Coping with caution fatigue created by COVID-19

July 28, 2020
Illustration of a woman wearing a mask with her hands on her head in frustration, surrounded by coronavirus particles and lightning bolt icons
Cancer patients need to carefully assess risk levels and take proper precautions before deciding to go out, even as frustration and anxiety grow about when the COVID-19 pandemic will be over. iStock

Some people thought life would be back to normal by now, but instead, South Carolina is facing increasing rates of coronavirus.

Cancer patients have to be particularly careful, given that research is showing they can be more susceptible to the virus. Even worse, people are dealing with what Wendy Balliet, Ph.D., describes as caution fatigue. Balliet is an associate professor in the Department of Psychiatry and Behavioral Sciences and a psychologist who works with cancer patients at the Medical University of South Carolina’s Hollings Cancer Center.

Caution fatigue is when people experience low motivation or don’t have the energy to adhere to health guidelines, despite the increasing threat, and they crave being able to return to normal activity. “Caution fatigue is seen in everyday life as well, like when you ignore an alarm that goes off at the same time every day because you’ve heard it before,” she said.

“For individuals considered high risk for acquiring COVID-19, watching seemingly ‘healthy’ people return to restaurants, bars, parks, bowling alleys, gyms and other public places can elicit multiple difficult emotions,” she explained. “Those emotions include frustration, anger, fear and anxiety, loneliness and even a false sense of safety.”

Balliet hopes to raise awareness about this fatigue and its impact on patients and their families. “You have been treading water since March with most of the world, and it is so hard to keep treading to stay afloat as you see people around you walk to shore, no longer struggling against the tide,” she said.

“However, the storm is not over, and, if you are a person with cancer or other health conditions that put you at high risk, being vigilant about your health now is more important and more difficult than ever.”

Wendy Balliet, Ph.D. 
Dr. Wendy Balliet works with cancer patients to help them navigate the stress of treatment and offers additional coping strategies to deal with caution fatigue. Photo by Dawn Brazell

According to guidelines from the Centers for Disease Control and Prevention, high-risk individuals, and those they live with, should carefully assess their levels of risk and protect themselves before deciding to go out. It is important to consider avoiding activities where social distancing can’t be maintained as well as continuing to be rigorous in preventative measures such as keeping hand sanitizer on your person, wearing a mask in public and asking others around you to do the same.

It’s more important than ever for people to be proactive to counter the added stress they are feeling and to know it’s normal. The American Psychological Association has been conducting a “Stress in America” survey yearly since 2007. This is the first year since the start of the survey that a significant increase in average stress among the public was observed.

“The uncertainty of this pandemic has not waned as such — neither has the public's anxiety,” she said, adding that for those managing chronic health conditions, the added stress of COVID-19 becomes a cascade effect.

“It is completely normal to be experiencing a wide range of emotions that vary over time throughout this pandemic. Being able to name and accept your emotions is the first step toward building resilience. It is important to remember it is OK to feel uncomfortable because the fact is, these are uncomfortable and uncertain times.”

Coping with isolation

Living well now means balancing staying safe and remaining social. She quotes the words of author and researcher Brene Brown who defines connection as “the energy that exists between people when they feel seen, heard, and valued; when they can give and receive without judgment; and when they derive sustenance and strength from the relationship.”

It’s important to share feelings of loneliness and isolation with trusted and valued friends, which, ironically, combats those same feelings of loneliness and isolation. “The willingness to be vulnerable to talk about hard things allows us to actually feel more connected to those we share with, even if it’s from a distance.”

Balliet recommends:

  • Socially distanced driveway gatherings.
  • Online book clubs.
  • Daily outdoor time.
  • Socially distanced walking (if approved by your doctor).
  • Exercise, yoga, meditation, using online formats to connect with others.
  • Online games: Words with Friends, Scrabble.
  • Drive-in movies.
  • Netflixparty.com: link up with friends and host long-distance movie nights and/or TV watch parties.
  • Meetup.com: Meetup.com is a platform where you can find and build local communities. Historically, this was done offline to meet new people, learn new things, pursue passions and get out of comfort zones. However, many of the meetup groups are now online due to COVID-19. Examples of meetup groups include gardening, yoga and meditation, cooking, writing and book clubs.
  • Houseparty.com: a face-to-face social network where you can connect with the people you care about most. The app makes video chat effortless, alerting you when your friends are “in the house” and ready to chat so you can jump right into the conversation. It also offers opportunities to play games like trivia and Heads Up! with friends.
  • Write handwritten letters to loved ones.

Having tough conversations

Many families are having to have tough conversations, especially if loved ones disagree about what is safe to go out and do.

Balliet recommends that cancer patients state their needs using “I” statements to get conversations started and to communicate how the situation impacts them.

A sample script:

I am currently receiving chemotherapy and as a result, I have a lowered immune system, which means my body can’t fight viruses as well as a healthy immune system. I feel worried about my health and acquiring COVID-19 when people around me aren’t wearing masks.

“It is helpful,” she said, “to remember the goal is not to accuse others or make them feel blamed or untrustworthy but to help educate them to understand your unique condition that might make you at higher risk for contracting COVID-19.”

Remembering, too, that the old adage “knowledge is power” can be particularly useful in situations such as these. Balliet recommends spelling out the reasons for being cautious, including the latest statistics about how the state has become a hot spot in the last few weeks, or sharing directions a physician has given you.

Practice extra self-care

Unusual times require extra special self-care. Worry can be adaptive and is the brain’s automatic survival mechanism. It helps, she said, for people to think ahead, plan and cope. “When it becomes maladaptive is when it starts to interfere with living the life you want or results in feelings of chronic exhaustion or demoralization,” she explained.

“This looks differently for different people, and it is important to identify when anxiety is experienced as physical, mental or both, as you will use different tools to cope with different types of anxiety. If you find that worry or stress is interfering in your daily life, making it hard to complete seemingly easy tasks, it is important to reach out to a mental health professional for help.”

Bootcamp guide to combat quarantine fatigue

Collage of a woman sitting cross legged on a yoga mat, a cup of tea next to flowers and a sugar bowl, a woman jogging at sunset 
Some healthy ways to combat quarantine fatigue include practicing yoga, doing relaxing activities and exercising and getting out in nature.

Quarantine fatigue, which relates to being confined to a restrictive environment, can be generally described as exhaustion that is related to the new and consistently restrictive lifestyle that has been implemented to slow the spread of COVID-19. Part of what causes fatigue is the long-term uncertainty and unpredictability and the feeling that there is no end in sight.

Step 1: Identify the signs of quarantine fatigue

Without awareness, we cannot change, so it is important to know the common signs of quarantine fatigue. They include irritability, stress, anxiety, increased/decreased appetite, sleep difficulty, generally feeling unmotivated or apathetic, racing thoughts and feeling constantly on edge.

Step 2: Take action

  • Limit the news. Avoid it during the first and last parts of the day, as this is how you start and end your day.
  • Allow yourself to grieve. “We have all missed milestones this year, whether that is weddings, graduations, bell-ringing ceremonies for end of treatment and even funerals.”
  • Recharge — through yoga, meditation, baths, walks in nature or on the beach (socially distanced) or watching funny TV shows.
  • Stop and breathe.
  • Focus on what can be controlled and let go of everything else. Remember, you cannot stop worries from cropping up, but you can control your response to them. Avoid adding stress to an already stressful time.

Resources Balliet recommends:

Article: That Discomfort You’re Feeling Is Grief
Article: Special Care Focus: Coronavirus (Technique for Reducing and Overcoming Fear)
Video: Face COVID: How To Respond Effectively To The Corona Crisis
Article: 15 Apps to Keep You Healthy While Sheltering in Place
App: COVID Coach (self-care tool)
Workbook: Coronavirus and anxiety workbook (free)

About the Author

Dawn Brazell
MUSC Hollings Cancer Center

Keywords: Cancer, COVID-19, Fitness and Wellness