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Navigating the Fog of Long COVID

Ways to cope with fatigue, brain fog, and anxiety.

Key points

  • Common symptoms of long COVID and associated conditions (LCAC) include chronic fatigue, neurocognitive difficulties, anxiety, and depression.
  • The neurocognitive research on LCAC highlights difficulties with brain fog, attention, memory, and executive functioning.
  • Mindfulness, cognitive remediation, and ACT can potentially mitigate the prominent and disruptive symptoms of fatigue, brain fog, and anxiety.

This post was written by William Tsang, PsyD, Robert M. Gordon, PsyD, and Elina Talis, PsyD

Long COVID and associated conditions (LCAC) can affect many systems in the body. It is characterized by the persistence of symptoms including exhausting fatigue, neurocognitive difficulties such as mental fog, chest and muscle pain, and weakness, as well as anxiety and depression lasting beyond three months from the onset of the SARS-CoV-2 infection, and cannot be explained by an alternative diagnosis (Peter, et al., 2022; De Luca et al., 2022).

Kenny S./Unsplash
Kenny S./Unsplash

Fatigue and Sleep

There are two types of fatigue that characterize LCAC; post-viral fatigue and post-exertional malaise (PEM). Post-viral fatigue is a persistent feeling of being tired regardless of the amount of sleep or rest. PEM occurs after a range of activities including ranging from taking a walk and spending time at a social function. Together, these symptoms can make it difficult to complete daily chores and job tasks, and to spend time with family and friends.

Individuals living with LCAC experience frustration and grief over their inability to perform activities that were taken for granted and anxiety regarding the uncertainty of how long their symptoms will last.

The following tips are offered with the caveat that what might be useful for one person may not work for someone else.

Tips for Managing Fatigue

  • Tracking. Keep track of your daily activities and note patterns and activities that affect your energy level. For example, you may find that you have more energy for harder tasks in the morning or after breakfast.
  • Prioritization. Within one hour of waking up, jot down a list of tasks for the day. Visualize the day ahead and prioritize activities based on what you learned from tracking. Try to break down larger tasks into smaller, more manageable steps with clear timeframes.
  • Pacing. Imagine that you have a battery or gas tank with only a certain amount of energy for the day. Incorporate relaxation breaks to recharge as you cross off the items on your list.

Tips for Sleep

  • Stick to a consistent wake time each day. This helps set your circadian rhythm so that your body learns to sleep at a desired time.
  • Limit naps to 15 minutes. Many individuals with LCAC need to nap in order to recharge, but it is important to keep them brief. Remember to set an alarm, and avoid napping close to bedtime.
  • Develop a relaxing bedtime routine that does not involve binging TV or scrolling social media.
  • Keep the bedroom for sleep and intimacy. If you are not asleep in 15-20 minutes, do something relaxing outside of the bedroom until you feel sleepy. Just make sure to avoid screen time.
  • Avoid caffeine and substance use within 4-6 hours of bedtime.

Brain Fog, Attention, and Memory

The neurocognitive research on LCAC highlights difficulties with brain fog, attention, and memory. If you’re wondering how these are related, some researchers have found that LCAC affects areas of the brain implicated in attention, processing speed, and executive skills like multitasking and decision-making (Alemanno et. al, 2021; Becker et al., 2021). Unfortunately, these cognitive skills also underlie memory, specifically the efficiency in how we take in information and recall it.

“Brain fog” is a term used to describe symptoms that affect your ability to think including mental fatigue, forgetfulness, and lack of focus. Individuals with LCAC often report that brain fog affects a large part of their day, making it difficult to hold conversations, complete daily tasks, understand and retain written material, and respond to emails.

Tips for Managing Brain Fog, Attention, and Memory

  • Set realistic expectations. Try not to compare yourself to your pre-COVID self.
  • Make a daily to-do list and try to do the most difficult item when you have the most energy.

Use the Pomodoro Technique

  • Identify a task that you need to complete.
  • Set a timer for 25 minutes (It is fine if you finish earlier).
  • Work on the task with minimal distractions.
  • When the alarm sounds, take a 5-minute break.
  • Repeat the process three more times.
  • Take a 30-minute break and start again.

Stress Management and Anxiety

LCAC is frequently accompanied by feelings of stress and worry as well as physical manifestations of anxiety (e.g., muscle tension, stomach issues, and headaches). Individuals also report coinciding neurologic symptoms that can make the day more difficult.

Tips for Stress Management

  • Practice mindfulness, such as visualization, and make positive self-affirmations or self-compassion comments daily to increase resilience and reduce stress.
  • Pace yourself and make space: Take breaks, incorporate daily walks based on your physician’s guidance, get sunlight, and separate work and home life, even in the remote office.
  • When possible, avoid doing work in the bedroom. If space is limited, create a divider between the workstation and the bed, so as not to associate the sleeping area with stress.

Tips for General Anxiety and Re-Infection Anxiety

Review FACE COVID steps using the principles of acceptance and commitment therapy (ACT). The steps are summarized below. Here is a link to the free e-book by Dr. Russ Harris, the creator of FACE COVID.

F = Focus on what’s in your control

A = Acknowledge your thoughts and feelings

C = Come back into your body

E = Engage in your body

C = Committed action

O = Opening up

V = Values

I = Identify resources

D = Disinfect and distance


  • Follow an information diet by limiting exposure to COVID-19 news and social media.
  • Make a list of things you can and cannot control.
  • Reevaluate values and priorities.
  • Speak with a mental health professional with a background in LCAC if your symptoms become unmanageable, distressing, and impact daily functioning.

Concluding Thoughts

Although much remains unknown about Long COVID, we can utilize principles of mindfulness, cognitive remediation, and ACT to help mitigate the prominent and disruptive symptoms of fatigue, brain fog, and anxiety. By introducing the tips outlined above into their daily lives, individuals can hopefully achieve some symptom relief and a sense of empowerment in navigating feelings of uncertainty and fear of the future.


William Tsang, PsyD is a psychologist at New York University Langone Health-Rusk Rehabilitation specializing in the evaluation and treatment of patients with Long COVID and Associated Conditions.

Robert M. Gordon, PsyD is a Clinical Associate Professor at New York University Grossman School of Medicine. He is a member of the Hospital, Health and Addiction Workers, Patients and Families workgroup (established by 14 divisions of the American Psychological Association) that sponsors this blog.

Elina Talis, PsyD is currently completing an Advanced Rehabilitation Research and Training fellowship at NYU Langone’s Rusk Rehabilitation


Alemanno, F., Houdayer, E., Parma, A, Spina, A., Del Forno, A., Scatolini, A., Angelone,, S., Brugliera, L., Tettamanti, A., Beretta, L., et al., (2021). COVID-19 cognitive deficits after respiratory assistance in the substance phase: A COVID-rehabilitation unit experience. PLos ONE, 16, e0246590.

Becker, J. H., Lin, J. J., Doernberg, M., Stone, K., Navis, A., Festa, J. R., & Wisnivesky, J. P. (2021). Assessment of cognitive function in patients after COVID-19 infection. JAMA Network Open, 4(10), e2130645.,30645

De Luca, R., Bonanno, M., & Calabro, R. S., (2022). Psychological and cognitive effects of Long COVID: A narrative review focusing on the assessment and rehabilitative approach. J. Clin. Med., 11, 6554.

Peter, R. S., Nieters, A., Krausslich, H. S, Brockmann, S. O, Gopel, S., Kindle, G., Merle, U., Steinacker, J. M., Rothenbacher, D., & Kern, W. V. (2022). Post-acute sequelae of COVID-19 six to 12 months after infection: Population based study. BMJ, 37:e071050. https://doi.o4g/10.1136/bmj-2022-071050

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