Cognitive behavioral therapy (CBT) lessens fatigue and improves concentration among long-COVID patients, finds a Dutch randomized controlled trial published yesterday in Clinical Infectious Diseases.
The Amsterdam University Medical Centers–led study involved 114 long-COVID patients with severe fatigue and functional impairment 3 to 12 months after infection. Participants were randomly assigned in a 1:1 ratio to receive either CBT or usual care (mainly physical therapy and/or occupational therapy) from November 12, 2020, to September 21, 2021. The average number of interactions (email and video, in-person, and phone visits) between patients and therapists was 11.8.
Participants completed two symptom-based questionnaires during the study. Most patients were nonhospitalized and self-referred from one of six centers.
CBT helps long-COVID patients better manage their symptoms, senior author Hans Knoop, PhD, said in an Amsterdam University news release. "Together with patients, we look, for example, at how they can improve their sleep-wake rhythm," he said. "We also help them become more active again with small, safe steps. For example, by going for short walks."
Improvements sustained at 6 months
Patients who received CBT were significantly less fatigued on the fatigue-severity subscale of the Checklist Individual Strength than usual-care patients both immediately after therapy completion and 6 months later (-8.8 points; 95% confidence interval [CI], -11.9 to -5.8). There were also improvements in physical and social functioning, physical symptom severity, and concentration.
"Cognitive behavioural therapy also appears to be a safe treatment," Knoop said. "Our research shows that the symptoms did not worsen, and new symptoms arose less often."
Symptoms did not worsen, and new symptoms arose less often.
The researchers said that the symptom relief achieved after CBT doesn't mean long COVID is a psychological problem and cautioned that CBT doesn't work for everyone. "We encourage research into its underlying (neuro)biological mechanisms," they concluded. "Relatedly, while the majority of patients were no longer severely fatigued following CBT, a substantial group remained severely fatigued. Research into other treatment approaches is warranted."