When Sawsan was nine, her teacher told everyone to choose a topic, any topic. They would then take turns to stand up in front of the class and present said topic for at least two minutes. Her heart began to thump, and her mind flooded with horrifying scenarios: what if she got up and fell over on her way to the front of the class? What if she started talking but no words came out and then she vomited? The idea of 30 faces staring at her was intolerable.
"It felt like pure panic," she says from her apartment in Sydney. "So I went home and begged my mum to help me get out of it. Luckily, she did. Things aren't really that much different 20 years later, honestly." The freelance accountant was diagnosed four years ago with social phobia. She's undergoing CBT (cognitive behavioural therapy) with a psychologist, but with the exception of her family and boyfriend, social situations still make her short of breath, dizzy, and tight in the chest. So when coronavirus hit and social isolation measures swiftly followed, it felt like a "pressure valve" was released. "This sounds bad, because people are dying, but it's been a major holiday for my nervous system," she explains. "I wake up now and feel an actual sense of calm. That is huge for me."
Sawsan isn't alone: epidemiological data suggests social anxiety affects about seven percent of the population at any given time. And it's reasonable to assume many sufferers at the severe end of the spectrum will have found solace in the orders to stay home. But what happens when life gradually returns to normal, and the mental health "holiday" is over? As Sawsan puts it, "That's the price I have to pay now … I'm definitely worried I'll be even worse. I am dreading a lot of stuff, like meeting people for work and my boyfriend asking me to try an outing with his friends."
We asked some experts in anxiety what to expect once lockdown ends, and how to mitigate the potential distress of re-entering society.
Prof Caroline Hunt, head of the Clinical Psychology Unit at Sydney University and co-chair of the Mental Wellbeing Working Group "Under current 'stay at home' instructions, there is no pressure for [individuals with severe social anxiety] to confront the places and situations that are threatening to them, and this would provide some relief," confirms Prof Hunt. "But we know from research that if a feared situation is avoided for a period of time, it becomes harder to confront that situation again, and the anticipation that it will cause anxiety becomes stronger."
Prof Hunt recommends making a concerted effort not to use the restrictions as an excuse to avoid the things they fear. "For example, can the individual with social anxiety continue to engage in social activities, or work-related activities that involve interactions with others, through platforms like FaceTime, Skype or Zoom? I would be thinking about activities that could be undertaken that challenge their fears even if this is in a small way."
She stresses the point that even those with little experience of anxiety are feeling increased worry at the moment. For that reason, it's important to give yourself a break, and "aim for some self-compassion".
Dr Nicholas Van Dam, Senior Lecturer at Melbourne School of Psychological Sciences and Deputy Director at Melbourne University's Brain and Mental Health Hub
Dr Van Dam agrees that the end of social distancing may well cause distress for those like Sawsan. But he also emphasises that normality as we knew it will take longer than we think, and will most likely be gradual for all of us, "not just those with social anxiety and agoraphobia for whom a return to 'normal' will potentially lead to extreme exacerbation of their condition."
"After long periods of physical distancing, we likely begin to adapt to a different way of interacting with one another," he explains. "For example over video calls, from a distance, cautiously. It is unreasonable to assume that we will all drop our fear of the potential pathogens that others are potentially carrying and rush to shake their hands or cram in next to them on the tram.
"I do think there is a certain expectation among some that social interaction is and should be enjoyable," Dr Van Dam adds. "Often social withdrawal is perceived by the general public as unusual or maladaptive. You hear prominent authors and scientists say, on a regular basis, that we are 'social animals' with the assumption being that we all thrive under conditions of social interaction. While this is true to some extent, there is variation in how much social interaction we each want. Not all social interaction is enjoyable for everyone."
Leonardo Fontenelle, Professor of Psychology at the Turner Institute for Brain and Mental Health, MONASH University
Social distancing might masquerade symptoms of [social anxiety disorder], says Prof Fontenelle, but it's definitely a "pseudo-improvement". Avoidance might lead to a short-term decrease in anxiety, but we'll be expected to resume face-to-face contact, making it likely that some people with social anxiety disorder will "relapse".
"The best way of improving from an anxiety disorder is through continuous exposure to the stimuli that is pathologically feared," says Prof Fontenelle. "This can be done with the help of a behaviour therapist. Although this situation is new to everyone, including most therapists, and there are still many unanswered questions, therapeutic exposure to these stimuli—either social or not—can also occur through the internet." So continue sessions with your psychologist remotely, if they're not back at the office yet, and talk to them about how else you can accrue "exposure" online. It may soften the blow when it comes to heading back outside.