My article on long covid published in The Psychologist
I was pleased to see contributions from fellow psychologists and other health professionals with clinical and lived experience of long covid in The Psychologist in January. However, I also noted that some contributors made some quite startling claims about the condition.
In particular, Dr David Joffe, a physician, researcher and vice-chair of the World Health Network Long Covid Working Group, described long covid as a 'direct, organic, neurological condition', and claimed that 'the vast majority of long covid patients will never achieve anything close to their prior function'. I was concerned that notions such as these are neither accurate, nor helpful to people trying to navigate recoveries from long covid and related conditions. I know that when I was recovering from long covid and ME/CFS, I would have felt devastated to read such a damning claim.
For this reason, I wrote an article that was published in the The Psychologist. In the piece, I tried to offer some nuance around the claims made by Dr. Joffe. Here are 10 key points I made in the piece:
Whereas some researchers agree with Dr Joffe's assumptions about long covid being a 'direct, organic, neurological condition', others do not. Some researchers suggest that the available evidence points to long covid being a potentially reversible functional somatic symptom disorder. On either side of this debate, there is a tacit acceptance of a diagnostic paradigm of zero sum causality: syndromes must be classified as either functional or organic. Yet this functional-organic distinction has historically been heavily criticised and shown to be inconsistently defined and used in clinical practice.
As neurologist Suzanne O'Sullivan states: 'Every medical problem is a combination of the biological, the psychological and the social. It is only the weighting of each that changes'. This should surely not be a controversial statement; we do our patients a disservice if we seek to make sense of long covid in an artificially constructed biomedical silo, divorced from wider psychological and sociological influences.
Acknowledging the potential role of psychosocial stressors is not at all to deny the biological reality of conditions like long covid. The emerging research is suggestive of several possible physiological mechanisms of long covid. However, with long covid sufferers presenting with virtually infinite constellations of 203 possible symptoms, across multiple bodily systems, the notion that it is possible to isolate a single biological cause, explanation or treatment for this condition is up for debate.
Many symptoms associated with long covid are implicated in the relationship between the brain and the body: fatigue, brain fog, heart palpitations, dizziness, anxiety, and low mood (Lyman, 2024).
A study conducted by the team of renowned Yale immunologist, Professor Akiko Iwasaki, found that the strongest predictive biomarker for long covid was not immunological, but a low baseline level of cortisol – which has itself been associated with chronic stress.
Known risk factors for long covid, including immune disruption, psychosocial stress, and gut dysbiosis, arguably represent an imbalance in the body's defence system. It stands to reason that interventions which target each of these areas may be beneficial.
One study led by Associate Professor of Medicine at Harvard Medical School, Dr Michael Donnino, tested the use of Psychophysiologic Relief Therapy for people living with long covid. The intervention led to very significant improvements in symptoms among participants, including median reductions in fatigue of 44 per cent, brain fog of 67 per cent and pain of 52 per cent. Whereas 57 per cent of participants felt exercise made their symptoms worse at the beginning of the study, only 9 per cent did four weeks into the 13-week study.
There is a growing body of research which offers hypothetical models of persistent symptoms in long covid which draw on a fascinating emergent field of neuroscience called predictive processing. In short, it is posited that following events that are stressful or traumatic to the mind and body – from adverse childhood experiences, to medical trauma, to bacterial or viral infections – the brain begins to 'lose confidence' in the body's ability to respond to future challenges.
Against the backdrop of such research, we glimpse the possibility that Dr Joffe's prediction that 'the vast majority of long covid patients will never achieve anything close to their prior function' runs the risk of becoming self-fulfilling. The nocebo effect (Bernestein et al., 2024), may be at play when people receive innaccurate and unhelpful messages that they are suffering from an irreversible 'organic' disease from which they cannot recover.
Psychologists are particularly well equipped to support people dealing with vicious cycles which are at least partly perpetuated by the 'tricky' nature of our brains (Gilbert, 2013). The growing body of research described above offers psychologists the possibility of supporting people to begin to create the conditions for the brain and nervous system to respond to symptoms and stressors from a place of coherence and growing safety.
Read the full article over at The Psychologist.
