Anxiety / somatization
Anxiety, health anxiety, or symptom amplification — real physiological effects that can mimic organic disease.
Anxiety — including health anxiety and somatic symptom amplification — produces real physiological symptoms (palpitations, chest tightness, breathlessness, dizziness) that overlap heavily with organic Long COVID and can amplify the perception of other symptoms. Roughly a third of emergency-room chest pain that looks cardiac is actually anxiety, which gives a sense of how large this overlap can be. Screening is cheap (GAD-7, PHQ-15), and CBT and meditation help. As with depression, this coexists with organic mechanisms rather than replacing them.
How it's tested
Anxiety screen (GAD-7 / PHQ-15)
Short validated questionnaires for anxiety and somatic symptom burden.
Treatment options & their evidence
Graded honestly — including treatments that failed in good trials, which is worth knowing.
Cognitive behavioral therapy (CBT)
Strong evidencepromise 3 · 2 RCTsThe best-evidenced behavioral option for fatigue/coping (e.g. the ReCOVer 'Fit after COVID' RCT). It targets perpetuating factors and does NOT assume a psychological cause; note it improves subjective fatigue more than objective activity or cognition.
Caution: Must not include graded-activity escalation where PEM is present, and must avoid 'dysfunctional beliefs' framing.
Mindfulness / meditation
Mixed evidencepromise 1.22 · 1 RCTAn MBSR RCT improved anxiety, depression, and stress (weaker effect on core fatigue/cognition). A useful low-risk adjunct for the mood/stress cluster.