Codeveloping a Novel Intervention for People With Post‐COVID Condition: The Balance‐ACT Study

ABSTRACT Introduction 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...

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Published inHealth expectations : an international journal of public participation in health care and health policy Vol. 28; no. 3; pp. e70320 - n/a
Main Authors 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
Format Journal Article
LanguageEnglish
Published England John Wiley & Sons, Inc 01.06.2025
John Wiley and Sons Inc
Wiley
Subjects
Online AccessGet full text
ISSN1369-6513
1369-7625
1369-7625
DOI10.1111/hex.70320

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Abstract ABSTRACT Introduction 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. Methods 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. Results 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. Conclusion 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. Patient and Public Contribution 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.
AbstractList ABSTRACT Introduction 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. Methods 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. Results 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. Conclusion 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. Patient and Public Contribution 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.
ABSTRACT Introduction 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. Methods 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. Results 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. Conclusion 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. Patient and Public Contribution 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.
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.INTRODUCTIONSome 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.METHODSThis 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.RESULTSThe 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.CONCLUSIONWe 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.PATIENT AND PUBLIC CONTRIBUTIONThis 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.
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.
Author Duncan, Emma L.
Chalder, Trudie
Khan, Tasbiha
Hart, Nicholas
Brewin, Debbie
Felton, Lily
Kalfas, Michail
Nicholson, Timothy
Metcalfe, Alan
Witard, Oliver
Rafferty, Gerrard F
Moore, Julie
Beckwith, Carole
Jolley, Caroline
AuthorAffiliation 3 Department of Respiratory Medicine King's College Hospital NHS Foundation Trust London UK
6 Department of Twin Research and Genetic Epidemiology King's College London London UK
8 School of Life Course & Population Sciences, King's College London, Guy's Campus London UK
4 Lane Fox Clinical Respiratory Physiology Research Centre London UK
1 Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
5 Lane Fox Respiratory Service London UK
7 Guy's & St Thomas's NHS Foundation Trust London UK
2 Centre for Human and Applied Physiological Sciences, King's College London Faculty of Life Sciences & Medicine London UK
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/40485127$$D View this record in MEDLINE/PubMed
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GrantInformation_xml – fundername: This research was funded Guy's and St Thomas' Charity (COV210803). T.C. is part‐funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at a UK NHS Foundation Trust and received additional COVID‐related grants from UKRI. E.L.D. has received funding for research into Long COVID from the Chronic Disease Research Foundation, specifically for the genetics of PCS/ongoing symptomatic COVID‐19. Has also received funding from the BMA Foundation and Guy's and St Thomas' Charity for Long COVID‐related research. C.J. has received funding from the BMA Foundation for research into Long COVID.
– fundername: This research was funded Guy's and St Thomas' Charity (COV210803). T.C. is part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at a UK NHS Foundation Trust and received additional COVID-related grants from UKRI. E.L.D. has received funding for research into Long COVID from the Chronic Disease Research Foundation, specifically for the genetics of PCS/ongoing symptomatic COVID-19. Has also received funding from the BMA Foundation and Guy's and St Thomas' Charity for Long COVID-related research. C.J. has received funding from the BMA Foundation for research into Long COVID.
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ISSN 1369-6513
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Thu Aug 21 18:25:18 EDT 2025
Fri Sep 05 15:55:33 EDT 2025
Mon Sep 08 14:02:51 EDT 2025
Thu Jun 12 01:53:13 EDT 2025
Tue Aug 05 12:02:05 EDT 2025
Fri Jun 27 10:01:07 EDT 2025
IsDoiOpenAccess true
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Issue 3
Keywords patient outcomes
post‐COVID condition
psychological intervention
Long COVID
acceptability
multidisciplinary care
Language English
License Attribution
2025 The Author(s). Health Expectations published by John Wiley & Sons Ltd.
This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Snippet ABSTRACT Introduction Some people experience persistent symptoms, such as fatigue, brain fog and breathlessness, long after the onset of COVID‐19 infection....
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...
ABSTRACT Introduction Some people experience persistent symptoms, such as fatigue, brain fog and breathlessness, long after the onset of COVID‐19 infection....
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SubjectTerms acceptability
Acceptance and commitment therapy
Acceptance and Commitment Therapy - methods
Access
Accessibility
Adult
Animation
Brain research
Breathlessness
Chronic illnesses
Citizen participation
Clinical outcomes
COVID-19
COVID-19 - complications
COVID-19 - psychology
Dissemination
Drafts
Efficacy
Fatigue
Fatigue - etiology
Fatigue - therapy
Feedback
Female
Fidelity
Flexibility
Fog
Health care
Homeostasis
Humans
Infections
Intervention
Long COVID
Male
Medical personnel
Middle Aged
Mindfulness
multidisciplinary care
Original
patient outcomes
Patients
Physiology
Post-Acute COVID-19 Syndrome
post‐COVID condition
psychological intervention
Psychotherapy
Public involvement
Qualitative Research
Rehabilitation
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Title Codeveloping a Novel Intervention for People With Post‐COVID Condition: The Balance‐ACT Study
URI https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fhex.70320
https://www.ncbi.nlm.nih.gov/pubmed/40485127
https://www.proquest.com/docview/3224392446
https://www.proquest.com/docview/3216916604
https://pubmed.ncbi.nlm.nih.gov/PMC12146418
https://doaj.org/article/374bcd5b00954770b5ec148dcf847ae4
Volume 28
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