COVID-19 and processes of adjustment in people with persistent pain: the role of psychological flexibility

“…in fl exibility, including the Patient Health Questionnarie-9 (PHQ-9) [18] to measure depression, the Generalized Anxiety Disorder-7 (GAD-7) [19] to measure anxiety, the Insomnia Severity Inventory (ISI) [20] to measure insomnia, and the Multidimensional Psychological Flexibility Inventory…”

“…Patient Health Questionnarie-9 (PHQ-9) [18] to measure depression, the Generalized Anxiety Disorder-7 (GAD-7) [19] to measure anxiety, the Insomnia Severity Inventory (ISI) [20] to measure insomnia, and the Multidimensional Psychological Flexibility Inventory (MPFI) [21] to measure both PF and PI.”

“It is apparent that the unprecedented circumstances of the COVID-19 pandemic will require new research directions and clinical approaches to address current priorities, future needs of those a ff ected now, and to prepare for future pandemics [5, 6].”

“The rates for depression, anxiety, and insomnia found here are substantially higher than levels previously found in a general sample of Sweden [2] and in the larger sample from which these data were selected, where the rates were 27, 16, and 45% [16].”

“Many of the PF and PI facets have been studied and applied in treatment for chronic pain outside of the context of COVID-19 [15] and have been recommended for application in this context [7].”

“In some ways this is also consistent with a long history in psychology and chronic pain where “ negative ” variables such as cata-strophizing and fear and avoidance have always performed well in studies while the list of positive variables that achieve a similar status has always been small [25].”

“ . study in people with chronic pain in the UK [9] and large prospective general population studies in the UK [23] and Italy [24].”

“This includes studies conducted in Spain [10, 11] Canada [8, 12], the United Kingdom (UK) [3, 9] and the United States [13], to name a few.”

“This includes studies conducted in Spain [10, 11] Canada [8, 12], the United Kingdom (UK) [3, 9] and the United States [13], to name a few.”

“This includes studies conducted in Spain [10, 11] Canada [8, 12], the United Kingdom (UK) [3, 9] and the United States [13], to name a few.”

“This includes studies conducted in Spain [10, 11] Canada [8, 12], the United Kingdom (UK) [3, 9] and the United States [13], to name a few.”

“Because people with chronic pain appear to have been particularly a ff ected, these priorities hold especially true for them [7 – 9].”

“ . study in people with chronic pain in the UK [9] and large prospective general population studies in the UK [23] and Italy [24].”

“This is particularly true for those in vulnerable circumstances, those with chronic health conditions, or already su ff ering restrictions in functioning [2], including those with chronic pain [3, 4].”

“Because people with chronic pain appear to have been particularly a ff ected, these priorities hold especially true for them [7 – 9].”

“…El Rafihi-Ferreira et al., 2022; McCracken et al., 2011; McCracken et al., 2021; McCracken et al., 2022; McCracken et al., 2023; Zakiei et al., 2022), whereas psychological flexibility was found as a predictor of lower levels of insomnia severity (McCracken et al., 2022; McCracken et al., 2023).”

“The correlation and regression outcomes are consistent with previous research showing that CF (Mastin-Purcell et al., 2025; McCracken et al., 2023), sleep hygiene (Chou et al., 2015; Galvin et al., 2022), sleep control (Grandner et al., 2020) and mental health (Palagini et al., 2022) are all…”