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Column: Re-entry anxiety

Many of us have been quarantined in our homes for weeks. Shelter Island and the country are beginning to open. But, what happens if you feel too anxious to return to any part of your life?

Most of us talk about anxiety as a bad thing. But some anxiety is good and normal. It is actually protective. When early humans encountered a large predator, such as a bear, they became anxious and hid or ran away. The problem with anxiety is that in modern life we rarely encounter a truly life-threatening situation, such as a large predator.

Enter COVID-19. The crisis tapped into the anxiety and fear areas of our brains. The early weeks of the pandemic were justifiably frightening and anxiety provoking. To address those fears, we all stayed in the safest place we knew — our homes.

While some people were less strict about staying at home, as a mental health doctor I can tell you that many people have not left their homes or apartment buildings for weeks at a time, having others deliver groceries to them. They were scared and anxious. Now they are scared and anxious to return to the world. And, it is normal and healthy to have some anxiety about re-entry.

But long-term quarantine has adverse mental health effects. Studies show that quarantine generates symptoms such as low mood, insomnia, stress, anxiety, anger, irritability and emotional exhaustion, or even full depression and post-traumatic stress. And the longer you stay in quarantine, the more severe and long-lived these symptoms can be.

The thing is, coronavirus hasn’t gone away. It’s still an invisible microscopic entity that is potentially life threatening. Yes, you could keep your risk of infection as low as possible by isolating indefinitely. But, you probably don’t want to do that. You miss being outside, seeing friends and family. Living your life. So, the real question is: How do I lower my anxiety enough so I can begin to leave my home and do activities that I miss? 

How do we reduce their fear and anxiety? We need to get them back to the activities they have avoided by quarantining at home.

Three ways

Have a conscious decision to accept some risk: Nothing you can do will create a risk-free coronavirus life. Even staying at home is risky. But life is full of risk. Every time you leave your home you increase the risk something might happen to you. Motor vehicle accidents are the best example. But are you willing to deprive yourself of living your life? Risk is a personal decision. We each need to ask ourselves what amount of risk we are willing to take. For example, I don’t ride motorcycles on highways, but I might on Shelter Island, and I’d never ride one without a helmet. Similarly, I am willing to see friends and family outside without a mask, but not inside, and I definitely am not yet comfortable getting on an airplane. 

How much risk you are willing to tolerate means educating yourself. A lot more is clear about coronavirus than earlier in the pandemic. The medical field is clearer about how risky specific activities are. However, due to significant time spent sheltered in place, many of our anxieties about coronavirus may be out of proportion with the actual risk.

Remind yourself what physicians and scientists know

Seeing others outside or in any well ventilated space is fairly safe.

People are wearing masks now, and that significantly reduces the spread of the virus.

Continuing to regularly wash hands and maintaining physical distancing reduces infection.

Remember

Compare how you feel with the facts. The actual risk is probably a lot lower than it feels. Practice pushing yourself outside your comfort zone. Now that we know there are ways to safely begin to return to our previous lives, we need to push ourselves beyond the anxiety.

Make a list of about 10 activities outside your home that give you fear and anxiety, such as walking around your neighborhood, driving to the grocery store, meeting friends in a park, getting a haircut, etc. Order them based lowest to highest levels of anxiety.

Start with an activity that is moderately hard for you. For example, if you are already going to the grocery store but not seeing friends, push yourself to see a friend outside.

As you work through the activity, you’ll likely realize that it wasn’t nearly as scary or anxiety-provoking as you thought it would be. You might even remember how nice it was to do the activity.

Repeat the same activities, and the anxiety reduces more and more with each repetition. Continue, and move through your list.

Deal with anxiety

You might feel it in your body: tension, nausea, breathing fast and/or a high-heart rate. Take controlled, slow, deep breaths and reassure yourself by reminding yourself of what precautions you are taking.

Final thoughts

If you have friends or family who are struggling to leave their homes, consider a few things.

First, what are the person’s risk factors? Are they someone who, if they fell ill to coronavirus, it might be very serious, such as if they have an increaed risk of infection, including obesity or older age. If so, they may need to proceed cautiously.

Second, encourage people to push themselves, but avoid directly pushing them. Anxiety symptoms can be made worse if a person is forced into a situation.

Third, encourage people to see situations differently. Remind them that they are taking thoughtful precautions such as being in a well ventilated area, while wearing a mask, and maintaining distance.

Dr. Ryan Sultan is a board-certified adult and pediatric psychiatrist, and an assistant professor of clinical psychiatry at Columbia University Medical Center. His family has been on Shelter Island for over 60 years.