Patients' lived experience and reflections on long COVID: an interpretive phenomenological analysis within an integrated adult primary care psychology NHS service.

BACKGROUND: Long Covid is an unknown illness which has been shown to affect sufferers regardless of mild initial COVID-19 or age. There is still a lot unknown about long COVID illness. There has been a call to understand this illness not only from a professional standpoint but also through the lived experience of patients. Patient reported outcomes through lived experience research is one such angle. To date, no research has explored the overall lived experiences and long COVID illness trajectory perspectives of the patients. This study aimed to gather patient reported outcomes of their long COVID through lived experience research. It recruited adult participants aged 18-years and over who had been referred to a primary care integrated psychology service. The study employed qualitative research using semi-structured interviews and Interpretive Phenomenological Analysis methodology. RESULTS: A total of eighteen participants completed the study. From their lived experiences, the participants uncovered the varied symptoms of long COVID. They also uncovered their lived progression of living with an unknown chronic illness. Common themes included uncertainty, mental and social impacts, and the processes of self-advocacy, mastering their symptoms, subjective recovery and future coping. CONCLUSION: This study uncovered the lived experience of long COVID in participants. The results from this study uncovered the lived subjective biopsychosocial experiences of long COVID chronic illness. Traditionally, patients receive care and recommendations from healthcare professionals. However, as long COVID is a new illness, this care model was limited. The participants in the current study described being left with a sense of uncertainty and role confusion. However, participants were able to realize their locus of control over their long COVID illness progression. This illustrates that patients have the resources to uncover the unknowns of this new illness which could inform clinical practice and further research. This suggests that that long COVID needs to be approached from a biopsychosocial perspective which emphasises patient involvement.

Patient-led integrated cognitive behavioural therapy for management of long COVID with comorbid depression and anxiety in primary care - A case study.

OBJECTIVE: Long COVID affects approximately ten-percent of people following post-acute Coronavirus infection. Long COVID is a complex, multisystemic recent illness. Therefore, there are currently no unitary guidelines on its management. The UK national guidelines currently recommended that interventions are guided by objective research evidence and subjective experiences of patients. They also emphasise multidisciplinary/interdisciplinary professional care and patient self-management. METHODS: The current case study applied patient-led integrated cognitive behavioural therapy in a 36-year-old male presenting with long COVID symptoms with comorbid depression and anxiety. It applied integrated interdisciplinary CBT with emphasis on enhancing patient self-management. The patient attended twelve, individual, 60 min video sessions, via Microsoft Teams over a period of five months. The treatment was conducted in collaboration with the patient's general practitioner, physiotherapists and cardiopulmonary specialists. In line with the National Institute for Health and Care Excellence guidelines, it applied symptom monitoring, graded pacing and behavioural experiments. RESULTS: At the end of therapy, the patient showed reliable change in his somatic symptoms, depression and anxiety symptoms. He also showed improved quality of life. DISCUSSION: This case illustrates the effective use of patient-led CBT for managing symptoms of long COVID with comorbid depression and anxiety in primary care.

Beyond the COVID-19 pandemic: 'Learning the hard way' - adapting long-term IAPT service provision using lessons from past outbreaks.

Infectious disease outbreaks have occurred sporadically over the centuries. The most significant ones of this century, as reported by the World Health Organization, include the EVD epidemic, SARS pandemic, Swine Flu pandemic and MERS pandemic. The long-term mental health consequences of outbreaks are as profound as physical ones and can last for years post-outbreak. This highlights the need for enhancing the preparedness of pragmatic mental health service provision. Due to its magnitude, the novel COVID-19 pandemic has proven to be the most impactful. Compared with previous outbreaks, COVID-19 has also occurred at higher rates in frontline staff in addition to patients. As COVID-19 is more contagious than earlier outbreaks, there is a need to identify infected people quickly and isolate them and their contacts. This is the current context in which mental health services including IAPT have had to operate. Evidently, Improving Access to Psychological Therapies (IAPT) services are a major mental health service provider in the UK that have demonstrated variability in their response to COVID-19. While some IAPT services quickly adapted their existing strengths and resources (e.g. remote working), other services were less prepared. To date, there are no clear unitary guidelines on how IAPT services can use their pre-existing resources to respond to the long-term effects of outbreaks. In light of this, the current paper aims to reflect on the lessons learned from past outbreaks in order to consider how an enhanced remit of IAPT might integrate with other services to meet the long-term needs of patients and staff affected by COVID-19. KEY LEARNING AIMS: (1)To understand the development of IAPT within the NHS mental health services.(2)To understand the nature of past outbreaks and COVID-19.(3)To reflect on lessons from past outbreaks in order to understand how IAPT can respond to the long-term effects of COVID-19.