be a ‘Twindemic?’
From perceived risk to caution fatigue, Jefferson experts share insights into why there are differences in how people approach measures intended to prevent spread of the coronavirus.
There seems to be a collective sigh of relief and some return to normalcy, as Philadelphia and surrounding counties enter the “yellow” phase of the pandemic. But state and health officials are cautioning people that the novel coronavirus is still very much present, and that abandoning preventative measures like social distancing and masking could fast-track us back to “red.”
There have already been indications that people’s resolves to follow these measures have been flagging, with numerous reports of large gatherings taking place even before the recent nationwide protests against racial injustice and police brutality. There have also been spikes in cases in areas that had relaxed social-distancing guidelines. Ten weeks into the pandemic and a social isolation unlike anything we’ve ever encountered, are these cautions falling on weary ears?
We talked to two mental health experts at Jefferson to help us understand the psychology behind why there are differences in how people approach the safety measures that have helped us “flatten the curve,” and how we can have constructive conversations about them as restrictions lift.
Caution Fatigue is Getting to Us
“In the beginning, the threat of COVID was front and center and everyone was really motivated to flatten the curve,” says Virginia O’Hayer, PhD, a clinical associate professor in psychiatry at Jefferson. “But we can only sustain that level of vigilance for so long. As time has gone on, people have slowly lost motivation to follow safety measures. Some have called this ‘caution fatigue’.”
Even though the declining numbers of cases and casualties provide some much needed hope, it still feels like there’s no end in sight for this pandemic. The race to create a therapeutic or a vaccine is one we are all watching with baited breath, but it’s clear that it could take till the end of the year to clear all the necessary safety and efficacy checkpoints.
“There’s not really a script for how to deal with such prolonged periods of stress, anxiety, and loss of normalcy,” says Dr. O’Hayer. “Moving to ‘yellow’ can feel like we’re not in full-crisis mode and people are understandably looking for a reprieve. It’s hard to tap into our psychological resources that are already depleted.”
“There’s also the huge impact of social isolation,” adds James Hagenbaugh, PsyD, staff psychologist and clinical coordinator at Jefferson’s Student Personal Counseling Center. “People haven’t seen their parents, grandparents, and friends. We are social animals, and interaction with others is essential for our well-being.”
“We still have to continue to take it a day at a time,” says Dr. Hagenbaugh, “and maintain our emotional health by getting good sleep, staying active, eating well, and persevering with the coping mechanisms that have served us well so far.”
We All Perceive Risk Differently
In any situation, we all fall on a spectrum of avoiding risk, and taking risks. We assess risk based on the information that we’re getting, from the news, family and friends, and the events happening in our surrounding environment. Risk assessment also depends on our personal circumstances and life experiences. “During COVID, those who are immunocompromised or who have pre-existing conditions that make them susceptible are not going to be taking risks,” says Dr. O’Hayer. “And this goes for their caregivers and family members as well. Or if we’ve lost someone to illness, we may be more vigilant because we’re more aware of the trauma that comes with hospitalization and end of life care.”
Moving to ‘yellow’ can feel like we’re not in full-crisis mode and people are understandably looking for a reprieve. It’s hard to tap into our psychological resources that are already depleted. -Dr. Virginia O’Hayer
All these factors in risk perception influence the degree to which people have been following safety measures during COVID-19 – some wear masks only in enclosed spaces and not outside, some people wipe down their groceries, others don’t. As the curve flattens and we go “yellow,” this divergence may widen.
“With COVID, it’s hard to assess the risk because we don’t have all the information yet, it’s an ongoing crisis,” says Dr. Hagenbaugh. “So there are many people right now who are thinking ‘Well, I haven’t caught it, and none of my friends or family have caught it, so maybe it’s OK to go into a store without a mask or have a large gathering’.”
“If you or a loved one hasn’t been affected by COVID, then it can feel like this amorphous thing that is talked about in the news,” says Dr. O’Hayer. “It is human nature to feel less inclined to avoid risks or make these sacrifices when it hasn’t impacted you directly.”
Resistance Could Be a Form of Coping
When someone walks very close to you or doesn’t follow the six-foot guidance, it can seem like a violation of space. In those moments, it’s hard not feel threatened by the person seemingly flouting measures that are keeping us all safe.
Dr. O’Hayer suggests trying to reframe the ignorance or resistance as a coping mechanism for that person. “We are all under a tremendous amount of strain and carrying a lot of emotional overhead” she says. “It’s hard for us to be mindful all the time. For some, the ’out of sight, out of mind’ approach might be a way to emotionally detach from a situation that is so dire.”
There have been instances of more outright resistance, and even hostility. Late April, in a Philadelphia grocery store, a woman spat on another customer because the latter requested her to maintain social distancing.
“There is no excuse for that kind of behavior, but I think it’s important to understand why someone might react that way,” says Dr. O’Hayer. “With masks on, we’re losing a lot of data from facial expression, like smiling and even eye movements. And a flat face with no expression, is interpreted as hostile and unfriendly. So tensions are already high. Then when you ask someone to keep their distance or move away, I imagine it can feel like a rebuke or like you’re suggesting that the person is dirty or gross. I think framing it as ‘I’m trying to keep both of us safe, because I could be carrying the virus too’ might help mitigate that defensive reaction. Other pro-social signals might also help, like waving “Hi” and using a calm and friendly tone of voice.”
Focus on What You Can Control and Vocalize Boundaries
Whether it is a matter of someone absent-mindedly bumping into you in the street or a more hostile interaction like the one above, Dr. Hagenbaugh suggests focusing on what you can control. “Firstly, it’s important to let whatever emotion come up – anger, frustration, sadness – and feel it,” he says. “Secondly, it’s important to assess what you can’t control vs. what you can control. You can’t control that individual, but you can control your response. So if someone is not moving out of the way, move to the other side of the street or change directions. If there is a danger of a verbal or even physical altercation, de-escalate to the best of your ability, or remove yourself from the situation as quickly as possible and find someone who can help.”
Tensions can arise with your own family and friends who may not be adhering to social distancing and masking to the same extent as you are. It can be an uncomfortable conversation to have. “The best way to approach it is to come from a place of caring,” says Dr. Hagenbaugh. “Emphasize to your loved one that you care about them, and the best interests of both of you and your families. This makes it more digestible, and usually you can come to an understanding.”
He also recommends vocalizing boundaries, and setting consequences if those boundaries are impinged upon. “If you have family members or friends who insist on coming over or having playdates, define a simple boundary, like, “You can come over as long as everyone is wearing masks”,” he says. “But it’s also important to let them know that if they aren’t wearing masks, that you’ll have to ask them, politely, to leave.”
Empathize and Share, Don’t Shame
With many anecdotes of social distancing or lack thereof being shared on social media, it’s easy to react in that moment with anger, and attempt to shame the person for their actions. “Shaming just entrenches the person in their view, creating more division,” says Dr. O’Hayer. “As humans, we’re much more likely to change our behavior based on reward than on punishment. So shaming or bullying isn’t going to be very helpful.”
Instead, Dr. O’Hayer recommends taking a more empathetic approach and trying to share information.“In psychology, we use a technique called motivational interviewing that was originally designed to help people quit smoking or manage drug use,” she says. “Firstly, you ask someone permission to give information. You might ask them something like “What do you know about pros and cons of wearing a mask? Can I share some information with you” And if they consent, the rule is that you can only tell them 3 things. For example, you can tell them that masks reduce the risk of transmission by up to 75%. This strategy has proven to be effective in eliciting change, while also being empathetic.”
We’re Doing Our Best
It’s clear that we are in this for the long haul, and social distancing and masking are a part of our daily lives now. “We have been grieving our loss of normalcy for so long,” says Dr. Hagenbaugh, “and we are all going to have different trajectories to acceptance.”
“If we all come from a place of thinking everyone is just doing their best, we can have more constructive conversations and ultimately keep ourselves and people around us safe,” says Dr. O’Hayer.