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Anxiety

Are You Hesitant About "Re-entry?"

Tips from a social anxiety expert.

Key points

  • COVID-19 changed our lives in ways we couldn't have imagined.
  • We adapted to life in the pandemic, but we also became more isolated and virtual communication became "the new normal."
  • As we return to social activities, many of us may be feeling anxiety.
  • Be kind to yourself, listen to your body's cues, and follow the rest of these tips may make the transition easier.

By Natalie Dattilo, Ph.D.

The COVID-19 pandemic upended our lives overnight and in ways we never imagined. Few anticipated that the length of this crisis would extend beyond a few weeks or months, let alone a whole year. For many of us, daily routines changed significantly, and as a result, we experienced a sudden and traumatic sense of loss. A loss of normalcy and familiarity. Life as we knew it was no more.

We made the necessary accommodations and recalibrated accordingly, like the adaptive species we are. Over time, new routines became old routines. Strange habits became standard, and what was once foreign, is now familiar.

In the process, however, we became secluded, increasingly isolated, and socially malnourished. Consequently, social re-engagement may present some unique challenges and, despite an eagerly anticipated "return to normal," don’t be surprised if you have mixed feelings about it.

As a clinical psychologist who specializes in the treatment of anxiety disorders, I help people overcome their avoidance of situations that cause fear, trepidation, or panic. From a trauma-informed perspective, feeling a little nervous at the thought of social "re-entry" after a year of disappointment, isolation, deprivation, and loss should be entirely expected. Activities most of us used to do without thinking twice, like going to a restaurant, going into the office for work, traveling, commuting, flying on a plane, conversing with someone in the same room at the same time, shaking hands, hugging, all may feel a bit weird.

If you struggle with an anxiety disorder, like generalized anxiety, social phobia, agoraphobia, panic, PTSD, or OCD, you may be experiencing an acute exacerbation of symptoms. You may find yourself in worry loops, feeling preoccupied or stressed, and struggling with insomnia more than usual. You may feel an increased sense of dread, uncertainty, apprehension, discomfort, awkwardness, tension, and avoidance. For those who struggle with a stress-linked chronic medical condition, you may also notice a flare-up of symptoms as anxiety activates inflammation. Rest assured, these feelings and symptoms will likely diminish once you begin doing things again.

Avoidance of the things that cause us anxiety only serves to reinforce or strengthen the anxiety. Anti-avoidance strategies are required here.

Exposure therapy is an evidence-based psychological treatment for social anxiety. To start, we make a list of avoided or uncomfortable situations and then rank them from least distressing to most distressing. Then we set a goal to check each one off the list, starting with the easiest. We may practice together beforehand (called “role play” or "behavioral rehearsal”) and work to develop important skills, like assertive communication, relaxation, distress tolerance, or interpersonal effectiveness. We may also practice something called “imaginal exposure,” which is imagining the scenario in your mind and playing it out that way – picturing what you might feel, say, and do. Every time you engage in anti-avoidance strategies, your brain rewards your effort, you strengthen your social-emotional muscles, and you gain a little more confidence. As your social confidence goes up, your social anxiety goes down.

Even if the anxiety you feel is fairly mild, which is normal, I would recommend the following steps to help overcome any “re-entry hesitancy” and begin the process of "social refeeding:"

1. Make a list – Take a minute to write down activities you used to do regularly that you haven’t done in a while or ones you really miss. This may also include things you won't do anymore, like wear a mask indoors (once that’s deemed safe), wipe down your groceries, sanitize obsessively, etc. Then rank them from easiest to hardest, or most to least convenient, and then start checking them off one by one.

2. Start small and take it slow – You may have to work your way up to, say, a cross-country flight or a concert in a closed arena, when those are allowed again. It’s OK to ease back into it. Imagine a cold swimming pool: While some people may feel comfortable jumping right in, some may prefer to acclimate slowly, one step at a time.

3. Expect it to feel a little weird at first – Resist the urge to assume something is wrong with you if you feel anxious, apprehensive, or nervous. If you find yourself saying things like: “It shouldn’t be this hard” or “What’s wrong with me?” or “Why do others seem to be doing OK?” then practice the following re-statements: “I wish this was easier, but for now it’s still a struggle and I’m getting better every day;” “There’s nothing wrong with me – it’s normal to struggle during these not-normal times;” and, “Although it may appear others are doing better than I am, I don’t know that for sure – honestly, everyone is just doing the best they can, including me.”

4. Remember, re-adjusting is a process – Getting comfortable with things we haven’t done in a while, like sitting within six feet of one another, standing side by side, or passing people in a grocery aisle, may take a little time. It makes sense that a part of us will feel hesitant to do the things we’ve been told for over a year are “unsafe.” You may have to repeatedly reassure your brain's threat detection system that it's "safe and OK" as it learns to respond to a new set of circumstances.

5. Finally, be patient with yourself and especially with others – You may find yourself feeling agitated or impatient, you may even feel a little panicky in enclosed places or in large crowds. This will likely go away over time, but if your anxiety persists or worsens, please don’t hesitate to seek support or speak with your doctor. Other scientifically supported self-care practices to help mitigate the effects of anxiety include regular effortful exercise, natural sleep, social connection, gratitude practice, laughter or play, and meditation for relaxation or focus.

Courtesy Dr. Dattilo
Natalie Dattilo, Ph.D.
Source: Courtesy Dr. Dattilo

Natalie Dattilo, Ph.D., is Director of Psychology, Department of Psychiatry, Brigham and Women’s Hospital. She received her doctorate in clinical health psychology from the University of Florida and completed her fellowship at Indiana University School of Medicine in Indianapolis. She provides psychological evaluation and treatment at Brigham & Women's Hospital and is an Instructor of Psychiatry at Harvard Medical School.

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