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Re-entry anxiety post-COVID

Many who have been suffering with lockdown restrictions are now experiencing anxiety during the transition from social isolation to a packed diary again

01 April 2021, at 9:00am

Acceptance and commitment therapy (ACT) is a form of psychotherapy which invites people to open up to unpleasant feelings, learn not to overreact to them and not to avoid situations where they are invoked.

So, what’s the point of knowing that? You may ask

Well, the restrictions of the last 12 months have been gruelling for many of us. The loneliness and anxiety felt by the halting of our usual basic liberties have caused a tsunami of mental health concerns. Unfortunately, many of the same people who have been suffering the most with these restrictions are now experiencing anxiety during the transition from social isolation to a packed diary again (the re-entry phase).

We worked so hard at accepting that it is what it is, taking one mindful day at a time. We focused on only the present moment rather than worrying about, or even planning for, the future. We got used to not planning anything to avoid the feelings of disappointment when plans were cancelled.

We reprogrammed ourselves to enjoy this cosy bubble of home where every day is Groundhog Day and the diary is empty. So now, we’re throwing the doors wide open and rushing back to normality as fast as the statistics will allow. All good right? Not necessarily.

ACT is widely used by therapists for the anxiety that cancer survivors experience on “re-entry”. Cancer survivors may experience uncertainty about the meaning and purpose of their lives following cancer, triggering anxiety. Additionally, they may worry: “does this symptom mean that my cancer is back?”, “how can I live knowing that my cancer might return?” and “now that treatment is over, why I am not back to normal?” Fear of cancer recurrence figures prominently, yet the focus of anxiety extends beyond just that.

Moreover, anxiety often persists for a decade or more after cancer treatment, representing the largest mental health difference between long-term cancer survivors and community controls.

Firstly, very importantly, I do not equate restrictions on our freedom in any way, shape or form with having cancer. Nor do I think that the wonderful liberation unfolding for us over these next few months is like returning to normal life after surviving cancer. That’s especially true because, while a person is enduring the godawful process of cancer treatment, the rest of the world is going on about their usual business without them “as if nothing untoward is happening”. COVID and lockdown has affected almost every human on earth and so is a completely different scenario.

What I am saying though is that we can learn from the re-entry anxiety cancer survivors experience as we begin to understand the re-entry anxiety that we are feeling on coming out of lockdown.

Many may question the meaning and purpose of their lives after COVID following this chance to stop, pause and re-evaluate. Others may have no choice but to pursue other career paths due to redundancy. Each of these can trigger anxiety.

We may worry that this cough or headache is the start of a COVID infection. We may continue to worry about our aged or susceptible loved ones developing the disease despite vaccinations. We may wonder how, now that life is returning to normal, why we don’t feel normal. And we might judge ourselves as “wrong” for feeling all of the above.

We have discussed acceptance before

Acceptance is, in a nutshell, allowing ourselves to feel any emotion we are feeling non-judgmentally. One at a time, so that you can identify what that emotion is, give it a name, feel the physical effects of that emotion, look it in the eye and notice that it is present. That’s the opposite of shutting those feelings in a box only for them to come back another day and grab us unawares.

Commitment is like deciding what we want to do as a result of each emotion we are feeling. Internally, that might be deciding to live with it and even “befriend” it. Alternatively, it may be deciding to let it go for now or for longer. Neither is right nor wrong. Externally, we may decide on physical actions, such as: do I want to shout? Do I want to convey a loud sigh? Do I want to run away? Do I want to just not reply to messages? Do I want to make plans to go to the pub and then cancel at the last minute because I just can’t face it?

Making these decisions consciously is helpful because it means that each reaction is not just us running on autopilot, it’s us being self-regulated. The spin-off of good self-regulation is happier, more content people with positive interactions with others.

ACT promotes forms of coping that predict positive psychosocial outcomes among cancer survivors: actively accepting cancer-related distress, reducing cancer-related avoidance, clarifying personal values and committing to meaningful behavioural change.

ACT allows for, rather than minimises, the distress of cancer and fear of recurrence – an approach that may authentically validate the fears of re-entry phase survivors, many of whom live with the real possibility of relapse and early mortality. Thus, ACT may help cancer survivors increase their capacity to live meaningfully and effectively even with persistent side effects and uncertainty about the future.

I, for one, am in awe of cancer survivors who show any indication that they are accepting of these anxieties. Often, society and even the closest of family members, are so joyful for the cancer survivor when they come to the end of their treatment and are given a clean bill of health, that the survivor themselves feels totally alienated from those they feel closest to. At a venue where I counsel cancer survivors and cancer patients, time and time again I hear that the survivor with the discharge note from their oncologist emerges from the rigorous schedule of years of appointments. The champagne corks are popping, balloons are everywhere and the survivor feels more alone than ever. Their family is celebrating but their support network has just evaporated as they are discharged from the only group of people who can truly understand how they feel. Some clients have said that they would choose to not be in remission or cured of their cancer rather than face this re-entry.

Being aware that the jaw-dropping strength of cancer survivors getting back to “normality” is far greater than the strength we will need to get back to the pub is respectful and, perhaps, not something we had thought of before now.

Telling yourself that there are people far worse off than you who have cancer or who have had loved ones die due to COVID, while it is of course very true and not to be trivialised, rarely helps to relieve anxiety.

Self-shaming is of benefit to no one

Some of us may have an underlying worry that, just as we get used to going to the pub again, it will all be “taken” from us. It may be the fear of disappointment that stops us from booking a holiday even though we’re allowed to do so.

Accepting this plethora of feelings and identifying them one by one is a start.

Giving ourselves permission to feel these emotions is helpful.

Knowing that there are vast numbers of people feeling exactly as we are helps because we realise that it’s the nature of being human in 2021.

Laura Woodward Counselling

Laura Woodward has been the surgeon at Village Vet Hampstead for over 10 years. Laura is also a qualified therapeutic counsellor and is affiliated with the ACPNL and the ISPC. She runs Laurawoodward.co.uk – a counselling service for vets and nurses.

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