Transcription:
Cave Syndrome - What it is and What You can do to Help Yourself or Others

Melanie Cole (Host): After a year or more in social isolation, as so many of us have been, some people are afraid to return and venture out and return to their former lives despite being fully vaccinated. And there's even a name for this, they call it Cave Syndrome. So, what are the signs and symptoms, and what can you do to help yourself or your loved one and is Cave Syndrome even really a bad thing?

Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole and joining me today is Dr. Ijendu Korie. She's a Psychiatrist in the Behavioral Health Department at Henry Mayo Newhall Hospital. Dr. Korie, I'm so glad to have you join us again today. So what are we experiencing right now? What have you seen?

Because a lot of us are vaccinated, hopefully more than a lot of us, and we're still being told to mask. Some are still social distancing or being told to. What's going on right now that you see as far as anxiety about the Delta variant?

Ijendu P. Korie, MD (Guest): Thanks for having me, Melanie. So, I just wanted to give a little bit of explanation on the whole Cave Syndrome thing. It's a terminology. I think it was Dr. Bregman from Florida that probably used that terminology first and it quickly got very popular, regarding resuming what we used to know as normal before the pandemic. So, that's what Cave Syndrome is. Some people call it COVID anxiety. In my own clinical notes because quote-unquote "Cave Syndrome" is not an official diagnosis, I just write, you know, COVID related anxiety. And I describe what my patient is going through. There are two ways to look at this. And I kind of look at it as two branches of one tree. So, we all experienced the pandemic. It was like hell to say the least for many of us. And we had never seen anything like that before. And with all the restrictions that were recommended and necessary, we learned to live life differently. And many working Americans had to work from home. Kids have to be at school. Essential workers basically were the only people who were out for the most part. So, after a whole bunch of us have been home, not for a week, it's not like you were asked to stay home for just a weekend.

This is like almost two years of our lives, it's like living in a cave and that's how this terminology came about. And then you've lived in a cave for so long, and then now they're saying, okay, you can go shop again or whatever. And then you come out to your cave door and you're told, well, the monster is still out there, but you know, you're vaccinated. So maybe you wouldn't be sick.

The one branch of it I want to talk about is the fact that it's a normal feeling because this is not one week. So, I would say that it's important for those of us who feel that significant anxiety to at least legitimize our anxiety in the sense that like, you're not beserk, you're feeling something that you should feel because you've literally been in a cave and now you're being told that, okay, you have some protection and then you should go. And then you're confused. I've been masking every time I came out for the last two years, and now I'm being told I could be outside where it's open without a mask.

I don't know if the virus is going to fly in the air and get in my nose. You know? So one branch is to legitimize it, to know that well, I'm feeling this because it really happened. The other branch of it is to check and see if it's affecting your function to the point where it's making you miserable. And that is where you seek help. But we cannot remove the fact that it's a legitimate fear.

Host: And I agree with you and it is, and I've known people that were agoraphobic. Now, is this something that you in that field in the psycho, in the psychiatric field are likening this in a little way to agoraphobia? Or is this a whole new thing that we're looking at a little bit differently?

Dr. Korie: That's a great question, Melanie. The bigger part of my thought is to tell everyone listening that this is not, it's not a new human response to the kind of tragic event that has happened the last one and a half years. So, the symptomatology of this quote unquote "Cave Syndrome" is very similar to what you see in other types of anxiety, spectrum type of disorders, including agoraphobia that you're talking about. So, it is anxiety. There is a root of it. There is a trigger. It is not from the blues. You know, it's not just happening because someone just decided to be anxious.

So, it does fall into that spectrum. It's very complex though, in the sense that there is anxiety part, there is also the part that is the fear part of it. And then it crosses over to the spectrum of trauma because it has also been traumatic for many of us and some people more than others. For example, if someone actually lost a family member to COVID-19, it goes beyond the anxiety related to getting the disease to the trauma of actually being part of the life of the disease, then seeing them suffer and then losing them.

So, it does actually, in my opinion, cross diagnosis. So, it goes into the anxiety spectrum. Then it comes into the trauma spectrum, and then of course the phobias do come into the anxiety, bigger family of diagnosis. But I don't want us to forget the trauma part of it.

Host: I agree that and how interesting, the way that you're putting it in and that it's almost three fold. It's an anxiety issue. It's a trauma issue. It could enter into the phobia issue. It must be really fascinating for your field to be looking at this particular Cave Syndrome. So what do we do about it?

And I'm someone who lost my father to COVID and when I see people out there having fun, like you said, and it's just opened back up, but yet we're not done with it. And how do we, those of us that don't really want to enter back into society or are afraid to in these varying degrees of this new syndrome. What do we do about it? What do you want us to do about it?

Dr. Korie: First of all, I do want to express my empathy for the of your father. And I also do want to express the same thing to anybody who is listening, who has lost a loved one, a family member, a friend to COVID-19, because it's real. We saw it happen. So, in terms of what to do, I want to again, reiterate that some reluctance is normal, so that we don't call it a natural response to trauma what it is not. So, some reluctance, some hesitance is a normal reaction to an event that is, like you said, triple fold just as this pandemic or the Cave Syndrome or the experience that people are having. So, knowing that some reluctance is normal. I think one of the first things people should do who are experiencing this is to cut yourself some slack, like give yourself a break, tell yourself that the feeling you have has a reason to it. And why am I saying this? I have seen patients who are more worried about a possible diagnosis than the diagnosis is making them worried. I don't know if that makes any sense. So, if they're heard, for example, that they might have Cave Syndrome, they're more worried about what it might be then they should be because they're just scared that had this crazy thing that's going to be happening to them or that is happening to them.

So, when I'm able to educate a patient to know that the fact that they are having a lot of reluctance stepping out of their house is a normal reaction to the type of experience we all have had. What is this fear preventing me from doing? If this fear is preventing you from doing things will help you feel better. For example, if it's preventing you from reaching out to family and friends, then that's where to stop and think and begin to reflect and say, wow, I need to begin to think positively.

I need to begin to move forward to the things that will help me start getting back to quote unquote "normal" again, to some extent. So, it's really, almost like kind of a mindfulness approach to it, to reflect on your experience and then think about what to do to kind of counter it. And then you would say, well, yes, my fear is legitimate. My hesitance is legitimate. However, if I continue to be in severe hesitance, then I'm never going to go see my grandmothre. And seeing my grandmother makes me happy. It makes me healthy. It makes my mental health better. So, I'm going to venture into it since public health recommendations say that my grandmother is vaccinated and I'm vaccinated.

And if it's not a whole bunch of people in there, and we've not been exposed to COVID-19 patient recently, I could safely go see my grandmother. That's going to make my grandmother happy. That's going to make me happy. And I'm just one little step away from Cave Syndrome. So, you know, having that positive approach after we have legitimized our feeling is one step.

The second thing I want to say, which is what we do for most phobias, depending of course, on the technique you're using to help the patient; is to face to fear. Again, the first step of facing your fear is legitimizing your fear. And so if you can put the recommendations that are evidence-based on paper for yourself and write down I'm vaccinated. Number two, I'm going outside to the park. Number three, it's very ventilated. So number four, public health recommendation says if A, B, C are in place, it's safe. Then you can look at that and then face your fear. So I would like the listeners to know that facing your fear is my recommendation, which I do give to my patients about the anxiety that this related to COVID, which we're calling Cave Syndrome at this point. And I just want to give a few strategies of how to face your fear.

One of them is, do not compare yourself to other people because you've legitimized your fear and you recognize that it's legitimate and that, you know, it's real. Do not compare yourself to the comfort level of another person, because your speed of coming out of your cave is not going to be the speed of your neighbor. So, if your neighbor is comfortable going partying, don't compare yourself to your neighbor because maybe your neighbor did not lose their grandmother to COVID-19. In that way, you go at your own pace.

The other side is this, when you think about going outside, do the mindfulness exercise of flipping your fears. And instead of focusing on the horrible things that might happen, you focus on the good things that might happen if you go outside,.You focus on the fact that you might get used to going outside again, or you might be able to do those things that you really want to do. Or take your children to those places that you want them to go. So, these are two key things, knowing that you're unique, your experience is unique and not comparing yourself to another person, and then using mindfulness tools to switch your thoughts around, to be positive, instead of thinking about all of the bad things that might happen if you go outside.

So overall, you know, when you put the hope of being normal again, as a goal, maybe little by little, you can begin to get out and eat, however it's overwhelming and you're not able to get back to function the way that you consider optimal, it's time to get help because there is help. It's a type of anxiety. It might be a type of trauma treatment, but there is always help.

Host: Well, there is, and you're giving us a lot to think about and really great advice. Do you have any final thoughts that you'd like to leave us with as far as Cave Syndrome, anxiety about COVID and everything, Dr. Korie, man, there's a lot going on in this world and it can be really scary. But being grateful, using gratitude, whether it's spirituality, whatever to appreciate what we have and you know, kind of work on the rest.

Dr. Korie: I would say to curb your own realistic expectations of yourself. Meaning remember that the trauma that we've all gone through is very real. So, don't beat down on yourself when you think that you're overcome by fear. Take the little steps that I talked about and begin to see how to face them, but don't beat down on yourself because it's a real experience that you had. Don't forget to give yourself a break and go at your pace in getting out of the cave. And it is a normal human experience to respond to trauma the way that we all are.

Host: Well, it's certainly is and you've given us a lot to think about. Thank you so much, Dr. Korie, what an excellent guest you are. And to find mental health resources in your area, please visit the National Institute of Mental Health website at NIMH.NIH.Gov. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital.

You can always visit our website at henrymayo.com to learn more or to get connected with providers like Dr. Korie. If you want to hear more podcasts, you go there too. So, there's a lot available. There's a lot of resources available. We thank you so much for listening to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And thanks for listening.