Nico: Narrative Intervention for Long COVID Pilot Feasibility and Acceptability Study

Background and Purpose: People living with Long COVID frequently experience high symptom burden and trouble with activities of daily living (ADLs). COVID impacted not only those people living with Long COVID but also put further stress on the mental health system in the US. This study aimed to establish the acceptability and feasibility of an asynchronous narrative intervention for people living with Long COVID.

Methods: People self-reported as living with Long COVID were recruited through social media ads and posts. Measures were administered at both baseline and the study intervention conclusion at three months by sending email links. In addition, program experience and satisfaction semi-structured interviews were conducted with participants who completed the intervention portion of the study. Results were analyzed using content analysis and thematic inquiry for patterns of experience utilizing a team consensus approach.

Results: Sixteen study participants enrolled, while eleven completed the intervention and participated in the semi-structured satisfaction interviews for a completion rate of 69%. All participants reported being satisfied with the program and felt it was helpful. Multiple participants reported that they enjoyed that the program was asynchronous and by email because it gave them the flexibility to engage with the program when they had time. They also reported that they enjoyed referring back to initial emails and conversations whenever they wanted. One participant suggested trying a video first session to establish rapport. Another participant requested additional time to engage with the therapist and write more about her experience. These results suggest that the NICO intervention is feasible and acceptable for people living with symptomatic burdensome chronic illnesses. Anxiety and depression both improved for participants in the intervention arm. At baseline, GAD averaged 9.6, indicating mild to moderate anxiety (range: 0-19); at three months, GAD scores improved to 4.1 on average, indicating minimal anxiety (range 0-16). PHQ scores at baseline were 9.3 on average which means the higher level of mild depressive symptoms (range 0-17), and 5.5 on average at three months, which indicates the lower end of mild depressive symptoms (range 0-21).

Conclusions and Implications: The NICO research study provides evidence to support the feasibility and acceptability of an asynchronous narrative intervention for people living with chronic illnesses like Long COVID. Since many chronic illnesses impact a person’s ability to engage with traditional in-person talk therapy and the limited availability of mental health professionals, finding flexible mental health intervention delivery options will be essential to helping the increasing numbers of people living with chronic illnesses. Additional research is needed to refine and implement the NICO intervention to help the many people living with Long COVID.