Closed Mind Body Intervention for Long COVID-19 [Massachusetts, USA]

[Evergreen]

So there is a misprint in the protocol where it says 'Behavioral: Mind Body Intervention #1' twice. And the otherwise identical wording is an attempt to mask which is the 'test' treatment?

I think it must be a misprint since in the first column the second group has a #2 marking.

Sorry, yes, you are right, I had misread your initial comment as referring to column 1 rather than column 2!

 

[Evergreen]

If you download the supplemental data file of the pilot study here (the link is between the acknowledgements and the references), you get to see what the experimental treatment will probably be. Scroll down - the protocol starts after supplemental figure 2.

Psychophysiologic Symptom Relief Therapy (PSRT) Treatment Protocol

PSRT is based on the notion that nonspecific pain and idiopathic symptoms are a result of psychophysiological processes. The PSRT intervention consists of a single one-on-one session with an instructor, group educational and skills-training sessions, and a mindfulness-based stress reduction (MBSR) program which includes one full-day (approximately 6 hours) session/retreat. The group educational and skills training sessions are held twice per week for four weeks with each session lasting 1.5-2 hours. The MBSR program consists of one 1.5-2 hours class per week for eight weeks (in addition to the full-day MBSR retreat and an orientation class)…

That amount of contact would weed out the more severe who might have been captured by the SSS-8 in greater numbers, leaving those who scored higher on the SSS-8 due to higher distress overrepresented. (Relevant to our chat above, @forestglip!)

Note weeks 1-4 are components I-III. The last 9 weeks are mindfulness-based stress reduction:

Component I: Psychophysiologic Education

The goal of this component is to help participants recognize that their symptoms are part of a psychophysiologic process instead of arising solely from a physical etiology. Recognition of the psychophysiologic process is accomplished through education on the relationship between the mind and body, exploration of participants' pain and symptom history, and identifying “inconsistencies” in the experience of symptoms or pain (such as variation in symptom location or triggers). Understanding the relationship between psychological stressors and symptomatology is emphasized throughout the intervention. By identifying patterns of increased stress exacerbating symptoms, participants are able to appreciate the contribution of underlying stressors to their conditions. For example, one participant had pain when walking upstairs while at work but recognized (upon reflection during the course) that he did not have pain when walking up even more stairs when on a vacation…

Component II: Desensitization (including visualization) and returning to physical activity

Conditioned responses of pain and/or symptoms, perpetuated by psychological underpinnings, can arise after physical triggers and remain after the initial trigger subsides. Similar to the classical conditioning model, a neutral stimulus can become a symptom-inducing trigger when coupled with a pain/symptom-inducing stimulus...For example, muscle tension previously arising from pain may become associated with neutral stimuli like sitting or walking leading to fear, avoidance behavior, and restriction. As a result, a key portion of our intervention is “desensitization”; these techniques are aimed towards breaking the cycle of pain/symptoms and decoupling the fear of symptoms with the neutral stimuli.

Visual motor imagery (visualization of a symptom-inducing situation) is a desensitization technique where participants are asked to visualize a movement or action that typically induces symptoms. This visualization often brings on symptoms. When visualization induces symptoms, the notion that symptoms or pain are a result of a psychophysiologic process is reinforced. Participants are encouraged to repeatedly visualize movements or actions, without physically moving, while also engaging in self-soothing behavior like affirmational statements. This repetitive exposure to visualization-induced symptoms ultimately reduces symptoms until participants are no longer able to experience symptoms through visualization. At this point, when symptoms are no longer evoked from visualization, participants may begin to incorporate the movements or actions that they had visualized as inducing symptoms...

Another crucial component of desensitization is identifying the movements, actions or environments in a participant’s daily life that have been conditioned to induce symptoms or pain. For example, if sitting triggered symptoms, participants would sit and repeat the knowledge that their symptoms arising from sitting is conditioned instead of a response to a physical issue. With repeated exposure and practice, the neutral stimuli and pain/symptom response are decoupled or deconditioned and symptoms subside. Participants are then able to incorporate tasks and activities that they previously avoided. Through a successful return to daily life and activities, the “knowledge therapy” component of PSRT is reinforced as participants recognize that their symptoms do not arise from physical triggers but psychological ones. Participants can then safely return to activities under the supervision of a physician (example below)…

One participant was having pain in their hand and wrist while journaling about a stressful situation. The journal exercises were then intentionally changed to be about a joyful experience. Upon completing the exercise, the participant recognized that the pain did not come on while writing about a joyful experience…

Component III: Emotional expression - psychology of the syndrome

This emotional expression component of the treatment occurs in conjunction with the education and desensitization components. In 1959, the idea that chronic pain or chronic physical symptoms may be precipitated and perpetuated by avoided emotions and negative thought processes (e.g., anger that participants do not acknowledge or address) was described (4). Such ideas about emotions and physical symptoms have been supported by recent research (5–10). Treating a psychophysiologic disorder requires appreciation of factors that exacerbate chronic symptoms such as conflict and emotional avoidance, as well as incorporation of emotional expression strategies. Activities aimed at improving emotional expression, like writing exercises, journaling and self-reflection, give participants an opportunity to express avoided emotions which have previously exacerbated symptoms (11)…Journaling is performed both during the sessions and as a home practice and includes free writing, cluster writing, writing a compassionate letter to oneself, forgiveness of self or others, dialogues, or an unsent letter.16…Participants are also introduced to writing dialogues (writing as if they are two people interacting about a specific situation), and to writing an "unsent letter" where they write an expressive letter to a significant person (without actually sending the letter)…

Component IV: Stress reduction - Mindfulness Based Stress Reduction (MBSR)

The last nine weeks of the intervention are oriented towards developing techniques for stress reduction while continuing to practice what has been learned in the earlier weeks of the treatment. The knowledge gained in the earlier weeks along with the improvement of activities and symptoms allows for the optimal environment for this portion of the program...