Background: Patients with COVID-19 infection are vulnerable to many varied long-term effects that can negatively impact health and overall well-being.1,2 Group psychotherapies have successfully been applied in various medical illnesses that impose financial, social, and psychological burden.3 Current literature does not describe a group psychotherapy approach for patients with post-acute sequelae of COVID-19 (PASC). Here, we present a group therapy aiming to assist patients in processing psychological correlates of PASC as an adjunct to their medical care.
Case: We developed a weekly open-structured online group therapy facilitated by two resident psychiatrists utilizing supportive techniques. Inclusion criteria were patients with a medium-high psychosocial baseline who were negatively impacted by documented or suspected COVID-19 infection and suffering psychological stress. Participants were recruited via hospital referral networks and included following a phone call screening with one of the therapists. Group therapy focused on several predominant themes in the PASC recovery process.
Discussion: The group identity was shaped by a common experience of poorly understood COVID-19 complications and long-term effects impacting physical and psychosocial function. Due to alienation in the form of invalidation and lack of understanding in the medical community, the group’s shared suffering created a secure environment for catharsis. The therapeutic themes consisted of envy of those with mild or asymptomatic COVID-19 recovery, disruption of attachments, identity diffusion as it relates to chronic illness, lack of faith in conventional medicine, information sharing of possible treatments, coping with uncertainty, and hope in the face of suffering. Participants demonstrated a wide range of psychological responses akin to grief4, formulated as the process of grieving their prior healthy selves. The large range of the participants’ type and severity of affected functioning was harnessed by the group facilitators as a way to explore transference reactions. Common reasons for dropout were financial burden, poor distress tolerance, and progression in achieving goals of adaptation and identity consolidation. Participants with greater impact on daily functioning, difficulty adapting to loss of function, and ongoing identity diffusion were interpreted to likely benefit from ongoing group therapy. Overall, patients reported significant subjective benefit from the sense of belonging and acceptance and the opportunity for accountability to the group.
Conclusion: Patients with PASC experience psychological challenges that may be mitigated by group psychotherapy. Further research is needed to evaluate the impact this intervention may have on psychological endpoints.
Karanbir Padda, MD– Psychiatry Resident, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, United States
Yochai Re'em, MD– Psychiatry Resident, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, United States
Debra Faecher, LCSW-R– Licenced Clinical Social Worker, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, United States