title: The role of acceptance in rehabilitation in life-threatening illness.
abstract: BACKGROUND
  Palliative care rehabilitation aims to maximize physical and psychological functioning, but negative thoughts can hinder patients from attempting this approach. Acceptance and commitment therapy (ACT), a modified form of cognitive behavioral therapy, encourages individuals to experience and manage negative emotions by focusing on changing individual behavior and so improve functioning. ACT has been used in many health-related behavioral interventions but not in palliative care rehabilitation.
  
  
  OBJECTIVE
  To investigate the relationship between acceptance (often called experiential acceptance in ACT) and psychological and physical status.
  
  
  METHODS
  Cross-sectional study in which a consecutive sample of patients attending a specialist palliative care day therapy unit for rehabilitation completed the Acceptance and Action Questionnaire-II to measure acceptance and the Kessler-10 questionnaire to measure psychological morbidity. Physical function was assessed by a timed two-minute walking test and one-minute sit-to-stand test. Correlation statistics and multivariable regression analyses were used to explore the strength of relationships between acceptance and psychological morbidity and physical function.
  
  
  RESULTS
  One hundred one patients were recruited, mainly white women with a mean age of 64 years. Correlation analysis showed a negative association between acceptance and psychological morbidity (r=-0.59) and a positive association between acceptance and sit to stand (r=0.27) and distance walked (r=0.21). All three of these relationships were statistically significant after adjustment.
  
  
  CONCLUSIONS
  These associations suggest that it may be possible to reduce psychological morbidity and improve physical mobility by increasing patients' acceptance using an ACT-based intervention. Future work is now needed to develop an ACT-based intervention in palliative care rehabilitation and test its acceptability and feasibility.
authors.affiliation: Marie Curie Palliative Care Research Unit, Research Department of Mental Health Sciences, University College London, London, United Kingdom. joseph.low@ucl.ac.uk
authors.forename: Joseph
authors.initials: J
authors.lastname: Low
authors.forename: Sarah
authors.initials: S
authors.lastname: Davis
authors.forename: Robyn
authors.initials: R
authors.lastname: Drake
authors.forename: Michael
authors.initials: M
authors.lastname: King
authors.forename: Adrian
authors.initials: A
authors.lastname: Tookman
authors.forename: Karen
authors.initials: K
authors.lastname: Turner
authors.forename: Marc
authors.initials: M
authors.lastname: Serfaty
authors.forename: Baptiste
authors.initials: B
authors.lastname: Leurent
authors.forename: Louise
authors.initials: L
authors.lastname: Jones
mesh_terms: D000342:Affective Symptoms / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation*; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data*; D012046:Rehabilitation / Q000706:statistics & numerical data; D012917:Social Adjustment; D019452:Terminally Ill / Q000523:psychology* / Q000706:statistics & numerical data*; D016896:Treatment Outcome