Cognitive and affective psychoeducation for Long COVID: A randomized controlled trial

Abstract

Long COVID is a complex condition characterized by persistent symptoms, including cognitive difficulties and fatigue, which significantly impact daily functioning. Although various intervention strategies inspired by approaches used in the rehabilitation of other neurological conditions have been developed to address these issues, evidence of their efficacy in Long COVID populations remains limited. This study aimed to compare the effectiveness for cognitive complaints of two psychoeducational interventions - one focused on cognitive difficulties and the other on affective symptoms in Long COVID patients with cognitive problems. COVCOG (Long COVID: treatment of cognitive difficulties) is a randomized controlled trial using a parallel two-group design. Long COVID patients underwent neuropsychological assessments at pre-, 2- and 8-month post-intervention. The intervention comprised four 90-min sessions of either a cognitive-focused or an affective-focused psychoeducational programme. The effects were measured on cognitive complaints (primary outcome), cognitive performance, fatigue, sleep difficulties, quality of life, psychological distress, and impact on work and daily activities (secondary outcomes). Linear mixed models (LMMs) were used. One hundred and thirty Long COVID patients were randomized. One hundred and twenty-two (mean age: 47 ± 10; 69.7% female) were included (63 in the cognitive group and 59 in the affective group). The low dropout rate (12% at 2 months and 9% at 8 months post-intervention) and the patients' substantial active engagement - 92% attended all intervention sessions - assured the feasibility of both interventions. LMM analysis revealed a statistically significant improvement with time in subjective cognitive complaints, objective cognitive performance (attention, working memory and long-term memory), quality of life, fatigue, sleep, some psychological distress subscales and work impairment (all Ps < 0.03, with small to moderate effect sizes), but no group-by-time interaction, suggesting that trajectories did not differ between arms. However, some improvements are specific to one intervention or the other. Designed specifically for this population, both psychoeducative interventions provide insights into improving the management of Long COVID patients with cognitive problems. Longer treatment may be needed for more meaningful improvements.