As the country re-opens — and often shuts down again — therapists say 're-entry anxiety' is on the rise. 

By Julia Malacoff
Aug 21, 2020 @ 3:49 pm
Re Entry Anxiety Lead
Credit: Westend61/Adobe Stock

In 2019, around 8 percent of the U.S. population showed symptoms of an anxiety disorder, according to the Centers for Disease Control and Prevention’s mental health surveys. The stats from the COVID-19 era? Since April, rates have jumped, rarely dropping below a whopping 30 percent. In other words, it’s safe to say anxiety is on the rise.

Mental health experts aren’t surprised. “During this pandemic, anxiety is a normal factor,” says Markesha Miller, Ph.D., a licensed psychotherapist. After all, we have a seemingly endless list of unknowns to contend with, particularly around newly-loosened guidelines (that often get reversed).

“We face a great deal of uncertainty as the country re-opens and shuts down again,” says Stephanie Newman, Ph.D., a psychoanalyst and author. That may be why many people’s concerns largely center around a phenomenon called ‘re-entry anxiety.’

What is ‘re-entry anxiety’?

“Re-entry anxiety is a hot topic in most therapy sessions and with most people I come across daily,” says psychotherapist Kelly Keck, LMHC. Mostly, it involves feeling anxious when faced with activities that, pre-pandemic, would have felt totally normal and safe.

Think: having a panic attack in the grocery store, breaking down in tears at the thought of going back to the office, or not being able to get through your kids’ school drop off without a racing heartbeat set off by stress.

“The pandemic has heightened our awareness and increased worry related to comfort and safety,” Keck explains. “As a result, things like grocery shopping or work or social events are now viewed through the lens of this new reality. And for many people, it presents a lot of unforeseen nerves.”

“In Los Angeles where I live and practice, the idea of re-entry anxiety is real and thriving,” adds  Allie Shapiro, M.D., a psychiatrist at Community Psychiatry. “Many parents tell me they do not feel safe sending their children to school if they reopen at this point.” Plus, people wonder if establishments that have reopened are safe at all, given that many things have opened only to shut down again and remain closed.

Who’s affected by re-entry anxiety?

Interestingly, some people who dealt with anxiety pre-coronavirus may be better equipped to handle re-entry anxiety now. “They’ve been doing it for some time now,” Keck explains, and the coping mechanisms they normally use — exercise, therapy, meditation, breathwork, and more — are likely to work well in this situation, too.

But there are two groups of people who are experiencing heightened anxiety around re-entry and their health in particular, therapists say. “Regular anxiety sufferers, or those with health anxiety (excessive worry over becoming ill) are reporting a higher level of worry related to what might otherwise be general aches and pains,” Keck says. “They tend to catastrophize and worry it’s the worst possible scenario, questioning what their plan needs to be to ensure health safety.”

The reason behind this makes sense: ”Highly anxious people tend to be more sensitive to things happening in the environment around them, and during a time like this it’s likely they’d suffer intense symptoms.”

People with pre-existing conditions that put them at higher risk for COVID-19 complications are also experiencing heightened levels of re-entry anxiety, according to Miller. ”For many of these individuals, it is a life or death situation because of their compromised immune system.  Therefore, their health becomes their primary source of anxiety as we move to the re-entry phase; while for others the major focus may be the unknown of what the new normal may look like.”

How to know if you’re dealing with re-entry anxiety:

So how can you tell the difference between normal, reasonable hesitation about going back out into the world and full-on re-entry anxiety? Here are some signs to look out for.

You can’t sleep.

“Difficulties with sleep would likely be the first sign that you have some anxiety, whether related to re-entry or generally related to this pandemic,” Shapiro notes. “This could be issues with falling asleep, staying asleep, or waking up in the morning when needed.”

You’re not interested in seeing friends or family.

As the country is moving to the re-entry phase, some people are continuing to avoid contact with others, Miller says. If you don’t have a desire to return to your life prior to COVID, or find it difficult to be outside your home, it could be anxiety at play.

You notice physical symptoms of anxiety.

These can include an upset stomach, headaches, a rapid heart rate, or just generally feeling unwell, Shapiro says. “These would be most prominent prior to an anxiety-provoking event such as going to the grocery store, the office, or any crowded setting.”

You constantly imagine the worst-case scenario.

“Thinking the same disturbing thought over and over, being unable to let it go or distract yourself, a feeling of doom, and worrying things will never get better: these are some signs of overarching anxiety and burnout,” Newman says. “We may walk around thinking about the worst in an attempt to prepare ourselves for dangers we anticipate.”

You’re feeling completely exhausted.

All that worrying leaves us feeling drained. “It’s like an iPhone with too many apps open in the background at once,” Newman says. “The persistent worry, anxiety, and grief runs our batteries down.”

How to cope

When it comes to helping yourself feel better, action is always better than inaction, Newman says. Here’s where to start.

Try to embrace change.

“Sometimes we have to learn to move in the direction of the wave,” Miller says. When your brain resists how things currently are, it causes stress and anxiety. So actively taking steps to get used to how things are now can really help. “For instance, identify how this new normal will look for you and your family,” Miller suggests. “You set the tone for it; Don't allow it to set the tone for you. Instead of focusing on what you cannot do, focus on what you will do.”

Stay informed about local guidelines.

“People with high anxiety have a difficult time differentiating between reasonable risk and the risk associated with anxiety,” Shapiro says. So the best way to determine the real risk level is to look at what’s happening in your local setting. “This changes constantly, but there is always a local health department that provides recommendations for what are considered safe activities and behaviors in a particular place and point in time.”

If your anxiety is still high after assessing local guidance, Shapiro recommends stepping back to consider if the thought process you're having is truly reasonable. “It might be helpful to ask a friend or close family member to talk through how you're feeling, or seek out professional help and advice.” (More on that below.)

Don’t seek constant input and feedback about the outside world.

Yes, it’s important to stay up to date, but when it comes to anxiety, there’s such a thing as too much information. “It’s tempting to try to get ahead of the worry and master current and future anxiety and grief by seeking info and feedback in the hopes of achieving a modicum of control,” Newman says. “Tuning into 24-7 news and scrolling your phone might seem like a good idea or might be a reflexive act. Don’t do it.” Take time to step away from your screens, and you’ll be happy you did, she adds.

Weigh the best- and worst-case scenarios.

Keck often asks clients to think of these — so they can plan for the worst but hope for the best. Doing so can also help you figure out what you’ll need in order to feel safe in a given re-entry situation. “For example, if you want to socialize because you’re feeling deprived, you need to ask yourself under what circumstances you’d feel comfortable being social,” Keck explains. “Create a plan and look at the spaces for flexibility that are within your comfort zone. Always know what is outside of your comfort zone and how you might exit a situation that doesn’t feel good.”

Start slow.

When you start to venture out again, know that baby steps are completely okay. “Start by taking each interaction and each day one step at a time,” Shapiro says. “Consider bringing a trusted friend or close family member with you.”

Go with your gut.

Because of the gut-brain connection, anxiety can cause physical symptoms. If this happens when you’re out and about (or are preparing to be), it may be your intuition protecting you from the threat, Miller says. “It doesn’t mean that you shouldn’t do it or it’s a bad idea, it may just mean that you don't feel safe enough and other measures need to be put into place. It is important to understand that our perception becomes our reality. Therefore, if we perceive a risk, our anxiety tells us that there is a risk and we need to create a means of comfort and safety.”

Remember that you’re not alone, and get help if needed.

“It's important to remember that you are not alone in what is going on, and anxiety during this situation is common even if you've never experienced it before,” Shapiro says. “If you feel things are getting out of hand or out of control, start by talking to a friend or family member.” If that doesn't help, consider therapy.

In addition to virtual sessions offered by psychiatrists, psychologists, and other therapists, you can check out online therapist directories like the American Psychoanalytic Association, American Psychological Association, Psychology Today’s database, or any local psychological association. “Don’t wait or feel like you have to go it alone,” Newman adds. You can also contact the National Suicide Prevention Lifeline at 1-800-273-8255.