Promising Mind Body Study Offers New Hope for Long Covid Patients
A scientific study just published in Mayo Clinic Proceedings helped long Covid sufferers find significant relief from fatigue, insomnia and other somatic symptoms using a mind-body approach. The 13-week protocol called Psychophysiologic Symptom Relief Therapy was very effective at reducing the symptoms of long Covid in this non-randomized study, according to lead investigator Dr. Michael Donnino of Harvard Medical School. Participants report that shortness of breath decreased by a median of 80-percent, brain fog went down by 67-percent and pain lessened by 52-percent.
Patients in the small pilot study also returned to daily activities, experienced a higher quality of life and harbored less fear about their health. At the beginning of the study, all 23 patients categorized their symptoms as high or very high. By the end of the study, 70-percent said that was no longer the case.
In one patient’s words, “This has been life changing and life saving.”
The mind-body intervention through Beth Israel Deaconess Medical Center in Boston included patients from age 18 to 60 who tested positive for a previous Covid-19 infection but didn’t have organ damage. On average, participants had already seen three specialists. More than half had tried another mind-body approach but their symptoms persisted. According to Donnino, patients with debilitating symptoms often experienced relatively rapid relief in the program.
“We enrolled 23 participants who had long Covid for a median of about 9 months and saw improvement in the majority after the first four weeks of the program,” says Donnino. “We observed improved symptoms across all measured domains.”
Participants who previously complained of a poor quality of life saw a “statistically significant and clinically meaningful reduction in somatic symptoms,” according to the scientific paper published August 2023.
As one participant wrote, “I have my life back.”
PSRT PILOT STUDY MEDIAN SCORES: Psychophysiologic Symptom Relief Therapy for Post-Acute Covid-19 (Slide courtesy of Michael Donnino)
At the end of the 13-week cohort, patients reported these median improvements:
Shortness of breath down 80%
Pain interference down 77%
Pain anxiety down 74%
Brain fog down 67%
Somatic symptoms down 60%
Physical function limitation down 54%
Pain intensity down 52%
GI Symptoms down 50%
Fatigue down 44%
In a survey given to ten participants after the study, the majority said their symptoms had almost completely resolved. The others wrote that their symptoms had improved, they developed a positive attitude about remaining symptoms or both of these. Some previously described being depressed and scared to do life activities like work or parent for fear of symptoms flaring up.
one participant wrote, “I am much happier, more mindful and believe the quality of my life is BACK!!!”
A wide range of symptoms lessened even as participants became more active. At the beginning of the mind-body study, 57% strongly agreed that exercise made their symptoms worse. By the end of the intervention, only 4% agreed that exercise made their symptoms worse.
Psychophysiologic Symptom Relief Therapy (PSRT) is based on the premise that stress, repressed emotions and psychological processes can cause chronic symptoms like persistent pain, lethargy, headaches, GI distress and dizziness—as long as pathological causes are ruled out. The research team writes that psychophysiologic symptoms are perpetuated by ongoing stressors and a conditioned response in the brain. As patients focus on their symptoms with fear, it can further condition the brain to associate previously neutral stimuli as threatening.
PSRT PILOT STUDY RESULTS: Psychophysiologic Symptom Relief Therapy for Post-Acute Seqelae of Covid-19 (Slide courtesy of Michael Donnino)
The scientific literature describes how soldiers returning from battle—and other stressed populations—suffer from a similar symptom picture including malaise, anxiety, tachycardia, dyspnea and sleep problems. In addition, people with post-traumatic stress disorder or PTSD show decreased cognitive capabilities and brain changes on MRIs.
The Boston team notes both historical and scientific evidence that psychological states can cause significant physical symptoms. Emotional stress is known to trigger benign physical responses like blushing, leading to capillary blood flow. It can also cause serious conditions like takotsubo’s cardiomyopathy or broken-heart syndrome in which extreme stress weakens the heart muscle, mimicking symptoms of a heart attack.
Recent studies show psychological stress can cause chronic pain and other syndromes in the absence of a structural or pathological cause.
Donnino’s team used a four-part approach with Long Covid patients to help them understand the basis of their symptoms, express their emotions, unlearn conditioned responses and modulate stress. They met with participants over video conference for a total of 18 classes. (I led one of the classes in each cohort, sharing strategies I’ve used to heal from chronic fatigue syndrome and help clients recover from long-haul Covid.)
The mind-body intervention covered four areas:
.01 Psychophysiologic education
Patients learn the rationale and mechanism for how emotional stress can impact the brain and cause a wide range of chronic symptoms. This knowledge can lower fear of tissue damage, which enables them to resume activities with more confidence. Participants also explore links between their symptoms and life stressors. They identify inconsistencies, such as feeling pain while walking up stairs at work but not on the staircase at home. Diseases with a structural cause don’t change in location and intensity in the way psychophysiologic symptoms do.
.02 Desensitization
Benign activities like sitting, standing and eating certain foods can become coupled with threat when the brain is stressed. To train their brain that these stimuli are safe, participants first visualize a movement or situation that typically triggers symptoms. This imaginative exercise often has the same effect as the actual movement. For instance, several people felt chest pain, headache and shortness of breath while simply imagining they were walking across the room. This offers proof of a psychophysiologic process and exposes people to the stimuli in a safe, graded way. Next, they slowly resume activities they’ve avoided with soothing behavior.
.03 Emotional expression: psychology of the syndrome
Recent research shows that repressed emotions can cause and worsen chronic symptoms due to the way they affect the brain centers and autonomic nervous system. The mind-body connection has been well-explained by Dr. John Sarno in his book The Mindbody Prescription and Dr. Howard Schubiner in his book Unlearn Your Pain—texts patients received in the study. Long Covid sufferers also learned to express a wide range of emotions they previously held inside—including anger, sadness and even joy—through writing exercises, self-reflection and small group discussions.
.04 Stress reduction: Mindfulness Based Stress Reduction
The last nine weeks of the program focused on stress-coping tools through Mindfulness Based Stress Reduction, which has been proven to lower stress, anxiety and depression in studies. In mindfulness classes, participants learned how to cultivate present moment awareness. This trains them to observe thoughts and sensations without emotional reactivity. The MBSR component also includes stress education, breath awareness, yoga practices, sitting meditation and body scans.
By the end of the mind-body intervention, participants not only felt better physically and emotionally, they wrote comments like, “The skill set I have gained has been life-changing and is influencing every facet of my life.”
Another participant wrote, “I now have such a better understanding of myself, my vulnerability, and my coping mechanisms. I am so thankful for this time.”
Donnino is planning a large, randomized study with long Covid patients using the PSRT approach. Estimates show that between 10 to 30-percent of adults infected with the virus develop post-Covid symptoms in the United States. Many patients are told that microclots, mitochondrial dysfunction, autoimmune reactions or a virus spike protein could be causing chronic Covid. The Harvard team notes that none of these theories have been proven to be a direct cause of the symptoms.
In fact, one research study looking at 189 adults with post-Covid symptoms found no evidence of persistent viral infection, autoimmune reaction or abnormal immune activation. The team led by Michael Sneller at the National Institutes of Health found an association between anxiety and the development of post-Covid symptoms.
Another study published in JAMA Psychiatry showed that people with high levels of distress prior to a Covid-19 infection had an almost 50-percent greater risk of post-Covid symptoms. The study looked at nearly 55-thousand people experiencing depression, anxiety, worry about COVID-19, perceived stress and loneliness before developing an acute infection. Previous studies suggest that distress is associated with long-term symptoms after Lyme infection, as well as with chronic fatigue syndrome and fibromyalgia.
Lead author Michael Donnino discovered mind-body medicine through his own experience with chronic pain. In his early forties, severe back pain forced him into disability leave from his job as a critical care and emergency medicine physician at Beth Israel Deaconess Medical Center and a professor at Harvard Medical School. A battery of treatments and medications didn’t help. Donnino couldn’t work, exercise or even sit, due to constant pain in his back and tingling down his leg.
Against all odds, donnino experienced a dramatic recovery through the work of Sarno and Schubiner, despite the fact that he was initially skeptical.
Given his experience authoring 230 scientific manuscripts for high impact journals like JAMA, Donnino felt compelled to conduct a large, randomized clinical trial on chronic back pain using PSRT. An impressive 64-percent of back pain patients who participated in the mind-body intervention were 100-percent pain-free six months after the study began. Almost four times as many people experienced a back pain cure from PSRT than from standard care.
Donnino says the back pain pilot study showed very promising treatment effects. His team is now doing a larger, randomized back pain study.
“We had people who went from years of chronic back pain and reduced activity where they were not exercising to being pain-free and jogging again,” says Donnino.
Donnino believes the back pain patients fared well because they were accurately diagnosed and treated for the underlying cause: the way stress and emotions activate the brain and nervous system. As it happens, some back pain patients also complained of post-Covid symptoms and saw improvements from symptoms like fatigue alongside the resolution of back pain. This discovery led Donnino’s team to conduct the long Covid study published in the August 2023 issue of Mayo Journal Proceedings.
Interestingly, two of the long Covid participants contracted an acute case of Covid-19 during the study but still showed marked improvements by the end of the program. While Donnino acknowledges this is a small study without a control group, he believes this approach offers a new paradigm and great promise for symptoms that have baffled modern medicine.
Thank you to Michael Donnino and team for the opportunity to consult on the study.