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Table 2 Overview of Fit after COVID modules

From: A randomised controlled trial testing the efficacy of Fit after COVID, a cognitive behavioural therapy targeting severe post-infectious fatigue following COVID-19 (ReCOVer): study protocol

Module name Instrument and cut-off score Brief description of module content
1. Goal setting   - Psychoeducation regarding the cognitive behavioural model of post-infectious fatigue following COVID-19.
- Patients set treatment goals in concrete activities that will be performed when the patient’s impairments and fatigue are alleviated.
2. Sleep-wake pattern Sleep diary
ISI ≥ 10
- Targets a disrupted sleep-wake pattern.
- Patients establish a regular sleep-wake pattern and follow sleep-hygiene practices.
- Patients are encouraged to stop sleeping or lying down at daytime.
3. Helpful thinking J-FCS ≥ 16
IMQ ≥ 30
SES ≤ 19
- Targets dysfunctional cognitions regarding fatigue.
- Patients learn to identify unhelpful thoughts and replace them with helpful thoughts, gain more self-efficacy and learn to focus less on their fatigue.
- Patients learn to redirect their attention away from bodily symptoms.
4. Social support a SSL-D ≥ 14
SSL-I ≥ 50
- Targets low perceived social support and negative interactions.
- Patients learn how to communicate with significant others about their fatigue, be assertive and adapt expectations about their environment.
5. Graded activity Activity pattern (actigraph), relatively active vs. low active - Targets a low or fluctuating physical activity pattern.
- Patients with low activity pattern start with gradual increase in their daily physical activity.
- Patients with a relative active activity pattern learn first to evenly distribute their activities during the day and then subsequently gradually increase their daily activity.
6. Processing the acute phase of COVID-19 a IES, subscales ≥ 10 - Targets emotional problems of patients who did not process the acute phase of COVID-19.
- Patients are helped to process negative experiences from the acute phase of their illness.
7. Fear and worries regarding COVID-19 a COWS ≥ 10 - Targets excessive fears and worries regarding COVID-19.
- Patients record what the content of their fear and worries is regarding COVID-19.
- Patients learn to formulate helpful thoughts and to distance themselves from their anxious thoughts.
8. Coping with pain a Subscale pain of the SF-36 ≤ 40 - Targets dysfunctional cognitions with respect to pain.
- Patients are helped to deal with pain in such a way that it does not limit them during the gradual increase of activities.
9. Realising goals   - Patients make an action plan to work on their formulated treatment goals, like increasing social and mental activities.
- Patients learn about the difference between severe fatigue and normal fatigue.
- Patients learn to let go of the regular sleep-wake pattern and even distribution of activities.
- Patients evaluate their progress.
  1. aOptional module
  2. ISI Insomnia Severity Index [48], J-FCS Fatigue Catastrophizing Scale [49] IMQ Illness Management Questionnaire [50] SES Self-Efficacy Scale [51, 52], SSL-D Van Sonderen Social Support Inventory, subscale discrepancy, SSL-I Van Sonderen Social Support Inventory, subscale interactions [54, 55], IES Impact of Event Scale [56, 57], COWS COVID-19 Worry Scale (adapted from Cancer Worry Scale (CWS)) [58], SF-36 Short Form Health Survey [40]