THE APPLICATION OF A BRIEF MINDFULNESS INTERVENTION IN PEOPLE WITH SEVERE COVID-19

Introduction: The practice of mindfulness, formalised in the structuring of well-known protocols such as Mindfulness Based Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT), have proven to be very effective in reducing stress related to chronic conditions (Cherkin et al., 2016; Johns et al., 2015) and of depression (Hilton et al, 2017; Schumer, Lindsay, & David Creswell, 2018). However, these protocols generally require a high level of engagement for participants, which is why, in the present exploratory study, we opted to evaluate the implementation of a shor and less intensive Mindfulness-based protocol, but which showed good results on health-related outcomes, even with a single session (Howarth, Smith, Perkins-Porras, & Ussher, 2019). The overall objective of this exploratory study was to develop and evaluate the implementation of a short-term, Mindfulness-based intervention conducted in telemedicine, compared with usual care alone, on the symptoms associated with Post Traumatic Stress Disorder Stress Disorder (PTSD) of persons who have previously tested positive for COVID-19, admitted to a resuscitation and/or intensive care unit and then in pulmonary rehabilitation following negativization. Methods: The present pilot randomised controlled trial compared the impact of a Mindfulness-based brief intervention conducted in telemedicine (n = 20) for a period of 5-6 sessions of 45 minutes each, for a total commitment of 3 weeks, to a wait-list control (n = 20), involving people who have been previously tested positive for COVID-19, admitted to intensive care or reanimation and subsequently in respiratory rehabilitation following negativization. The General Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), Impact of Event Scale (IES), Perceived Stress Scale (PSS), State Shame and Guilt Scale-8, Peritraumatic Perceptions of Fear and life threat, Psychological General Wellbeing Index (PGWBI), respiratory functions, oxygen saturation, haemogasanalysis were detected at baseline, 3 weeks, and 3 months. Descriptive analyses were conducted with respect to clinical and socio-demographic variables, as well as the primary and secondary outcomes. All statistical analyses were conducted according to an intentionto-treat system. In addition, using linear mixed models, intra- and inter-group comparisons were carried out on the primary and secondary outcome indices. The analyses were considered statistically significant for p<.005. Moreover, semi-structured interviews conducted according to the Interpretative Phenomenological Analysis (IPA) approach detected the participants' emotional experiences, expectations, and beliefs about their experience of illness. Themes that emerged and recurring themes during the course and interviews were analysed from a qualitative point of view, distinguishing the data emerged from the participants' interviews and those from the carers. Results: This pilot study found that the Experimental Group pursued improvements in terms of symptoms related to Post Traumatic Stress Disorder (PTSD) and the secondary outcomes outlined above over the course of the three surveys. Furthermore, with regard to the parameters pertaining to respiratory function, spirometry and arterial and venous haematochemical examinations, these were not inferior to those achieved by the Control Group. From the qualitative analysis part, it was possible to detect the presence of descriptive, linguistic, and conceptual comments. Relevant was the theme of contact with death and the emotional experiences associated with it, which emerged in different keys in both patients and caregivers. It is also useful to note the reported progressive change of perspective on how the patient deals with the remaining symptoms of COVID-19 during the proposed sessions. Conclusion: This study showed the potential of an affordable and widely accessible Mindfulness-based brief intervention in clinical practice, offering a view of hospital-territory continuity following the acute phase of COVID-19 disease.