Fig. 1

Therapeutic strategies for changing the cognitive, behavioral, emotional, and deconditioning-associated factors that might have impeded the recovery of this patient from post-COVID ME/CFS. The fatigue associated with post-COVID ME/CFS has been thought to be derived from the biological mechanisms associated with this condition. However, as the duration of the post-infection period lengthens, fatigue itself or the natural recovery from this condition might be modulated by a variety of factors. In our patient, two factors were thought to be associated with her ME/CFS. The schematic diagrams, although speculative, illustrate how these pre-treatment factors might have led to a vicious cycle and impeded her recovery and how the interventions facilitated her post-treatment recovery. a Cognitive/behavioral/emotional aspects: Before treatment, the patient’s coping strategies were based on maladaptive beliefs and her limited knowledge of the characteristics of the fatigue associated with this disease, i.e., physical, emotional, or cognitive exertion easily induced crashing and PEM. After treatment, her adaptive coping efforts were based on her acceptance of the condition and her increased knowledge of how to manage the fatigue associated with this condition. b Deconditioning-associated aspects. (-) indicates amelioration after treatment. ME/CFS: myalgic encephalomyelitis/chronic fatigue syndrome; PEM: post-exertional malaise