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About half of all people surveyed by the American Psychiatric Association said they were worried about adjusting to in-person interaction.
SAN FRANCISCO — When the pandemic narrowed the world, Jonathan Hirshon stopped traveling, eating out, going to cocktail parties and commuting to the office.
What a relief.
Mr. Hirshon suffers from severe social anxiety. In the past, casual get-togethers and meetings came with a rapid heartbeat and clenched fists. He preferred to interact virtually, and welcomed the Zoom meetings that others merely tolerated. Even as he grieved the pandemic’s toll, he found lockdown life to be a respite.
“There is cognitive dissonance to feeling good in the middle of the pandemic,” he said.
Now with normalcy about to return, Mr. Hirshon, a public relations consultant, finds himself with decidedly mixed feelings — “anticipation, dread and hope.”
Mr. Hirshon, 54, belongs to a subset of the population that finds the everyday grind not only wearing, but also emotionally unsettling. These include people with clinical diagnoses of anxiety and obsessive compulsive disorder, but also run-of-the-mill introverts, who are socially uncomfortable.
A new survey from the American Psychological Association found that while 47 percent of people have seen their stress rise over the pandemic, about 43 percent saw no change in stress and 7 percent felt less stress.
Mental health experts said this fraction of the population found the quarantine protective, a permission slip to glide into more predictable spaces, schedules, routines and relationships. And the experts warn that while quarantine has blessed the “avoidance” of social situations, the circumstances are poised to change.
“I am very worried about many of my socially anxious patients,” said Andrea Maikovich-Fong, a psychologist in Denver. That anxiety “is going to come back with a vengeance when the world opens up.”
She doesn’t for a moment diminish the larger picture of the pandemic’s toll. Millions have died around the globe, and the plague itself has caused severe grief and anxiety — for parents and children, medical workers and those just trying to survive economically. The mental health industry, she said, “is struggling to keep up.”
But for people with severe anxiety and obsessive compulsive disorder, these sharp restrictions in some ways reinforced their intense impulse to withdraw.
Early on in the pandemic, “these patients were feeling very vindicated,” said Ms. Maikovich-Fong. For people who feared contact with other people or germs, “even the government was telling them that everything they thought they should be doing was the social norm.”
Now, she said, she’s already seeing the discomfort set in for “some kids going back to school or adults who were working remotely.”
“There are a lot of people walking around with a false sense of security, who are a lot more comfortable than they were a year ago,” she said. “That’s not sustainable.”
This counterintuitive dynamic is playing out for teenagers and children, too.
A study published in February in European Child & Adolescent Psychiatry looked at the mental health impact on 1,000 young people in Canada during the pandemic, and found that 70 percent of study subjects aged 6 to 18 reported some negative impact. But 19.5 percent in that age group saw some improvement, leading the authors to conclude of the impact: “Mostly worse; occasionally better.”
Researchers found that some children with social anxiety and learning disorders saw improvements in anxiety and depression. “The stay-at-home directives may have provided relief from sources of stress, therefore improving symptoms of anxiety or irritability,” according to a summary of the research by the Hospital for Sick Kids, which is affiliated with the University of Toronto and supported the research.
Ryan Fenstermacher, a high school senior in Connecticut (who asked that his city of residence not be published), said school can increase his social anxiety. “Like group projects, they’re always terrible for me — my anxiety comes from not being able to predict what they’re going to do, what they’re going to say,” he said. “There’s no escape route.”
Not so when he’s on Zoom. “You can turn off your camera, mute people online,” he said.
For some students, the return to the classroom is proving challenging because they’ve gotten accustomed to being offline. In Mountain View, Calif., an intensive therapy group is tackling teenage mental health challenges, and its participants include a new member as of mid-March: a 15-year-old who started with the group this week to try to cope with social anxiety.
Her mother, who asked that their names be withheld to protect the girl from embarrassment or bullying, said that the girl, who is in 10th grade, appeared to have essentially forgotten how to socially interact. The idea of returning to school makes the adolescent terribly anxious and, absent therapy, “would be terrible news for her,” her mother said.
Mary Alvord, a psychologist who runs a large group practice in Maryland serving adolescents, said that many adolescents have suffered during the pandemic. “We don’t want to diminish that,” she said. But “there is a subset of kids who are doing better.”
Some adolescents, Dr. Alvord said, have found a respite from bullying and social anxiety, and students struggling in school now get more help from their parents and worry less about their in-classroom performance.
Then there are the little ones.
“Kids will say, ‘My mom used to travel all the time. I never even saw her and she was so tired, and now my parents are home all the time and they even play games with us,’” Dr. Alvord said.
For some adults, the pandemic provided a glimpse into just how much anxiety they were experiencing on a regular basis. Josh Bernoff, a public speaker and author who lives in Arlington, Mass., said he was constantly stressed by traveling, figuring out where his next on-the-go meal was coming from and making socially awkward conversation with people he didn’t know that well.
Now, he says, “all my interactions are virtual, so I don’t worry about shaking hands and the awkwardness of in-person.”
“When I go to bed at night, I know what I’m doing the next day, and I don’t worry about it,” said Mr. Bernoff. He loves the predictability of life — like what time he’s having lunch and dinner and where it’s coming from. “I hate to sound paranoid about this, but I like being in the same place as my refrigerator.”
Mr. Bernoff hastened to say he can’t wait for the pandemic to end — “and go to dinner with my wife.”
“I don’t want this to go on forever,” he added, “but for just this year, this period, it’s been a little island of stability.”
Mr. Bernoff is fortunate to have consistent work; research shows that anxiety and depression triggered by the pandemic can disproportionately impact those with shakier economic prospects. A large-scale study of 36,000 subjects in the United Kingdom, published in the December 2020 issue of The Lancet, found that mental health challenges were elevated for some people early in the lockdown and then eased in general as the lockdown eased, with some groups more susceptible than others.
“Being female or younger, having lower educational attainment, lower income, or pre-existing mental health conditions, and living alone or with children were all risk factors for higher levels of anxiety and depressive symptoms at the start of lockdown,” the study found. That began to ebb, the researchers found, as people acclimated and lockdowns eased.
By contrast, the anxiety-ridden people who experienced relief during the pandemic probably are in higher income brackets, said Ms. Maikovich-Fong, the therapist from Denver. They are more likely to have jobs they can do remotely, allowing them to remain employed but with less stress than before.
In the end, that relief may not only prove temporary but also actually intensify anxiety as people try to re-engage.
“The more you avoid something that makes you anxious, the harder it is to do,” said Martin Antony, a psychology professor at Ryerson University in Toronto and an expert in phobia and anxiety. He added of people with more extreme cases: “They may find when the pandemic ends, it’s much more difficult.”