All minds are welcome 

Managing Anxiety after COVID-19

By Dr. Rebecca Blakeman

For most of us, our world was turned upside down in the early months of this year, due to COVID-19. We were thrust into situations we could never have imagined pre-pandemic. We could no longer do normal activities such as work in offices, visit with family and friends, enjoy an evening on the town, participate in worship services, or go to school, because it was not safe to do so. 

Leaving home placed us at significant risk of serious illness, or at significant risk of spreading serious illness to our loved ones. Most of us had never experienced this type of safety issue, and naturally this led to an increase in anxiety. While anxiety in this situation was an adaptive response (anxiety preps our brain for making better, safer choices), what do we do with the anxiety when it is time to return to the real world, when the danger has been drastically reduced? 

We may not know when, and it may vary by geographical area, but the day will come when the safety risks have declined substantially and it is now considered at least relatively ‘safe’ to leave our homes and begin resuming some of our previously enjoyed activities. While many people believe they will rush out, eager to dine at all of their favorite restaurants and excited to hug everyone who comes in sight, the reality is likely to be much different for many people. Because anxiety is an adaptive response for keeping us safe (we are ‘wired’ with it), our brain and central nervous system (which are designed to keep us safe) may not be as eager to join the world and resume our activities. 

Our brains set off safety alarms at the start of the COVID crisis, which served to keep us safe and healthy; without a process of reprogramming those alarms, many people are likely to experience considerable anxiety when faced with having to return to the outside world. This is a normal reaction to the situation we have endured and does not necessarily indicate a clinical disorder; however, there are steps we can take to ease the process and ‘reprogram’ the alarms that may no longer be necessary. 

First and foremost, be safe. We cannot control everything that happens in the world around us, but we can take steps to increase our safety and decrease our risks. Because the virus is still present, practicing safe behavior does not necessarily mean that we are continuing to live in fear, but rather that we are making good choices that will realistically lower our risk, and thus make us feel less anxious. It is not realistic, nor desirable, to reduce anxiety in dangerous situations, if we have taken no steps to reduce the danger, thus taking reasonable safety measures is important. What does this mean from a practical standpoint? 

*Be aware of the case numbers in your surrounding area. If there have been no new cases, or very few new cases, in your area recently, then you can feel more relaxed about doing previous activities. If you know that there have been an increase in recent cases nearby, it would likely be prudent to hold off on unnecessary outings. 

*Wear a mask. There is considerable research that indicates a person with the virus wearing a mask greatly prevents the spread of the virus; the more people that wear masks, the safer we all are. Because wearing a mask reduces risk, wearing a mask can reduce anxiety. 

*Continue to practice social distancing by standing 6 or more feet away individuals who do not live in your household. Again, this reduces risk, which can reduce anxiety. 

Secondly, start small. Our brains have done a wonderful job of keeping us safe and convincing us that anything out of the house is risky. When it is time to return to activities outside of the home, many of us will need to ‘reprogram’ our brains. This will involve doing activities that would likely trigger anxiety alarms, so that the brain can ultimately realise that we participated in the behaviour/activity, and nothing bad happened because it was actually safe. 

While there are different approaches to this, I find that most people do better by starting small and gradually moving towards ‘bigger’ behaviours or events; much like wading slowly into a pool of water, rather than jumping into the deep end if we are afraid of the water. 

 

This gradual approach involves less anxiety, which makes us more likely to follow through, and ultimately more likely to succeed. What does this mean from a practical standpoint? 

*Initially, if possible, limit activities to those that are most likely to have decreased risk of spreading the virus, such as outdoor activities that do not involve being in crowds. This will help your brain to ‘get used to’ being out of the house, around others, without significant risk. 

*Initially, if possible, limit social activities to those involving people with an extremely low likelihood of having the virus, such as people who have been completely isolated at home (with no symptoms) for at least 14 days. This again helps your brain and nervous system to ‘practice’ being around 

others with virtually no risk; as you do this, the brain re-learns that this is safe, which reduces anxiety. 

*Initially, if possible, limit outings to brief activities, such as going to the store or running other simple errands. Shorter trips reduce risk while also allowing your brain to get used to being out of the house, which reduces anxiety long-term. 

Finally, manage your thoughts. Anxiety involves not only our automatic physical responses to situations (e.g., rapid heart rate, sweating, sick feeling in the stomach), but also our thoughts. We can reduce anxiety by learning to manage thoughts that trigger or exacerbate anxiety. 

Be deliberate in where you allow your thoughts to go, and what thoughts you allow yourself to focus on. What does this mean from a practical standpoint? 

*Be aware of your thoughts. Many times our thoughts are so automatic that we are not even fully aware of what we are thinking. Take time to recognize your automatic thoughts, which may be something like, “This is dangerous,” or “I’m going to catch the virus.” 

*Evaluate or challenge your anxious thoughts to see if they are valid. For example, if you automatically think, “This is dangerous,” consider what evidence there is for or against this thought. If there have been no new cases in your area for a week or more, you are wearing a mask, you are not coming into close prolonged contact with others, there is extremely limited risk. Focus on factual information for evaluating the accuracy of the anxious thought. 

*Replace the anxious thought with a factual thought that is less likely to cause anxiety. For example, in response to the previously mentioned anxious thought, it might be more factual, and less anxiety provoking, to think, “It 

has previously been risky to go to the store. However, there have been no new cases in this area, despite the fact that testing is available to anyone. I also wear my mask and see most people wearing one as well. The stores have worked really hard to clean all surfaces we need to touch. I won’t be in the store but a few minutes. It seems much safer to go to the store now, compared to before.” 

*Remind yourself routinely that most people who go to the store (or whatever 

activity you are doing) do not catch the virus. 

*Remind yourself that you have never been able to control every potential risk in life, but with this virus, you are doing everything you can to reduce risk (just like wearing a seatbelt every time you get in a car). 

Most of the above mentioned strategies are applicable when some degree of risk still exists. However, these same strategies will be applicable once the virus is truly eradicated. As treatments and vaccines become available, and as new cases vanish, it will be easier for some to spontaneously jump into large group activities and other social gatherings. 

However, some will continue to feel hesitant. Again, this is a normal reaction to what has been a traumatic and life altering experience. When the day comes that the virus is no longer a concern, focus on the known facts…focus on the number of people vaccinated, the lack of new cases, the success of areas that have completely returned to ‘normal’ activities without any new cases, etc. Then allow yourself to start small in your venturing out, always planning the next, larger ‘step’ towards returning to your previously ‘normal’ activities. And if you find that this remains difficult, seek assistance from a professional, as brief counselling is likely to help you get back to your previous lifestyle quicker than you thought. 

And as always, remember that this is temporary. We will get through it together, even if physically apart. And above all, never lose hope.