Watching TV during lockdown, did you notice rising anxiety at the sight of people standing too close to one another, or touching an elevator button with their bare hand? It's amazing how quickly we became accustomed to life in socially-distant, don’t touch anything, lockdown mode. And as most of the country prepares for — or eases into — a lifting of restrictions, those feelings can accompany us back out into the world.
And of course they would. “It's normal, healthy and important to be anxious about re-entry,” said Louisville-based licensed clinical psychologist Kevin Chapman, PhD, who specializes in anxiety and related disorders.
In fact, many of us should maintain a healthy degree of anxiety, said former New York State Commissioner of Health, Dr. Nirav R. Shah, Senior Scholar at Stanford Medical School and medical advisor to Covid Act Now, a multidisciplinary team of technologists, epidemiologists, health experts, and public policy leaders working to provide disease intelligence and data analysis on COVID-19 in the U.S.
“If you're over age 60, or younger and have chronic conditions, it would be prudent to remain anxious and maintain social distancing for the foreseeable future,” Shah said. “Younger adults should also consider the trade-offs between community welfare and individual preferences — and avoid those behaviors that might lead to increased spread.”
Some anxiety is protective
Chapman says that anxiety is adaptive, meaning that anxiety serves a function of protecting us. “It's like we shouldn't feel this way about an elevator button? Should you not?” he said. We have every reason to be anxious about touching a public surface like that right now.
However, he said, “There's a difference between anxiety — the adaptive emotional experience when I'm encountering a threat like [being] with people in long lines who potentially have COVID-19 — that's normal, versus chronic anxiety that prevents me from doing anything.”
Chapman said his "concern is that individuals with a propensity toward an anxiety disorder will certainly manifest upon resuming normal life. “In other words, new cases of anxiety disorders will occur due to COVID-19 being a significant enough ‘stressor’ to trigger underlying anxiety.”
It's normal, healthy and important to be anxious about re-entry.
Kevin Chapman, clinical psychologist
The trouble is that with anxiety disorders, he explained, “there's a tendency to avoid any situation that's going to trigger any sort of distress." Successfully avoiding these situations can bring temporary relief, but "it backfires and perpetuates more anxiety," Chapman said. Successfully navigating a triggering situation, however, gives our brain a new association, making these experiences less fraught in the long run.
We can’t just stay home forever. How, then, can we prepare?
A 5-step plan to fight re-entry anxiety
Chapman uses an acronym to break down a set of skills using cognitive behavioral therapy to manage strong emotions through the re-entry process: FIGHT, as in fight COVID-19 anxiety.
F: Focus on what you can control.
While there’s a lot of uncertainty associated with COVID-19, and anxiety and uncertainty go hand in hand, he said, there are actually a number of elements we can control. Those include how much media coverage we allow ourselves to watch and how much we talk about it. We can also control the things we can do in our immediate environment, and we can follow CDC guidelines as it relates to social distancing. This focus will give us a sense of control and predictability, he said, that will help us manage anxiety much more effectively.
I: Identify negative thoughts
While negative thoughts are inevitable right now, those that are catastrophic in nature, or that are predictive — as in ‘this is going to happen to me’ or ‘I know that this won't end anytime soon,’ create intense emotions, Chapman said. An important skill is to identify those negative thoughts and recognize that they contribute to maintaining strong emotions.
G: Generate alternative thoughts
This isn’t about positive thoughts, necessarily, Chapman explained, but coming up with more flexible thoughts. “It's not a ‘you got this, attaboy’ sort of thing. What if you feel like you don’t got this?”
He recommends coming up with what he calls a retrieval cue, something that reminds you to remain in uncomfortable situations. That can be an image or a small statement — Chapman likes to use an anchor. “It's a reminder of being flexible, being present, not escaping, that triggers the brain to recall the right things to do and say in that situation, and helps you remain.”
“I create a hierarchy of social situations that are uncomfortable, identify my thoughts in advance, and then become more flexible in those thoughts,” he explained. That cue “reminds me of anxiety being harmless, of anxiety being adaptive and helpful, and I ride the wave as opposed to fleeing.”
H: Highlight adaptive behaviors
Chapman recommends finding behaviors you can engage in to help navigate strong emotions. That could be exercise, mindfulness, and meditation, or connecting with family and friends even if it’s via technology.
A critical adaptive behavior is anchoring in the present, he said. Say you’re in a crowded subway car and feel anxiety rising, a technique to use in the moment is breathing in through the nose for four seconds and out through the mouth for six. “That stimulates heart lung synchronization, so now you're anchored and grounded in the present moment,’ he said. “And then you do what I call a three point check: What am I thinking right now? What am I feeling in my body right now? What am I doing, or feel like doing right now — and it might be I feel like peacing out and escaping immediately. Well, am I reacting to what's happening right now, or to a future path? The bottom line is, I need to respond to what's happening in the present moment.”
Following the situation, ask yourself what you learned, Chapman said. “Your brain learns a new non-threatening association despite how you feel in that context. So it's not about stress reduction. It's about learning something new, learning that I can tolerate discomfort, learning that this sky isn't actually going to crack and learning that it might be better than I expected it to be.”
Arguably the most important element is to teach someone else to do the same thing, Chapman said. “We're all in this fight together. If we band together and use the same skills and strategies. I think that we will make it through together.”