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Managing Anxiety About Wearing Masks

By Dr. Jessica Gold, Assistant Professor, Department of Psychiatry, Washington University

WHY DO SOME PEOPLE FEEL ANXIOUS ABOUT WEARING A MASK?

Usually, the problem is that somebody has general day to day anxiety, they have some association with masks, or something has happened to them like maybe they recovered from a long illness where they had to wear a mask, or a family member was really sick and wore one, or they’ve had a trauma where their mouth was covered.  Any one of these could trigger anxiety because when they put on the mask, it reminds them of those sensations of worry or fear. They don’t fear the mask itself, but the feelings associated with wearing one.

HOW COMMON IS MASK ANXIETY RIGHT NOW?

This pandemic is such a new and different situation and we don’t like unknowns because what we don’t know can scare us. For some, avoiding doing something makes it worse. For example, you’re scared of flying so you never fly. You put it off and the anticipation makes you more fearful.

When it comes to wearing a mask, or fears in general, there’s a group that feels anxious just thinking about wearing one and they think they can’t do it. Then there’s a group that has tried wearing one and doesn’t like how it feels. This second group is probably working on overcoming the fear because they know they are supposed to wear one, but it’s still anxiety-provoking.

There are probably more people struggling with this than we talk about it. We don’t talk [enough] about mental health in general. I can easily hear people say, ‘Just put on the mask and deal with it”. But there are things you can do to make it more comfortable.

WHAT CAN SOMEONE DO TO ALLEVIATE THE FEAR OF WEARING A MASK?

The first thing to understand is that our brain is tricking us and when we put a mask over our mouth, it’s normal to feel like we can’t breathe and want to take it off. You have to teach your brain that it’s safe and that you CAN breathe.

For those who have experienced trauma, we do exposure therapy. Start by being in a super safe setting, usually at home, by yourself, or with someone you trust, and just start trying to wear the mask. You may not be able to put it on yet, just hold it in your hand, then hold it up to your face. We often call this an ‘exposure hierarchy’. Now you can give your anxiety a number from 1 to 10, 10 being the most anxious, and 1 the least. Your goal for this first step is to get to a 3. There is still a stress reaction, but you did it, and it was ok. Begin by saying, I am going to wear a mask for 2 seconds, then next time try 20 seconds until you’re at several minutes or however long you need.

Next, change your environment, go outside. Don’t start with a grocery store but a walk to the park or someplace with fewer people, maybe a quick walk. By building yourself up you will realize: 1) You won’t die from wearing a mask or from the anxiety, 2) You can tolerate it, 3) What you are doing is actually quite boring! You build up to a place where you are comfortable.

If you don’t need the building up process and just feel anxious while wearing one, you can try to control the locations and timing you are wearing one. Maybe a busy time at the grocery store makes you anxious so that you breathe heavily, then you feel like you can’t breathe. Try going at a less busy time of day.

It’s also good to remember that masks are not one size fits all. There are different fabrics, different sizes. You might feel more comfortable wearing another kind. Also, by choosing or designing your own mask, you are regaining control, and that in itself can be healing.

WHAT IF YOU MUST WEAR A MASK AT WORK, AND THERE’S NO TIME TO EASE YOURSELF INTO IT?

Acknowledge the Anxiety

Give yourself some grace to say, this is hard, it’s ok that it’s hard, I’m getting used to it, I’m feeling anxious.

Breathe

Practice breathing exercises using something like the Breathe2Relax app can be helpful. This is where you practice diaphragmatic breathing like in yoga. If you get more comfortable controlling your breath, you will breathe less heavily, control your breath, and be able to say, I’m safe, I’m ok. You can practice this home before work, or even at work on a break if you feel worried

Be Mindful

Mindfulness can also be helpful and physically grounding. During an anxious moment at your desk, for example, you can say to yourself, I’m on my chair, my feet are on the floor. You can also start naming things you see around you. Some people like to use apps such as Headspace and Calm, but really this is something you can do on your own anywhere. Quick coping skills for anxious moments. It doesn’t call attention to what you’re doing in the office or at work. You’re just making yourself feel safe in the moment. Learning how to do that on the weekends.

Take Breaks

If possible, incorporate more breaks into your day. This may just be stepping outside, going to the washroom, any place where you can safely take your mask off. Some people might be fine with a mask in the office some not, they may need to go outside during breaks, go to the bathroom and be alone, a place you can go and safely take the mask off. There might be some places where this is ok and incorporate mask breaks into your day.

AS A WORKPLACE MANAGER, HOW CAN YOU SAFELY ADDRESS THIS CHALLENGE WITH YOUR TEAM?

Bosses need to be more flexible about understanding that this is a different work environment and most people didn’t sign up for this. It’s not fair to assume that everyone is going to be fine with wearing a mask. Some vulnerability as a leader is a strength and makes employees feel safer. As a leader, you don’t have to say you have anxiety yourself, but you can say something empathetic or validating. Maybe that’s admitting that you too have struggled with adjusting to x, y, and z, that you understand how hard it may be wearing a mask, and that you’re there to listen. By decreasing the hierarchy, you make other people feel like it’s a normal reaction to be struggling.

You can also point people towards their employee benefits program by reminding them that it’s available to them if they need additional support.

HOW DOES THE ANXIETY ABOUT WEARING MASKS MANIFEST ITSELF IN CHILDREN VERSUS ADULTS?

I think that kids express worry the same way as adults do, they just don’t know the words for expressing it. Kids may seem irritable and scared, but instead of saying that they are afraid, they might cry, act out, or run away. They may fidget and take it off more, and this can look like active rebellion. Kids are not as likely to say,’ I don’t like the feeling’ or ‘I’m worried’.

AS A PARENT, HOW CAN YOU BEST SUPPORT YOUR CHILD WEARING A MASK?

Parents can make it fun and not a punishment because the world is scary. Finding ways to incorporate mask-wearing into a game can be helpful. Have your kid pick out their own mask. There are also a lot of cool designs for kids. You can find Star Wars-themed masks if they like Star Wars or goofy ones with faces. Letting them be creative and fun is important and letting them pick it out gives them ownership.

Another thing to consider is that kids learn a lot from emotional expressions on faces. Practice interpreting of emotions while wearing one: Am I sad, angry, happy?

HOW CAN YOU SUPPORT SOMEONE YOU CARE ABOUT WHO IS EXPERIENCING ANXIETY ABOUT WEARING A MASK?

By validating their feelings and assuring them that they’re not just doing it for no reason or just for themselves. If you invalidate their feelings, it can lead to feelings of shame and guilt.

Most people who have anxiety about it are wearing their mask anyway, but I think it’s important to remember that there are valid reasons why people may be struggling and when we shame people and get angry, we should take a beat. There are reasons why this might be hard for someone so before we get livid [when someone we know or see isn’t wearing a mask], we should remember that some people who are struggling care a lot and often take criticism harshly and they are trying and encouragement would go a long way versus what the hell is wrong with you. Realizing that there may be valid reasons why people worry. Some people are getting excuse notes, which makes no sense.

Anyone can wear a mask with the right work to get there. They just need encouragement, assure them by saying, ‘I know you can do this and I’ll help support you through it’.

Dr. Jessica Gold, MD, MS, is an Assistant Professor in the Department of Psychiatry at Washington University in St Louis School of Medicine, specializing in college mental health, medical education, and physician wellness. She writes regularly for the popular press about mental health, stigma, and medical training.