A Critical Examination of "Awe" as a Therapeutic Modality in Long COVID Mental Health

The recent article from UC Davis Health, "Experiencing Awe May Help People with Long COVID Feel Better Mentally," presents an intriguing, albeit concerning, narrative regarding novel interventions for the mental health sequelae of Long COVID.

While the exploration of non-pharmacological approaches to well-being is commendable, the proposition that "experiencing awe" could serve as a meaningful intervention for a complex, multifaceted condition like Long COVID, especially as heralded by its primary proponents, warrants rigorous clinical scrutiny. As a retired academic and clinical studies professional focused on evidence-based practice in mental health, this piece raises several methodological and conceptual red flags that verge on what might be characterised as therapeutic oversimplification, if not outright quackery, when presented without substantial caveats.

The study, published in Nature: Scientific Reports, involved a mere 68 participants, a sample size that is statistically insufficient to draw robust, conclusions about a therapeutic intervention for a condition affecting millions.

While preliminary findings from small cohorts can sometimes inform larger studies, the immediate leap to advocating for healthcare systems to integrate "the many wonders that bring us awe" into "systemic care" (as quoted from Dacher Keltner) is a significant overreach. The very nature of "awe-inducing activities"—such as watching inspiring videos or taking nature walks—is inherently subjective and susceptible to significant placebo effects. Participants engaged in a novel, potentially enjoyable activity, which can naturally elevate mood and reduce perceived stress, irrespective of any specific "awe" mechanism. The control group, which merely "continued their daily routines," fails to adequately account for the attention and novelty inherent in the intervention group, thus compromising the study's internal validity. A more rigorous control would involve an equally engaging, but non-"awe"-focused activity, to isolate the specific impact of awe.

Furthermore, the operational definition and measurement of "awe" itself present considerable challenges for clinical application. "Awe," described as "an emotion we feel when we experience something vast or beyond our usual understanding," is profoundly subjective and resistant to standardised quantification. While the study reported reductions in depression and stress, and increased well-being, the absence of significant differences in anxiety levels between the groups is a crucial omission, given that anxiety is a pervasive and debilitating symptom in Long COVID. This selective improvement highlights the potential for a narrow therapeutic window, undermining its purported broad utility. Clinically, interventions must demonstrate consistent and comprehensive benefits across the spectrum of psychological distress.

The advocacy for "simple, low-cost awe-based activities" as a "new approach to supporting mental health" risks trivialising the profound and often debilitating mental health challenges associated with Long COVID. Patients with Long COVID frequently grapple with severe fatigue, debilitating brain fog, chronic pain, and profound social isolation, leading to complex presentations of anxiety, depression, and post-traumatic stress. To suggest that a few moments of "awe" can effectively ameliorate such entrenched suffering without robust, long-term efficacy data is not only simplistic but potentially harmful. It can divert individuals from seeking proven, evidence-based psychological therapies—such as Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), or psychopharmacological interventions—which have demonstrated efficacy through rigorous, large-scale randomised controlled trials.

The enthusiasm surrounding such preliminary findings, particularly when framed in a manner that suggests immediate integration into clinical practice, can foster a landscape ripe for unsubstantiated claims and, indeed, mental health quackery. While the intrinsic value of connecting with nature or art is undeniable for general well-being, elevating these activities to a primary clinical intervention for a serious medical condition based on limited data is irresponsible. The history of mental health is replete with examples of fads and unproven therapies that, while benign in isolation, can become detrimental if they preclude access to effective treatment or offer false hope.

In conclusion, while the exploration of novel psychosocial interventions is vital, the UC Davis Health piece on "awe" for Long COVID mental health underscores the critical need for scientific rigour and clinical prudence. A small, preliminary study with methodological limitations cannot justify the sweeping recommendations put forth. True clinical scrutiny demands larger, well-controlled trials, clear operational definitions, and demonstrated efficacy across diverse patient populations and symptom profiles. Until such evidence emerges, clinicians and patients alike should approach such propositions with extreme caution, prioritising established, evidence-based interventions for the complex and challenging mental health landscape of Long COVID.

Note: This piece reflects my personal perspective and is intended for discussion, not instruction.

References:

• American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). American Psychiatric Publishing. (General reference for mental health conditions and the need for evidence-based diagnosis and treatment.)
• Lewis, L. (2024). The Perils of Pseudoscience in Modern Psychiatry. Journal of Clinical Inquiry. (Hypothetical reference for the dangers of unproven therapies.)
• National Institute of Mental Health. (Current Guidelines). Evidence-Based Treatments for Depression and Anxiety. (General reference for established clinical guidelines and interventions.)
• Smith, J. (2023). Methodological Challenges in Psychosocial Intervention Research: Sample Size and Control Group Considerations. Journal of Health Research Methodology. (Hypothetical reference discussing limitations of small sample sizes and control groups.)