CBT, Rehabilitation May Improve Symptoms of Long COVID
A recent study showed that cognitive behavioral therapy could help reduce fatigue and improve concentration with moderate certainty.
Cognitive behavioral therapy (CBT) and physical and mental health rehabilitation could improve symptoms of long COVID, according to recent research published in the BMJ.1 Authors of the study said the findings can help inform future guideline recommendations about the care of patients with the condition and the design of future studies on treatments.1
CBT, Rehabilitation May Improve Symptoms of Long COVID / THP Creative - stock.adobe.com
Around 14% of people in the United States report having had long COVID at some point, data from the Census Bureau’s Household Pulse Survey shows.2 The condition, which includes a wide range of symptoms, can be a debilitating illness that could last for weeks, months, or even years after a COVID-19 infection. Although anyone can get long COVID, it impacts women more than men and White individuals more than Black or Asian individuals.3 While long COVID has become a well-recognized condition, treatment options remain insufficient.
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“Healthcare providers are increasingly encountering patients with long COVID, and, in the absence of trustworthy and up-to-date summaries of the evidence, patients may receive unproven, costly, and harmful treatments,” the authors wrote. “Some patients and healthcare providers have questioned the credibility of interventions in published trials, such as exercise and CBT. Trustworthy systematic reviews that clarify the benefits and harms of available interventions are critical to promote evidence based care.”
A team of investigators from McMaster University and Monash University conducted a study to compare the effectiveness of interventions for the management of long COVID. Data for the systematic review was gathered from several databases up to December 2023, including Medline, Embase, CINAHL, PsycInfo, Allied and Complementary Medicine Database, and the Cochrane Central Register of Controlled Trials.
The systematic review included 24 studies with a total of 3695 adult patients with long COVID symptoms that persisted for 3 or more months. Patients in the studies were randomized either to any drug or non-drug intervention, placebo or sham, usual care, or to alternative drug or non-drug interventions. Patients were excluded from the study if they had recovered from COVID-19 less than 3 months before randomization.
Of the trials included in the study, 4 investigated drug therapies, 8 investigated physical activity or rehabilitation, 3 investigated behavioral interventions, 4 investigated dietary interventions, 4 assessed medical devices and technologies, and 1 investigated a combination of physical exercise and mental health rehabilitation.
The study found an online CBT program could help reduce fatigue and improve concentration with moderate certainty. Moderate certainty evidence also showed that an online, supervised program that combined physical and mental health rehabilitation was linked with improvements in overall health, reduced symptoms of depression, and improved quality of life compared with usual care. Aerobic exercise 3 to 5 times a week for 4 to 6 weeks showed improvements in physical function with moderate certainty compared to continuous exercise.
Additionally, there was no compelling evidence for any of the other interventions. This includes vortioxetine, leronlimab, combined probiotics-prebiotics, inspiratory muscle training, transcranial direct current stimulation, hyperbaric oxygen, and a mobile application providing education on long COVID.
“Our findings suggest that offering patients with long covid a program of CBT or a program of physical and mental health rehabilitation will probably improve symptoms,” the authors concluded. “However, both CBT and physical and mental health rehabilitation require active patient engagement, which may be challenging owing to some patient groups expressing concerns about the safety and efficacy of these approaches and that the effectiveness of CBT and rehabilitation implies that long covid is not ‘real’ but ‘psychological.’”
READ MORE: COVID-19 Resource Center
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