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

Abstract

An increasing number of young and previously fit and healthy people who did not require hospitalisation continue to have symptoms months after mild cases of COVID-19. Rehabilitation clinics are already offering cognitive behavioural therapy (CBT) as an effective treatment for long COVID and post-COVID-19 fatigue syndrome based on the claims that it is effective for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)—the most common post-infectious syndrome—as no study into the efficacy of CBT for post-COVID-19 fatigue syndrome has been published. Re-analyses of these studies, however, showed that CBT did not lead to objective improvements in heterogeneous groups of ME/CFS patients, nor did it restore the ability to work. The group of patients with long COVID and post-COVID-19 fatigue syndrome, on the other hand, is homogeneous. We therefore analysed the Dutch Qure study, as it studied the efficacy of CBT in a homogeneous group of patients who developed Q-fever fatigue syndrome—which affects up to 30% of patients—after the largest reported outbreak of Q-fever, to see if CBT might potentially be an effective treatment for long-haulers after COVID-19 infection. Our reanalysis found that the Qure study suffered from many serious methodological problems, which included relying on one subjective primary outcome in a study without a control group for the non-blinded CBT treatment group, using a post hoc definition of improvement, waiting 2 years before publishing their objective actometer results and ignoring the null effect of said results. Moreover, only 10% of participants achieved a clinically meaningful subjective improvement in fatigue as a result of CBT according to the study’s own figures. Consequently, CBT has no subjective clinically meaningful effect in nine out of every ten patients that are treated with it. Additionally, the subjective improvement in fatigue was not matched by an improvement in disability, even though the disability was fatigue related according to the researchers. On top of this, CBT did not lead to an objective improvement in physical performance. Therefore, it cannot be said that CBT is an effective treatment for Q-fever fatigue syndrome either. It seems therefore unlikely that CBT will reduce disability or lead to objective improvement in long COVID or in post-COVID-19 fatigue syndrome.

Long covid—mechanisms, risk factors, and management

“…The implementation of group therapy via videoconferencing in people with early psychosis during the covid-19 pandemic shows promising results, with a pilot study showing improvements in psychotic symptoms and self-esteem,183 however, a review article provides information to suggest that CBT is ineffective in reducing long covid symptoms, including fatigue, with only 10% of participants achieving clinically meaningful improvements 184…”

Long COVID, a comprehensive systematic scoping review

“…2 as “non-original short communications”) as follows: 5 commentaries [ 78 – 82 ], 3 letters to the editors [ 83 – 85 ], 1 short communication [ 86 ], 1 “piece of mind” [ 87 ], 4 “news” [ 88 – 91 ], 1 perspective [ 1 ], 15 editorials [ 92 – 106 ], 1 special article [ 107 ], and 2 viewpoints [ 108 , 109 ]. The other articles in this category were: 9 case reports/case series [ 110 – 118 ], 10 narrative reviews [ 10 , 15 , 119 – 126 ], 1 systematic review on the respiratory system [ 127 ], 4 guideline papers, 3 clinical updates, 1 “report”, and 1 consensus statement [ 128 ]. There was only 1 systematic review that elaborated on the pulmonary aftermaths of Long COVID [ 127 ].…”

“…Twenty-eight (23.3%) articles were regarding management options: 13 rehabilitation care [ 22 , 28 , 45 , 59 , 60 , 71 , 94 , 115 , 119 , 123 , 129 – 131 ], 5 general care [ 26 , 47 , 57 , 105 , 132 ], 1 designed and validated a psychometric tool for assessing mental health consequences of Long COVID [ 42 ], and 1 was about “how to return back to the pre-morbidity activity level” [ 63 ], and 8 articles were on more comprehensive “multidisciplinary-care” of long COVID patients [ 84 , 90 , 98 , 107 , 128 , 133 – 135 ].…”

“…Myalgia Encephalomyelitis (ME) Association on post-viral fatigue syndrome (PVFS) highlighted the role of a multidisciplinary approach in managing chronic fatigue; it included resting, activity management, mental well-being, nutrition, and adequate sleep [ 78 ]. Also, based on the experience of post-infectious fatigue syndrome induced by Q-fever, it was generally thought the cognitive-behavioral therapy (CBT) could be beneficial in the management of post-infectious fatigue syndrome [ 170 ]; however, a recent study by Vink et al, reanalyzed the results of “Qure study” and showed that CBT was neither helpful in that regard nor possibly in the post-infectious fatigue syndrome of COVID-19 [ 119 ].…”

The COVID-19 Pandemic and the Need for an Integrated and Equitable Approach: An International Expert Consensus Paper

“…Psychological programs for citizens are another approach to implement defined programs and solidarity networks to manage these issues. 124 The aggravation and prolongation of such a frail situation is leading to many other diseases (treatment omissions and diagnosis delays) and family fractures (violence, divorce, separation) as indirect consequences of this pandemic which has turned every facet of life upside down. Posthospital discharge VTE may also be considered and prevented.…”