The Brain Retraining Debate Is Missing the Point

Why Understanding Recovery May Matter More Than Winning the Argument

Brain retraining is by far the most polarizing topic in chronic illness communities. Let’s just say that the idea that you can rewire neural pathways to eliminate symptoms in conditions like long COVID and myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) sounds, to some, farfetched at best and reprehensible at worst.

For most people in these communities, brain retraining is a pseudoscience that psychologizes illnesses that are clearly biological in nature. For others, brain retraining is a ray of hope in the dark tunnel that is a chronic illness. And for perhaps an even smaller minority, these approaches were the answer, the cure, the thing that led to meaningful improvement or even a full recovery after years of suffering.

I understand all three perspectives.

I was skeptical of brain retraining and neuroplasticity-based approaches myself when I’d first heard about them in chronic illness forums and communities online. I did not believe my illness was psychological. I did not believe I was sick because of my thoughts. I did not believe I could simply “think” my way out of the devastating condition that is long COVID.

And I still don’t believe those things.

What changed my mind was not a theory. It was an outcome.

After trialing more than 80 pharmacological and non-pharmacological interventions, I experienced a near-complete resolution in symptoms thanks to brain retraining, a result that I struggled to explain through any other plausible mechanism.

This experience made me stop and assess the state of the field when it comes to recovery from long COVID and ME/CFS. I could only ask: If people are recovering, shouldn’t we be trying to understand why?

The Debate We Are Actually Having

Much of the debate around brain retraining focuses on deciding which category it belongs in: legitimate treatment or pseudoscience. But this framing misses the central issue, in my opinion.

The important question isn’t whether every explanation offered by brain retraining and neuroplasticity-based programs is correct. Many of them likely are not. The important question is: Why are people recovering, and is there a plausible biological mechanism through which changing brain function could improve symptoms in chronic illnesses like long COVID and ME/CFS?

And the answer to that question is clearly yes.

The brain regulates autonomic function, immune function, inflammation, hormone production, perception of fatigue, pain processing, sensory processing, threat detection, motivation, behavior, and countless other physiological systems. Scientists do not dispute this. The real argument isn’t whether the brain influences biology. It’s whether interventions that target brain function can bring about meaningful improvement in chronic illness symptoms.

Knowing what we know about neuroscience and the ways in which the brain works, it would be surprising if they could not.

Are Brain Retraining Programs Just Pseudoscience?

A lot of people with chronic illnesses like long COVID and ME/CFS view brain retraining and neuroplasticity-based programs as little more than pseudoscientific businesses selling false hope to desperate people.

I understand why. Chronic illness communities are full of false claims about treatments, expensive programs, and coaches that promise far more than they can deliver.

At the same time, I think it is a mistake to dismiss every brain retraining or neuroplasticity-based approach or program as pseudoscience simply because some of the marketing surrounding them is poor.

The central idea (that changing patterns of brain activity can influence physical symptoms) is not inherently pseudoscientific. In fact, neuroscience has demonstrated time and time again that the brain can alter countless physiological processes.

The question is not whether the brain influences the body. The question is whether specific interventions meaningfully leverage those mechanisms in long COVID and ME/CFS. That is a question that deserves investigation rather than dismissal.

A False Choice Between Biology and Mind-Body Approaches

One of the biggest misconceptions in this space is the idea that you cannot believe in a biologically caused illness and also believe it can be helped by approaches that focus on the mind-body connection. This is simply not true.

A person can have viral persistence and still benefit from brain retraining.

A person can have autoantibodies and still benefit from brain retraining.

A person can have autonomic dysfunction and still benefit from brain retraining.

A person can have measurable physiological abnormalities and still improve through interventions that alter neural activity.

In medicine, it is common to accept that the brain can influence or cause physical symptoms in other conditions.

Chronic pain, stroke rehabilitation, phantom limb pain, functional recovery after injury, and placebo effects all show just how powerful the brain is and how much it can alter our physiology.

But when similar ideas are discussed in chronic illness communities, they are interpreted as if they are denials of any underlying biological abnormalities.

But I don’t believe brain retraining and mind-body approaches work because the illness is psychological. I believe they work because the brain itself is biological.

What If Autoantibodies Are Real?

An objection I have heard in the long COVID community is that long COVID presents with biological abnormalities such as autoantibodies, microclots, immune dysfunction, inflammation, autonomic dysfunction, and more.

I agree.

But the fact that a plethora of scientific research points to biological deficits in long COVID doesn’t help us determine whether those abnormalities are driving symptoms, simply contributing to symptoms, or are part of a larger self-sustaining system.

For example, it could be that autoantibodies initially cause symptoms but don’t maintain them. In a scenario such as this, it could be that interventions targeting neural pathways might reduce symptoms even though an original biological trigger existed. Such interventions could potentially even reduce symptoms despite the continued existence of the original biological trigger.

This is just an example, though, and the point isn’t whether this is correct or incorrect.

The point is that biological mechanisms and brain-based mechanisms can coexist.

Brain Retraining Does Not Need to Repair Every Abnormality

A common criticism is that brain retraining does not address the underlying pathophysiology.

This might be true. Oh, but if only we knew the underlying pathophysiology! But alas, we do not.

In fact, we might know that abnormalities in long COVID and ME/CFS exist, but we still don’t fully understand whether they are causing the illness, whether they are simply downstream consequences of other causal processes, or whether they are responses the body is using to adapt to the illness.

But if an intervention like brain retraining improves symptoms, then understanding that intervention’s mechanisms for recovery becomes a scientific question worth investigating.

The Recovery Data Problem

One of the most interesting aspects of the long COVID and ME/CFS communities is that little attention is paid to people who recover.

Across other disease areas, recovery is treated as an important source of information.

In these disease areas, researchers often get curious about recovery and ask questions like: What changed? What interventions were used? What patterns are we seeing across recovery events? What mechanisms might explain improvements?

But when someone who had long COVID or ME/CFS recovers, they are often dismissed, ignored, accused of never having been sick, or told that their experiences are dangerous to discuss.

I find this deeply concerning.

Recovery stories are not scientific proof, but they are observations. And observations have historically been the starting point for scientific discovery.

Why People Become Angry

Another thing that I am intrigued about, but not surprised about, is the emotional intensity and flat-out outrage surrounding this topic.

People rarely become this angry about interventions they believe are ineffective—and even those which are harmful to some people.

Lots of interventions harm patients with chronic illnesses. Of the 80+ interventions I trialed, at least two made me significantly worse, one to the point of feeling like I was barely making it without being nearly bedbound.

But you never hear outrage about pharmacological treatments that make some patients worse. People usually just provide feedback that those treatments didn’t work for them, and everyone moves on.

But when it comes to mind-body approaches and brain retraining, the reaction often seems to be driven by something deeper. Many patients have been told their illness is psychological when it was not. Many have been dismissed, harmed, abandoned, or denied care. And as a result, any discussion involving the brain is often interpreted as another attempt to deny the reality of the illness.

That fear is understandable.

But acknowledging a role for the brain is not the same thing as saying an illness is imaginary.

The brain is not the opposite of biology.

The brain is biology.

What I Would Like to See

I am not asking people to accept brain retraining uncritically.

I am asking for scientific curiosity.

I would like to see rigorous scientific research examining why some people improve.

I would like to see studies comparing different recovery pathways.

I would like to see researchers investigate neural mechanisms alongside immune mechanisms, metabolic mechanisms, vascular mechanisms, and infectious mechanisms.

Most of all, I would like to see us stop treating biological and brain-based explanations as competing camps, especially because the most likely answer may ultimately involve both.

Long COVID is extraordinarily complex, after all, and there, of course, might be multiple systems interacting, which should not be controversial.

My Position

My position is simple:

1. I do not know exactly why brain retraining helps some people.

2. I do not think we have enough evidence to claim that brain retraining works for everyone, or even for most people.

3. I do not think improvement proves that long COVID and ME/CFS are psychological.

4. I do not even necessarily think biological abnormalities disappear simply because symptoms improve.

What I do think is that recovery deserves investigation.

When people improve, science should become more curious, not less.

The question is not whether recovery should be believed.

The question is: Are we willing to learn from it?