Constraint-Induced Cognitive Therapy Found to Improve Multiple Long COVID Symptoms

Constraint-induced cognitive therapy (CICT), which combines behavior change techniques with speed of processing training, was found to improve brain fog and other symptoms associated with long COVID while allowing many afflicted patients to return to work, according to the results of a randomized controlled trial (RCT) published in Rehabilitation Psychology.¹

Long COVID can affect patients for months. | Image Credit: © THP Creative - stock.adobe.com

CICT, which is a modification of constraint-induced movement therapy, is used to aid in the rehabilitation of patients following stroke or traumatic brain injury and in those with multiple sclerosis or other neuromuscular conditions. The strategy comprises multiple treatments that teach the brain to recondition itself following a brain injury, allowing patients to help relearn areas of the brain that are weaker than others.²

There is an imperative need for effective treatments for long COVID. The condition, which stems from lingering and sustained inflammation following infection with the SARS-CoV-2 virus, has impacted tens of millions of Americans since the pandemic began. Even as COVID-19 transitions to an endemic phase, 9 million to 10 million Americans still report experiencing symptoms that range from physical, such as muscle weakness or shortness of breath, to neurological, like brain fog or memory loss.^3,4

Data indicates that up to 14% of those dealing with lingering symptoms have been unable to return to work 3 months following COVID-19 infection. Long COVID has clear individual and community-wide impacts that necessitate effective treatment modalities. Given the neurological improvements shown in patients with other conditions using movement therapy and brain exercises, the current investigators sought to evaluate the efficacy and feasibility of CICT to rehabilitate long COVID-associated cognitive measures.^1,3,4

Investigators enrolled 16 community residents who were 3 or more months post-COVID-19 infection. The enrollees all reported mild cognitive impairment, along with dysfunction in the performance of essential daily activities. The participants were randomized to receive immediate CICT or treatment as usual (TAU) with crossover to CICT. Treatment was measured using the Canadian Occupational Performance Measure to determine impacts on instrumental activities of daily living (IADL). Furthermore, employment status and brain fog—measured using the Mental Clutter Scale—were analyzed.^1,3

In total, 14 patients completed an intervention—7 receiving CICT and 7 receiving TAU. Critically, all benchmarks of feasibility were met; compared with TAU, immediate-CICT produced substantial improvements in IADL performance (3.7 points, P < .001) and brain fog (-4 points, P < .001). Furthermore, 4 of the 5 nonretired participants undergoing immediate-CICT returned to work following treatment, while no TAU participants did, according to the investigators. These positive results indicate the provisional effectiveness of CICT in resolving sustained long COVID symptoms among those who adhered to the protocol; however, the investigators cautioned that a large-scale RCT with an active-comparison group is necessary to better elucidate the effects of this rehabilitation method. In addition, more research can determine why the magnitude of improvements in this trial was significantly larger compared with prior trials.^1,3

“That may be because this study population had substantial deficits with room for substantial improvement, or it may be there is extra benefit from combining the exercises with this type of coaching,” Henry Mahncke, CEO of Posit Science, said in a news release accompanying the data. “Either way, it suggests that brain training is a promising approach to helping people with long COVID.”³

REFERENCES

1. Uswatte G, Taub E, Ball K, et al. Long COVID brain fog treatment: An early-phase randomized controlled trial of constraint-induced cognitive therapy signals go. Rehabilitation Psychology. Published 2025. Accessed May 6, 2025. doi:10.1037/rep0000626

2. University of Alabama at Birmingham. Constraint-induced movement therapy—Department of Psychology. Accessed online May 6, 2025. https://www.uab.edu/citherapy/

3. Ericho Communications. Study shows large improvements in long COVID symptoms and return to work. EurekAlert! Published May 5, 2025. Accessed May 6, 2025. https://www.eurekalert.org/news-releases/1082652

4. Venkatesh AK, Yu H, Malicki C, Gottlieb M, et al. The association between prolonged SARS-CoV-2 symptoms and work outcomes. PLOS One. 2024;19(7):e0300947. doi:10.1371/journal.pone.0300947