“Cognitive Behavioral Therapy for Post-Covid Fatigue: Dutch Study Shows 60% Improvement After 17 Weeks”

People who remain severely fatigued for a long time after Covid-19 may benefit from cognitive behavioral therapy. Dutch research shows that about 60 percent of the patients who followed the therapy were clearly less tired after 17 weeks of treatment. They could concentrate better, and other physical complaints also decreased. That effect was still measurable after six months. The study appeared Monday in scientific journal Clinical infectious diseases.

“The findings are consistent with what we see in other diseases in which severe persistent fatigue occurs, such as after breast cancer and in multiple sclerosis (MS) and type 1 diabetes,” says study leader Hans Knoop, professor of medical psychology at Amsterdam UMC. “Cognitive behavioral therapy also has a positive effect on those disorders in some of the people with fatigue.”

The study involved 114 people who continued to suffer from severe fatigue in the 3 to 12 months after experiencing Covid-19. Almost all of them had contracted the disease before vaccination. Half of them received cognitive behavioral therapy, the other half received usual care: supervision by a general practitioner or specialist, physiotherapy and, where necessary, occupational therapy.

A strange sensation

One of the participants is Wendy van Iperen (52), a sober Zeeland, and owner of a clothing store in Kapelle. “I had Covid-19 for three weeks and I just didn’t get better. After two hours of work in my shop, my legs became mush and the lights went out, then I had to lie down and sleep. A strange sensation, I am self-employed, I am never sick. When I saw an advertisement on Facebook for this study, I immediately called and first asked what cognitive behavioral therapy entailed. Because it really wasn’t in my mind.” Van Iperen decided to participate. “I wanted to be able to run my shop again and take care of my horses.”

The participants’ treatment consisted of a mix of online modules and an average of twelve contacts with a psychologist, as needed by e-mail, telephone, video call or face-to-face.

The cognitive behavioral therapy did not work for everyone, but it did work for a majority: 60 percent of the participants were no longer seriously tired afterwards. In the control group, this was only the case in 27 percent of the patients. Patients who had received the therapy were able to concentrate better, work and see friends went better, and shortness of breath and sleeping problems were further reduced than in the control group.

Surrendered himself

Follow-up studies should show whether these findings also apply more broadly – ​​it mainly involved people with post-covid who had not been hospitalized for Covid-19, and who had self-administered.

Van Iperen also recovered. “I had to get in and out of bed at set times, and I was allowed to rest during the day, but not sleep again. That was extremely difficult. I’ve always been taught to listen to your body, but that wasn’t the case now. In the weekly contact with the psychologist, for example, it was about how your environment reacted to your complaints.”

She also learned to dose her energy. “At first I had to walk five minutes a day, and whenever I could, I was allowed to build up to five minutes. Now, after seven months of therapy, I’m back to working full time, and I can take care of my horses and still work in the garden in the evenings. I am still short of breath from time to time, but otherwise completely cured. I never thought that cognitive behavioral therapy also helps with these kinds of complaints.”

If you think something is permanently broken, that has an impact

Hans Knoop professor

This study does not provide an explanation for the positive effect. But Knoop does have an idea: “We think that a disease, such as Covid-19 in this study, causes the fatigue, and that it is sometimes partly maintained by certain attitudes or habits. This could be a disturbed sleeping pattern, for example, or the way in which activities are distributed throughout the day.”

How someone feels about fatigue and pain can also play a role, says Knoop. “For example, if you think that something is permanently broken due to the infection and that you will never recover, that has an impact.”

Knoop is happy to clear up a widespread misunderstanding. “The fact that cognitive behavioral therapy can help with post-covid fatigue does not mean that the cause is psychological, nor that there is no physical cause. It is important that we continue to look for the biological cause.”