In reality, it took months for COVID-19 to spread around the globe after its first reported case in Wuhan, China on November 17, 2019. But for many Americans, the world seemed to change on one surreal day of rapidfire news.
On March 11, 2020, the World Health Organization officially declared COVID-19 a pandemic. The U.S. announced a European travel ban. The NBA suspended its season. And perhaps in the most bizarre, “this-can’t-be-real-life” turn of events, Tom Hanks and Rita Wilson shared that they had tested positive for the virus. Shortly after, cities and states around the country would declare various states of emergency and quarantine.
While research is ongoing about the psychological effects of this health disaster, many have discussed the difficulty of managing the depression, stress, and trauma that have resulted from facing COVID-19 while being isolated from loved ones and stripped of comforting routines.
Now, after long periods—and in some cases months of lockdown—some people are struggling with a different kind of anxiety: the fear of going back outside. “I think it largely stems from fearing that going out is not safe yet, especially in the absence of a vaccine,” says Lily Brown, Director at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania.
As economies reopen and quarantines ease up, how can you ease back into “the new normal” while protecting your mental health?
What Drives Re-Entry Anxiety?
When infection rate, hospitalization numbers, and other key figures allow for a safe reopening, that’s an undeniable cause for celebration. But you’re not alone if the idea of eating beside people in restaurants or going to the hair salon makes you unsure.
“There is a lot of uncertainty about what’s safe and what’s not right now,” says Brown. “That really is a breeding ground for anxiety, as it relates to contracting the virus or the fear of responsibility in spreading the virus.”
As a relatively new disease, there’s a lot to discover about COVID-19. For example, exactly how effectively it can spread outdoors and why some patients are “super-spreaders.” While our knowledge is growing, any scientific gaps could cause an anxious brain to assume the worst.
Roxane Cohen Silver, professor of Psychological Science, Medicine, and Public Health at Northwestern University, believes that the conflicting information people receive from various sources hasn’t done our anxiety any favors, either. Instead, it’s likely to confuse what actions we should be taking, as advised by medical professionals.
“There are different messages coming from local, statewide, and federal public health officials, and then there may be political messaging that conflicts or supports that,” says Silver.
Despite the conflicting information, Silver notes that three medical recommendations have remained consistent for several months: maintain at least six feet of physical distance from others, wear a face covering in public, and wash your hands regularly.
What happens when re-entry anxiety meets an anxiety disorder? Those with obsessive-compulsive disorder (OCD) are struggling in particular.
“People who have a tendency toward OCD are going to find that it’s even more challenging to push themselves to re-engage in normal healthy behaviors. This is, in part, because the symptoms of OCD are some of the things that have been recommended for the past three months by the CDC and WHO to make sure we don’t contract the virus,” says Brown.
Now, using your sleeve to open a door and avoiding touching surfaces is common practice.
“Right now, I think what’s best for people in that situation is to practice distress tolerance. Meaning, you’re going to have to figure out strategies for living in the grey area. It’s not going to be clear-cut that a certain activity is absolutely safe or absolutely dangerous. A lot of the path forward is going to be figuring out what risks you’re willing to take because they make your life better and what risks feel too dangerous.”
Fear of contamination isn’t the only type of re-entry anxiety therapists are noticing. While some people are eager to resume dinner parties and get-togethers, those with a history of social anxiety disorder are experiencing a particularly difficult time readjusting.
“We sort of adapted to a version of social life through Zoom, but a lot of us are out of practice just being with people,” says Brown. “If you already lean toward social anxiety, it’s likely going to be hard—at least in those early weeks—to re-engage.”
(Illustration: Lori Richmond)
How To Distinguish Between Valid Concern And Excessive Anxiety
With any case of anxiety, it’s crucial to learn when you’re exaggerating a potential risk in your own mind—and the same is true here. (The cruel joke being, of course, that COVID-19 is a very real threat.) So how can you tell the difference between overblowing the danger of a socially-distant picnic and a rational desire to avoid a crowded mall?
- Safety first. While the risk of catching COVID-19 is not going to be 0% until there’s a vaccine, you can ease your anxiety and minimize the possibility of exposure by following the latest advice of leading health authorities like WHO and the Centers for Disease Control and Protection and your own doctor, especially if you have underlying medical conditions. “Lets say a patient is worried about contracting salmonella from uncooked chicken,” says Brown. “Is there a risk they could contract salmonella? Absolutely. Should that stop you from making chicken? Probably not, because the risk is relatively low provided that you take a few basic precautions.” If you aren’t able to observe guidelines during an activity, you probably shouldn’t be doing it.
- Check in with others. Assuming you’re able to safely follow social distancing measures, it may also help to consider what your local government and medical officials suggest, as well as what your friend groups and community are doing. “It’s not a perfect answer, but that’s where the anxiety stems from for a lot of people,” says Silver. “Normative behavior can dictate our thinking.”
- Risk versus reward. Ultimately, the decision is yours. A general rule of thumb, according to Brown, is to ask yourself if anxiety is stopping you from enjoying life. “If avoidance behaviors are having a negative impact, either because they’re losing their job or they can’t engage with people in the way they like to, that’s the point where I would push them to see if they might be willing to take some risk,” she says.
Take Control Of Your Anxiety
If you think your re-entry anxiety is posing a problem, here’s how you can take the first steps back to “normal.”
- (Re)establish structure. As quarantines started, many people either lost their jobs or began to work from home. While some quickly established new routines, others floundered with excessive free time. “We know that having a lot of unstructured time is a major risk factor for depression,” says Brown. “I think the earlier people can establish healthy routines for themselves and get structure built into their schedule, the faster they’ll start to feel better.” Push yourself to stay active, whether that means getting exercise, meeting with friends (virtually or in-person), or working.
- Establish a game plan. While avoidance might feel like a relief in the short-run, it will actually worsen anxiety over time. If you don’t have access to a therapist, Brown recommends trying self-directed exposure therapy. First, make a list of the kinds of situations that you’ve been avoiding—like going to a coffee shop or store—and rank how anxious each one makes you on a scale of 1-100. “We want people to start with something that’s around 30-50,” says Brown. “It shouldn’t be so easy that you don’t get any mastery or movement out of the practice, but we don’t want it to be overwhelming. It’s all about finding that sweet spot.” As you complete each activity, work your way up the list to ones that make you nervous.
- Seek help. It’s often easier to stick with the goals you make when you have someone coaching you along the way. Whether you’re trying exposure therapy or just need to talk, you’re more likely to make progress with support from family and friends.
- Stay positive. Don’t forget to celebrate successes, no matter how small. Instead of thinking about what you’re too worried to do, focus on what you’ve accomplished and what’s to come.
- Embrace telehealth. (Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions.) It’s not always possible to meet with a therapist right now, but telehealth is more readily available than it ever has been, thanks to relaxed payment policies because of COVID-19.