101 - Dr Sally Riggs - Long Covid & the Nervous System

Episode 101 of the Long Covid Podcast welcomes back Dr Sally Riggs for a chat about Polyvagal theory and how this relates to Long Covid. We talk through some Polyvagal strategies that can be tried as well as Sally's personal experience.

Episode #23 - Sally's previous episode

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(music - Brock Hewitt, Rule of Life)

Transcript

Jackie Baxter  
Hello, and welcome to this episode of the long COVID Podcast. I am delighted to welcome back Dr. Sally Riggs to the podcast today. Sally is a psychologist and has been living with long COVID for about three years. But she's also been using her professional skills to work finding things that can help. So we're gonna be talking about a whole load of stuff today. So a very warm welcome back.

Sally Riggs  
Thank you so much, Jackie. It's wonderful to be here again,

Jackie Baxter  
This is going to be really interesting. And we've just spent about 40 minutes talking about nothing. So we should probably get on with this now. So I'm sure many people will have heard your previous episode, which was episode 23, I discovered earlier, which feels like an awfully long way back. But for those that haven't, would you mind just maybe giving a quick overview of yourself and what it is that you do?

Sally Riggs  
Yes. So I am a psychologist by background, you can probably hear my somewhat still British accent, I grew up in the UK, I trained as a psychologist in the UK, I moved to the US about 15 years ago. And I'm based here in New York City, which is particularly relevant because New York City was the first place that got hit hard with COVID in March 2020. And I got sick right at the beginning, in fact, a week before our official lockdown started. And so I think that brings me up to sort of three and a half years. Although at this point I am more or less recovered. 

And gosh, I mean, I had the sort of classic. And I know we talked more about this in the first episode, but sort of getting worse and worse and worse throughout 2020. But still working and trying to run. I'm a runner by background, I run ultra marathons. Then 2021, really chronic fatigue very, very, you know, shut down, which we'll talk more about what that means in a moment. 

And towards the end of 2021, like probably most people listening, I tried all kinds of things. And you know, was somewhat understanding the idea that long COVID has an autonomic nervous system component, and that I needed to do some things to try and calm my nervous system. Even though I was a psychologist, I didn't really know much about that, we don't really get taught terribly much about nervous system stuff in grad school, and came across a thing called the safe and sound protocol, almost by accident in September of 2021, which is polyvagal intervention. And that was really the first thing that kick started my recovery. 

And then since that time, sort of December 21, I've gone into a huge rabbit hole, deep dive of learning polyvagal theory and all the stuff about the autonomic nervous system, particularly as it relates to us with long COVID. There's a lot out there that is really aimed at people who are spending most of their time in rest and digest. And most of us are the opposite of that. And so really understanding things from our perspective. 

I then started working with people with long COVID in January 2022. And have continued to do that for the last 18 months, sort of learning more as I went, working with more people, and building out various things for people with long COVID to help them in their journey.

Jackie Baxter  
Amazing. Yeah. So it sounds like you have been kind of learning learning as you go and learning from others as much as you've been learning from yourself. I think in a lot of ways. Maybe I mean, that's certainly what I've done. 

Sally Riggs  
Yes. 

Jackie Baxter  
So you mentioned lots of different things there. And we're going to dive into kind of all of this, I think, in the next wee while. But I think what would be really useful to start with would maybe be to give a bit of an overview of what polyvagal theory is and how that kind of relates to long COVID and the nervous system, because these are all big buzzwords that we kind of hear. But it might be a good place to start, I think.

Sally Riggs  
Yes. So polyvagal theory. It's a theory that was originally put forward by this guy, Dr. Stephen Porges, who is a scientist at the University of Indiana. And most of us will have heard at some point in our lives, probably in school, about the autonomic nervous system. And what most of us are originally taught is that it's two systems, parasympathetic, which is your rest and digest, and sympathetic, which most of us were taught is your fight, flight or freeze. 

Well, it actually turns out that it's three systems. And what's really interesting is that this comes from our physiology. So if you look at the nerves that make up our autonomic nervous system, you have got the sympathetic nerve, which obviously does our sympathetic stuff, which is fight or flight. And that basically runs from your brainstem down your spine. 

And then you've got this other thing called the vagus nerve, which we talk about a lot in long COVID. But it has two branches, the ventral branch, which starts actually in your face, and kind of goes into the top of your chest. And that does what we call social connectedness, which is your rest and digest. But it involves all of that human interaction, smiling, talking in a lovely warm voice, gratitude, self compassion, acceptance, all that lovely, warm and fuzzy stuff. 

And then there's the dorsal branch of the vagus nerve, which goes all the way down through every single organ system, into your gut. And that is the part of the nervous system that does freeze. And it's separate from the sympathetic system. And why this is super relevant to us is because freeze actually means shutdown. And it's a mechanism that we're born with. Babies are actually not born with rest and digest or the capacity to do that. They're just born with fight or flight, and shutdown. 

And this is where we get into the trauma stuff, or the beginnings of the trauma stuff. If for whatever reason, as a baby, when you go into fight or flight, you don't have a caregiver who picks you up and soothes you, we don't have a mechanism for soothing ourselves. And so at a certain point, that becomes dangerous to the body. And so it has this rip cord, which is the dorsal vagus, that shuts everything down, shuts down all your major organ systems, and you stay super still, don't waste any energy, until such time as somebody comes along and soothes you. And you can get back up the ladder, as we say, because we kind of tend to think of these stages as being sort of one on top of the other. 

And this is super, super relevant for us. Because you now know that the vagus nerve does get damaged in long COVID, probably by the spike protein. And it makes it such that it's very hard for us to do that rest and digest piece, and therefore the shutdown becomes much more dominant. And that shutdown is the chronic fatigue that we all experience, your gut slows down, your digestion slows down, you feel heavy, you don't have any energy. And it makes it very hard for us to do anything, and we feel awful. 

So when people are talking about You need to calm your nervous system, what we're actually talking about in long COVID is not - most of the time, we're not in fight or flight, we might have been for extended periods. And that's certainly part of the picture. But at a certain point, that shutdown mechanism takes over and we just are in permanent shutdown. 

And certainly, that's what was happening for me in 2021. I could barely get out of bed, I could barely take a shower. I was trying to work but I wasn't really managing to. And when I did the Safe and Sound Protocol in that September, that then sort of kick started my nervous system so that I could experience rest and digest again.

Jackie Baxter  
Yeah, it's fascinating, isn't it? And it makes so much sense when you explain it. Because I think something that both fascinated me and was maybe a bit comforting in some ways, because you know, when you have Long COVID, and when you're in the sort of early stages, and you're thinking what on earth is going on with me, my body is not my own, panic stations, everything is awful, that I think everybody has probably experienced on some level. It's a horrible, horrible time. 

And actually realizing that, although this is actually completely horrible, and there's absolutely no denying that, actually your body is trying to protect you. It's not that your body is like, I'm going to do this because it's going to annoy her or whatever. It's kind of, you know, 

Sally Riggs  
or that it's given up. 

Jackie Baxter  
Yeah, exactly. It's more we are doing this because we don't see any other option, we're going to shut you down because it is the safe thing to do. It's kind of like, you know, when the lights will come on in your car and the car goes, Okay, we're not going to run anymore, because we're going to explode.

Sally Riggs  
Yeah, it's kind of like going into hibernation and hiding out there until help comes. And unfortunately, then it does, you know, for most of us who've gone into that chronic fatigue state and that can go on, as we know, you know, from people who've had MECFS before long COVID was a thing, you know, for many, many, many years if we don't intervene. And so then it becomes dysfunctional that the body is trying to protect us, but we're just stuck in that shutdown state and we're like, Hey, I need to get out. And it's like, no, no, I'm still protecting you. And it's hard. 

I think one of the most fascinating things that I have learned in the last 18 months, and, you know, I hear people say this time and time again, you know, I'm in shutdown, or I'm in fight or flight, I need to get out,. When in actuality, the more we fight against those states, you know, it's like that the cartoon guy whose legs spin around, and he doesn't move anywhere, we're wasting all our energy, and we don't have very much, we don't have enough, just spinning our wheels. And actually, that isn't helping us to get anywhere, which is tough. 

So I think, you know, the autonomic nervous system understanding of long COVID has pretty much become mainstream, I think most people are aware of it. But the polyvagal theory understanding, I think, is new to a lot of people. And so there's lots of messaging out there about calming your nervous system or resetting your nervous system, as if there was some kind of magic reset button on the back that you could press. And there isn't, and it's a lot more complex than that. 

And learning to lean into these states, learning what the states feel like for you, most of us, especially because we've been super symptomatic for a very long time, and that's so uncomfortable, have gotten to a place where we kind of dissociate from that. And so we don't really focus in on our body because it's super uncomfortable. And we're just like trying to distract ourselves with telly, or audiobooks or whatever it is. And so when someone says, Okay, what nervous system state are you in right now? I don't know, I have no idea. Or we just guess, and we probably pick the wrong one. 

And so a big part of polyvagal work is learning you, learning your nervous system, what it looks like when you're in fight or flight, what it looks like when you're in shutdown. And also, which of your symptoms correspond to that? Because we know a lot of the symptoms that we have are autonomic nervous system generated - blood pressure, heart rate, hot and cold, even thirst and hunger, are all part of that autonomic system. 

And so when we're having all of those flare ups, you know, what does that mean? Does that mean that I'm actually going into fight or flight? Does it mean that I'm going into shutdown? Does it mean that I'm bouncing between the two? Figuring that out isn't easy. And I think that is some of the information that is missing from a lot of the stuff that's out there about calming your nervous system.

Jackie Baxter  
Sure. And I mean, you've just said that it can be very individual for different people. But are there specific, or certain maybe groups of symptoms that might be more certain states than others that you could run through a little bit?

Sally Riggs  
Yes, there are certain symptoms and also emotions that can be associated with the different states. So if we take fight or flight first, because that's the one that most people think about, you know, and have some vague familiarity with. 

So fight or flight, typically is what happens when we need to be performing in some type of way, either in like a crisis emergency or in something pleasant, like musical performance or recording a podcast or you know, somewhere where you're sort of on. And so what happens there is the blood runs away from our extremities, and concentrates on all of the kind of central things that are going on in your body. So that can mean that your heart rate goes up that you feel warmer. But it can also mean that you get anxiety or excitement, which are somewhat similar. 

And I think what's super relevant for us with long COVID in fight or flight is that's where you will get your diarrhea. That's where you will get your insomnia, that's where you will get your nightmares, hot flashes, hyper vigilance, panic, fear, anxiety, all of those things, which we all experience to a certain extent. And all of those are signs of being fight or flight. 

Now interestingly, for me, as I was learning this and plotting out my symptoms, one symptom that I get very commonly, which I believe is an MCAS symptom, is chest pain. And then when that goes on for a certain length of time, that turns into what they call coat hanger pain on my back, which is basically you imagine the shape of a coat hanger on your back. And that's where it hurts. And something that I figured out fairly quickly is the first sign for me that I'm in fight or flight is chest pain. And if that goes on and becomes coat hanger pain, then that usually means that I'm past the point of no return and I'm going into shutdown and I don't have any choice. 

So there may be symptoms that you have. You may not get chest pain, but you may get other things in your body that you can figure out, okay, that's a sign I've gone into fight or flight. And then where's my threshold? Can I? Can I do something? Can I move this energy through? Can I complete this sympathetic cycle and be okay? Or am I being pulled back into shutdown. And that's part of kind of what we're learning here. 

And then if we think about shutdown, obviously, I've already highlighted the fatigue, the heaviness, that's also where you're going to get no gut motility. So you're going to have constipation. And then that's also where that sort of numbness, lack of feeling comes in. But also can also be the sadness, the depression, that despair, the hopelessness, all of that kind of that we also experience very commonly with long COVID.

Jackie Baxter  
Yeah, so that's really useful. So one of the things I found very useful was my sort of like warning signals. So for example, for me, my breath was the thing that I always was my go to. So when I found my breathing was starting to speed up a little bit. That was when I went, Okay, this is probably where we should stop. This is where we should implement some deeper breathing, something else. Because otherwise, I'm going to start dipping down into places that I don't want to be. So really understanding what that kind of meant. 

And, you know, being able to kind of, not always, but sometimes stop it in its tracks before it got worse. Of course, if I ignored the breathing, or if I wasn't able to stop whatever I was doing, then, you know, things would then start to get worse and to spiral downwards. And I would end up in those places that I didn't really want to be. So that was definitely worth learning. So it's really kind of useful, isn't it, to understand partly what the kind of symptoms or the likely symptoms are going to be, but also, as you say, everybody's different. And everyone's going to have their own warning signals and their own sort of specific symptoms that crop up at certain times. 

Sally Riggs  
Yeah. 

Jackie Baxter  
So yeah, that's really, really interesting. So, I mean, you've mentioned the safe and sound protocol. And this was something that you said that you actually did first, and that it really kind of gave your nervous system a bit of a kick up the backside. I would love to hear a little bit about what it is to start with, and what it does.

Sally Riggs  
Yes, the safe and sound protocol is an intervention also designed by Dr. Stephen Porges. And it is an auditory intervention. So it is music that has been manipulated to tease apart the high and the low frequencies. And you are left just with the middle frequency. And there's something super special about the middle frequency, it's basically the frequency of human speech. And this is the frequency that communicates safety to our nervous system. 

So it's a passive intervention, because you are just basically lying back and listening to this music. It is five hours in total. But we listen to it very slowly. Because essentially, what it is doing is helping you to improve that vagus nerve functioning, or what we sometimes refer to as vagal tone and vagal flexibility. And it's working much like an elastic band, in the sense that if you have a brand new elastic band that is very tight, and it's not flexible at all, if you pull it really hard, it will just snap and you won't have an elastic band anymore, you'll just have a piece of string made out of elastic, so you want to stretch it gently and then let it contract back again. 

And so there's music, which has a sort of copyrighted algorithm for the frequency manipulation, sort of goes up and down in waves as to how much the frequency manipulation happens, similar to kind of stretching your vagus nerve like an elastic band and then letting it go back again. And so if we listen to it in two minutes, five minutes, maybe 10 minutes maximum bursts, then we are stretching our vagus nerve and increasing our vagal tone and our vagal flexibility. And over a period of time, then just by listening passively to this music, we are improving our nervous system.

And what happened for me, which was so interesting, even though I'm a psychologist and things like self compassion practice and gratitude practice have sort of been standard in the industry for years. I never really understood them. And I you know, would talk to my patients about them, but I had never really experienced them personally. And doing the SSP, I suddenly experienced these things for the first time in my life, possibly, you know, huge waves of gratitude, and suddenly the ability to accept my experience. And that was wonderful. 

But it was also sort of so eye opening. First of all, you know, there wasn't something wrong with me before, it was just that my nervous system was in a state where I couldn't access those things. And secondly, I've now done this intervention that allows that to open up and I have this possibility for all kinds of other experiences that I never thought were possible, necessarily. 

So something that has come up for me again, and again, and I hear this a lot from other people with long COVID, too, is that in our recovery journey, and especially, you know, even though we don't have approved, so called evidence based treatments, there's a lot of discussion and a lot of narrative about You should do this. And you should do this, and you should do this. And we all try a lot of things. And some of the time those things don't work. And it's very easy for us to get Oh what's wrong with me. Why isn't this work? Am I doing it wrong? Is there something wrong with me? 

The chances are, it's because your nervous system is not in the right state. And so you don't have access to those things. And so you know, people who say, Oh, it's all about acceptance, you have to accept that you've got long COVID, that this is going to be somewhat of a chronic illness. Well, that's lovely if you're in rest and digest, but if you're not in rest and digest, you can't access that. 

So for me, the safe and sound was a wonderful start to my recovery journey, it opened up the capacity of my nervous system much more than it had ever been before. And then it allowed me the opportunity to then go on this deep dive, learn much more about polyvagal theory, and the strategies that worked for me that I now implement, you know, on a minute to minute day to day basis throughout my life. 

So for example, I'm sitting here talking to you right now. To help my nervous system feel safe while I'm talking to you, I've got a weighted blanket in my lap, and I've got a rolled up towel in the exact right position to support my back, right behind me between the chair and my back. 

Now, that will be different for other people, what you might need is a weighted blanket around your neck, or thick socks on your feet or something on your wrists. But there are lots of teeny tiny little cues that our nervous system is responding to all day long, which are subconscious. They're not verbal, that it needs just to feel safe and feel anchored and feel comfortable. 

Jackie Baxter  
Yeah, that's really interesting. And I love what you were saying about, you know, being able to kind of understand things like the gratitude and the self compassion that actually, you weren't even able to get even before you were ill. So that's really, really interesting, isn't it that your nervous system is actually, you know, things have happened to it, to actually make it maybe in some ways better than it was?

Sally Riggs  
I would say? Yeah, definitely. Yeah. And I think that's something that many of us are finding with long COVID, that the nervous system thing didn't just start with the acute infection. That we had some dysregulation and things going on with our nervous system, you know, throughout our lives, which were totally understandable as maybe a result of things that we had been through throughout our lives.

And, you know, people talk about running on fumes, well, that is being in fight or flight for an extended period of time. And certainly that was something I used to do quite regularly. And I'm sure you used to do that too. And figuring that out and now changing my life so that that never is a question. There is never a push on through, there is never a running on fumes. My nervous system comes first for everything. And that is so wonderful to have the opportunity to do that.

Jackie Baxter  
Yeah, so you've just talked about the SSP. How would somebody listening go about accessing this.

Sally Riggs  
Yes. So the safe and sound protocol is it's a copyrighted five hours of music, which is available through practitioners who have been certified by the company that owns it. Stephen Porges created originally, it's now owned by a company called Unyte ILS. And in order to provide it to clients, you have to be trained and certified and have an active subscription. And we can put a link in the show notes to their database of practitioners. 

However, a couple of things that I would say - the safe and sound protocol is used for a wide number of therapeutic applications. And in order to be a certified practitioner, you don't have to be a licensed psychologist. You could be a chiropractor, or an occupational therapist or a yoga teacher, or a health coach. And some of those people will be incredibly skilled and know a great deal about Long COVID. And some of those people will know nothing about us and our experience in the world. 

And so, in fact, I think I have a video on my YouTube channel that talks through if you're looking for a safe and sound practitioner, these are the key things to look out for. Because it is a very powerful intervention. And something that's really important to keep in mind with all of this nervous system work, is that if we are predominantly in shut down, every single one of us has to go through fight or flight to get back to rest and digest, and fight or flight is not comfortable. And if we don't have the right support when we're there, that can be very overwhelming. And it can slam us further down into shut down for a longer period of time. 

And so it is important that you are doing it with somebody, personally, for long COVID I think it's really important that you do it with a practitioner face to face that you can either see them on a zoom screen, or you're meeting in person, although that gets tricky because personally, I do still wear a mask. And if I'm sitting in an office with somebody, and they can't see my face, then you're not really doing that co-regulation thing that you need. 

But ideally, you need someone who is certified and has a warm smiley face across from you, that can be there so that if your nervous system does get a little dysregulated as you're listening, they can re-anchor you and help you feel safe again.

Jackie Baxter  
Yeah, sure. And I think I remember you saying something a while ago that listening to this, you know, I guess maybe to do with the different nervous system states that you're going to be traveling through, that actually it can bring up some sort of quite heavy stuff in some people?

Sally Riggs  
Yeah, absolutely. Yeah. So looking out for a practitioner. Now, that being said, I do offer it in my practice. And we do have a number of different formats. We offer it in a group format, that is facilitated by health coaches that are trained and have personal experience with chronic illness and or even long COVID themselves. Or you can do it individually with me, or you can do it with one of my practitioners. 

But I appreciate there are millions of us out there with long COVID. And so we don't have the capacity to see absolutely everybody. So there may be somebody locally to you who is qualified, but just check them out, as per, you know, to make sure that they are understanding of our nervous system's reactivity, and that they're going to provide the right supports for you.

Jackie Baxter  
Yeah, definitely. Because the last thing you would want to do would be to do it in a situation that wasn't the right one for you. And actually not to get anything out of it, or even, heaven forbid, to make things worse.

Sally Riggs  
Absolutely. Yeah. Yeah. I mean, I guess the one thing I didn't say about it. So in terms of exactly how it's working physiologically in our body, and we're not totally sure, because obviously testing the inside of your body is a bit invasive. And doing that while you're listening to music is even more invasive. But it engages the muscles in the middle ear that connects into our vagus nerve, you know where it starts in the brainstem. 

And what I find super interesting as a psychologist, which is kind of getting into attachment theory, is that that sort of middle frequency, which is like human speech, basically while you're listening, it's kind of the same as simulating those early attachment experiments where you've got the mom and the baby, and the mom is talking in that lovely singsong voice and the baby is all soothed and content. 

And then you ask the mother to freeze her face and stop talking. And you literally watch the poor baby melt down into fight or flight. And then you tell the mother to come back and start being lovely and warm and the singsong voice again, and you watch the baby reorient into being soothed. 

And so basically, that's what that music is doing. And many of us did not get all of what we needed in our attachment as babies. And so this is kind of redoing that, and allowing your nervous system to sort of get that attachment soothing, except you're doing it to yourself, essentially, which is lovely.

Jackie Baxter  
Yeah, that's a really lovely way of looking at it. I like that. 

Sally Riggs  
Yeah. 

Jackie Baxter  
So I think the other thing that we were going to talk today is about your e-course, which I think is literally launching as we speak. And this is something that you have kind of developed using your own experiences of long COVID, and what has helped you I think, into something that people can access and kind of work through. But I'd love to hear a bit more about it, rather than me kind of spitballing.

Sally Riggs  
Yes, I'm really excited about this, Jackie, because I think it has sort of taken me 18 months, you know, to get this information together in my brain, and then to distill it into an online course. I think it started the idea for the course, you know, I would so frequently see people posting in the Facebook groups and things, how do I calm my nervous system? And my answer is always polyvagal strategies. But you know, that means nothing. What does that mean? What strategy you're talking about? Or how do I do it, and you can't write the answer in a Facebook post, and you can't even write it in one YouTube video. It's much more complex than that. 

So essentially, what I've done is I've taken everything that works for me. So it's all tried out on me. And there are in there some strategies that I say, you know, my body doesn't love this one, but other people do. So I'm putting it in here for you so that you can try it out and figure out, you know, what's going to go in your toolkit. And I work with individual clients, and I have been since January of last year. So a lot of this is tried and tested with the clients that I've worked with too. And we've put it into a format. 

So there are three modules. And so the first module is called Sensitivities, and it's helping you figure out your own nervous system. So there's stuff in there explaining polyvagal theory, why it's relevant to long COVID, lots about trauma and how trauma kind of relates to all of this. And then we help you to learn to track your own nervous system, not your symptoms. I know lots of doctors out there are telling people to track their symptoms. Actually, we're going to track on nervous system, which is much more helpful. 

And then we also go into, I think there are sort of five obstacles that most of us find sort of get in the way of doing this work. Perfectionism, which is something that you and I have talked about, and can both relate to,. Obviously, chronic fatigue can be a barrier to trying to do any work. Another big one is self criticism, which is huge for us, certainly has been huge for me, and I am still working on it. Insomnia is another one that we all struggle with and can get in the way of things. And I'm blanking on the fifth one, which is not memory problems. But there is a fifth one, anyway, there'll be a fifth obstacle in there, I promise. 

And then the second module is all the strategies, and we go through them one day at a time. So you only practice one strategy for that day, and you can't move on until you've practiced it. And then the next day, you get a new strategy. And you practice that all day, which is very important for getting our nervous systems to figure out - does this strategy work for me? Does it not? Do I need to tweak it, etc. 

And then the final module we call Support, which is really thinking more holistically - all the things in your life that support, or not, your nervous system, and how to kind of reconfigure those, so that ultimately you're putting together that dream life that we all want and can have, except now it's going to be different, because it's going to be supporting our nervous system from the start. And that is super exciting for me. 

Jackie Baxter  
Yeah, this sounds awesome. And is this kind of, because you know, you've just mentioned some of the kind of obstacles to doing Stuff. And you know, one of the things that we have problems with as long COVID people is things like fatigue and concentration even. So is this something that people can work through at their own pace, kind of as and when?

Sally Riggs  
Absolutely and I what I intended to do and trying to get the information in there, but still to keep the videos to as short as possible. So each lesson has a video, but you don't have to watch it by video, you can also just listen to an audio file, if right now your light sensitivity is too much for looking at videos. And we also have transcripts if you just want to read the transcript because you're at the point where your body can't do sound or visual. And trying to keep the videos between sort of five and 10 minutes. And obviously, you can also play it on 1.25 or 1.5 speed, so that it's not even as long as that. 

And then each lesson has some exercises or a worksheet or some type of homework for you to work on. And really sort of keeping it interactive, even sort of throughout the video. We sort of introduce the topic and then there are some questions for you to think about, and then we get into the material, and then we practice it together on the video, and then you get to do it by yourself. So really trying to make it sort of bite sized chunks. super accessible, you know, tailored to us as much as possible and modifiable as much as possible for what we need. Yeah. 

And I know that some people will get the course and try and do the whole thing in a weekend. But I through-out stress how important it is to go slowly and do pacing and take your time. And you have your time to watch it. So yes, I think from my mind, going slowly, and learning this stuff and implementing it and kind of absorbing it into your nervous system is the most important thing.

Jackie Baxter  
Yeah, because I suppose if we think about it, if you're trying to put yourself under all this pressure to do it all really fast, actually, you're sending the wrong signals to your nervous system anyway, aren't you really?

Sally Riggs  
Yes, exactly.

Jackie Baxter  
I also know that that is exactly what I would try to do. 

Sally Riggs  
I did the dynamic neural retraining system, I don't know if you've done that program. And I think I did the whole thing. I think it's meant to be done in three days. And I think I did the whole thing in one day. So you know, but that was well before I learned about my nervous system. And now I certainly wouldn't approach it in that way. 

What I'm also really excited for, Jackie, with this course, is that, obviously, there are lots of courses out there. And many of the ones that were existing pre-COVID, for other chronic illnesses, have very kindly welcomed us with open arms, and now include, "and for long COVID." And, you know, I'm all for inclusivity. And I think that's really important. And especially, you know, the MECFS community is huge. And having our cohort give weight to that has been such an important thing. 

And yet at the same time, long COVID, we have gone through so much gaslighting and discrimination and misunderstanding. And it's so lovely to have a course that every single sentence will have the phrase "long COVID" in it, and every single thing is tailored to us. So instead of, you know, I've done quite a lot of courses, you know, you listen to this course and it's for chronic pain. And every time they say chronic pain, you just have to say symptoms. There won't be any of that this will be 100% for us from start to finish. 

And what I've also found with nervous system stuff, you know, there are some courses out there that do talk about nervous system, but they don't fully appreciate the three levels. And so they're still just talking about sympathetic versus parasympathetic, which is totally missing 90% of our experience. Or they do understand the three levels, but they just say, "and you should calm your nervous system" with no instruction on exactly how to do it. 

And then there's tons of polyvagal stuff out there and wonderful books by Stephen Porges and Deb Dana, who is a social worker who does lots of polyvagal stuff, but they are all aimed at people who spend most of their time in rest and digest. And so the strategies that I've really chosen here, are much more attuned to our nervous systems. And, you know, I keep finding myself saying the words sort of "rudimentary" or "basic," which isn't really fair. But they're just personal to where we are now. 

You know, going for a walk in nature is lovely. But if I can't get out of bed to get to the bathroom, I'm not going for a walk in anything. And you know, if then I'm told, Well, why don't you open up YouTube and look at lovely pictures of nature on the YouTube? Well, what if my body is so stimulated, that opening up the YouTube is too much for it? So these are really back to basics, starting from total shutdown. And building from that point. If you are still in bed 24/7, you will still be able to do this course.

Jackie Baxter  
Amazing. Do you have maybe a favorite polyvagal strategy that you could just talk through, just as an example?

Sally Riggs  
Oh, gosh, that's a good question. Yes, I mean, to caveat, you're going to hear this out of context. So as I always say, you still need to learn what nervous system state you're in. And so if you don't know, you need to know that work, and just doing this strategy is not going to magically fix your nervous system. 

But one that I really love, and especially while I'm sitting at my desk here, is called Orienting. And it sort of comes from the idea that when our body has been through trauma and is in a heightened nervous system state, we can be hyper vigilant. And so we sort of only fixate on things especially, you know, the subconscious perception of our nervous system fixates on the things that are not safe, and that confirm that. And we don't take in all the details. And therefore we're not taking in all the other cues that could be calming our nervous system down and cueing it for safety. 

And so this strategy is called Orienting because you are essentially looking around to take everything in. And so what I do here because I have a window right behind my desk, which looks up the beautiful avenue here in New York, and so I have to take my glasses off to focus that far. But I'm really just looking and taking in everything I can see down at street level, there's people sort of wandering around, and cars, and yellow cabs and as much as I can see. 

And then if I come back into the room, which is also really important. So I'm then just going to take in all the way behind me all the way under the desk, and I'm just looking, looking, looking. So I'm not judging anything, I'm not sort of, Oh, my goodness, that's dirty, and I need to put it away, and oh, gosh, what's that suitcase, I'm just looking at what I can see. And just letting my eyes take it in, letting my eyes take it in, and especially the what's behind you, and what's underneath the desk, and what's above you, because that's all subconscious cues, that could be telling our nervous system that we're not safe. And we just want to let it know, there's nothing here, that's bad. 

And I find and I don't know, if you find as you were doing that a little bit as I was talking you through it. The things that then let us know that our nervous system is responding nicely to that type of an intervention, noticing that your body takes a deep breath, suddenly out of nowhere, which I noticed, just as I was about to continue talking, I got a big deep breath, or a yawn or a sigh, or noticing that your stomach is kind of softening. And so doing a strategy like that, and then paying attention to your body and just seeing what you notice. Does that lovely kind of calming sensation come over you? Are you noticing anything there, Jackie?

Jackie Baxter  
Yeah, I was just thinking, I wouldn't have said that I was remotely stressed, but then when you started talking about that. And I looked out the window and I thought, oh, there's trees and blue sky. And I feel actually more relaxed than I did. So there you go, it works. 

Sally Riggs  
Yes. So that's just a flavor of one of the strategies that will be in there. And what I particularly like, that's also important to stress. I think another thing that is talked a lot about in long COVID is fear, and how as part of our recovery, we need to stop being fearful of things. And that we do need to start doing things in a way that isn't fearful. And that's a message that you know, lots of people talk about. 

And one thing that I would want to qualify about that that is, absolutely fear is a big part of fight or flight. And cueing our nervous system for safety is never going to be a cognitive process. By which I mean, telling yourself that you're safe is never going to work. So there are people out there who will do like put your hand on your heart and say I am safe, I am safe, I am safe. Now, putting your hand on your heart could be a somatic practice that could cue your nervous system for safety. So as I do that, I do feel actually that my nervous system calms a little. But the words are irrelevant. 

What we are endeavoring to do, because our nervous system is this thing called neuroception, which is basically like all of the internal physiological information that tells your body that it's safe or not. And that includes perception. So stuff that comes in through your eyes, you know, the warmth around you, the sounds, the smells. Taking all of that in with orienting is going to cue your body that it's safe. Saying to your body, I'm safe, I can do this, I'm fine, don't have fear. It's okay. Those bits are irrelevant. It's the doing and the cueing that is important. Does that make sense?

Jackie Baxter  
So it's someone giving you a hug, rather than telling you that they love you?

Sally Riggs  
Yes, exactly. And Jackie, you can give yourself a hug. And that's another one of the strategies that is in the course. So we don't even need to wait for other people to help us out with stuff. And I think that's also the wonderful thing. If you have someone to give you a hug. That's amazing. And, you know, obviously through COVID, some of us weren't hugging for various reasons. And yet, you can still hug yourself, and cue your body to calm, which is wonderful.

Jackie Baxter  
Oh, that's such a lovely thing to finish on, I think. Well, thank you so much for joining me today. It's been so cool hearing about everything that you are doing and diving a bit deeper into it. So I'll make sure that all of those links go into the show notes. So if anyone's interested in following up any of that, then do check that out. And yeah. Thank you so much for giving up your time today.

Sally Riggs  
Thank you so much Jackie

Transcribed by https://otter.ai