Developing an Integrative, Recovery-Based, Post-Acute COVID-19 Syndrome (PACS) Psychotherapeutic Intervention

Project Abstract At present, 34.6 million people in the United States, and 273,232 Veterans tested or treated in Veteran Affairs facilities contracted COVID-19. While the exact prevalence of Post-Acute COVID-19 Syndrome (PACS) among Veterans is unknown, estimates of psychiatric/neurological PACS using a large global sample of COVID-19 patients (N=236,379) suggest a prevalence of approximately 11,390,400 Americans, and 90,311 Veterans in VA care, with rates likely to increase over time. Moreover, large scale studies suggest up to 35% of individuals experience functional impairment 8 months after COVID-19, and high prevalence of post-infection mental illness including anxiety disorders, depression, and post-traumatic stress disorder. Using longitudinal data from our academic affiliate, Icahn School of Medicine at Mount Sinai's COVID registry (n≈1200), and local James J. Peters VA's Clinical PACS program, coupled with our expertise in recovery-based psychotherapy, we are uniquely poised to develop an innovative treatment for Veterans struggling with PACS. Our intervention aims to improve psychological adjustment to PACS symptoms, promote resiliency, and facilitate coping, all of which can impact functional status and quality of life. The PACS-Coping and Recovery (PACS-CR) intervention we aim to develop focuses on psychological adjustment and coping, and augments medical, rehabilitative and neurological treatment for this population. Our approach is based on the CHIME model of personal recovery which includes five overarching processes: 1) Connectedness; 2) Hope and optimism about the future; 3) Identity; 4) Meaning in life; and 5) Empowerment. We will target the CHIME processes using established psychotherapeutic techniques such as skills training, acceptance-based and identity-based principles. Based on adaptations from existing recovery-based and COVID-19 distress group interventions that our team has developed and piloted, we are proposing a treatment framework that consists of a core of twelve 90-minutes sessions (1x/week x 12 weeks) with additional weekly sessions on specialized topics that are optional. We are proposing a treatment development NIH Stage 1A study to develop a Post-Acute COVID-19 Syndrome psychotherapeutic intervention, "PACS Coping and Recovery" (PACS-CR) through an iterative development process while collecting pilot data to assess its acceptability and feasibility. Our treatment development SPiRE will focus on 1) determining the treatment needs of Veterans with PACS, 2) developing the treatment using pilot qualitative data and aided by stakeholder feedback, 3) refining the intervention by three iterative pilots of our groups, testing both in person and telehealth versions. Pre and post measures will be utilized to track functional improvement and the degree to which this recovery-focused intervention has enabled the veterans to engage in meaningful life changes.