Esther12
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Abstract
Objective
In this paper we consider the role that acceptance plays in fatigue and physical and social functioning. We predicted that lack of acceptance would be positively correlated with fatigue and impairment in functioning; that there would be a significant relationship between perfectionism and acceptance; and cognitive behavioural therapy (CBT) would increase acceptance.
Methods
Two hundred and fifty nine patients with chronic fatigue syndrome (CFS) completed questionnaires measuring fatigue, physical functioning, work and social adjustment, lack of acceptance, perfectionism and depression. Ninety consecutive attenders received a course of CBT and completed further questionnaires at discharge and 3months post-treatment. Correlations and multiple hierarchical regressions were used to determine relationships between acceptance, perfectionism and clinical outcome variables.
Results
At baseline, lack of acceptance was the key factor associated with impaired physical functioning and work and social adjustment. Lack of acceptance and doubts about actions were associated with fatigue in a multiple regression analysis. At discharge and follow-up patients showed significantly increased acceptance, as well as reduced Concern over Mistakes, less fatigue and impairment of physical functioning, and improved work and social adjustment.
Conclusion
This is the first study to our knowledge which shows a change in acceptance after CBT and a relationship between acceptance and perfectionism. Acceptance may be an important factor to consider within treatments for CFS.
http://www.jpsychores.com/article/S0022-3999(11)00212-1/abstract
From the paper:
(Lack of) Acceptance
The study used a slightly adapted version of the Chronic Pain Acceptance Questionnaire or CPAQ [34]. The original questionnaire is divided into two factors — activity engagement and pain willingness. For the purposes of this study, only the pain willingness subscale was used, and the word ‘pain’ was replaced with ‘fatigue’. The concept of willingness refers to the recognition that avoidance and control of pain are often not viable. So, fatigue willingness refers to feeling little need to attempt to avoid or control fatigue. Nine items, including statements such as “Keeping my fatigue level under control takes first priority whenever I'm doing something” and “I need to concentrate on getting rid of my fatigue” are scored on a 7-point Likert scale (where 0=‘never true’ and 6=‘always true’) so the higher the score, the higher the lack of acceptance. Cronbach's alpha was high in this study (.83).
Although the encouragement of acceptance may be done as part of addressing unhelpful cognitions, it might be more effective for an increased focus on acceptance to be included in therapy. CBT could focus on acceptance of the symptom of fatigue, using attentional strategies to facilitate this. However we are not suggesting acceptance of disability which can be reduced or prevented by behavioural change. It is possible to change functional limitations [42] and recover from the disability associated with CFS [43] and [44]. It may be that by being accepting of symptoms, that acceptance itself could reduce symptoms and disability which may be related to coping strategies — though this would need to be tested empirically. Ideally this would involve a randomised controlled trial of acceptance and commitment therapy.
However we are not suggesting acceptance of disability which can be reduced or prevented by behavioural change.
How do you know what that is? What are they suggesting acceptance of then? This paper doesn't really seem to say. How are people supposed to know what level of disability should be 'accepted', and what can be changed?
Does anyone know more about what 'acceptance' would tend to mean in these contexts? Having read the paper, I still don't really know. For things like anxiety, there's Acceptance of Commitment Therapy, but this paper seem to be talking of acceptance of fatigue, rather than cognitions. Hopefully someone here will be better informed about this stuff than I.
re perfectionism, high standards, etc: Knowing what standards one should set for oneself is difficult without access to meaningful information about whether one faces long-term restrictions in capacity or not. If one is (for example) being wrongly encouraged to believe that one's reduction in capacity following a severe case of glandular fever is a result of deconditioning and a fear of exercise which can be reversed by behavioural change, then this quackery would be likely to lead to inappropriate standards being set. That seems to be the a common problem when someone's cognitions are managed with inaccurate information.