COVID-19 changed the world in many ways. One of those ways is that all human beings now live in a world with ongoing risk of developing persistent, disruptive, and sometimes intensely disabling post-infection symptoms. These symptoms are sometimes called “Long COVID.” Long COVID has significant impacts on mental health, and mental health interventions like therapy can help.

Long COVID: The Myths and The Facts

Long COVID is also called Post-COVID Conditions (PCC), long-haul COVID, and post-acute sequelae of COVID-19 (PASC). It is the subject of ongoing scientific research, news coverage about its disabling impact on both children and adults, political conversations about public health, and social media discourse. 

Long COVID myths based in ableist and anti-scientific biases are pervasive. Common myths include that Long COVID is “all in your head,” “caused by vaccines,” or an “excuse to be lazy.” These beliefs cause harm to public health and create hurtful stigma for those who are experiencing Long COVID. In reality, post-viral conditions are well-documented by decades of scientific research and research is progressing and helping us understand Long COVID a little more every day. 

So far, we know that Long COVID involves the development of new, persistent, and/or recurring symptoms after a COVID infection. Long COVID is a condition that impacts multiple body systems and can involve a variety of respiratory, neurological, cardiac, and psychological symptoms. These symptoms can be mild and manageable or entirely debilitating, and research so far cannot fully predict or explain these outcomes. However, research does indicate that Long COVID can occur after any COVID infection of any severity. In fact, most people who develop Long COVID do so after a mild COVID infection, and Long COVID can develop even after a totally asymptomatic infection. This means some people with Long COVID never even knew they had COVID in the first place.

The discovery that Long COVID is a possible outcome after a COVID infection of any severity also means that Long COVID is more common than scientists first thought. Research indicates Long COVID occurs in 10% to 30% of people after a COVID infection.

One complicated, ongoing question in the research is this: who is most at risk of developing Long COVID? The research in this area has evolved significantly in the last five years. For example, the early pandemic belief that children are especially resilient and low-risk for Long COVID has been debunked, and some initial studies reporting this have even been retracted due to rampant errors. 

Other research has identified groups of people are at higher risk of developing Long COVID. So far, we know that the more times a person gets COVID, the more likely they are to develop Long COVID, which can also be dramatically worsened by additional infections. We also know that many marginalized groups, such as trans people, BIPOC people, elderly people, and women are at higher risk of Long COVID. Preexisting disabilities and medical conditions, such as asthma, cancer, heart problems, and autoimmune conditions also result in higher risk. Having certain mental health conditions, such as depression, anxiety, stress, and ADHD have also been found to increase risk of Long COVID by as much as 45%. Another important consideration is occupation: people such as healthcare workers and teachers are at higher risk of Long COVID due to repeated exposure to illness at work. 

How Long COVID Impacts Mental Health 

You may be wondering how therapy is relevant for a medical condition like Long COVID. While society often thinks of our physical symptoms as separate from our psychological experiences, this simply isn’t true. Physical symptoms have psychological impacts, psychological symptoms have physical impacts, and living with complex medical diagnoses is often an emotionally challenging and life-changing experience. 

As described above, Long COVID symptoms may manifest in many different types of medical symptoms, and Long COVID most commonly occurs after mild infections. As a result, developing Long COVID may feel like it happened “out of nowhere,” which can cause emotional turmoil. Additionally, Long COVID patients may experience a complicated, prolonged medical mystery involving life-threatening or life-changing symptoms that could be unpredictable, recurrent, or permanent. These experiences are distressing, disruptive, and sometimes even traumatic. The psychological impacts can be profound and may include an increase in stress, anxiety, depression, or PTSD symptoms. 

Following the psychologically difficult experience of developing Long COVID, living with the condition presents both medical and psychological challenges. As described above, research increasingly indicates that Long COVID is common, but the condition continues to be highly stigmatized, even among medical professionals. As such, living with Long COVID can be a deeply isolating experience. Many people with Long COVID are unaware, undiagnosed, or hide their symptoms due to stigma, internalized ableism, or difficulty grieving their changed health status. Moreover, the unpredictable nature of Long COVID and the few available treatment options can lead to feelings of anxiety, depression, and even thoughts of suicide. 

Long COVID can also impact mental health by exacerbating existing mental health conditions and mimicking the development of new mental health conditions. For example, as noted above, ADHD is one risk factor for developing Long COVID. Long COVID commonly involves difficulties with concentration and brain fog, which can worsen existing ADHD or cause people to wonder if they’ve developed ADHD or had it all along but didn’t realize it. This has been discussed as one possible factor driving the current rise in people seeking ADHD evaluations. 

Research into Long COVID increasingly suggests that it is not only that the experience of living with Long COVID can result in experiences like anxiety and depression, but that the condition itself may cause brain and mind-related symptoms. Research indicates about 90% of those hospitalized with COVID and 25% of people who did not require hospitalization during a COVID infection will go on to develop brain or mind-related symptoms like depression, anxiety, sleep problems, headaches, or chronic fatigue. While researchers are still investigating the cause, so far it is believed this may be happening because the COVID virus causes brain inflammation and changes in metabolism in the brain, which in turn creates psychological changes.

How Therapy Can Help

The impacts of Long COVID can be daunting, especially given that there is no cure for Long COVID at this time. However, therapy holds great promise to help those experiencing Long COVID and those who want to make adaptive changes to reduce their risk and protect their well-being. 

While Long COVID is a new phenomenon and medical science will need time to understand it and develop specific treatments for it, there are already existing therapies for many Long COVID related concerns. Because these therapies have been around for decades, we already know they can improve the lives of those who experience difficulties related to medical conditions. For example, psychological interventions like therapy have been used successfully with people experiencing cancer, traumatic brain injuries, autoimmune disorders, genetic conditions, and other post-viral illnesses. They can help with Long COVID, too. 

For example, at Aviva Psychology Services, there are multiple well-established forms of psychotherapy available that address anxiety, depression, grief, and trauma. These therapies can dramatically reduce symptoms and dramatically improve quality of life regardless of the underlying origin of the symptoms. Treating these conditions, even while Long COVID persists, can improve quality of life in meaningful ways.

Aviva Psychological Services is also home to multiple psychologists who specialize in clinical health psychology. In the area of clinical health psychology, there are robust interventions available to help address many common Long COVID experiences such as chronic pain, executive dysfunction, chronic fatigue, brain fog, and insomnia. Clinical health psychologists also specialize in helping people make adaptive changes to protect their health. For example, they can provide support for implementing lifestyle changes such as clean air practices to reduce risk of airborne illness, guide you through developing self-care strategies after mental and physical abilities are altered by disability, and can help you navigate the stress of occupational or relationship changes necessitated by health conditions. 

Some psychologists at Aviva Psychology Services specialize in working with chronically ill and disability communities. These providers have expertise in helping people manage experiences of ableism and discrimination, the stress of managing illness and disability, grieving losses associated with health status, the ripple effects of changes in our work and personal lives, and navigating changes in identity. Working with these psychologists can help those with Long COVID develop rich, meaningful lives even in the face of extremely difficult circumstances. 

One particular benefit of mental health services for Long COVID is that unlike much medical care, which requires in-person visits for evaluations and procedures, therapy can be conducted via telehealth in the form of video and/or telephone appointments. This can be helpful in multiple ways. For example, Long COVID is frequently an energy-limiting condition and often makes travel logistically complicated. Additionally, having Long COVID means that exposure to and contracting additional illnesses, including but not limited to additional COVID infections, are more dangerous. Sitting in public waiting rooms or therapy offices can therefore be a significant health risk for medically-vulnerable people, and teletherapy provides a safer, more accessible option. 

Whether your Long COVID related therapy targets a specific mental health condition like depression, explores disability-related experiences like ableism, or happens in-person or via telehealth, there is one universal truth: you deserve and can build a rich, meaningful life even while living with Long COVID.