Psychiatric and psychotherapeutic recommendations for long/post-COVID and ME/CFS: a narrative review of international guidelines 2026 Kaya et al

[Andy]

Background: Long/post-COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are often accompanied by fatigue, cognitive impairments and psychological symptoms. Psychiatric and psychotherapeutic care is challenged by unclear evidence, symptomatic overlaps, and controversial treatment recommendations.

Objective: Presentation and comparison of psychiatric and psychotherapeutic recommendations in relevant international and national guidelines on long/post-COVID and ME/CFS, focusing on psychotherapy and psychopharmacotherapy.

Methods: A narrative review was conducted. National and international guidelines focusing on ME/CFS and long/post-COVID published between 2020 and 2025, particularly by the WHO, AWMF, NICE, CDC and IQWiG, were included. The selected guidelines were analyzed in terms of key aspects.

Results: Psychiatric pharmacotherapy is recommended only for comorbid disorders. Psychotherapeutic interventions are mostly recommended as supportive in the guidelines. Activating treatment approaches, such as graded exercise therapy (GET) are generally viewed critically in connection with postexertional malaise (PEM), whereas for patients without PEM, several guidelines explicitly endorse moderate, individually adapted activation. Pacing strategies are highlighted across guidelines as a central concept of activity management.

Discussion: Psychiatric and psychotherapeutic interventions in long/post-COVID and ME/CFS are supportive but not causal treatments. Guidelines recommend symptom-oriented, individualized therapeutic approaches as well as an integrative consideration of somatic, social and psychological factors in the sense of the biopsychosocial model. There is a high need for specific research on psychotherapeutic intervention forms in these patient groups.

Open access (in German)

 

[Utsikt]

Guidelines recommend symptom-oriented, individualized therapeutic approaches as well as an integrative consideration of somatic, social and psychological factors in the sense of the biopsychosocial model.

It seems like they read the guidelines but didn’t understand the processes that created them. There is no evidence that ME/CFS should be managed biopsychosocially.

There is a high need for specific research on psychotherapeutic intervention forms in these patient groups.

We’ve already done that. If you bothered reading the research you would have known it failed every single time, or was of so low quality that it’s useless.

 

[Sean]

Two steps forward, one step back.

They are slowly coming around, but it is going to be a tortuous, prolonged, and probably only ever partial admission and acceptance on their part.

 

[bobbler]

Two steps forward, one step back.

They are slowly coming around, but it is going to be a tortuous, prolonged, and probably only ever partial admission and acceptance on their part.

Nah I can’t be sure uts a step forward re the psych ideas…. it’s the perpetuates symptoms even if it’s not the initial cause stuff isn’t it? Ie not supportive in the sense of ‘we know what you are going through so you want to talk about the frustrations or deal with grief or whatnot’

But a believe you might feel less pain if you think about it less type ‘supportive’ still sliding under that parsing of the term?

And they only use the line about ‘wasn’t original cause’ to reduce the weight of proof that would be required from them that they think ‘just inferring it’s the cause but using the term perpetuate’ gives them as wiggle room?

 

[Chandelier]

Letter to the editor by Mirja Nicolas, Hermisson, Büchner et al.:

Recognizing Bodily Experience, Resisting Psychosomatic Reductionism, 2026, Nicolas et al

Spoiler: Authors

Nicolas, Mirja; Schneider, Diana; Fritz, Fabian; Hermisson, Sabine; Büchner, Ronja; Matthies-Boon, Vivienne

Spoiler: Excerpt in German

Körperlichkeit anerkennen, psychosomatische Verkürzungen zurückweisen
…
Dies wird seit Jahren kritisiert; es psychologi- siert und marginalisiert die Biologie der Er- krankungen, führt zu körperlichen Schädi- gungen und schiebt die Verantwortung für Krankheit den Betroffenen zu [1-3]. Dabei ist zu berücksichtigen: Leitlinien entstehen bisher nicht regelgerecht mit ausreichen- der Partizipation von Betroffenen. In der Folge perpetuieren sie oft einen Diskussi- onsstand, der hinter der Kritik amibiopsy- chosozialen Modell" zurückbleibt. ME/CFS und Long COVID verdeutlichen daher die
Notwendigkeit partizipativer Medizin. Der Empfehlung von Kaya et al., neuro- psychologische „Modelle" stärker in Leitli- nien zu berücksichtigen, können wir nicht folgen. Die Originalquelle formuliert An- nahmen hypothetisch. Evidenz wird nicht ausgewiesen, weshalb die Ableitung ei-
ner stärkeren Leitlinienberücksichtigung - auch aufgrund fehlender Abgrenzung gegenüber anderen Erklärungen - einen rein normativen Schritt darstellt. Wir kri- tisieren das „Osloer Modell" (2023) zu- dem, weil es veralteten kognitiv-behavi- oralen Hypothesen entspricht. Es postu- liert, Symptome persistierten aufgrund ei-
ner dysregulierten zentralnervösen

Excerpt OCRed from a photo:

This has been criticized for years: it psychologizes and marginalizes the biological basis of these illnesses, causes physical harm, and shifts responsibility for illness onto those affected [1–3]. It is important to bear in mind that, to date, clinical guidelines have not been developed in accordance with established standards and with sufficient participation by patients and other affected individuals. As a result, they often perpetuate a state of debate that lags behind the criticism of the biopsychosocial model.

ME/CFS and Long COVID therefore highlight the need for participatory medicine. We cannot endorse Kaya et al.’s recommendation that “neuropsychological models” be given greater consideration in clinical guidelines. The original source formulates its assumptions hypothetically. Since no evidence is presented, deriving a stronger recommendation for their inclusion in clinical guidelines—also in the absence of any clear differentiation from other explanatory approaches—constitutes a purely normative step.

We also criticize the “Oslo Model” (2023) because it reflects outdated cognitive-behavioral hypotheses. It postulates that symptoms persist because of a dysregulated central nervous—

Web | DOI | PDF | Der Nervenarzt | Paywall

 

[Chandelier]

Excerpt OCRed from a photo:

From a new photo:

---

...the muscular changes seen in Long COVID with post-exertional malaise (PEM) can be distinguished from the consequences of strict bed rest [4].​

​

In the interest of the patients’ mental health, we call for their physical experiences to be validated unequivocally and for their autonomy to be respected. Those affected must decide for themselves whether they wish to accept psychotherapeutic support.​

​

Such support should not be understood in the traditionally “biopsychosocial” sense, but rather as accompaniment on an equal footing. Finally, we emphasize that criticism of psychosomatic approaches does not stigmatize them; rather, it is part of any scientific discourse that seeks to ensure appropriate medical care.​

​

​

Spoiler: German Original Text

sich muskuläre Veränderungen bei Long COVID mit PEM von den Folgen strikter
Bettruhe unterscheiden [4]. Wir fordern im Sinne der psychischen Gesundheit der Erkrankten, ihre Kör- oerlichkeit kompromisslos zu validieren und Selbstbestimmung zu achten. Be- troffene müssen selbst entscheiden, ob sie ein psychotherapeutisches Angebot wahrnehmen. Ein solches ist nicht als traditionell „biopsychosozial" zu sehen, sondern als Begleitung auf Augenhöhe Abschließend betonen wir, dass Kri- tik an psychosomatischen Ansätzen die- se nicht stigmatisiert, sondern Bestandteil jedes wissenschaftlichen Diskurses ist, der das Ziel einer adäquaten medizinischen
Versorgung verfolgt.

---