One of the patterns I see in neuroplastic recovery from conditions such as ME/CFS and Long COVID is that people can begin to feel better, understandably get excited about having more life available to them, and then start pushing hard back into it. More work. More exercise. More socialising. More appointments. More stimulation. More catching up on everything illness took away. It is something I work carefully with people on, once they are back to work, to ensure they are mindful, attuned, paying attention to their default patterns they may have learned a long time ago of pushing, doing more, being busy.
When any of who have had these conditions neglect ourselves emotionally, or physically, after a period of doing really well, they can unfortunately crash again. This can feel incredibly frightening. It can seem as though recovery has disappeared or that the body has somehow gone backwards. But there is another way we can understand what may be happening.
First, ME/CFS and Long COVID are not simply nervous system conditions. Both can involve complex immune, autonomic, metabolic and vascular changes, and post-exertional malaise (PEM) is particularly important to recognise in ME/CFS and in people with Long COVID who experience it. Neuroplasticity should never be used to dismiss these biological realities. We are essentially an under nourished society; physically, emotonially and spiritually.
Our nervous system is also part of this whole-body system. And learning how to move flexibly between activation and restoration can be an important part of recovery along with nourishing our physical needs. Our bodies are rhythmic by nature. We mobilise and we recover. We focus and then soften. We connect and then need time alone. We exert ourselves and then replenish. Regulation does not mean being calm all the time. A healthy nervous system should be able to mobilise. We need sympathetic energy to work, exercise, travel, play, have difficult conversations, get excited and engage fully with life.
The important part is being able to come back out of that activation again. When someone has been very unwell or living a restricted life for a long time, new energy can feel precious. We want to use it. And there can also be enormous pressure to prove that we are better, make up for lost time or finally get our old life back. But capacity often returns gradually and unevenly. Feeling more energy does not necessarily mean that our brain and body are ready to sustain continuous demand.
If we repeatedly override tiredness, sensory overload, emotional needs or the signals asking us to slow down, we can gradually find ourselves spending more and more time in sympathetic mobilisation. Fight/flight can be obvious, but it isn't always panic. It can look like being constantly busy. Feeling wired but tired. Difficulty stopping. Racing thoughts. Irritability. Poor sleep. Internal pressure. Hypervigilance. Trying to squeeze one more thing into the day. Or becoming intensely focused on getting better and getting life back.
Women may be especially vulnerable to these conditions, with important sex differences in the hormonal, immune and autonomic systems that shape how our bodies respond and adapt to stress. And then there is the sheer load many women carry. We were told we could “have it all”—and I am deeply grateful to the women who fought for our right to work and participate fully in society—but for many women, work was added without the caregiving, mental load, emotional labour and household responsibility being taken away. Research confirms that women still carry disproportionately more unpaid labour, and that this additional burden is associated with poorer mental health in working women. Without enough time to replenish, the cumulative cost of continually adapting to demand can show up across our stress, metabolic and hormonal systems. Sometimes illness is where we finally discover that the way we have been living simply isn't sustainable.
The nervous system is continually receiving information from both inside and outside the body and making predictions about what is required to keep us safe. If activation repeatedly exceeds our current capacity, particularly without enough recovery, sleep, nourishment, emotional processing and experiences of safety, the overall message can begin to become: there is too much happening and I don't have enough resources for this. And fight/flight is expensive. If the brain perceives that mobilisation isn't solving the problem and the demands continue to feel bigger than the resources available to meet them, another protective strategy can emerge: shut down.
Suddenly the person who had been doing so much better may experience profound fatigue again. Brain fog. Heaviness. Withdrawal. Increased symptoms. Emotional flatness. Loss of motivation. That unmistakable feeling that the entire system has simply said, “No more.” This does not mean that everything we learned has disappeared. It may mean that your system needs something different from you. Rather than seeing shutdown as the enemy, we can become curious about why the brain and body might have decided that conserving energy and reducing engagement was necessary again.
Did I move from healthy activation into fight/flight?
Did I stop listening to my body's rhythms once I started feeling better?
Did I fill every bit of new capacity rather than allowing some capacity to remain?
Did I begin overriding myself again?
Did recovery quietly become another place where I learned to abandon my own needs?
These questions are very different from asking, “What did I do wrong?”
And there is an important distinction here around PEM. In ME/CFS, post-exertional malaise is a defining feature of the illness, and many people with Long COVID experience PEM too. A significant post-exertional deterioration should not automatically be interpreted as the brain becoming frightened or as something to push through. Appropriate pacing respecting our innate needs (both physical, emotional, energetic), medical care and respect for genuine physiological limits matter. But pacing does not have to mean teaching ourselves that activity is dangerous either. This all or nothing, boom and bust, is PART of healing the conditions as we learn that there is actually a middle path, a new way of living that might be very new to us.
We can gradually expand our lives while also developing a much more intimate relationship with our own capacity and our own needs. We can learn what healthy mobilisation feels like in our body and what it feels like when that energy begins tipping into fight/flight. We can notice the earliest signs of overload rather than waiting until the body has to scream. We can build small moments of downshifting into active days rather than needing enormous periods of recovery afterwards.
Most importantly, we can stop making our bodies responsible for forcing us to rest. We want the brain to repeatedly experience: I can mobilise and come back down. I can do things and recover. I can have energy without using every last drop of it. I can notice my needs and respond to them. Activation has an ending. Rest is available before I collapse. Those are powerful experiences of safety.
Over time, this is how we build greater flexibility and capacity. Not by remaining permanently inside a tiny comfort zone, but not by bulldozing our way out of it either. Recovery is not about proving to the brain that you can push harder.
It is a dance; an art of helping the brain and body discover that more and more of life can be experienced without overwhelm. The aim isn't “never activate.” The aim is being able to move into energy and back into rest. Into challenge and back into safety. Into the world and back home to yourself.
That flexibility is genuine regulation. And for the highly sensitive people I work with, part of the deep lessons of these conditions is learning to expand without abandoning ourselves along the way. This is how over time, sometimes a much longer period of time than social media shows us, we begin to live a sustainable recovery in contact with the world, and with ourselves.
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