Methods to “ACT” on “Long-Haul COVID” and Mental Health Issues

Post-acute sequelae of COVID-19 or “long COVID”, or “long-haul COVID,” are terms that everyone has heard, but how familiar are most people with the malady? You may very well know someone who has “long COVID” since those afflicted could number some 7.4 million Americans.¹

According to the US Centers for Disease Control and Prevention, the most common lasting symptoms are fatigue, shortness of breath, cough, joint pain, chest pain. Other issues include cognitive problems, difficulty concentrating, depression, muscle pain, headache, rapid heartbeat, and intermittent fever.² In addition to the lingering symptoms, COVID-19 may be the cause of grief over the loss of loved ones, or struggles with loneliness and isolation.³

As the current estimates of the risk for long-term symptoms range broadly from 15% to 80% of patients with or who have had COVID-19,⁴ it’s something to be aware of in your patients.

The barriers that patients with “long COVID” face continue to mount, highlighting the need to enhance coping strategies and find ways to live meaningfully in the face of uncontrollable situations. We spoke with Joseph J. Trunzo, PhD, professor and chair of the Department of Psychology and deputy director of the Center for Health & Behavioral Sciences at Bryant University in Smithfield, RI, who wrote the book, “Long Haul COVID, A Survivor’s Guide: Transform Your Pain & Find Your Way Forward.”

Dr Trunzo’s research and clinical work focus on treating anxiety and mood disorders in those recovering from chronic illnesses. He delves deeply into the topic of COVID-19 in his book, co-authored by Julie Luongo, a “long-haul COVID” patient herself who provides the second voice in the book. While Dr Trunzo outlines the clinical aspects of ACT (Acceptance and Commitment Therapy), Julie illustrates how her use of the ACT approach has benefitted her.

The book covers:

• What are the long-term effects of cognitive dysfunction?
• How to redefine your pain and overcome the obstacles of “long COVID.”
• What are evidence-based tools for coping with illness, fear, and change?

Your book utilizes ACT. Can you describe ACT?

Dr Trunzo: ACT is what I would call an extension or an outgrowth. It’s part of the third wave of behavior therapies, the first being radical behavior therapy, based largely on B. F. Skinner’s theories, with limited to no cognitive elements. The second wave introduces human thought into the process, leading to the cognitive behavioral based therapies. And then finally, the third wave of behavioral psychotherapies, and there are several of them, start to incorporate mindfulness and acceptance.

At its core, ACT is really about helping people to be what we call “psychologically flexible” around situations that are difficult, uncomfortable, or uncontrollable, and helping them to live the best life that they can, even if they’re not feeling the best way that they can in that moment.

What makes ACT a good resource for people with “long COVID?”

Dr Trunzo: There’s a lot of empirical support for the effectiveness of ACT. There are well over 200 randomized clinical trials investigating ACT at this point, showing that it’s effective in helping people be more functional who are experiencing a very wide variety of diagnoses, such as depression, anxiety, trauma, chronic illness. It’s designed to be transdiagnostic, so at its core, ACT is really about helping people alleviate suffering. It doesn’t really matter what they’re suffering from, the techniques and the approach can be applied regardless.

What is the best way for a mental health professional to use your book?

Dr Trunzo: I’m a big fan of bibliotherapy, so workbooks or things that clients can take with them outside of the session, to just reinforce some of the items covered in session and carry it with them through the week between appointments. I’m all for that, and that tends to be how I use books in therapy. 

If mental health professionals do give the book to clients, they can have their clients read the book, do some of the exercises together, and work through things step-by-step. So, it can be, “Here’s this book that has a lot of the details about what we’re going to be doing in session, and that we’re going to be talking about, so read this at home. Take it with you. Use it as a reference guide to continue to practice the things that we talk about.” 

There are 168 hours in a week, and you might get 45 minutes of that 168 hours. You have to have other ways for the person to engage with the material beyond just the session, and I think the book is a really good way to do that.

I would also say: familiarize yourself with the techniques and the approaches talked about in the book, and then I would encourage mental health professionals to get more formal training, for example, to attend an ACT-based workshop.

ACT is very experiential, and it’s very hands-on, so it’s not the kind of thing that you can just read about and learn. You can read about it and kind of understand it, but you really have to do it. Most of the ACT workshops are very, very experientially based, so professionals should get some kind of additional training beyond just reading the book. But then, once they feel a little comfortable with what it’s all about, and they’ve done some of those trainings, I would encourage them to give the book to their clients. Have their clients read the book, do some of the exercises together, and work through things step-by-step.

What else would you like to add?

Dr Trunzo: I think that because this is applied specifically to people who are suffering from “long-haul COVID,” or really chronic illness, being able to understand and see ACT in the context as it’s applied to this particular population I feel is useful. As clinicians, we see a lot of people with depression. We see a lot of people with anxiety. If you’re not used to seeing people who have chronic illnesses, some of the things in the book, I think, can really help you to get inside the head and the experience of people who have done that, or are experiencing that.

The other thing about the book is my co-author, Julie Luongo. She’s not a clinician, so in the book I explain all the science and the techniques and then, Julie, who had “long-haul COVID” and used the ACT approach in helping her to deal with that while she was recovering, gives the patient perspective. The book, I think, is really useful in helping people to understand the mindset of people who are suffering from some of these difficulties and some of these problems.

Joseph J. Trunzo, PhD, professor and chair of the Department of Psychology and deputy director of the Center for Health & Behavioral Sciences at Bryant University in Smithfield, RI.

References

1. Burks M, Crann T. A Mayo doctor warns lawmakers of long-haul COVID’s health, economic toll. MPRNEWS. Published February 14, 2022. Assessed April 5, 2022. https://www.mprnews.org/story/2022/02/14/doctor-on-longhaul-covid

2. COVID ‘Long Haulers’: Long-term effects of COVID-19. Johns Hopkins Medicine. Updated on December 8, 2021. Assessed April 5, 2022. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-long-haulers-long-term-effects-of-covid19

3. Trunzo JJ, Luongo J. Long haul COVID, A survivor’s guide: Transform your pain & find your way forward. 1^st ed. Hampshire UK: John Hunt Publishing; 2021

4. COVID-19: Understanding long COVID. Emory News Center. Published March 23, 2022. Assessed April 5, 2022. https://news.emory.edu/stories/2022/03/hs_long_covid_q_and_a_23-03-2022/story.html

This article originally appeared on Psychiatry Advisor