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It's Scary Out There!

Dr. Kathleen Pike a Professor of Psychology and Director of the Global Mental Health WHO Collaborating Centre at Columbia University wrote a blog about managing the anxiety of emerging from the safety of our pandemic pods. I thought it was on point and is an interesting read given the times we are living through. Enjoy!

It’s Scary Out There

FRIDAY, APRIL 16, 2021

I was talking with a friend the other day about meeting for coffee. We are both vaccinated. It didn’t seem reckless, but as we anxiously confirmed the details, it sounded like we were complete newbies to the coffee meet-up. A friend’s kid who is in high school told me he would rather avoid going back to school because he felt uneasy about being around so many people again. Another friend is still wiping down her groceries.

This anxiety is entirely understandable. We have been bombarded with messages warning us about threats to our health, livelihoods, and lives. The foremost instruction has been to retreat to private spaces and minimize public activity. If we are lucky, doing so has protected us. When we do things that make us feel safe, reduced anxiety is our reward. When behaviors are rewarded, we are more likely to repeat them. So as the pandemic recedes and vaccinations rise, how do we manage the anxiety of emerging from the safety of our pandemic pods? 1. How does anxiety ‘talk’ to us? It may not feel pleasant, but it is helpful to think of anxiety as a messenger inviting us into greater awareness of our thoughts and feelings. When we find ourselves apprehensive about situations, perseverating on a possible future risk, or worrying about potential bad outcomes, we call it anxiety. We recognize the physical experience of anxiety when our heart rate speeds up; our breath becomes faster or more shallow; we start sweating or feel chilled or have butterflies in our stomach. These manifestations of anxiety are cues that we don’t feel safe. They are an invitation to pause, assess risk, and develop a strategy of response. 2. But shouldn’t the vaccine make me feel less anxious? Yes, but… to put it kindly, communications about this coronavirus have been muddled. We have received seriously mixed messages about risk transmission, vaccine efficacy, and immunity. Some of this is because many things about the virus are still unknown even after eighteen months of global attention. It is also due to evolving knowledge, the complexity of the emerging data, and agenda-driven misrepresentation of science. The result has been that we are not sure what to believe, and anxiety is correlated with ambiguity and uncertainty of risk. 3. So is it safe to get coffee? Maybe. As the pandemic recedes and vaccinations rise, the first step to lessening our anxiety is to perform our own data-informed assessment of risk. We need to focus on ourselves, the other people involved, and the environmental context. Am I vaccinated? Have I had any recent risk exposures? Do I have any current symptoms that might pose a risk? The same questions apply to the other person/people we are meeting. Then we can assess whether the venue or environmental context is in line with recommended risk-management practices. 4. What if even after I assess that the risk is low, I still feel anxious? That will be a common experience for many of us in the coming months. Behavioral psychology explains how this works: we were presented with elevated environmental risks and instructed to reduce our social interactions. By withdrawing from risk exposure, our anxiety went down. We like feeling less anxious so we got comfortable with the new-normal – even if we do not like some of its implications (such as not visiting with friends and loved ones, loneliness, and Zoom fatigue). These negative implications will serve as the incentives to motivate us to restart certain routines again. Once we assess that moving forward is safe, the best practice for overcoming associated anxiety is controlled, repeated exposure to the stress-inducing situation. This ‘unlearning’ process is known as extinction. 5. How does the extinction of anxiety work? Ample evidence demonstrates that if we want to feel less anxious about returning to some of our pre-pandemic activities, we will have to expose ourselves to those contexts. The systematic behavioral strategies of desensitization and exposure initiate an ‘unlearning’ process that revises the messaging in our brains – corresponding to the depotentiation of synapses within the amygdala. Over time, habituation occurs as a result of refamiliarizing ourselves with the objects/ activities/ situations that had become associated with anxiety. By confronting the source of our anxiety rather than avoiding it, we see for ourselves that we are okay. This enhances our sense of safety and agency, and sets us up for success with the next exposure. So I had coffee with my friend. It was very strange that something that used to be so commonplace felt so unfamiliar. We sat at a distance. We sipped our drinks cautiously. We talked about what we missed most this past year and what was on our wish lists for the coming year. Bit by bit, anxiety gave way to connection. Connection gave way to joy. Of course, for many people and places in the world socializing in-person is still in the future. When the timing is right, I hope these basic behavioral psychology principles will be useful. There’s nothing like a good cup of coffee with a friend.

Kathleen M. Pike, PhD

Kathleen M. Pike, PhD is Professor of Psychology and Director of the Global Mental Health WHO Collaborating Centre at Columbia University

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