Discussion
fatigue, traumatic brain injury, cognitive disorders, anxiety, depression, cognitive difficulties, post-traumatic symptoms, cognitive deficits, cognitive impairments, cognitive complaints, neurological complaints, disability
This randomized controlled trial with minimization aims to test the effectiveness of two approaches commonly proposed to people with cognitive complaints on patients with long covid. Because of the impact of cognitive disorders on functional disability and long-term quality of life, such clinical trials seem essential to target the type of intervention that can be proposed to reduce post-COVID cognitive disorders and their impact on daily life (subjective perception of difficulties and quality of life). This is especially true given the unknown outcome of long-term cognitive deficits in that population.The cognitive approach aims at a better understanding of cognitive impairments and the adoption of adequate strategies to manage them. The approach targets difficulties frequently reported in patients with COVID (sleep and fatigue, attention and concentration, memory, and organization) with several modules whose dosage is adapted to the person's difficulties. The intervention is based on a biopsychosocial model (i.e., an integrative approach taking into account cognitive, contextual and psychological factors) and therefore also aims to reassure, reduce some misconceptions and negative interpretation bias of difficulties. This psychoeducational approach is different from restorative cognitive intervention which aims to improve cognitive performance itself. This type of high-dose intervention requires several dozen sessions with specific exercises to train deficient cognitive process [In the context of mild traumatic brain injury (mTBI), persistent cognitive difficulties can be addressed through this type of cognitive psychoeducation. However, some psychoeducational programs focus less on cognitive difficulties per se and more on managing the negative emotions associated with cognitive difficulties and other post-traumatic symptoms [In this context of a potential dissociation between the evolution of complaints and objective difficulties, a CBT type approach also seems appropriate. Therefore, the cognitive intervention is here compared to another potentially effective intervention focused on the management of emotions. It will aim at helping patient to better recognize their emotions, to determine how to react to them, by giving them the tools to better manage their post-COVID anxiety and stress. Patients will also be brought to become aware of their values and to develop his/her motivation to change. Finally, patients will also be made aware of interpretation biases and negative adaptive behavior (e.g., avoidance of problem situations).It is reasonable to think that the effect on cognitive functioning of an intervention targeting affective dimensions (anxiety, depression, motivation, etc.) will be lower than an intervention more specifically targeting cognitive dimensions. However, this prediction has to be taken with caution. No study at this time assessed which of the two interventions has the larger effect in long covid patients or in other neurological population. Furthermore, studies testing the effectiveness of a CBT approach used very general scales measuring the set of persistent post-concussion symptoms after mTBI. They do not specifically include measures of cognitive complaints. There is evidence in studies that this type of intervention results in moderate changes in quality of life, with small effects on functioning in daily life and neurological complaints [To the best of our knowledge, there is no clinical trial dealing with these cognitive difficulties in long COVID. Therefore, there is no data to suggest which strategy would help these patients.