Anxiety

How Anxiety Shapes Extreme Social Distancing

New study suggests the role of COVID-19 anxiety in social distancing.

Posted May 23, 2020

The practice of social distancing to prevent the spread of COVID-19 is one that some people take more seriously than others. You may notice some individuals who steer very clear of you, even beyond the six-foot guidelines, wearing all the recommended protection for going out in public. Others seem to be a bit more cavalier about the need to socially distance, even if they have plenty of room to move about without invading your personal space.

Perhaps you have a neighbor who’s organizing a “socially distant potluck party," noting in the invitation that it will only be held if the weather is good enough to go outside in a nearby field. When the day comes, lines are drawn in the field around where families should gather themselves. Needless to say, everyone would have to return to their own homes to attend to bathroom needs.

In fact, the event isn’t actually potluck, because you will bring the food you eat and provide your own paper cups and napkins. You’re grateful for the hard work your neighbor put in to give your neighbors a much-needed break from social isolation, but you get a sense that you’ve been put somewhat to shame by all of this advance planning. If it were up to you, you're not sure if you could actually muster the resources to pull it off. Part of you even wonders if your neighbor is just a socially responsibility show-off.

The need for social distancing, along with the wearing of face masks, presents one of the most intriguing, if not important, tests of the role of human behavior in the prevention of communicable disease. In the past, flu seasons brought about greater recognition of the need to wash your hands and to cough or sneeze into your sleeve (if not a paper tissue). Food-borne diseases spread by contaminated produce, such as romaine lettuce, also required that people made changes in their behavior to avoid becoming ill. However, the widespread role of human behavior in disease prevention has never received so much attention.

Consider this statement from Dr. Deborah Birx, one of the top coronavirus advisors in the U.S. back in early March, about what will slow the spread of the virus:

"It’s just behaviors. Each of our behaviors translating into something that changes the course of this viral pandemic.”

There’s an implication in this quote that behavior should be easy to change, somewhat of an obvious flaw in this thinking. Nevertheless, lacking a vaccine or any other practical method of mitigation, many other respected health officials cite individual behavior as the only tool the world has right now for slowing COVID’s spread until a vaccine is developed.

Given the importance of behavior change for this public health crisis, what are some of the ways that people can be encouraged to incorporate social distancing into their everyday lives? It would seem that we could learn a good deal from the examples of those people, like your neighbor, who seem determined to receive a perfect social-distancing score. Knowing what motivates them could potentially help inspire others to follow their example.

In a newly published open-access article, Nottingham Trent University’s Craig Harper and colleagues (2020) suggest that fear, plain and simple, could be one of the key features predicting who is likely to make the kind of behavioral changes that public health experts wish to see. Although studies of the attitude-behavior link tend to discount the role of fear as a sufficient motivator for long-term behavior change, the kind of fear involved in COVID-19 may be unlike that of any other, less immediate, threat to life.

Think of it this way: You can decide to stop smoking in hopes that, decades from now, you won’t get cancer or heart disease. You can even take up a new diet and exercise regimen because you don’t want to die prematurely of an obesity-related illness. But is the cost of an undesirable outcome at some vague point in the future enough to keep you going when those decisions become “Monday morning hard” (in the words of one smoking cessation drug commercial)? When it comes to protecting yourself from COVID-19, the link between the disease and your behavior is much more immediate. Maybe fear isn’t such a bad motivator after all.

The newly-emerging field of COVID-19 research, stimulated by the behavioral call to action, is beginning to identify the components of this pandemic-related fear. Harper et al.’s review of this literature suggested that “combining a sensible level of fear about the illness with messages related to personal agency could encourage safety-promoting behavior in the form of hand hygiene and social distancing” (pp. 3-4). So, maybe it’s not some altruistic need to contribute to the common good that prompts the seeker of top social distancing grades, but just an ordinary need for self-preservation.

To test the role of fear vs. altruism in prompting social distancers to rise to the top of their class, the UK team developed an online survey that asked participants to provide self-report ratings of the frequency of engaging in seven prevention-related behaviors (prior to their government stay-at-home or lockdown orders). Read over these items on a scale of 1 (no change) to 4 (changed dramatically) with respect to the period before your own government issued lockdowns or stay-at-home orders:

  1. More hand-washing
  2. Changing travel patterns
  3. Working from home
  4. Stockpiling food
  5. Stockpiling medicine
  6. Changing care provided to family members (children, elders)
  7. Social distancing

If you’re like the people in the online sample, your average score per item would be about a 2.6, which puts you on the mid-to-high end of the scale. To get an idea of the range of scores, most people (about 70 percent) scored between a little less than 2 per item and as high as just over 3. Those at the top of the range would score at about a 3.8 (or perhaps a perfect 4).

Now that you’ve graded your own social-distancing skills, it’s time to see what factors predicted the highest degree of compliance in the Harper et al. study. You can test your own COVID-19 fears by clicking on the survey description of a new Fear of Coronavirus Scale (FCV-19S) measure described here. Participants in this study received an average of 2.6 on a 7-point scale, signifying a moderate amount of COVID-related fears.

To measure altruism, the authors used a “moral foundation” scale that included self-ratings on the five areas of showing such virtues as caring for others, feeling a sense of loyalty to your country, being respectful of others, and feeling that your motives are “pure.” On a 1-5 point scale, the majority of participants rated themselves lowest (about a 2) on in-group loyalty, and highest (about a 4) on believing in the virtue of fairness.

Participants also completed several standard mental health measures, including scales assessing quality of life, depression, and anxiety. Coronavirus fears were, as you might expect, related to higher scores on anxiety and depression, and also to lower well-being scores. These findings add to the evidence that the FCV-19S scale has validity, and also suggest that if you’re more anxious in general, you’ll also be more worried about contracting the virus.

Back to the test of the main predictors of social-distancing adherence, the findings showed that it was, in fact, the people with higher COVID-related concerns whose behavior had changed the most even before their governments imposed measures designed to protect the public. However, as the authors point out, the “fear” component of the FCV-19S itself was not the highest motivator of behavior change.

Fear is an emotion that can paralyze you and, when inordinately high, can signify poor mental health. Rather than fear, the items on the FCV-19S most strongly related to anxiety were the strongest behavior change predictors of social-distance compliance. Anxiety, the UK researchers explain, is “a preparatory reaction to ambiguous or distant stimuli.” Unlike fear, anxiety may actually prompt you to take constructive action.

Even so, the emotion of fear in the context of a pandemic, the authors argue, should not be pathologized. Moreover, when that fear becomes “functional," it may actually prove to be a protective mechanism. Altruism, or a desire to contribute to the welfare of others, by contrast, had no predictive effects on social distancing behavior. These findings turn upside down the idea that fear, or in this case anxiety, is not a good motivator for behavior change, at least when the threat is seen as immediate rather than decades away. 

Returning now to the question of who will excel at social distancing, the UK findings suggest that it will be the people highest in anxiety and, to a lesser extent, fear, who will be the most scrupulous social distancers. Though you might have suspected your neighbor’s extreme planning for the "potluck" to be nothing more than a demonstration of some type of moral superiority, in fact, it's more likely that your neighbor is motivated by more basic emotional responses.

To sum up, you don’t need to feel resentful or one-upped the next time someone out-social-distances you. Instead, recognize that the behavior comes from a place of self-preservation, a strategy that might not be all that bad to emulate.

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References

Harper, C. A., Satchell, L. P., Fido, D., & Latzman, R. D. (2020). Functional fear predicts public health compliance in the covid-19 pandemic. International Journal of Mental Health and Addiction.  doi: 10.1007/s11469-020-00281-5 (online open access)