LONG COVID: CAN MINDFULNESS HELP WITH SYMPTOMS?

The impact of Long Covid is gaining greater recognition as a real condition or syndrome, with numbers of people suffering from it becoming increasingly evident, and it is appearing in both adults and children. As with many less clearly defined conditions, especially those that do not fit easily into medical criteria, being taken seriously, and accessing appropriate resources can sometimes feel as difficult as the condition itself.

In some way, Long Covid has the advantage of, firstly, being part of a world-wide pandemic with a great deal of attention being paid to it, and secondly, following on from the exceedingly difficult and long battles fought for decades by those with ME, Chronic Fatigue and Fibromyalgia. This is not to say that Long Covid is a replica of any of those conditions, but rather that the symptoms evident in Long Covid certainly overlap in certain areas.

Similarities between Conditions
Having worked in the field of health and mental health and written several books and articles on aspects of it, similarities between the symptoms of Long Covid and those associated with ME, Chronic Fatigue, Fibromyalgia, cancer, chronic pain and anxiety and depression immediately became apparent. In brief, some that stood out were:
• fatigue/chronic fatigue
• brain fog
• breathing difficulties
• confusion
• pain (neuropathic, joint and/or general body aches)
• digestive problems
• memory problems
• sleep disruption
• feelings of anxiety and depression
• fear
• shame

Mindfulness
There is a strong body of evidence documenting how mindfulness has been shown to help with anxiety and depression, pain management, symptoms of cancer, stress, tinnitus, hypertension, diabetes, sleep, and many more physical and psychological conditions, and we are getting to know that Long Covid includes many of the same issues, notably the list mentioned above. All these conditions bring about suffering in different forms, and mindfulness can, and does, help to shift the perspective on it.

Mindfulness is not a cure of any form, but it can assist with the management of physical and psychological distress or disruption. In general, meditation does not run the risk of harming people, although it is not suitable for everyone nor is it recommended for people with severe mental health issues unless done in a controlled and structured manner. Having said that, anyone starting off with it should always approach it using care and gentleness.

Meditation is the cornerstone of mindfulness, but the mindset of mindfulness (the concepts of it) can in itself be beneficial especially for those who initially are reluctant to engage in any form of focused breathing.
In my experience, combining mindfulness with psychological concepts allows for a more inclusive and grounded approach. Taking a multidynamic approach that includes a biopsychosocial model and mindfulness facilitates viewing an individual as mind and body rather than mind or body. (cf. Mindfulness-based Multidynamic Approach below).

Mindfulness & Breathing
We all know how to breathe but doing it in a more conscious and aware manner allows us to develop not only our lung capacity or better utilisation of our breath, but it dampens down the stress response and releases physiological tension. In addition, mindful breathing engenders an interactive relationship between one’s mind and body in a manner that allows for focus, redirection of attention and a sense of control over what often feels disrupted and chaotic. It develops the invaluable capacity to psychologically step back from distress, and approach it in a more functional, or less disruptive, way.

For those who continue to have breathing difficulties, diaphragmatic, abdominal or belly breathing is particularly important. Most people are unaware of the mechanism of good breathing and it is essential to learn as it can ease some of the distress by allowing for greater oxygen intake and better breath control. In addition, it engages you in using your breath as a psychological and stabilising anchor. By using diaphragmatic breathing and breathing in a more aware and controlled manner, you may find that it allows you to engage in a degree of physical movement or exercise, no matter how small that movement is. Mindful movement at any level, when done carefully and within your own limits, is beneficial.

Mindfulness is far more than good breathing alone. The meditations allow for greater awareness of your breathing and breath, but fundamentally, facilitate your using them to your advantage both physically and psychologically.

The Stress Response
Fear, anger, distress, and pain activate the stress response, which is a physiological mechanism switched on at a primitive level long before we are conscious of it. It is a survival mechanism so attempts to squash or override it are unwise. Unwarranted overactivation of this response can lead to further physical implications due to the repeated secretion of cortisol and adrenaline and the body being required to reset after each activation. This can damage organs and leave one feeling tired, even exhausted. As it is unpleasant and disruptive, it can also impact one’s mood, enthusiasm, and willingness to engage with others or in life.

Post-traumatic Distress
The Stress Response mechanism is frequently overactivated when people have experienced high levels of distress or trauma. Having a life-threatening illness or one that has brought about a significant change in your level of functioning is traumatic, and I wonder if there are many who have survived Covid and those who now have Long Covid, who are experiencing post-traumatic distress? The reliving of experiences, intrusive memories, nightmares, flashbacks, ruminations, anxiety, irritability, and sleep disturbances are all symptoms that fall into that category, some of which may be part of Long Covid but may also be an indication of post-traumatic distress, or in some cases, PTSD.

They are unpleasant symptoms and repeatedly experiencing them will certainly lead to further distress and interfere with recovery. If people do experience a high level of these symptoms, it is not advisable to launch into long or deep meditations as meditation is often a time when thoughts arise, sometimes distressing ones, and monitoring their impact on you is important. Too much, too soon is never advisable. A short mindfulness practice, such as paying particular attention to your sensations when eating a piece of fruit or when taking a shower are good starting points.

Mindfulness-based Multidynamic Approach
Traditional approaches and interventions have tended to emphasize one or the other, mind or body, but humans are far more complex than a simple either/or dichotomy. Integrating a biopsychosocial viewpoint includes the biological (genetic and physical) aspects of an individual, their psychological make up, influences and internal view of self and the world, and the social set up of the person from family dynamics to cultural, social, and environmental ones.

Couple this personalised knowledge with mindfulness and an intervention becomes considerably more pertinent and personal, facilitating and encouraging engagement. Using such a model does not require much more work than other approaches but it does contextualise that specific person. Assessments and interventions are often one-dimensional or skewed towards a dominant profession even in multidisciplinary work.

By combining mindfulness with this biopsychosocial concept, it opens the door to an integrated, whole-person and flexible approach. The signs and symptoms of Long Covid are both physical and psychological, and the two will interact. For example, suffering from pain and fatigue will have a severe impact on a person’s ability to exercise or engage in activities, including work, and this in turn will affect their mood. Our minds are inextricably linked to our bodies, and vice versa, and mindfulness encourages the quietening of disruptive neuronal pathways and the creation of more functional ones.

Another aspect included in this approach is the concept of using our capacity as humans to view our thoughts and actions as if from above, and to then be able to decide if they are helpful or not and change them accordingly (metacognition). This is a remarkable ability we possess but it is frequently underutilised in therapeutic approaches. The same goes for pain memory and how we can turn down the volume on pain, and the Gateway Theory, which in short suggests that there are factors that can reduce our pain and factors that can increase it.

These and other areas have significant influence over how we can manage our difficulties and are valuable additions to the practice of mindfulness and meditation.

Conclusion
The evidence for both mindfulness and psychological input on health and mental health conditions is abundant. The main advantage of using an integrated mindfulness approach in addition to any medical or allied interventions is that it rightly addresses the whole person within his or her psychological and social context. The relevance of these frequently excluded factors should not be dismissed, especially as we know that ethnicity, level of income, work and community are key factors to not only contracting Covid and other illnesses but surviving and recovering from them.

Overall, it would seem likely that using what is already known to work in specific areas may be a good start. There is no point reinventing the wheel, so accessing well-established resources is something that can be taken advantage of, and built upon, whilst new areas or information come to light.

Books are available using this model:
Pain Management
Anxiety and Depression
Managing Symptoms of Cancer (this book incorporates a range of issues including managing pain, sleep disturbances, pacing, and fatigue which is why it is included here).
Monkey Mind and The Mountain: Mindfulness for 8 – 80 year-olds. (This book is for children and adults).
Life Happens: Waking up to yourself and your life in a mindful way.

Further information on the framework used can be found under MODEL

Should you wish to contact me there is a form on the website. www.lifehappens-mindfulness.com