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)

Use of virtual reality in the inpatient rehabilitation of COVID-19 patients.

INTRODUCTION: Use of virtual reality (VR) in healthcare has expanded in recent years. The challenges faced by patients with prolonged COVID-19-related hospitalizations - social isolation, disability, neurologic sequelae, adjustment-related anxiety, depression, and stress - may be mitigated by the novel use of VR as one modality of a comprehensive rehabilitation plan. This descriptive study aimed to understand patient satisfaction and perceived benefit of virtual reality on a COVID-19 recovery unit, as well as the logistical and operational feasibility of providing VR content for patients and staff. MATERIALS AND METHODS: During the COVID-19 surge in New York City in 2020, the COVID-19 Recovery Unit (CRU) of a large academic hospital invited patients and staff to participate in VR sessions with three categories of experience: (1) Guided meditation, (2) Exploration of natural environments, (3) Cognitive stimulation games. Patients and staff were surveyed about satisfaction and perceived benefit. RESULTS: 13 patients and 11 staff were surveyed, with median patient satisfaction scores of 9 out of 10, with ten representing "extremely satisfied," and median staff satisfaction scores of 10. 13/13 patients answered "yes" to recommending the therapy to others, and 12/13 answered "yes" to perceived enhancement of their treatment. 11/11 staff answered "yes" to recommending the therapy to others, and 11/11 answered "yes" to perceived enhancement of their wellbeing. DISCUSSION: A VR program implemented on a COVID-19 rehabilitation unit for patients and healthcare providers was rated as highly satisfactory with perceived benefit by survey respondents. Participants commented that the use of VR was useful in coping with isolation and loneliness, and could be implemented within the context of clinical care for COVID-19 patients as part of a comprehensive rehabilitation model. The use of VR was also logistically and operationally feasible on the CRU. Future work to compare benefits of VR to standard neuropsychological rehabilitation is needed.

Frequency and profile of objective cognitive deficits in hospitalized patients recovering from COVID-19.

Early reports and case series suggest cognitive deficits occurs in some patients with COVID-19. We evaluated the frequency, severity, and profile of cognitive dysfunction in patients recovering from prolonged COVID-19 hospitalization who required acute inpatient rehabilitation prior to discharge. We analyzed cross-sectional scores from the Brief Memory and Executive Test (BMET) in a cohort of N = 57 COVID-19 patients undergoing inpatient rehabilitation, calculating the frequency of impairment based on neuropsychologist diagnosis and by age-normed BMET subtests. In total, 43 patients (75%) were male, 35 (61%) were non-white, and mean age was 64.5 (SD = 13.9) years. In total, 48 (84%) were previously living at home independently. Two patients had documented preexisting cognitive dysfunction; none had known dementia. Patients were evaluated at a mean of 43.2 (SD = 19.2) days after initial admission. In total, 50 patients (88%) had documented hypoxemic respiratory failure and 44 (77%) required intubation.  Forty-six patients (81%) had cognitive impairment, ranging from mild to severe. Deficits were common in working memory (26/47 [55%] of patients), set-shifting (21/44 [47%]), divided attention (18/39 [46%]), and processing speed (14/35 [40%]). Executive dysfunction was not significantly associated with intubation length or the time from extubation to assessment, psychiatric diagnosis, or preexisting cardiovascular/metabolic disease. Attention and executive functions are frequently impaired in COVID-19 patients who require acute rehabilitation prior to discharge. Though interpretation is limited by lack of a comparator group, these results provide an early benchmark for identifying and characterizing cognitive difficulties after COVID-19. Given the frequency and pattern of impairment, easy-to-disseminate interventions that target attention and executive dysfunctions may be beneficial to this population.