In the evolving landscape of Long COVID research, the idea that this complex, multi-system condition could be addressed through talking therapy or graded exercise alone is increasingly out of step with scientific evidence. While psychological support has its place, it is essential to acknowledge that Long COVID is not simply a matter of mindset or mental health. It is a biomedical condition, rooted in measurable physiological dysfunction, and deserves to be treated as such.
The Science of Long COVID: A Brief Overview
Long COVID is not a vague or subjective experience; it is associated with identifiable disruptions to multiple bodily systems:
Endothelial Dysfunction
Research shows that SARS-CoV-2 can damage the endothelial cells lining blood vessels, contributing to long-term vascular inflammation. This can manifest as chest pain, cognitive difficulties, and fatigue. Repairing damaged blood vessels is a medical challenge one that cannot be resolved through dialogue alone. Endothelial recovery requires targeted clinical intervention.
Mitochondrial Dysfunction
Mitochondria, the body’s energy producers, can become impaired in Long COVID. This is akin to running on faulty batteries. Cognitive reframing or motivational techniques cannot reverse mitochondrial damage; restoring energy function requires biomedical strategies.
Persistent Inflammation and Hypoxia
Ongoing low grade inflammation and oxygen deprivation are common in Long COVID patients, contributing to symptoms like fatigue, brain fog, and organ stress. Addressing these problems involves treating physiological inflammation not just providing psychological support.
Reactivated Viruses and Immune Dysregulation
Emerging evidence suggests that the virus may persist in reservoirs or reactivate dormant infections such as Epstein-Barr. Managing this involves immunological treatment, not conversation-based care.
Real-World Analogies: Let’s Be Clear
Would we suggest talking therapy to treat a blood clot? Or mindfulness to cure pericarditis? Of course not. And yet, Long COVID patients often face these kinds of oversimplified suggestions.
Suggesting that therapy alone can resolve Long COVID is akin to advising a stroke survivor to simply stay positive. It misses the mark and worse, risks trivialising a serious condition.
Where Talking Therapy Does Have a Role
To be clear: psychological support can be extremely valuable for many, it is vital. But its role is in helping people cope with the emotional trauma of prolonged illness, the disruption to daily life, and the frustration of not being believed.
Many with Long COVID have experienced gaslighting, misdiagnosis, and abandonment by systems ill equipped to help them. In this context, therapy can help process grief, anger, and isolation not cure the underlying disease, but support the person navigating its impacts.
Therapy, in this case, is not a treatment for the virus, but a tool for surviving the social and psychological fallout of being ill in a world that too often denies or diminishes their experience.
A Vital Distinction
It is critical to make a clear distinction: talking therapy may support someone living with Long COVID, but it does not treat Long COVID. It cannot reverse immune dysfunction, resolve inflammation, or eliminate viral persistence. Presenting it as a frontline treatment risks doing harm by delaying appropriate medical investigation and care.
We must also be careful not to let the availability of psychological services become a substitute for urgently needed biomedical support. Historically, when medicine lacks clear answers, it has often defaulted to psychosomatic explanations. While sometimes well intentioned, this tendency can undermine patients whose conditions are complex, under-researched, and misunderstood.
Kindness is essential. Empathy matters. But neither replaces rigorous medical treatment.
In Summary
Offer therapy but offer it for what it is: a valuable source of emotional support. Not a substitute for medical care. Not a cure for a biomedical crisis.
Disclaimer: This article is intended for informational purposes only and should not be interpreted as medical advice. Always consult a qualified healthcare professional regarding your individual circumstances.
Long Covid Journey 