Fennell Phase Inventory

The Fennell Scale or Fennell Phase Inventory (FPI) is a self-report measure developed in 1999 by the DePaul Myalgic Encephalomyelitis & Chronic Fatigue Syndrome Research Team in the Center for Community Research, DePaul University, Chicago, Illinois, USA. Researchers who developed the scale are Leonard Jason, Patricia Fennell, Susan Klein, Guy Fricano, Jane Halpert, & Renee R Taylor.

The Fennell scale identifies four phases of coping typically experienced by individuals with chronic illness and has been tested to confirm it applies to the ME/CFS population. Unlike many other models, the Fennell Scale takes into account the relapsing and remitting nature of ME/CFS, thus allowing that progression through the phases is non-linear and that a patient may fit into more than one phase at a time. It, also, does not assume that the patient will eventually be cured.

The four phases represent a progression of coping. Phase I, the crisis phase, can occur after the initial onset of the illness and is characterized by the individual entering into a state of emotional crisis; Phase II, the stabilization phase, involves the continuation of emotional turmoil as symptoms begin to stabilize; Phase III, the resolution phase, is described by individuals who have accepted the ambiguous and chronic nature of their illness and are beginning to construct meaning out of their experience; and Phase IV, the integration phase, occurs when the individual achieves integration between their pre- and post-illness selves, reintegrates or forms new supportive networks, activities, vocation (if possible) and is able to fit their illness into their philosophical or spiritual framework.

Fennell Scale

 * Rate each of the items below on a five point scale
 * 1= definitely do not agree
 * 2=do not agree
 * 3=somewhat agree
 * 4=agree
 * 5=very strongly agree


 * ___1.   I feel like I am falling apart.a
 * ___2.   I am just beginning to recognize when and how my symptoms occur.b
 * ___3.   I am beginning to accept the fact that I will never be completely like I was before the illness and that I will need to become a new person.b
 * ___4.   I now have learned that living with the illness involves getting sicker, at times, and improving, at times.c
 * ___5.   The primary way for me to improve is if my physician finds me the right treatment.a
 * ___6.   I am beginning to seek support and information from others who have or who know about the illness.b
 * ___7.   I am in the early process of creating meaning about my illness experience.b
 * ___8.   I have gained a sense of myself that is blended - a combination of my life before and after I first got sick.c
 * ___9.   I need to know with certainty when and if I am going to get better.a
 * ___10. I am just starting to feel like I have some control of my life.b
 * ___11. I am beginning to learn how to live with the unknown or chronic nature of my illness.b
 * ___12. I have better and more satisfying relationships with people I care about since I first became sick.d
 * ___13. It is my fault I got sick.d
 * ___14. I am just starting to realize that there may be things I can do to help myself feel better.b
 * ___15. I am starting to see my illness experience as having some value.b
 * ___16. I am proud of myself for living with this illness.c
 * ___17. I think about my illness all of the time.a
 * ___18. I am just beginning to stabilize (i.e., feeling a bit less confused and a bit more ordered).b
 * ___19. For the first time, I am beginning to have compassion and love for myself and for what I have endured.b
 * ___20. I am a better and wiser person since I first got sick.c


 * a = Crisis Factor
 * b = Stabilization Factor
 * c = Integration Factor
 * d = not scored

Scoring
The Crisis mean score was calculated by adding items 1, 5, 9, and 17 of the Fennell Phase Inventory and dividing by four. The Stabilization mean score was calculated by adding items 2, 3, 6, 7, 10, 11, 14, 15, 18, and 19 of the Fennell Phase Inventory and dividing by ten. The Integration mean score was calculated by adding items 4, 8, 16, and 20 of the Fennell Phase Inventory and dividing by four.

These scoring criteria are in Jason, Fricano, Taylor, Halpert, Fennell, Klein, and Levine (2001, January). Using Crisis, Stabilization, and Integration mean scores (see above), each participant was then assigned to one of the four groups according to the following algorithmic criteria derived from the cluster analysis from the data in the Jason, Fennell, Klein, Fricano, Halpert, and Taylor (1999) study. Criteria for the Crisis group were a Crisis score of 3.00 or above and Stabilization and Integration scores of 3.30 or below. Criteria for the Integration group were a Crisis score of 2.50 or below, a Stabilization score of 2.80 or below and an Integration score of 4.25 or above. Cases not in either of these groups that had either a Crisis score 3.10 or above, a Stabilization score 3.40 or above, or an Integration score of 3.75 or above were classified into a Resolution group. Cases that did not meet any of the above criteria comprised the Stabilization group.

Studies using Fennell Scale with ME/CFS population

 * 2009, The relationship of Fennell phases to symptoms among patients with chronic fatigue syndrome"'Abstract: The Fennell Phase Inventory (FPI) is an instrument designed to measure phases of the illnesses known as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). The current study explored how the FPI was related to physical and psychological functioning as well as coping style. Based on FPI scores, 111 adults with ME/CFS were placed in one of three groups: crisis, stabilization, or resolution. Results showed that the crisis group demonstrated significantly worse functioning than at least one other group for depression, quality of life, mental functioning, anxiety, and self-efficacy; and utilized less adaptive coping styles. These results indicate that patients with ME/CFS who are in the crisis phase tend to experience more severe psychological and physical symptoms and utilize poorer coping strategies. Those in the resolution phase maintain the most adaptive coping strategies. Implications for these findings are discussed.'"
 * 2004, The Fennell Phase Inventory in a Belgian Sample"'Abstract: The present study is a follow-up of the research conducted by Jason, Fennell et al. (1995, 1999, 2000) on a multistage theory for chronic fatigue syndrome (CFS). This multistage model is a very promising method for the evaluation of patients suffering from CFS and could facilitate the appropriate selection of various psychosocial therapies that improve the patient’s ability to cope with their illness. Four predictive factors emerged with moderate to excellent reliability. A Spearman’s rank correlation revealed positive correlations between our four-factor model and the three-factor model identified by Jason et al.(1999). A correlation matrix between the dimensional psychological investigation and the Fennell Phases revealed characteristics as suggested by previous research.  Biological  parameters  varied  over  the  different phases suggesting an important interaction between body and psyche.'"
 * 2000, Chronic fatigue syndrome: an examination of the phases"'Abstract: The present study examined the Fennell Phase Inventory, an instrument designed to measure the phases typically experienced by individuals with chronic fatigue syndrome (CFS). This inventory yields three factor scores of Crisis, Stabilization, and Integration. These factor scores have been employed in a cluster analysis, yielding four clusters that matched the four phases predicted by Fennell: Crisis, Stabilization, Resolution, and Integration. The present study represents a partial replication study of a prior investigation of the Fennell Phase Inventory by Jason et al. (in press), but that earlier study did not have an independent physician examination to diagnose patients with CFS. In the present study, 65 patients diagnosed with chronic fatigue syndrome by a physician were recruited and administered the Fennell Phase Inventory and other measures assessing CFS-related symptoms, disability, and coping. Each of the 65 patients was classified into one of four predefined clusters measuring a Crisis phase, a Stabilization phase, a Resolution phase, and an Integration phase. Relationships were explored between three of these cluster groupings and measures of symptoms, disability, and coping. Results confirmed Fennell's model, revealing significant differences between the three clusters in terms of levels of disability and modes of coping. Results suggest that the Fennell Phase Inventory accurately differentiates phases of adaptation to illness experienced by individuals with CFS.'"

Learn more

 * 2012, The Four Phases Of Chronic Illness By Patricia A. Fennell, MSW, LCSW-R