Reading the Signal: A Two-Part Model and Thought Record Worksheet for Long COVID

Long COVID · CBT · Practice-informed

A two-part handout and thought record. Part one is the body doing something real that medicine is still working to explain. Part two is the alarm the mind adds on top: fear about what symptoms mean, constant checking and pressure to fix things. The alarm does not cause the illness, but it can make a hard day feel bigger and lonelier. The sheet has a five-column record for frightening symptoms, honest alternative thoughts to borrow and a guide to telling a useful check-in from anxious checking. The two-part model is established practice and has not been trialled alone in Long COVID, and a study of 44 people found that greater perceived illness threat and low mood went with greater fatigue without showing which causes which.

Underlying mechanism: Two-Part Model Psychoeducation and Illness-Threat Appraisal Record for Long COVID

What it helps with

  • Teaching, early and twice, that the symptoms are real and the alarm is a separate part that can be turned down.
  • Noticing frightening thoughts about symptoms before any attempt to change them.
  • Finding honest, kind alternatives such as "This is how my illness feels today. I have a plan", which never dismiss a symptom.
  • Separating a few planned check-ins from constant, anxious scanning of the body.

How clinicians use it

  • In Session 2 fill in only the first three columns with one recent example and do not challenge the thought yet.
  • In Session 5 use the last two columns to explore what else could be true, and use the check-in guide to talk about planned versus anxious checking.
  • Say clearly that nothing on the sheet suggests symptoms are imagined, and that any new or worsening symptom goes to the medical team.
  • Do not tell clients that changing appraisals will reduce fatigue. The link is correlational.

Clinical Implementation Guide

  1. Teach the two parts, body and alarm, and fill in the first three columns for one recent example.
  2. Return later to the last two columns, always kind, honest and never dismissing a real symptom.
  3. Agree a few planned check-ins in place of constant scanning.

What the worksheet looks like

Reading the Signal — worked example
The alarm saysA steadier, honest version
This fatigue means something is badly wrong.This is how my illness feels today. I have a plan and I can contact my team if it changes.
If I stop watching my body I will miss a warning.I can check in at set times and trust that a plan is in place between them.
I will never get my life back.I do not know how this will go. I can take a small steady step today.

Clinical cautions

Never use appraisal work to suggest that symptoms are exaggerated. The aim is to reduce fear and isolation, not to argue with the body. New or worsening symptoms are for the medical team and are not thoughts to be reframed. Attention flexibility work is extrapolated from CBT for health anxiety and has not been tested for Long COVID. This tool does not diagnose any condition and is not a substitute for individual face-to-face therapy or for emergency crisis support.

References

  1. Thomas, B., Pattinson, R., Cunningham, G., Bundy, C., & Davies, J. L. (2026). Somatosensory processing in long COVID fatigue and its relations with physiological and psychological factors. Experimental Physiology. Advance online publication. https://doi.org/10.1113/EP093600.

Copyright and use in research

© 2026 Dr Richard Pomfret and Third Wave Therapy Tools. May be used in research with the author and site cited. Version 1.1, approved 21 October 2026, revised as the evidence develops.

Suggested citation (APA 7th edition): Pomfret, R. (2026). Steady Ground: A stepped, measurement-led psychological protocol for adults with Long COVID (Version 1.1) [Therapist guide and worksheets]. Third Wave Therapy Tools. https://thirdwavetherapytools.com/

Part of

Steady Ground

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