Community Submissions
By Krista Francis, PhD, RCH
For many in our community living with Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or Long COVID (also known as Post-COVID syndrome), daily life can feel like a constant calculation of energy. One of the most challenging aspects of these conditions is a phenomenon known as Post-Exertional Malaise (PEM). Understanding PEM and exploring supportive therapies like hypnotherapy can offer new paths toward management and recovery.
What is Post-Exertional Malaise (PEM)?
Post-Exertional Malaise is a hallmark symptom of both CFS and Long COVID. It is defined as a significant worsening of symptoms following physical, mental, cognitive, or emotional effort (Steinacker et al., 2022). Unlike typical tiredness that improves with rest, PEM often involves:
Delayed "Crashes": Fatigue and other symptoms may not appear immediately but can occur hours or days after the triggering activity (Steinacker et al., 2022).
Prolonged Recovery: A PEM "crash" can last for several days or even longer, making traditional rehabilitation—which often focuses on increasing activity—difficult and sometimes counterproductive (Steinacker et al., 2022).
Multi-Organ Impact: Beyond simple exhaustion, PEM can involve neurocognitive impairment (often called "brain fog"), muscle pain, and headaches (Steinacker et al., 2022).
How Can Hypnotherapy Help?
While PEM is a physiological challenge, research suggests that hypnotherapy can be a valuable tool in managing the nervous system's response to the condition.
1. A Tool for Neuroplasticity Hypnosis is defined as a state of consciousness involving focused attention and reduced peripheral awareness that enhances a person's capacity to respond to therapeutic suggestions (De Benedittis, 2022). From a neurobiological perspective, hypnosis acts as a "bridge" that allows us to influence the central and peripheral nervous systems (De Benedittis, 2022). Research indicates that hypnotic states can actually "decouple" certain brain processes, helping the brain process information more efficiently and with less stress (De Benedittis, 2022).
2. Managing Symptoms and Stress Studies have shown that psychotherapy and hypnosis can have measurable, long-lasting impacts on brain function and metabolism (De Benedittis, 2022). For those with PEM, hypnotherapy can help:
Manage fatigue and pain (Hammond, 2001).
Reduce the "mental drifting" and confusion associated with cognitive impairment (Hammond, 2001).
Regulate the body's stress response, which is crucial since emotional stress can also trigger PEM (De Benedittis, 2022).
Evidence in Practice: A Case Study
A notable study detailed the treatment of a 21-year-old CFS patient who suffered from severe cognitive impairments and fatigue (Hammond, 2001). The patient experienced "mental drifting" and exhaustion after just 2-4 hours of activity (Hammond, 2001).
As part of her treatment, she was trained in self-hypnosis, which she practiced for 3-4 minutes several times a day to manage stress and maintain balance (Hammond, 2001). The results were significant:
She showed considerable improvement in her levels of fatigue, vigor, and mental clarity (Hammond, 2001).
These improvements were not just temporary; they were maintained at follow-up tests 5, 7, and 9 months later (Hammond, 2001).
A Path Forward
Living with PEM requires a careful strategy, often involving "pacing" to avoid crashes (Steinacker et al., 2022). Incorporating hypnotherapy or self-hypnosis training can provide an additional layer of support, helping to harmonize the brain's activity and improve overall quality of life. If you are struggling with Long COVID or CFS, consider speaking with a professional about how these mind-body techniques might support your specific journey toward health.
Thank you, A, for asking me to write about this topic. If you have a topic you'd like me to write about, feel free to contact me at hello@kristafrancis.ca
References
De Benedittis, G. (2022). The potential role of hypnosis and neurofeedback in linking neuroscience to psychotherapy. The International Journal of Clinical and Experimental Hypnosis.
Hammond, D. C. (2001). Treatment of chronic fatigue with neurofeedback and self-hypnosis. NeuroRehabilitation, 16(4), 295-300.
Steinacker, J. M., Kirsten, J., Schulz, S. V. W., Jerg, A., Kersten, J., Matits, L., & Schellenberg, J. (2022). Rehabilitation after COVID-19 – the challenge of post-COVID syndrome with post-exertional malaise. German Journal of Sports Medicine, 73(5), 163-166. https://doi.org/10.5960/dzsm.2022.539