Long Covid and CBT

CBT is commonly recommended for those with Long COVID, despite a sparse evidence base. There has been no randomised control trial comparing CBT for long COVID with a credible attention control condition. Rather a study of CBT for severe fatigue [Kuut et al 2023] has been pressed into service as a proxy, for a gold-standard study. This lacks credibility as:

  1. There are objective measures of recovery from Long Covid such as return to work and distance walked compared to pre-infection. By contrast, studies of severe fatigue rely on a subjective measure of the person’s self-report of fatigue. As such Kuut et al, like studies cannot be judged as being in the same category as a gold-standard study.
  2. The Kuut et al (2023) study has all the methodological limitations that Vink et al described in their 2020 paper.

What we have is the ongoing spin of CBT.  But does it matter? It does, because sufferers from Long Covid are pushed in the direction of a treatment in which ‘unhelpful cognitions and behaviours’ are believed by the therapist as pivotal in the maintenance of symptoms. Therapists have varying degrees of transparency about this. The Long Covid sufferer is likely distressed by their symptoms, with the prospect of redundancy and the strain on relationships. They are very vulnerable, they do not need it implied, however nicely phrased, that they are responsible for their condition with unhelpful beliefs and behaviours.


Professionals can compound matters by muddying the waters  on aetiology and diagnosis. In instances were no Covid test was done and the diagnosis of Long Covid is a best guess on the evidence available, it can be suggested that the Long Covid morphed into Chronic Fatigue Syndrome . Thus, the Long Covid sufferer can find themselves ushered down a CFS treatment pathway. But as Vink et al (2020) argue that if objective measures of outcome are used there is no evidence that CBT works for CFS.

Long Covid sufferes are stressed but that does not automatically mean that the difficulties they are experience equate to a psychological disorder. At best assessment of anxiety and depression in Long Covid suffers is based on self-report measures, which are notorious for yielding false positives. I have yet to come across a case were the prescence of anxiety and depression was assessed using a gold-standard standardised diagnostic interview.

Looking at a Long Covid Sufferer through an anxiety/depression window requires a rigorous justification, in general the burden of proof is lacking.  The client’s view, if allowed to be heard is that the better window to look through is of having a chronic physical condition that is inherently frustrating. Some may or may not find a support group of similarly effected individuals helpful. But there should be no pretence that this will resolve their disability or return them to pre Covid functioning.

What window is NHS Talking Therapies looking through?


Dr Mike Scott