Brett, Caroline

Revell, Emily R.

Clark, Andrea

2026-05-26T14:21:45Z

2026-05-26

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.

https://era.ed.ac.uk/handle/1842/44748

en

The University of Edinburgh

post-viral fatigue

chronic fatigue syndrome

myalgic encephalomyelitis

long covid

post-covid-19 syndrome

psychological interventions

systematic review

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

Thesis

Doctoral

DClinPsychol Doctorate in Clinical Psychology