Using Mindfulness and Compassion for Long COVID

Like so many clinicians, I treat several people with long Covid. And, like so many clinicians, I struggle to figure out what might help. For nearly two years now, I have been experimenting with using mindfulness and self-compassion with my patients. I hope this essay will expand the conversation and help many people find new ways to manage their symptoms.

Long Covid usually involves a complex cluster of symptoms that present shortly after the illness has passed. Current estimates are that as many as 30 percent of patients are affected. Some symptoms, such as shortness of breath or extreme fatigue, seem to be a continuation of the active phase of the illness. Yet others may occur after patients think they have recovered, such as brain fog, joint pain, chronic discomfort, chest pain, dizziness, depression, headaches, loss of smell and taste, vomiting, sleep problems, and memory lapses.

Many are unable to work. At first, many physicians were skeptical and dismissive, believing that the complaints were psychosomatic. But now, long Covid is considered to be a real illness. There is consensus among researchers that it involves an abnormal immune response linked to increased inflammation. Some investigators see neurological aspects and are researching neuroinflammation. It impacts a wide range of patients, from teenagers to the elderly.

For most of the patients I see, it has been devastating and confusing, involving isolation and doubt, self-loathing, depression, and despair. As a mindful self-compassion teacher, I have been interested in connecting self-compassion and pain.

Chris Germer, one of the originators of the mindful self-compassion program, and I researched this topic that is now published (see below). I have also been interested in researching ways that mindfulness can help decrease inflammation, reducing interleukin-6, a biomarker of inflammation.

While I have been suggesting Yin Yoga and restorative breath practices, such as Andrew Weil’s 4-7-8 breath and Stephen Porges’ polyvagal breath with Covid patients, what has been deeply comforting to many is a compassionate body scan.

Bringing Kindness to the Body

• Find a comfortable position, lying on your back. Place one or two hands on your heart as a reminder to bring kind awareness to yourself. Take a few slow relaxing breaths.
• In this exercise, bring kind attention to each part of the body, discovering how it is to be with the body in an affectionate way. Incline your attention toward the body like you would pay attention to a young child.
• If there are judgments, pain or discomfort, unpleasant associations, you may want to put a hand on that part of the body, perhaps imagining kindness flowing from your hand into your body.
• Let this exercise be as gentle and comforting as possible. There is no need to stay with an area of the body if it is too difficult.
• There is no need to change anything in the body; allow it to be just as it is.
• Begin to bring attention to your toes, noticing any sensation, perhaps giving your toes an inner smile of appreciation.
• Move to the soles of your feet, giving them a little appreciation. They work so hard to hold your body up.
• If there is any discomfort, allow that area to soften, Address the sensation with kind words, noting the sensation and allowing it to be
• Now feel both feet. If there is no discomfort, extend gratitude for the discomfort you don’t have.
• Bring attention to your legs, one part at a time, noticing whatever sensations are present. Send kindness if there is discomfort. Move slowly, bringing attention to your ankles, calves and shins, knees.
• When your mind wanders, return to the sensations in that part of the body.
• Move to your thighs, hips, abdomen, groin, buttocks, lower back, upper back, chest.
• As you move from one part of the body to another, return your awareness to the sensations that are present, bringing kindness and gratitude to each part of the body.
• Continue to bring awareness to your shoulders, upper arms, elbows, lower arms, hands, fingers, throat, back of the neck, back of head, forehead, eyes, nose, cheeks, lips, chin, whole face, perhaps appreciating how your eyes, nose and ears guide and inform you all day.
• When you have paid loving attention to each part of your body, put your hand on your heart again and give your entire body a final shower of affection.
• If you like, try some of these phrases: My sweet body, you are doing the best that you can. Or, May I be with this pain, may I be with this suffering.
• Other phrases that have been helpful are from the Zen Master Thich Nhat Hanh. “Breathing in, I calm my body. Breathing out, I rest. I am home.”

Body like earth, mind like sky.

In treating long Covid, we find that rigorous exercise can be more exhausting than anticipated. I often suggest that folks try walking meditation, even for a few minutes, simply anchoring in the earth. Again, using phrases from Thich Nhat Hanh can be grounding and healing. You might want to try the following: With every step, a step of peace. Or, With every step, my feet kiss the earth.

Many people also find it useful to say the classic phrases of lovingkindness:

May I be safe and free from suffering

May I be healthy

May I be happy

May I be at peace

May I live in ease

May I live in wisdom, love, and compassion.

Traditionally, at end of these meditations, we send blessings to all beings who are suffering. So, let me end on that note:

May all beings who have COVID be free from pain and suffering, may all beings be at peace.