Understanding psychological flexibility in long COVID: associations with stress, fatigue, and somatic symptom burden.

Psychological flexibility is a therapeutically modifiable construct that has been associated with lower symptom burden in multiple chronic condition populations, but its role in long COVID remain unclear. This study explored associations between psychological flexibility processes (openness to experience, behavioral awareness, valued action) and stress, fatigue, and somatic symptom burden in long COVID. A total of 379 U.S. adults with long COVID participated in a 2023 cross-sectional online survey. Participants were convenience sampled from mass email and social media platforms. The average age was 41.9 years, with most identifying as female (53.3%), White (87.9%), and not Hispanic or Latino/a/x (85.2%). Hierarchical linear regression models assessed the association between individual psychological flexibility processes (CompACT-15) and stress (PSS-10), fatigue (PROMIS Fatigue-6), and somatic symptom burden (SSS-8), with a significance level of p < 0.05. Moderate-to-high stress (80.3%), high fatigue (T = 60.65), and high or very high somatic symptom burden (70.5%) were common among participants. Behavioral awareness (β = -0.32, p < 0.001) and valued action (β = -0.23, p < 0.001) were each significantly negatively associated with stress. Behavioral awareness was negatively associated with fatigue (β = -0.22, p < 0.001) and somatic symptom burden (β = -0.20, p < 0.001), while openness to experience was positively associated with fatigue (β = 0.25, p < 0.001). Behavioral awareness appears to be particularly impactful in explaining fatigue and somatic symptom burden among individuals with long COVID. Future studies may explore psychological flexibility interventions, particularly those focusing on behavioral awareness, for improved outcomes. [ABSTRACT FROM AUTHOR]