Long COVID: Psychological risk factors and their modification

Background: After a SARS-CoV-2 infection has subsided, somatic symptoms persist in a significant proportion of those affected, a phenomenon known as "Long COVID". In addition to pathophysiological ones, initial studies indicate an involvement of psychological risk factors in the development of Long COVID. Of the potentially modifiable psychological risk factors, disease-related fears and dysfunctional symptom expectations in particular seem to contribute to symptom persistence. With regard to the development of effective therapies, it is therefore essential to investigate whether symptoms of Long COVID can be improved through targeted modification of disease-related fears and dysfunctional symptom expectations. The planned study will be carried out in collaboration with the DFG-funded research group SOMACROSS (FOR 5211), which is investigating risk factors for persistent physical symptoms in ten clinical pictures.Aims: Our primary goal is to investigate whether symptoms of long COVID are caused by modification of disease-related fears and dysfunctional Symptom expectations can be improved. Second, we aim to identify additional risk factors for symptom persistence. Finally, exploratory risk factors for symptom persistence in Long COVID are compared with risk factors identified within the framework of FOR 5211. Work program: To determine whether symptoms of Long COVID improve through modification of disease-related fears and dysfunctional symptom expectations, an observer-blinded, three-arm randomized controlled study is being conducted. 240 patients with long COVID will be randomized into 3 groups: expectancy management to reduce disease-related fears and dysfunctional symptom expectations plus usual treatment (intervention 1), non-specific supportive treatment plus usual treatment (intervention 2) or only usual treatment (control). In both intervention groups, 3 individual sessions are conducted online and a refresher session after 3 months. The primary endpoint is the change in somatic symptom severity at the end of the intervention. Additional risk factors for symptom persistence will be evaluated in the control group. Comparisons with risk factors for other diseases identified as part of FOR 5211 serve to provide insights into disease-specific and general mechanisms of action for persistent physical symptoms. Expected Impact: The study will shed light on the mechanisms of action of an expectation management intervention in Long COVID, which, if proven effective, can be used independently or as part of more comprehensive therapeutic approaches can be used. In addition, it will provide a better understanding of symptom persistence in Long COVID by identifying additional disease-specific risk factors. The study will elucidate the mechanisms of action of an expectation management intervention in Long COVID, which, if proven effective, can be used on its own or as part of broader therapeutic approaches. In addition, it will provide a better understanding of symptom persistence in Long COVID by identifying additional disease-specific risk factors. The study will elucidate the mechanisms of action of an expectation management intervention in Long COVID, which, if proven effective, can be used on its own or as part of broader therapeutic approaches. In addition, it will provide a better understanding of symptom persistence in Long COVID by identifying additional disease-specific risk factors.