رفاه در بیماران مبتلا به سندرم خستگی مزمن: نقش قبول واقعیت
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|38525||2006||5 صفحه PDF||سفارش دهید||3764 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Psychosomatic Research, Volume 61, Issue 5, November 2006, Pages 595–599
Abstract Objective Research in chronic pain patients has shown that accepting the chronic nature of their illness is positively related to quality of life. The aim of this study was to investigate whether acceptance is also associated with better well-being in patients suffering from chronic fatigue syndrome (CFS). Methods Ninety-seven patients completed a battery of questionnaires measuring fatigue, functional impairment, psychological distress, and acceptance. Results Results indicated that acceptance has a positive effect upon fatigue and psychological aspects of well-being. More specifically, acceptance was related to more emotional stability and less psychological distress, beyond the effects of demographic variables, and fatigue severity. Conclusion We suggest that promoting acceptance in patients with CFS may often be more beneficial than trying to control largely uncontrollable symptoms.
Introduction Chronic fatigue syndrome (CFS) is a severe and invalidating experience of fatigue, which lasts for at least 6 months . Most patients report a low ability in somatic, psychological, cognitive, and social functioning, which often leads to professional difficulties , , ,  and . As yet, the experience of chronic fatigue is medically unexplained . In an attempt to diminish suffering and improve quality of life, several models have been developed, addressing possible initiating, exacerbating, and maintaining factors  and . 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 ,  and . 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 ,  and . 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 . In a questionnaire study  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 . 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.  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 . McCracken and Eccleston  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 . 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.
نتیجه گیری انگلیسی
Results 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 their major source of income. About one fourth of the sample (25.7%) was still employed. More than one third of the sample (36.6%) had lower or profession education as highest education level, whereas 17.2% received middle education. A large group (36.5%) had higher nonuniversity education, and 9.7% received university education. Mean self-report scores on all instruments are presented in Table 1. The mean scores on the CIS and the SIP-68 are indicative of severe fatigue and functional impairment  and . The HADS scores are indicative of psychological distress in our sample . Table 1. Correlations between indicators of well-being, fatigue, and acceptance Mean S.D. 1 2 3 1. CIS (fatigue) 47.52 10.47 2. SIP-68 19.32 10.06 .49⁎⁎⁎ 3. HADS 19.68 6.02 .40⁎⁎⁎ .33⁎⁎ 4. ICQ (acceptance) 13.64 4.12 −.41⁎⁎⁎ −.25⁎ −.54⁎⁎⁎ ⁎ P<.05. ⁎⁎ P<.01. ⁎⁎⁎ P<.001. Table options Correlation analyses Correlations are shown in Table 1. Of particular relevance is that acceptance is negatively correlated with all three indicators of well-being, showing that acceptance is associated with lower levels of fatigue, functional impairment, and psychological distress. Regression analyses The results of the regression analyses are reported in Table 2. Acceptance is a unique predictor of fatigue severity, beyond the effects of depression, as measured by the HADS. Furthermore, fatigue severity is a significant predictor of both psychological distress and functional impairment. However, psychological distress is best predicted by acceptance, explaining an additional 16% of the variance beyond the effects of demographic characteristics, fatigue severity, and duration of the complaints. Table 2. Hierarchical regressions on different indicators of well-being Dependent variable Predictors ΔR2 R2 (adjusted) β (standardized) P Fatigue severity Depression .15b .12b .27 .016 Acceptance .06a .17c −.26 .017 Psychological distress Fatigue severity .15b .11a .23 .026 Acceptance .16c .27c −.43 .000 Functional impairment Fatigue severity .23c .28c .40 .000 Acceptance .02 .28c −.14 .154 Somatic autonomy Fatigue duration .09a .13b .24 .021 Acceptance .00 .13b .07 .532 Mobility control Fatigue severity .13c .23c .27 .009 Acceptance .02 .24c −.15 .131 Psychic autonomy Fatigue severity .11b .15b .27 .013 Acceptance .01 .15b −.10 .366 Social behavior Fatigue severity .25c .27c .49 .000 Acceptance .00 .26c −.04 .675 Emotional stability Acceptance .09b .10a −.32 .005 Mobility range Fatigue severity .10a .10a .31 .004 Acceptance .00 .09a −.05 .674 Only acceptance and significant predictors in the final model are reported. P values for standardized β's in italics indicate significant contributions of predictors after Bonferroni correction for multiple (9) comparisons (P<.006). a P<.05. b P<.01. c P<.001. Table options The regressions on the six subscales of the SIP-68 allow a more fine-grained analysis of the different domains of functioning. Fatigue severity is the best predictor in most aspect of functional impairment. However, acceptance is the strongest predictor of “emotional stability,” explaining an additional 9% of the variance beyond self-reported fatigue and duration of the complaints. A higher level of acceptance is related to less problems on this domain.