More than a year after shelter-in-place orders rolled out across North Texas, life as you knew it pre-COVID may be starting to take shape again. Schools are open for in-person learning, shopping centers and restaurants have no enforced social distancing-related capacity limits anymore, businesses are bringing their workers back into the office, and people are starting to travel again. But what if everything we just listed strikes a pang of anxiety deep within? We’re not talking about the “humph” feeling you may have at the thought of not being able to wear PJ pants while working anymore; we’re talking about a real sense of apprehension and nervousness. It even has its own name: ‘cave syndrome.’

“Cave syndrome is the feeling of unease in integrating back into public spaces after experiencing social isolation,” says Megan Graves, a licensed clinical social worker manager at Texas Health Behavioral Health.

Even though Graves notes that cave syndrome isn’t a medically diagnosable condition, she says its effects can be viewed on a spectrum. Milder cases may include feelings of anxiety while engaging in activities outside of the home, whereas more severe instances can create an inability to leave your home or engage in any form of social interaction.

There are typically two groups most people suffering from cave syndrome tend to fall into. The first are those who have become accustomed to our “new normal” and are hesitant to let go of some of what they see are positives to doing everything from home and limiting our in-person interactions. These people can be both vaccinated or unvaccinated.

The second group usually pertains to fully vaccinated individuals who still have a deep fear of infection or spread despite assurances by health organizations and governing bodies.

While some sense uneasiness is to be expected (think about the apprehension you had just entering a grocery store again for the first time post-lockdown), cave syndrome can have some serious ramifications, especially if it’s jeopardizing your ability to stay employed.

Why We Struggle to Leave the Cave

The fear of the unknown is as old as time. Fear is instinctual; it’s there to protect us and keep us safe. Add in the fact that so much was unknown about the coronavirus early on and staying home definitely felt like a trusted, safe space. You could control what crossed the threshold and your exposures.

“For many, the fear of the unknown related to COVID-19 has triggered anxiety surrounding leaving one’s home,” Graves explains. “Though COVID-19 has brought these symptoms into the spotlight, cave syndrome can develop from any form of prolonged isolation.”

Even though you may be vaccinated and/or plan to wear a mask, social distance, etc., that fear can be hard to let go of if you’re overestimating the risk and probability of contracting the virus.

A recent study by the American Psychological Association reported that 49 percent of surveyed adults anticipated being uncomfortable about returning to in-person interactions; 48 percent of those who have received a COVID vaccine said they felt the same way.

But beyond your perceived risk of getting infected, going back out into the world requires us to pivot back to our more “socially accepted” selves. Once again, you have to worry about what to wear, what you look like, trips you may or may not be taking, office chatter, dinner with old friends, playdates, etc. After a year of putting these things on the backburner, you may be reluctant to bring back them up to full boil on the front burner again.

Getting Used to Getting Back Out There

So what can be done if someone is afraid to go out? Is it a question of needing professional treatment or just a bit more adjustment time? Well, it depends on the level of severity, Graves says.

“Many of us are feeling pressure to resume a ‘normal’ life before we feel comfortable doing so,” she explains. “For those feeling that pressure, having honest conversations about your concerns would be a good place to start.”

Graves adds that getting creative in how you reintegrate could also be helpful.

“For instance, perhaps you start with one day a week back at the office; or going into the pharmacy to pick up your prescription instead of using the drive-thru,” she says.

For more severe cases of cave syndrome, Graves says speaking with a therapist and/or psychiatrist can be a great place to start, especially since many are still offering virtual visits that you can do from the comfort of your home.

Many Employee Health or Employee Assistance Programs also offer guidance for finding mental health assistance, and oftentimes it’s free or provided at a discount.

How to Get Back Out There

One way to prepare yourself for getting back into the world is through gradual exposure, says Graves. The idea is to build your tolerance by adding to the experience each time.

An example of this would be driving to your office and then driving back home. The next time, you can drive to the office and get out of your car before returning home. Then, you can get out of the car and walk to the door of the building before returning home. Continue adding to this activity gradually and you’ll notice your comfort level increases with each step.

“When testing the waters again, if you begin to feel anxious, panicked or overwhelmed at any point, there are few techniques you can try to ground yourself at the moment,” Graves says. “You can try deep breathing (a big breath in through your nose, slow breath out through your mouth), counting backward from 20, washing your hands or face with cold water, or taking a few minutes to practice stretching your body.”

Practicing mindfulness, especially since much of the fear is rooted in a perception of how dangerous it will be out there, can also be a great way to address your fear, and you can even do this from home.

Mindfulness starts with identifying what is bothering you, then focusing on narrowing down what exactly that means for you.

“Integrating controlled breathing techniques with silence and stillness is at the forefront of mindfulness,” Graves explains. “There are several smartphone apps that help with mindfulness, such as Headspace, Calm, The Mindfulness App, and Mindfulness Daily.”

Preparation can also go a long way to help you conquer that fear. Prepare as much as you can the night before your planned outing to reduce stress the day of. This can look like setting out your outfit, packing your bag and filling your car with gas.

Be Patient with Yourself

Think about it — you didn’t just suddenly become OK with being cooped up in the house all day overnight. It was something you gradually had to get used to and you eventually found a routine and a rhythm and a comfortability. Although we all were impacted by the pandemic and global lockdowns, it doesn’t make it any less traumatizing. We collectively had to suddenly change nearly every aspect of our daily lives in order to protect ourselves and others — and naturally many of us developed coping mechanisms and new forms of distress as a result.

If you have to leave the house because of demands from your job or other obligations, Graves suggests practicing some deep breathing or listening to your favorite music or podcast on your way there to get you in a good headspace. While you are there, set aside some time and find a space that allows you a bit of alone time.

“And when you return home, relax! Don’t feel obligated to do chores or tackle additional responsibilities,” she adds. “You’ve done a tremendous amount in conquering your fear!  Allowing your body and mind to rest will help you process the day and all the emotions that came with this accomplishment.”

As you begin to gain assurance and comfortability again, you will gain confidence and be able to move on to new challenges. But if you find that you’re still having an intense fear associated with leaving your home or it doesn’t feel like something you can conquer on your own, reach out to a trusted mental health provider or primary care physician who can help provide you with the necessary tools and resources to get back out there.

But as the Delta variant, a more contagious variant of the original coronavirus strain, continues to spread, and with counties in Texas lifting their threat levels again, the desire to leave the cave may be waning even more and cave syndrome may be hitting a bit harder. If you have no choice but to leave your home, it is still recommended that you take all of the necessary precautions, such as wearing a mask, washing or sanitizing your hands regularly, refrain from touching your face, and social distance — even if you’ve been vaccinated. Although there are instances of “breakthrough” cases among vaccinated individuals, the CDC maintains that getting fully vaccinated is still your best shot at protecting yourself from the virus.