a collage of a medical mask, we're open sign used at retail locations, a syringe and viles to convey elements of things opening up after the pandemic

COVID-19

How Will We Cope With a “Return to Normal”?


It’s perfectly reasonable to have some trepidation about the post-vaccine stage of the pandemic. A clinical psychologist explains how to cope with the anxieties and hesitancies that come with reentering the new normal.



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Throughout the pandemic, many of us found ourselves fantasizing about what life would be like once we were vaccinated. Some dreamed of returning to “normal” life activities. We’d go to the movies. Eat in a restaurant. Visit friends. Take a trip. It was the reward we’d give ourselves for a year of isolation. But when vaccines became widely available in the U.S., we were faced with a reality that was still filled with uncertainty and far more gray areas then we could ever have anticipated. Questions about reopening and socializing safely, vaccinating children, chronic illness brought on by long-haul COVID, and more remain. Turns out, after more than a year of trauma, going back to “normal” isn’t a simple, quick, or cut-and-dry transition.

Despite all the recent, ableist headlines that attempt to peer-pressure you into thinking your post-pandemic uneasiness is “COVID anxiety syndrome” the truth is that it is perfectly normal and totally reasonable (rational even!) to have some trepidation about a return to society.

The fact is, we are currently living through a mass-death event. Thirty-three million Americans have been infected by COVID so far and 582,000 and counting have lost their lives to it. The unemployment rate is currently around 6 percent (though experts believe the true number is much higher). And the U.S. is still tracking about 4,600 new hospitalizations every day. Meanwhile, about 10 percent of those infected are now possibly facing life with a chronic illness as long-haul COVID numbers rise.

On top of all that, those of us with disabilities, marginalized communities, people of color, those in the Black community, and anyone without privilege watched as our fellow humans devalued our lives in new ways. And while there is very good science showing the vaccine’s incredible effectiveness against the original strain and the variants, they are still extremely new. Not to mention the big pockets of the population that are anti-vaxxers. We also don’t have data yet about whether vaccination has prevented long-haul COVID in the few breakthrough infections that have been documented. So it’s understandable, in fact completely rational, that so many of us are making a slow, hesitant reentrance.

DAME recently asked readers to submit their questions about life in a post-vaccine world. We wanted to know what your post-vaccine anxieties are, so we asked you to share your fears with us. To help understand these concerns and how to grapple with them, we spoke with Dr. Krystal Lewis, Ph.D., a clinical psychologist at the National Institute of Mental Health (NIMH). She specializes in cognitive behavioral therapy, has a practice helping adults and children cope with anxiety, and is currently researching pediatric anxiety. We presented your questions and concerns with Dr. Lewis, along with some of our own. Here’s what she has to say.

 

DAME: Shouldn’t we be more excited to return to “normal”? Why are so many of us feeling more anxious than happy?

Dr. Krystal Lewis, Ph.D.: I would say it’s a pretty natural response given that we don’t have a demarcation for the end. We have the vaccine available, and that’s relatively effective. But [once] you get the vaccine, it’s still important you wear your mask and there’s still restrictions. You’re finding out “I still have to practice caution.” It doesn’t quite match up to what our expectations were. There’s anticipation of being able to live more freely and then you don’t actually feel that freedom. There’s no end point yet. That makes it tricky for planning and projecting.

It’s balancing that sense of optimism, that things will shift, with the fact that it’s been an extremely slow process. There are so many emotions people have been dealing with, and now we’re moving into another summer remembering lost opportunities, milestones, the anxiety of the post Easter spike… A lot of ups and downs, and the unknowns make it very hard.

Is this common after a large collective trauma?

With this collective experience, there are pros and cons. Since literally the whole world has been dealing with it, a lot of people are receiving the same information, and you can talk about this with basically anybody who has been alive during this time. Though people respond individually, a collective trauma normalizes the sense of anxiety and fear, the grief of loss of activities. It can be helpful that you aren’t so alone and isolated in the experience.

On the other hand, where it might not be as helpful is when you compare yourself to how other people are responding. Other people aren’t experiencing the same challenges you are, and that can be a cause for distress. You can relate to other people, but it can be hard when you notice other people are thriving. Especially at the beginning of the pandemic, a lot of the work that psychologists were doing was normalizing the heightened sense of fear and anxiety people were having. Isolation, loneliness, and depression—knowing that other people are experiencing similar emotions is helpful.

The collective sense can normalize the experience, but understand your own individual resilience. What is it that you need during this time? It might be a slower integration. Even if your friends are expecting you, you might have to modify how you’re jumping back into this. And that’s OK. It’s figuring out what works for you. Know your boundaries. You might not know that until you start going out and feeling uncomfortable and knowing something’s off. Don’t be afraid to step away from the group and do something differently if that’s necessary.

Speaking of socializing, many of our readers expressed fears that they’ve lost their knack for being around people. They asked questions like: “How do I even make friends again IRL? I feel like all my social skills have atrophied.” And: “I honestly don’t want to shake anyone’s hand again when I meet them. I don’t want their germs. Also never again eating a birthday cake where someone blew out the candles.” Or even: “I don’t know how to be anymore.” 

It’s helpful for people to know that’s a common experience. When we work with anxiety patients, we create a method of exposure. Try not to avoid interaction, but set up safe and controlled activities. Start with one friend and visit a venue where there’s minimal risk or go for a walk. Something where you don’t put too much pressure [on it]. Remember: our social skills can be like when you learn to ride a bike. Once you get back on, it comes back to you, it’s natural. If you didn’t have difficulty with them before, you might feel a little rusty, but once you start engaging it might come back to you.

It’s tough, it’s going to take some time for people to re-integrate. If you’re most concerned about the social aspect, it is going to feel awkward and out of the norm of what you were doing. But with practice it gets easier. Choose someone who may have already been in your social circle, a family member or someone where you don’t have to worry about COVID risk. If you’re back in the office, have a two- or three-minute conversation with someone. Remember that a lot of people are experiencing the same thing you’re experiencing. It takes practice.

There are also lots of resources out there, if you find you’re really struggling. Reach out to a therapist or join a social support group (a specific group for people who have social anxiety, which, just because you’re in a group environment you’re practicing talking to people) that can help with the reintegration if you’re finding that you’re really anxious. You can look up therapists on Psychology Today and the NIMH website—both also talk about mental illness so you can look at the symptoms to see if this is social anxiety and you need to seek out help.

There are still some unknowns about the vaccine and everyone’s personal risk assessment is different. Folks are concerned about how they’re going to navigate the uncertainty that still exists. We had questions like: My biggest concern after I will receive the vaccine will still be about contagion, specifically when it comes to all the variants. More than me getting one of them and getting sick, I am most afraid of catching one of them and passing it on, if the vaccine doesn’t cover that.”

“I’m really worried about my kids not being able to get vaccinated anytime soon, especially with the B117 and other variants coming out as more highly transmissible and causing more symptomatic illness. Are summer camps still out? Schools?”

“I’m eager to ‘get back to normal’ but scared that I won’t even physically be able to, if that makes sense. Even after most people are vaccinated, am I ever going to want to get in an elevator with a stranger and breathe the same air? It sounds horrifying, right?”

A lot of our normal practices are no longer necessarily going to be normal. It’s most important to start with not overwhelming yourself with all these unknowns. Anxiety is a fear of the unknown, and so the more we focus on all of these unknowns in terms of the variants and how COVID is transmitted the more anxious we’ll be. It’s most important to make sure you’re following guildelines and stay updated but don’t overwhelm yourself because the news is telling us what we don’t know.

It can be a very hard decision to determine whether you should send your unvaccinated kids to school or whether you should spend time in your social circles, so focus on what you can control in the situation. How can you keep yourself safe? You can control, for the most part, where you go and who you’re around. Limit your exposure to the point where you feel comfortable and know this is going to be a slow process. Stay in the present. It’s natural to jump into the future and worry about what will happen.

If you have a question and there’s something you don’t know the answer to, you can do your due diligence but make sure you’re limiting the time you’re doing it. There may not be a need to overly consume the news. Balance being aware but not tuning in too much to the point where you’re feeling overwhelmed. Focus on what you can control and stay in the present moment.

That probably doesn’t apply to everyone, but for the most part we can structure things in the way we feel most comfortable. You will feel pressure as you see other people doing more. You can feel the pressure and think “maybe I should be doing that” but remind yourself you have the right to decide what you’re comfortable with.

There’s a lot of worry about how relationships have changed throughout the course of the pandemic. Specifically, people have lost faith in some of their friends and family who didn’t take it seriously. We received questions like: 

“Having to start dealing with people who are COVID deniers and anti-vaxxers again is stressing me out. I don’t know how I can ever trust their judgment on anything. For the last year, I’ve lived in a bubble where I could eliminate them from my life, but that will end once I get my second shot and am able to return to work.” 

“Learning who is shitty and loudly selfish is definitely a game-changer… we can’t unsee that.”

“I’ve gotten used to not having to deal with the steady family obligations, and while I look forward to seeing some, there are many I’m disappointed with for not taking the pandemic seriously enough.” 

“I have zero desire to interact with, let alone socialize with, many friends and colleagues I’ve seen act like fools for a year now, all while proclaiming how safe they have been. My social world is going to be very, very small after this.”

When dealing with people who have different beliefs as you, that can be quite frustrating. With the mandated quarantining and social distancing you could avoid those interactions. Now you might have to be around them. If you have relationships with people who have different beliefs you can share your beliefs and encourage them to engage in safe practices. If they’re choosing not to be safe and you have an issue with that, it changes the landscape of your friendship.

Speaking to the emphasis on “I have to be around them,” see if these are people you can have conversations with to get to a place of understanding. It’s almost like having different political views—you can just not talk about it, but if the fear is they’re risking your life, then don’t be around them. If you don’t feel comfortable, you can make a decision to say: “I’m not going to this family gathering.”

Or you can try to just keep it light. Talk about other things you’re not strongly sharing your stance on because you’ve seen their true colors. If you’ve seen it from a distance, a post they put online or how they’ve been behaving, I would encourage you to have the conversations to see where they’re coming from. If they’re a good friend they might be able to listen to your beliefs. If not, it’s about managing your time that you have to be around them. That’s perfectly OK. We go through phases. You’re an adult and you’re not completely powerless. You’re empowered to make the decision to be around and not be around certain people. Outside of COVID, we’ve seen division and split, it’s about balancing people you feel comfortable around. Relationships change.

Many folks with chronic illness and disabilities have appreciated that, throughout the pandemic, the rest of the world has, in many ways, experienced life as they have lived it for years. There’s fear that as the world opens up they are going to find themselves left out and left behind once again. Readers told us:

“I’m chronically ill, so my life has mostly been unchanged, but this means everyone else gets to go back to doing their thing and I’m … still here.”

“How do I deal with everyone being over it when COVID long-haulers like me are stuck being sick?”

“My biggest fear is that everyone will return to “life as usual” without making any real lasting change. The way we treat access to health care in this country, the way workers and students are encouraged to show up even when they’re sick, and the threat of being penalized for it.”

“My worry/sadness on this topic is people forgetting that some of us, even post-vaccine, even post-pandemic, will still be stuck in isolation due to chronic illness/disability.”

It’s important to focus on what you have control over in terms of protecting yourself. This ties into limiting frustration over people not having consideration for high-risk populations. What are the things you can do? Not focusing on limitations, but finding joy in daily living. What are the things you can do daily that you can enjoy? Individual activities that help you to find meaning. Find a cause and invest in it, relate it to awareness about chronic illness or disability and find ways to help spread information for people who feel they’re being left behind.

It’s natural to have that frustration and fear, and I know for some of the kids I work with it’s helpful to have support groups and people who can relate to your experience. It could be helpful to find people who also know what you’re going through. It can be frustrating to talk to people who don’t quite get it.

The tough part is what do you do with that? Because it’s a valid point and every feeling is warranted. It could be shifting to what are the things that are safe for you to do. Where can you place that frustration, even in a small way, that it will make a difference? Turning your fear into action.

One of the most common questions was a general sense of distrust of the outside world. After realizing that so many people simply did not share the same aversion to risk, there’s now a feeling that many people are simply no longer to be trusted: “I wonder how to trust anyone anymore. I’ve had to be out and working, but I don’t trust being in the same space with anyone. Everyone has such different values and beliefs on the virus, how do we know someone isn’t lying about getting a vaccine? How can I go to the store? Etc.”

It’s very easy to get stuck in that fear of not knowing who is doing the right thing. And it’s more important in those scenarios to focus on yourself. For example, focus on the one co-worker you see wearing a mask and engaging in safe practices. You have to start somewhere and start small, giving someone a little bit of a window and seeing how that goes. Otherwise, there’s no way to move forward if you feel like there’s nobody you can trust.

I’ve heard a lot of folks saying they’re “agoraphobic now” or that the pandemic has caused them to “develop agoraphobia,” but I know this is a clinical anxiety disorder that has a specific definition. Can you explain what it is so that folks can consider if it really is something they’re facing?

The lay understanding is fear of leaving the home. But it’s a diagnosis of excessive fear of public places. People with agoraphobia are afraid they won’t be able to escape, they’re afraid of having a panic attack, a fear of losing control. And so they may end up isolated and detached.

The fear in the pandemic is specific to contracting COVID. But generally if you are driving in your car by yourself and you’re fine or if you’re going out for a hike and you’re fine [that’s different from agoraphobia]. With people who have agoraphobia it’s an intense fear of leaving the home. Even driving their own car or being away from their home base, which is safe. With agoraphobia, people perceive places as being dangerous. Someone who has agoraphobia would be significantly anxious to leave their home base even if COVID isn’t there. The danger is not a specific danger, it‘s a broad-base fear of something bad happening, which is related to panic symptoms.

Interestingly, some of the responses that we received are that people’s lives have changed and they don’t want them to revert back to how they were before. Their lives were too busy and overwhelming: “I was over-scheduled prior to the pandemic and can’t fathom the thought of going back to endless meetings and obligations. I am anxious about saying “no.” The silver lining of this year is what I’ve learned about myself and I am anxious about the possibility of losing that clarity in the rush to get back out there. My values and interests have realigned. I want my life to reflect that.”

Across the board, a lot of people have shifted in terms of what is important to them. A lot of people have realized they don’t want to live the way they were living pre-COVID. It’s important for people [to] foster their new values by setting appropriate boundaries and structuring their lives the way they want to live. Prioritize your own needs and wants—start with something small. Start by practicing saying “no” and build on that. It’s a mindset shift, especially if that’s not how you’ve been living prior. You’ve been overly scheduled and accommodating and now you want to live in a different way. Part of that is going to be changing your behavior. Face it head-on. Start saying “no” and building up to changing your life the way you want to.

It’s helpful to hear you’re not alone. The collective experience of what’s been going on, normalizing these experiences of not wanting to live your life that way, and giving permission to yourself to live how you want to live. Say no, set boundaries, and value yourself in that way.

Can you give us some ideas of what a boundary is and how to set one?

What is a boundary: it’s a limit we set for ourselves and that can be in relation to interpersonal relationships or work you have to do. A person with healthy boundaries will be able to tell other people “no,” say what they can or can’t do, and are comfortable opening themselves up to receiving negative feedback. A lot of people don’t know they need to set a boundary until it’s crossed or they’re overstretched and stressed and they’re not sure why.

A safe way to say you have a boundary is really just telling people what is acceptable or not acceptable to you. It’s really focusing on the behavior. For example, maybe you have a co-worker who’s constantly coming to your desk and taking your things, it’s just pointing out your preference and telling that person “I’d really appreciate it if you ask me” or “It’s making me feel uncomfortable …” Stating how you feel, what the behavior is, and what you would like to happen. That’s more helpful than just responding with a straight no—but sometimes it’s helpful just to say no. You can say: “no, because …” and then you can say what your preference is.

That said, a lot of people don’t like using the word “no.” There are different ways you can say no without using the word. You can say, “I don’t think that’s a good idea for me right now.” You won’t be offending or disappointing other people if you focus on you and not the other person: Saying, “That’s not the best fit for me,” feels more polite. Or: “That doesn’t really work for me.”

 

 

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