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Your friend insists you join her at an indoor concert for her birthday. Your sister brings over her sniffling kiddos unannounced. Your coworkers refuse to wear a mask when they step into your cubicle.  

As an immunocompromised patient, you know you need to set boundaries in these scenarios to protect yourself. After all, a bout of COVID-19 or flu could put you in a high-risk situation. 

But it’s easier said than done. Just don’t worry about what people think, you’ve been told. But if you’re a people pleaser, when the moment comes to say no, you may find yourself saying “okay, sure” before you can stop yourself. Then, the guilt and regret sets in. 

“It’s important for immunocompromised patients to learn to set boundaries because it can be a matter of life or death,” says Samoon Ahmad, MD, Clinical Professor of Psychiatry at NYU Grossman School of Medicine. “For those who struggle to draw the line in the sand, it’s important to put the decision in the starkest terms: Are you willing to potentially fall gravely ill just to avoid upsetting someone?” 

If you have trouble setting boundaries, here’s what you need to know to shift your mindset — and keep yourself healthy. 

Recognize What Makes You Prone to People-Pleasing

There may be several reasons you find yourself catering to others’ requests, even if it puts you in harm’s way.  

“People pleasers tend to feel guilty or as though they are disappointing others when they say ‘no’ or set firm boundaries,” says Dr. Ahmad.  

This can take a few different forms: For instance, within a professional setting, you may have a fear of reprisal for not “taking one for the team.” Or within social settings, you might feel that setting boundaries with a friend or family member may hurt your relationships.  

Generally, people who are fearful of abandonment have difficulties setting boundaries, which could be connected to low self-esteem. However, there may also be a number of reasons that, as an immunocompromised person, you don’t want to push back against certain requests. 

“The most common reason is because immunocompromised individuals, especially those who have recently developed a condition, don’t want to seem fragile,” says Dr. Ahmad. “On the one hand, they want to be free to live how they please without constantly thinking about their illness. On the other, they don’t want others to avoid asking them to participate in social or professional events because of a perceived inability to do so.” 

Similarly, you may struggle to set boundaries with others because you don’t want to be defined by limitations.  

In any case, you’re not alone if you’re a people pleaser: In a 2022 poll from YouGov, a market research and data analytics firm, researchers surveyed 1,000 American adults and found that about half (49 percent) would self-identify as people pleasers. Nearly 15 percent said they “definitely would.”  

Women (56 percent) were more likely than men (42 percent) to describe themselves as people pleasers. In fact, 70 percent of women say they often go to great lengths to avoid conflict and 68 percent say they often put other people’s needs first at the expense of their own.  

About half of Americans (52 percent) say they often feel like they can’t say no when someone asks them for something. Women are more likely (55 percent) to experience this than men (49 percent). 

No matter why you find yourself with people-pleasing tendencies, the important thing is that you recognize the habit so that you can reframe your thought processes and pinpoint strategies to better advocate for yourself.  

Get Clear on Your Non-Negotiables

You won’t say no to everything, but you need to determine what is always a no-go for you, based on its risk level. 

“Keep a list of your non-negotiables,” says Kim Gorgens, PhD, Clinical Professor and Director of Continuing Education at the Graduate School of Professional Psychology at the University of Denver. “Once you get clear on that, perhaps you give yourself less of a hard time for offering concessions that aren’t on your ‘hard no’ list.” 

For instance, maybe you know that crowded movie theaters are on your non-negotiable list, but you’re open to inviting one or two friends over for a movie night. What feels comfortable and safe will be unique to you (and you should also consult your doctor, who can help you gauge your risk level based on your immunocompromised status).  

In general, factors that lower or increase the risk of COVID-19 transmission include the following, per the U.S. Centers for Disease Control and Prevention:  

• Length of time: Contact time longer than 15 minutes (say, sitting next to an infected individual at a concert) is more likely to result in transmission than, say, two minutes.
• Coughing or heavy breathing: Activities like coughing, singing, shouting, breathing heavy from exercise increase the risk of transmission.
• Mask status: If both the infected person and another person are masked, the risk is substantially decreased. It’s highest, of course, when nobody is masked.
• Ventilation: Poorly ventilated indoor spaces pose a higher risk than well-ventilated spaces (moderate risk) or being outdoors (lower risk).  

Once you have your list of non-negotiables, you won’t be faced with a decision you have to make on the spot when someone pushes you to do a high-risk activity. Instead, you’ll already have decided that it’s on your non-negotiable list — and it’ll be that much easier to say “no.”  

Practice What You’ll Say

If you find yourself freezing up when it’s time to set boundaries, you need to practice first. It may feel a little goofy practicing a conversation with your houseplants, dog, or even a trusted friend who can provide feedback, but simply stating your boundaries out loud will give you more confidence when it’s time to communicate them to someone else. 

“It really is as simple as feeling like you know what you set out to do and you already practiced a script, so you can do it when you need to,” says Dr. Gorgens. “You might think, ‘That didn’t hurt as much as I thought it would,’ and after that, it’s a little easier each time.”  

Consider who in your life you need to set boundaries with and decide who you’ll start with.  

“You might feel prepared to jump in head-first with your thorniest coworker or family member, or you might need a sloping, gentle approach that builds confidence as you get your script perfected,” says Dr. Gorgens. “I think both approaches lead to the same outcome. If one of those two things make you feel more comfortable, that means that’s the right approach.” 

Practice How You’ll Say It

First, recognize if you’re prone to over-explaining and stop yourself in advance. 

“In our minds, we feel like we need to explain or offer concessions or relinquish control in a way,” says Dr. Gorgens. “But ‘no’ is a complete sentence.” 

Of course, in a real-life setting, you may feel like just saying “no” is a little too abrupt or seems inauthentic based on the relationship you have with the person you’re speaking to. In that case, Dr. Gorgens recommends practicing other types of short phrases, such as “I don’t feel comfortable going to indoor exercise classes. How about we go for a hike together next weekend instead?”  

As you practice, take note of how you speak and the tone of your voice. It’s easy to dilute your message by injecting laughter (known as “laughter padding”) or a questioning tone into your message. 

“This is especially visceral for people who identify as women, who have adapted a social role of having a natural way of discrediting our power and control in the world,” says Dr. Gorgens. “If you’re laughing or you add a lot of levity or you add a question mark after saying ‘no,’ your message gets diluted. This is where practice is so key.” 

When you’re nervous, you tend to rely on habits, which may include laughter padding. But the more you practice, the more prepared you are to avoid that.  

In particular, if you practice with an honest friend, they may give you feedback like, “Hey, that was great, but I noticed that you’re laughing throughout it — which makes me take your boundaries less seriously.”  

Set Boundaries Early On

The most difficult people to set boundaries with in your life will be those you have existing relationships with. The easiest way to set boundaries is to establish them early on within a relationship and to stick to them.  

“Setting new boundaries in existing relationships can be more difficult,” says Dr. Ahmad. “However, when circumstances change — in this case, when an individual comes to realize that they have a condition that makes them immunocompromised and more vulnerable to severe illness — the way in which one behaves needs to change.”  

Regardless of whether you’re speaking with a new friend, romantic partner, coworker, or employer, your boundary-setting will eventually become second nature.   

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Learn more about our FREE COVID-19 Patient Support Program for chronic illness patients and their loved ones.

I remember when I was first diagnosed with rheumatoid arthritis, I desperately wanted to feel the way I felt before I became ill. Free of pain, fatigue, medications, and doctor’s appointments. 

Then the pandemic hit, and now, I crave feeling the way I did before this shit show started in early 2020. Life was a bit easier; I felt better physically and emotionally.  

I’ve been stuck in this COVID funk for what feels like forever. I recognize I am languishing. In these past three years, I have seen my health decline and myself age in almost rapid ways. My body feels different. My mind feels different. My soul feels different.   

Before the pandemic I was flourishing. According to my rheumatologist, I was so close to remission. But then it all changed… 

The Toll of COVID on My Health

Over the last three years, a lot has happened that hasn’t been good for my rheumatoid arthritis or overall health, including surgeries, tests, a cancer scare, a new diagnosis, periods of drawn out illness, and medication changes.  

It’s safe to say that life has thrown a lot of shit at all of us these last three years — and it has had a profound impact on my physical and emotional health and habits.  

• I am lonely and yearn companionship but also want to be left alone 
• I’ve become isolated from friends and family (It’s been over three years now since I’ve seen my dad who lives across the world.)  
• I am angry and bitter 
• I’m exhausted and burnt out 
• I lack motivation 
• I feel numb and empty inside 
• I have become more sedentary 
• I have increased my bad habits 
• I put on weight that I worked so hard to lose  
• I feel disconnected from the world, shut in and forgotten about.  

My medications and my disease make me high-risk for COVID complications, which means to keep myself safe, I’ve had to set boundaries with others. Unfortunately, this has opened my eyes to how some people view the chronically ill. 

• I’ve lost friends because they made fun of me wearing a mask or getting vaccinated.  
• I’ve lost respect for people who’ve shown their worst colors and lack of care for others during the pandemic.  
• I’ve seen medical professionals and treatments that give me a quality of life mocked by people who’ve never needed them.  
• I’ve been told that people get sick and die all the time. It’s not their problem to help keep others safe.  
• I’ve been told I am brainwashed because I asked others to wear a mask or because I believe in modern medicine. 

Finding the Good in COVID

There were also many good changes since the pandemic — things that gave me hope and joy over the last three years. Without them, I probably would have lost it.  

Advocacy

I’m incredibly grateful for advocacy to keep me going and give me something to do in the darkness. Over the last three years, I have definitely become more passionate about advocacy and health research. 

I was also educated others about autoimmune diseases and what a respiratory infection can mean for us. Doing so got me featured on radio, tv, and web throughout the course of the pandemic.  

Virtual Care

Before the pandemic I would have to haul myself into the doctor’s office weekly for some minuscule need. Now I can chat with my doctor while sitting on the beach or in my pjs from home. With telehealth, I can spend less time being a patient and more time doing things I want to or need to do.  

Virtual options in the form of volunteer meetings and conferences have also helped make life easier with RA. I can pace myself, multitask (like exercise during meetings with the camera off, of course), and rewatch sessions or meetings to soak up all the information.  

Fewer Infections

I went 2.5 years — the longest period of my life — without having a respiratory infection. Though COVID finally caught up with me when I took my son to a soccer game. The mom guilt of not doing much for my child was gnawing at me and I was given free tickets.   

Mental Health Support

I changed my antidepressant because I felt the one I was using at the beginning of the pandemic wasn’t working for me. It has helped — my anxiety has decreased and I’m sleeping better — but it’s not a total solution for the emotions I’ve been going through lately. But switching medications wasn’t the only thing I did, I also reached out to my clinical social worker to talk about some of the uncomfortable emotions I was experiencing.   

Joy in a Quieter Life

A lot of what I did before the pandemic I can’t really do anymore — either because my favorite hang outs went out of business or became too costly or posed a potential risk to me. And I’ve made peace with that, finding a new joy in a quieter life.  

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Even as we’ve learned how to manage COVID-19 in the last few years with vaccines, boosters, and antiviral treatments like Paxlovid, researchers are still exploring the somewhat mysterious effects of long COVID — and its link to mental health.

Nearly eight percent of adults in the United States have long COVID symptoms. These are symptoms that last three or more months after first contracting the virus and are symptoms patients didn’t have before COVID-19, per the U.S. Centers for Disease Control and Prevention.

Your chances of developing long COVID may be associated with your psychological state, according to new research. In a September 2022 study published in JAMA Psychiatry, researchers analyzed 3,193 participants who had reported COVID-19 infection and found that depression, anxiety, perceived stress, loneliness, and worry about COVID-19 were associated with a 1.3- to 1.5-fold increased risk of self-reported post–COVID-19 conditions.

These factors were also associated with an increased risk of daily life impairment related to post-COVID symptoms.

The associations were still significant even after researchers adjusted for health-related factors. What’s more, researchers found a dose-dependent association: Participants who experienced high levels of two or more types of distress had a nearly 50 percent higher risk of post-COVID-19 conditions than those who did not experience a high level of distress.

Keep in mind that these results shouldn’t be misinterpreted to mean long COVID symptoms are psychosomatic, or caused by a mental factor. The researchers say that’s because of four key things:

1. Among respondents who developed post-COVID-19 conditions, more than 40 percent had no distress at baseline.
2. Symptoms of post-COVID-19 conditions differ substantially from symptoms of mental health (although fatigue and brain fog may occur with depression, other symptoms like smell and taste problems, shortness of breath and difficulty breathing, and cough are not common mental illness symptoms).
3. More than 50 percent of patients with post-COVID-19 conditions report relapses triggered by physical activity (on the other hand, physical activity actually prevents relapse of mental illness).
4. Results were similar when excluding participants who reported only psychiatric, cognitive, or neurological symptoms.

Inflammation and immune dysregulation may be the link between psychological distress and post-COVID-19 symptoms, according to the study researchers. Distress is associated with chronic systemic inflammation, which can result in the production of pro-inflammatory cytokines over time. This may cause respiratory, neurological, cardiovascular, muscular, and gastrointestinal long-haul COVID-19 symptoms.

Factors like autoantibodies, chronic immunosuppression caused by stress, and hypometabolism in the brain’s frontal lobe and cerebellum (which is associated with major depression and has also been implicated in post-COVID-19 fatigue) may also play a role.

“Other studies have found that people with long COVID have higher levels of inflammatory biomarkers or the presence of autoimmune antibodies,” says Siwen Wang, MD, lead author of the study. “Some people with depression or anxiety also have increased levels of inflammatory biomarkers and autoimmune antibodies, so these overlapping mechanisms might explain the main hypothesis we have linking psychological distress and long COVID.”

The researchers used data from three large ongoing study populations: the Nurses’ Health Study II, Nurses’ Health Study 3, and the Growing Up Today Study. They followed up with participants with surveys between April 2020 and November 2021. Limitations of this study include that the study population was predominantly white and female and had a significant proportion of healthcare workers (limiting generalizability).

Further research is needed to determine whether interventions that reduce distress can help prevent or treat post-COVID-19 conditions. This might include typical interventions such as anti-depression or anti-anxiety medications, therapy, and regular follow-ups, says Dr. Wang.

What Research Says About Long COVID and Mental Health

Long COVID has been linked to conditions such as depression, anxiety, insomnia, and brain fog in other studies as well.

For instance, one study published in The Lancet Public Health found that COVID-19 survivors who were bedridden for more than a week had a 61 percent higher risk for depression and 43 percent higher risk of anxiety than uninfected participants throughout the study period.

Meanwhile, a 2021 study published in Cardiovascular Diabetology suggests that long COVID is primarily caused by microclots that starve cells of oxygen. These microclots form around trapped inflammatory markers, which can lead to inflammation in the brain. Some experts believe this could explain the pathology of long COVID and associated issues like anxiety.

Sleep disturbances are also estimated to affect up to 50 to 75 percent of COVID-19 patients, per a 2021 review in the Journal of Personalized Medicine. Meanwhile, brain fog — the feeling of slow or sluggish thinking — occurs in an estimated 22 to 32 percent of patients who recover from COVID-19, per Harvard Medical School.

“Based on the available data and the patients with whom I’ve worked, the biggest mental health challenge for individuals, particularly those suffering from long COVID, has been the brain fog and mental fatigue,” says Samoon Ahmad, MD, clinical professor of psychiatry at NYU Grossman School of Medicine. “These symptoms can be crippling. Patients who are dealing with these challenges tend to feel overwhelmed and depressed, which only adds to the overall psychological burden of dealing with long COVID, as well as contributing to inflammation.”

In a study in the journal Nature, researchers looked at brain changes in 785 participants ages 51-81 whose brains were scanned twice (including 401 people who contracted COVID-19 between their two scans). They found evidence that COVID-19 can reduce gray matter in regions that control emotion and memory, causing the brain to shrink.

What’s more, a January 2022 study published in Brain Communications suggests that some people might not even realize they have problems with memory and attention after recovering from a mild case of COVID-19. In this study, performance on attention and memory tasks were poorer in participants who had COVID-19 compared to those that didn’t. However, these effects seemed to improve within six to nine months.

“Being in a distressed state — whether it’s due to anxiety, depression, loneliness, or just an extreme amount of stress — can lead to persistent inflammation throughout the body and in the brain and lead to improper digestion, disrupted sleep, higher levels of stress hormones, and imbalances in proteins known as cytokines, which are key players in our immune system,” says Dr. Ahmad.

This stress-induced, pro-inflammatory state can also lead to a dysfunctional immune system, which can make you more susceptible to long-term symptoms of respiratory tract infections like COVID-19 or even the flu, adds Dr. Ahmad.

Maintaining a Good Baseline of Mental Health

The experts we spoke to agree that, theoretically speaking, tending to your psychological health and practicing good mental hygiene could potentially lower your risk of developing long COVID. Taking steps to reduce stress means making healthy lifestyle choices, even if they may not seem closely connected to mental health. Just one example: Eating a well-balanced diet.

“Avoiding a diet composed of highly refined and processed foods and instead choosing fruits, vegetables, lean meats, and whole grains will help reduce inflammation — and there is evidence indicating that such a diet can reduce anxiety and depression, as well,” says Dr. Ahmad.

Other ways to reduce stress include getting restful sleep, exercising, and avoiding loneliness by being in the company of friends and family, adds Dr. Ahmad.

Loneliness is a major contributor to poor mental health. In fact, patients who struggle the most with their mental health after COVID-19 tend to be those who rarely leave home, says Serenity Serseción, PhD, a licensed psychologist based in Sunnyvale, Calif.

“Any way that people can go outside and interact with others in a safe way is best,” says Dr. Serseción. “The people who stay at home 24/7 tend to be more depressed and have lower energy. They’re not getting vitamin D from going outside and they tend to be more isolated.”

You can still be part of your community without putting yourself at risk for COVID-19. If you don’t feel comfortable gathering with others, start by chatting with friends on a video call, attending a drive-in movie (and staying in your car), or simply talking on the phone during a walk outside in your backyard or an uncrowded park.

“For some reason, just the act of not going outside seems to lead people to not reach out to others, even when they can use tools for interacting online or on the phone,” says Dr. Serseción.

There are also several popular apps that can help you keep your mental health at a healthy baseline. The UCSF Weill Institute for Neurosciences recommends the following apps:

• Headspace (meditation and mindfulness)
• Healthy Minds Program App (meditation and mindfulness)
• Meru Health (coping with anxiety and depression; healthcare provider referral needed)
• Sanvello (coping with anxiety and depression)
• CBT-i Coach (coping with insomnia)

“I think the experiences of the last two years have really driven home the point that you can’t separate the mind from the body when you’re treating a patient, because the two are constantly influencing each other in profound ways and have a reciprocal relationship,” says Dr. Ahmad.

What This Means for You

The link between mental health and long COVID is particularly important if you’re immunocompromised, because you may be more susceptible to severe COVID-19 and long COVID.

“If someone is in good mental health and taking care of themselves mentally and physically, even if they have a chronic health issue, they don’t tend to have as poor of a prognosis as someone who isn’t doing those things,” says Dr. Sercesión.

Of course, if you’re high-risk for severe COVID-19, the past few years have likely been particularly challenging for you. It may feel like everyone is “returning to normal,” while you continue to take every mitigation effort you can to avoid contracting COVID-19 — even if it means declining holiday parties or family gatherings.

You may be told to “just think positive!” or find yourself in a cyclone of negative thoughts. Neither is helpful: The key is to keep your mindset neutral.

“Even in mental health, thinking positively usually is not the solution,” says Dr. Serseción. “It’s best to think in a neutral way. Toxic positivity can be as harmful as being overly negative, so think about things realistically and have balanced thoughts.”

For example, you might think: “If I go outside, I might have a negative run-in with someone — but I also might not.” Keep in mind that staying balanced may involve spending more time with people who support you and spending less time with those who spread negativity or toxic positivity.

And, importantly, trust in yourself and the symptoms you’re experiencing. Just like with an underlying condition, even invisible symptoms of long COVID are very much real. “I think that sometimes people think, ‘Maybe I’m imagining all of this, maybe it’s not real,’” says Serseción. “But they are having real symptoms. There are things they can do to improve it, but not if they deny that something’s happening.”

The key takeaway: Keep in touch with your doctor about your symptoms, work to keep your mental health at a good baseline, and know that you deserve to address the symptoms you’re experiencing. 

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My client Clara was having a difficult time. She told me she is feeling overwhelmed by the rapidly changing guidelines about how to stay safe from COVID, and especially the shifting requirements about masking. 

“I feel like everywhere I go no one is wearing a mask, and they look at me as if I’m a freak.” She continued: “Everyone is over this — and I can’t be. I am so tired of it.” 

I empathized. It is a stressful and confusing time, and people with immunocompromised systems continue to be at risk. That makes it not just confusing, but frightening. 

I asked Clara what wearing a mask meant to her. “It means I’m different — I’m not like everyone else — and now it’s like I’m waving a flag that makes me stand out even more.” 

Ah yes — this seems to be the heart of it. So many of my clients already feel “different,” or not like everyone else. They are watching what they eat or drink, they are taking medications that have side effects, and they don’t always have the energy their friends and family have to go out. In so many ways, they already feel “not like everyone else” — and here comes a big visible symbol of that. 

“Clara,” I asked: ”How important is it for you to stay healthy?” She looked at me as if I was crazy. “It’s my life,” she answered. “You know that.” 

“Yes, I do,” I replied. “And I know you have made a lot of sacrifices and important decisions to help yourself be as strong and empowered as you can be.” 

“Yes,” she agreed.  

“In fact,” I continued, “I’ve seen you be a bad ass about a parking space, and take on your doctor when you felt she was patronizing you.” She nodded. “So I’m wondering — where did that attitude of my way or the highway go when you wear a mask.” 

Clara was quiet for a few minutes. “I don’t know,” she reflected. 

“I don’t think anyone can shame you if you are feeling that empowered self,” I said. “I know you can’t have that attitude all the time — but it is your life, your body, and you are going to do everything you can to protect yourself. It can be hard to feel so vulnerable or different, but I know you — and I know your strength.” 

Clara nodded. 

It wasn’t the end of our session, and it wasn’t the end of Clara’s journey with her illness and pain, but it was a place of shifting her attitude. She remembered her hard-won wisdom that in her life it was “me first” no matter how anyone else looked at it.  

She has a right to be safe and take exquisite care of herself, and wearing a mask is a part of that — even if no one else knows why she’s doing it. Clara realized her attitude made a difference in how she experienced her masking. She found herself smiling at others wearing masks, realizing she didn’t know their back story either. 

It is a frightening and stressful time — and wearing a mask is only a part of all the issues that are a constant fact of life with chronic illness. Note what helps you to de-stress and makes it easier on yourself. Continue to make the practice of caring for your body, mind, and spirit your number-one goal — no matter what kind of static you get.  

You are worth it. 

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Throughout the pandemic and now, you may have seen a bevy of articles or social media posts written about lessons learned from the past few years — whether it was something trivial like how to make bread or a more meaningful takeaways (like how to care for the safety of loved ones). 

It’s a common habit we humans have: Creating a narrative around a global pandemic that has caused so much distress helps us make sense of it.  

“The way that we find purpose in experiences, and especially hard experiences, is to spin a narrative and believe that there’s a lesson,” says Kim Gorgens, PhD, Clinical Professor and Director of Continuing Education at the Graduate School of Professional Psychology at the University of Denver. “That meaning-making piece of human experience is where there’s so much richness. The trap is, interestingly, assuming that everyone takes away a lesson or you’re supposed to.” 

For members of our  immunocompromised community, the past few years may have been a time of extreme anxiety and isolation — and perhaps you feel like you don’t have a lesson that you learned from that.  We talked to immunocompromised individuals about their experiences and their thoughts on this topic, and here’s what they had to say.   

We already knew some of the lessons

Up until the pandemic, the general population gave little thought to wearing masks. Suddenly, millions of people had to quickly learn terms like “social distancing,” “quarantine,” and even “immunocompromised” — things they may have heard before, but perhaps didn’t truly understand.  

“I remember wearing a mask on an airplane as I was going to a conference in December 2019, and I had people looking at me like, ‘What is wrong with him?’” says Jed Finley, who was diagnosed with ankylosing spondylitis as a tween and is part of the COVID-19 Patient Leadership Council. 

As guidelines shifted, many realized that even if they were immunocompetent themselves, they needed to make adjustments for those more vulnerable in their communities. And if they were considerate and responsible, they hopefully did so.  

“It brought up a topic that I think we all had concerns about, but it really put it on the front pages,” says Finley. “It took a worldwide pandemic to open the eyes of the rest of society.”

In fact, many of the things that were proposed were “things transplant patients are told all the time,” says Roxanne Watson, a heart transplant recipient who is also part of the council. “After I got my heart, I wore a mask for about six months — every day, everywhere. That wasn’t unnatural to me, but it was weird to see everyone doing it during the pandemic.”  

Once the surprise of seeing so much of the general population masking up and taking precautions set in, though, Watson says she was grateful for the lessons learned about hygiene on a broader scale.  

“The best thing is just the sanitary part, people became more sensitized to sanitary habits,” says Watson. “It’s always good to have the general public learn more.” 

Of course, for immunocompetent individuals, this shed light on the millions of people across the country (and even more around the world) who have weakened immune systems.  

Experts estimated that nearly 3 percent of Americans meet a strict definition of having a weakened immune system, per a 2016 research letter from the journal JAMA. However, many more with underlying conditions could be affected if they contract COVID-19, per the Kaiser Family Foundation.   

We hope some lessons aren’t unlearned

“One value that the pandemic has granted to the larger population is that they understand better what the experiences of persons with any manner of chronic illnesses or immunocompromised circumstances experience on a daily basis,” says Dr. Gorgens. 

The immunocompromised community has long been privy to the necessities of looking out for themselves, coping with loneliness when self-isolating, and creating boundaries when it’s in their best interest.  

While we can hope that the pandemic has forever opened many people’s eyes to the importance of protecting those most vulnerable in our communities, it’s easy for some to resort to old ways.  

“For a little while, we were all in this together,” says Finley. “Shortly after that, many people said, ‘Okay, we’re good.’ It was kind of like they were only concerned about themselves — but when it came to people who were still at high risk of getting sick, it didn’t really matter anymore.”  

At Finley’s school where he works as a teacher, he and one other teacher are still wearing masks. (Schools across the United States have now dropped mask mandates, except for public schools in Hawaii at the time of publication.)  

“One student asked me, ‘Why are you still wearing a mask?’” says Finley. “When I said I don’t want to spread germs and I don’t want to breathe in other people’s germs, he said, ‘You’re going to get sick whether you wear a mask or not.’” 

Meanwhile, Watson hopes basic hygiene lessons that have been picked up during the pandemic won’t be forgotten just because certain mandates have been dropped.  

 “I don’t want people to turn around so quickly,” says Watson. “I can see them not wanting the masks and all that, but I think we should stay vigilant on sanitary things we’ve learned along the way — the handwashing, especially — and not go, because the mandates are over, everything is over. Everything is not over.” 

Of course, one of the most important lessons many have learned throughout the pandemic is how effective vaccines can be in warding off severe disease, which Watson hopes will stick.  

“People need to continue to vaccinate,” says Waston. “I’ll be getting my fourth shot, my second booster, soon.”   

Some lessons are small, others matter most

Learning how to, say, best organize the pantry during isolation may not be the most meaningful of lessons. But for those who did walk away from the pandemic with a better understanding of what it means to protect their neighbors, essential workers, and loved ones, they will have gotten at least a glimpse into an immunocompromised person’s life.  

“Some of it is trite, but some of it really is heartfelt and relatively wise, written by people outside of the immunocompromised community, about things that the immunocompromised know to be their truth every day,” says Dr. Gorgens.  

As for other lessons learned? Finley says he did find out what steps were most important to take to protect himself from COVID-19, as we all did throughout the pandemic. At the beginning of the pandemic, he wiped down groceries and showered immediately upon returning home — and later realized it wasn’t all necessary.  

However, he doesn’t believe there was a larger takeaway or enlightening moment for him.  “It was an educational moment, but in the end, I don’t feel like there was much of a lesson that was learned,” says Finley.  

And that’s perfectly okay.  

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Although much of the general public may feel like “normal life” is back after the pandemic — as mask mandates have been lifted, work-from-home employees return to offices, and many resume their pre-pandemic ways — things aren’t so cut and dried for the immunocompromised.  

If you have an underlying condition that puts you at higher risk of severe COVID-19, following shifting public health guidance may have been a particular challenge for you and your families during the pandemic, especially since this guidance is often different for the immunocompromised than it is for the general population.  

“Because public health guidelines for immunocompromised people may change when the more general guidelines do not, immunocompromised people may be getting different information from their families, their friends, or even their health care providers on how to stay safe than they get from professional organizations or regulatory bodies,” says Beth Wallace, MD, MSc, a rheumatologist at University of Michigan Health, Michigan Medicine. 

If you’re immunocompromised, this may make you feel a number of ways: anxious, lonely, stigmatized, or singled out, to name a few. However, this is the time to rely on others in the immunocompromised community for support. While you may feel alone, you’re certainly not — and there are many others experiencing the same things you are.  

“As many people are becoming more relaxed, obviously immunocompromised patients don’t have that luxury,” says clinical rheumatologist Magdalena Cadet, MD, Associate Attending Physician at NYU Langone Health in New York City. “It’s important that these individuals still reach out to each other to provide that social and emotional support.”  

5 Ways to Support Each Other During COVID

Here are five ways rheumatologists and psychologists say the immunocompromised community can support each other during this stage of the pandemic.

1. Join a forum to express your concerns and feeling

Of course, it can feel extremely isolating if you’re the only one who still seems to be concerned about COVID-19.  

“If you are already part of a community in which you are used to being marginalized in general, it just feels like again you’re being excluded,” says Melissa Matos, PhD, a licensed clinical psychologist at Re-Active PT and Wellness, a rehabilitation and physical therapy clinic in Long Beach, California. “I think that has been a salient experience for people who are immunocompromised and living with chronic health conditions throughout the pandemic.” 

At the beginning of the pandemic, your employers, friends and family, and others may have been very willing to set up accommodations to help you live safely (like offering remote work and requiring masks at events). You may have also felt more comfortable going grocery shopping or running other errands when universal masking was required.  

“Now that many peoples’ perception of COVID is changing, these accommodations are going away, and some things that immunocompromised people used to feel safe doing no longer feel safe to them,” says Dr. Wallace. “This is affecting people’s quality of life, not just because they’re changing how they interact with others, but in many cases because they feel like society — and in many cases, their family, friends, employers, and so on — are moving on without them and they’re being ‘left behind.’”  

One way to address this is by opening up to other immunocompromised patients, even if it’s virtually via an online support group or forum like the Global Healthy Living Foundation’s free COVID-19 support program for chronic disease patients and their families.  You can follow CreakyJoints on social media — Facebook, Instagram, Twitter, Tik Tok, YouTube — to connect with other patients who are seeking community for living with arthritis and other chronic illness.  

“Whatever you are feeling in a given moment, you are absolutely valid and entitled to feeling those emotions coming up,” says Dr. Matos. “One of the feelings that many immunocompromised people have talked about is not only feeling excluded, but also a bit jealous of those who can resume normal activities.”  

 Other immunocompromised patients may be able to offer tips and advice based on how they’re navigating this new phase of the pandemic. But even if they don’t, having someone to listen and validate your feelings can make all the difference. 

“By being available to connect and say, ‘That happened to me, you’re not alone,’ you’re sharing your experiences,” says Dr. Matos. “I think there’s something really powerful about feeling validated and normalized, and feeling validated by someone else who understands your experience — like others who are immunocompromised.” 

 It can make a big difference: In fact, according to a November 2020 study of individuals undergoing social isolation and social distancing published in the journal Psychiatry Research, the risk for elevated levels of depression symptoms was 63 percent lower in those who reported higher levels of social support compared to those with low perceived social support. 

 2. Take mitigation efforts together

Your level of risk depends on your unique circumstances, but if your doctor has suggested that you continue to take mitigation efforts like wearing a mask in public, it’s easy to feel singled out. 

 You may even get questioned by strangers for your decision to wear a mask (while this should be rare and we hope it never happens to you, here’s how to handle pushback for wearing a mask in public). However, you may feel less singled out if you have an immunocompromised friend or family member who will join you in masking up for outings. 

 If you need to continue wearing a mask to manage your risk of COVID-19, you’re certainly not alone. The U.S. Centers for Disease Control and Prevention (CDC) recommends talking to your health care provider about precautions like wearing masks indoors in public if you are immunocompromised or at high risk for severe illness when COVID-19 levels in your community are medium or high. Many doctors and specialists are still recommending that certain patients continue to wear face coverings.  

 “At this point in the pandemic, I think masking is still important for those vulnerable to developing severe complications from COVID infection,” says Dr. Wallace. “However, local and federal mandates can be very helpful in helping immunocompromised people, their families, and their providers determine more precisely what the risk level is in their community, so they can decide what precautions make sense for them.” 

 There’s power and support in numbers: Find someone who also wants or needs to continue masking and protect yourselves together. You may even be able to get your immunocompetent friends and family on board if you ask them to wear a mask with you.  

“I think there’s this worry about being the only person wearing a mask, and that can feel very anxiety-provoking, especially if you have an experience of being marginalized,” says Dr. Matos. “If you can, wear a mask with other people — even if they’re not immunocompromised.” 

 3. Learn from each other

 Knowledge is power, and the most powerful thing immunocompromised people can do for each other is share what they know about local available preventive drugs and therapeutic treatments for the immunocompromised (for instance, monoclonal antibody drugs like Evusheld and antiviral treatments), where to find protective N95 masks, and when new booster shots can be administered for the immunocompromised.  

 “There’s strong and increasing data that our current vaccines prevent COVID-related death and severe illness, including in the immunocompromised population,” says Dr. Wallace. “It’s hard right now to predict the degree to which other treatments, like monoclonal antibodies and antivirals, will affect the COVID landscape for immunocompromised people, but they’re definitely providing hope that some degree of normalcy will be possible in the not-so-distant future.”  

 First, however, you need to know how to access these preventive measures and therapeutic treatments — and picking the brains of other immunocompromised in your community can be a great way to do so. Join local Facebook groups or other support groups to learn from those in your town or region. And of course, be sure to also consult your doctor and trusted websites like the CDC and the American College of Rheumatology.  

“Right now, we know there are therapies available for patients who get COVID-19, so I think it is important for these patients to go to the CDC website and the American College of Rheumatology website — and they can discuss among themselves the options that are out there,” says Dr. Cadet.  

 4. Stay active together

Fitting in physical activity is paramount, especially if you’re living with a rheumatic disease or type of inflammatory arthritis. Although it may feel too risky to go to the gym (where others are working out unmasked), you may find it helpful to join in workouts with other immunocompromised individuals in a setting that feels safe.  

“There are still a lot of online classes being offered by gyms or personal trainers, so I think getting everyone together and participating as an online class is definitely do-able and safe,” says Dr. Cadet. “We’re also entering the spring and summer months, so taking a walk is always a great thing to do together.” 

You can also do your strength training together over Zoom calls or, if you’re able to afford it, hire a personal trainer to come and train a very small group of friends outdoors (or indoors if they’re wearing masks). 

“Again, if you do that, keep the group small and limited to those who are vaccinated and boosted,” says Dr. Cadet.  

If you feel like you became less active during the pandemic due to restrictions, you’re not alone. In a study presented at ACR Convergence 2021, the annual meeting of the American College of Rheumatology, over half of surveyed participants (55.5 percent) — who were adult patients with rheumatic and musculoskeletal diseases in an academic health care system in North Carolina — reported that they engaged in less physical activity since the start of the pandemic.  

Physical activity isn’t just beneficial for conditions like rheumatoid arthritis and psoriatic arthritis. Overall, it also makes your immune system function better, it helps your body respond to viruses more quickly and optimally, and can also help your body respond efficiently to vaccines, per UW Medicine.  

5. Join virtual activities

Don’t forget to engage in your favorite activities and hobbies, whether it’s cooking or crocheting. Doing so in a group — in a safe, virtual setting — can help boost your mood and connect you with others who may not be ready to meet up in person yet.  

“There are still a lot of people doing virtual activities,” says Dr. Matos. “If you’re still able to engage in mutual interests or activities where you can maintain safety standards that feel comfortable to you, that’s something that would be very helpful.”  

If you feel safe, that may also involve meeting with one or two others in person with mitigation efforts in place — like staying outdoors or wearing masks.  

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Join the Global Healthy Living Foundation’s free COVID-19 Support Program for chronic illness patients and their families. We will be providing updated information, community support, and other resources tailored specifically to your health and safety.

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Will this ever end? That is the lament I’m hearing often from my clients now (as well as from my friends). We are TIRED. We are tired of the coronavirus, tired of the confusing messages about how to live with it, and — most of all — tired of the toll all of this continues to takes on our health and happiness.

How do we navigate a time that has no clear sign posts, and where we continue to feel endangered?

This is particularly true for my clients who have compromised immune systems or live with chronic conditions like pain. Because of their health issues, they’ve already made untold adjustments — both large and micro shifts — to live their lives with a reasonable degree of balance and sanity. The pandemic has undone that delicate balancing act for many of them.

There are no easy or quick fixes, and you already know that. Most of what I share with my clients you also already know. But we are back to basics as we dedicate ourselves to building up our mental and physical energy reserves that have been so depleted.

Coping with High Anxiety

The number one concern I hear is “my anxiety is up again.”

Yes, and no wonder. Anxiety is the signal for “I don’t feel safe” or “I’m not going to be safe.” That feeling gets coupled with the unpredictability that is all around us: from Omicron to our work requirements to how we feel every day. If I can’t count on any external stability, I will feel anxious about how to locate or ground myself.

Slow down

So back to the basics. Start with breathing. If you are able, do some gentle walking that allows you to notice the world. Slow down in whatever way works best for you. In that slowing down, noticing the ways you are okay in this moment. Be present to what is — and remind yourself that you are handling this.

This doesn’t “fix” anything, but it restores some of your capacity to deal with what is. It reduces anxiety by bringing your parasympathetic nervous system back on line from the “fight or flight or freeze” state where many of us hang out a lot of the time.

Limit your information intake

From that state of more expansiveness in our bodies and minds, my second recommendation is to listen for what you (and you alone) need. The overwhelm of information, misinformation, and conflicting information about how to protect ourselves and stay well is de-stabalizing.

A recent study done at Rutgers University found that conflicting health information not only causes confusion, but backlash toward the information itself.

“This suggests that conflicting health information can not only tire us out and dull our responses but may also impact our behavior, potentially putting us off from following advice about our health,” according to Emily Reynolds, writing about the research findings for the British Psychological Society.

Pay attention to what YOU need to feel well and safe. Listen to your own wisdom about what’s right for you, even if others disagree. The reality we are waking up to is that this is all so new and fast-moving that no one has the best expert advice.

Your job is to pay attention to what works for you, your body, and your sense of safety. Spend less time Googling and researching what others are saying. I am not suggesting that you ignore common-sense advice, and advice that has clearly been studied and researched.

We don’t know enough about Omicron (or any other new variant) to declare it “not a big deal.” We don’t know enough about what will happen as it gets warmer. We don’t really know the interactions between this virus and other kinds of inflammatory disease, or immunocompromised systems. As usual, that research will be later in coming. So pay attention to your own best practices, and the advice of your doctors and trusted sources. Help yourself not be any more overwhelmed.

Give yourself compassion

Finally, be kind to yourself. No one is at their best. This has been happening to everyone, and all of us are tired and frayed. Allow yourself to forgive yourself for any ways you have not been your best self — give yourself some compassion. Living through a pandemic, and taking care of life requirements like bills and meals and clean clothes, as well as managing the significant health challenge of your disease is an remarkable accomplishment.

I know you may find this hard to believe, because you are so used to coping, and this is just one more gigantic burden you are coping with, as you always do. But this — juggling everything you already are while living through COVID — isn’t just “one more thing.” It’s been a world-disrupting rift in life as usual. It has bankrupted mental health reserves, and here you are. Getting up, doing your work, reading a blog, holding on to some hope and sanity. Give yourself a hug or a pat on the back. Be kind.  We are joining hands and hearts to get through this. And gentleness and compassion ease the way.

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Over the course of the past year, it felt at times like the COVID-19 pandemic was being thwarted by one source of hope after another — more people were getting fully vaccinated, additional treatment options were becoming available, and there were periods in which cases receded.

While we’re still certainly not back to square one of the pandemic (after all, we have a major preventive measure now: vaccines), it can still feel devastatingly discouraging when news emerges of increases in COVID-19 infections or hospitalizations. For some people, this can lead to a draining sense of hopelessness. When will things finally get back to some degree of “normal?” Will they ever?

These feelings may be even more exacerbated if you’re immunocompromised or high-risk for severe COVID-19. Many people have been living in fear for more than three years of getting sick with or dying from COVID. They have been strictly following safety precautions, staying home, limiting travel and social gatherings, and feeling the mental toll of isolation.

However, there are key things psychologists say you can do to cope with more distressing news about COVID-19 — and reason for hope — more than three years into the pandemic.

Accept worry and stress

The pandemic has been raging for over three years. At this point, it can be tempting to try your best to ignore new bouts of worry or stress as they creep up. However, that may only make matters worse.

“Own the uncertainty, unease, fear, and anxiety around not knowing the future,” says Kim Gorgens, PhD, Clinical Professor and Director of Continuing Education at the Graduate School of Professional Psychology at the University of Denver. “Be really vigilant to identify that and acknowledge it as part of the experience.”

Research shows that suppressing emotions can have a myriad of negative health effects. In fact, a 2013 study in the Journal of Psychosomatic Research found that emotion suppression may raise risk for earlier death, including death from cancer and cardiovascular disease.

Also, know that you’re not alone in feeling the way that you do. In a recent survey conducted by The Harris Poll on behalf of the American Psychological Association, 63 percent of respondents agreed that uncertainty about the next few months causes them stress. Meanwhile, about half (49 percent) reported that the pandemic has made planning for the future feel impossible.

“I think it is a very reasonable and expected position to be in,” says Jonathan Wong, PsyD, a psychologist at Keck Medicine of USC. “You’re allowed to be worried, first and foremost. If we can extend that understanding, acceptance, and self-compassion, I think that lowers some of the stress and pressure we put on ourselves.”

That said, accepting your fears and showing yourself self-compassion is different from sinking into negativity or adapting a “worst-case scenario” mindset.

“Be wary of things like cynicism — this is where your peer network and family can be really helpful to call you out on that stuff,” says Dr. Gorgens. “You’ve got to have each other’s backs, find your allies, and use them to your advantage.”

Stay connected to family and friends

Fostering your relationships with loved ones continues to be more important than ever. If this was top of your mind when the pandemic began (say, you established Sunday Zoom dinners), but your efforts slowly faded away over the months, reevaluate how you can connect with those in your circle.

Even if you’re being cautious about spending time with others in person, continue to seek out creative ways to meet virtually or chat over the phone.

“Going through uncertainty by yourself is physiologically and psychologically different than if you’re able to do that with someone else,” says Dr. Wong. “There is a real benefit to staying connected to family and friends during this time of uncertainty in whatever way you can.”

Here are a few ways you can continue to connect with your loved ones (even if you can’t or decide not to meet in person):

• Watch a movie together virtually (watch parties on many streaming services make this easy!)
• Make it a goal to call a family member or friend when you go outside for a walk
• Use social media to reconnect with someone you’ve lost touch with
• Take a live online class to learn more about a hobby you’re interested in, such as coffee barista classes, drawing, baking, or learning a new language
• Join an online workout class
• Connect with the CreakyJoints community on social media (check out virtual events like Global Healthy Lifestyle Events too)

Be mindful of your news consumption

If the daily news cycle is giving you added anxiety or stress, the cumulative effects of it may outweigh the benefits of being informed. When you find yourself doomscrolling — the act of taking in a flood of bad news by continuously scrolling through social media or browsing the web — give yourself a gut-check about why you keep reading.

“You might think, ‘Well, if I’m informed, then somehow I can control the situation,’” says Dr. Wong. “I think to a certain extent, that’s a very helpful way to look at things, but if you are clear on other activities that you can do to help you feel in control, then you can move on to those instead.”

For instance, you might make a list of items you can do in the next day or week (having a clear timeline is helpful, says Dr. Wong) to stay safe from COVID-19. These might include:

• Wearing a mask in public and social distancing
• Skipping the movies and catching up with friends via Zoom instead
• Getting your vaccines

Keep things in context: With many media outlets, the news is designed to catch your attention. If you find your go-to news source flaunts flashy, alarmist headlines, bookmark one to two trusted sources of information you can check on a regular basis instead — like the World Health Organization or the U.S. Centers for Disease Control and Prevention.

“Remember that scary, flashy, alarmist news sells commercials,” says Dr. Gorgens. “It’s designed to rattle us, so be really thoughtful about where you’re consuming news from.”

Make time for a hobby that distracts you

Self-care doesn’t necessarily have to be bubble baths and clay face masks. Try to do something you enjoy every day, even if it’s only for 15 minutes.

“Look for an activity that makes you lose track of time, where you’re not worried about what’s going to happen next or what you want to add to that experience,” says Dr. Wong. “That’s a self-care activity and it can be really helpful.”

When people have a hobby, they have a more positive (and less negative) mood, less stress, and lower heart rate than when they’re not engaged with a hobby, per a 2015 study of 115 participants in the Annals of Behavioral Medicine.

Reconnecting with your favorite hobbies may also help you connect with those who share your passions. Join a club — whether virtually or in person (if you’re fully vaccinated and feel comfortable doing so) — and let the activity take your mind off the worries and stress of pandemic news.

Find 3 good things per day

You may already be familiar with the practice of writing down things you’re grateful for every day. Dr. Wong recommends expanding that: Every day, write down three good things, then post your list in a visible place in your home and share it with a loved one.

“That provides a combination of shifting perspective, making it feel like it’s accessible, and then sharing that with somebody else,” says Dr. Wong. “Gratitude can be part of this, but sometimes it can be hard to pinpoint how you’re benefiting from something. When we think about three good things, it could pertain to you or to somebody else.”

Consider what you’ve learned from managing your health conditions

If you’re immunocompromised or high-risk for severe COVID-19, you certainly have additional stressors during the pandemic. But because of your history, you also have a toolkit of coping mechanisms that you can employ during this time — and inspire others to use.

“Our population has the unique experience of having faced these kinds of long-term, consecutive disappointments,” says Dr. Gorgens. “In some ways, it doesn’t necessarily make it easier to cope with, but it’s more familiar to our people. There are unique lessons that our population can share with the rest of the world.”

Whether it’s setting boundaries to protect yourself, maintaining a routine that’s tailored to your needs, or looking for the little things that bring you joy each day, leveraging those tools right now is more important than ever.

And finally, keep this in mind: There is still plenty of reason for hope. Consider how we’ve gained access to multiple vaccines to fight COVID-19 and treatments like antiviral pills. As time goes on, we’ll learn even more about how to prevent and treat this disease in the most vulnerable — and the general population.

“There is a reassurance in the application of science to modern problems,” says Dr. Gorgens. “There’s a way that the lightning speed of science offers a tremendous amount of hope.”

Get Mental Health Support

We understand how difficult it can be to cope during these uncertain times, especially when you are living with chronic illness. It is important to talk to someone who can help. You should contact your primary care physician or your insurance provider to learn about the supportive resources that are available to you. Here are other mental health resources for your reference:

• To find local support groups and services, you can call 1-800-950-NAMI (6264) or email info@nami.org. The National Alliance on Mental Illness HelpLine can be reached Monday through Friday, 10 AM to 6 PM ET.
• For a counselor or therapist in your area, view the resources page at Mental Health America: Finding Therapy.
• If your mental health concern is an emergency for you or someone else, call 911.
• If you are having suicidal thoughts or have or are thinking of hurting yourself, you should call the National Suicide Prevention Lifeline’s 24-hour toll-free crisis hotline, 1-800-273-TALK (8255).

Learn more about our FREE COVID-19 Patient Support Program for chronic illness patients and their loved ones.

Many people, including several of my clients, have been feeling some sort of way over the past year. They are struggling to feel energized and concentrate on the day-to-day. They aren’t joyful or enthusiastic about anything.

It’s not depression, per se. It’s not quite burnout. It’s something that they just can’t describe.

But University of Pennsylvania psychologist and TED Talk speaker Adam Grant, PhD, has been able to define it. Recently, Dr. Grant published a piece in the New York Times  that accurately describes what so many people have been feeling during the pandemic: languishing.

Languish, as Dr. Grant writes, is “a sense of stagnation and emptiness. It feels as if you’re muddling through your days, looking at your life through a foggy windshield.”

When I described this to my clients, many exclaimed “Oh yes! That’s it!”

And it makes sense; naming a feeling helps normalize it and brings the vague unease into focus. It has also helped them to take their first step out of the fog.

But where does that first step lead to? People want to “fix this.” They want to “heal.” They want to “move on,” as so many patients have told me.

What they really want, in my opinion, is to stop being so stuck.

I don’t believe we can push ourselves out of languishing. It doesn’t work to threaten yourself with “shoulds.” As in, “I should go see this person since I’m fully vaccinated” or “I should want to go out to dinner on the weekends, since I always did before.”

Pushing yourself out of this newfound comfort zone is not a kind practice and it is ineffective in the long run.

But I have seen clients nudge — rather than push — themselves toward some energy and some lightness. The key is to pay attention to where you feel little sparks, and lean into that.

One client has been feeling indifferent about meals. She misses eating out with friends and, in what Dr. Grant defines as “revenge behavior,” she has become bored and resistant to any kind of eating. But one day last week, she made a cheese sandwich, taking care to put on ingredients that she enjoys, and ate outside while she soaked up the sun. She reported to me she felt a strange sensation — a little bit of happiness and contentment.

When you notice those moments of happiness, build on them. Stop, notice, and savor the feeling — contentment, happiness, joy, love, affection, warmth, or whatever it may be. And then look for the next moment.

It will be a process. After all, we didn’t start to languish overnight. It took a few months of neglect and sadness and loss to shut down our hearts and our bodies.

So it makes sense that moving on from that emotional state will also take some time. But you can start by identifying how you feel, and then discover — and — receive some small enjoyments.

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Join the Global Healthy Living Foundation’s free COVID-19 Support Program for chronic illness patients and their families. We will be providing updated information, community support, and other resources tailored specifically to your health and safety. Join now.

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Last March, we were dropped into a time of challenge and chaos. No one knew what was coming next, or how long the uncertainty would last. But, as human beings do, we adapted.

In many ways, we slowed down. We carved out time for meaningful calls and Zooms with loved ones and took long, masked walks outside. In other ways, we sped up, moving forward with projects we’d put off for years or starting the next chapter sooner than expected. Our expectations around work and social situations took a new shape to fit in with the new times.

Now we’re in another new phase — the transition between what became the norm during the pandemic and what will be the norm as we slowly return to some version of pre-pandemic life. And although people may be excited about some aspects of resuming life as it was before March 2020 (and anxious about others), it’s important to acknowledge that times of transition can be more challenging than what came before or what will come next.

The reason: They require more effort. We don’t just “endure” transition like we do an unexpected, forced change. Rather, we are required to make choices to manage the transition and come out well on the other side of it.

For some of my clients, the return of social events and the possibility of seeing people in person are forcing them to make choices, often by asking tough questions. What feels safe? What seems like the highest priority? How does one choose between the array of possibilities, tempered by the worry that it’s really not that safe?

For one client — let’s call her Sue — the lockdown was a relief in many ways. With stay-at-home orders in place, she no longer had to explain that she was too tired to go out or didn’t feel well enough to visit her mother. The expectations were eliminated, and so were her choices. But as society transitions back to pre-pandemic normalcy and expectations return, she feels conflicted over how to spend her time and limited energy.

Another client, “Joe,” also enjoyed having a restricted calendar over the past year. He didn’t feel obligated to socialize. Now with the doors opening to the world, he feels overwhelmed and exhausted by the choices. Psychologists describe this as “cognitive overload,” a mental state that occurs when you have to process too much information at a given time.

But as strenuous as transition periods may be, they also provide us with the opportunity to rethink our priorities.

There is no rule saying you have to go back to the way things were. You can make choices that serve your new priorities and new way of life. Doing so requires and courage and honesty — with yourself and others — but it can be done.

Take Sue. She wanted to prioritize rest and relaxation, and made a change to do so. She told her family that she was looking forward to an in-person visit. But rather than going every week as she had before the pandemic, she would only be going once a month.

Similarly, Joe too wanted less “running around” — as he termed it — and “decided not to get pulled back into all the groups” he had been a part of before the pandemic.

In addition to courage and honesty, making these changes requires kindness and reflection. You have to stop and reflect on the past year. From there, you have to decide what parts of your pre-pandemic life you want to jump back into, and which ones you want to alter.

If you’re feeling anxious about this transition back into “normalcy,” try to think about it as an opportunity to restructure your life into a shape that fits who you are now. Not automatically to pick up former obligations and routines, but to carefully choose how you want to spend your time and energy; to observe what gives your life meaning and how to make those experiences a priority.

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