Blog: Working Alongside People with Long Covid: a Psychologist’s Learning

[Sly Saint]

"Today’s guest post is written by Dr Richard Pione, a clinical psychologist, CBT therapist and former Psychological Wellbeing Practitioner. Richard has worked within several different clinical health psychology settings, with the most recent being a short-term post within a Long COVID MDT. Richard shares what he has found to be helpful when working with people experiencing symptoms of Long COVID."

Context:
I am not an expert in Long COVID. The below are just things that I have found helpful to bear in mind when working with people experiencing Long COVID symptoms.

Beginners mind:
Even if you have developed Long COVID symptoms yourself (or have spoken to others that have it), do not assume you know what the person has been experiencing. There has been great variation in regards to the type and degree of symptoms that people with Long COVID are experiencing so far. Be curious, non-judgemental and validating.

Expectations?
Has the person been asked to see you as no one else can make sense of their experiences? Do they think they have been sent to you as they believe other professionals consider Long COVID to be a psychological phenomenon? Are there expectations that you as a Health Care Professional will cure their Long COVID?

Myalgic Encephalomyelitus/ Chronic Fatigue Syndrome (ME/CFS) context
There seems to be a great deal of crossover between the symptoms of ME/CFS and that of some types of Long COVID. There is evidence to suggest that when working with ME/CFS that the graded exercise approach has been shown to be ineffective and, in many cases, lead to physical deterioration (The ME Association, 2020). So be cautious in advising how much exercise/activity a person with Long COVID should partake in. NHS guidelines for Long COVID do recommend 1 walk per day; Physios for ME recommend that an assessment of post exertional malaise (PEM) is carried out before any activity is suggested, and that physical activity is well paced and informed by the assessment of PEM.

Historically, there is also an understandable degree of mistrust between some with ME/CFS and some of the psychology community. Some CBT therapists/ psychologists it was felt, implied that ME/CFS came along with a set of irrational or incorrect negative thoughts that could be ‘corrected’ via cognitive restructuring. Or indeed, believed that ME/ CFS could be cured through a mixture of cognitive restructuring and behavioural activation/ activity scheduling and Graded Exercise Therapy. I’m mentioning this, as because so much is unknown about Long COVID at this time, it’s possible that these symptoms are here for the long term, and that perhaps, our role as clinicians are to help people to adjust/ manage the symptoms as best as they can (i.e. pacing, ACT-like intervention). For more information, see Shepherd (2020). It’s also possible, that those with Long COVID symptoms could understandably mistrust or be suspicious of psychological intervention given what has happened in the past to those with ME/ CFS.

https://notaguru.blog/2021/04/17/working-alongside-people-with-long-covid-a-psychologists-learning/

Apart from slipping in ACT and the questionable Boom and bust approach to pacing I think this is quite well balanced particularly as it is framed within IAPT.
It includes info from MEA #MEAction and @PhysiosforME .

 

[rvallee]

Small bits of progress add up.

But there was never any implying about thoughts and beliefs, it is the explicit foundation of the entire paradigm and it is not subtle in the slightest, people lying about what they mean does not change their meaning. It's important to speak inconvenient truths as they do not otherwise get corrected. It's especially hard for someone professionally into CBT, but it's the simple truth.

 

[5vforest]

Indeed. I suppose that on the whole it is good that this viewpoint is being published. But it's also funny to see the author twist himself into a pretzel with sentences like:

Some CBT therapists/ psychologists it was felt, implied that ME/CFS came along with a set of irrational or incorrect negative thoughts that could be ‘corrected’ via cognitive restructuring.

 

[Trish]

Indeed. I suppose that on the whole it is good that this viewpoint is being published. But it's also funny to see the author twist himself into a pretzel with sentences like:

Some CBT therapists/ psychologists it was felt, implied that ME/CFS came along with a set of irrational or incorrect negative thoughts that could be ‘corrected’ via cognitive restructuring.

I agree. That statement massively downplays the fact that the whole edifice of CBT as treatment for ME/CFS was built on the 'false beliefs' premise and cognitive restructuring to try to persuade people they could exercise without detriment. It wasn't just that some therapists 'felt it implied' this theory. It was the overt primary purpose of the therapy.

CBT is based on changing thoughts/cognitions in order to change behaviours. If there are no 'wrong thoughts' that need to be changed, and there is no behaviour change that is going to help, then CBT is not justified at all.

 

[NelliePledge]

It is a very convoluted sentence - the passive at the start avoids making it explicit that he’s saying that PWME ‘felt’ that psychologists/therapists implied that ME/CFS involves irrational thoughts......

whereas he only has to look at what the proponents of CBT/GET say to see it is out there not implied and that PWME drawing attention to this is based on substance rather than what they feel.

most of it isn’t bad but that sentence is weak, trying to distance himself from criticising the basis for CBT/GET