Among the many perks to working with patients each day as a practicing psychiatrist, one of the most helpful is the tendency to hear some of my own challenges and experiences reflected in the common threads of their stories. Rather than feeling isolated during such a stressful time, I can appreciate how many of us are living through the very same struggles.
Recently, a unique topic has been cropping up in sessions—heightened anxiety in previously comfortable situations. For example, a formerly avid concert-goer notices her heart beating unusually rapidly in a crowded venue. Or perhaps a stroll down a busy sidewalk evokes a state of dread, dissipating only when back in a quiet apartment.
Our brains have been through a lot recently. Humans, as a social species, evolved with group dynamics, interpersonal interactions that provided support, meaning, and collaboration. Asking us to lock ourselves away in our respective houses and withdraw from daily life, we lost more than our planned gatherings and vacations.
The plasticity of our neuronal connections means we learn new things quickly, and can adapt to even the most novel circumstances. Sometimes, however, this learned connection can interfere rather than protect. If we spend months avoiding crowds, busy stores, public transportation due to the threat of contagion, our brains understandably begin to stamp these activities with a big red X. “Not Safe!” Unable to grasp the context, our protective minds will continue to shout warnings even when that activity becomes far less dangerous.
In my own experience, a trip to NYC, usually one of my favorite places because of the frenetic energy, triggered surprising sensations of anxiety: stomach clenching, heart beating quickly, eyes scanning opportunities for escape. However, recalling how my patients had observed similar experiences, I explored this mild agoraphobia with compassion rather than fear. “Hello brain, thank you for trying to keep me safe. I know this feels like something I shouldn’t be doing, but I’m ok.”
Agoraphobia, as defined by our profession’s Diagnostic and Statistical Manual-5th edition (DSM-V), is “marked fear of or anxiety about two or more of the following situations: 1. Using public transportation, 2. Being in open spaces like parking lots or bridges, 3. Being in enclosed spaces such as shops and theaters, 4. Standing in line or being in a crowd, or 5. Being outside of the home alone.
Though we may not experience anxiety in these situations to a degree that requires treatment, I believe many of us will notice a hesitancy to dive back into mixing and mingling. As we return to a world with decreased social distancing, fewer masks, and bigger crowds, it will likely take time to adjust. Entering situations previously perceived as dangerous can lead to anxiety, heightened vigilance, and a desire to escape. The protective—and primitive—parts of our brain need positive experiences to relearn and reassure.
We must certainly continue to be wise in our choices in these—let’s hope—waning days of the pandemic. We may never return to regular handshakes as a business greeting, or at least will feel resistance when a friendly hand is extended. However, we might need to give ourselves and our loved ones a gentle push on occasion, encouraging a re-exposure to social settings. With time and repetition, our brains will rewire to associate a gathering of people with something positive, engaging, even fun, rather than a threatening event.
In addition to exploring with curiosity, I encourage you to also grant yourself compassion as your remarkable brain relearns what it means to be safe in this new world. It may take some time, and perhaps we may make different choices than before (hello, fellow introverts), but the limits we place on activities should be because we have other interests, not because anxiety is causing us to constrict or avoid. Slow progress, step by step, will help us reengage.
Take your time, friends, and good luck.
