How can we prevent people coping with anxiety from being left behind as things start opening up again?

For many, the introduction of vaccines and the removal of most restrictions has led to a welcome return to a more ‘normal’ way of life - but does this run the risk of making people with anxiety (and other mental health issues) feel even more isolated and excluded from society? One of the side effects of the lockdown was that it placed everyone in a similar position - with working from home, Zoom calls and the cancellation of large social events becoming the norm. This may have been a blessing in disguise for some - as they were able to interact on a level they were comfortable with, without feeling that they were missing out, or forced to do things that were a struggle. 

Neuroscientist, author, and mental health expert Dr Dean Burnett was kind enough to provide us with his insight on issues surrounding the return to the status quo, for those who are not yet ready for the end of restrictions:

In your Web series on ‘your brain in lockdown’ you said it is natural to be stressed during the pandemic. What would you say to people who are worried that social interactions they have formerly coped with, or enjoyed, are a cause of stress or anxiety now things are starting to go back to normal?

There's a lot I can say to such people, but the main point is the one already raised; it's normal, expected even, to experience stress and anxiety about what you're going through. There are two factors to consider. One is that we've all spent many long months not socially interacting in the usual way, so we're out of practice somewhat. What was once very familiar is now less so, and uncertainty is a reliable stressor for our brains, so that alone will likely induce anxiety etc. But perhaps more importantly, we haven't gone back to normal. Not yet. Covid is still around, the health hazards haven't gone away, and places and venues seem to have their own system of regulations. Again, it's more uncertainty, more hazards, especially when compared to pre-pandemic behaviour. It's important to stress that we haven't gone back to normal, and if anyone insists that we have and you behave as such, it's them who are in the wrong, not you for being cautious. So, you can feel justified about limiting your interactions and proximity to others. Looking after your own wellbeing, physical or mental or emotional, during these times is more important than ever. 

Do you have any advice for people who have previously struggled with anxiety in day to day life - without an option of stepping back from work/ commitments - and are now finding it even more difficult to go back into situations they find challenging since the break provided by lockdown? 

This is a particularly thorny issue, as inadequate workplace setup for dealing with mental health concerns was a constant problem in countless places even before the pandemic. During/after it, it'll no doubt be even trickier to get what's needed. I think it all comes down to your employer, and how flexible/approachable they are. If you have managed to work remotely and successfully during the pandemic, then a precedent has been set, and a decent employer would hopefully recognise that they'll get more work out of an anxious employee when they work remotely compared to forcing them to come back to the office. Hopefully, post-pandemic life will have more empathy for individuals with struggles, as everyone has gone through a very hard time, so can hopefully relate more to anxiety problems and the like. As a last resort, individual workers may have more influence over what they have to do now, given how isolation and distancing are still advised in many places.

But, as with all things, it can often come down to just getting used to it again. When you first arrive back at work, it's important to remember that everyone else is in a similar situation, so wouldn't necessarily expect too much of you. That's the optimistic scenario, at least. Ultimately, you should embrace anything that is within your control, and use that to offset the anxiety-causing factors where possible.

In your blog post of June 20th you said; “The idea that we, as a population, could carry on normal (economically productive) life in the presence of a deadly pandemic is laughable.” With widespread vaccination now providing some protection, a lot of people are starting to be more comfortable carrying on as normal - to a greater or lesser extent. However many people, especially those with anxiety and various other mental health issues, are not ready to move towards more normal interactions. How can we make sure that those people are not excluded from society post lockdown?

This will obviously vary considerably for individual situations and contexts, and ideally there would be some initiative from the top, government led for example, to help with this. That does seem unlikely though, so I wouldn't rely on that at all. I guess the most obvious approach is to engage with others in any way you feel most comfortable. If you set up a regular Zoom quiz or something, keep those going for as long as is feasible. If there are events or gatherings in open spaces that you feel able to attend, do so. While it's good to maintain wariness about the virus and how it's progressing, it's also not healthy to dwell solely on the negatives and worst case scenarios. We have made a lot of progress on ways and means to deal with the virus, so the risks and hazards are not what they once were. Also, people are far more familiar with technological communication now, which offers safer, more controlled ways of engaging.

 However, it can be a two way thing. If you know someone who struggles with anxiety or depression or anything else that keeps them from socialising, try to include them where you can. Make a habit of inviting them out, even if you know they won't come. It could serve to keep them in your mind, and from an emotional perspective, there's a world of difference between being unable to meet someone and not feeling welcome to meet someone. The latter is worse, so try and avoid it where possible.

If you know someone who struggles with anxiety or depression or anything else that keeps them from socialising, try to include them where you can. Make a habit of inviting them out, even if you know they won't come.

Following on from that, during lockdown we all learned new ways of coping via technology; working from home, interacting via Zoom etc. Do you think this could provide opportunities for those who suffer with mental health issues to become less isolated from their communities? Should we encourage workplaces/ theatres/ events etc. to continue to develop these ‘safe spaces’ for engagement?

Yes, if we can encourage the maintenance/propagation of more online events, that could certainly help with accessibility for all manner of people who need it. I also feel the big leaps in remote working we've made shouldn't be squandered, as they offer so much scope for a whole new way of working, one that could benefit everyone.

Is it healthy to challenge imposed norms around social interaction? Should society as a whole be more willing to adapt to support people who may find ‘normal’ life a struggle - or do you think the focus should be on better access and support through CBT/ therapy or medication? 

There's surely a healthy balance that can be struck here. It's actually something that's often debated in the mental healthcare fields. On one extreme, you get those who seem to think that any notable deviation from the norm, in terms of behaviour or cognition, should be medically treated. On the other extreme, there are those who insist that mental illness/disorders don't exist at all, and that everyone is mentally sound, it's just society that is too rigid to allow some people to function. The truth, as ever, undoubtedly lies somewhere between the two polar opposites. It's true that all mental diagnoses are based on social norms and how much someone differs from them, which is an issue in and of itself. So, challenging social norms always has some merit to it, as they're not absolutes. They're created by people. Not too long ago, homosexuality was deemed socially abnormal, and gay people were stigmatised and medicalised for being mentally unwell. Since then, we're progressed, and don't do that any more. Who's to say what things we deem normal now will be viewed as archaic in a few decades?

On the other hand, to expect every member of society to adapt new ways of engaging and interacting with every individual case would be unworkable, impractical, and unreasonable. Regardless of how unwell you may genuinely be, insisting that everyone you meet alter their behaviour to suit your needs is unrealistic, to say the least. You may not want to change or alter your situation with medication or therapy, and that's your right. But by the same token, other people aren't then obliged to suit your needs too. Compassion, consideration, and empathy are always important, appreciated, and often necessary when dealing with someone's mental health situation. But it's a two way street, and a mental health problem doesn't mean you have a blank cheque to make demands of everyone around you. As ever, there's a balance to be struck.

  • Dr Dean Burnett is a doctor of neuroscience and a lecturer. He is the author of ‘The Idiot Brain’, ‘The Happy Brain’, ‘Psycho-Logical’ and ‘Why Your Parents Are Driving You Up the Wall and What To Do About It’. He also writes regular articles and blogs, alongside work as a podcaster, pundit, science communicator and comedian.

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