SEVERE COVID anxiety improved for most participants over 18 months although recovery was not universal.
Long-Term Severe COVID Anxiety Trajectory
This prospective UK cohort tracked 285 adults with severe COVID anxiety for 18 months and quantified symptom change using descriptive statistics and regression modelling. Overall group-level patterns showed major reductions in severe COVID anxiety with almost seventy percent relative mean reduction. For many patients this suggests that the intense physiological reactivity fear of contagion and avoidance behaviors associated with severe COVID anxiety naturally attenuate over long follow up. However, a quarter of participants continued to worry every day about SARS-CoV-2 even after all legal restrictions were withdrawn and thirteen percent reported persistently severe symptoms beyond the pandemic emergency period. This finding underscores the long tail clinical relevance of severe COVID anxiety recovery patterns because daily rumination and hypervigilance can remain entrenched even when infection risk declines. The data indicate that time exposure to normalized community activity and changes in national case trends are insufficient in isolation for a meaningful minority.
Factors That Predicted Slower Symptom Improvement
Increasing age depressive symptom severity and sustained health anxiety were associated with slower improvement in severe COVID anxiety. Belonging to a minority ethnic background linked with greater biological risk from COVID-19 was also associated with persistent severe COVID anxiety. These findings suggest overlapping affective drivers rather than environmental exposure as dominant mechanisms shaping severe COVID anxiety recovery. They also reinforce the interconnectedness between physical disease threat appraisal and mood disturbance phenotypes.
Intervention Effects and Contextual Exposures
An embedded feasibility trial evaluated a brief online CBT intervention however this did not affect severe COVID anxiety trajectories. In addition, contextual exposures including vaccination status daily national case counts and prior infection history did not change severe COVID anxiety recovery patterns.
Reference: King JD et al. Trajectory of severe COVID anxiety and predictors for recovery in an 18-month UK cohort. BJPsych Open. 2025;11(6):e263.
