For many illnesses, behavioural therapy helps to combat fatigue, and that also applies to tiredness following COVID-19

Hans: ‘For years, we have investigated fatigue in chronic illnesses. There are no medicines against these but you can learn different ways to deal with chronic illness. We have developed a treatment for cognitive behavioural therapy that has proven to be successful in combating fatigue as a consequence of various illnesses. Examples are people with diabetes, Q fever and following a treatment for cancer. And then we thought: let us investigate if it is also effective in the case of Long COVID. With behavioural therapy, we teach people to promote their own recovery. For example, you can change your sleeping habits or you can learn how to distribute your physical activity across the day. You can view it as a form of rehabilitation.’

Tanja: ‘Prior to the treatment, we examine for each patient what we should focus on during the treatment. We therefore match the treatment to the factors that are important for the person concerned. In other words: we provide tailored cognitive therapy. If the sleep rhythm is disrupted, then we focus on that. Yet another patient might need coaching for activities or can learn to look at fatigue from a different perspective. For the study, we worked together with six hospitals. Half of the patients received cognitive behavioural therapy and the other half the usual care. In the majority of cases, this was occupational therapy and physiotherapy.’

Hans: ‘It was amazing to see that many people spontaneously applied to participate in the study. They had read about it via social media or had been informed about it in another way. I have conducted research for many years, but I’ve never before witnessed a study that attracted so many participants so quickly. We included 114 patients with Long COVID: so two groups of 57 people. They were allocated randomly. We could have easily performed our study with five times as many people. There clearly was a high demand for care.’

Tanja: ‘It was equally striking that people in the cognitive behavioural therapy group did not often make use of other care, such as occupational therapy and physiotherapy, whereas people in the group that received the usual treatment did. We have not yet investigated the reasons for this. They probably did not have the energy to do anything else besides the cognitive behavioural therapy because this consisted of a full programme with tasks and intensive supervision, whether or not face-to-face. With such an intensive programme, it is quite possible that the participants think: I am not going to keep on seeing other care providers too.’

Hans: ‘The effect of cognitive behavioural therapy would have been even easier to establish if both groups had not had any occupational therapy or physiotherapy at all. However, not providing such treatment was not an option of course. People have symptoms and want to get rid of them. They will not simply wait until we have finished with our study. With our research, we jumped onto a riding train. Everybody was already receiving different types of care even though nobody knew whether that care was effective.

The study has now been completed and the results have been published in the scientific journal ‘Clinical Infectious Diseases’. The cognitive therapy had a clear positive outcome. After cognitive therapy, most participants were considerably less tired and could concentrate better. They also made progress physically and socially. Furthermore, the results were found to persist over time. After six months, the differences with the usual care were still present.

Tanja: ‘However, I find it interesting that people registered in large numbers for the cognitive behavioural therapy, despite the offer of physiotherapy and occupational therapy. This shows just how much distress people experience owing to Long COVID. They suffer from severe tiredness and are confronted by limitations. They can no longer resume their everyday activities. It is a very affected group.’

Hans: ‘And if you see just how many people worldwide are affected by the infection then it is clear that in all those countries, an awful lot of people will continue to experience symptoms. Although our research reveals that cognitive behavioural therapy can help, I do not think that one particular treatment is effective for everybody. We need to develop more types of treatment. That underlines the importance of funding research into post-COVID. We need to examine which subgroups you can distinguish so that personalised care can be provided. There is a lot of variation within the group of people who have Long COVID.’

Hans: ‘Cognitive behavioural therapy is a treatment in which you learn to do things differently so that the symptoms decrease. Research is needed into more types of care and into what constitutes the best care. But we also need biomedical research into the causes of Long COVID. We need to divide our resources across several research areas. Then we can develop the best treatment for each patient via different routes, which is how personalised care comes about’.

• Clinical Infectious Diseases

• Long Covid
• Blog series "I'm researching long COVID"