3], [4], [5], [6]. As yet, the experience of chronic fatigue is medically unexplained [7]. In an attempt to diminish suffering and improve quality of life, several models have been developed, addressing possible initiating, exacerbating, and maintaining factors [8], [9]. One factor that has proven to be related to the functioning of CFS patients is self-efficacy. Research has revealed that self-efficacy, defined as the perceived ability to control illness, has a positive effect on fatigue and associated impairments [10], [11], [12]. Although there is definitely merit in the idea that active attempts to control fatigue and disability contribute to a better quality of life, there may sometimes be negative effects. In particular, research in patients with chronic pain has pointed out that attempts to control uncontrollable pain may prove futile and may only fuel frustration, distress, and hypervigilance to symptoms [13], [14], [15]. Research with chronic pain patients has shown that giving up attempts to control pain and accepting chronic pain lead to a better adjustment to chronic pain [16]. In a questionnaire study [17] in 160 chronic pain patients, acceptance of pain was associated with less psychological distress, and less disability, even after controlling for the effects of pain severity. Similar results emerged from a study in patients with rheumatoid arthritis and multiple sclerosis [18]. That study further showed that acceptance was associated with an increase in physical and psychological health status at a 1-year follow-up. Viane et al. [19] investigated the role of acceptance in well-being in two questionnaire studies with chronic pain patients. Both studies showed that acceptance was related to better psychological but not physical well-being.
Acceptance is a complex construct that consists of several components. Although many patients relate acceptance to giving up, recent studies have explicitly rejected this negative view [20]. McCracken and Eccleston [14] have argued that acceptance is best conceived of as halting the dominant search for a definitive solution of physical complaints and as a reorientation of attention towards positive everyday activities and other aspects of life. Research has further indicated that acceptance often involves a search for a new identity, implying a re-evaluation of personal goals, values, and life priorities [21].
Although the idea of acceptance is less common in the field of CFS than in chronic pain, there is ongoing discussion in clinical practice about whether the aim of cognitive-behavior therapy should be learning to control fatigue or pacing and accepting limitations. In the present study, we investigate whether acceptance contributes to well-being in patients with CFS. We hypothesize that acceptance will be associated with lower levels of fatigue, psychological distress, and functional impairment.
Section snippets
Participants
The sample consisted of 110 patients with CFS who were on a waiting list for cognitive-behavioral treatment in the Ghent university hospital. All patients fulfilled the CDC [1] criteria for CFS. The study was approved by the local ethical committee, and all patients provided informed consent. They received a package of questionnaires by mail and were requested to send it back after completion.
Questionnaires
We used three indicators of well-being: fatigue [Checklist Individual Strength (CIS)], psychological
Characteristics of patient sample
The initial response ratio was 72% and amounted to 91% after a reminder by telephone. Questionnaire data were incomplete in three patients. Valid questionnaire data were available for 97 patients. The final sample consisted of 19 males and 78 females, with a mean age of 40.06 years (SD=8.36; range: 21–58 years). Mean duration of the complaints was 7.89 years (SD=6.30; range: 1–26 years). Respectively 30% and 34% of the patients had a disease or invalidity benefit, and most of them cited this as
Discussion
The main finding of this study is the effect of acceptance upon several domains of well-being, which is a new and intriguing finding in the field of CFS. Particularly interesting is the protective role of acceptance in psychological aspects of well-being. This may be important, because it is well-known that problems in psychological functioning may maintain chronic illnesses such as CFS [28]. Although new in CFS research, the positive role of acceptance in psychological well-being is in line
Acknowledgment
Stefaan Van Damme is a postdoctoral researcher of the Fund for Scientific Research Flanders (Belgium). The authors want to thank Ilse Viane and Karen Panis for their input in previous versions of this paper.
Part of the data presented in this study has been published in Dutch. Source: Van Damme, S., Viane, I., Panis, K., Van Duysse, A., Mariman, A., Michielsen, W., & Crombez, G. De invloed van aanvaarding op kwaliteit van leven bij patiënten met het chronisch vermoeidheidssyndroom [The role of
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