Healing the Effects of Long-Covid
The New Post-Viral Epidemic
In recent months, I've had an influx of new inquiries from people seeking help for long-covid and symptoms like brain fog, dizziness, low blood pressure, sensory sensitivity, anxiety, rapid heart beat, and persistent, debilitating fatigue.
All of them had covid at some point. And now they have diagnoses like long-covid, POTS, tachycardia.
So what can they do to heal? Often, they have tried doctors, the mainstream medical system—only to spend precious time and energy for marginal progress.
An Array of Meds . . .
Many of them are given medication—benzodiazepines, gabapentin, antidepressants, heart medications, blood thinners, immune modulators, beta-blockers—that often come with mild to moderate side effects and unfortunately not a lot of relief.
Next the Psychiatrist . . .
In med school, physicians are taught that there must be the presence of an antigen to feel sick. But in the absence of it (in this case a negative covid test or weeks after the onset of infection), there are few answers as to how and why symptoms may persist or new symptoms could arise; it is not uncommon in those cases for a patient to be sent to a psychiatrist.
Long-Covid Treatment Development, the Wild West . . .
If you google “long-covid treatments,” you will find many articles that state “there is no proven treatment.” One peer-reviewed science journal described treatment development as the “wild west.”
What About Looking to the Autonomic Nervous System?
While the allopathic medical model searches for answers in pharmaceuticals and more invasive treatments, there are a number of them readily available here in the world of autonomic nervous system regulation, brain retraining, and trauma healing.
As a practitioner working with nervous system regulation, I’ve repeatedly seen clients failed by mainstream medical approaches. Folks will often come to me, spent from going doctor to doctor looking for answers, feeling like no one believes them, and left with little hope.
Long-Covid and a History of Nervous System Dysregulation
When I complete an intake with someone who has come to me for help with long-covid symptoms, I’ll typically find a history of other insults and injuries—a head trauma, anxiety, a recent loss, earlier complex trauma, prior struggles with anxiety or depression.
Intergenerational and Early Developmental Trauma and Its Implications with Long-Covid
With early trauma—or intergenerational—we start to see a picture that may explain why a post-viral syndrome like long-covid can show up and continue to persist.
Understanding Early and Intergenerational Trauma
With early trauma and intergenerational trauma, caregivers—who are the ones to provide the conditions for the development (and myelination) of our ventral vagus (a parasympathetic branch of our autonomic nervous system responsible for social engagement and helping us feel safe and connected)—often don’t have enough of their own because of trauma in the family line that has impacted generations before them.
In a blog post describing early developmental trauma, Frederique Georges, MFT, SEP, beautifully describes the dance of mother and child after birth that contributes to regulation of our autonomic nervous system and the beginnings of myelination of the ventral vagus:
A healthy foundation or physiology means secure attachment. When mom and baby connect after birth, a dance is initiated between them: it is a back and forth which involves ultimate attunement, engagement and moment-by-moment state matching. Their responses are coordinated rapidly, synchronized by their mutual gazes and voices. This deeply unconscious communication allows moments of intense engagement and arousal but also small increments of disengagement to allow for rest states. In this synchronized dance of intense connection and the split seconds of rest, the intuitive mom modulates her baby’s nervous system, his/her brain development, emergent motor skills, immune system, emotional being, body functions and many other facets of development. Even though misattunements will be common and inevitable during these interactions, mom will modulate the baby’s stress responses and repair the hyper or hypo arousals to bring equilibrium back to the system. Through this subtle synchrony, psychological attachment and its associated emotions are slowly built in: bonding can occur in a safe and healthy way, internal emotional structures are constructed as a solid foundation. We call it regulation of the nervous system.
Georges then goes on to describe what happens when these conditions are not met:
Sometimes the conditions are not optimal for a healthy foundation. A caregiver can be depressed, neglectful, anxious, traumatized, addicted, isolated or lacking support. In some tragic cases, violence is chronically inflicted upon a young child.
When a depressed mother is holding her baby, he/she will match her state of numbness in an ultimate effort to connect and be seen. If an overbearing caregiver is riddled with anxiety, the baby will tune into the anguish as a guide and sometimes even try to regulate mom. These are only two examples of a multitude of scenarios that can present. They can have serious consequences on the development of the nervous system, on the bonding experience and on the subsequent development of disorders. These interpersonal deprivations and failures in the early stage of human development resonate through life and adulthood. Allan Schore, a neurobiology and attachment specialist attributes most of all psychopathology to ruptures of the bonding/regulation sequence that occurs during the first 12 to 18 months of life between the caregiver and the baby. He says we “download” our nervous system from our caregiver’s.
If there is no nervous system co-regulation between the caregiver and the baby, there can’t ever be self-regulation in adulthood: the individual will most likely hover between high states of arousal (anxiety/flight-anger/fight) and shut down (depression/freeze). There is no middle way. Symptoms might appear: anxiety, depression, numbness, fear and worry, irritability and anger. Behaviors and coping mechanisms come into place to the rescue of the symptoms in an effort to maintain some sort of wellbeing (ex: OCD for anxiety). Relationships suffer. Sometimes medication is needed to function on a daily basis. Illness and autoimmune disorders manifest every so often later in life.
Georges spells out the consequences of early trauma to a human biology so poignantly. In her same blog post, she goes on to say this is not a life sentence. While the effects of early trauma can be powerful, lifelong, and impact every aspect of our being (our relationships, work, health, and so on), there is hope for healing that can also have a profound impact on our recovery.
And I believe that recovery is possible through nervous system regulation.
Early and Intergenerational Trauma and the Ventral System
Typically when inevitable threat (or simply every day stressors) enter our lives, we “activate” into fight or flight to protect ourselves. Once that threat is gone, we “de-activate” with the help of our ventral (parasympathetic). When we have experienced early trauma, however, our nervous system may not have enough ventral connection to help us climb back up the autonomic ladder . . . and we stay stuck in sympathetic activation.
As we move through life, without this ability to fully de-activate, we develop coping strategies (adaptations) or “defensive accommodations” as a kind of surrogate ventral vagal state—e.g. if I am activated, and I don’t have enough connection to someone else’s ventral state or sufficient ventral of my own, the intelligence of my system will devise ways to help me soothe—and while this strategy can help to keep us cope and feel a degree of safety, soothing is not the same as true regulation where the physiology of sympathetic arousal or the “energy conservation state” of dorsal can shift into a state of presence, calm, rest and digest.
We may also call this state the “false window” where we live in a heightened state of sympathetic arousal and dorsal shut down and develop management strategies to help cope with our distressed physiology. These management strategies—like overworking, distraction, overexercise, substance dependency, even depression—can help keep us in a state of functioning or equilibrium, granted not one that is true regulation (parasympathetic ventral), yet a skillful and intelligent adaptation all the same. People with early trauma, who haven’t sufficiently developed a real window, may go on living like this for years (unaware) until this strategy reaches a critical mass.
That can show up as “rock-bottom” with addictions, a painful break-up of a family, chronic health issues and various syndromes and “mystery symptoms” that may have gone on for years under the radar or managed in certain ways but then suddenly spill over into panic attacks, mast-cell activation, POTS, IBS, fibromyalgia, and chronic pain.
Long-covid is similar. An insult to the system comes in—one that has been broadcast by the media as life-threating (and most certainly can be) and drilled into us as a dreaded disease (which it also can be). The threat response it can bring on can overwhelm our resources. Even without its media attention, historically viruses were life-threatening and our primitive brains can still rush to survival activation when sick. For many, if the immune system has succeeded in overcoming the threat, life can resume. But for some, the threat response persists—as I’ve described earlier—in a system that is chronically distressed with little access to ventral regulation.
So for the folks with whom I work, who have both early and intergenerational trauma, and may have other syndromal presentations (such as prior history of anxiety, migraines, chronic pain, inflammatory bowel issues, and so on), the answer lies in working with autonomic regulation—something many doctors and researchers don’t take into consideration in their search for treatment options.
Therefore, for someone whose “last straw” is a long-covid presentation, but who has a history of early and intergenerational trauma, coming into this work of autonomic nervous system regulation means creating (often for the very first time) a real window of tolerance—real ventral vagal myelination—so their system will have a safe place to “land,” or regulate out of its chronic (possibly life-long) state of activation and threat.
How Does Regulation of the Nervous System Work?
The aim of nervous system regulation is to reduce the impact of chronic activation on our system. Shifting between high states of arousal and dorsal shut down is extremely challenging to our organs, systems, and overall well-being. We heal, digest, engage, connect, feel safe, build reserves, and regenerate when we are in a regulated nervous system state.
When we talk about regulation, we get the idea that we move from activation to deactivation, to settling, calm, peaceful, and safe. And that is true; however, when we provide modalities that help with nervous system regulation the regulation itself may depend on the person in front of us. For some, it could mean helping them return to their original state—for example, someone who reports that they haven’t felt like themselves in years after a series of stressful events. For another, it may be creating resilience so that when their system mobilizes into a threat-protective state, it can also shift back to a regulated (ventral) state once the threat is over. And for others, still, it might mean creating a foundation for regulation in the first place, where there may have been none-as in the case of early and intergenerational trauma, which I wrote about earlier and shared about in the passages from Frederique Georges’ blog post
To illustrate this further, take an adult who has a good degree of ventral-vagal capacity, no history of complex trauma but experiences a shock trauma that doesn’t get resolved and therefore leaves them stuck in sympathetic activation (fight or flight). As a result, they begin to develop migraines. The person goes to doctors to get help with the migraines and is given medication, but the medication doesn’t fully alleviate their symptoms and also has the unfortunate side effect of mild insomnia. Because of the insomnia, the person is stressed out during the day and finds it difficult to work and stay focused. The complications continue until the person’s nervous system shifts into a state of freeze. And they begin experiencing depression. They come to me for depression and migraines.
With a look at their history, we discover the shock trauma that preceded their currently symptomology. We use tools like the Safe and Sound Protocol and Somatic Experiencing to give the body the space it needs to process the trauma and return to its former state of equilibrium. By processing the trauma, we have allowed room for incomplete self-protective responses and suppressed emotions to come forward and have space to be felt and resolve; similarly, the Safe and Sound Protocol helps shift the person’s nervous system to a state of ventral regulation. We’ve effectively resolved the traumatic energy that was being held in this person’s nervous system and, with that, they were able to discontinue use of the migraine medication, sleep better—and the dorsal shut-down that they had been living in is no longer needed; as a result, their depression lifts. The migraines subside. And their focus at work returns.
For many individuals, however, things may not be as straightforward. Perhaps there is a history of early and intergenerational trauma and very little—if any—foundation of ventral. In addition, traumatic experiences may have been complex (meaning multiple insults to the system—not just one—e.g., medical trauma, early developmental, relational, shock) and chronic (ongoing). These cases are often best served by first building a platform for ventral regulation—so working with therapeutic touch and a practitioner who can provide safe space to create some relational trust and co-regulation.
When we are aiming to build ventral regulation for the very first time in a system that has lived in a false window, chronic sympathetic activation, and freeze (dorsal), and has a history of intergenerational and early developmental trauma, we are working with the system as if it were a baby, recreating a place of safety (as if between mother and child), and eventually conditions where the person’s nervous system can come to know connection, rest, and regulation. This takes time, as we work in small increments to “move the needle,” so to speak. But it can be one of the most powerful and life-changing means of healing when true regulation comes into a nervous system.
Will Things Like Yoga and Meditation Help?
Often, in their search for answers and efforts to get well, people will ask me about yoga, hypnosis, vagus nerve stimulators, positive affirmations, changing core beliefs, vitamin therapy, meditation, and more.
While all of these can be comforting, soothing, and beneficial to a system that is stuck in chronic activation with nowhere to go, I say yes, sure—but realize that you can still be dissociated and do yoga, that vagus nerve stimulators may help calm a response to stress in the moment, but they do not create a real window of tolerance for us long-term that is sustainable. Similarly, positive affirmations and changing our beliefs are “top-down” approaches similar to cognitive-behavioral therapy that won’t touch the root of what’s needed here—connection to the body and a more lasting state change, along with the creation of more capacity in the ventral-vagal parasympathetic of our nervous system.
Recommended Modalities for Autonomic Nervous System Regulation
Having personally experimented with a number of treatment modalities, as well as having worked with others with intergenerational and early developmental trauma (and chronic health syndromes) who have tried many things, I’ve come up with a brief list of some of my favorite and most impactful and effective modalities for working with nervous system regulation and healing at a root level that—while taking time (these are not quick fixes)—can really bring about genuine healing and recovery, including for people facing long-covid symptoms.
Somatic Experiencing:
For working with somatic embodiment, embodied awareness, and staying regulated. This can be excellent for shock trauma—and shifting nervous system states.
Safe and Sound Protocol:
Can be instrumental in shifting a person out of chronic freeze and ideally into more ventral regulation and can help support the work of other modalities by encouraging ventral regulation and, further, co-regulation.
Transforming the Experience-Based Brain (TEB) (or “Coregulating Touch):
This modality is specifically geared toward Early Developmental Trauma and is a hands-on touch therapy that can be done in person or remotely.
Other Touch Modalities:
There are a number of other co-regulating touch modalities that are focused on regulation (while TEB’s focus is primarily early developmental trauma and building a foundation for ventral regulation).
Another one is craniosacral therapy in the Upledger tradition.
Finally, a word about Limbic (or “neural”) retraining:
There are many programs out there for this. Ashok Gupta has one that has become very popular and even addresses post-viral syndromes like long-covid. However, my clients have had mixed-results doing this, especially if they are working from a place of experiencing acute and overwhelming symptoms. While I think there is great value in neural retraining programs, I think first getting a good degree of support and nervous system regulation on board is key for these methods to really be effective.
In Closing . . .
Finding answers to long-covid recovery in the mainstream medical world isn’t impossible, but what is currently available is largely palliative. To get to the root of healing from long-covid, working with autonomic nervous system regulation is essential to any healing plan.
Credits and references:
False window infographic: https://wisebodytherapy.com/my-tools/healing-developmental-trauma-table-work-touch-therapy/
Early bonding and the foundation for regulation: https://wisebodytherapy.com/my-tools/developmental-trauma-early-dysregulation-nervous-system/
The Early Development of the Autonomic Nervous System Provides a Neural Platform for Social Behavior: A Polyvagal Perspective by Stephen Porges and Senta A. Furman https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079208/
Case Study of the use of the Safe and Sound Protocol with Long-Covid: https://integratedlistening.com/case-study/long-covid-nervous-system/
Stephen Porges on the use of the Safe and Sound Protocol with various syndromes: https://integratedlistening.com/an-afternoon-with-dr-stephen-porges-qa-part-1/
The Safe and Sound Protocol in Harvard Review of Psychiatry: https://journals.lww.com/hrpjournal/Fulltext/2022/09000/Neuromodulation_Using_Computer_Altered_Music_to.3.aspx
Ashok Gupta on Treating Long-Haul Covid: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325493/