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How to fight fear and anxiety when quarantine ends

The coronavirus pandemic has done a number on our mental health. We asked five psychologists for advice on emerging from our homes to a changed world.

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Part of the May Issue of The Highlight, our home for ambitious stories that explain our world.

Governments around the world are rolling back some of the most severe aspects of quarantine. After months of being cooped up and kept apart, friends and family will eventually begin to socialize again. Some workers will return to the office, and public spaces — from restaurants to movie theaters — will begin to implement strategies to make returning customers feel safe.

Few of us will be the same coming out of quarantine as we were going in: People with preexisting mental health conditions lost many of the routines that helped them cope, exacerbating their problems in the process. Many have experienced fresh hardship, like the loss of a job or the death of a loved one, which they likely weren’t able to properly mourn. And everyone has been forced to dramatically alter how they live, work, and accomplish even the most mundane tasks, such as shopping for groceries.

Emerging from such circumstances will create unique side effects. Though some states have begun to reopen parts of their economies, with the virus still active, for many people, FOMO may have been replaced by FOGO — a.k.a. the fear of going out. While some people are ready to rub shoulders with strangers, others will be apprehensive about returning to the social sphere, in part because without a vaccine, leaving our homes will come with a real risk of infection. But anxieties about resuming public life have also been magnified by our months indoors, with the lack of exposure to people and places only intensifying our fears about the outside world.

“We’re going to have to work through this quarantine state of mind even when the physical quarantine has lifted,” Sheva Rajaee, founder of the Center for Anxiety and OCD in Irvine, California, told Vox in April. In some countries, the psychic stress is already showing. In Wuhan, China, where the first cases of Covid-19 were reported, the lockdown has lifted — but restaurants are empty, active temperature checkpoints dot the city, and some residents continue to hide inside, fearing a second wave of outbreaks.

How Americans will adapt to the new normal is the question on everyone’s minds. Vox asked five psychologists, whose expertise ranges from disaster resilience to the epidemiology of mental health, what they expect to see in the coming months. Their advice for coping with the unprecedented challenges, edited for length and clarity, follows.

Accept that your anxieties are normal

Roxane Cohen Silver, professor of psychological science, medicine, and health at the University of California, Irvine

I’ve been conducting research on how individuals and communities respond to traumatic life events for about 40 years. This is unlike anything we’ve experienced before, for a variety of reasons: There’s an invisible threat. We don’t know how bad this will get. We don’t know how long this will last. And, importantly, this is a global threat.

There are a few strategies that can help. None of them are perfect. People should moderate the amount of media they’re engaging with; a steady diet of bad news is not psychologically beneficial. People should understand that their feelings are normal and natural, and they’re not going crazy. This is a very unusual and stressful and worrisome time. It’s okay to be feeling anxious. And there are many, many, many people experiencing losses — and those are real, and those should not be minimized.

But so much is out of the control of the individual. It depends on the ability to test whether people have the antibodies to the coronavirus. It depends on whether there is any sort of treatment. And in the absence of a vaccine, we’ll need people to feel confident in the authorities and the science telling us what is risky and what is less risky.

After 9/11, there were large concerns people would never get on an airplane again. So there were three things that the government did that led people to feel comfortable getting on an airplane: They introduced plainclothes air marshals, the airlines hardened the doors so cockpits can only be opened from the inside, and they introduced screenings at the airport. That’s just one example of the ways our public authorities can engage in an information campaign to make people more comfortable.

Learn to manage your emotional response to fear

Christopher Pittenger, director of the OCD Research Clinic at Yale University

I work primarily with people with obsessive compulsive disorder. They often struggle with uncertainty and difficulty managing what’s dangerous and what’s not. That’s something we’re all struggling with now. Their reaction to the pandemic has been interesting. Some people with OCD are certainly struggling, but others are doing surprisingly well. Everyone else’s fear of uncertainty and their desire to avoid contamination is validating. And in this crisis, the ambiguity is gone. That clarity can be reassuring.

As we go back to going out into the world to socialize, it’s going to come with some real amount of risk. And we’re all going to have to deal with the question: How much of that risk am I willing to tolerate?

One of the things to do is to talk through a scenario systematically and just accept the fact that there isn’t going to be absolute certainty, and learn to manage that emotional response to uncertainty. This is something we’ll do in therapy, not just for OCD but for a lot of anxiety disorders. It’s called exposure and response prevention. We’ll go ahead and trigger the emotional response — we’ll look at the spider, we’ll allow our hands to be contaminated, whatever it may be — and sit there and tolerate the emotion. What often happens is there’s risk, and that leads to anxiety, and that anxiety leads to more anxiety because we tend to assume, “If I’m anxious, something dangerous must be happening.” If we can learn to label the emotion and recognize them as signals that may be useful sometimes but don’t mean you’re in danger, then we can try to break that cycle of the anxiety or the fear feeding on itself and learn to tolerate it better.

Practice mindfulness, and cut out unhealthy routines

Rossi Hassad, epidemiologist and psychology professor at Mercy College

If you ask any mental health expert today, they’ll say disaster equals post-traumatic stress disorder. During the Spanish flu, we didn’t have that classification. But if you go back to anecdotal reports and a few narratives from the 1918-’19 epidemic, the description fits: Spanish flu survivors reported sleep disturbances, depression, mental distraction, dizziness, and difficulty coping at work.

Post-traumatic stress disorder is directly related to the intensity of one’s exposure to the traumatic event. The prevalence is generally reported to be 30 to 40 percent among direct victims, 10 to 20 percent among rescue workers, and 5 to 10 percent for the general population.

After a disaster, there is also an increase in cases of major depressive disorder. There tends to be an increase in substance use problems. And with the Spanish flu, the death rate in the US was positively correlated with the rate of suicide. When there’s so much uncertainty, there are feelings of hopelessness.

Most people are resilient, and they will weather this very well. If they do have mild symptoms, they will bounce back emotionally. But some people will need some form of psychological support, from self-care to professional care.

Mindfulness, as simple as it sounds, runs very deep. We encourage people to be mindful of how they consume the news. We want them to engage in healthy routines and be mindful of the use of tobacco, alcohol, and other drugs, which can worsen your mental health and physical well-being in the long term. And if people need more support, we want them to know they can contact their state and city health departments, the CDC, and other organizations to get information on accessing professional services.

Fight apprehension by keeping yourself distracted

George Bonanno, director of the Loss, Trauma, and Emotion Lab at Columbia University Teachers College

This is so unique. And it’s not a traumatic moment. It’s chronically stressful, so we begin to fall apart physically, and the stress response starts to fail to work properly, and then you start getting depressed or anxious.

The natural reactions we have to adverse events are adaptive, but they can become uncoupled from an actual threat and become a general apprehension about the world.

We’ve been trying to identify what makes people resilient for 30 years. We’ve identified a bunch of stuff: optimism, confidence in your coping strategies, mindfulness, social connection. But scientifically, all of these things have small effect sizes. Optimism explains maybe 3 or 5 percent of resilience. Even if you add all these things up, you don’t get much of the story. The reason is that they don’t always work because life is complicated. There are no magic bullets. There are no three things or five things that you can do that will solve the problem. We have to be creative.

Friends have already told me that they’re watching movies and [if they] see someone touch, they freak out a little bit now — “Don’t touch that!” I imagine some people will be uneasy for some time afterwards, and will be until there are more assurances. We have to use the tools we have at our disposal in the meantime. We need social contact — people have been Zooming with their friends. Humor is really good. It’s not a panacea, but smiling and laughing works. People should distract themselves; there are plenty of movies to watch right now. But the idea is whatever you do, if it helps you, as long as it doesn’t become prolonged or harmful, that’s great.

Get involved to help stave off feelings of powerlessness

Susan Clayton, environmental psychologist at the College of Wooster

Our behavior has been changed so dramatically. Right now there’s this real sense of unreality for a lot of people. In the early days, it was like, okay, we’ll shelter in place for two or three weeks and it will all go back to normal. It quickly became clear that was not the case. Now, when we transition back to a different lifestyle, we have to go slowly or it could be stressful, especially if we reopen the economy before we have a vaccine or a treatment.

The virus is going to force us to take baby steps. But it will be good for our mental health, and also our physical health, to try not to come out of the pandemic all at once. I think there are some things we are doing that are better — that we might want to continue to do — even when worries about the pandemic subsides: having more business meetings virtually, sleeping in, families spending more quality time together. The need to go slowly does encourage us to be mindful and make more deliberate choices. It’s like, “All right, I’m going to do this one thing differently,” and not return to all our old behaviors immediately. We need to think about how this experience can contribute in a positive way to who you are.

With both climate change and the coronavirus, people feel very helpless because it is this global problem, and they feel nothing they can do as individuals will make a difference. But what the response to the coronavirus has shown us is that we can make pretty dramatic changes when we have to. It is helpful to get involved in some way. People can try to make their community more sustainable, or it could be political action, or it could be finding another group of people to meet with and talk about these problems. Taking action can help overcome that feeling of powerlessness, and that’s good for your mental health.

Eleanor Cummins reports on the intersection of science and popular culture. She previously wrote about social-distancing scofflaws and misguided celebrity pandemic social media for The Highlight.

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