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Tired all the time: The role of acceptance in Chronic Fatigue Syndrome

Tired all the time: The role of acceptance in Chronic Fatigue Syndrome. Kevin E. Vowles, Ph.D. University of Bath Association for Contextual Behavioral Science 01 July 2009. Background. There are clinical and conceptual parallels between chronic pain and chronic fatigue.

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Tired all the time: The role of acceptance in Chronic Fatigue Syndrome

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  1. Tired all the time:The role of acceptance in Chronic Fatigue Syndrome Kevin E. Vowles, Ph.D. University of Bath Association for Contextual Behavioral Science 01 July 2009

  2. Background • There are clinical and conceptual parallels between chronic pain and chronic fatigue. • In ACT, there is an assumption that common processes exist across the spectrum of human problems.

  3. What is CFS(/ME)? • Persistent fatigue • “Brain fog” • Post-exertional malaise • Sleep is not refreshing • Pain is very common • Flu-like symptoms very common • Often lots of worry, sadness, etc.

  4. Some quick stats: • It is a diagnosis of exclusion. • 50%+ are depressed • There is no reliably effective medical intervention • CBT and Graded exercise seem to work ok according to meta-analyses.

  5. What do we know from chronic pain (& other chronic conditions too!) • Less struggling with (insert your bad stuff) is associated with better functioning. • More engagement in (insert what makes you tick) is associated with better functioning.

  6. The Chronic Pain Acceptance Questionnaire(20 Items; 2 subscales) What, then, does “acceptance” of chronic pain look like? • Participation in important activities of living while pain is present. • Activity Engagement • “I am getting on with the business of living no matter what my level of pain is.” • Allowing pain to be present without attempts to avoid or control it, especially when such attempts inhibit the above. • Pain Willingness • “I have to struggle to do things when I have pain”

  7. The Fatigue Acceptance Questionnaire(20 Items) • “I am getting on with the business of living regardless of my level of fatigue.” • “I have to struggle to do things when I am fatigued”

  8. Two statistical questions: • Does the FAQ have the same subscales (i.e., factor structure) as the CPAQ? • Do scores on the FAQ account for variance in functioning above and beyond fatigue?

  9. 187 Participants • Assessment Clinic, Tertiary care setting • 75% women • Mean age 40 yrs (+ 13) • 97% white • Symptom duration – 3.8 yrs (median), 6.5 yrs (mean) • Diagnoses included CFS (59%), ME (20%), & Post-viral fatigue (12%) • 87% had pain • 87% reported altered sleep • 61% unemployed

  10. Range of factor structures evaluated (2 – 4 factors) 2 factors: Activity Engagement (α = 0.87) Fatigue Willingness (α = 0.70) Scale content identical to CPAQ, with the exception of 2 items which switched. Factor Analysis

  11. Fatigue Severity Disability Physical Psychosocial Depression Anxiety “Sensitivity” Usual Pain Intensity Average Daily Uptime Work Status Values Success Measures

  12. Regression • If we knew about acceptance, would we know more about how one is functioning than if we only knew fatigue alone? • Controlled for gender, age, symptom duration. • Entered fatigue severity. • Entered both acceptance subscale scores.

  13. Physical Disability

  14. Psychosocial Disability

  15. Depression

  16. Usual Pain

  17. Anxiety Sensitivity

  18. Daily Uptime (hrs)

  19. Work (yes/no)

  20. Values Success

  21. More questions? • Can we define the “problem” of CFS as a problem of behavior (and not of fatigue)? • Is it possible that control efforts directed at meaningful living will contribute to different results than efforts direct towards fatigue reduction?

  22. Thanks for your attention k.vowles@bath.ac.uk www.bath.ac.uk/pain-management/

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