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Learning to Live with Long Covid

Updated: Nov 6, 2023

long covid support bristol

More and more people are being diagnosed with long covid, a debilitating & frustrating long term illness that develops following an initial infection of covid-19. Long covid symptoms vary from person to person but they often include pain, aches, flu-like symptoms, fatigue, 'brain fog' & breathlessness. Naturally these symptoms massively affect everyday life, wellbeing & physical health. This blog explores what we know so far about long covid and discusses the role of psychology in symptom management.

Covid-19 is a novel coronavirus that emerged in late 2019. When infected by the virus symptoms include persistent cough, shortness of breath, fever & loss of taste & smell. In some cases the person remains asymptomatic (meaning the person does not experience any symptoms despite being infected with the virus), however presentations generally range from mild-to-moderate to severe & fatal, with fatality rates increasing with age.

Many of those infected with COVID-19 experience an acute (short term) illness & typically make a full recovery within three weeks. However a subgroup of patients continue to experience symptoms at least three months after the acute illness phase has passed, irrespective of whether they experienced a mild or severe illness. Common symptoms reported at three months include low level flu symptoms, fatigue, breathlessness, persistent cough, aches & pain, ‘brain fog’ (difficulties with thinking, planning, organising, concentration & memory) & emotional lability.

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Understandably these symptoms can hugely impact day to day life. Some people find they get tired very easily after mental and physical activity. They report that it is hard to get out of bed, to get through the day without napping, or to do their usual routine activities because of fatigue and exhaustion. Some people find that they cannot concentrate or remember things. Other people find it hard to get through physical activity without feeling breathless or in pain. This means that everyday activities like getting dressed, preparing a meal, walking the dog, going to work, meeting up with friends, playing sport etc. are very hard to engage in.

A common analogy that people with long covid use to describe their experience is that it feels like their battery drains more quickly than they would expect. The more the battery is drained, the more pain, fatigue, breathless and brain fog can all flare-up. And once the battery is drained, they find that it takes longer for their battery to recharge than they would expect.

long covid support

Understandably, this often leads to feelings of frustration, anger, annoyance or a sense of unfairness or injustice. People often ask 'why me?'. Some people report feeling irritable and find they are short-tempered with others. Many people report to me that they feel like they are a completely different person. Some people say to me that they feel like their identity has changed and they don't recognise themselves anymore.

Interestingly I see a lot of people with long covid who are front line workers e.g. doctors, nurses, physiotherapists, teachers etc. I wonder if this is because firstly these are people who are more likely to be exposed to the virus and therefore more likely to catch it. And secondly I wonder if it is because people in these professions are driven to help others and are used to putting others before themselves, therefore returning to work as soon as they feel well enough without giving their body the chance to full recuperate from the virus.

Due to the novelty of the virus there is a lack of research with regards to who is more likely to develop long covid, why it develops and how we can treat it. Currently, there is no consensus regarding the clinical categorisation of a ‘long covid’ syndrome (at the time of writing). However there is a general agreement amongst the medical community that a post-acute syndrome of prolonged symptoms exists & that treatment or management of the symptoms is essential to minimise disability & distress. As more research is published & our knowledge of covid-19 evolves it is hoped that understandings of the mechanisms underlying long covid symptoms will inform diagnosis & treatment approaches.

In the interim drawing on the evidence-base for existing post-viral & post-intensive care syndromes as well as the evidence-base for the individual symptoms of long covid such as chronic pain, chronic fatigue & breathlessness can help to guide management of the symptoms. A review of the research suggests that treatment and management approaches should be provided by a multi-disciplinary team of health professionals including psychologists, doctors, nurses, physiotherapists and occupational therapists. This enables holistic management of symptoms, adopting a whole person approach.

Generally, the role of the psychologist is:

  1. To support the person with long covid to adjust and adapt emotionally to living with the condition and

  2. To support with the development of self-management coping strategies.

To support with this, psychological management of long covid symptoms focuses on three key areas – managing our:

  • thoughts

  • feelings

  • behaviours

This is because, understandably, people with long covid can get stuck in a pattern of thinking negatively about their symptoms, which then affects how they feel emotionally and how they act or behave. This then has an impact on the body and physical state, which can increase the intensity of long covid symptoms. For example common thoughts such as ‘long covid is awful, I can’t cope- nothing I do makes a difference’ can lead to feeling stressed, frustrated & hopeless, which can lead to lowered motivation and avoidance of self-care rehabilitation exercises. This in turn then affects the body, leading to physical de-conditioning and increased emotional/physical arousal, which can worsen long covid symptoms.

long covid support

Thought management strategies focus on helping the person with long covid to adopt helpful thinking patterns by using evidence and facts to challenge and change any unhelpful thoughts. This may involve engaging in small behaviour experiments to test out the accuracy of the persons thoughts, or reviewing past events and experiences to see if there is evidence to contradict the thoughts.

For example, helping the person to connect with times they have been able to successfully manage their symptoms, say at a work event or social gathering, and helping them to think about the coping skills they drew on can help to modify the thought 'nothing I do makes a difference'. This also helps to identify personal symptom management strategies that can be used. In turn this leads to improved emotional wellbeing and increased feelings of confidence - prompting the use of helpful coping strategies such as pacing and relaxation strategies. Overall -improved positive feelings and adoption of helpful behaviours both contribute to an improvement in long covid symptoms.

long covid support bristol

Behavioural management strategies focus on supporting the person to safely & gradually engage in activity through setting realistic goals that progress in intensity over time. This helps the body to recondition, helping to rebuild strength, stamina and energy levels, as well as leads to more helpful thoughts and positive feelings- creating a more helpful cycle.

Behavioural management strategies also include sleep hygiene support, communication skills training and pacing strategies. Pacing helps with conserving battery levels, helping to find a balance between stopping symptoms from flaring up and the body from deconditioning by engaging in activity little and often. This reduces engagement in common unhelpful behaviour patterns such as complete avoidance of activity &/or the boom-bust cycle, where the person over-engages in activity until they crash physically & mentally & require prolonged periods of rest to recover.

Another key behavioural management strategy is developing effective breathing strategies such as abdominal (tummy) breathing & rectangle breathing. These strategies draw on the diaphragm & facilitate a deep breathing style, which reduces our energy use & lowers emotional/physical arousal, enhancing feelings of relaxation and reducing concentration & memory issues, fatigue, breathlessness, tension & pain. Other relaxation strategies can be helpful too - including progressive muscle relaxation, which involves tensing and relaxing each muscle in our body, and visual imagery relaxation, which involves focusing on pleasant and calming images in our mind.

Some people also find that they require an emotional processing space. This helps with processing feelings about living with long covid and coming to terms with the impact it has on daily life. This support can help with adapting and adjusting to the diagnosis, paving the way towards acceptance. This can be achieved by talking things through in psychological therapy or through engaging in creative or expressive activities such as writing, art or sport.

For further support with long COVID symptoms please refer to the following resources:

¨ Your COVID Recovery NHS Website:

If you feel that you need more support than these self-help resources or if you feel like you would benefit from an emotional processing space then please get in touch to book an assessment with one of our specialist counsellors or clinical psychologists.

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