Self-management of long Covid: Fatigue, low mood and anxiety

Long Covid is pretty new so all health professionals, from doctors to psychologists, are still trying to work out the best practice in their own areas. However, some useful guidance has been published by the NHS and British Psychological Society (BPS).

Based on my understandings of this guidance, experience as a counsellor/psychotherapist and what I have shared with my long Covid clients until now, I shall cover the following topics here:

1. What is long Covid and its symptoms?
2. How to self-manage long Covid's two major effects: i) persistent fatigue, and ii) mental health impacts such as low mood and anxiety. This is crucial as good self-management of both fatigue and mental health shall help with the recovery (see BPS 2020, references 1 and 2 below).

What is long Covid and its symptoms?

Long Covid is a range of symptoms that Covid-19 patients continue to suffer from, even after 12 weeks of no longer being infected by the coronavirus (SARS COV-2). Symptoms for long Covid range from physical, functional to psychological. These symptoms and their severity do not seem to be related to the severity of Covid-19 a patient had. 

The physical symptoms range from persistent fatigue, heart palpitations and tight chest, difficulty in breathing, temperature, cough and headaches. For these, patients must see their consulting physicians.

The above physical symptoms and patients’ specific social factors (e.g. financial status, their pre-illness jobs, and family responsibilities) combine to impact how they may start to feel about themselves, such as:

The above negative ways of thinking and feeling about themselves may lead to long Covid-19 patients experiencing recognised psychological conditions such as low mood (or depression) and anxiety with some feeling suicidal even.
 
Some Covid-19 patients who had been hospitalised and received mechanical ventilation may develop post-traumatic stress disorder (PTSD) due to delirium and sedative prescribed there. Cardinal PTSD symptoms include flashbacks of traumatic images, persistent nightmares, avoiding reminders of illness and/or the traumatic event/s, increased vigilance around the bodily changes/symptoms.  

Relatives of Covid-19 patients may also experience PTSD related to the trauma they experienced by seeing their loved ones gasping for breath or in other kinds of physical distress either at home or hospital. Relatives of hospitalised patients may not have been allowed to visit them even. In which case, the trauma and pain of hearing news of their loved one’s decline and/or seeing them distressed on mobile devices may even be greater.

For PTSD, both Covid-19 patients and their relatives must seek help from the clinical psychology services of the NHS or private EMDR therapists.

Self-management techniques for persistent fatigue

These practical ideas are based on my professional practice and existing guidance in the area of chronic fatigue syndrome. I have seen clients setting themselves challenges beyond their current physical capacities, e.g. doing a five-mile bike ride or gardening for a couple of hours, and then finding themselves completely wiped out - needing up to 24-48 hours of sleep to even get up. Such ‘boom and bust’ activity has been found to lead to chronic health problems in the cases of post-viral fatigue, therefore should be avoided (BPS, 2020, see reference 1).

So as a first step, I explain to my clients two simple theories:

What is spoon theory?

To explain, the spoon theory involves estimating how many spoons of energy you have on a particular day. It is best done as soon as you wake up and remember each task uses one spoon of energy.

You also need to make a list of your priority tasks e.g. daily living tasks (such as bathing and brushing teeth), and desirable tasks (e.g. reading work emails and having a telephone chat with a friend), with associated estimations of energy you may require for them on that day.

Your tasks and their related energy consumption would result in a table. This table would vary for you on a day-to-day basis and over your recovery period. You can find further information on spoon theory and see a graphic presentation of what an energy consumption table would look like at mummyingandme.com.

For the daily optimum energy management, it is a good idea to leave some spare energy in your tank, just like the motoring advice to not drive your vehicle when in reserve, to aid recovery. After your tasks and energy levels table is ready, you should plan and pace the tasks. This means deciding on the sequence of tasks and where you would take breaks.

During the breaks, you can do simple breathing techniques, mindfulness or meditations to aid relaxation and recovery. Yoga therapist Heather Mason provides many videos of breathing techniques and meditations on her website. However, if you are my client, I teach mindfulness and breathing techniques during the sessions and provide audio recordings too.

You can even think about delegating some tasks either from the outset or when you start to feel that you would run out of energy. 
 
This type of personal energy self-management would need refining by trial and error, so you would have to be patient with yourself. However, if optimised, it shall boost your confidence in being able to do essential tasks and thus live more independently. This, in turn, should enhance your current and future positivity.

Self-management techniques for low mood and anxiety

As the physical capacity builds slowly since long Covid symptoms may come and go in a wave-like pattern, you may experience a myriad of emotions such as feeling guilty about not being able to help your partner, parents or other carers; being a burden on the family; letting the family down by not being able to work if you have lost your job due to illness; frustrated by tasks that were easy for you to do before but now seem daunting; isolation and boredom.

Writing or pouring your heart out on the pages of a diary or journal may be very therapeutic for such frustrations, anger and disappointments (see my article: Garg, 2021). This type of writing should not only allow you to be emotionally honest with yourself in a creative way but also help you to accept your situation more, resulting in improved interactions with your carer/s.
 
For worries and unhelpful thoughts about falling ill again, dying and not being able to return to work ever etc., you can help yourself by asking the following key questions:

• What is the evidence for my thought or worry?
• What would my friends say about it?
• What would I tell my friend if he/she asked me about it?

Your answers to the above questions shall help you to manage your unhelpful thoughts and worries better.

For more guidance on self-management of long-Covid associated physical and mental health effects and returning to work etc., you may like to access the following resources/references, particularly NHS England’s Covid recovery information.

1. The BPS (2020). British Psychological Society response to NICE
   Draft Guideline on Management of Long-Term Effects of Covid-19. (Accessed 15 March 2021).
2. The BPS (2020). Meeting the psychological needs of people recovering from severe coronavirus (Covid-19). (Accessed 10 April 2021).
3. Garg, A (2021). Poetry in the therapy room. Therapy Today, April, pp. 39-41.