living your life, despite covid

Recently, I have been thinking a lot about how to help my patients make decisions about "living their lives" as the COVID pandemic drags on into its third year.  This has been most relevant to me when working with anxious patients in their 20s/early 30s - patients who under different circumstances would be exploring career choices, dating, seeing friends, and pursuing varied interests.

While I have encouraged safety throughout the pandemic, always referring back to the most current scientific guidelines, I have wondered if some patients with anxiety have been using  COVID as an avoidance strategy.  Even when case rates were quite low, these patients were avoiding social interactions completely, not pursuing interests or hobbies outside of the home, and putting off making important decisions about their careers.  Not surprisingly, social anxiety seems to be the factor driving this avoidance.  

We are left with an interesting dialectic - COVID is still very much a threat requiring vigilance AND in order to move past social anxiety (and live a life of meaning and value), we must put ourselves into the exact situations that the COVID rules says we should avoid.  How can we hold both of these truths at the same time?  Here are some thoughts:

-Engage in "COVID-safe" exposures - For people with social anxiety, there are definitely exposures that can be accomplished while still being very safe with respect to COVID.  Here are some Ideas:

• Organize regular FaceTime/Zoom cocktails or coffee with friends
• Join an interest group (like a book or film club) or philanthropy that is still meeting on Zoom
• Take a class on Zoom (exercise, academic, etc) that offers some opportunity for social interaction
• Attend weekly religious services on Zoom (again, bonus if there is a casual meet-up before or after or a weekly Bible/Torah study discussion group)
• Meet up with friends or go on dates outdoors when COVID rates and weather allow
• Go on job interviews (virtual or in-person with masks).

-Perform a cost/benefit analysis - As parents, we have been performing cost-benefit analyses non-stop for the past two years.  The potential benefit of attending school has outweighed the risk of getting COVID (particularly since our district has always had a mask mandate and since the vast majority of kids in our community are vaccinated).  The potential benefit of playing an outdoor sport has seemed worth it, while playing an indoor sport with close contact seemed too risky.  A mostly outdoor summer holiday within driving distance happened - flying to a more exciting vacation locale has not.  To be honest, it gets exhausting to engage in these mental gymnastics but it is worthwhile.  Some questions that can help:

• is this a once in a lifetime event (like a family wedding) or something that will come around again (a regular night out with friends in the city where you live)
• is the passage of time a factor?  For example, if you desire a partner and family, putting off dating for several years might not make sense.  Similarly, if you are thinking about embarking on a long training program for a career you have dreamt about, putting off your education for several years might also not make sense.  
• how does this decision affect your mental health?  Some people are more comfortable and content being alone than others.  If loneliness triggers sadness/depression for you, seeing friends and dating might be important be worth the risk.  

-Engage in some healthy social comparison:  It is so hard to make decisions during the pandemic due to all the uncertainty associated with it.  There are no sure-fire ways to completely avoid getting COVID and there are also no ways to predict the future and see how the choices we are making today impact our lives in the future.  It can be helpful to take a look at what trusted friends are doing - friends who have a similar attitude about COVID, who might be of similar age and health status (for example, what are my friends doing who are double-vaxxed, boosted, and follow CDC guidelines for mask wearing and social distancing?).  Am I doing more than them, behaving in around the same way as them, or doing much less than them?  If the answer is the latter - it might be worth considering the impact your anxiety might be having - anxiety about COVID and/or anxiety about social interactions.  Gradual exposure can be used to test out your beliefs in both domains.  For example, plan several coffee dates with friends at a place with outdoor seating or distanced seating.  After each interaction, check out if your anxiety about getting COVID goes down AND if your social anxiety goes down - both should!