As more vaccines are available, students return to classrooms, and people start booking travel again, the idea of returning to life outside might seem daunting. After all, many people have become used to staying six feet away from others to stop the spread of COVID-19. Some health professionals predict many people will experience anxiety as they resume old routines.
Samuel Nordberg, Chief of Behavioral Health at Reliant Medical Group, gives advice on identifying these feelings and working through them. He specializes in anxiety disorders like agoraphobia.
KCRW: What is agoraphobia?
Samuel Nordberg: “The standard diagnosis for agoraphobia requires two things. It requires symptoms, and it requires what we call ‘functional impairment.’ The symptoms are struggling with fear related to open public places like restaurants, movie theaters, workplaces, and school. And then the second chief criteria is a very strong avoidance of those places. And the functional impairment piece is related to that withdrawal and avoidance, impacting somebody's ability to do all the things to live their life the way they want.”
Because so many of us have been avoiding potentially-crowded places like grocery stores, do you think more people are developing agoraphobia?
“The pandemic is creating a pretty perfect breeding ground for the development of the kind of worry and avoidance patterns that are related to agoraphobia. We've been told for a year that it's critically important to stay home, because there is an uncertain and anxiety-provoking threat out in the world in the form of the virus.
As we have stayed home, followed that guidance, and observed the news with that continued uncertainty and fear, it's certainly possible, particularly for people who are predisposed to anxiety and worry, that they may have developed some habits related to avoiding some of those settings that may, in fact, when we do decide to return, result in some real challenges to do so.”
How do you know if you have agoraphobia, versus just being cautious and prudent about staying healthy?
“There are a couple of things that we're observing. One is that our patients who had agoraphobia before the pandemic are happy being at home. And you may not know that yet, because you may not have had the challenge that exposes you or forces you to engage in going to those places that will generate the anxiety and the avoidance that would be impairing. We suspect that for most adults who are working from home, they may not know yet that this is going on for them.
We are seeing it in our kids who are being asked now to return to some schools that are reopening. We're getting more kids coming in with fear and anxiety related to riding the school bus and spending eight hours at school. These are anecdotal, but we are seeing an uptick in the number of cases that we're seeing for those challenges.”
How do you treat these younger patients if they have this new anxiety?
“It starts with understanding how this develops in the first place, which is through a pattern of developing a fear of being in those open spaces, then having the anxiety associated with that fear. ... So every time you avoid going to one of those places, or you leave one of those places prematurely, you're rewarded with a feeling of relief. Repeated over and over, that cycle builds and reinforces that avoidance.
In order to recover from it, you essentially have to reverse that cycle. You need to develop the skills to tolerate and manage your anxiety, without leaving those open spaces.
So the work that we tend to do is not that different, for example, from weightlifting, where you don't want to set somebody up with a ton of weight. You want to gradually build up to the goal weight that you're trying to lift, where maybe at first you're imagining going to those spaces, and then you're [actually] going to those spaces, but only for a very limited time. You're gradually building up your skill, building up your tolerance, building up your ability to get back out there.
And while you're doing that, you're also working on challenging your cognitive worry by saying, ‘Well, I was worried that the following things were going to happen. But when I started going out there, it turns out they didn't happen.’”
You personally went through this work because you were in the Twin Towers at the World Trade Center during 9/11. Can you describe your experience?
“At the time I was working on Wall Street. I was in the North Tower when the first plane struck, and obviously had a pretty terrifying experience. That generalized into panic, agoraphobia, and post-traumatic stress disorder, such that I was afraid to get on public transportation, I was afraid to go into restaurants, afraid to go into places where I thought I might be trapped [or] where I couldn't see an exit. And generally afraid of not being able to to escape. And it took me quite some time to develop an understanding of what was going on.
One of the things that's so hard about this is that we can often be very hard on ourselves when we notice that we aren't doing things that other people are. When we notice that we're so afraid and avoidant that we're unable to engage in a full life, it can be very difficult to move from a place of self-blame and self-deprecation to a place of working the problem. And that ultimately is what got me to a place where I was better able to manage, which was [having] friends and family who were constantly working to help me reengage and constantly supporting me to put myself out there.”
Since so many people are experiencing this right now, are you hopeful that they’ll find the support necessary to overcome it?
“When we go through something that changes our assumptions of the way the world works, which certainly this pandemic has done, there isn't a return to normal. There's a moving on to something else. And there certainly can be a return to many of our old habits. But it's not like we're hitting the reset button and forgetting the last year. We're going back to some things that are important to us, while also processing the last year.
And so in that regard, I think that there can be some solidarity. There can be some ways of having a more national conversation about things like agoraphobia and the challenges that we might expect Americans to struggle with because of the nature of the pandemic. But we would need to do a better job of having a national dialogue about mental health than we have done in the past.”
Right, because there’s an impetus to just say, ‘It's over, let's move on and not really deal with the lingering mental health effects,’ which a lot of people are going to experience.
“It’s important to remember that when we talk about mental health effects, we're all somewhere on a continuum. One of the ways in which stigma often comes about is thinking that folks are somehow different because they are challenged with mental health struggles. All mental health really is just a more extreme version of the same continuum that all of us are on. We all have a certain amount of worry and anxiety. We all react to fearful things in much the same way.
But some of us hold on to those things for longer than others. For some of us, it's harder to let go of that fear. It's harder to move our minds from a year in which we're told that being social is dangerous, to then resetting and saying, ‘All right, here we go back into society.’ For some people that might be easy, and for other people, that might be hard.”