You probably know that wearing masks during the COVID-19 pandemic helps to protect others’ health and your own health. You want to do your part to keep everyone safer, but still feel anxious about the idea of wearing a mask. If you’ve already tried masking and got so anxious or uncomfortable that you thought you could not deal with it, then the information in today’s blog post can help. With a recent resurgence in COVID-19 cases in Nova Scotia, it’s as important as ever now to take action and learn to get comfortable with a mask through small, reasonable steps.
The number 1 way to overcome this kind of anxiety is through exposure. We can do this gradually, and it is a highly effective method. The short explanation is simple: start wearing a mask, even for a few seconds. Keep repeating this, and gradually increase the time until you are wearing a mask for minutes and eventually hours. Believe it or not, your anxiety will decrease, as your brain automatically learns that nothing horrible ends up happening. The feeling of fear and the physical discomfort will slowly fade, and the fear may go away completely. It’s fairly common for anxiety to briefly increase during the beginning of an exposure exercise. Such increases are temporary; anxiety will get weaker and weaker when you engage in more exposure.
Here is a more detailed example outline of how you might accomplish anxiety exposure exercises on your own. This outline starts smaller, with imaginal exposure. If you feel able to move straight into actual exposure in the real world, then you can start at that level.
- Imagine yourself putting on a mask. Start with imagining for a minute.
- Then, move up to two minutes, after a break. Imagine how the material feels on your face, how your skin feels a little warmer than usual, how the air around your mouth and nose may start to feel warmer, how you hear air flowing across and through the mask.
- Look at pictures and videos of other people wearing masks and going about their ordinary business. Spend a few minutes at a time on this.
- Hold a mask lightly against your face, but not as close or snug as you would when wearing one. Start by doing this for 10 seconds, breathing as normally as you can. Keep coming back to this – take 5 minutes and do 10 seconds on, 10 seconds off.
- Repeat the last step, but this time put the mask on normally so that you don’t have to hold it on with your hand.
- Start wearing a mask at home for longer periods of time, when you’re just sitting down and not exerting yourself. The human body does not require an enormous amount of air to keep itself running in fine shape when you’re sitting down. We don’t have to breathe hard to sit down, and after a while, you will probably notice that your body is doing just as well as it does without a mask. Plenty of air will get through. Medical research shows that oxygen saturation levels do not normally decrease at all with the use of cloth masks or procedure masks – your blood gets just as much oxygen as usual.
- Move on to wearing mask while walking around the house, and walking around outside. Start with seconds, move on to minutes, and eventually move on to hours.
- Do some light exercises at home or outside with a mask on (e.g., aerobics, yoga, exercise bike, mixed slow jogging and walking)
- Continue trying a mask in a variety of environments – small rooms, big rooms, outdoors
Masks Allow Enough Air
There are some important things to know about all the masks that have been recommended for reducing the spread of COVID-19 (e.g., valved or non-valved N95 masks, cloth masks, procedure/surgical masks). While the air may seem to move slightly slower through a mask when breathing hard, all approved masks allow us to take in all the air we need to live. At the same time, there are important things you need to understand about anxiety, and how it can trick us into freaking out. When we have worried thoughts, such as “I don’t think I will get enough air”, we start to feel anxious.
Physical Symptoms of Anxiety
With anxious emotions and worried thoughts, it is very common to start having physical symptoms of anxiety. These can include some shortness of breath, faster heart rate, sweating, increased heart rate and discomfort in the stomach area. These physical symptoms of anxiety are essentially harmless. If we believe they are harmful, though, and we think they mean that something is going seriously wrong with our bodies, we might get very scared. By reminding yourself that physical symptoms of anxiety are normal and harmless, you can learn to continue your normal routine without letting anxiety stop you from acting.
Anxiety Decreases with Exposure
If you have worn a mask, and then gotten anxious, you might feel short of breath because you are anxious. However, you may have thought that it was hard to breathe because of the mask. If you feel anxious every time you put a mask on, you probably will notice some unpleasant physical sensations going on, and then you’ll think that the mask is causing them. In reality, the anxiety is probably causing these unpleasant sensations. The good news is that we can’t really stay ultra anxious for a long time; after an hour, it’s extremely unlikely you can keep feeling as anxious as you were in the first 5 minutes. Our minds and bodies kind of get tired of being at maximum alert, and can’t stay freaked out forever. As we continue to be exposed to a feared situation without the feared outcome (e.g., being unable to breathe) happening, our minds and bodies basically unlearn the fear. We learn that we are safe, and we can relax.
I have asthma. Early on in the pandemic, I was a little more easily unsettled when wearing masks. I quickly discovered that I was never in real danger of inadequate air supply, even when running laps. With exposure, I felt more and more mentally calm each day I exercised with a mask on. My lungs and muscles also became stronger with regular exercise, so I was less winded when running, even though exercise can be an asthma trigger for me. When breathing very hard and feeling like I needed to catch my breath, I would sometimes slow down or stop running, but leave the mask on. Focusing on breathing for 5 more seconds at a time, or 10 more feet further on my walk/run at a time, enabled my breathing to gradually stabilize. Then, my mental calm returned. I have relatively mild asthma, and it is well managed. If you have asthma or another breathing condition, please consult with your doctor.
When engaged in normal activity, and sometimes even vigorous exercise, masks are not going to harm you. Individuals with more severe asthma or other respiratory conditions may not be able to wear certain kinds of masks (e.g., some individuals with chronic obstructive pulmonary disease, people with external oxygen delivery devices/other medical equipment that makes a mask physically impracticable). If you are concerned that a respiratory health condition might prevent you from being able to wear a mask normally and safely, please speak to a medical doctor. For a very small percentage of the population, there are medical obstacles. In such cases, these are normally people who would be at a high risk of serious complications from COVID-19, and may have more compromised immune systems. For any medical concerns, a medical doctor or other qualified medical professional can answer your questions about mask use. They will help make sure you have all the information you need!
You Can Do It!
My knowledge of psychological science does not prepare me to guide action on public and individual physical health issues. However, my understanding of the scientific method and how medical researchers use the scientific method gives me great confidence in the vital information we are being provided by medical researchers. Medical researchers and practitioners know what we need to do to prevent transmission of the novel coronavirus. We can work to overcome our anxiety about the unique demands placed on us in this pandemic. It can be hard work. By doing it, we make sure we are able to do our part to protect our neighbours and ourselves. Medical staff are working extraordinarily hard, under difficult conditions, to take care of people in hospitals. Our actions can make it so that more people will stay healthy and not need the hospital. You can help save lives, and that’s a wonderful thing! Let’s all do what we can. Today, you can take some practical steps to begin challenging your mask anxiety – over time, you can win!
If You Need Help
If you or someone you know is struggling with anxiety about mask wearing, or other anxiety during this pandemic, we can help you to get past the roadblocks anxiety is putting in your way. I regularly use cognitive-behavioural therapy (CBT), an evidence-based first line treatment for anxiety, to help clients who are struggling. CBT gives people practical techniques that they can carry with them for the rest of their lives, long after therapy. Learning everyday CBT skills could help you respond to your anxiety and eventually overcome it.
For a more general discussion on anxiety, you may find one of our past posts, understanding anxiety, informative.
Here are some links to information and resources to help cope with difficulties brought on during the pandemic:
Note: this blog post is written from the perspective of psychological science. This blog post does not constitute medical advice. For all medical questions, please consult with your medical doctor. This blog post nevertheless takes into account widely available public health guidelines and recommendations from medical experts, who have clearly stated that mask use is appropriate and safe for the majority of the population.
Barlow, D. H. (2014). Clinical handbook of psychological disorders: A step-by-step treatment manual. Fifth edition. New York: The Guilford Press.
Chan, N. C., Li, K., & Hirsh, J. (2020). Peripheral oxygen saturation in older persons wearing nonmedical face masks in community settings. Journal of the American Medical Association. doi: 10.1001/jama.2020.21905
Kyung, S. Y., Kim, Y., Hwang, H., Park, J. W., & Jeong, S. H. (2020). Risks of N95 face mask use in subjects with COPD. Respiratory Care, 65(5), 658-664.
Ougrin, D. (2011). Efficacy of exposure versus cognitive therapy in anxiety disorders: Systematic review and meta-analysis. BMC Psychiatry, 11. doi:10.1186/1471-244X-11-200
Parker, Z. J., Waller, G., Duhne, P. G. S., & Dawson, J. (2018). The role of exposure in treatment of anxiety disorders: A meta-analysis. International Journal of Psychology & Psychological Therapy, 18(1), 111–141.
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Samannan, R., Holt, G., Calderon-Candelario, R., Mirsaeidi, M., & Campos, M. (2020). Effect of Face Masks on Gas Exchange in Healthy Persons and Patients with COPD. Annals of the American Thoracic Society, (ja). doi: 10.1513/AnnalsATS.202007-812RL