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Tanzina Vega: I'm scared to go back. I just don't know who to trust anymore.

Tanzina Vega: This is The Takeaway, I'm Tanzina Vega. After more than a year of isolation, quarantine, closed businesses and mask-wearing, the United States is starting to open up again. Across the country, Americans are posting vaccine selfies and beginning to think about warm weather and finally being able to visit with friends and family. Grandparents have even been given doctors' orders to hug their grandkids, but under the veneer of joy, there's an unease that many people, myself included, are feeling about a so-called return to normal.

The collective trauma of more than 500,000 Americans dead from the virus isn't something that we can forget so easily. There's also anxiety underpinning questions like, "Am I safe? What kind of filtration system is this building using? How often should I be sanitizing?" And, there are some darker elements of American society that also portend to return to normal. The shootings in Boulder, Colorado, and Atlanta, Georgia, which killed 10 and 8 people respectively, have reminded many Americans of the risks of being in everyday spaces. The thought of eventually returning to a crowded concert hall or riding a packed subway train can cause many folks to feel anxious. Here's what some of you had to say about how your feeling.

Robin: Hi, this is Robin from San Diego. I really enjoyed working from home. I love the fact that I had an amenity and now I will be back in a space where everybody is more watching, and being amongst people, haven't shopped in a grocery store. I've been ordering my groceries. I haven't been anywhere. I haven't seen my daughter in over a year. I haven't really seen friends, and sort of gotten used to it and I feel safe, but I know it's time to venture out. It feels nervous. I feel nervous.

Alison: Hi, my name is Alison and I'm calling from the Seattle area. I would say that, yes, I do have concerns about returning to a normal way of life after COVID. I have a child who has been identified as higher-risk, and I'm just worried that without a children's vaccine, he's just compromised when we go to school or live our life. While my husband and I will be vaccinated, I still have some paranoia, I guess, about him, but I am excited for life to go back to normal as well. It's a complicated situation.

Bruce: Hi, this is Bruce in Lakewood, Washington. We have completed our vaccinations, but we're going to still stay masked. We have anxiety about indoor dining and being in large crowds, especially indoor crowds.

Jane Allen: Hi, Jane Allen from Northern Michigan. Anxieties about returning to normal life? Yes. Living much like Thomas Merton during The Hermitage Years has become quite comfortable. Even the thought of needing to socialize for more than a moment of friendly chat is absolutely terrifying. I've never been good at small talk anyway, and I'm afraid I'll either simply stand gap-mouthed or blather stupidly. I've honestly been happy to be completely alone. Suggestions welcome, and thanks for asking.

Tanzina Vega: Other listeners said they were actually looking forward to a new reality.

Christian Georgiou: Hey, my name is Christian Georgiou from South San Francisco, California, and no, I have no anxieties whatsoever about getting back into society and not wearing a mask and all that when this stuff's all clear. If it's all clear and it's safe and it's good to go, I'm all with it. I'm actually looking forward to be able to flash my handsome face around town again. It's been too long. No anxieties. Looking forward to it. Can't wait.

Tanzina Vega: Joining me now to discuss our collective anxiety about re-entry in a post pandemic world is Dr. Jessica Stern, clinical psychologist and clinical assistant professor of psychiatry at NYU Langone Health. Jessica, welcome back to the show.

Dr. Jessica Stern: Thanks so much for having me.

Tanzina Vega: We heard the last caller there who I now imagine running around at some point around San Francisco with jazz hands, which is awesome, but there are other folks, myself included, who are feeling a little anxious. I know there's a lot of different types of anxiety. Let's talk about easing back into the way things were pre-COVID and what this sense of anxiety actually is.

Dr. Jessica Stern: Yes, definitely. There's a lot of anxiety that's happening in many different forms. I think it's been very confusing for some people to figure out how to re-enter into the world and in a world that's been very, very different for the past year. People have lots of mixed feelings, excitement, fear, worry, all of the different emotions, and that's very, very normal, most definitely.

Tanzina Vega: There's different kinds of anxiety. We knew Americans had anxiety before the pandemic. There have been increases in cases during the pandemic. Isn't that right?

Dr. Jessica Stern: Yes, definitely. Absolutely.

Tanzina Vega: As a professional, are you looking at this and concerned about the people who have developed anxiety during the pandemic and that we are just more anxious now as a country?

Dr. Jessica Stern: Yes. It's tricky because some of the anxieties that have developed throughout COVID have been adaptive, meaning that they've been helpful. What I mean by that is there are some folks who felt very anxious about going out and interacting with people, and in a lot of ways that's been helpful because it's encouraged people to adhere to the safety precautions. What's also happened is that sometimes that's created a sense of difficulty for people to be able to live their lives, and what's happening now is a lot of that anxiety is continuing to linger and just potentially going to hold people back in living their life and figure out what is safe and what isn't safe, and what anxiety is helpful versus what anxiety is unhelpful or is keeping someone stuck.

That's where it gets a little bit tricky and a little bit messy. We're looking very cautiously. We, as professionals, are looking very carefully at what's been helpful for people and what's perhaps an anxiety that can be slowly retired, if you will.

Tanzina Vega: Let's talk about what people should be looking for in terms of identifying anxiety. I feel like it's something we talk a lot about, but really what are the signs that someone is experiencing anxiety?

Dr. Jessica Stern: There are a couple of things we look for. The primary, biggest one is avoidance. This one similar, to what I had just mentioned, is a little bit tricky because there's a certain type of avoidance that can be helpful in terms of safety precautions. However, if someone feels like they're pulling back so much from seeing people or doing activities, whether it's virtually or in-person in a safe way, such that they're not able to live a fulfilled life, that's something we look forward to.

Similarly, if they feel like they pull back so much so that they start to feel really isolated or very, very overwhelmed about what is safe and what isn't safe, that can be something that's an indicator that there might be some anxiety going on as well as not feeling like someone can maybe trust the pieces of information that they're receiving from public health officials and things like that. If someone's receiving guidance and they feel like, "I don't know if I can trust that guidance," that can potentially be an indicator that someone might be feeling a little bit more anxious than they otherwise might need to, or maybe did early on in the pandemic.

Tanzina Vega: There are also other types of anxiety, for example, that we have been largely, because of the pandemic, we've largely been at home. Many of us have had to adapt to that and then going out into public spaces has often been something that we do masked and sometimes wearing gloves and we're very quick to get in and out of supermarkets. We've really adapted, I think, to social distancing and staying six feet away from other people. As those restrictions begin to loosen, so to speak, as more people begin to get vaccinated-- I recall the first time I walked into a café here where I live and saw two people not wearing masks and drinking coffee together, and I was stunned. Is that normal?

Dr. Jessica Stern: Yes, I would definitely agree. I had a similar experience when I walked into a coffee shop for takeout as well. I think what happened, of course, is that over this past year, we got so used to a specific type of living and we got essentially comfortable in it, even if it wasn't something that was enjoyable or something that we wanted, it was something we got used to, and to be in this place now where we're slowly starting to see those standards change again, even if it was what we were used to over a year ago, it feels very odd because we became conditioned to be so safe and to adhere to those safety precautions, especially for those of us who were taking the precautions quite seriously, it seems a little bit odd to be seeing these things changing. I think, for many people, it feels very scary and a little bit uneasy.

Tanzina Vega: How do we work through that? I recall, particularly at the peak, in New York City, of the pandemic, and when I say the peak, I mean last year, around this time in March, when we were still learning about the virus and there were ambulance sirens every day. I live very close to a home for elderly residents that was really the center of a lot of activity and the epicenter of the virus. There's a lot of fear of just doing things like doing laundry and encountering people at the supermarket. How do we start to heal from some of that?

Dr. Jessica Stern: I think the most important thing we need to do is to do this slowly, and what I mean by that is not rush ourselves. I was thinking about this yesterday. I think a helpful way to think about this is almost to approach re-entry kind of like an on-ramp on a highway, but with the speed of an off-ramp. You're going slowly. You're not letting cars behind you feel like you need to be pressured to speed up or to move more quickly than you feel comfortable.

The reason that I think that this is important is because we want to do this in a step-wise manner so that way we can slowly start to test the waters and dip our toes into the cold water that might feel very unnatural. When treating anxiety, and this is true for non-COVID anxiety as well, one of the things we like to do is have people approach things that make them anxious in a slow, progressive manner. Not to throw themselves into quickly, but not to avoid either, and to do little bit by bit.

I think this is going to be especially true for re-entry where people can slowly start to test the waters for themselves, maybe doing a little bit of laundry here, maybe going to the grocery store once in a while, and just slowly build up their stamina to be able to re-enter into daily activities and not to feel rushed or pressured, but to also find little ways to make challenges for themselves that feel consistent with the professional advice that they're hearing out there in the media and from their clinicians and their healthcare providers.

Tanzina Vega: Obviously, the people are going to take this at different paces. Everybody has their own individual risk, I guess, tolerance.

Dr. Jessica Stern: Definitely, and I think a lot of that is going to vary on people's individual lifestyles, as well as the locations that they live in, and a lot of local regulations and standards are going to vary, for sure.

Tanzina Vega: Jessica, I want to play you another call we got from one of our listeners. Someone who's having trouble trusting in the government right now.

Mark: My name is Mark and I'm calling from Sacramento, California. My primary anxiety is that our leadership seems to put short-term economic interests ahead of human lives and listening to the science. I don't trust our leaders to make good decisions to save the maximum number of human life, and it goes for both parties. Newsome, Cuomo, even local leaders, they've been profoundly disappointing in how they followed the request of businesses and lobbyists to designate sectors and businesses as essential. It's putting citizens' lives at risk and undermining the messages about personal risk assessment in any attempts for scientists to communicate. I'm scared to go back. I just don't know who to trust anymore.

Tanzina Vega: What do we do about that type of anxiety?

Dr. Jessica Stern: I think it's really tricky. I think for a lot of reasons, very legitimate reasons people have had such a difficult time figuring out who they can and can't trust, especially because there's been so much mixed information and some fairly disorganized planning in terms of resolving COVID vaccination rollouts and variable precautions in terms of masks or lack thereof. It's been really, really tricky. I think what can be helpful is for people to find perhaps either local leaders or public health officials that have a less of a role in legislature and government.

Maybe local medical centers or things of this nature and to find individuals that you can either listen to through media or that you can actually reach out to for consultation or phone calls or things like that, that you can talk to on a little bit of a more individual level and that feel like they're a little bit more health-aligned. That can potentially be a resource in that way.

Tanzina Vega: We have to talk about the fact that just this week there was a mass shooting in Boulder, Colorado where 10 people were killed at a grocery store. Last week, eight people, including six people of Asian descent, were killed in a mass shooting in Georgia. We, as a country, have an issue, Jessica, as you know, with mass shootings. This is, sadly, endemic to our society. Yet, we've been without one largely during the pandemic. This recent spate of killings, I think, for me, and for some other folks has really peaked the levels of anxiety. It's almost like we forgot that this was something that could happen in public and here we are again. How do we manage this?

Dr. Jessica Stern: Yes, it is positively heartbreaking, just absolutely heartbreaking to see this happen. It's almost like now, in retrospect, we can look back on the pandemic and say that there was this hidden blessing in a terrible time that we didn't even realize almost. Now that things are starting to reopen, we're seeing such horrific violence and heartbreak and lack of safety for people, which is really, really scary. Very, very scary, I think, now that people are starting to gather. It's going to feel a lot scarier and less safe to be in public settings where we have seen such mass-violence towards people.

I think it's going to feel a little bit like a challenge for people to get back out there and start to see what we saw before so much pre-pandemic, in terms of shootings and things of this nature. I think this is one of those places in which really slowly reintegrating back into society is going to be important, and also finding ways that feel reasonable for one's own lifestyle to challenge the fear of going out in public while also understanding what is happening and validating for oneself that there is a legitimate fear out there. It's going to be really tough to see what unfolds in terms of trends and violence of this nature, moving forward in the next couple of months.

Tanzina Vega: Jessica, what do we know about the fact that there's some people who don't want this life to end, who actually say they have been thriving working from home or not dealing with socially anxiety-inducing situations, which could be anything from just talking to people-- I think there are lots of people now who, just in average every day interactions, might feel a little anxious because we're not even supposed to be that close to each other. There are people who said that these restrictions helped them. How do we help them adjust to going back to 'normal'?

Dr. Jessica Stern: Yes. I think you touched on a couple of really important points. I think there are two reasons for why, largely speaking, two thematic reasons for why people feel anxious about going back. One is this safety precautions and feeling anxious about safety. The other one that you just touched on is that there are a lot of people that found that this lifestyle, if you will, has been very conducive to their preferences or their personalities or their levels of comfort.

I have heard from many, many people who either feel socially anxious or are more introverted, or just quite frankly, who prefer a more independent, flexible work schedule that have found that this works really well for them. For a lot of people, too, they've been able to fit out workouts when they couldn't otherwise or cook more home-cooked meals that were healthy or spend more time with their kids in between appointments and things like that. There have been things about this that have actually really worked for people or people have been able to find silver linings.

My biggest tip is to take stock and take inventory of what's been working for you over this past year. Maybe it's a lifestyle health-wise, exercise-wise, the way in which you've been communicating and socializing with others, and as best as possible to hold onto those and to integrate those into your life moving forward. Maybe that means having conversations with people in your life. Maybe it means having conversations with bosses or things like that.

Tanzina Vega: I was going to say, we have to tell people that this is a new parameter for me. I think there's also some anxiety about saying, "I haven't had to see that person in a year," and now it's like, "Do I have to see that person?"

Dr. Jessica Stern: Exactly. I think that we, as a culture, are going to have to talk much more explicitly about what we want and what we don't want and what our boundaries are and what our values are, and to find ways to work through that. It's going to be very, very important for us.

Tanzina Vega: It's going to be a very interesting journey to unfold. Dr. Jessica Stern is a clinical psychologist and clinical assistant professor of psychiatry at NYU Langone Health. Dr. Stern, thank you for joining us.

Dr. Jessica Stern: Thank you so much.

Mark Kaufman: Hi, my name is Mark Kaufman. I'm calling from Silver Lake, Ohio. I'm 73 years old. I've had the Pfizer vaccine. I got my second shot a month ago. I'm very confident that I'm not going to catch COVID or most of the variants. However, I want some definitive information that I can no longer be a virus-spreader. I rely very much on the science and I feel safe. I just want to make sure that I'm going to be safe to others.

Rosa: Hi, this is Rosa from Jersey City, New Jersey. I have some hesitation about going out. I have been keeping as safe as possible for the last year. This past week, I went to one of my local supermarkets and while looking in the refrigerator section for some items, a male came from behind me insisting to get out of the way, so he can go into the refrigerator and get some items. It just doesn't feel comfortable between not wearing a mask and being so aggressive. I feel that in light of the recent occasions of two shootings, and people coming out of this pandemic, it's very difficult. So I'm very concerned, but thank you very much for your expert and enlightening us regarding anxiety and coming back to our regular life.

Larry Daugherty: Hello, my name is Larry Daugherty, and I'm from Zephyrhills, Florida. I'm not really having any kind of anxiety issues. I started an outreach to help people that were affected by the pandemic when everything started. So, I've been in the middle of it since day one. I've been blessed because I'm not in a position where I'm able to get the vaccinations, but I do social distancing and take precautions. When things do get to be a little stressful, I just take off and go for a nice hike for the day or go camping for the weekend, but I am ready for normalcy, whatever that may be.

James: Hello. My name is James and I'm calling from Dover, Ohio. To answer the question, after a year of practicing social distancing, do I have anxieties about life getting back to normal? My answer would have to be no. Here, in rural America, we did not change our lives as much as those living in urban areas did. Actually, the county where the manufacturing facility for the company I work for is located, well, they've hardly done anything differently.

Interestingly enough, they haven't suffered from the pandemic in a greater way than those areas that took more precautions. I traveled throughout the country, and I've noticed this pattern repeated from state to state from rural to urban areas. Many rural areas seem to not change as much of their lifestyle, and urban areas taking more precautions. I've always tried to respect the wishes of those people whom I was in the company of. It's a sad day when anybody dies from any illness. I'm assuming that one day we will look back and we will have answers. At this point in time, I think we are doing a lot of guesswork.

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