Anxiety, panic attacks & the connection with wearing a mask.
Now that the mask mandates are changing once again, we are entering a new phase of understanding the limits and needs of the population who suffer from visible, but most importantly invisible illnesses, disabilities, or chronic struggles.
During the last year there hasn’t been much research done on the impact of being mandated to wear a mask has caused on people. There has been research done in the past on “mask claustrophobia” in head and neck cancer patients who are receiving radiation treatment and how this anxiety can have a negative impact on their overall treatment progress and psychological perspective on their prognosis. During radiation therapy, patients are stabilized using a fitted thermoplastic immobilization mask and have to engage in this procedure numerous times a week for months. Nixon et al. (2018) conducted a study where they found that there have been no validated assessments to measure the patient’s level of mask anxiety prior to their treatment, which is an area that should be, in my opinion, addressed in the near future as a way to help mitigate psychological risk when engaging in their first round of treatment. This study also found that some of the contributors to mask anxiety are: prior experiences of claustrophobia, having pre-existing psychological/mental health issues, other concurrent stressors in one’s life, taking psychoactive medication, having a pre-existing fear of enclosed spaces, of one’s face being covered up, movement restriction and prior anxiety/panic attacks. Klug et al. (2020) found that some patients experience potent memories of the mask numerous months after their treatment has ended if they experienced a high level of mask anxiety. These researchers have suggested that to help decrease patient’s mask anxiety, providers should attempt to engage in guided imagery and self-talk, music therapy, aromatherapy, help normalize the distress by being empathic and providing consistent care, offer verbal encouragement, breathing and relaxation strategies prior to the treatment beginning.
The little research that has been done over the course of the last year has shown that wearing face-masks in the healthcare environment, where client and provider are required to wear their mask has had a negative impact on individual’s willingness to adhere to medical advice and medication compliance, overall satisfaction and clinical outcomes (Wong et al., 2013). This has been associated with the decrease in nonverbal communication and an inability to observe subliminal facial expressions that would normally influences one’s emotional state, attitudes and behaviors. Human beings rely on expression cues that are observed near the mouth that infer emotion, often displaying empathy, warmth and genuineness and without the ability to see those some individuals have interpreted their interactions with others as callous and hostile.
But how has this been impacting everyday individuals during their normal functioning?
People have been experiencing panic attacks while wearing their masks, without having ever experienced panic/anxiety issues in the past. Individuals are reporting feeling vulnerable, uncertain, fearful of having to wear their mask and what happens if they can’t take it off/can’t breathe, in addition to physiological symptoms like rapid heartbeat, rapid breathing, and breaking out in a sweat (Lang, M.). Researchers show that the area of the face that is covered by protective face masks is highly thermosensitive, which means that an increase in the temperature in the facial skin covered by the mask significantly impacts thermal sensations throughout the entire body, creating an overall hot sensation.
In addition, for some surgical masks (protective face masks) have been connected to “risk”, “threat”, “loss”, pain (preconceived narratives around masks) and can evoke significant distress within some individuals if they have not been made aware of the rationale behind the mandate. We are encouraged to help our collective understand the true need to wear the masks as a way of protection instead of wearing them based on fear-induced narratives.
We weren’t warned about this potential side effect of wearing a mask regularly, and we most definitely weren’t informed on how to help ourselves navigate this overwhelming experience if it does occur. Similar techniques used to help radiation patients navigate mask claustrophobia are suggested for individuals experiencing mask anxiety with the protective face masks; diaphragmatic breathing, utilizing a mantra or self-talk, mindfulness strategies and aromatherapy inside the mask or behind the ears.
The American Disability Association (ADA) released policies around face masks and individuals with disabilities that state:
Examples of a person with a disability who might not be able to wear a face mask include: people with PTSD, severe anxiety, or claustrophobia as they may feel afraid or terrified when wearing the mask and become unable to stay calm and/or function while wearing their mask; some individuals with Autism (ASD) who are sensitive to touch and texture may experience a sensory overload when their nose and mouth are covered, lending to feelings of panic and extreme anxiety
[Research done at Harvard (Schmerling, R., 2020) shows that people who are having the most trouble complying with the mask-mandates and other pandemic related restrictions are:
Individuals with dementia as without constant supervision and reminders, they may taking off their mask or wear them incorrectly and fail to maintain appropriate distance from others
Individuals with breathing problems (ex: Lung Disease)
Individuals who experience claustrophobia (most common phobia affecting 5-10% of the population)
Individuals with depression and anxiety]
If you find yourself resonating with one of the areas above, please reach out to learn how to advocate for yourself around mask mandates and pandemic policies and regulations.
How to help be an ally for those in need:
For business owners: If a person with a disability is not able to wear a face mask, do I still have to allow them in my business or agency? Reasonable modifications (changing policies, practices and procedures) to a face mask policy must be made so a person with a disability can participate in, or benefit from, the programs offered or goods/services provided
Examples of reasonable modifications include: allowing a person to wear a scarf, loose face covering, or full face shield instead of a mask, allowing consumers to order online with curbside pickup or no contact delivery in a timely manner, allowing consumers to order by phone with curbside pickup or no contact delivery, allowing a person to wait in the car for an appointment and enter an appointment when notified to do so, and offering Telehealth appointments.
Thoughts? Questions? Email drjessicareyka@grassroots-healing.com
Resources:
“The ADA and Face Mask Policies.” Disability Issues Brief: The ADA and Face Mask Policies, www.adasoutheast.org/ada/publications/legal/ada-and-face-mask-policies.php.
Klug, Natalie, et al. “Unmasking Anxiety: A Qualitative Investigation of Health Professionals; Perspectives of Mask Anxiety in Head and Neck Cancer.” Journal of Medical Imaging and Radiation Sciences, vol. 51, no. 1, 2020, pp. 12–21., doi:10.1016/j.jmir.2019.09.009.
Lang, Mary. “Why Protective Face Masks Make You Feel Anxious and What You Can Do to Cope: BeekSpeak, the Blog of Beekley Medical.” BeekSpeak, the Voice of..., blog.beekley.com/why-protective-face-masks-make-you-feel-anxious-and-what-you-can-do-to-cope.
Nixon, Jodie L., et al. “Exploring the Prevalence and Experience of Mask Anxiety for the Person with Head and Neck Cancer Undergoing Radiotherapy.” Journal of Medical Radiation Sciences, vol. 65, no. 4, 2018, pp. 282–290., doi:10.1002/jmrs.308.
Robert H. Shmerling, MD. “Avoiding COVID-19 When Following the Guidelines Seems Impossible.” Harvard Health, 28 July 2020, www.health.harvard.edu/blog/avoiding-covid-19-when-following-the-guidelines-seems-impossible-2020072820654.
Wong, Carmen Ka, et al. “Effect of Facemasks on Empathy and Relational Continuity: a Randomised Controlled Trial in Primary Care.” BMC Family Practice, vol. 14, no. 1, 2013, doi:10.1186/1471-2296-14-200.
*Disclaimer: This blog is made available by Grass Roots Healing, LLC/Dr. Jessica Reyka for informational and communicative purposes only, not to provide psychological services and/or psychotherapy. By using this blog site you understand that there is no psychologist client relationship between you and the blog publisher. This blog should not be used as a substitute for competent psychological services from a licensed/pre-licensed psychologist in your state.*