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A Deep Dive on the Human Factors of Cave Syndrome
Hey everyone, as a companion piece to our podcast, we are trying something new by posting a deep dive into the Human Factors News stories we cover on the show. By approaching it this way, we're hoping to bring you continued Human Factors coverage through a digital written medium.
Last week we discussed COVID-19 and cave syndrome. Today, we will take a deeper dive into this impactful topic.
What is Cave Syndrome?
Cave syndrome, a term coined by Miami psychiatrist Dr. Arthur Bregman as the lockdowns near their end around the U.S., refers to the discomfort and fear people feel about leaving their homes to reenter society because they have become accustomed to isolation or have safety concerns. It is considered a variation on agoraphobia, a fear of places or situations that may cause panic attacks, and has been compared to hikikomori (shut-in syndrome), an extreme form of agoraphobia that causes individuals to isolate for at least six months.
Some in the psychology community suggest that cave syndrome can be attributed to three factors: habit, risk perception, and social connections. In particular, we are now in the habit of wearing masks, social distancing, and socializing virtually instead of in person. We tend to perceive our risk of infection to be greater than the actual risk may be, especially if we are vaccinated, and we focus on that risk of infection or death instead of the risk of negative health effects from a lack of socializing.
If this sounds relatable to you, you are not alone: the APA’s recently released Stress in America report found that nearly half of Americans (49%) feel uneasy about socializing once the pandemic ends and 46% do not feel comfortable returning to “normal” after the pandemic (these figures are virtually the same for people who have received the vaccine and those who have not).
The Vaccination Situation Today
The vaccination rollout in the United States has been going strong for a few months now. As of May 23, 2021, the CDC reports that 49.2% of Americans have received at least one dose of the COVID-19 vaccine, while 39.2% are fully vaccinated. With more and more people receiving the vaccine, we are able to gather more data about its health and social impacts.
Recently, the CDC revised its mask guidelines for those who have been vaccinated. The new guidelines essentially say that people who are fully vaccinated can resume their normal activities without masks or social distancing, unless otherwise required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.
There are currently three COVID-19 vaccines available in the United States: the 2-shot Pfizer-BioNTech vaccine, the 2-shot Moderna vaccine, and the 1-shot Johnson & Johnson/Janssen vaccine. People are considered fully vaccinated two weeks after they receive their last dose of the vaccine, regardless of which one was used. Most recently, the Pfizer-BioNTech vaccine approval was extended for adolescents (12- to 15-year-olds) (May 12, 2021). There is not currently an expected date for when children younger than 12 years old will be able to get the vaccine.
COVID-19 has shaped how comfortable we are (or are not) about going out and interacting with others, even if there is a very small chance of risk. People are naturally highly risk-averse, so when we perceive there is a risk to something, we prefer to minimize it. This has led to a reluctance to socialize in person or return to “normal” activities, such as going to the movie theater or dining at a restaurant.
The pandemic has also changed family dynamics. Social distancing, especially when concerned for older or high-risk family members, has led to an increase in virtual visiting. With children attending virtual school or a hybrid of in-person and online learning, families have had to adapt and reorganize. Many adults lost their jobs during the lockdown, changed careers, or started working from home. While extroverts may have felt the impact of lockdowns and social distancing as particularly hard, many introverts have enjoyed the decreased social obligations of this time and have been able to thrive. Some people explored new hobbies, honed their skills, or were finally able to complete those projects they were working on before COVID-19. Working from home has allowed people to move away from big cities and into less expensive, less populated ones farther from the coast. Changes such as these shifts in schedules and lifestyles create significant stress for people and will influence the lasting effects the pandemic has on us.
A big question that will require longitudinal studies is what impact the COVID-19 pandemic has had on children. Studies are already discovering that many minors have begun exhibiting new psychological issues since the lockdowns began. A recent meta-analysis of several studies looking at this issue found that 34.5% of children were found to be suffering from anxiety, 41.7% from depression, 42.3% from irritability, and 30.8% from inattention. The review found that the pandemic and quarantine had a large negative impact on 79.4% of children. Some children also experienced a significant fear of COVID-19, boredom, and sleep disturbances. More data will need to be gathered as the pandemic comes to an end and post-pandemic to get a better picture of the specific ways in which COVID-19 has impacted minors, especially any long-term effects.
More people have been communicating online than ever before. This has led to friendships, from the deep to the superficial, among people who have never met in person. With a craving for social interaction, virtual socializing platforms such as Instagram, Twitter, Reddit, Zoom, and Discord have become more commonly used to connect with others around common interests. While these platforms have been available for years, they are now seen as valued alternatives for getting social interaction. Face-to-face communication may still be preferable to many, but it now has competition from virtual social tools.
Trust in Others
Although the revised CDC guidelines tell us that if we are fully vaccinated, we can return to pre-pandemic activities (back to “normal”), many people no longer trust others to be safe to be around. It feels hard to trust that other people who are not wearing masks or social distancing are fully vaccinated. This has led to the question of how to give people that sense of safety without infringing on people’s rights and without being discriminatory.
The general protocol right now is to rely on people being truthful about their vaccination status. International travel largely requires proof of vaccination or a negative COVID-19 test. Some airlines and countries have started using digital health passports. These are smartphone applications that allow access to your health data, such as COVID-19 test results or vaccination records. There are valid concerns about this method, such as the security of sensitive health information and inequality stemming from the requirement of a smartphone to be able to use the digital passport. As of now, however, it seems to be at least a temporary solution for some companies and countries.
Where Do We Go from Here?
To help with cave syndrome, the original Scientific American article we discussed suggests creating a sense of purpose, meditating, playing or listening to music, praying, psychotherapy, exposure therapy, or medication. Here are some additional steps you can take to help overcome cave syndrome:
- Review the facts of COVID-19 transmission on the CDC website, especially if you are already fully vaccinated
- Check out your state or local COVID-19 and vaccination numbers
- Develop and use your social support network: arrange to meet up with a friend or family member you feel safe with who was not in your pandemic bubble
- If continuing to wear your mask or maintain social distancing helps you feel comfortable re-entering society, continue doing so
- Take it slow: plan and do one activity outside your home, such as getting a coffee or going on a walk, by yourself or with someone else, and repeat that activity or do similar ones until you can build back up to more involved pre-pandemic activities
- Evaluate your current risks: this might include whether or not you are vaccinated, any pre-existing health conditions, or the risk to others in your household. Remember that you can always consult your doctor to get an expert’s opinion
- Look up current data about the vaccines and COVID-19: new data is constantly being released regarding the pandemic and vaccinations, and it may help you to feel more confident about re-entering society
The Human Factors Connection
Human factors, as we know, is everywhere! A major part of our field revolves around making sure that a product or service will have increased acceptance among end-users. To be able to return to “normal,” it was thought that we must achieve herd immunity through vaccination. With the current predominant strain in the United States, B.1.1.7, our herd immunity threshold is 80% immunized so that the virus eventually fades away. There is still 30% of the country that is hesitant to get vaccinated, which means that, even if the virus did not mutate and vaccinations were spread evenly through every county in America, we would still not be able to reach herd immunity.
However, recent expert opinion is that as long as we can get vaccination levels high enough to make COVID-19 hospitalizations manageable, we can call it a success. This would bring COVID-19 to a similar severity level as the flu, allowing the country to get back to a sense of normalcy. To get there, we need as many people vaccinated as possible. This is where human factors psychology comes in: acceptance of the vaccine.
The Acceptance Trifecta: Trust, Anxiety, and Motivation
To understand how to encourage acceptance of the vaccine, we need to remember these key concepts: trust, anxiety, and motivation. In this case, we need to help people trust the vaccine will make them and their families safer, ease their anxieties about the vaccine, and motivate them to follow through with getting the vaccine.
A study that examined the acceptance of hypothetical COVID-19 vaccines found the following:
- Longer lasting protection increased acceptance of a vaccine
- Less adverse effects from the vaccine increased acceptance
- Full FDA approval increased acceptance
- If the vaccine originated in a non-U.S. country, it decreased acceptance
Another study developed recommendations to help with vaccine acceptance. These recommendations include:
- Take a human factors approach to COVID-19 vaccination (including social, behavioral, and communication science)
- Ensure the public is properly informed about COVID-19 vaccination benefits, risk, and supply
- Communicate meaningfully and crowd out misinformation
- Ensure that allocation and distribution of the vaccine is evenhanded to increase public confidence in a fair vaccination campaign
- Provide vaccination opportunities in safe, familiar, and convenient places (e.g. schools, grocery stores)
- Establish public oversight committees for COVID-19 vaccination at state and local levels as an accountability mechanism
These recommendations take into account the human factors involved in increasing acceptance, including how to increase trust in the vaccine, decrease anxiety around getting the vaccine, and motivate people to get the vaccine.
By increasing vaccine acceptance, our vaccination rates will increase. As vaccination rates increase, it will become safer to return to “normal.” With an increase in safety, we can alleviate at least some of the stressors that factor into cave syndrome.
How Else Can HF Help with Cave Syndrome?
A major component of human factors psychology is the concept of individual differences. Part of cave syndrome is anxiety about having to go from limited social interaction (or even none) to constant social interaction, or that we will be expected to perform without any awkwardness when we are in person with others.
It is important to remember that you can control your social interactions to a certain extent. While your friend Phil may be excited to return to “normal” and have all sorts of plans with people, that may not be what is best for you right now, and that is okay. Some people are going to be as social as they can be after the restrictions are lifted, some people are going to remain the same, and most of us will be somewhere in the middle. Find what works for you.
With so little face-to-face communication with anyone outside our household over this past year and a half, it can be intimidating to think about having in-person conversations with people outside our bubbles. As with many things, the first step can be the most intimidating, and it is easy to get discouraged or give up if the first experience is not a positive one. It can help to think of this as a human factors challenge: how can you set up that first experience to be the best it can be for you so that you continue to do it and decrease your anxiety around this task? Maybe you meet up with your best friend for a walk on the beach or eat outside at your favorite restaurant. Maybe you host a dinner for people you have missed during the lockdowns. Again, find what works for you to increase your satisfaction with the task of socializing.
It can also be helpful to think of other perspectives. Will your friend really judge you harshly for any awkwardness in your conversation and interactions? Probably not. We all lived through the same pandemic and are all bringing our own new social skills and habits with us as we re-enter society. It will take some adjustment for all of us, and being understanding of that adjustment both for others and ourselves will go a long way towards alleviating any cave syndrome thoughts and feelings we may have.
For more Human Factors Cast content, check back every Tuesday for our news roundups and join us on Twitch every Thursday at 4:30 PM PST our weekly podcast. If you haven't already, join us on Slack and Discord or on any of our social media communities (LinkedIn, Facebook, Twitter, Instagram).
Explore Some More
- Anxious about post-COVID life? You may have 'cave syndrome'
- Cave Syndrome: Viral and Social Toxins, and the Inner Life
The Vaccination Situation Today
- Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations
- Impacts of lockdown on the mental health and wellbeing of children and young people
- Objections: With Adam Klasfeld: The Settled Law Behind 'Vaccine Passports' (Feat. Prof. Eric Feldman)
Where Do We Go From Here?
- CDC: COVID-19 Breakthrough Case Investigations and Reporting
- CDC: Evidence suggests fully vaccinated people do not transmit COVID-19
- New Data on COVID-19 Transmission by Vaccinated Individuals
- What is Covid 'cave syndrome' — and how to fix it
The Human Factors Connection