What doctors wish patients knew about dusting off social rust

For month after month after month, the COVID-19 pandemic has kept hundreds of millions in the U.S. stuck at home and away from large crowds and extended face-to-face interactions. Now, despite the rapid and alarming spread of the SARS-CoV-2 Delta variant, many now-vaccinated Americans are returning to in-person schooling, larger gatherings and more.

Yet a lot of people are also experiencing anxiety about returning to social situations because what used to come so naturally doesn’t feel like second-nature anymore. It may feel as though their social skills are rusty.

Like the term coronasomnia, “social rust” has become part of our vocabulary during the pandemic. Also known as social anxiety, social rust is natural after dealing with the uncertainty of the COVID-19 pandemic. That’s because the activities so many were used to doing, such as attending a social gathering or sharing a meal, may feel awkward or anxiety inducing.

Two AMA members took the time to discuss what patients need to know about brushing off that social rust. They are:

• Alёna A. Balasanova, MD, director of addiction psychiatry education and co-director of the addiction psychiatry consultation-liaison service at the University of Nebraska Medical Center.
• Frank Clark, MD, an adult psychiatrist in Greenville, South Carolina and an American Psychiatric Association delegate to the AMA Section Council on Psychiatry. He is also a former member of the AMA Minority Affairs Section Governing Council.

“We have been distanced, now we’re trying to reintegrate and we’re kind of rusty—we’re not used to it,” explained Dr. Balasanova. “We’re not used to going out and doing things with friends anymore because we haven’t in so long.”

“For some people, they’ve just been raring to go and can’t wait, while for other people, they have grown comfortable with the status quo, comfortable with working via Zoom and working from home,” she said, noting that “going back to the office or into social settings can be really stressful, particularly with masking—if you still want to mask and maybe others around you are not masking, that can be really anxiety-provoking too.

“Sometimes folks feel this pressure to have to unmask to be like everybody else to which I would say you absolutely don’t have to do that,” said Dr. Balasanova.

“The body does not forget. Think about it as muscle memory for social skills,” Dr. Clark explained, noting that it all “depends on the comfort level of the individual,” but that using “a SMART Goal approach” might help.

One key step is “setting a boundary that works for you and your family,” he said. “Be mindful that the expectations you may have for socialization might be different from others based on their comfort level.”

For example, “individuals may be less likely to want to congregate in large settings if they have a loved one at home who is immunocompromised,” said Dr. Clark.

“You should do what makes you comfortable based on your health and well-being,” Dr. Balasanova said. “What you can say to somebody is that I'm not comfortable unmasking yet, so I'm going to keep my mask on and just very plainly state that.”

In July, the Centers for Disease Control and Prevention (CDC) recommended that Americans—even those who are fully immunized—wear masks in indoor public spaces if they live in areas with high or substantial rates of virus transmission. Learn more about why the CDC is again turning to masks to help stop COVID-19.

As people head back to work or school, “there will likely be a new normal. Some may choose to wear masks. Some may not be comfortable hugging or shaking hands,” Dr. Clark said, noting that “things may feel awkward the first time you attend a gathering after months of isolation.”

But it “will be important to acknowledge our feelings and have self-compassion,” he said.

Discover why depression and anxiety are prevalent during COVID-19.

“If you're not comfortable going to a big group gathering that you're invited to, you can say, ‘Hey, I'm going to sit this one out. I'm not quite comfortable going to a large group quite yet. Maybe we can do something one-on-one next month,’” explained Dr. Balasanova. Then offer an alternative that you are comfortable with.

“And maybe you're not comfortable with one-on-one either, so offer something else like a Zoom party—we all know how to do those very well,” she added.

Throughout it all, “it is essential to practice self-care everyday regardless of whether pandemics or other storms in life come our way,” said Dr. Clark, adding that “we owe it to ourselves to live our best life.”

Try to “set boundaries that are tailor made for you and your family” and “don’t allow others to shame you for setting boundaries that provide you with a sense of peace and comfort,” he explained. “If you want to only attend gatherings that are outside, then it is OK to tell a friend that you do not want to attend an indoor gathering.”

At the end of the day, “respect yourself and respect others who may have different boundaries than you,” Dr. Clark said.

“We are human beings who are imperfect and seeking growth in our lives,” said Dr. Clark, noting that “it is OK to say that today is not a good day for me.

“Be true to who you are that day as it relates to your feelings,” he added. “Be honest and don’t be afraid to be vulnerable with the people who are a part of your sanctuary or circle of trust.”

“The other thing is giving yourself permission to be wherever you are at on that journey,” said Dr. Balasanova. “That’s really important because we are social creatures by habit as humans and we yearn to be with the pack. We want to do what everybody else is doing.

“And I think giving yourself permission to say that it’s OK that I'm not doing that yet because I'm going to do me and I'm going to focus on my health and my well-being,” she added. “What ends up happening is we get a tug of war there too because we want to do what the pack is doing.”

“Yet another part of us is really afraid to do that because of our health and so then we're fighting with ourselves. Then that leads to a lot of anxiety and stress,” said Dr. Balasanova. “If we give ourselves permission to be OK—wherever we are at—that can really lift a burden off our shoulders.”

Discover what doctors wish patients knew about post-COVID anxiety.

While many people are heading back to the office—whether full-time, part-time or hybrid—it is important to “be mindful of your bandwidth and emotional currency,” said Dr. Clark. “It is healthy to take a break from work and play catch up with friends and family.”

That is why it is important to “be intentional and schedule a catch-up date,” he said. “Put it on the calendar. Make it a priority.”

There are also many people who started working from home at a new job during the pandemic. As a result, they have never been into the office.

That is when it “could be beneficial to have a champion help support employees as they transition into an environment that can evoke a multitude of emotions including fear and worry,” said Dr. Clark, adding that a champion in the office can even benefit those who have been to the office before.

“If the anxiety has become debilitating to the point where it is impacting a person’s overall functioning, then seeking a mental health professional could be beneficial,” said Dr. Clark. “Anxiety is on a continuum and there are a multitude of ways to address it.”

Some ways include “therapy, exercise such as yoga, medications, therapy and medications, and meditation,” he said, emphasizing that it is “not a one size fits all.”

“Whether it's for social anxiety, mental health or alcohol use and substance use stigma, the general public has negative associations with those things and flipping that on its head is really important to me,” said Dr. Balasanova. “These are universal things. You are not alone because there are a million people right now feeling these exact same things and help is available.

“Help is multimodal. It meets you where you're at. It is individualized and so whatever you need is going to be different from what somebody else needs or your neighbor needs,” she added. “We no longer use a cookie cutter approach.”

Read about what doctors wish patients knew about pandemic fatigue.

With the notion that social skills have laid dormant for a while, Dr. Clark put together a haiku to keep in mind: “Social rust laments / Physical touch wants to thrive / COVID needs to die.”

“Be patient and find the silver linings during each gathering you have whether it be large or small,” said Dr. Clark.

The AMA has developed a COVID-19 resource center as well as a physician’s guide to COVID-19 to give doctors a comprehensive place to find the latest resources and updates from the CDC and the World Health Organization.