Long COVID: Psychological Risk Factors and Their Modification

• Applicants: Dr. Petra Engelmann; Professor Dr. Bernd Löwe; Professorin Dr. Antonia Zapf
• Subject Area: Public Health, Healthcare Research, Social and Occupational Medicine
• Term: since 2022
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 508447247

Background: After a SARS-CoV-2 infection has resolved, a variety of somatic symptoms persists in a substantial portion of affected patients, a phenomenon described as “Long COVID”. There is growing evidence that in addition to pathophysiological, psychological risk factors are involved in the development of Long COVID. Among the potentially modifiable psychological risk factors, illness-related anxiety and dysfunctional symptom expectations in particular seem to contribute to symptom persistence. With regard to the development of effective therapies, it is therefore imperative to investigate whether the clinical symptoms of Long COVID can be improved by a targeted modification of illness-related anxiety and dysfunctional symptom expectations. The proposed study will be carried out in conjunction with the DFG-funded Research Unit SOMACROSS (RU 5211), which investigates risk factors for persistent somatic symptoms in ten different conditions. Objectives: Our primary aim is to investigate whether Long COVID symptoms can be improved by modifying illness-related anxiety and dysfunctional symptom expectations. Second, we aim to identify additional psychosocial risk factors that contribute to the persistence of Long COVID symptoms. Third, in an exploratory approach, we aim to compare risk factors leading to symptom persistence in Long COVID with conditions under investigation in RU 5211.Work programme: To assess whether Long COVID symptoms can be improved by modifying illness-related anxiety and dysfunctional symptom expectations, we will conduct an observer-blinded, 3-arm randomized controlled trial. 240 patients with Long COVID will be randomized into 3 groups: targeted expectation management aiming to reduce illness-related anxiety and dysfunctional symptom expectations in addition to treatment as usual (intervention 1), non-specific supportive treatment in addition to treatment as usual (intervention 2), or treatment as usual only (control). Both active intervention groups will comprise 3 individual online video consultation sessions and a booster session after 3 months. The primary outcome is baseline to post-interventional change in overall somatic symptom severity. Additional risk factors for symptom persistence will be identified in the untreated control group. Comparisons with risk factors for other conditions identified in RU 5211 will be conducted to provide evidence of disease-specific and generic mechanisms of actions for the persistence of somatic symptoms.Expected impact: The study will shed light onto the action mechanisms of a targeted expectation management intervention for Long COVID which, if proven effective, can be used stand-alone or in the context of broader therapeutic approaches. Further, it will enable a better understanding of symptom persistence in Long COVID by identifying additional disease-specific risk factors.

• DFG Programme: Research Grants