1 Question, 5 Answers is a column where we ask different types of healthcare pros to weigh in on the same issue.
Since late April 2020, the proportion of American adults reporting symptoms of generalized anxiety disorder has rarely dipped below 30 percent, according to an ongoing survey by the National Center for Health Statistics. In 2019, that number was closer to 10 percent, according to the most comparable pre-pandemic data we have.
We can confidently blame all (or most) of this chronic worrying on the coronavirus. But that’s a little broad. Over the course of the weirdest, saddest year-plus in our collective existence, our specific corona-related concerns and challenges have been in flux. Now, we’ve reached a point where we can feel optimistic about returning to normal. But we have no idea what “normal” means anymore, and the prospect of returning to it has ushered in another phase of pandemic anxiety, experts say.
With this in mind, we asked five mental health pros about the changes they’ve observed in patients’ anxiety since the pandemic began. We also asked them for advice on dealing with a future that still carries so many unknowns. Here’s what they had to say.
Dr. Kruti Patel, PhD
Licensed clinical psychologist
How have you seen anxiety shift in patients during the last year?
In the beginning, more people were focused on fear of how long quarantine would last and transmission of the virus. It slowly began to change into stress around isolation and loneliness as we stayed longer in quarantine and found out more about the virus and how it spreads. The anxiety also slowly started to include layers of grief and loss as people began missing important events or losing people. At this time, people started getting burnt out and overwhelmed with not getting a break from their duties or overworking.
Currently, I’m seeing more fears about re-entering society and engaging with people. As more get vaccinated, they are having more interactions with others or leaving their houses more—but because they have stayed inside and away for so long, these things that were ‘normal’ now feel so unfamiliar. I’m guessing we might go back full circle regarding anxiety as we’re learning about these new strains. It’s definitely been difficult to hold anxiety for so long, to be vigilant to this virus for so long and to hold onto some sort of hope.
What is your no.1 tip for coping with the continued uncertainty of COVID?
Take things slowly and listen to yourself. Anxiety can become heavier the longer we carry it; we’re not meant to be in anxiety for this long. If you find yourself becoming overwhelmed or even starting to become overwhelmed—seek help, you don’t have to carry it alone. Reach out to friends, do what you feel you need to do, or seek therapy.
Mona Eshaiker, LMFT
Long Beach, CA
On shifting anxiety: The global pandemic has absolutely exacerbated anxiety and stress, especially for women and people of color. With the closure of schools and daycare centers, for example, the burden of childcare has fallen mainly on mothers. Also women make up about 70 percent of the healthcare workforce, which has undergone a tremendous amount of strain and overtax during the pandemic. Lastly, with the recent attention to Black deaths in the US, many BIPOC individuals are re-experiencing racial trauma, which is emotionally taxing.
On coping with continued uncertainty: Identifying and articulating boundaries has been most useful for my patients. For mothers, it can mean articulating co-parenting expectations. For people of color, it can mean limiting exposure to media and social media and prioritizing wellness.
Leslie Peña-Sullivan, DSW, LCSW
Psychotherapist, immigration researcher and adjunct lecturer at the NYU Silver School of Social Work
New York City
On shifting anxiety: I have seen anxiety shift slightly in the undocumented Latinx population. When the COVID pandemic first emerged, there were significant concerns about the potential disclosure of lack of legal status, resulting in the immigrant community not seeking crucial testing or even necessary care should they develop severe symptoms. As the public charge rule went into effect on February 24, 2020, many undocumented immigrants were left with concerns about acquiring potential legal status or even being deported if they sought medical services for COVID symptoms. Many undocumented immigrants were also at increased risk of being exposed to COVID, given the essential nature of their work. The anxiety related to the disclosure of an undocumented immigration status remains. The [medical] concerns have shifted from seeking testing and medical services to vaccine eligibility. Many clients have endorsed concerns about negative immigration-related consequences due to fears of disclosure of status to the federal government should they receive the vaccine.
On coping with continued uncertainty: For this population, reach out and connect with local community-based agencies that provide services to the immigrant population. Several of these agencies are a part of a coalition that can connect stakeholders and partner agencies that are well-informed about immigration policy and can disseminate the appropriate information to the community.
Dr. Raymond Raad, MD
Psychiatrist and co-founder of RIVIA Mind, an outpatient holistic mental health center
New York City
On shifting anxiety: Over the spring and early summer, as the lockdowns continued and what was supposed to be weeks turned into months, anxieties grew significantly and feelings of despair began to set in. We noticed this most severely in people who were isolated. While some people were home with families or friends, lots of others who lived alone struggled with persistent loneliness. And of course anxiety about the disease itself persisted. Later in some summer, as more options for gathering with others came about, and more people felt comfortable going out, some of the despair improved.
But then we saw a drastic worsening this past winter. In fact, this past winter was the hardest period for many of our patients, especially those who live alone or are otherwise isolated, those with children and without school or childcare, and many others who simply struggled to remain motivated in their lives. It is well known that depression tends to worsen in the winter, and some individuals with SAD (seasonal affective disorder) become depressed only in the winter, and this winter in particular was far harder and worse for many of them than a typical winter.
On coping with continued uncertainty: Find a practical goal or purpose for yourself, and pursue it during this time. Those patients who did the best in the past year seemed to have a hobby, or a pursuit, that was practical and safe. We have patients who worked on a movie or video side project, or a weaving or knitting project, or who even picked up hiking in the past year. Of course they still faced anxiety and despair at times, but the pursuits helped them through the worst of it. We are goal-driven animals, and when circumstances interfere with our regular goals, we have to find others to help keep us motivated.
Ryan Howes, PhD
Clinical psychologist and author of the Mental Health Journal for Men
On shifting anxiety: A year ago, my clients (and friends, and family) were very afraid that they, or someone they loved, would contract COVID and suffer severe illness or death that was so widely reported and a real possibility. They were adjusting to working from home, schooling from home, or losing work and adjusting to that. The uncertainty of how long this would last was a constant worry, and the hope of a vaccine and a return to ‘normal’ was so far in the future it was difficult to grasp.
One year later, we have a different emotional landscape. Many are hopeful about the vaccines and their positive impact. They see light at the end of the tunnel and are beginning to make plans for the summer and beyond. But that doesn’t mean their anxieties are abolished.
Many people have grown accustomed to the slower pace of life and worry about increasing demands on their time as work, school, and social events open up. Some have found they were more introverted than they thought and worry that they will disappoint others when they turn down future invitations to meet up. Others fear that new strains or new viruses will continue to pop up and we’ll be in one lockdown or another for years to come. Overall, those with a tendency toward anxiety have many ‘What if?’ scenarios at their grasp that anxiety can grab onto.
On coping with continued uncertainty: The best we can do is resist the urge to forecast too far in the future and take care of what is happening right now. Are you socially distanced and masked today? Good, that’s something you can control. Are you following guidelines and doing what you can to take care of yourself? That’s our best defense against problems in the future. Control what you can, and trust that you’ll be able to respond to new information and guidelines as they emerge. You’ve made it this far, through the worst of this, just hang on a bit longer.
Responses have been condensed and lightly edited.