A thesis of clinical research and practice: Part A: [Psychological Associations with Long Covid]; Part B: [Long Covid: Finding Resolution in a Dichotomised World]; Part C: Summary of clinical practice and assessments
Creators: name: Petker, Saara
Publisher: name: University of Surrey
Year: 2023

description: A significant proportion of the population that have previously contracted the Covid-19 virus have gone on to develop long lasting symptoms known as Long Covid. Despite its prevalence, Long Covid remains a poorly understood medical condition. Existing research has portrayed the role of psychological processes in similar medically unexplained illnesses such as chronic fatigue and pain. Therefore, this thesis aimed to explore the psychological component of Long Covid, specifically understanding the role of psychology in the onset and experience of Long Covid. <br>
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description: Part one of this portfolio presents an empirical paper investigating psychological risk factors for Long Covid using quantitative measures. The study was initially designed to gather cross-sectional and longitudinal data; however, due to ethical issues only the cross-sectional component was completed. The study received criticism from potential participants regarding its psychological outlook on Long Covid. This ultimately led to the discontinuation of the study, resulting in a significantly smaller sample size than planned (n=95) and no longitudinal component. The findings showed no significant associations between psychological factors and Long Covid. The null findings were likely impacted by the cross-sectional methodology and small sample size. <br>
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description: Part two of this portfolio presents a second empirical paper which qualitatively investigates the role of psychological processes in the lived experience of Long Covid. Due to the response to the first study, this paper additionally explores patients’ own beliefs about psychology’s role in their condition. The findings reveal themes of fear relating to the uncertainty of Long Covid, feeling disbelieved, and searching for a cause. They additionally suggest that while Long Covid patients reject claims that psychology plays a causal role in their illness, many recognise that the course of illness is impacted by psychological processes. <br>
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description: <b>Part A: First Empirical Paper</b><br>
description: Psychological Associations with Long Covid<br>
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description: <b>Background:</b> A significant proportion of the population that have previously contracted Covid-19
description: have developed long lasting symptoms. This has become known as Long Covid. Biomedical
description: research has speculated at the various biological mechanisms underpinning the condition, but
description: these hypotheses remain inconclusive and are yet to provide an evidence-base for standardised
description: treatment. Evolving research has consequently adopted a more holistic biopsychosocial approach
description: to understand Long Covid. Psychological models of health have illustrated how the way in which
description: a person appraises their illness or feels socially supported during their illness can impact health
description: outcomes. The present study therefore aimed to address a gap in the literature by exploring
description: whether there is an association between psychological processes (such as illness appraisal) and
description: the presence of long Covid.<br>
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description: <b>Objective:</b> To explore the association between psychological processes, such as how an
description: individual makes sense of and feels socially supported during their Covid-19 illness, and the
description: presence of Long Covid.<br>
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description: <b>Design:</b> The study initially involved both a cross-sectional and longitudinal design and collected
description: data quantitatively using an online questionnaire. Due to ethical concerns however, only the
description: cross-sectional component was completed.<br>
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description: <b>Participants:</b> 95 UK-based participants consisting of 26 males and 69 females completed the
description: questionnaire. Of these, 28 participants had not previously contracted Covid-19 (control group),
description: 18 previously had Covid-19 acutely and recovered within 4 weeks, and 49 participants had
description: Covid-19 and went onto develop Long Covid (symptoms lasting longer than 4 weeks after the
description: acute Covid-19 infection).<br>
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description: <b>Measures:</b> Participants completed measures of clinical and personal demographics, health
description: anxiety, fear of Covid-19, coping style, illness representation, social support, and perceived
description: loneliness during acute Covid-19.<br>
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description: <b>Results:</b> The Long Covid group were significantly older than the ‘no Covid’ and ‘acute Covid
description: only’ groups. Participants with Long Covid reported on average more severe symptoms of
description: breathlessness and sleep problems during their acute illness than those in the acute Covid group.
description: No statistically significant differences were found in measures of fear of Covid-19, health
description: anxiety, illness representation, coping style, social support, or perceived loneliness between the
description: acute Covid and Long Covid groups.<br>
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description: <b>Conclusions:</b> Psychological processes such as how individuals make sense of and feel socially
description: supported during were not significantly associated with Long Covid, except for of fear of Covid-19
description: which appeared to be linked to Long Covid. However, the methodology used in the present study
description: limits the causal references that can be drawn from the findings. Future research should
description: adopt prospective longitudinal methods and explore psychological mechanisms which may
description: influence the development and persistence of Long Covid.<br>
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description: <b>Part B: Second Empirical Paper</b><br>
description: Long Covid: Finding Resolution in a Dichotomised World<br>
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description: <b>Background:</b> It is estimated that Long Covid currently affects the lives of two million people in
description: the UK, yet it remains a poorly understood condition. A rapidly evolving body of research has
description: started to explore the subjective patient lived experience of Long Covid to improve
description: understandings of Long Covid’s course. While there is a growing emphasis on the
description: biopsychosocial framework for understanding the condition, little qualitative research has
description: focused on the role of psychological processes in the lived experience of Long Covid.
description: Importantly, Long Covid patients have expressed strong negative responses towards
description: consideration of the psychological components of their condition. This raises questions around
description: the beliefs held by Long Covid patients about psychology’s role in their condition, and in turn,
description: how likely they are to utilise psychological input.<br>
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description: <b>Objective:</b> To explore the role of psychological processes in the lived experience of Long Covid
description: with an emphasis on patients’ own beliefs about psychology’s role in their condition.
description: Method: Qualitative data was collected from 14 UK-based participants with either self-reported
description: or formally diagnosed Long Covid using semi-structured interviews. Data was analysed using
description: reflexive thematic analysis.<br>
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description: <b>Analysis:</b> Three main themes were generated: “Living in uncertainty’, ‘Why should I trust you if
description: you don’t believe me?’, and ‘Once I know the cause people will believe me’. Transcending these
description: themes was a tension between the professional experts of Long Covid and the experts by lived
description: experience of the condition, and a consequent dichotomy between the psychological and medical
description: explanations of Long Covid. Overarching these themes was the resolution of this dichotomy
description: through an acceptance of the synthesis of the biological and psychological components of Long
description: Covid.<br>
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description: <b>Conclusions:</b> Overall, the experience of Long Covid was characterised by uncertainty,
description: particularly regarding cause and treatment, and feeling disbelieved by medical professionals
description: which motivated patients to focus their attention on proving the biological cause of their
description: condition. This in turn seemed to lead to an initial rejection of a psychological component of
description: Long Covid and intensified the perceived dichotomy between medical and psychological
description: understandings of the condition. For some, however, this dichotomy was overcome by a need for
description: cognitive coherence and a recognition of the synthesis of medical and psychological factors in
description: Long Covid. The findings implied that while Long Covid patients reject claims that psychology
description: plays a causal role in their illness, many recognise that the course of illness is impacted by
description: psychological processes. The findings provide implications for practice and future research. <br>