Although the pandemic is far from over, due to the increasing availability of vaccines and the implementation of public health measures, COVID-19 infection rates are finally declining. President Biden has even suggested that the country may return to some sense of normality by the Fourth of July. The American Psychological Association, however, has indicated that COVID-19 has also caused a national mental health crisis that could have repercussions for years to come. In one CDC survey, nearly 41% of adults reported they were struggling with mental health or substance use issues.

CNBC technology reporter Salvador Rodriguez recently said, “More than a year into the pandemic, people have become accustomed to the lives they’ve built and the routines they’ve created in their “covid caves” and are not looking forward to a return to normal.” He believes that this stems from ongoing infection fears and anxiety about re-entering society. He also believes that some people are afraid of losing what they gained — like more time with family, increased fitness, and time to focus on personal interests.

My wife, Diane, says that families fall into three broad categories in regard to how they responded to the pandemic. The first group consists of people who most frequently stayed at home and only went out for necessities or emergencies. These people made almost all their purchases online. They ordered groceries and take-out and used delivery or curbside pickup. They never went to restaurants and assiduously avoided crowds. They worked from home as much as possible and if given a choice, they had their children participate in online learning. They were extremely conscientious about social distancing, mask wearing, hand washing, sanitizing, and following quarantine guidelines. This group may be the one that has the most difficulty in reacclimatizing once the pandemic is over.

The second group consists of people who often stayed at home, wore masks, hand washed more, and socially distanced. They, however, continued to shop in stores, as infrequently as possible, for both groceries and other items. They may have worked at home when possible, but also made occasional forays back to their workplaces. They occasionally went to restaurants and when possible to church, funerals, and other small and controlled gatherings, but avoided large crowds and close-in spaces such as airplanes. I think we probably fell into this group. There were times when I felt anxious or threatened when a building seemed too crowded or someone stood too close to me.

A third group pretty much ignored the pandemic, possibly denying it altogether. They only followed public health mandates when forced to do so. They maintained their usual activities, so far as possible, even when it included maskless contact with crowds. Of course, they were still impacted by COVID-19-related issues such as the closing of businesses and schools, job losses and other stressors.

It is unclear if people growing accustomed to feeling less safe in public might increase the number of cases of anxiety disorders such as agoraphobia (the fear of leaving home and being in crowded, public or open places). Psychologist Laura VanWort-Meng from LifeStance Health in Boston, however, believes that “For people who are already at risk of developing agoraphobia, this is a perfect storm in which the disorder can develop.”

According to the American Psychiatric Association agoraphobia also includes fear of public transportation, enclosed spaces such as shops, restaurants and theaters, and standing in line. Such places are avoided and are only endured with intense fear or anxiety.

Many people with agoraphobia are able to leave their homes, but only to go to familiar places where they feel comfortable. In America about 2% of adults have agoraphobia. The risk for agoraphobia increases significantly if an individual is already diagnosed with an anxiety disorder, is female, is under 35 years of age, has a biological relative with agoraphobia, or has an anxious personality. Up to half of people with agoraphobia also have panic attacks.

One-time traumas causing agoraphobia are more common in works of fiction like “Great Expectations” and “Cold Comfort Farm” than in reality. Children, however, who refuse to leave home and go to school occasionally are responding either to a trauma at school or, just as likely, something that happened at home that makes then afraid to leave, such as the death of a loved one or the need to protect a sibling.

Humans all possess an emergency system that activates when we are threatened. This system floods the body with adrenaline, gets the heart pumping, increases respiration, and diverts blood flow from the extremities. All of this prepares the body for flight or fight. The problem is that occasionally, there are false alarms and this intense activation occurs with no immediate threat. These are called panic attacks.

The fear experienced in agoraphobia is irrational and out of proportion to the actual threat. When people began staying at home to prevent the spread of COVID-19, this did not qualify as a phobia, since the threat was real and serious. Of course, a significant issue is how people will determine when the real threat has actually subsided. Some people say that they would believe the danger is over when some acknowledged authority such as Dr. Anthony Fauci or the Centers for Disease Control say it is. Others are less trusting and want to see what happens to other people first.

To be formally diagnosed with a phobia there must be “clinically significant distress or impairment” in social, occupational, school, or other areas of functioning. In the COVID-19 pandemic, however, technology and other factors have allowed some people to fashion a way of life, in which agoraphobic behaviors no longer result in the same level of disadvantage. Working online, home delivery of food and other necessities, video conferencing and social media communication with friends and family all mitigate against social and occupation impairment — perhaps transforming a previous disorder into an alternative lifestyle.

People experiencing problems adapting to the post-pandemic world should seek professional help. Yale psychologist Marney White says that individuals who are anxious about re-entering society may want to start out taking small steps, like going on a short walk, then meeting outdoors with other vaccinated individuals, then going somewhere indoors wearing a mask, and so on — continually building up confidence. Such approaches have been called fading, graded exposure, and desensitization. Experts, who recommend cognitive behavior therapy think that challenging one’s maladaptive beliefs about the feared situation is also important. Most experts agree, however, that exposure and restructuring irrational beliefs are the keys to overcoming fears and anxieties.

Terry L. Stawar, Ed.D., lives in Jeffersonville and is the CEO of LifeSpring Health Systems. He can be reached at tstawar@gmail.com.

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