Fennell Phase Inventory

The Fennell Phase Inventory (FPI) or Fennell Scale 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, US. Researchers who developed the scale are Leonard Jason, Patricia Fennell, Susan Klein, Guy Fricano, Jane Halpert, & Renee R Taylor.

The Fennell Phase Inventory identifies four phases of coping typically experienced by individuals with chronic illness and has been tested to confirm it applies to the myalgic encephalomyelitis/chronic fatigue syndrome ME/CFS population. Unlike many other models, the Fennell Phase Inventory 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 Phase Inventory

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 Phase Inventory 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, Association Between Fennell Phase Inventory Scores and Immune and RNase-L Parameters in Chronic Fatigue Syndrome

  "Abstract - All patients suffering from a chronic condition, are challenged to manage the reality of their disease, the accompanying anxiety, the problems of daily living, and the effect on relationships. Therefore, when confronted with debilitating complaints, patients suffering from chronic fatigue syndrome (CFS) need to adapt to a new way of living during the course of their illness. Fennell developed an integrated model to manage CFS. This article is a follow-up of a study by Jason et al. (9, 10) to verify the existence of the different phases. Although not all differences are statistically significant, a clear distinction is made according to the conclusions drawn by Jason et al. (9, 10). Relationships between these distinctions and measures of symptoms, disability, psychological distress, coping, and immune parameters were revealed using non-parametric statistical tests."

• 2004, The Fennell Phase Inventory in a Belgian Sample (Full Text)
• 2000, Chronic fatigue syndrome: an examination of the phases (Abstract)
• 2000, An Empirical Verification of the Fennell Phases of the CFS Illness

  Abstract - "The Fennell Phase Inventory is an instrument designed to measure the phases typically experienced by individuals with chronic fatigue syndrome. In a previous study, a three-factor solution emerged. A cluster analysis was then conducted using the three mean scores for each individual, and four clusters emerged. These clusters matched the four phases predicted by Fennell. The Fennell Phase Inventory appears to be a promising way of differentiating the phases that are experienced by individuals with CFS."

Learn more

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