Mindfulness Therapies for COVID-19-Related Anxiety and Persistent Lyme Disease Symptoms

Mindfulness Therapies for COVID-19-Related Anxiety and Persistent Lyme Disease Symptoms

Mindfulness Therapies for
COVID-19-Related Anxiety and Persistent
Lyme Disease Symptoms

Brian Fallon headshot

Brian Fallon, MD, MPH, is a psychiatrist who studies the anxiety associated with illness. One of the clinical studies he is directing—which is currently recruiting participants—uses Kundalini yoga, meditation, and cognitive behavioral therapy for anxiety related to COVID-19. Fallon says that the value of mindfulness therapies extends to the health of the entire body, including the immune system. Similar studies are asking whether these therapies are beneficial for people with chronic Lyme disease.

Fallon also studies the reasons for persistent cognitive impairment, fatigue, and pain among people with histories of Lyme and other diseases. “Some of the people I was seeing had been told they were hypochondriacs, but I thought they were not hypochondriacs,” he says. “I thought they were suffering from something physical, something medical that hadn’t yet been properly diagnosed. I started to wonder if some of these patients might have undetected Lyme disease.” Fallon’s book—Conquering Lyme Disease: Science Bridges the Great Divide—coauthored with Jennifer Sotsky, MD, is a comprehensive resource for anyone asking this question.

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    Brian A. Fallon, MD, and
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A Q&A with Brian Fallon, MD, MPH

Can you tell us about the clinical study on COVID-19-related anxiety that you’re currently recruiting people for?

When COVID-19 struck here in New York, it was an anxiety-provoking and somewhat terrifying time for those on the front lines. As a clinician, psychiatrist, and researcher, I thought we could create a study that could be launched quickly online that might be helpful to people suffering with anxiety during COVID-19. We decided that we could not have a comparison group that didn’t also provide some benefit. So we have three groups, all of which get anxiety-reduction training using cognitive behavioral methods. We provide educational materials covering anxiety, worry, health fears, how thoughts influence our emotions, how certain thoughts and thought patterns can be destructive, and how thought patterns can be changed. In addition, two thirds of the people get augmentation with a mindfulness-based therapy. There are two types that we’re using: One is meditation, and the other is Kundalini yoga.

The meditation arm of the study practices breathing and meditation. Kundalini yoga is a daily practice that incorporates movement, light stretching, a certain type of breathing, and meditation. We are hoping that everybody will benefit from participating in this study, which is ongoing, but that perhaps those who get the mindfulness therapies will do a little bit better.

Any kind of daily practice that becomes ritualized in a way that allows your body and your mind to slow down for about fifteen or thirty minutes a day can be very beneficial. You’re allowing yourself to quiet the endless chatter that’s in your brain and to breathe in a calming way, and that’s enormously soothing. Our study will give that to patients as a practice, as well as cognitive behavioral therapy, which is a proven therapy for anxiety reduction.

Who can participate?

This is for people who have not yet had COVID. These are the people who worry about getting COVID. These are the people who are anxious because they’ve lost their jobs, or their jobs are insecure, or their financial stability is suffering, or someone they know has gotten sick or died, or they worry about their own symptoms excessively even though they haven’t yet contracted COVID-19.

It is an online study, open to anyone in the US. Right now, we have a little over 200 subjects. We hope to enroll as many people as we can and continue the study for another three or four months. [Editor’s note: You can find more info here.]

Have you gotten any preliminary feedback?

We haven’t looked at the preliminary results of the COVID-19 study yet, but we have just finished a Kundalini yoga study that we did with people who had persistent symptoms after antibiotic treatment for Lyme disease, and the results look promising; I can’t say more as the study is now being reviewed for publication. We know from other studies that yoga and meditation are very helpful for anxiety and depression and can have benefits for the immune system. We want to be as healthy as possible during this time, and our mood contributes to our health.

How did you, a psychiatrist, come to do research on infectious diseases like Lyme disease and COVID-19?

I started out in my training as a psychiatrist and got my board certification in psychiatry. I became very curious about hypochondria, which is when people worry about illness when they’re not actually ill. I realized that some of the people I was seeing had been told they were hypochondriacs, but I thought they were not hypochondriacs. I thought they were suffering from something physical, something medical that hadn’t yet been properly diagnosed. I started to wonder if some of these patients might have undetected Lyme disease. And some of them did. This was in the early ’90s, when Lyme disease was a relatively new infection in the United States.

I realized that a lot of people were struggling with persistent symptoms after Lyme disease that were due to either persistent infection or a postinfectious process. I decided to test different interventions to see what treatments work best for people who have persistent symptoms after Lyme disease.

Why is your focus on anxiety and mindfulness therapies?

I’m very interested in mind-body therapies because people need to be able to do something themselves to help modulate their own nervous system. We know that things like meditation and yoga can help the autonomic nervous system be more balanced so that the heart doesn’t race and the breathing isn’t too fast. So that your musculature is not so stressed out that you have pains in your head and down your spine and shooting pains down your leg. We know that anything that can be done to reduce stress can be enormously helpful for mental and physical functioning.

Can you tell us about the clinical trial you are planning to do on persistent symptoms related to chronic Lyme disease?

About 10 percent of people who contract the infection that causes Lyme disease suffer from persistent symptoms even though they get antibiotic therapy. Patients are calling it chronic Lyme disease, which is understandable. The academic community uses the term post-treatment Lyme disease syndrome, which means you’re not sure exactly what’s causing the post-treatment Lyme symptoms. It might be an active infection, or it might be a postinfectious process.

In many ways, the persistent symptoms associated with Lyme disease are similar to what people are reporting now after COVID-19: fatigue, muscle pains, brain fog. I think some of the treatments that might be helpful for the post-Lyme patients may also be helpful for the COVID-19 long-haulers—the people who have persistent symptoms after COVID-19. With the Lyme disease study, we are again going to be comparing meditation and Kundalini yoga. We’ll be posting the various studies on our website.

COVID-19 is caused by a virus, and Lyme disease is caused by a bacterium, and the symptom profile is very similar in these post-viral and post-bacterial disorders. But they’re not necessarily the same disorders. We did a study where we compared the spinal fluid of chronic fatigue patients, and patients after treatment for Lyme disease who had persistent cognitive problems. We found that even though they both look like they have chronic fatigue syndrome, the Lyme disease patients had 600 unique proteins that weren’t there in the chronic fatigue patients. And the chronic fatigue patients, in turn, had 600 unique proteins that weren’t there in the Lyme group. So even though symptoms may be similar, they’re not exactly the same.

Can you tell us about the clinical study you are carrying out on a drug to treat chronic Lyme disease?

We’re doing a study now looking at a medicine called disulfuram, which is a psychiatric medication. It’s commonly known as Antabuse, and it’s used to help alcoholics stop drinking. If you drink when you’re taking Antabuse, you have a violent bodily reaction that you don’t want to get ever again, because it’s very, very unpleasant. So people who are on disulfuram generally do not drink. From screening thousands of compounds, we have recently learned that disulfuram is one of the most effective agents against the Lyme bacterium. It’s more effective, at least in a lab setting, than standard treatments for Lyme disease. So the question is: Is it possible that some of these patients who have persistent symptoms may have a persistent infection that disulfuram could eradicate?

There are some clinicians in the community who’ve been giving disulfuram to their patients with persistent Lyme disease symptoms and they’re reporting generally good results. However, disulfiram needs to be carefully studied—both for safety and to test whether it leads to improvement. Disulfuram is not something to take lightly as it can have serious side effects. If you have any exposure to alcohol while you’re on this drug, you could have a very severe physical reaction. If you have heart disease when you have a disulfiram-alcohol physical reaction, you could have a heart attack. You want to be carefully monitored when taking disulfuram. We are recruiting now for this study, and we just got approval to do it remotely.

I’m very optimistic about medicine and about science right now. Just look at the COVID-19 pandemic. We have three or more vaccines that are almost ready to go. That’s phenomenal to see so much progress in the course of less than a year. And the treatments that we have now have dramatically reduced the death rates that previously had been reported for COVID-19.

Brian A. Fallon, MD, MPH, is the director of the Center for Neuroinflammatory Disorders and Biobehavioral Medicine and of the Lyme and Tick-Borne Diseases Research Center at Columbia University. Fallon received his MD and MPH from Columbia University and is board-certified in psychiatry. His research focuses on anxiety associated with illness and the causes and treatment of persistent symptoms in patients with histories of Lyme or other diseases. Fallon coauthored Conquering Lyme Disease: Science Bridges the Great Divide with Jennifer Sotsky, MD.

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