Tara Herrmann, PhD has a history of asthma and was in the emergency room and hospital numerous times growing up. Before Covid-19, she already struggled with masks as simply wearing one would worsen her anxiety and “put me back in that place.” She said she would have rather have had an asthma attack than wear a mask. But, with Covid-19, she has “just had to deal.” It has not been easy for her, but eventually she found a mask that did not elicit anxiety and wearing one has become easier over time. Given that Dr. Anthony Fauci, the Director of the National Institute for Allergy and Infectious Diseases, and Dr. Robert Redfield, the Director of the Centers for Disease Control and Prevention, highlighted the importance of wearing masks during their testimony before the Senate yesterday, it is only becoming more clear that her ability to learn to wear a mask despite her anxiety may actually save lives.

Yet, Tara is not alone in her discomfort. In fact, feeling anxious about wearing a mask is actually a normal physiologic reaction.

Dr. Jennifer M. Gómez, Assistant Professor in the Department of Psychology and Merrill Palmer Skillman Institute for Child & Family Development (MPSI) at Wayne State University says our bodies detect when we are not getting the resources we need to survive and one of those resources is air. Even though wearing a mask does not put a person in danger of actually suffocating, Dr. Gómez says the mask will tell our body, “Hey! I think there’s something bad here that’s interrupting breathing! Danger is afoot!” Our body will then respond by hyperventilating, becoming anxious, or panicking to alert us that there could be a problem, in this case trouble breathing, to cause us to do something about it. Our reaction is intended to save our lives and is actually what our body is supposed to do. Dr. Gómez notes, however, that the problem lies with the fact that the mask is tricking our body and we aren’t actually in danger of getting less oxygen by wearing a mask. This is only worsened by the fact that we actually can easily remove the mask to breathe in all of the air we want. In other words, Dr. Gómez says, “your body is responding like your fire alarm in your house does when the kitchen gets too smokey but there’s no fire. It’s a false alarm.”

Historically, this reaction to masks was also found in soldiers during World War 2 who experienced gas mask phobia, or a type of claustrophobia that resulted in extreme agitation, hyperventilation, and removal of protective gear in dangerous situations. Even though back then, protective gear was heavy and unwieldy and technology has improved this aspect, this phenomenon still continues to occur today in military theaters where chemical or biological warfare is suspected. This is now considered a “readiness” issue and military personnel train while in protective gear in order to ensure that they will be able to function with it in the field.

Unlike those in the military, civilians are not trained in daily mask wearing and wearing one may be particularly challenging for some at-risk groups who may be easily triggered to have false alarms. This includes people, like Tara, who already have difficulty breathing due to asthma or other conditions like chronic obstructive lung disease, who may have increased anxiety wearing a mask, even if they don’t otherwise have a mental health condition. This might also occur for those who do have a history of anxiety, panic, or trauma. Dr. Gómez says for some people with a history of trauma, like sexual abuse in childhood or domestic violence, wearing a mask may remind them of the trauma. For example, for someone who during a sexual assault was unable to breathe because the perpetrator was covering their mouth and nose, when they put on a mask, it can bring up that same fear and fright, even if they are not consciously thinking about their sexual assault. According to Dr. Gómez, “the body remembers such traumas implicitly. So, again, your body is overreacting because it thinks you’re unsafe and it wants you to do something about it.” Your body is simply protecting you.

Dr. Ginger Nicol, Associate Professor and Child and Adolescent Psychiatrist at Washington University in St. Louis, says that kids with anxiety or those under the age of six could have more trouble wearing masks simply because they need more information to gauge the emotional state of others and it is harder to read emotions when wearing a mask. In fact, Dr. Nicole Nugent, Associate Professor in the Department of Psychiatry and Human Behavior at the Warren Alpert Medical School of Brown University, states she played games with her son to get him used to wearing his mask and to help him get used to seeing others in one. She started by having him first guess if she was happy, sad, or mad with her mask on, and then, she did the same with his emotions in the mask “so he could see it works both ways and that mask wearing was fun.” Mask wearing may also be a challenge for children and adults with neurodevelopmental disorders like autism, Dr. Nicol notes, as they may have sensory processing difficulties that make it hard to tolerate a mask. Additionally, those with ADHD may have more trouble keeping the mask on, and might need more practice, frequent reminders, and more frequent breaks. Whatever the reason for the difficulty, it is important to have grace with yourself and remember, as Dr. Nugent says, “Anything that is new is always uncomfortable at first.”

5 Quick Tips To Getting Comfortable Wearing A Mask:

1) Learn to exercise control over your breathing: Dr. Nicol encourages everyone to practice “mindful, diaphragmatic breathing”– before you even put your mask on. To do this, she says you should try something called 4-7-8 breathing. To do this, you inhale for 4 seconds, hold your breath for 7 seconds, and then exhale for 8 seconds. This will help you to slow down your breathing and also strengthen the muscles in your chest and abdomen to make your breathing more efficient. She suggests that other breath training programs can also help to consolidate these skills, and so can something like a regular yoga practice.

2) Gradual Practice Makes…Tolerable: Dr. Gómez says logic like “I can take off my mask whenever I feel like I can’t breathe” can often help your mind, but will not be able to help your body’s response to anxiety. For that, you need to practice wearing a mask. To do this, she suggests putting your mask on at home when you are not planning to use it that day, so that there is no time pressure. Then, she says to do the following:

  • With the mask on, breathe in, paying special attention to the fact that you can breathe.
  • As your body ramps up its anxious physiological response, tell your body: “It is safe. It’s just a mask. See look, I’m breathing.”
  • Take big, deep, long breaths to show your body that you can breathe. Continue the self-talk: “I have nothing to be ashamed of. My body is responding in the way that it should to keep me alive and well. It’s just confused. So, I’m showing it that I can actually breathe here.”
  • You can also take the mask off, again to show your body that if it does become too much, you can take the mask off and breathe fully. 
  • You can then, put the mask on and breathe again, or, it may be that today, you couldn’t practice that long because your mind and body became so anxious that it was unbearable. That’s okay. You can try again tomorrow. 

For some people, Dr. Gómez says, doing this just once will be enough, but for others, it may take more practice. Dr. Joshua Morganstein, Chair of the the American Psychiatric Association’s Committee on the Psychiatric Dimensions of Disaster, emphasizes that this practice should and can be gradual and at your own pace, like is done with anything distressing (think: airplanes or spiders). He says if 1 minute is too long to wear a mask, you can do it for 10 seconds, and if 10 seconds is too long, then you can do it for 2 seconds. But, you just want to gradually increase your comfort and familiarity with it over time. Dr. Nugent adds that she would recommend initially practicing at home or in a safe setting. The goal would be to habituate or “get to the point where it feels boring and no longer distressing” in that low pressure setting and then, slowly, increase the “intensity”. This might mean you go for a drive wearing your mask or a walk where no one is nearby and continue to exposure yourself to harder and more populated environments. During this time, Dr. Nugent notes, it is important to challenge your thoughts. If you are thinking “I am unable to breathe” then tell yourself, “I did this a hundred times at home – I know I can do this.” That is, of course, because you can!

Dr. Nicol adds that somewhat similarly you can use behavior shaping approaches to increase mask wearing in children with neurodevelopmental disorders. For example, she suggests that you start with just holding the mask and pairing this with a pleasant physical stimulus like a hug. Then, over time, you can gradually increase the mask exposure with longer wearing times and more rewards. This will help encourage kids to keep it on when needed.

3) Control timing and location:

Especially if you are new to wearing a mask, or helping someone else get adjusted to wearing one, Dr. Nicol emphasizes that it is important to take breaks. In other words, when thinking about your day, you need to find areas and times when you can safely be mask-free. Tara adds that she knows her anxiety is worse when she is around more people, so for her work, she has been doing more telehealth, and she has been choosing to go to the grocery store at 6 am. You have to do what works for you.

4) Find the right mask for you: Not every mask works for every one. Tara suggests that you might start off by asking yourself which part of the mask gives you anxiety? Some may be too heavy or thick, or might make you too hot because of the type of cloth used. You may be able to find a mask that is lighter or made for athletes, or a different fit or fabric entirely. Your discomfort may even go beyond just covering the face, and involve how tight it pulls, and again, there are different masks that are designed to do this differently. Tara suggests that you experiment with different styles and fabrics of masks until you find one that you can wear at least somewhat comfortably. She says she had to find one that did not mimic what it felt like when she was having an asthma attack (like a cloth mask) or the fit of an oxygenation mask. For trauma survivors, Dr. Gómez adds it may help to design the mask, to give them control over it, and make sure it is distinct and looks nothing like any of their other clothes. For children, Dr. Nicol feels it is important to find ways to make masks “fun.” She says you can do this by “decorating them, putting them on stuffed animals, or incorporating mask wearing into fun/game-like activities at home can reduce fear and avoidance.” The bottom line is, you control your mask choice and your first mask does not have to be your last mask.

5) Wearing a mask is altruistic: Tara says that before Covid-19 when she did not wear a mask, it was only jeopardizing her own health, and now, it is not just about her. She says “in a way, mentally it’s like suck it up buttercup. This honestly was probably the biggest factor.” If altruism, or doing something for the greater good, can motivate you at all, she says it can help to focus on that thought and how you are helping and protecting others, as you try to push aside the anxiety. Brooke Vittimberga, a bone marrow transplant recipient, adds “I’ve also learned to lower my expectations-I’m not going to be 100% comfortable. It’s okay to trade some comfort for the safety of myself and others.” In other words, no one said wearing a mask was comfortable or even fun, but it can save lives, and that is important.

Mask Shaming Won’t Help: Try Understanding

While it makes sense to be angry with someone for not wearing a mask during a pandemic, Dr. Morganstein does not feel this is effective as it can cause people to retreat into defensiveness and their own corners, instead of connecting and bridging the divides. He also notes that many people have “invisible wounds” and this approach does not help them troubleshoot the process. Perhaps instead, we should consider using validation, and providing good, tangible information about how having anxiety about wearing masks all of the time is real and normal, but you can learn to tolerate it. This argument might actually be much more persuasive.

Pike Place Market sign ″While in Public Wear a Mask″
An artist’s take on Pike Place Market after a statewide facemask order went into effect in Washington.  RUDY_WILLINGHAM

Dr. Gómez adds “being uncomfortable, scared, or triggered is nothing to be ashamed of. All we can ask for from ourselves is to try our best. And you, your safety, and the safety of others is worth your trying and re-trying to teach your body that the mask is safe to wear.” Given that universal mask wearing might be the next step for the country’s fight against Covid-19, it is in all of our best interests if we help each other learn to tolerate and then overcome our anxieties about wearing them.

Source: Forbes

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