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Acceptance and Commitment Therapy Helps Coronavirus 'Long Haulers'

Analysis  |  By Christopher Cheney  
   November 22, 2021

Approach to psychotherapy encourages patients to be observant of their thought processes and to focus on values.

Acceptance and Commitment Therapy can help coronavirus "long haulers" cope with the chronic illness, a psychology professor and practicing psychologist says.

One of the more mysterious characteristics of COVID-19 is that a significant number of patients who are long haulers experience symptoms for weeks or months after recovering from the acute phase of the illness. Coronavirus long haulers have a range of physical symptoms, including cough, shortness of breath, constitutional symptoms such as numbness and tingling, cardiac issues, hair loss, and deconditioning.

Coronavirus long haulers can also experience several behavioral health conditions, says Joseph Trunzo, PhD, a professor in the Department of Psychology at Bryant University in Smithfield, Rhode Island, and a practicing psychologist at Providence Psychology Services in Providence, Rhode Island. Trunzo is also co-author of a book on coronavirus long haulers—Long Haul COVID: A Survivor's Guide.

"At the top of the list, in no particular order, are depression, anxiety, significant and overwhelming fatigue, and cognitive dysfunction, which is commonly referred to as brain fog. There are rare instances where the behavioral health issues become more significant and problematic, including hallucinations and psychosis, but those are relatively rare," he says.

Brain fog is one of the most common long haul COVID symptoms, Trunzo says. "People do not seem to be processing information as quickly or as easily or, sometimes, at all. They may have short-term memory problems. They are not encoding information in the way that they would normally do. Prior to their COVID infection, they might have been able to read a magazine article and remember and digest it well. After their COVID infection, that kind of comprehension becomes very hard."

Acceptance and Commitment Therapy for coronavirus long haulers

Acceptance and Commitment Therapy (ACT) can ease the burden of long haul COVID, Trunzo says. "ACT is a form of psychotherapy grounded in behavioral science that has a lot of empirical evidence in helping people with chronic illnesses to live as rich and full a life as possible, even though they may be experiencing significant symptoms."

Defusion is one of the primary skills taught to patients in ACT, he says.

"The idea is to separate yourself and be more observant of your thought processes. As human beings, we tend to take whatever we think as gospel truth. So, when the thought pops into your head, 'I'm never going to get better,' defusion is the process of rather than having that thought and accepting it as true, you take a step back and say, 'I just had a thought that I might not get better.' Putting yourself in a more observant stance as to what your thought process is then gives you an ability to make better decisions around how functional the thought really is," Trunzo says.

ACT sets aside the truthfulness of thoughts and focuses on their utility, he says.

"For example, with the thought, 'I'm never going to get better,' ACT is not interested in arguing whether that is true. The only thing that ACT cares about is whether there is any functional value or usefulness to that thought. When you can observe your own thought processes, you can ask yourself whether a thought has functional value or usefulness and decide whether it is worth engaging in those thoughts," Trunzo says.

ACT also focuses on values, he says.

"Values are the things that we find inherently meaningful and important to us. ACT encourages values to be the guideposts for all decision-making. For example, someone could have a value of being close to family and friends. But brain fog makes it hard for them to go to trivia night with friends. Their mind is just not sharp enough. The behavior—going to trivia night—is driven by the value of connecting with friends. Even though someone may not be able to engage with the specific behavior of going to trivia night, there are other ways that they can connect with that value. They can have friends come over to watch a movie or have friends over for dinner," Trunzo says.

ACT can help coronavirus long haulers deal with the loss of control from the chronic illness, he says.

"ACT is an approach to psychotherapy that helps people to deal with situations over which they do not have a lot of control. For people who have long haul COVID, they do not have a lot of control over their symptoms. We do not have a lot of treatments. ACT is a way to help people deal with this kind of a situation. ACT can help people engage in their lives in a way that is still meaningful and can provide enrichment. It can help people move forward rather than having them trapped in the thought, 'I cannot do anything in my life until I get physically better.' ACT can help people break out of that cycle."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


Acceptance and Commitment Therapy (ACT) helps chronic illness patients to live a rich and full life despite significant symptoms.

ACT can help coronavirus long haulers deal with the loss of control from the chronic illness.

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