Did the pandemic give you social anxiety?

When March 2020 rolled around, every social aspect of our lives changed practically overnight: grocery stores became fear-inducing, birthday parties moved to Zoom, and weddings were cancelled. We found ourselves nervously calculating the risks of seeing people we cared about. Some of us were strictly quarantined while we scrolled past photos of friends hanging out in large groups.

For more than a year, anything involving other people has been a confusing - and sometimes terrifying - experience. And in response, our brains did what they do best: they adapted. Now, as we begin to resume life as usual, we may find that social angst remains. If you’re reading this, you’re probably asking the same question as millions of others:

What if I don’t feel comfortable socializing anymore? Will I remember how to be myself around other people? I feel like I’ve changed and I don’t want to see people anymore. I know I won’t be able to relax at this big sporting event - it’s been a long time since I’ve been around more than just a few people. How do I get rid of social anxiety?

The answers won’t be the same for everyone, but looking at a mix of history and neuroscience is a good place to start.

Social anxiety during pandemics: a look at 1918

While a relatively limited body of research has examined the mental health impact of the 1918 pandemic, data shows a connection between pandemic life and a decline in mental wellbeing.  

A Norwegian demographer who collected pre- and post-pandemic data from asylum hospitalizations recorded that 1918 flu survivors tended to suffer from “sleep disturbances, depression, mental distraction, dizziness, and difficulties coping at work” for years after the pandemic had ended. He also saw a clear relationship between the United States’ high pandemic death rates and subsequent suicidal feelings among the population. In Great Britain, doctors and researchers reported various neurological changes in patients who had survived infection -- depression among them.

Last year, The Atlantic looked at diaries, newspapers, and other ephemera from Americans who were “locked down” during the 1918 pandemic, and “quarantine social anxiety” might be an apt name for their experiences (which had, as the author put it, “dark consequences for human relationships”). People were afraid to have conversations with each other (there was no video conferencing), mistrust permeated societal structures, and the constant fear of death took the place of the supportive friends and families who would have otherwise helped each other through hard times. In the years after the pandemic, survivors gave accounts of how they felt people had changed -- “people didn’t seem as friendly as before.”

Continuing research that dives into the lasting effects of worldwide trauma have shown that some pandemic survivors experience the same mental health challenges as those who have lived through wars. It makes sense, given both instances involve widespread loss of life over which one has little to no control, and subsequent collective grief.

Do I have Social Anxiety Disorder...or is it post-pandemic social anxiety?

According to neuroscientific research conducted by Total Brain and the Center for Adolescent Research and Education in February, nearly half of us displayed risk factors for social anxiety because of the pandemic. And, as the pandemic winds down in the U.S., the majority are experiencing “re-entry anxiety” about returning to an office setting.

First, it’s important to understand the difference between different types of social anxiety as a natural result of isolation and the actual condition of Social Anxiety Disorder (SAD). According to the DSM 5, Social Anxiety Disorder is a crippling phobia of being judged by others and of embarrassing oneself (particularly in front of people with whom someone is familiar). It can cause upsetting, intrusive thoughts and physical reactions. (This is not to be confused with Agoraphobia, which is an extreme fear of going outside of one’s home.)

Signs of Social Anxiety Disorder include panic attacks, avoidance of social interactions (and for severe social anxiety disorder, structuring life around that avoidance), panic attacks, freezing, and the inability to make eye contact, among other things. It’s important to note that SAD presents differently for each person, including by age -- Social Anxiety Disorder in children can materialize in the form of tantrums, being non-verbal, and unwillingness to leave a parent’s side.

How do you know if you have social anxiety or SAD? Consult with a doctor to help determine where you are on the social anxiety spectrum -- it may be a temporary discomfort with the social activities we’ve been deprived of for so long, or it may be a result of different issues resulting from pandemic.

Also consider how you felt throughout the pandemic. If adjusting to isolation was really hard for you rather than a relief (and you don’t have a predisposition for SAD), then you’re most likely feeling a generalized anxiety about resuming normal life, and not reacting in a way that’s irrational or out of proportion to the situation (which would be Social Anxiety Disorder). 

Another way to gauge whether or not you might be at risk for SAD is through an online assessment. Take our 15-minute assessment, which asks several questions that specifically screen for Social Anxiety Disorder. 

What can cause social anxiety? Looking at the neuroscience

Scientists are still in the process of understanding what causes social anxiety. In some cases it can be genetic, while in other cases it can be a result of a traumatic life event. Social isolation anxiety can potentially morph into Social Anxiety Disorder.

About 12% of U.S. adults report having social anxiety at some point in their lives, with women more likely to experience it than men. Social anxiety in teens is not uncommon; 9% were determined to have SAD according to diagnostic interview data.

Imaging studies show that people with SAD have multiple regions of the brain that are “functionally and anatomically altered” -- though a larger study concluded that SAD patients had more grey matter in the brain. (And still, other studies have been contradictory as to the cause and relationships between brain structure and SAD.)

In terms of the pandemic as a cause, social anxiety can be the result of another underlying issue caused by trauma, like PTSD (Doctors and nurse, in particular, are at high risk for PTSD resulting from the COVID-19 pandemic.) 

Does isolation cause social anxiety? Sure it can. Anxiety from isolation is normal and not a disorder -- and anyone who feels that way isn’t alone. A clinical psychologist who wrote a piece for The New York Times said that even her patients who describe themselves as extroverts are experiencing social anxiety.

A survey of older adults in the UK that examined the connection between the social isolation brought on by COVID-19 lockdowns and mental health found that isolation worsened components of depression and anxiety, and those that didn’t suffer from those things before were at greater risk of experiencing them.

In a study that looked at how school closures prompted by COVID tied into social anxiety in children, the researchers found that it may have delayed children’s ability to overcome the disorder since, “Exposure to feared situations is generally regarded as an essential component of anxiety treatment.” Social Anxiety Disorder can prompt people to isolate, which continues the cycle (confirmed by a 2013 study on the connection between isolation and those who have Social Anxiety Disorder).

How to address social anxiety

Those who suffer from Social Anxiety Disorder can opt for psychotherapy, medication, and other interventions depending on their particular case. CBT for social anxiety has proven helpful. CBT, or Cognitive Behavioral Therapy, focuses on changing dysfunctional thinking, behavior, and emotions by eliminating negative, irrational beliefs (and is a method that Total Brain utilizes, as well).

Those experiencing nervousness and fears about socializing because of the past year, and not an actual case of SAD, also have many resources they can turn to in order to learn how to deal with social anxiety. 

The Total Brain app has several useful tools for overcoming social anxiety. Social anxiety is associated with three brain capacities monitored by Total Brain: social connectivity, emotion awareness, and anxiety control. 

A key tool for addressing social anxiety is managing the stress that comes with it. Quick breathing exercises (like Focus Breath or Full Yogic Breath) and longer meditation exercises -- as well our neurotines library -- can help the socially anxious gain more control over their fears and thinking. 

Other brain training activities that Total Brain offers for social anxiety include:

  • Body Language, which helps users identify body language cues in order to better understand the reactions of others around them.
  • Emotion Booster and Emotion Match, which helps users improve their interpretation of facial expressions and the emotions they convey to make social connection easier. (Emotion Booster does this by guiding recognition of the six basic emotions we tend to show, whereas Emotion Match focuses on the interpretation of them.)
  • Faces and Names is a memory exercise ideal for people who tend to forget names of new people because of their social anxiety -- particularly in a professional setting. Repeated training with this game strengthens users’ abilities to remember the link between people's faces, names, and occupations without getting overwhelmed. It also trains the brain, in general, to retain long strings of information.

Making the effort to overcome social anxiety is important to our overall health; building social connections improves health, wellbeing, and longevity. Take it step by step. Don’t dive in, full-force, or feel like you have to accept every social invitation that comes your way. Start with meeting a couple of friends for coffee for an hour, and then work your way up from there. 

Identify your “triggers” - specific activities that cause you to feel more intense social anxiety (interacting with a cashier at a store or getting on the bus, for example, may be more triggering to having to engage in small talk with an unknown neighbor). Social media can also be an anxiety trigger.  Better understanding the nature of your social anxiety will make it easier to inform a treatment approach.

In the meantime, read this post to learn constructive ways to manage feelings of loneliness, and download the Total Brain app for a series of exercises that can help tame social anxiety.

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mental health in the covid-19 era
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