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Brian Lehrer: Brian Lehrer on WNYC, and for this membership drive, we'll end each show with a little explainer on how to take care of yourself now that our listening area is slowly emerging from the pandemic. We pick five different topics based on what we've been hearing from you and seeing around the internet. Up first, a closer look at social anxiety and how exposing yourself to certain events gradually may be able to help. Joining me now talk about managing social anxiety as we return to life post-COVID is psychologist, Dr. Ilyse Dobrow DiMarco.

She's the author of Mom Brain: Proven Strategies to Fight the Anxiety, Guilt, and Overwhelming Emotions of Motherhood, and she recently wrote an article in The Washington Post titled Dreading Post-pandemic Crowds and Social Situations? Exposure Therapy Can Help. Welcome back to WNYC, Dr. DiMarco. Hi.

Dr. DiMarco: Thank you so much for having me again.

Brian Lehrer: What's exposure therapy?

Dr. DiMarco: Exposure therapy is a type of therapy that sort of falls under the umbrella of cognitive behavioral therapy, and it is a research-supported type of treatment. Basically, the idea behind exposure is that one of the things that drives anxiety the most for people is avoidance, which makes sense. If you're nervous about something, you try to avoid it, but the problem is when you're avoiding something, whether it be a large crowd or a mall or whatever else, you never learn that you can navigate it effectively, and the anxiety stays alive.

What exposure therapy aims to do is to slowly expose people to the things that they are most fearful of and really to do it in kind of gradual way. This isn't the way it has to be done. Some people advocate, and actually research supports throwing people into the fire, that seems to work too, but generally, with my patients, what seems most palatable is to start small and build.

For example, if you're really nervous about navigating, say, a summer wedding at the end of August, maybe you start practicing slowly exposing yourself to smaller and more intimate outdoor gatherings to kind of build yourself up to get to that wedding. That's kind of the philosophy behind exposure.

Brian Lehrer: Now, a lot of our listeners are just bursting to get out there again and interact, and they may be hearing this and even hearing the setup to this and thinking, "Wait, what? This is a thing?" You write in your Washington Post article about your patients, while they've been outwardly rejoicing about the world reopening, they've been privately panicking. Who's panicking about what?

Dr. DiMarco: Yes, a lot of people are panicking, which is very interesting. Again, I think we all kind of assumed that when we return to life, we would all be thrilled because we've missed this so much, but of course, remember that COVID sanctioned long-term avoidance. If you're someone who pre-COVID tended to get nervous in various social situations, you basically got a free pass, didn't you? For a year plus to not have to face those situations, and all of a sudden, you're being thrown back into them again.

I would say to that, a lot of my patients who didn't actually necessarily have issues with public outings and such before COVID, do now because again, they've avoided for over a year and they're out of practice. [unintelligible 00:03:41] about this in the article and what I've heard a lot about it, as somebody who works in the suburbs of New York City, is people who are dreading their commute again, who said, "It was fine, I would take this crowded train, and it was no problem because I was used to it. I did it every day for God knows how many years. I've not done it in a year and change and now the prospect of being on a crowded train is terrifying."

Again, we're seeing people who would have avoided or wanted to avoid pre-COVID but also people who avoided during COVID and are now worried about getting back to their regular routines in life.

Brian Lehrer: That's not just about the virus might be there on the train. That's about the people who are there on the train?

Dr. DiMarco: Yes, it's about all of it, interestingly, and I've heard about lots of different ways this anxiety is manifesting. For some people, it is the virus. I'll tell you, particularly after the mask mandate was lifted a couple of days ago, I have a lot of patients who are deeply uncomfortable with that. Again, for some people, it's just facing other people in different scenarios, and for some people, it's more of a dread than an anxiety.

I hear a lot about people who say, "Oh Gosh, I was so happy to avoid--" I work with a lot of moms of young kids, and they'll say, "Gosh, I was so thrilled to avoid kids' birthday parties. I hate those things. They're at these huge kitchens, and there's germs everywhere, and oh God, am I dreading having to do those things now." Again, I think it's partly dread around sort of COVID-related exposure, but it's also dread of many other aspects of public life.

Brian Lehrer: How about for kids who might not even be used to being around their own grandparents anymore or anything like that?

Dr. DiMarco: Yes, it's so interesting to see how this is playing out for kids because so much-- I think for teenagers in particular and really little ones in particular, I'm hearing a lot about that because for teenagers, they have really done most of their lives online, this whole past year. Then, some really little ones have been just with their parents 24/7 when they might not have otherwise. I think what that creates for the teens, of course, it creates a feeling of social anxiety of, "Oh my gosh, what's it going to feel like when I'm out and about with a bunch of other kids doing actual real stuff in life?"

Then, I think for the little ones, what my child psychologist friends are telling me, is they're seeing some separation anxiety issues where they're fearful of separating from their parents because they spent so much time with their parents. I've even seen that. I have patients with kids, elementary-school-aged, who are telling me a little bit about that, like, "Well, my kid never had issues leaving me before, and now, they're afraid when I go out to dinner or when I go somewhere, because I haven't gone anywhere in so long."

I think it really manifests in kids as well. As I mentioned in the piece, you can do exposure stuff with kids too. Work with your kids and plan out different gradual exposures that they can do and reassure them that you'll be with them and you'll be supporting them. It's a really good strategy again for kids too to get back out into the world.

Brian Lehrer: I'll close with one line from your article about exposure therapy, which means dipping yourself into the water a little bit at a time, "Your only goal should be to get yourself to and from these experiences, not necessarily to enjoy them."

Dr. DiMarco: Yes.

Brian Lehrer: The medicine that will lead to comfort later on, we hope. We will have to leave it there with Dr. Ilyse Dobrow DiMarco, author of Mom Brain: Proven Strategies to Fight the Anxiety, Guilt, and Overwhelming Emotions of Motherhood. She recently wrote that article in The Washington Post called Dreading Post-pandemic Crowds and Social Situations? Exposure Therapy Can Help. Helpful indeed. Thanks a lot.

Dr. DiMarco: Thanks so much for having me, Brian.

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