With vaccine distribution increasing and states relaxing restrictions on indoor gatherings, many of us are contemplating the prospect of resuming activities long abandoned over the last year. Some people can hardly wait to board a plane for a Hawaiian vacation or gather at a favorite restaurant with friends; others are feeling, as one patient of mine put it, “not ready for things to go back to ‘normal.’”
And what does “normal” even mean in the current context?
We know from studies conducted after the quarantines imposed during the SARS epidemic that the mental health ramifications of even short (more than 10 days) periods of enforced isolation are not trivial. Reactions included post-traumatic stress disorder, avoidance behaviors, and anger, lasting in some people for several years. Research conducted in the aftermath of the COVID pandemic is already uncovering similar—and even more pervasive, given the duration—patterns.
The absence of in-person social interactions over the last year may make it especially hard to go back to seeing people face-to-face (or, mask-to-mask, as it likely will be for quite some time) for those prone to social anxiety. Avoidance is a prevalent coping mechanism, albeit not a healthy one. It might relieve anxiety in the short run but over time, avoiding triggers backfires because it prevents practice.
Returning to the office or seeing friends in the flesh might feel awkward because social skills have grown rusty. And heightened body awareness might add to the uneasiness. Wearing “hard pants” after a year of working from the couch in sweats can feel strange and uncomfortable, especially for those (22% by one estimate) who have put on some weight during the pandemic.
People with OCD may fear seeing even fellow vaccine recipients unmasked and cling to washing and decontamination rituals adopted early in the pandemic, even if they are no longer deemed necessary. The over-estimation of danger is a thinking style common to all anxiety disorders. And as one recent study showed, news reported by media outlets in the US skewed overwhelmingly negative—87% of COVID coverage in national US media, compared with 64% in scientific journals, emphasized bad news—adding to the atmosphere of threat for those hypersensitive to it.
Even in the absence of preexisting mental-health issues, nearly all of us will experience some degree of post-traumatic stress, complicating our return to a BC (Before COVID) life. The trauma of actual illness and of losses—of lives and livelihood for many—have left deep emotional scars. Navigating the reentry into the world will take time, patience, and understanding, of others and ourselves. We all are grappling with a confusing mixture of emotions: excitement, fear, and even nostalgia for the early days of quarantine, when decisions were more black-and-white and unambiguous, and a sense of being “in it together” prevailed. Current times present a much higher level of uncertainty, making life far more complicated.
Acknowledging difficult feelings and allowing them to surface rather than trying to push them away are important strategies for coping with any challenge to emotional equilibrium. The road to the new “normal” will be rocky. But cultivating an attitude of acceptance will make the path less treacherous.
As states have been opening up, life has become more complicated. Many people found shelter-in-place mandates easier to navigate because they didn’t have to make decisions about whether to go out. But now, we have to consider the personal importance, and relative risks, of various activities, such as attending a protest, meeting friends for drinks at an outdoor patio, eating a meal at a restaurant, or getting a haircut. Having more choices leads to more uncertainty and, often, more anxiety.
Leaving the safety of home and feeling anxious, perhaps even panicky, about venturing into the world mimics the condition of agoraphobia, which means, literally, “fear of the market place, or place of assembly.” Agoraphobia is classified as a panic disorder because panic attacks typically occur in crowds or on public transportation, where escape is difficult. Subsequence avoidance of situations where a panic attack has occurred often leads to a narrowing of safety zones. People with agoraphobia may, if untreated, become completely housebound.
After several months of quarantining at home, going out can feel very strange. If you’ve been staying inside since March, not even taking a walk around the block, you may find yourself feeling nervous and jittery the first time you leave your apartment or house. The best approach is to start with just a short outing, gradually increasing the time and distance away from home to build tolerance.
Another consequence of the quarantine may be heightened social anxiety, which often takes the form of excessive concerns about being evaluated negatively and judged by others. For example, someone with social anxiety might worry about being seen as irresponsible for not wearing a facemask when walking in a park (and social media only adds to the confusion, with accounts of assaults on both masked and unmasked people.) If you’re uncomfortable meeting others for a socially distant get together, then don’t. Everyone has a different tolerance for risk, and you shouldn’t feel pressured into accepting someone else’s decision about what is safe or embarrassed by your greater need for caution.
Setting limits with friends and family about safety practices can also be difficult for someone who worries about disappointing others. Should you let your parents, who are more casual about taking precautions than you, fly to visit you? Should you agree to meet your friends for an indoor meal at a restaurant because they are pleading with you to join them? Should you allow a lonely friend to join your quarantine pod?
In these unprecedented times, we cannot rely on social convention to help us decide what choices to make. And we can’t expect friends or family to help because they may have vastly different interpretations of risk. So we need to decide what feels right for us.
But if you are so fearful that you have become housebound, you will want to begin returning to the world, using reliable scientific sources, and not anxiety, to guide your decisions about what activities are reasonably safe. Both sunlight and exercise can ease stress and strengthen the immune system. So take those first steps and go outside for a walk.
No matter what your current role is – new teleworker; parent with young children; older retired person; college student back in the parental home – you are facing challenges both mental and physical during these uncertain times. Living in unrelenting proximity with family or roommates can strain even the closest relationships. The loss of your usual, in-person social connections may make you feel lonely in spite of the constant company of others. And if you live alone, you may be experiencing a particularly acute sense of loneliness and isolation that can become overwhelming if you do not address it.
Nothing can take the place of hugging a loved one, high-fiving a friend, giving a teammate an encouraging pat on the back, dancing at a wedding, or welcoming a new colleague with a handshake. Physical contact with people not in your immediate quarantine circle is not an option right now. But maintaining close connections is possible and, more than ever, vitally important.
Former Surgeon General Dr. Vivek Murthy has talked extensively and written a soon-to-be published book about the health risks associated with loneliness and ways to bolster feelings of connection. He says we can feel lonely even when we interact with others, if we keep an emotional distance. A lack of authenticity during interpersonal encounters fosters loneliness. Being only partly present – checking social media and texts while talking on the phone, say – can be particularly distancing.
So how can we meet our hard-wired needs for social connection and intimacy from a physical distance?
1)Make virtual connections meaningful.
I’ve begun to see a lot of “Zoom burnout” lately, stemming from the proliferation of online meetings, happy hours, and game nights. Interacting with friends and colleagues through a grid on a screen can seem like an antidote to loneliness. But too many of those encounters can make us feel even more detached and isolated if we overload our schedules with them, as many of us are doing, either through necessity or desperation. Try incorporating opportunities for more intimate interactions. Even a 5-minute phone call or FaceTime with an old friend, adult child, parent, or grandparent can offer an opportunity to connect with someone who really knows and cares about us, especially if we fully engage in the conversation without diluting our attention by multitasking.
2) Wave at a stranger.
According to social-psychology research, even seemingly insignificant social interactions, such as making small talk with a stranger in an elevator or chatting with the barista when we order our morning cappuccino, can boost mood and promote a sense of belonging. Elevator greetings and daily coffee runs may be things of the past right now, but we can still create opportunities for casual social exchanges from afar. Try acknowledging a passerby across the street instead of hurrying along with your head lowered. A nod or a wave can be a way of saying, “We’re all in this together.” You may feel a little less lonely as a result. And the small gesture of camaraderie might help someone else get through the day, which brings me to the next point.
3) Reach out to others.
Helping another person can make you feel good, plain and simple. Instead of dwelling on your own pain, make a small difference in another’s life. It doesn’t have to take much time. Just calling a friend who is alone or offering to buy groceries for an elderly or at-risk neighbor will give you a fresh perspective on your own struggles.
4) Practice mindfulness.
Mindfulness, as defined by the esteemed meditation teacher Jon Kabat-Zinn,is “awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally.” By focusing attention on our bodies and minds right now,without judging our emotional state, we can learn to tolerate difficult emotions, such as loneliness, without struggling against the pain and compounding it. In other words, just become aware of the feeling of being lonely, and try to disengage from the dire messages your mind is sending (“I can’t stand this. If I feel like this for much longer I’ll go crazy. I’ll never be happy again. Nobody else is as miserable as I am.”) The practice of meditation, available through hundreds of apps and YouTube videos, is a way to develop the skill of mindfulness.
5) Cultivate self-compassion.
Doctor Kristen Neff, a psychologist, and colleagues have demonstrated through hundreds of research studies the value of self-compassion for coping with negative emotional states. In a recent interview with Dan Harris on the 10%Happier podcast, she elaborates on how the practice can be particularly helpful for dealing with the challenges we are facing now.
The first step in approaching adversity with self-compassion is, again, mindfulness: become aware of your suffering. The second is to recognize that you are not alone in your struggles, a particularly salient reminder during this global pandemic. Just knowing you are suffering along with all of humanity can help ease feelings of isolation. And the third step, which can be hard for many people, is to comfort and support yourself, as you would a friend or loved one, with a phrase or physical gesture that resonates with you. Dr. Neff recommends putting a hand on your heart, or patting your shoulder reassuringly, or even giving yourself a hug, while you tell yourself, “It’ll be OK,” or “I know you’re hurting right now,” or another statement that rings true for you. It can feel sappy, but the evidence suggests the practice works. And if you are self-isolating right now and are particularly starved for the warmth of a human touch, extending a literal, supportive hand to yourself may help fill the void, if only just a little.
In this moment, we are all struggling to adjust to a new, very surreal way of life. Although we cannot control the situation, we can make it more tolerable by accepting it, even if we don’t like it, rather than trying to fight against it. To differing degrees, we are grappling with a whole range of negative emotions – anxiety, sadness, grief, boredom, anger, frustration, and, yes, loneliness. Our only choice is to cope as best we can, forgive ourselves for having bad days, and remind ourselves it will not be like this forever.
This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.