Lynne S. Gots, Ph.D.
Licensed Psychologist
Quarantine-Induced Agoraphobia and Other Anxieties
By Lynne Gots, posted on July 27th, 2020.
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.
Tags: Agoraphobia, COVID-19 Anxiety
Posted in Anxiety, COVID-19 Mental Health |
Coping with Loneliness While Sheltering in Place
By Lynne Gots, posted on April 16th, 2020.
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.
Tags: coronavirus, Loneliness, self-isolation
Posted in Acceptance and Mindfulness, Anxiety, COVID-19 Mental Health |
How to Keep Your Anxiety from Spreading Like a Virus in the Face of COVID-19 [Updated]
By Lynne Gots, posted on March 7th, 2020.
The new Coronavirus outbreak has infiltrated our public consciousness, and it is exhausting. When the media are constantly bombarding us with updates about fatality counts and quarantines, even the most unflappable are finding it hard to stay calm. Everyone seems to be running to the nearest supermarket to stockpile disinfectant wipes, bottled water, and canned goods. So how are people with health anxiety and OCD—who are already prone to excessive worry about uncertainty, contamination, and illness— supposed to cope?
In treating anxiety, I use the evidence-based approach called Exposure/Response Prevention to help people tackle their fears and limit the compulsive behaviors, such as excessive washing, designed to make them feel less anxious about risk. But some of the practices my colleagues and I would typically recommend for someone with contamination worries, such as limiting hand-washing and avoiding the use of hand-sanitizer, fly in the face of current public health recommendations. Even so, if you keep in mind the rationale for exposure-based approaches to anxiety, which is to learn to tolerate discomfort and uncertainty, you can still come up with a personal plan allowing you to follow reasonable disease- prevention guidelines without letting your anxiety skyrocket and control your behavior.
- Take reasonable precautions.
Use only one source, such as the CDC, to create your “response-prevention plan,” or rules for practicing sensible health habits without giving into compulsions. Follow the plan you’ve made in advance so you don’t let anxiety dictate your behavior in the moment. - Less is better than more if you have OCD. For example, the CDC says “clean frequently…wash your hands often…for at least 20 seconds.” The words “frequently,” “often,” and, “at least” are ambiguous—and potential landmines for the OCD brain. Accepting uncertainty is a vital component of OCD treatment but, in this case, vague guidelines are not helpful. Decide you’ll wash your hands for 20 seconds, not 40 or 60 “just to be safe.” Don’t let anxiety make you doubt, second- guess, or modify the plan.
- Limit your consumption of the news and social media. You will be informed enough without knowing every detail about the outbreak. Decide which news outlets you will follow, how long you will spend reading them, and put yourself on a predetermined schedule for checking your sources. Don’t go down a rabbit hole seeking information. Unless you are on the frontline of the public health effort, you don’t need to know as much as the experts. And don’t look to random internet sources for preventative measures. According to a recent Washington Post column, Craig’s List is selling DIY Coronavirus vaccines. Which don’t exist.yet.
- *Don’t modify your activities just because you’re anxious. Unless your employer has implemented a mandatory telework policy, continue to go to work. Take your kids to the playground. Eat out if you normally enjoy going to restaurants. Spend time with friends. Shop at the supermarket. Get haircuts and manicures (sadly, many of my Chinese manicurist’s clients have been cancelling appointments out of misplaced fear). Of course, you should follow your response-prevention plan for washing when you are in public places where you are coming into contact with a lot of people. *See update below.
- Practice mindfulness and acceptance techniques. Whether you use meditation, yoga, prayer, or exercise, focusing your attention on the present moment, rather than ruminating about a catastrophic, uncertain future, can help you cope.
This is a challenging time for all of us. But we don’t need to make it worse than it already is by fueling our anxiety. If we practice responding to the uncertainty with reason and thoughtfulness rather than reacting out of panic, everyone will benefit.
Update: When I wrote this post only ten days ago, the coronavirus situation was very different from how it is now. The current national emergency mandates strict social-distancing practices, which make my advice to carry on normal activities no longer medically sound. or feasible.
I will be writing another post in the coming days with tips for staying sane while stuck in the house.
Tags: coronavirus anxiety, OCD
Posted in Anxiety, COVID-19 Mental Health, General, Health Anxiety, Mental Health and the Media, Obsessive Compulsive Disorder |
