Background: Using Non-Invasive Ventilation (NIV) in an acute setting for COVID-19-related acute hypoxic respiratory failure (AHRF) can be a stressful and anxiety-inducing experience for patients in the Respiratory and Intensive Care Units (RICU and ICU). Aims and objectives: This study aimed to investigate the presence of anxiety, symptoms related to Post Traumatic Stress Disorder (PTSD), psychological distress, and depression about the perception of one's disease state in people with COVID-19-related AHRF undergoing NIV during their stay at RICU/ICU and after rehabilitation. Methods: Fifty-two people with COVID-19 (M=66.9; SD=9.17) were evaluated during hospitalization in the RICU/ICU, and at 6 months, after rehabilitation, for symptoms of anxiety, psychological distress, Post Traumatic Stress Disorder (PTSD), and depression, in relation to the perceived severity of illness and NIV?s usage. Results: Patients with COVID-19 experienced increased fear and anxiety due to the severity of their illness and the uncertainty surrounding the disease in the acute setting. The need for NIV indicated more severe COVID-19 disease, which significantly increased fear and anxiety [(t(14)= 2.79, p=.014] compared to the remission period, leading to feelings of loss of control and a decreased psychological well-being [(t(17)= 2.35, p=.031]. Resilience significantly improved over time [(t(16)= -4.78, p<.001]. Conclusions: Healthcare professionals need to supply more attention and support, such as offering reassurance, providing information, and addressing any concerns or fears.