Anxiety in a post-COVID world

A return to the next normal post-pandemic may trigger anxiety for people anticipating a more public-facing life after a year of isolation.

Newton’s cradle where one end swinging ball is a covid virus cell and the other is a content happy face.

A post-pandemic world is arguably near. Experts anticipate a “return to normal,” or the next iteration of normal, in 2022. Many people correlate the end of mask-wearing with the end of the pandemic, or see herd immunity as the marker for safety. Whatever goalposts people reference for pandemic’s end, there is an agreement among public health officials and infectious disease specialists that 2022 will be much different than 2020, with the current year a time of adjustment and some restrictions eased.

For many people, the possibility of meeting up with friends and family, visiting public spaces, and even being amongst crowds is an exciting possibility. For others, these social environments may trigger anxiety. Whether an individual has a history with anxiety, or is experiencing novel twinges of uncomfortable apprehension confronting public life, the transition to a more robust public life will present a flurry of new emotions to navigate.

Thea Gallagher
Thea Gallagher, psychiatry professor at the Perelman School of Medicine and outpatient clinic director of the Center for the Treatment and Study of Anxiety. (Image: Penn Medicine)

“We are creatures of habit,” explains Thea Gallagher, a psychiatry professor at the Perelman School of Medicine. “It may be anxiety-provoking to do things we haven’t in a long time.” As the outpatient clinic director of the Center for the Treatment and Study of Anxiety, Gallagher and her team’s work pre-pandemic involved exposure therapy for individuals working through social anxiety and phobias. Applying this kind of cognitive behavior therapy in treatment for anxiety disorders, exposure therapy helps individuals face fears instead of avoiding them, in turn changing how one thinks about fears cognitively, and the likelihood of experiencing a negative outcome. This practice affects the anxiety a person will feel when they think about a situation, or are in it.

On March 11, 2020, life engaging in the commons ground to a halt. While the awareness of COVID was not new, the national lockdown drove many people still engaging regularly in public life to a stop. Gallagher and her team had to come up with creative ways to tweak exposure therapy for a new, mostly online world—for many, exposure therapy turned to being active participants in Zoom meetings.

The more homebound people became, and more isolated, routines and public interactions went dormant. Like a muscle, social tolerance and adaptability goes soft from lack of use. For people with no history of social anxiety or phobias, this can lead to a new, unfamiliar sensation of discomfort and unease. “One positive aspect of the pandemic is that people are more open and public about anxiety and phobias. There is less stigma about talking about it and even seeking help,” Gallagher says. Indeed, throughout 2020 the interest in psychiatric telehealth grew so much, providers struggled to keep up with the demand.

“There is less stigma about needing help, because more people are coming out saying they are struggling,” says Gallagher. “People are accepting, owning, and wanting therapy.” In addition to being creatures of habit who are out of habit, the pandemic has added a lot of new mental material on our plates. Many families are juggling work and homeschooling, while others are navigating unemployment. And a lot of people are sick, or have a loved one who is sick. Still others have lost friends and family to COVID. These are unprecedented times with new stresses, and compound stresses.

Now, with vaccines trickling to populations, and some states even lifting restrictive COVID measures (regardless of whether the impact on public health will be negative), the United States is entering a new phase in the pandemic, and routines will gradually shift once again.

“I do think for people who struggled with clinical or subclinical social anxiety and never got help, it is going to be even more difficult to go back,” Gallagher predicts. “For people who struggled before and got used to a new routine, be prepared for it to be difficult and challenging, but don’t avoid it. A core tenet of work we do with exposure therapy is the more you do it, the easier it becomes over time.”

One advantage Gallagher points out is that the United States will not enter a post-pandemic world overnight. “This isn’t a yearlong snow day, and once the roads are cleared life as we know it resumes. A return to life lived more in the public realm will be gradual, and our reactions will exist on a spectrum. We need to normalize the fact that things will be awkward getting back to life, and normalize some level of anxiety and apprehension.”

Gallagher warns against “hiding behind the pandemic.” For people who had to push themselves to be in social settings before the pandemic, it will be that much more difficult. People will need to monitor how extreme their reaction to public life is, or whether anticipatory anxiety is growing to the point of putting off social interactions. “If it starts to feel so anxiety-producing you can’t do it, or you avoid social settings entirely because you feel you can’t process it, that is hiding behind the pandemic.”

The fears and uncertainty that humanity has lived with and navigated are not unfounded. SARS-CoV-2 is a very real, deadly threat. Individuals who have been colloquially called “germaphobes” in reality exist on an OCD spectrum. The environment is riddled with germs, and before the COVID-19 pandemic, people lived with varying levels of germ awareness and avoidance practices. People know to wash their hands before eating, not to touch their face with dirty hands, etc. For people with OCD, the fear of germs exceeds the level of threat. With an airborne global contagion, an elevated threat response to germs becomes normalized. And with good reason—COVID kills.

Gallagher explains this is a normal response. “A vaccine doesn’t measure infection rates. It will take time to reach herd immunity, and something like this can happen again.” Her advice: Follow CDC guidelines, but don’t go above and beyond. “We will live with a level of uncertainty for the rest of our lives—we already do. We take risks every day, getting in cars, crossing the street. We will have to look to leaders and follow CDC guidelines, but don’t go above and beyond what they recommend or caution against.”

The heightened fear and awareness of humanity’s own mortality that COVID has brought is not unlike a new parent’s heightened emotions and fears postpartum. For many parents of newborns, and those who previously had a healthy relationship with their own mortality, risk, and fears, having a new baby heightens the sense of risk and the magnitude of mortality. New parents see how vulnerable babies are and how little it takes for something to happen to them. It can make living in the world more scary than usual. “Heightened fear of COVID is similar to being a new parent and having unprecedented fears,” Gallagher says. “People have lost loved ones who shouldn’t have died if not for COVID.”

“We need to build our uncertainty muscle,” she adds. “We have to learn to tolerate it and live with it. Fear comes to us, and grows bigger. Do I want to spend my life worrying, or try to control what I can?” How that translates to life post-COVID means to take precautions, but live a life without being hampered by fear.

The last year has turned a large portion of the population into shut-ins. People are avoiding public interactions to stay safe. But avoiding public life and all the things that make us feel human, excited, and engaged with our humanity is not there. There are no outlets to get one’s mind off a growing sense of anxiety. Anticipating a life lived more in the public can be a way to engage with the world in a way that keeps us human.