For the last three months, around two million people have “shielded” themselves against the novel coronavirus by staying indoors, on recommendation of the UK government. On May 31, however, the guidelines were updated to enable those who are clinically vulnerable to go outdoors if they wish. But they must remain vigilant and won’t be able to visit their loved ones under new plans to ease restrictions by creating “support bubbles”.
It’s not hard to see that spending so long stuck indoors worrying about a potentially fatal infection must be hard to cope with psychologically. The new measures may indeed be a source of further anxiety rather than relief for shielders—particularly when you consider that, of those who have died as a result of COVID-19, 91% had a pre-existing health condition.
Other factors that contribute to psychological harm for this group include coping with cancelled clinics, difficulties accessing medication, reduced exercise and lowered mood. Some perceive they are being stigmatised as a result of being forced to disclose to others that they are clinically vulnerable. Despite this, shielders have been largely neglected in government briefings and news items.
While many clinically vulnerable people ultimately feel safe at home during the pandemic, studies looking at the psychological impact of patient isolation report high levels of fear, loneliness, boredom and anger. This is especially relevant for over 70s, many of whom will already be struggling with social isolation, multiple health problems and compromised mobility. This is concerning, as loneliness is associated with higher mortality rates, particularly in the older population.
So being able to step outdoors should come as good news. The outdoors can offer pleasurable activities to elevate mood, social support and independence. These things could kick-start the virtuous cycle of doing more enjoyable activities that make you feel good, resulting in improved mood and increasing motivation to do more.
But is this enough of an incentive to step outside the safe zone of the home? Many are fearful.
Barriers to the outside
Around half of people with medical conditions already struggle with anxiety and/or depression. So it is very likely that, in the context of a global health threat, those shielding will see further deterioration in their mental health. This can come with a lack of motivation and create a barrier to taking those first steps outside.
For those with underlying health problems, it is vitally important to maintain vigilance, both in terms of precautionary measures and checking physical symptoms. But this can easily become excessive, which can serve to increase anxiety and, in turn, physiological symptoms. This is a vicious cycle that can make people avoid going outdoors.
And when we avoid something due to anxiety, we stop ourselves from finding out what would have happened had we persevered. We didn’t get to see that it would have been ok—strange, overwhelming, but psychologically survivable.
It is important that those who have been shielding keep following advice and safety precautions—do no more, no less. But even though it may feel hard, these people can go out. For most, it is about becoming used to the new experience of being outdoors. Once the first unexpected close encounter is dealt with, things may start to feel easier.
When it doesn’t, it can help to accept and understand your anxiety. Anxiety presents as worries about what might happen next, but also in many physiological ways such as palpitations, shakiness, chest tightening—this is adrenalin and caused by the fear response. Fear is a normal response to an abnormal situation. You can begin to tackle it with coping strategies such as physical exercise, breathing exercises/meditation and challenging unhelpful thoughts.
It is important to keep our thoughts accurate and in perspective, stay in the here and now and treat ourselves with self-compassion when things don’t go as planned.
For the most anxious, a gradual return to the outdoors may be best. A long walk in a busy park on a Saturday morning will undoubtedly lead to a peak in anxiety and may make the outside world feel overwhelming and unsafe. Instead, it may be better to start with a short walk at a time and place where there are fewer people around.
It is also important to appreciate the positive shift that stepping outside brings. This can be used to revisit hobbies and activities that bring pleasure and to engage your social network. A good reason to go out is a vital motivator when anxiety is a driving force to stay in.
Most people with clinical vulnerabilities lived with uncertainty even prior to COVID-19, adapting to changing medical circumstances and responding to health threats. Such people are often highly resilient and armed with a repertoire of adaptive coping strategies.
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