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Anxiety Disorders During the Pandemic

Can safety behaviors make anxiety disorders worse?

Many people engage in "safety behaviors" during anxiety-provoking situations. They make people feel more comfortable in situations by providing temporary relief from anxiety. Safety behaviors can range from the mildest to the most extreme. For example, some people allay their social anxiety by asking the other person many questions in social situations in order to keep the focus off them. Other people may drink alcohol or smoke marijuana before attending, or immediately upon entering, a social gathering. People with anxiety disorders, however, engage in safety behaviors obsessively in order to ward off anxiety attacks. For example, a person with an anxiety disorder may wash hands every half hour or check if the gas is off several times before leaving the house.

Alexander Krivitski/Unsplash
Source: Alexander Krivitski/Unsplash

During the pandemic we are now experiencing, many people with anxiety disorders are performing safety behaviors to keep themselves healthy. They are hoarding months' worth of toilet paper and hand sanitizer; washing their groceries three times before putting them in the refrigerator; sanitizing their doorknobs every hour although no one has entered or left the house; and washing their floors daily. And if they do not get the virus, they will consider the situation a “near miss” and credit their safety behavior for the non-catastrophic outcome. Hence, their safety behaviors and magical thinking will remain intact or be reinforced.

My patient, Diana, engages in an assortment of safety behaviors. During normal times, she hoards food so that she will never starve; washes her hands many times an hour; and wears a face mask to protect her from other people's germs. Now, the CDC is telling us to do all those things to protect us from the coronavirus! Diana's boyfriend, who used to try to wean her off her safety behaviors, is now telling her she was right.

Timothy engages in a different sort of safety behavior. He obsessively thinks that the worst is going to happen: He will be fired or his mother will die. Over the course of his therapy, we have come to understand that he unconsciously believes that thinking the worst will happen protects him from it actually happening.

When the pandemic is over and we return to "normal" life, many people with anxiety disorders may find their anxiety has worsened because of the traumatic situation we are all living through and because of their increased reliance on safety behaviors. Safety behaviors can interfere with overcoming anxiety disorders because the individual engaging in them cannot learn through direct experience that their feared outcomes are less catastrophic than anticipated. More importantly, individuals might experience an increase in the frequency of safety measures as a result of feeling that they protected them during the pandemic. (Click here for more on anxiety reactions to the pandemic.)