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by Richa Bhatia, MD, FAPA
Re-Entry Anxiety COVID 19

The COVID-19 pandemic has rapidly and abruptly changed human life in unexpected ways. In the last few months, since the COVID-19 stay at home restrictions came into place, millions of people have been working from home and practicing social distancing. As the lockdown restrictions are getting lifted or eased in various places, most people are experiencing some degree of re-entry anxiety, as they contemplate or attempt to navigate some degree of resumption of required pre-lockdown activities, such as going to work. This anxiety is commonly experienced in the form of fear, nervousness, worry, or dread.

What Underlies Re-Entry Anxiety?

The level of uncertainty inherent in the COVID-19 pandemic has been anxiety-provoking for most people. Still, in recent months, many people had started to become habituated to a new way of life, one that was primarily spent indoors. For many people, this started to feel safe or even comforting. Now, attempting to resume required activities, while the pandemic is still ongoing, is another transition that the brain needs to adapt to, in a short span of time. So, it’s not surprising that this new transition would be anxiety-provoking. The pandemic continues to engender uncertainty, which may involve worries about who might be infected, whether one will get infected/ill, worries about health of family members, job worries, financial worries, parenting worries, and/or other worries.

Is Re-Entry Anxiety Common?

It wouldn’t be an exaggeration to say that the COVID-19 pandemic has posed a threat to human health and life. So, anxiety is inevitable in response to this threat. Resuming required activities is, therefore, bound to cause additional anxiety. Re-entry anxiety in the current scenario is normal and even evolutionarily protective. It’s okay and even healthy to experience re-entry anxiety. Just like a certain amount of anxiety is useful for optimal performance in test-taking, similarly, some anxiety in the current scenario can help you stay safe, engage in appropriate preventive behaviors and exercise needed caution.

Note: Several places are re-instating stay-at-home orders or contemplating doing so. If that is the case with your state or area, then, this article does not apply to you. Follow your local guidelines and make any plans only in accordance with those guidelines. This article is for informational purposes only and is not intended to provide medical or psychiatric advice or recommendations, or diagnostic or treatment opinion. This is not a complete review or description of this subject. If you suspect a medical or psychiatric condition, please consult a physician and/or mental health professional. All decisions regarding an individual’s care must be made in consultation with your healthcare clinician, considering the individuals’ unique condition. If you or someone you know is struggling, please contact the 24/7, confidential National Hotline at 1-800-273-8255 or use the crisis text line by texting HOME to 741741.

10 Tips to Manage Re-Entry Anxiety Effectively

Here are some key things you can do to effectively cope with re-entry anxiety during these unusual times:

1. Practice Being in the Present Moment

Take a few minutes a day to pause and practice mindfulness. Mindfulness involves non-judgmental attention to and awareness of the present moment. Mindfulness practice can help reduce anxiety symptoms and enhance emotional well-being (1). Certain studies show that mindfulness based interventions can create positive brain changes (2). One example of a simple mindfulness based practice is breathing exercises which can help one feel calm and grounded. This occurs through activation of the parasympathetic nervous system which is linked with relaxation. Lowering of heart rate and blood pressure, lowering of stress hormone levels, are some of the other effects seen with mindfulness practice. Optimal benefits can be achieved when practicing regularly, even if it’s only for a few minutes a day. Check out simple techniques to practice mindfulness here: https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/accessing-your-ability-mindfulness-times-stress. More information about mindfulness courses and resources is available here
Note: If you have been diagnosed with an anxiety disorder or other mental health condition, you should consult your psychiatrist/therapist to determine if mindfulness based interventions are suitable for you, and if they are recommended to you, engage in mindfulness practice under the supervision of a trained mental health professional.

2. Recognize What You Can Control

Many people are experiencing a sense of lack of control during this pandemic. Doing simple, but, important things such as following COVID-19 guidelines (from authentic sources, such as CDC) can help you regain some sense of control in otherwise uncertain times. Recognizing and working on what you can control, can be a valuable step in overcoming anxiety.

3. Pay Attention to Your Unique Situation

Your re-entry anxiety may have additional, valid reasons- for instance, if you are 60 years of age or above, or suffering from underlying health conditions(s). Especially in this case, it’s important to consult your physician before making any re-entry decisions or plans. Your physician would take into account your age, medical conditions and your unique circumstance to determine your risk level, and make recommendations for next steps accordingly.

4. Engage in Something Fulfilling

Engage in something you find fulfilling, even if it is only for a few minutes a day. Playing a game with your child, listening to your favorite music or playing a musical instrument, exercising, painting/drawing, or helping an elderly neighbor (while maintaining physical distancing) are some examples of activities that can be fulfilling, depending on your individual interests. This can help you be more engaged in meaningful life activities, contributing to enhanced emotional well-being.

5.  Take a Gradual Approach

If required to resume certain activities, doing it gradually, one step at a time (while following guidelines), rather than rushing into things full force, is likely to work better. Gradual, as opposed to sudden resumption of an activity, is the preferred approach for anxiety. Don’t pressure yourself or compare with others in the process. Besides, prudence and caution are strengths in a pandemic.

6. Journal

Journaling can have positive health benefits. Even a few minutes a day (eg. 10-15 minutes a day) of journaling may be beneficial. Journaling in the form of free flowing writing (where you write whatever thoughts and feelings come up), can help you gain perspective, clarity and understand your thoughts and emotions better.

7. Schedule a Time to Worry

Scheduling a time during the day for worrying can be a useful strategy to manage anxiety. Select a time which you schedule as a ‘worry period’ for 20-30 minutes every day. When worry related thoughts arise during other parts of the day, postpone those to the worry period. Reflect on and consider your worries during the 20-30 minutes of worry period you’ve scheduled daily. This technique tends to be more helpful when practiced regularly.

8. Practice Gratitude

Gratitude based interventions can be helpful for anxiety (3). Particularly in a pandemic, when plans seem to be going awry, writing down about things one is grateful for, is a valuable exercise that can offer a bigger picture perspective.

9. Avoid Alcohol

Many people find themselves leaning on alcohol to cope with anxiety. It can start with a seemingly benign drink, and burgeon into something problematic. Get professional help if you find yourself in this scenario. Many people feel like these substances are helping in the moment, but, they are likely to increase anxiety and adversely impact brain health in the long term. If you have been diagnosed with an alcohol or other substance use disorder, or are struggling with alcohol or other substance use, follow through with treatment as recommended by your treating clinician and make any changes in consultation with your clinician.

10. Stay Connected

The pandemic has caused many to feel isolated. We know that social connectedness is a positive, protective factor for mental health. The good news is that technology makes it possible to stay connected with friends and family members, while exercising physical distancing, so, stay connected.

In addition to the above-mentioned strategies, it’s important to attend to self-care. Sleep, regular healthy meals, and regular physical exercise (as permitted by your physician), can go a long way in improving physical as well as mental health. Research shows that sleep disorders or chronic sleep deficits can increase risk of anxiety, depression and emotional dysregulation. Having a regular bedtime and waking up time, avoiding blue-light emitting screens an hour prior to bedtime, limiting caffeinated drinks in the evening, maintaining comfortable room temperature, and other sleep hygiene measures can help ensure optimal sleep.

When is Re-Entry Anxiety a Problem?

When re-entry anxiety becomes excessive or starts interfering significantly with your functioning in one or more areas of life, it’s time to seek professional help. The good news is that there are effective, evidence based treatments for anxiety disorders. Also, professional help is much more accessible nowadays, via telepsychiatry/telehealth.

Taking good care of your physical and emotional health may even seem like an added chore amidst a hectic pace of life, but, it can be the best thing you can do, not only for your life and well-being, but also, for those around you. And, when it feels like too much of a chore, that’s when your health likely needs you the most.

References:

1. Hofmann SG, Gómez AF. Mindfulness-Based Interventions for Anxiety and Depression. Psychiatr Clin North Am. 2017;40(4):739-749. doi:10.1016/j.psc.2017.08.008

2. Zeidan F, Martucci KT, Kraft RA, McHaffie JG, Coghill RC. Neural correlates of mindfulness meditation-related anxiety relief. Soc Cogn Affect Neurosci. 2014;9(6):751-759. doi:10.1093/scan/nst041

3. Heckendorf H, Lehr D, Ebert DD, Freund H. Efficacy of an internet and app-based gratitude intervention in reducing repetitive negative thinking and mechanisms of change in the intervention's effect on anxiety and depression: Results from a randomized controlled trial. Behav Res Ther. 2019;119:103415. doi:10.1016/j.brat.2019.103415


About the Author

Richa Bhatia, MD, FAPA is a Child, Adolescent and Adult Psychiatrist, dual Board certified in Child, Adolescent and General Psychiatry. She is the author of 2 books: ‘Demystifying Psychiatric Conditions and Treatments’ and ‘65 Answers about Psychiatric Conditions’. Previously, she served as a faculty member in the departments of psychiatry at Harvard Medical School and Geisel School of Medicine at Dartmouth. She serves as an Editorial Board Member for the journal, Current Psychiatry, and as Section Editor for Current Opinion in Psychiatry. She is a recipient of the Marian Butterfield award by the Association of Women Psychiatrists. She has extensive clinical experience treating patients suffering from a wide array of psychiatric conditions. In particular, her clinical interests are depressive and anxiety disorders, the interface between medical and psychiatric conditions, and differential diagnosis

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