Post-Pandemic OCD
Inoculation against pandemic-related anxiety is not included in the Pfizer vaccine. Nor in any other brand. Indeed, there are some people who find the dawn of a post-pandemic world rather daunting--the idea of going back to into the world elicits more anxiety than excitement. If you are one of these individuals you might be facing a new challenge: post-pandemic obsessive-compulsive disorder (OCD). The aim of this article is to discuss what this condition looks like, how it comes about, and some practical solutions to overcome it.
For whole a year there has been one overarching concern that the world struggled with: staying self and healthy. Our world changed: masks became the norm, meetings and family reunions took place over Zoom, and food delivery kept many from going hungry. We checked the news, hand-washed and hand-sanitized regularly, stayed six-feet apart, and perhaps at times were even a tad (or more!) more stringent than the CDC guidelines. We had a singular mission: don’t get Covid, and don’t infect others.
The state of high vigilance for an invisible threat, coupled with continuous behaviors to protect one from that threat--over the course of an entire year--has psychological consequences. Perhaps we can use one of my clients as an example for appreciating what these consequences look like (identifying content changed).
John is a nurse who works in an outpatient facility. He was one of the first to get fully vaccinated due to his position as a healthcare worker. His wife, a teacher, also recently got fully vaccinated. For the duration of the entire pandemic, everyone in John’s family was very meticulous in keeping all the guidelines. John’s parents are also fully vaccinated. They would like to start getting together with John now that everyone is vaccinated. John, however, will not hear from it. Further, his wife is begging him to go out to restaurant, to feel a sense of normalcy. But for John, all of these changes are just way too overwhelming and threating. He feels like it is just as dangerous out there. His family believes he is being irrational, and perhaps a bit controlling. (He almost wishes that things were back to pre-vaccine days when he did not have to worry about pressure to go back into the world.) “What if the vaccine didn’t work?” he worries. He can’t stop thinking “What if my vaccine was not administered properly?” For some reason the vaccine does not make him feel much safer.
Besides for the avoidance, he also engages in many anxiety-reducing behaviors. These include excessive handwashing and online research into likelihood of getting COVID post-vaccination. “Is it really worth taking any chances?” He wonders.
John’s behavior may not be the most helpful and functional, but they are certainly not outside of the realm of understandable. Let us make some sense of this.
One of the most fundamental laws that governs human behavior is the desire to avoid pain or discomfort. When a behavior successfully gives us relief from an unwanted outcome, we are essentially guaranteed to repeat that behavior again. If washing my hands gave me relief from feeling vulnerable to COVID, I will repeat that again in the future when I feel the same way. If avoiding going outside made me feel safe, I will likely avoid more in the future. That’s human nature. Not only is the avoidant behavior reinforced, but so is the fear of getting COVID. The more I measures I took to prevent COVID, the more I reinforced the fear of getting COVID. During the year of COVID, there was naturally—adaptively—a lot of avoidance. However, that avoidance left John, and many others, still feeling that things are dangerous. John tells himself “I know logically that I am safer now with the vaccine” but the pre-vaccine feelings are unchanged. The vaccine works on our biology--not our psychology. In order for John to get his feelings up to speed with his current biological state, he will need to match his behaviors with it. What this practically means, doing things even though they feel dangerous.
In other words, exposure therapy.
Exposure therapy involves taking steps towards things that feel threatening and not trying to reduce the possibility of the threat through a wide range of behaviors called compulsions. This is the therapy that I am teaching John. At first, we established the “red lines” based on CDC guidelines: what is in the bounds of exposure therapy that is deemed safe, and what is considered still unacceptable. Everything that is acceptable and that is still being avoided is material for exposure therapy.
With great courage, John started to expose himself to situations that felt threatening while not engaging in any usual self-protective measures that otherwise reinforce his current state of avoidance and fear. For example, taking a walk without a mask on, taking in the mail and not washing his hands right away, refraining from wiping down food from store. These will be followed by larger steps such as going to the supermarket (with a mask), going into his parents’ house while maintaining social distancing with mask.
With great courage, John is working his way up through the exposures, slowly marching towards a post-pandemic world.
