The role of acceptance in chronic fatigue syndrome Samantha K. Brooks, Katharine A. Rimes, Trudie Chalder ⁎ Department of Psychological Medicine, King's College London, UK abstract article info Article history: Received 27 April 2011 Received in revised form 4 August 2011 Accepted 12 August 2011 Keywords: Acceptance Chronic fatigue syndrome Cognitive-behaviour therapy 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 3 months 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. © 2011 Elsevier Inc. All rights reserved. Introduction Chronic fatigue syndrome Chronic fatigue syndrome (CFS) is a disorder defined by persistent severe fatigue, unrelated to exertion and not relieved by rest, lasting at least 6 months [1,2]. People with CFS generally experience muscle and joint pain; difficulties in cognitive and psychological functioning; disturbed sleep; and mental and physical exhaustion. These symptoms are associated with impaired physical and social functioning. The present study considers CFS in the context of a cognitive behavioural approach, which focuses on how cognitive, behavioural, physiological and social factors interact to perpetuate the condition [3]. One aspect of this model suggests that unhelpful beliefs or thinking patterns such as catastrophising lead to a reduction in activity which worsens symptoms of CFS and creates a ‘vicious circle’ perpetuating fatigue and disability. It has been suggested [4] that the desire to meet responsibilities and high standards may be hindered by symptoms of fatigue, and the perceptions of actual or feared failure may then exacerbate the symptoms and cause further distress, thus creating another ‘vicious circle’. This desire to meet high standards may well be an aspect of perfectionism, which will be discussed further below. One of the main interventions for CFS is Cognitive Behaviour Therapy (referred to hereafter as CBT), a collaborative treatment in which patient and therapist work together using a variety of techniques to improve fatigue and functioning. Therapy is adapted to the needs of the individual and may include: pacing (establishing a consistent pattern of activity and rest); gradual increase in activity levels; sleep management; and addressing unhelpful thinking patterns including perfectionism. Systematic reviews have shown CBT to be effective in improving functioning and reducing fatigue in CFS patients [5]. CBT, along with Graded Exercise Therapy, has also been shown in a non randomised trial to significantly improve “action-proneness” (cognitive and behavioural tendency towards direct action), although not to pre-morbid levels [6]. Acceptance Research on patients with chronic pain has suggested that attempt- ing to control pain which is uncontrollable (lack of acceptance) is associated with distress and frustration [7,8], reduced physical functioning [9], higher pain identity and more serious perceived consequences [10]. Lack of acceptance has also been shown to be inversely related to the ability to undergo positive, personal change for better health and wellbeing [11]. Conversely, increased acceptance – Journal of Psychosomatic Research 71 (2011) 411–415 ⁎ Corresponding author at: King's College London, Academic Department of Psychological Medicine, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK. Tel.: +44 207 848 0406; fax: +44 207 848 5408. E-mail address: trudie.chalder@kcl.ac.uk (T. Chalder). 0022-3999/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.jpsychores.2011.08.001 Contents lists available at SciVerse ScienceDirect Journal of Psychosomatic Research