Description: Have you heard of Long Covid? It involves a number of symptoms that resemble those seen in Chronic Fatigue Syndrome or in Myalgic Encephalomyelitis (CFS/ME) in which individuals recovered from Covid infections experience long-term shortness of breath, fatigue, and body aches and pains. What causes these symptoms? Are they due to lingering Covid effects? If not what else? Media speculation and searches for answers to these questions have raised another version of a recurrent debate in medical/psychiatric/psychological professional circles about the relationship between mental events and physical illness. I observed a bit of this debate 20 years ago while serving on a doctoral research supervisory committee for a PhD candidate who was examining pain management among medical patients with rheumatoid arthritis and included a comparison group comprised of patients tentatively diagnosed with either fibromyalgia or CFS. There were two physicians on the committee and at meeting where the student was presenting their proposal one physician indicated in a side comment that they were unsure how to refer fibromyalgia/CFS for treatment to which the other physician responded rather snidely, “I just refer them to the Psych ward.” Now, to be fair, at the dissertation defense 4 years later the second physician indicated that they were collaborating with the rheumatology clinic to develop a treatment protocol for fibromyalgia patents. The change in perspective was linked to a general shift away from maintaining a hard distinction between physical conditions and mental conditions which typically includes a belief that psychosomatic disorders are “not real.” These days, in theory, it is understood that psychosomatic ailments ARE real. For example, long term stress and anxiety causes things like high blood pressure. Given that this more wholistic approach to illness and wellness it is surprising that we are seeing some of the same old beliefs being offered up in relation to long Covid along with the suggestion that Cognitive Behavior Therapy should be a treatment of first choice for long Covid as the Covid itself has gone. Where do you stand on this matter? For a look at the most recent iteration of the “Bio is real Psycho is not” position on the application of the Biopsychosocial model to a new condition read the articles linked below which capture several facets reasonably well.
Source: Apparently just by talking about it, I’m super-spreading long Covid, George Monbiot, The Guardian; Long Covid is very far from ‘all in the mind’ – but psychology can still help us treat it, Carmine M Pariante, The Guardian.
Date: April 27, 2021
Article Link: https://www.theguardian.com/commentisfree/2021/jan/21/were-about-to-see-a-wave-of-long-covid-when-will-ministers-take-it-seriously and https://www.theguardian.com/commentisfree/2021/apr/14/super-spreading-long-covid-professor-press-coverage and https://www.theguardian.com/commentisfree/2021/apr/27/long-covid-psychology-treat-body-brain
Research into long Covid is essential and the role of treatments such as CBT needs to be included in that research but with caution given the issues associated with previous such work with CFS/ME patients. We have a way to go yet in the development of a proper understanding of the relationships among biological, psychological, and social factors in diseases and disorders. The biopsychosocial model is not intended to be a category system for sorting disorders as all three factors interact within each and every person struggling or dealing with things like long Covid.
Questions for Discussion:
- What is long Covid?
- What treatment options are there for long Covid and if we do not have any currently what research is needed to help us figure out how to assist those who are struggling with long Covid today?
- What are some of the issues with how the biopsychosocial model of disorder/illness is currently understood and applied?
References (Read Further):
People, Y. Special issue on the PACE Trial, by David F Marks in The Journal of Health Psychology Vol 22 issue 9 2017 [published online 31 July 2017]. Link
Williams, F. M., Muirhead, N., & Pariante, C. (2020). Covid-19 and chronic fatigue. BMJ, 370.
Meeus, M., & Nijs, J. (2007). Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome. Clinical rheumatology, 26(4), 465-473. Link
Geraghty, K. J., & Blease, C. (2019). Myalgic encephalomyelitis/chronic fatigue syndrome and the biopsychosocial model: a review of patient harm and distress in the medical encounter. Disability and rehabilitation, 41(25), 3092-3102. Link
Geraghty, K. J., & Esmail, A. (2016). Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm?. British Journal of General Practice, 66(649), 437-438. Link
Hulme, K., Hudson, J. L., Rojczyk, P., Little, P., & Moss-Morris, R. (2017). Biopsychosocial risk factors of persistent fatigue after acute infection: A systematic review to inform interventions. Journal of psychosomatic research, 99, 120-129. Link
Halpin, S., O’Connor, R., & Sivan, M. (2021). Long COVID and chronic COVID syndromes. Journal of medical virology, 93(3), 1242-1243. Link
Vink, M., & Vink-Niese, A. (2020, December). Could Cognitive Behavioural Therapy Be an Effective Treatment for Long COVID and Post COVID-19 Fatigue Syndrome? Lessons from the Qure Study for Q-Fever Fatigue Syndrome. In Healthcare (Vol. 8, No. 4, p. 552). Multidisciplinary Digital Publishing Institute. Link