Why Am I Still Feeling Anxious if The Pandemic is Winding Down?
It’s finally here! Most of the United States population is vaccinated. We can go mask-less in most situations. Businesses are opening up. People are getting together in person again. Hooray!! It’s what we’ve been waiting for! But wait…something feels off. You’re not experiencing the relief and joy you were expecting. You still wear or consider wearing a mask even in situations deemed by experts as not necessary. You still get an automatic stress reaction when people get too close to you. When questioned about this, you aren’t really sure of your reasoning. You just don’t feel quite ready.
Even if you are enjoying the return to normalcy and the most prominent emotions are relief and joy, you still have fleeting thoughts of worry cross your mind. “That person isn’t wearing a mask! Oh wait, I’m vaccinated and they probably are too…this feels really strange being around all these people, what if I get sick? Oh wait, I shouldn’t worry about that...Experts say this is okay, but is it really? It feels scary still.” These thoughts are then paired with a mild yet pesky and lingering feeling of nervousness and hyper-vigilance. You feel confused by these reactions. CDC says this is safe right? The vaccines have been thoroughly researched and proven effective, right? So why do I feel this way?
Before going further, let’s be clear that despite my use of the past tense, I am by no means implying that this pandemic is completely over. Vaccines are not 100% effective, some communities have low vaccination rates due to systemic barriers, there are still unknowns about some new variants, etc. The past tense simply refers to pre-vaccine and when numbers were higher. Also, this post is strictly talking about the United States as there are many nations at the peak of the crisis (links to help are at the bottom). We must maintain an appropriate level of caution and continue to do what we can to fight the spread in the communities and nations that desperately need it.
That being said, for those of us fortunate enough to have access to vaccines and live in communities where numbers are low, here is what we know. The CDC says, in non-healthcare settings, we can (1) resume activities without a mask and distancing unless required by law, (2) resume domestic travel with no testing or self-quarantine before and after, (3) leave the country without being tested unless required by the destination and refrain from self-quarantine upon coming back, (4) refrain from testing and quarantine after a known exposure unless showing symptoms or in specific settings, (5) refrain from routine screening testing (CDC, 2021).
This is great news! So why are many of us still feeling anxious, worried, hyper-vigilant, or uneasy? Well, it’s simple. This past year and a half has been nothing but trauma. Some people had a severe case of COVID, some had a mild case they were scared would turn into a severe case, some had someone close to them suffer or pass away from COVID, some were frontline workers and suffered vicarious trauma, some had to comfort friends and family who lost someone due to COVID, etc. Trauma trauma trauma.
Even if you were fortunate enough to experience none of the above, we all had the daily threat of a deadly disease. We had to be on guard at all times. Every time we left the house; every time those in our household left the house; every time we calculated risk; every time we coughed, felt more tired than normal, or had a headache; every time someone we care about informed us they were exposed to COVID, we experienced a spike in our cortisol levels and the survival centers of our brains lit up.
This happened repeatedly. Every single time you stepped outside- cortisol levels through the roof. Every second you waited for an update on your sick loved one- cortisol levels are out of control. Every patient you treated, every news update, those 3-5 days you had to wait to get test results- yes, those adrenal glands were hard at work releasing that cortisol.
So now bring us to June 2021 and life is starting to resemble normalcy. Our sympathetic nervous system, however, didn’t get the memo. In fact, those adrenal glands are so used to releasing nonstop cortisol for a year and a half that they are too worked up to even read and comprehend the memo. The frontal lobe (rational, planning center of our brains) is trying so hard to tell the sympathetic nervous system it can stop; but it can’t seem to stop. It’s been taught that people coming close to us, lack of masks, mild cough and headache, groups of people, etc. are threats that we need to be protected from. And at this point, it doesn’t remember any other way.
So that sympathetic nervous system is still hard at work, doing its thing, trying to keep us safe. It so badly wants to keep us safe that it’s still telling us there is a high level of threat to our safety, even when our frontal lobes objectively know that the threat is much lower.
You may be reading this thinking, “this doesn’t sound like me.” Of course, not everyone was affected this way, as everyone’s nervous system is different and everyone was affected by COVID differently. Some of you, however, may be fully identifying with this; and even find this trauma response to be debilitating or have a significant impact on your life. This is because the trauma reactions can become full-blown Post Traumatic Stress Disorder.
PTSD is an often debilitating disorder following a traumatic experience. The DSM-5 has a long list of symptoms, including intrusive thoughts, dissociative reactions, psychological and physiological distress when reminded of event, avoidance of reminders and triggers, negative beliefs of oneself, persistent negative emotional state, reckless behaviors, hypervigilance, etc. (DSM-5, 2013). This list does not even scratch the surface of the ways PTSD can affect a person and the impact it can have on a person’s life.
A recent study conducted in Italy found that 30 percent of participants (note the racial and cultural bias, as all participants were Italian and White) with severe COVID cases developed PTSD (Janiri, et al., 2021). A meta-analysis found that 21.5 percent of frontline healthcare workers now have PTSD (Li., et al., 2021). Many of those with loved ones who suffered from or passed away from COVID have also developed the disorder. Being forced to stay home has also created a situation where domestic abusers have more access to those they abuse, causing at least an 8.1 percent increase in domestic violence (Rodiguez, 2021). This also can cause PTSD. That’s a whole lot of people who now walk around in their day to day lives with a serious mental illness they didn’t have before.
Ideally, society would be prepared for this influx in trauma-related mental health issues, and we would have easy and affordable access to care. Unfortunately, that is not the case. Therapists are swamped (not to mention our own vicarious trauma, but that’s a conversation for another day). Our healthcare system doesn’t allow for mental healthcare to be accessible for everyone, especially after the financial impact of the pandemic. We also weren’t trained in treating pandemic-related trauma, as we never in a million years thought it would be something we’d be doing.
So what do we do? Let’s go back to the sympathetic nervous system. Right now, we’re stuck in that hypervigilant state where our sympathetic nervous system is screaming “danger!” and our frontal lobes are saying “no, we’re safe!” and they can’t seem to come to an agreement. But the frontal lobe has a few tricks up its sleeve! Sisters Emily and Amelia Nagoski discuss in their book, Burnout, ways to complete the “stress response cycle.” Basically, this means to tell the sympathetic nervous system to chill out and help the adrenal glands release less cortisol. Learn more about the stress response cycle here.
The Nagoski sisters emphasize that moderate to intense exercise is the most efficient way to complete the stress response cycle. They recommend 20-60 minutes per day. Other ways to complete the cycle include:
Physical activity- Even if it’s not an intense workout or run, just moving your body can help.
Breathing techniques- There are many breathing techniques involving counted breaths and breathing from your diaphragm.
Positive social interaction- This can be with friends and family, or just having small talk with someone in an elevator. Even something as simple as telling someone to have a nice day can help complete the cycle.
Laughter- Laughter in general is good, but laughing with people we like is even better.
Affection- This should be from someone who cares about and respects you, and who you care about and respect. The Nagoski sisters mention John Gottman’s six-second kiss and the twenty second hug.
Crying- Watch a sad movie, search “videos to make you cry,” on YouTube, whatever gets the tears rolling.
Creative expression- This includes painting, drawing, music, theater, creative writing, etc.
These are activities you can do on your own that physiologically are shown to help cope with traumatic stress reactions. But despite what I said earlier about therapists being swamped, don’t assume professional help is not an option. If you have the means, there are plenty of resources for finding a therapist, such as Therapy Den, Psychology Today, BetterHelp, or just word of mouth. Chicago Center for Relationship Counseling is currently taking new clients at a reduced rate at the Phoenix Clinic.
Lastly, as mentioned previously, the pandemic is not over. It is not over in the United States, and certainly not over globally. Specifically, India and Nepal need our help. You can donate through the COVID-19 Solidarity Response Fund, Project Hope, Give2Asia, and AID (Association for India’s Development).
Sources:
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2776722
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246454
https://www.globalcitizen.org/en/content/domestic-violence-covid-19-increase-us-ncccj-study/
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM V, 2013
Burnout, Emily and Amelia Nagoski, 2019
Cover Photo by Anna Shvets from Pexels
