COVID-19: Psychological flexibility, coping, mental health, and wellbeing in the UK during the pandemic
Open accessAbstract
The COVID-19 pandemic has profoundly altered the daily lives of many people across the globe, both through the direct interpersonal cost of the disease, and the governmental restrictions imposed to mitigate its spread and impact. The UK has been particularly affected and has one of the highest mortality rates in Europe. In this paper, we examine the impact of COVID-19 on psychological health and well-being in the UK during a period of 'lockdown' (15th-21st May 2020) and the specific role of Psychological Flexibility as a potential mitigating process. We observed clinically high levels of distress in our sample (N = 555). However, psychological flexibility was significantly and positively associated with greater wellbeing, and inversely related to anxiety, depression, and COVID-19-related distress. Avoidant coping behaviour was positively associated with all indices of distress and negatively associated with wellbeing, while engagement in approach coping only demonstrated weaker associations with outcomes of interest. No relationship between adherence to government guidelines and psychological flexibility was found. In planned regression models, psychological flexibility demonstrated incremental predictive validity for all distress and wellbeing outcomes (over and above both demographic characteristics and COVID-19-specific coping responses). Furthermore, psychological flexibility and COVID-19 outcomes were only part-mediated by coping responses to COVID-19, supporting the position that psychological flexibility can be understood as an overarching response style that is distinct from established conceptualisations of coping. We conclude that psychological flexibility represents a promising candidate process for understanding and predicting how an individual may be affected by, and cope with, both the acute and longer-term challenges of the pandemic.
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ACT-based interventions led to significant reductions in depression and stress symptoms in pandemic-exposed populations, with long-term effects persisting months after initial treatment.
“Several studies demonstrated that ACT-based interventions led to significant reductions in depression and stress symptoms in pandemic-exposed populations, with long-term effects persisting months after initial treatment [179].”
From Impact of Media-Induced Uncertainty on Mental Health: Narrative-Based Perspective. (2025) · cites this paper as [179]
The Discussion reports a cross-sectional association between psychological flexibility and distress and says the study cannot determine the direction of that association. It proposes examining whether interventions might help; the Conclusion says such approaches warrant further investigation. It does not report ACT treatment effects or months-long follow-up. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredAcceptance-based coping is a pathway to coping with the psychological repercussions of the COVID-19 pandemic.
“Acceptance-based coping is another pathway to coping with the psychological repercussions of the COVID-19 pandemic (Dawson & Golijani-Moghaddam, 2020;Gurvich et al., 2021).”
From RESILIENCE, COPING, AND THE COVID-19 PANDEMIC ACROSS THE GLOBE – AN UPDATE: WHAT HAVE WE LEARNED? (2023) · cites this paper as Dawson & Golijani-Moghaddam, 2020
The Measures section distinguishes the active, willing acceptance involved in psychological flexibility from passive acceptance as a coping response. The Conclusion says approaches targeting psychological flexibility may hold promise for managing the pandemic’s psychological impact, but it does not establish acceptance-based coping itself as an effective pathway. (LLM, conf=0.82)
Experimental — accuracy not yet measuredDuring the pandemic, psychological flexibility predicted wellbeing, stress, depression, and affect.
“Supporting this, PF was found to predict wellbeing, stress, depression and affect during the pandemic (Dawson & Golijani-Moghaddam, 2020; Gloster, Lamnisos et al., 2020).”
From Behind the masks: A cross-sectional study on intolerance of uncertainty, perceived vulnerability to disease and psychological flexibility in relation to state anxiety and wellbeing during the COVID-19 pandemic (2021) · cites this paper as Dawson & Golijani-Moghaddam, 2020
The Results (Regression analyses; page unavailable) report that psychological flexibility predicted wellbeing and distress outcomes during the pandemic, including depression and COVID-19-specific distress. The paper does not identify affect or a separate stress measure among those outcomes, so the full list attributed to it is not supported. (LLM, conf=0.84)
Experimental — accuracy not yet measuredA growth of literature has identified psychological flexibility as an underlying process surrounding increases in mental health difficulties related to the COVID-19 pandemic.
“A growth of literature has identified psychological flexibility as an underlying process surrounding the dramatic increases in mental health difficulties related to the COVID-19 pandemic (Dawson & Golijani-Moghaddam, 2020; Kroska et al., 2020; Pakenham et al., 2020).”
From ACTing towards better living during COVID-19: The effects of Acceptance and Commitment therapy for individuals affected by COVID-19 (2022) · cites this paper as Dawson & Golijani-Moghaddam, 2020
The Abstract describes psychological flexibility as a promising candidate process for understanding and predicting how individuals are affected by the pandemic, and the Discussion reports elevated clinical distress in the UK sample. But the Discussion also says the cross-sectional data cannot establish directionality, so the paper does not establish psychological flexibility as an underlying cause of the increase in mental health difficulties. Page numbers are not available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredACT-based interventions might provide people with a buffer against detrimental impacts of the pandemic and everyday anxiety and fear-inducing challenges.
“ACTbased interventions might provide people with abuffer against detrimental impacts of the pandemic and everyday anxiety and fear-inducing challenges (Kashdan et al . 2020; Dawson and Golijani-Moghaddam 2020; McCracken et al . 2021).”
From Recent findings in the pathogenesis and treatment of fear and anxiety (2022) · cites this paper as Dawson and Golijani-Moghaddam 2020
The Conclusion (page unavailable) says that approaches targeting psychological flexibility may hold promise for managing the psychological impact of COVID-19. The Measures section identifies psychological flexibility as a process conceptualised within ACT. The paper does not extend its intervention proposal to everyday anxiety- and fear-inducing challenges outside the pandemic. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Mindfulness, psychological flexibility, and psychological mindedness have been determined as factors that can directly affect the levels of psychological distress.
“mindfulness, psychological flexibility, and psychological mindedness (PM) have been determined as factors that can directly affect the levels of psychological distress”
From Fear of COVID‐19 and COVID‐19 stress and association with sociodemographic and psychological process factors in cases under surveillance in a frontline worker population in borneo (2021) · cites this paper as [27]
The Discussion (page not provided) reports a direct statistical relationship between psychological flexibility and distress. It also says the cross-sectional data cannot establish the direction of that relationship, so the claim that flexibility directly affects distress overstates the finding. The passages do not establish the claim for mindfulness or psychological mindedness. (LLM, conf=0.89)
Experimental — accuracy not yet measuredPsychological inflexibility exacerbates the detrimental impacts of COVID-19 on mental health.
“Results from additional research have consistently demonstrated that psychological inflexibility exacerbates the detrimental impacts of COVID-19 on mental health (Dawson and Golijani-Moghaddam, 2020; Kroska et al., 2020; Pakenham et al., 2020).”
From Dealing With the Pandemic of COVID-19 in Portugal: On the Important Role of Positivity, Experiential Avoidance, and Coping Strategies (2021) · cites this paper as Dawson and Golijani-Moghaddam, 2020
The Abstract reports that, in a UK lockdown sample, greater psychological flexibility was associated with better wellbeing and less anxiety, depression, and COVID-19-related distress. But the Discussion says the cross-sectional, correlational data cannot establish directionality. Thus the study supports an association, not the claim that inflexibility exacerbates COVID-19’s mental-health impacts. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredInterventions focusing on emotional regulation, cognitive flexibility, and acceptance are particularly effective for older individuals who may struggle with rumination and excessive worry when faced with distressing news.
“Such interventions, which focus on emotional regulation, cognitive flexibility, and acceptance, are particularly effective for older individuals who may struggle with rumination and excessive worry when faced with distressing news [178,179].”
From Impact of Media-Induced Uncertainty on Mental Health: Narrative-Based Perspective. (2025) · cites this paper as [179]
The Results (Correlational and Regression analyses; page not provided) link psychological flexibility with better wellbeing and less COVID-19-related distress and worry. But the study is cross-sectional, not an intervention trial, and does not show that such interventions are particularly effective for older individuals or address rumination in response to distressing news. (LLM, conf=0.88)
Experimental — accuracy not yet measuredCOVID-19 related findings show that psychological flexibility has direct effects on wellbeing.
“This finding is also consistent with COVID-19 related findings that PF has direct effects on wellbeing (Dawson & Golijani-Moghaddam, 2020; Gloster, Lamnisos et al., 2020; McCracken et al., 2021) and a moderating role between the psychological impacts of COVID-19 and mental health outcomes and wellbeing (Chong et al., 2021; Crasta et al., 2020; Daks et al., 2020; Pakenham et al., 2020; Smith et al.”
From Behind the masks: A cross-sectional study on intolerance of uncertainty, perceived vulnerability to disease and psychological flexibility in relation to state anxiety and wellbeing during the COVID-19 pandemic (2021) · cites this paper as Dawson & Golijani-Moghaddam, 2020
Certain psychosocial studies point to psychological flexibility as a key target for treating and helping affected individuals recover.
“Some of these identify psychological flexibility, or the ability to act with openness, awareness, and engagement (Hayes et al., 2006) as an important target in the treatment and recovery of those adversely affected”
From Health, well-being, and persisting symptoms in the pandemic: What is the role of psychological flexibility? (2022) · cites this paper as Dawson & Golijani-Moghaddam, 2020
Psychological flexibility forecasts how well people handle COVID-related distress beyond other known coping factors in various populations.
“literature from across multiple populations demonstrates that psychological flexibility predicts ability to cope with COVID-related distress over and above previously identified coping-factors (Dawson & Golijani-Moghaddam, 2020; Gloster, Lamnisos, et al., 2020; Pakenham et al., 2020).”
From ACTing towards better living during COVID-19: The effects of Acceptance and Commitment therapy for individuals affected by COVID-19 (2022) · cites this paper as Dawson & Golijani-Moghaddam, 2020
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- Authors
- Dawson, D. L., & Golijani-Moghaddam, N.
- Affiliations
- University of Lincoln (GB)
- Venue
- Journal of Contextual Behavioral Science
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 17
- Pages
- 126-134
- ISSN
- 2212-1447 (ISSN-L)
- PMC
- PMC7392106
- OpenAlex
- W3046001566
- Cited by
- 445
- References
- 72
- Citations by year
- 2026: 21 · 2025: 41 · 2024: 55 · 2023: 83 · 2022: 109 · 2021: 122 · 2020: 13 · 2013: 1
- FWCI
- 32.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Contextual Behavioral Science (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Lincoln Repository (University of Lincoln) (acceptedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
- Keywords
- COVID-19 pandemic, psychological flexibility, coping, mental health, well-being, lockdown, anxiety, depression, avoidance coping, approach coping, United Kingdom
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