When Normal Becomes Terrifying

Last year, it was difficult to imagine what life would be like today. Now, as we look back on a diminishing global pandemic, it’s sometimes hard to imagine life as it used to be. So it’s no wonder that some are showing resistance to shifting back to their old routine. Yes, COVID-19 Re-Entry Anxiety is real, and it’s becoming ever more prevalent as we slowly return to society.

The American Psychological Association reported in February that Americans were experiencing the highest levels of stress since April 2020 and that half of surveyed adults were uneasy about returning to in-person interactions. It’s as if everyone, having spent the last year adrift in COVID-space, alone or in our cubbies, must now navigate re-entry into co-existence.

“Re-entering the busy world will be a new type of stress because we’re not used to it anymore,” said Elissa Epel, Ph.D., professor, and vice-chair in the Department of Psychiatry at the UCSF Weill Institute for Neurosciences. “It simply has a lot of challenges embedded into it: being in traffic, getting to work on time, parking, managing family schedules, and having social interactions all day. Those are the small things that can add up to leave you feeling overstimulated or exhausted, making it an unpleasant transition.”

Plumbing the Depths of Re-Entry Anxiety

The degree of uncertainty caused by the COVID-19 pandemic has been anxiety-provoking for most people. And as a result, in recent months, many people started to adapt to a new way of life, one that was primarily spent indoors. For many of us, this began to feel safe, secure, and even somewhat comforting.

Now, as the pandemic winds down, and normal life is more or less resumed, the brain is again challenged to abruptly adapt. So it’s not surprising that this next transition is anxiety-inducing. And that is aside from the underlying sense of uncertainty that the pandemic continues to engender — residual concerns of infection, for one’s self and family members; employment and related financial worries, parenting worries, etc.

An alternative way to see this is that some are suffering from what European psychologists Marcantonio Spada and Ana Nikčević dubbed “COVID-19 anxiety syndrome.” This syndrome is characterized by coping behaviors “that can keep people locked into a state of continuous anxiety and fear,” causing people to avoid public places, and incessantly worrying about contracting the virus, Spada says.

Symptoms of this syndrome mirror other psychological problems, including OCD and PTSD, and closely mimic the psychological consequences suffered by those who have lived through war or disaster. After an entire year, Spada says, these habits may be hard to shed. And those who have financial pressures, inadequate social support, or have a history of mental health problems are at even higher risk.

At this point, we are surrounded by a continuum of mental health that spans from thriving to severe depression and anxiety. Many of us are stuck somewhere in the middle, in a kind of psychological limbo, a state that psychologist Corey Keyes in 2002 characterized as “languishing.” Merriam-Webster defines languishing as “to be or become feeble, weak,” “to live in a state of depression or decreasing vitality,” or “to become dispirited.”

Indispensable Tips to Mitigate your Re-Entry Anxiety

Besides professional treatment, there are some fairly simple, effective methods to deal with stress. Daily meditation has been shown to shrink the amygdala and thicken the pre-frontal cortex. Getting out into nature lowers cortisol levels. Exercise sparks emotional resilience and, for some, can be as effective as some medical treatments.

Sleeping for about seven hours each night, eating nutritiously, and social engagement are also important. And it helps to unplug from the news and social media whenever possible. Be sure to check in with your children on a weekly basis to help them cope. There is even a free, web-based program developed by Dr. Jud Brewer (MD, Ph.D.),Director of Research and Innovation at the Mindfulness Center and associate professor in psychiatry at the School of Medicine at Brown University, as well as a research affiliate at MIT, that can be found at mapmyhabit.com, which helps people chart their anxious habits to promote healing.

But for some of us, all of this may not be enough

More Targeted Assistance

1. Exposure Therapy in Slow Motion

After being cooped up in your home for so many months, you probably feel like you never again want to take your freedom for granted. It might be tempting to do it all in one week — a get-together with friends, going out to dinner, and then a road trip.

But, hold on, you may want to take it slow. “Practice saying no because we need to pace ourselves,” Dr. Andrea Bonior Ph.D., licensed clinical psychologist and author of Detox Your Thoughts: Quit Negative Self-Talk for Good and Discover the Life You’ve Always Wanted, says. “Otherwise, you might exhaust yourself and find yourself disappointed thinking, ‘What’s wrong with me? How come I didn’t feel great going out?’”

Ease into new activities by getting together with one friend at a time or planning shorter trips in your area. If you don’t gently reintegrate into society, you will risk burning yourself out and increasing your anxiety, which may set your re-entry plans back.

The wisest approach is to slowly confront those sources of fear by gradually increasing your exposure each time. Therapists call this “exposure therapy.” Most experts agree that a gradual reentry is both the safest and usually the most successful. Evaluate and calibrate your comfort level after those initial encounters until your anxiety recedes into the background.

At the same time, it is important to remember that when something is making you anxious, you shouldn’t avoid it but rather confront the issue as soon as possible. The longer you wait, the worse your anxieties become. Keep in mind that social isolation not only has short-term health implications, but can also impact mental health long term.

2. Unconditional Self-Acceptance

According to Dr. Bonior, it is important to avoid judging yourself for whatever feelings you have. “There’s a whole range of emotions and you can have them at the same time,” she says.

On the one hand, you might be excited to reenter the world, perhaps with new goals and a new perspective on life, while at the same time you are still mourning a loss due to COVID-19. While it might be stressful to realize that you have contradictory emotions, this is normal and it’s important to let yourself feel everything.

“You can be excited and scared at the same time,” Dr. Bonior says. Or you may cycle between different emotions—from happiness to guilt to stress. The key thing to remember is to go easy on yourself, and “be accepting and compassionate of the things you’re feeling,” she says.

3. Accept that your Life may now be Different

As you emerge from the lockdown, things may be quite different than they were 18 months ago. And this can significantly contribute to the anxiety that you are experiencing, Dr. Inger Burnett-Zeigler says. But accepting that reality, and the idea that things may never return to how they used to be, is crucial, Dr. Burnett-Zeigler explains.

Accepting your new reality allows you to more easily take control and plan your next steps. And as a result, such an understanding and acceptance will help to weaken the anxiety of reintegration.

“It’s not unusual for people to have difficulty with transition; that’s what we noticed at the start of COVID and that’s what we’ll feel as we transition back to the reentry phase,” Dr. Burnett-Zeigler says. “I think that for most people, reentry anxiety will go away if they manage it healthily.”

Walking Through Some Common Scenarios

Reducing Re-entry Anxiety for Travel

Even amongst the most experienced travelers, there are those who have been feeling anxious about getting back on a plane or staying in a hotel. It’s rather ironic that travel, which should reduce stress — has become yet another cause of anxiety instead. Dr. Erica Sanborn, a Los Angeles-based licensed clinical psychologist, encourages those who are worried about traveling to start small.

“When we treat anxiety in a clinical sense, we always start small,” she says. “Exposure therapy entails gradually exposing someone to small doses of the things that make them anxious and helping them manage the distress that comes up during the exposure. Once that feels manageable, we move up the ladder to more scary things.”

Regarding re-entry, this would translate into the following. Attending an international trip or participating in a large public event (say, a food festival in NYC) might need to wait a while. Begin at the bottom of the ladder by going for a weekend getaway within driving distance, or taking a short, domestic flight with your partner or close friend.

Lessening your Anxiety over Returning to your Office

For some of us, returning to our office presents the tallest readjustment hurdle of all. Aside from the anxiety-inducing experience from a COVID-19 perspective of sharing an indoor, enclosed space with coworkers, the prospect of resocializing with coworkers you’ve only seen on Zoom for the last year and a half is challenging as well.

Sanborn recommends that people push themselves during this re-entry phase to “take a hard look at which changes truly bring you more happiness and work better for your life versus those that feel good simply because they aid in avoiding discomfort.” She says that it is important to ask yourself whether working from home really does make you more productive, or whether it’s just a way to avoid the anxiety of going into an office.

Relearning to Socialize Outside the House

How do you transition from avoiding public areas, and only stepping into restaurants long enough to grab your takeout order, to joining friends for dinner on a crowded patio? Enjoying a night out now is accompanied by anxiety triggers. Sanborn advises that it’s imperative to pace yourself and make room in your schedule for rest as you venture out into the world.

“If you have longstanding or newly developed social anxiety, being out in the world will feel more draining than you may remember,” says Sanborn. “But beware of avoidance: We naturally avoid stimuli that make us anxious to protect ourselves. The problem is that this avoidance reinforces our anxiety.”

On the one hand, it all goes back to Sanborn’s original point of engaging in the activities that make us anxious, while at the same time not blowing our circuits. The key is, to begin with, taking small steps and allowing time and space to recharge. This is a secret to managing this patch of re-entry anxiety.

Distinguishing Between Fear and Anxiety

Just as our pandemic experiences differed from each other, our re-entry experiences will be diverse as well. “There’s going to be a range of potential anxiety,” said Stacy Torres, Ph.D., assistant professor of Social Behavioral Sciences at the UCSF School of Nursing, “and we really can’t assume things in terms of people’s lived experiences, or of how they’ve been safeguarding themselves – or not – in the past year.”

According to Sanborn, “Many people felt depressed and hopeless during COVID-19 because we were helpless or defeated by the realities of lockdown and a deadly virus. Now that we can safely re-enter the world, our anxiety that once served a protective function is making it hard to engage in the very activities that would help lift us out of our depression.”

Sanborn points out that it’s essential to distinguish fear from anxiety. “Fear is a healthy response to real risk — it keeps us safe. But anxiety is created in the mind, and is maintained by anxious thoughts (imagining the worst-case scenario, worry) and anxious behaviors (compulsions and avoidance).”

The challenge is, we had a bona fide reason to be fearful during the COVID-19 pandemic — which Sanborn calls an “adaptive” fear. However, COVID-19 fear has now “generated anxiety that lives in our mind even once the real risk has passed or changed.”

If there’s one critical takeaway from Sanborn’s advice, it’s this: “The best antidote to re-entry anxiety is to reduce avoidance — to engage in the very activities making us anxious.”

But take it slowly!