Post-viral fatigue & Mental Health following COVID-19
“I’ve experienced periods of fatigue before but never anything that has felt so debilitating as this, or that has lasted as long.”
- A nursing assistant with post-viral fatigue after COVID-19
In this blog, we will be discussing the impact of post-viral fatigue on mental health. We draw on the experience of an NHS nursing assistant who contracted COVID-19 five months ago, and has since been on extended sick leave. We will be offering some coping strategies from our clinical perspective and share how this person has been learning to cope with her condition.
Fatigue following a viral infection can be completely debilitating and last for several months.
“Overwhelming fatigue and exhaustion in my brain have made trying to read or concentrate on anything for long feel impossible. Over the months since the acute infection, the fatigue has eased but has remained to varying degrees, sometimes more like the early days, sometimes quite a lot better. Times where I have felt more energy and then done more than I am used to have very often had a disproportionate effect and set me back at times quite a long way. I feel I am still trying to learn and find my way with what I am capable of doing.”
The impact of these symptoms can induce a huge degree of anxiety and stress.
“My life has changed a lot. I have not been able to return to work and have been spending much more time at home and resting and on my own than I used to. Perhaps one of the main ways it has changed is having to think really carefully about what I am able to do, only plan a few things in my week, and for my plans to be very provisional on how I feel. One of the other main things that has changed is not really feeling very able to plan for the future, such as continuing to follow the career change path I had been on before getting Covid.”
Other thoughts and concerns might proliferate such as:
How will the mortgage get paid if I can’t work?
What will my colleagues think of me I don’t return to work?
Will I ever get better?
I can’t manage without my usual coping strategies such as going for a bike ride.
My life feels over.
My family will run out of patience with me being unable to help around the house soon.
All these thoughts can trigger our nervous system to go into the ‘threat’ state, which produces adrenaline and cortisol, adding to a sense of exhaustion. Being in this threat state can make the primitive part of the hard-wiring in the brain believe there’s a real threat to life and activate the fight, flight, or freeze response (for more on this sign up to our free webinar on Balancing Activity, Rest and Sleep).
Low mood, frustration and depression are often part of the picture.
Concentration and memory can also be affected, which can impact performing tasks and pleasurable activities, such as reading.
“I still notice that my brain gets very tired - or perhaps more accurately, feels generally fatigued - and doing anything that involves concentration, such as reading or computer work or having long conversations - can leave my brain feeling very exhausted and I need to limit the amount of time that I try and do these activities for.”
What can I do to help manage my anxiety and fear?
There are lots of different techniques that can help:
Bringing awareness to unhelpful thoughts
Thoughts just happen and it’s impossible to stop them completely. However, it can really help just to bring more kindly attention to what is arising. Writing your thoughts out can help you to recognise, label and challenge unhelpful thinking patterns, and also creates a distance from more unhelpful thoughts. Our Psychologists use Cognitive Behavioural Therapy and Acceptance Commitment Therapy in our rehabilitation programmes to support people with examining and unsticking from unhelpful thought patterns. There are various tools available to support realising that thoughts are not substantial, true and fixed. Apps such as CBT Thought Diary provide template ‘Thought Diaries’ which can be useful in helping to identify unhelpful thoughts.
“One of the main things that helps is developing more acceptance of where I am and my current capacities and limitations because of the fatigue. Of course, this isn’t always easy, but to be more at peace with where I find myself is hugely helpful. I know that battling with myself or the reality of the situation is in itself exhausting.”
Begin to bring gentle acceptance to how things are right now
“I think acceptance of where I find myself is real support for my mental health. It really helps me not to fall into unhelpful mental states. However, accepting that I will be low or upset at times about my situation and my health is also important, allowing myself to have a cry or share with a friend how tough things might have been is really important. It is hard to live with ongoing fatigue and at times it has also felt important to be able to grieve the losses that it has brought me in my life.”
Set a worry time
We know that trying not to think about worries is likely to just make them worse. Dwelling on worries can be an issue especially in the morning on waking. Our clinicians support our clients with creating adaptive responses to stresses and challenges like setting 'a worry time.’ This is a scheduled time in the day when you will deliberately think about your worries. If a worrying thought pops into your mind, day or night, note it down, continue doing what you were doing and come back to it in your ‘worry time’.
Do enjoyable, simple things
When you feel particularly anxious, try distracting yourself by engaging in a pleasurable (non-achievement-aimed) activity or calling a friend. Being in nature can be a real tonic when feeling overwhelmed, by just opening the senses to what can be seen, felt and heard in any moment. Sitting by the window and looking up at the sky, for example, is one way to be in a supportive soothing state, which can be highly restorative.
“Perhaps the other main support for my mental wellbeing has been spending time in nature. In the earlier stages of being ill and at low energy times since, this might just have been lying on my bed looking out of my window at the clouds and sky and listening to birdsong. At other times depending on my energy it might have involved going for a short walk and lying on the earth (which I’ve done a lot!). I’ve always found connecting with nature hugely important for my wellbeing, something about opening out to something much bigger than me, feeling held by my interconnectedness with the web of life, and just the pure and simple beauty of a blue sky, or the leaves on a tree shimmering in the breeze, or a blackbird’s song without fail lift my heart.”
“Just relax!”
Relaxing is often easier said than done when you are feeling anxious, and different approaches work for different people. There are plenty of apps available online such as Insight Timer or Calm that provide tools to support switching our nervous system into a calming, soothing state. Mindfulness and meditation are also invaluable. A key thing to note is what’s happening with our breathing, as both an indicator and then an antidote to worry and anxiety. We recommend this video to do a self-assessment of breathing, or this one about good breathing, which emphasises diaphragmatic breathing.
Breathing for relaxation (from the NHS):
Place one had on your abdomen, level with your lowest ribs. Breathe in through your nose to the silent count of 4, allowing your abdomen to swell. Breathe out gently through your mouth to the silent count of 6, allowing the abdomen to return to normal. Count to 2 and inhale again.
Try to keep your shoulders relaxed so they don’t rise and fall in time with your breathing. This will help your lower lungs to expand more efficiently.
At first, this may feel uncomfortable and as though you are not getting enough air. However, with practice, this slower rate of breathing will feel more comfortable. Practice will also make you aware of what is your normal breathing rate. When you become anxious and start breathing faster, you will then be able to use the exercise to bring your breathing back under control.
Written by Katherine Sewell, Content Writer and with kind contributions from Sarah & Dr Helen Ayres, Specialist Clinical Psychologist
https://www.yourcovidrecovery.nhs.uk/managing-the-effects/effects-on-your-mind/managing-fear-and-anxiety/