Thesis Psychological support for post-viral fatigue: evidence from a systematic review and lived experiences of Long COVID using interpretative phenomenologi

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Psychological support for post-viral fatigue: evidence from a systematic review and lived experiences of Long COVID using interpretative phenomenological analysis, a portfolio thesis

Post-viral fatigue syndromes (PVFS), including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long Covid, are persistent conditions associated with substantial functional impairment and no definitive treatments. Psychological support has been one area of interest, but its role...
era.ed.ac.uk era.ed.ac.uk

Psychological support for post-viral fatigue: evidence from a systematic review and lived experiences of Long COVID using interpretative phenomenological analysis, a portfolio thesis​


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ClarkA_2026.pdf (7.22 MB)
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Date

2026-05-26
Authors

Clark, Andrea


Abstract

Post-viral fatigue syndromes (PVFS), including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long Covid, are persistent conditions associated with substantial functional impairment and no definitive treatments.

Psychological support has been one area of interest, but its role has been debated, particularly in relation to Cognitive Behavioural Therapy (CBT).

This has led to growing interest in alternative approaches, such as ‘third-wave’ therapies.

However, the evidence base for these approaches in PVFS has not previously been systematically reviewed.

In addition, while psychological input is increasingly offered to people with Long Covid in the National Health Service (NHS), little is known about how such support is experienced by individuals with lived experience of PVFS.

This thesis therefore aimed to advance understanding of psychological approaches to PVFS by:
(1) systematically reviewing the evidence for third-wave therapies in this population
and
(2) qualitatively exploring how people with Long Covid experience one-to-one psychological or other mental health support within the NHS.

The systematic review identified ten eligible studies (two randomised controlled trials [RCTs], two quasi-experimental, four pre–post, two case series) investigating interventions including acceptance and commitment therapy (ACT), mindfulness-based cognitive therapy (MBCT), and mindfulness-based stress reduction (MBSR).

Findings indicated improvements in fatigue and quality of life in several studies, with large effect sizes in some studies and sustained gains at 3-12 month follow-up.

Anxiety outcomes improved across most studies, whereas evidence for depression and mindfulness were less consistent.

However, study quality was low to moderate, with small samples, heterogeneous designs and interventions, and limited fidelity checks, such as therapist competence.

The review concluded that third wave therapies show preliminary promise but require further high-quality investigation.

The empirical study adopted an Interpretative Phenomenological Analysis (IPA) approach to explore the lived experience of adults with Long Covid who had received one-to-one psychological or other mental health support.

Semi-structured interviews were conducted with eight participants with a diagnosis of Long Covid.

Analysis identified four themes.

The first, The Weight of Waiting, described the emotional distress during the waiting period for accessing support.

The second, Being Believed and Validated, captured the relief and significance of having symptoms acknowledged and taken seriously within therapeutic encounters.

The third, Therapeutic Fit, reflected the importance of relational connection, collaboration, and flexibility in shaping whether support felt helpful or misaligned.

The fourth, Grief, Adjustment and Acceptance, outlined how mental health support provided space to process losses associated with the impact of Long Covid on everyday life and to gradually adapt to life with ongoing symptoms.

Findings highlighted the importance of responsive, person-centred support for individuals with Long Covid.

Taken together, these studies contribute nuanced insights into the role of psychological support for individuals living with PVFS.

Findings provide a preliminary indication that acceptance- and mindfulness-based approaches may benefit this population, while the lived experience research underscores the need for person-centred psychological interventions that are collaborative, validating, and responsive to the challenges of living with Long Covid.

This thesis portfolio highlights the importance of integrating patient perspectives into service development and points toward clinical recommendations that prioritise evidence based, person-centred care.

URI

https://era.ed.ac.uk/handle/1842/44748
https://doi.org/10.7488/era/7263
This item appears in the following Collection(s)

Health in Social Science thesis collection
 
The framework they used to analyse the quality of the studies is beyond despair (EPHPP). This is how it instructs you to score the design:
Strong: will be assigned to those articles that described RCTs and CCTs.

Moderate: will be assigned to those that described a cohort analytic study, a case control study, a cohort design, or an interrupted time series.

Weak: will be assigned to those that used any other method or did not state the method used.
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Meaning that studies with no control group are rated as «moderate» quality. At least they punish studies for not describing the design.

This is how they rate outcome assessment:
Strong: The outcome assessor is not aware of the intervention status of participants (Q1 is 2); and the study participants are not aware of the research question (Q2 is 2).

Moderate: The outcome assessor is not aware of the intervention status of participants (Q1 is 2); or the study participants are not aware of the research question (Q2 is 2); or blinding is not described (Q1 is 3 and Q2 is 3).

Weak: The outcome assessor is aware of the intervention status of participants (Q1 is 1); and the study participants are aware of the research question (Q2 is 1).
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This means that if you have an unblinded study, and you withhold all information about blinding, then you get a better score than if you said outright that you didn’t blind anyone. They are rewarding being less open.

And they’ve somehow managed to rate Jonsjō’s uncontrolled feasibility pilot of ACT with only subjective outcomes (thread) as moderate for this category, which isn’t even right according to this seriously flawed tool because if there is only one group you are by definition aware of which group the participant belongs to.

Jonsjō was rated as moderate quality overall.

This has to be a joke. How can this be allowed to pass as a PhD?
 
The obvious answer is that if they assessed the quality of the studies properly, they would find that there is no evidence of efficacy whatsoever, and therefore there would be nothing to do interviews about, and no thesis. Or no psychology in general..
 
Utsikt said:
The obvious answer is that if they assessed the quality of the studies properly, they would find that there is no evidence of efficacy whatsoever, and therefore there would be nothing to do interviews about, and no thesis. Or no psychology in general..
Click to expand...
Well, you know... from a psychological point of view, if the studies are crap, by changing one's perspective they can become promising or good or an opportunity for growth :nerd:
 
Beneficial forms of psychological support:

People who mirror back to you that living with ME/CFS is crazy because of the fact that you live with a severe chronic illness that is still dismissed by large part of the medical establishment and society at large when you already got used to this, have learned to deal with it, and it has become normal for you.

Doctors who listen and prescribe off-label drugs that you feel help you after an anaylsis of the objective risks and potential benefits for your health (and not their reputation).

Doctors who acknowledge that you need help now and act on it and go with you to where it is uncomfortable instead of hiding behind the argument of non-existing guidelines to legitimize to do nothing and send you home.
 
Sean said:
Does this method work to get rich?
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It works by selling the method to people who will sell the method to people who will sell people the method to get rich. A reverse funnel of sorts!

What a bizarre premise, that the evidence base has not been reviewed yet. The are so many meta analyses of systematic reviews and it all goes back decades. And this preliminary work, which has had decades in literal application to hundreds of thousands of people, is promising. Well la-di-da professor Equipoise.

The most notable thing about this ideology is that it always starts with the premise that this already works and people would be stupid to say no to it. This is how it started, this is how it's still operating.

They call this evidence-based medicine, and will actually claim equipoise despite never even having considered the possibility that none of this will ever work, let alone more than enough evidence that it hasn't, in addition to being implausible anyway.
 
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