Psychological interventions on the front lines: A roadmap for the development of a behavioral treatment program to mitigate the mental health burden faced by COVID-19 survivors

Survivors of prolonged hospitalization due to coronavirus disease 2019 (COVID-19) are at risk for psychiatric symptoms that can interfere with rehabilitation and functional outcomes. We developed an inpatient and outpatient behavioral treatment program for COVID-19 patients. We describe the constellation of emotional symptoms we observed, the evolution of symptom presentation from the inpatient to the outpatient setting, and outline the challenges we faced and lessons we learned as we implemented cognitive-behavioral interventions to enhance functioning and decrease symptom burden. We highlight modifications to therapeutic techniques that we made for this population and discuss cultural considerations in our diverse patient population. Initial outcome data indicate that approximately two thirds of patients (66% in the inpatient setting, 65% in the outpatient setting) are discharged from our program without further psychiatric care. As the COVID-19 pandemic continues to intensify and reports of "long-haul" symptoms accumulate among survivors, behavioral interventions to address psychiatric sequelae are paramount. Our approach and experience from the first wave of the pandemic has the potential to inform the development of behavioral treatment programs to mitigate psychiatric symptoms in this vulnerable population, as well as the response of mental health providers to future pandemics and public health emergencies. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Impact Statement Coronavirus disease 2019 (COVID-19) survivors are at high risk of psychiatric illness and often experience anxiety, isolation, demoralization, and guilt in the context of a sudden change in physical functioning and social/occupational roles, medical complications, and environmental stressors. We developed an inpatient and outpatient behavioral treatment program after which approximately two thirds of COVID-19 survivors did not require further psychiatric care. By noting some of the challenges we faced and by implementing cognitive-behavioral and mindfulness interventions, clinicians may be able to address the emotional needs of individuals recovering from COVID-19. Our approach may also inform how psychologists respond to future pandemics and public health emergencies. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

The CopeNYP program: A model for brief treatment of psychological distress among healthcare workers and hospital staff.

In the midst of the Spring 2020 initial surge of the COVID-19 pandemic in New York, members of the Psychiatry Department of Weill Cornell Medicine/NewYork-Presbyterian Hospital rapidly created and implemented a brief, behavioral skills-based intervention program, "CopeNYP", to address the immediate mental health needs of the employees of the hospital and medical school. We describe the development, implementation and evolution of this telehealth-delivered program staffed primarily by in-house clinical psychologists, postdoctoral fellows, pre-doctoral interns and counselors who were redeployed or volunteered their time to provide urgent support for employees. We discuss the challenges and lessons learned in providing brief, skills-based psychological interventions for employees subjected to chronic stress. As the impact of the pandemic became prolonged, employees faced compounding stressors including social isolation, fear of infection, grief and loss, and sequelae of COVID-19-related illness combined with work-related demands. Our goal is to present our program design, implementation, and utilization as a blueprint for other institutions that would like to develop an evidence-based clinician-staffed psychological intervention program to support ongoing employee mental health needs.

A systematic review of neuropsychological and psychiatric sequalae of COVID-19: implications for treatment.

PURPOSE OF REVIEW: COVID-19 impacts multiple organ systems and is associated with high rates of morbidity and mortality. Pathogenesis of viral infection, co-morbidities, medical treatments, and psychosocial factors may contribute to COVID-19 related neuropsychological and psychiatric sequelae. This systematic review aims to synthesize available literature on psychiatric and cognitive characteristics of community-dwelling survivors of COVID-19 infection. RECENT FINDINGS: Thirty-three studies met inclusion/exclusion criteria for review. Emerging findings link COVID-19 to cognitive deficits, particularly attention, executive function, and memory. Psychiatric symptoms occur at high rates in COVID-19 survivors, including anxiety, depression, fatigue, sleep disruption, and to a lesser extent posttraumatic stress. Symptoms appear to endure, and severity of acute illness is not directly predictive of severity of cognitive or mental health issues. The course of cognitive and psychiatric sequelae is limited by lack of longitudinal data at this time. Although heterogeneity of study design and sociocultural differences limit definitive conclusions, emerging risk factors for psychiatric symptoms include female sex, perceived stigma related to COVID-19, infection of a family member, social isolation, and prior psychiatry history. SUMMARY: The extant literature elucidates treatment targets for cognitive and psychosocial interventions. Research using longitudinal, prospective study designs is needed to characterize cognitive and psychiatric functioning of COVID-19 survivors over the course of illness and across illness severity. Emphasis on delineating the unique contributions of premorbid functioning, viral infection, co-morbidities, treatments, and psychosocial factors to cognitive and psychiatric sequelae of COVID-19 is warranted.