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Quarantine Fatigue: How to Stay Vigilant About Your Safety During the COVID-19 Pandemic
Jackie Gollan, Ph.D.
June 17, 2020

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Dr. Jackie Gollan is associate professor of psychiatry and behavioral science and a clinical psychologist at Northwestern University’s Feinberg School of Medicine in Chicago. As a clinician, she uses evidence-based psychotherapy to treat people for depression and anxiety. Her research focuses on how habits interfere with our goals; this includes how people make decisions to approach or avoid situations.

As the quarantine and restrictions related to COVID-19 stretch into their fourth month — though some areas are loosening some restrictions — we may find ourselves not wearing a mask every single time we leave the house or being a bit more casual about washing our hands. This reaction is called “caution fatigue.”

In this podcast, Dr. Gollan explains caution fatigue and give us some tips on how to overcome it.

Listen to hear Dr. Gollan explain:

  • the differences between caution fatigue, alarm fatigue, and information overload
  • how to recognize if you’re experiencing caution fatigue
  • how to overcome caution fatigue

Running time: 20:30

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Show Full Transcript

Jamie DePolo: Hello. As always thanks for listening. Our guest today is Dr. Jackie Gollan, associate professor of psychiatry and behavioral sciences and a clinical psychologist at Northwestern University’s Feinberg School of Medicine in Chicago. As a clinician, she uses evidence-based psychotherapy to treat people for depression and anxiety. Her research focuses on how habits interfere with our goals. This includes how people make decisions to approach or avoid situations.

As the quarantine and restrictions related to COVID-19 stretch into their fourth month, although some places have started to open up, we may find ourselves not wearing a mask every single time we leave the house or being a bit more casual about washing our hands. This reaction is called caution fatigue, and Dr. Gollan joins us today to talk about it and give us some tips on how to overcome it.

Dr. Gollan, welcome to the podcast.

Dr. Jackie Gollan: Thank you for having me.

Jamie DePolo: First, since I just gave a real brief summary of caution fatigue, could you give us a more detailed explanation of what it is and tell us how it happens?

Dr. Jackie Gollan: In the midst of the COVID-19 pandemic, there’s been a lot of attention on helping people comply with quarantine safety guidelines. I’ve observed a phenomenon called caution fatigue, which is the low motivation and energy to observe safety information. It occurs when we become desensitized to stress warnings, and then we outweigh the valid risks of injury or infection for the benefits of seeking a reward like human connection or exercise or being in the outdoors. And so the burden of human cautious behavior, especially if prolonged, can seem unnecessary and then people start to become vulnerable to suggestions to bend the rules.

Jamie DePolo: I’ve read some headlines saying that, “Well, people just got bored. They got bored with doing the same thing all the time.” Does that factor into it, or is it really almost just kind of sensory overload? I’m wondering if there’s a difference there at all.

Dr. Jackie Gollan: Yeah, that’s a good question. There are a couple of things that explain this. The first is that we get a decreased sensitivity to repeated warnings. So essentially our brains adjust to the alarms to reduce our stress and then we can take longer to respond to warnings or start to ignore them.

There’s also, I think, a lot of decision-making that goes on, and complex decisions like this require a lot of energy. So we start to get tired about making those decisions about which actions are worth the risk and which actions are worth rewards.

Jamie DePolo: I see. Okay, thank you. Now, if a person’s been diagnosed with breast cancer, that’s clearly a threat to them. And then the COVID-19 pandemic happened on top of that diagnosis for a lot of people, so I’m wondering would people like that, who are experiencing these multiple threats, are they more likely to experience caution fatigue?

Dr. Jackie Gollan: I think it would vary. So I think for most people, they’re going to experience some adaptation. Fear is registered in the brain, and then if the threat is considered to be important there are messages sent through our body for us to respond to it properly. However, over time we start to use another part of our brain to understand the context of the threat, whether the threat is real or not, and that context helps us dampen the fear response. And so we then subsequently see the threat information as less threatening and we start to ignore it.

I think for people who have cancer, everybody’s different, and I think it depends on how you interpret the information. So some people will have an ability to balance their fear with a sense of perceived control and take actions that are appropriate for them.

Others may experience an imbalance, and that’s the imbalance between fear and perceived control, and that can create either lower or more excessive fear. So a person who’s gone through many rounds of chemotherapy and feeling vulnerable may have more fear, and that would lead to cautious behavior and potentially emotional distress or some impairment if they felt threatened.

Others may feel like they’ve gotten through it and they’re no longer vulnerable and then have lower fear, which could lead them to ignore true risks. I do think I’ve had a number of patients of mine report to me that having gone through treatment for cancer, breast cancer specifically, they are very attentive to their health and preserving all aspects of their health. So they tend to be much more cautious in this current state, this current situation.

Jamie DePolo: Okay, which is probably very good. Now, I’ve also read that what I would call information overload, like just a constant bombardment of information, can contribute to caution fatigue. And to me, anyway, it feels like since the first case of COVID-19 was diagnosed here in the United States, we have been in information overload. You know, “Do this, do that, wear a mask, wash your hands, use hand sanitizer, don’t go here, don’t go there.” So, can you help me understand how that fits into caution fatigue as well? Is it kind of the same thing, just that you’re getting so much information your brain can’t decide what’s important anymore?

Dr. Jackie Gollan: That’s a really good question, and it does differentiate from caution fatigue.

So there’s a concept called alarm fatigue, and often we see this with clinicians who are working around a lot of alarms, like medical devices and so forth in the hospital. And alarm fatigue is the sense that being bombarded by these warnings, these actual physical alarms, the person starts to regard them as nuisances. Because they go off so often, they are stressful and then they begin to be seen as nuisances, and then they start to actively ignore the warnings. The problem with that is that there are times when, in fact, alarms mean something, particularly in hospitals or construction sites or in schools, and so alarm management is important to prevent that bad outcome that is supposed to be prevented.

There is also a concept of alert fatigue, which is being bombarded by social media or media outlets with information, and the person continues to get alerts or updates about what’s going on around us. We probably all got subjected to that early in the pandemic phase, and people can get saturated by the information. They can’t tell what’s useful, and the excessive and continual alerts are distracting and they generate stress. And so, again, to reduce the stress we start to ignore the alerts, [so] they’re viewed as noise.

So we have alarm fatigue, which are actual true alarms, physical alarms that go off on devices that are designed to help people in their jobs and their situations. We have alert fatigue from the social media and media context.

Caution fatigue is the person who’s saying, “I understand that there is a risk, I have to take precautions to do something to protect myself to preserve the health that I have, but I’m willing to trade that off because I’m just so tired of taking these precautions: wiping down groceries, wiping down my hands, keeping social distancing.” Where I want to make that tradeoff of moving towards something that I want to do, like a reward of getting food at the grocery or seeing friends or getting outside and having a picnic that might not be appropriate. And they begin to ignore the true risk in order to get that reward back into your life.

Jamie DePolo: And it sounds like there is quite a lot of potential fatigue going on with everyone right now between all the things you mentioned, so I can imagine that people might be looking for some rewards.

Dr. Jackie Gollan: Yeah, I think so. People really thrive on a routine that they have, and also they rely a lot on habits. So when we set ourselves new goals that require this extra effort and attention, one, it’s hard to do. Two, it’s hard to remind yourself to do it when nothing bad happened to you, because there was no sort of actual consequence that you feel that you’ve removed. And so that’s hard to stay motivated when everything’s going okay. You’re not ill, why would you need to do these extra activities?

The thing that goes on there is there’s the sense that if we know that others are taking safety precautions, we might go ahead and do things that are a little bit more risky, like not wearing the mask and assuming that we are safe because everybody else has gone ahead and taken some of those safety precautions. And that concept is called risk compensation, which is, “I don’t need to do these things because the world out there is safer because other people are engaging in safety behaviors.”

Jamie DePolo: I see. I see. Now, does caution fatigue happen to everyone eventually, or are there some people that are just hardwired to automatically be always vigilant?

Dr. Jackie Gollan: I’m sure there is a subset of the population who are hardwired to be vigilant, and potentially I think that’s driven by prior experience. Meaning if you’ve gone through a very severe illness, you’re going to pay a lot of attention to your having a closed-home environment where you don’t allow any risk into your home. And certainly, people who are considering their well-being, their age, and what it might be like if they do get sick, what risk that would incur, I think, are far more attentive to keeping a safe environment around them.

But most people will adapt to those because it’s biologically driven. So initially fear is registered in the brain, and then if that threat’s considered to be important there are messages that are sent to the body to respond. But over time, another part of our brain is going to start to dampen down the fear response in order for us to cope with the stress, because being intensely fearful is quite a load on the body and the brain. And so it’s helpful for part of the brain to dampen the fear response by saying, “Gee, you know, I don’t know if this threat is as real as it seems. I don’t know anyone who is sick around me. I myself haven’t been sick. Gee, is this being amplified by the media?” And so we start to see the threat information as less threatening, and then begin to start to ignore it.

So in many ways the response of adapting to this, which can look like fatigue or caution fatigue, is something that is driven by the brain in order for us to learn to modify our fear.

Jamie DePolo: Okay. And I do want to follow up on that. So if someone is being treated for breast cancer or, say, they’re receiving chemotherapy, they may be immunocompromised, so they’re at higher risk of becoming sick. So it’s really important that those people stay vigilant about COVID-19. They keep practicing social distancing, they keep wearing a mask, they keep washing their hands, they keep taking all the really hardcore precautions. So how can people... their brain’s telling them to adapt, so how can they recognize that that’s happening and they may be becoming slightly less vigilant?

Dr. Jackie Gollan: Great question. I think if you can adhere or comply with the schedules that you had in the first month of this, that might be useful. Just to remind yourself that there are basic rules that you want to follow about social distancing and disinfecting some things around in your home or washing your hands and using a mask.

I think to recognize caution fatigue, you might want to ask yourself, “Am I habituated or desensitized to the repeated warnings, and I’m assuming that the risk will be lower than it is actually in reality?” So, are you assuming that the risk is lower than it actually is? For example, take a look at what the daily reports are for your region or for your city or state in terms of how many new infection cases there are and how many people, unfortunately, have passed away. That’ll give you a sense of risk.

The second thing is to see, are you recognizing the risk, but you’re not acting in a way that’s consistent to minimize that risk? So, are you maintaining some rigid expectation about risk and safety and disregarding the information that you think doesn’t fit those expectations? And an example of this is where we would say, “Well, I should be able to walk along the waterfront.” And that would be bending the safety guidelines at this point, because it’s not open. Are you expecting that you should be able to do that, and you’re ignoring what are the guidelines in front of you? Or are you expecting that you don’t have to wash your hands when you go out and about in the city? Because, again, that would be a fairly straightforward way of you understanding intellectually those risks, but you don’t emotionally feel like complying with it.

And then, I think, understand that if you’re reverting back to old habits rather than sticking to the goals of safety, we all are struggling with this, this is what it is to be human. And so just see that you might be getting tired of making some of those decisions during this state of uncertainty and that you’re prone to ignoring some of the warnings in order to reclaim your routine.

Jamie DePolo: Okay, thank you. And my final question is kind of a follow-up on that, and some of the answers might be the same. But how can someone overcome caution fatigue? Say they’ve recognized it. Like, I’ll give myself as an example. I was leaving the house to go to the grocery store, and I got halfway down the driveway and realized I did not take a mask. And I went, “Whoa, what is going on with me?” And I went right back and I got one. So how can we overcome this? Do we make ourselves lists? You know, do I do a checklist before you leave the house? What have you seen that helps?

Dr. Jackie Gollan: I have to recognize that I also have had this same experience where I walked right out of the home and then realized, “Uh oh!” And I think this is important, which is you’re going to stick with some habits, but as soon as you recognize that you didn’t follow through on the goal, maybe it’s because you saw someone else wear a mask and you thought, “Uh oh, I don’t have mine, and that would feel weird if I went out there,” or “I know I’m committed that I wanted to do this, go back and get it.” And what you’re just doing is overriding the habit with this new goal, and the new goal will become a habit over time. My son says that we’re going to be asked to wear a mask for quite awhile. So just recognize that is normal human behavior and that you’re working on a new routine.

I think towards answering your point or your question about what people can do? There are a lot of things you can do. I think you need to give yourself time to prepare for the goal, define what that goal is, and then set your intention. So stop and think, and then get prepared. So put your mask where the door handle is, put notes up like “wash your hands.” Things that just remind you to get to this new goal.

I have heard some of my patients that have gotten treatment for breast cancer say they’re small investments now that create a big payout. And that at the time they were getting treatment, they were willing to tolerate the inconvenience and the discomfort of getting the treatment for the benefit of getting health, which was their reward. And so many women who were getting through that experience were telling themselves, “Do everything that you could possibly do now to make it successful and start now to see a benefit, and then see the value of your self-control in terms of it paying out in terms of better health.”

In many ways, women are starting to see that their successes in those safety routines, and that that will hopefully help you feel like you can boost your effort. If the pandemic seems like a lot to take, you feel pretty overwhelmed and tired, then just start with a small goal. Deal with the routine you have this morning and don’t worry about this afternoon. Once this afternoon comes, reset your intention and focus on that.

I do think it’s helpful if you can focus on the risks that may be created for others. You know, how important it was for yourself getting through your own treatment and recovery and prevention of recurrence? And so really thinking about a behavior as having a value of a “we” thing, not a “me” thing. So, think of somebody else who’s going through treatment that you may know, or you could think about and then commit to keeping them safe. And that may motivate you also to commit to those safety behaviors to keep you safe.

A couple other things I would suggest: one is increase your sensitivity to the risk by looking for variety in your news. So, change up where you get your news about COVID and the pandemic so you start paying more attention to it. When it’s different, we start to look at that information as new and we start to think about it. So maybe read across different newspapers or non-dramatic sort of news shows as a way of keeping yourself alert to the information, all the while making sure you don’t suffer from alert fatigue.

And then see if you can set up a schedule of daily activities that builds your physical and emotional strength. So when we think about fatigue, it really is a depleting, draining kind of experience, and we want you to think about exercising safely, eating properly, setting achievable goals so that you feel like you’re emotionally, physically stronger as you’re getting through this. And one thing I think about is, how do I want to position myself emotionally, mentally, physically so by the time this pandemic phase ends I feel like I’m where I want to be at the end of that?

Jamie DePolo: Okay. Dr. Gollan, thank you. I especially like the point you made about thinking about other people. I don’t know how anybody else is wired, but that is really a motivator for me. I am much more likely to do something for somebody else than for myself, so that’s what I’ve been trying to do now is think about, “Okay, I have some friends who are at high risk so I need to take my precautions so they don’t get sick.” So that’s really helpful for me personally. Thank you so much for sharing this information. I think it will be really helpful for our audience.

Dr. Jackie Gollan: You’re welcome. And keep in mind, there’s going to be an end to this. And though we may not be able to see it, there will be one, and then hopefully we will be able to return to a new routine that is safe and taking care of each other.

Jamie DePolo: Yes. Thank you so much.

Dr. Jackie Gollan: Take care. Thank you.

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