The Spanish call it síndrome de la cabaña (cabin syndrome). The French prefer syndrome de l’escargot (snail syndrome). In English, we favour the less poetic ‘re-entry syndrome’, or ‘reverse culture shock’. Whatever the name, feeling anxious as we emerge from our shells or cabins to re-enter the COVID-19 world is very real.
At first, this concern might seem counterintuitive. Surely we should have looked forward to the easing of lockdown, being reunited with friends and—for those fortunate enough to have retained their jobs—the prospect of returning to our place of work. Yet, it turns out that this exact moment can coincide with heightened anxiety. The concept of re-entry syndrome dates back to the early 1960s. Two US psychologists, John and Jeanne Gullahorn, observed that after extended periods of travel, those returning home experienced downs as well as ups, readjusting to what was once familiar.
Explorers and expeditioners returning from the Antarctic were a case in point. This readjustment is understandably more challenging for those who have experienced some kind of trauma while away—soldiers returning to civilian life from a war zone, aid workers returning home or anyone coming out of prison.
Until now, psychological distress about this kind of readjustment has affected relatively few of us. Now it is something with which we are all grappling to a greater or lesser extent, according to Carmine Pariante, professor of psychiatry at King’s College London. He says: “Although most of us have not experienced such geographically remote isolation or traumatic experience, we can’t underestimate the impact that lockdown and social isolation have had on us.”
What is the impact of COVID-19 on our mental health?
Numerous studies from around the world confirm the negative impact that lockdown and social isolation have had on our mental wellbeing. Data from the Zurich Project in a report called The Social Development from Childhood to Adulthood has been used to explore the psychological impact of COVID-19 on young adults in Switzerland. Perceived stress and anger levels were significantly higher during the pandemic than before.
Meanwhile, academics at Dartmouth College asked students in the US to complete weekly assessments about anxiety and depression over a two-year period. Participants reported increases in both in comparison with the semester preceding the pandemic.
Pariante says there are many reasons for the dip in our mental wellbeing throughout this period. “Some of our experiences during lockdown might have included enhanced time for introspection, a shift in our life priorities, and practical changes in our work situation. Moreover, some of us might have experienced the true trauma of losing someone dear to COVID-19.”
He continues: “All of this has changed each of us so that we are no longer exactly the same person that we were before COVID-19—this is the core feeling underpinning re-entry syndrome.”
Kristen Gygi, an American therapist, says that although we are constantly changing, this period has accelerated this process. “Why is it hard to go home again after visiting the Arctic? Because you are not the same person you were when you left. In fact, you are not the same person you were yesterday, even if you never left your home. But a great adventure is likely to trigger quite a shift.”
Some groups have been faring worse than others in terms of their mental wellbeing through this difficult period. Findings from the UK COVID Social Study reported that levels of depression and anxiety are highest in young adults, people living alone, people living with children, those with a lower household income, people from BAME groups and people living in urban areas. People living with a pre-existing mental health problem also reported higher levels of depression and anxiety. These groups may find re-entry especially hard.
Why is re-entry so difficult and how can we embrace it?
Re-entry can be challenging for three reasons. First, there is a general feeling that we have been changed by COVID-19 and that we are navigating a new and foreign land. Second, some people are anxious because they experience a lurking worry of catching or spreading the virus. This is especially true of those with a fear of germs, or obsessive-compulsive disorder (OCD). Finally, we have fallen out of the practice of socialising. We can find it difficult to reconnect. This is particularly true for those with social anxiety.
One answer to all these feelings is ‘exposure therapy’, the gold-standard treatment for many anxiety disorders. This means confronting sources of fear safely—so in our new normal, masked and socially distanced. The key is to expose yourself gradually to more challenges little by little—an approach that has been shown to be an effective treatment for many types of anxiety disorders.
Dr James Arkell is a consultant psychiatrist working at the Nightingale Hospital in London. He says: “Exposure therapy taps into a basic function of the human brain. We quickly make associations between things. This is called classical conditioning. If you close your eyes and visualise sucking a lemon, you will feel your salivary glands tingle!”
In order for exposure therapy to work well, Dr Arkell explains that you need to stay out of the house long enough for the anxiety to fade so that you can make a new positive association between relaxation and being out of the house.
The alternative to exposure is avoidance. When we avoid what we fear we can feel temporary relief. The problem is that we feel the anxiety more keenly the next time we confront what worries us.
Although uncomfortable, there are lessons we can learn
As lockdown ends around the world, exposure therapy can help our wellbeing levels rise again, a process that is already beginning to happen. Researchers in the UK have been collecting data on a weekly basis exploring the longitudinal psychological impact of COVID-19. Depression and anxiety levels have been decreasing throughout the 18 weeks of the study. While the overall level is still higher than pre-pandemic averages, the results indicate that levels are returning to normal.
There are even some positives to this period. Dr Carla Croft, a clinical psychologist in Britain’s National Health Service, says we can grow after trauma: “Trauma can, indeed, help people to start to look for the gifts in this, the ways in which they have been stretched, taken on new skills, learned to see things differently. Psychologists like to use the term ‘post-traumatic growth’, which can certainly be an enriching and deepening experience.”
We are all adjusting to this new way of life. Slowly, we are beginning to venture out again: coffee in a cafe; socially distanced gatherings of friends; a meeting in an office. But like snails, and given all we have been through, we are allowed to take our time to emerge from the cabin.
Rachel Kelly is a British writer and mental health advocate. Her latest book, Singing in the Rain: 52 Practical Steps to Happiness, is published by Short Books