People are experiencing 'adjustment disorder' as lockdowns end and society reopens, a psychiatrist says

Restaurant social distance quarantine greenhouse Amsterdam
A restaurant in Amsterdam, Netherlands offers safe "quarantine greenhouses" in which guests can dine, May 5, 2020.

Eva Plevier/Reuters

  • When Americans were first told or required to stay home to help control the coronavirus pandemic, our collective anxiety skyrocketed.

  • But now, after adjusting to life "safer at home," many are experiencing a second wave of anxiety due to the prospect or reality of resuming activities like going to work or seeing friends.

  • One psychiatrist is calling it "phase two adjustment disorder," referencing the term that describes symptoms of depression and anxiety tied to major life chances like a divorce, job loss, or move.

  • To cope, experts recommend taking things day by day, get professional help if necessary, and remember that most people will adjust and symptoms will subside.

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The day the Illinois governor announced a shelter in place order March 20, Mallory Bradford, a Chicago resident, broke down crying in a grocery store aisle.

A song had come on that reminded her of a concert she'd gone to with her dad, and she knew it would be a long time before she could experience something like it again. Bradford, a tech company employee by day and standup comedian by night, also knew it would be a long time before she could perform or enjoy a carefree cocktail in a restaurant with friends.

The grief, she told Insider, "was real."

But now, after more than two months largely staying home, Bradford is experiencing another wave of distress: How and when will she be able to take a train, laugh into a microphone, hug her parents, or meet friends for a drink without feeling on edge?

"I don't know that I'll be able to fully enjoy that unless there's a vaccine," she said.

As the country begins to reopen offices, restaurants, beaches, and even salons, many Americans like Bradford are experiencing a similar type of anxiety that overcame them when such places were first shut down.

Experts are calling it "phase two adjustment disorder" and "re-entry panic syndrome," with one summing up the feeling like this: "What if the new normal sucks?"

But, like the first time, while the discomfort can morph into more serious mental health consequences if not well-managed, humans are largely adaptable, and most of us will adjust, again.

An adjustment disorder is prompted by big life changes

Adjustment disorder is a psychological term to describe symptoms of depression and anxiety prompted by a big life change like a job loss, divorce, or move. Being thrust into — or out of — a lockdown situation fits the bill too, Dr. Mimi Winsberg, a psychiatrist and chief medical officer at the mental health telemedicine service Brightside, told Insider.

"When we started to shelter in place, we were forced to adapt to new routines, and with that came stress and anxiety," she said. "Now, as we return to work with a new landscape and new perceived risks, we are having to adjust all over again."

medical coronavirus flu virus nyc street face mask gloves covid19 stores shut down closed restaurants social distancing delivery cox 141
medical coronavirus flu virus nyc street face mask gloves covid19 stores shut down closed restaurants social distancing delivery cox 141

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People are experiencing "phase two" adjustment disorder, she said, related to multiple areas of their lives, like the prospect or reality of returning to an office or public transportation, putting their kids back in childcare, and expanding their "germ bubbles" to include more friends.

The stress comes both from fears about potentially spreading or contracting the novel coronavirus and worries about what new routines aimed at keeping them safe will look like. (As New York City physical therapist Isa Herrera is questioning: if gathering at a vacation home means taking people's temperatures upon arrival and forbidding hugging, is it even worth it?)

For some, the stress also comes from the prospect of leaving their comfortable bubble and navigating the real world. "I'm upset at the idea of spending money on a dinner with someone I don't like, or working late to meet a deadline that won't matter, or even to be looked at and judged by people again," an anonymous reader wrote to Vice.

The anxiety is exacerbated by the uncertainty of it all: Employers can't say with confidence if or when they'll open and what protocols will be in place when they do; public-health officials can't say when the pandemic will be over or that any activity is risk-free; and family and friends can't agree on what activities are safe enough.

And, unlike the first phase of lockdown, "it's not a 'just stay at home and only leave for necessary activities'" message, Winsberg said. "There'll be more room for interpretation, and with that may come some anxiety and disagreements about how that's interpreted."

Focus on what you can control

Most people who experience phase-two adjustment disorder will, well, adjust, and eventually see their symptoms dull or come to an end.

"Human beings are incredibly adaptive and capable of tectonic shifts in life, as our collective ability to adapt seemingly overnight has proven," Julie L. Pike, a licensed psychologist in Chapel Hill, North Carolina, told Insider.

But, in some cases, feelings of depression and anxiety can persist and worsen. "Adjustment disorder is the tip of the iceberg," said Winsberg, who recommends taking a free online assessment to gauge the severity of your symptoms and connect to professional help if necessary.

Before it gets to that point, though, you can take some ways manage the discomfort around re-entry. First, continue with the practical habits that can help keep you safe: practicing excellent hygiene, wearing a mask when you may come into close, prolong ued contact with others; and staying home if you're sick.

Next, communicate — with your manager about telework options, for example, and your family and friends about their past behaviors and what they're comfortable with going forward.

"It's a little like those conversations that you have when you're first dating somebody and you're trying to negotiate exclusivity," Winsberg said. "You're like, 'OK, we'll hang out together, but how many other people are you hanging out with so I know what I'm exposed to?"

Park Avenue in Winter Park, Florida coronavirus re-opening

Joe Burbank/Orlando Sentinel/Tribune News Service via Getty Images

You may also want to take the discomfort as an opportunity to re-evaluate, and change, some of the activities you're dreading returning to. Maybe you've realized certain friendships are more draining than supportive, or that you don't need to return to the gym because outdoors walks have brought you more joy.

"If you can continue a more sheltered life with less public interaction and you can still accomplish what you need to work-wise and family-wise, it's important for each individual to strike that balance," Winsberg said. Just be careful you're not using the pandemic as a cover for unhealthy, socially isolating behaviors, she added.

Try to take things day by day, and don't think too far into the future

Finally, and importantly, take things day by day, realizing that obsessing over an unknown future "is a drain of our energy, creates a negative space mentally" and is ineffective.

She encourages clients to be aware of their thought processes and to catch themselves when they ruminate about something they have little or no control over.

"Have compassion for yourself that these are difficult times, we are all doing the best we can in a given moment," she says. "Trust that we will adapt as mother nature has programmed us to."

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