Psychological Interventions on the Front Lines: A Roadmap for the Development of a Behavioral Treatment Program to Mitigate the Mental Health Burden Faced by COVID-19 Survivors

Survivors of prolonged hospitalization due to coronavirus disease 2019 (COVID-19) are at risk for psychiatric symptoms that can interfere with rehabilitation and functional outcomes. We developed an inpatient and outpatient behavioral treatment program for COVID-19 patients. We describe the constellation of emotional symptoms we observed, the evolution of symptom presentation from the inpatient to the outpatient setting, and outline the challenges we faced and lessons we learned as we implemented cognitive-behavioral interventions to enhance functioning and decrease symptom burden. We highlight modifications to therapeutic techniques that we made for this population and discuss cultural considerations in our diverse patient population. Initial outcome data indicate that approximately two thirds of patients (66% in the inpatient setting, 65% in the outpatient setting) are discharged from our program without further psychiatric care. As the COVID-19 pandemic continues to intensify and reports of "long-haul" symptoms accumulate among survivors, behavioral interventions to address psychiatric sequelae are paramount. Our approach and experience from the first wave of the pandemic has the potential to inform the development of behavioral treatment programs to mitigate psychiatric symptoms in this vulnerable population, as well as the response of mental health providers to future pandemics and public health emergencies. Public Significance Statement Coronavirus disease 2019 (COVID-19) survivors are at high risk of psychiatric illness and often experience anxiety, isolation, demoralization, and guilt in the context of a sudden change in physical functioning and social/occupational roles, medical complications, and environmental stressors. We developed an inpatient and outpatient behavioral treatment program after which approximately two thirds of COVID-19 survivors did not require further psychiatric care. By noting some of the challenges we faced and by implementing cognitive-behavioral and mindfulness interventions, clinicians may be able to address the emotional needs of individuals recovering from COVID-19. Our approach may also inform how psychologists respond to future pandemics and public health emergencies.