Addressing Post COVID Conditions

You are not alone.

I have been caring for patients with chronic and autoimmune illnesses for over twenty years. A subgroup of such illnesses came to light in the wake of the COVID pandemic. There has been an explosion of long term post-COVID symptom patterns that are debilitating and which impact multiple bodily systems simultaneously. Although research is continuing, these conditions are currently not well understood, with much of the medical community unable to offer answers or guidance to those who are challenged by such symptoms. Additionally, minimal support exists for those who find themselves in this group, whether due to long COVID (symptoms which developed and remained following a COVID infection) or long vax (symptoms which began following an adverse reaction to a COVID vaccine).  Often, affected individuals find themselves suffering in silence, with the impact and severity of their symptoms disbelieved or minimized by medical professionals and family members. Here you will find a soft place to fall, practical tools and resources that can address residual symptoms, and a refuge where you are supported and understood. A bit of disclosure as well: As a result of my own complicated recovery from a post-COVID illness, I understand on a personal level the far reaching impacts of this complex of symptoms.

Some of the most prevalent/common symptoms that are present with post-COVID disorders — and which can be addressed or mitigated by psychotherapy — include the following:

  • depression

  • anxiety

  • hopelessness

  • panic

  • sense of foreshortened future

  • grief

  • frustration

  • sense of failure

  • worry

  • uncertainty

  • anger

  • isolation

In addition to emotional and mental distress, research has demonstrated that vagus nerve dysfunction is common in those with post COVID symptom presentations. We’re going to talk about biology for a minute — take a deep breath and stick with me. Take this as slow as you need to — I promise that it will make sense when we are done, and will give you more understanding about the post COVID symptoms that you may be experiencing.

You may have heard of the “fight or flight” response to stressors or trauma — this is a response of the part of the nervous system known as the sympathetic nervous system. It has been postulated that in post COVID conditions, this sympathetic portion of the nervous system is overly active. There is also a corresponding underactivation of the parasympathetic nervous system, the part that initiates the relaxation response in the body.

In short, the body spends too much time in fight or flight mode, and has difficulty switching into a relaxation response.

The vagus nerve is an essential part of the body’s relaxation response. Its inflammation and dysfunction post COVID is felt to be a vital contributor to the symptom complex that is experienced.

A little bit about the vagus nerve itself (stay with me just a bit longer — this is where it will start to make more sense). The vagus nerve is one of the 12 cranial nerves in the human body that are responsible for sending electrical signals and impulses between our brain and other body parts. It directly affects the function of such organs as the heart, lungs, esophagus, stomach, large intestine and small intestine.  Often, the symptoms of post COVID conditions include challenges with heart rate, palpitations, increased sweating, respiratory rate, loss of appetite, nausea, vomiting, diarrhea. These symptoms are believed to be directly related to the inflammation of the vagus nerve.

Dysautonomia (also common in post COVID conditions) is also related to vagus nerve impairment. Such conditions include POTS (postural orthostatic tachycardia syndrome), cardiogenic syncope/vasovagal syncope (fainting due to sudden drop in blood pressure), and orthostatic hypotension.

If the vagus nerve was working appropriately, it would disengage the sympathetic nervous system and essentially turn off the fight or flight response. With the vagus nerve inflammation and dysfunction that happen in post COVID conditions, this ability to turn off the fight or flight response is severely impacted. As a somatic psychotherapist who has specialized in working with trauma survivors, I have actively worked with patients on learning to improve their ability to regulate the nervous system (and the vagus nerve in particular). Some of the modalities I have studied which may be beneficial include Hakomi Somatic Psychotherapy; Sensorimotor Psychotherapy; Trauma Sensitive Heartmath; Safe and Sound Protocol (based on Stephen Porges’ polyvagal theory); and Trauma Informed Stabilization Therapy.

Attuning to your physical symptoms in a mindful way and using techniques to address the vagal dysfunction can lead to decreased physical symptom frequency and intensity, as well as providing an increased sense of control in the midst of what often feels like a chaotic and powerless situation.