Felton Lily, Kalfas Michail, Brewin Debbie, Beckwith Carole, Khan Tasbiha, Jolley Caroline, Hart Nicholas, Duncan Emma L, Nicholson Timothy, Witard Oliver, Moore Julie, Metcalfe Alan, Rafferty Gerrard F, Chalder Trudie
Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Centre for Human and Applied Physiological Sciences, King's College London, Faculty of Life Sciences & Medicine, London, UK.
Health Expect. 2025 Jun;28(3):e70320. doi: 10.1111/hex.70320.
Some people experience persistent symptoms, such as fatigue, brain fog and breathlessness, long after the onset of COVID-19 infection. This is known as the post-COVID syndrome (PCS). We developed a unique and holistic psycho-physiological intervention that integrates Acceptance and Commitment Therapy (ACT), a structured talking therapy, with principles of homeostasis. This aims to provide targeted support and treatment strategies for effectively managing the long-term repercussions of the condition and improve patient outcomes.
This empirical study was informed by theory and other research strands. These strands included a qualitative study of people with lived experience, a scoping review of interventions for fatigue (including rehabilitation) and insights from a patient and public involvement (PPI) group. The PPI group were actively involved in the development of the intervention, manuals and overall study management, ensuring it was relevant, ethical and aligned with patient preferences and needs.
The qualitative study uncovered the tangible contexts in which the intervention would be implemented, and the attraction of Balance-ACT for those living with PCS. People living with PCS (n = 19) and health care professionals (HCPs; n = 12) provided overall endorsement for the intervention. Through an iterative process, their feedback, alongside input from the PPI group, informed the development of key materials, including a therapist manual, participant handbook, mindfulness recordings and an animation. Therapists were trained, and a novel fidelity measure was developed to ensure adherence to Balance-ACT principles.
We used an iterative approach to develop the Balance-ACT intervention, which was acceptable to patients and HCPs. Subsequent research will examine the efficacy of Balance-ACT.
This article represents work conducted as part of the Balance-ACT project. People with the post-COVID condition (PCC) were involved throughout all aspects of this study, in line with the National Institute for Health and Care Research framework, and contributed in several key ways. It ensured the research captured a diverse range of illness experiences. The study design was refined and addressed potential barriers to engagement. Patient-friendly language was used to improve accessibility, making the study more inclusive. Additionally, the outcome measures were informed by patient input to enhance their relevance. Finally, dissemination was guided to ensure that the findings were both useful and accessible, using clear language in reporting and incorporating feedback from patient representatives on drafts to ensure clarity. C.B. recorded the mindfulness exercises and was a core part of the management team throughout.
一些人在感染新冠病毒后很长时间仍会出现持续症状，如疲劳、脑雾和呼吸急促。这被称为新冠后综合征（PCS）。我们开发了一种独特的整体心理生理干预方法，将接纳与承诺疗法（ACT）（一种结构化的谈话疗法）与内稳态原则相结合。其目的是提供有针对性的支持和治疗策略，以有效管理该病症的长期影响并改善患者预后。
本实证研究以理论和其他研究线索为依据。这些线索包括对有实际经历者的定性研究、对疲劳干预措施（包括康复治疗）的范围综述以及患者和公众参与（PPI）小组的见解。PPI小组积极参与干预措施、手册的制定以及整体研究管理，确保其具有相关性、符合伦理道德且与患者偏好和需求一致。
定性研究揭示了干预措施实施的具体背景，以及平衡ACT疗法对PCS患者的吸引力。PCS患者（n = 19）和医疗保健专业人员（HCPs；n = 12）对该干预措施给予了总体认可。通过反复迭代过程，他们的反馈以及PPI小组的意见为关键材料的开发提供了信息，包括治疗师手册、参与者手册、正念录音和一部动画。对治疗师进行了培训，并开发了一种新颖的保真度测量方法以确保遵循平衡ACT原则。
我们采用反复迭代的方法开发了平衡ACT干预措施，该措施为患者和医疗保健专业人员所接受。后续研究将检验平衡ACT的疗效。
本文介绍了作为平衡ACT项目一部分开展的工作。新冠后病症（PCC）患者按照英国国家卫生与保健研究院框架参与了本研究的各个方面，并在几个关键方面做出了贡献。这确保了研究涵盖了各种疾病经历。研究设计得到完善并解决了参与的潜在障碍。使用了便于患者理解的语言以提高可及性，使研究更具包容性。此外，结局指标参考了患者的意见以增强其相关性。最后，在传播过程中进行引导，确保研究结果既有用又易于获取，在报告中使用清晰的语言，并纳入患者代表对草稿的反馈以确保清晰度。C.B.录制了正念练习内容，并且始终是管理团队核心成员。
