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.
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] and [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] and [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] and [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] and [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.
