Social anxiety can increase distress related to mask-wearing during and after COVID-19

People who struggle with social anxiety might experience increased distress related to mask-wearing during and even after the COVID-19 pandemic.

A paper authored by researchers from the University of Waterloo's Department of Psychology and Centre for Mental Health Research and Treatment also has implications for those who haven't necessarily suffered from social anxiety in the past.

"The adverse effects of the COVID-19 pandemic on mental health outcomes, including anxiety and depression, have been well-documented," said David Moscovitch, professor of clinical psychology and co-author of the paper. "However, little is known about effects of increased mask-wearing on social interactions, social anxiety, or overall mental health.

"It is also possible that many people who didn't struggle with social anxiety before the pandemic may find themselves feeling more anxious than usual as we emerge out of the pandemic and into a more uncertain future — especially within social situations where our social skills are rusty and the new rules for social engagement are yet to be written."

Social anxiety is characterized by negative self-perception and fear that one's appearance or behaviour will fail to conform with social expectations and norms. Social anxiety disorder is an extreme manifestation that affects up to 13 per cent of the population.

The researchers reviewed existing literature addressing three factors that they hypothesized might contribute to social anxiety associated with mask-wearing: hypersensitivity to social norms, bias in the detection of social and emotional facial cues, and propensity for self-concealment as a form of safety behaviour.

"We found that mask-wearing by people with social anxiety is likely to be influenced by their perception of social norms and expectations, which may or may not be consistent with public-health guidelines and can vary widely by region and context," said Sidney Saint, an undergraduate psychology student at Waterloo and lead author of the paper.

The paper also highlights that people with social anxiety have difficulty detecting ambiguous social cues and are likely to interpret them negatively. These individuals also tend to worry about sounding incomprehensible or awkward. "We believe that both issues are likely to be magnified during interactions with masks," Saint said.

Another highlighted impact is that masks can function as a type of self-concealment strategy that enables people with social anxiety to hide their self-perceived flaws. Therefore, the desire for self-concealment may motivate their use of masks over and above their desire to protect themselves from contagion. "Due to their self-concealing function, masks may be difficult for some people to discard even when mask-wearing is no longer required by public health mandates," Saint said.

In addition to contributing insights to guide clinicians toward effective assessment and treatment, the paper shows that people with social anxiety may be particularly vulnerable to periods of norm transitions where expectations for mask-wearing are in flux or become a matter of personal choice.

The study, Effects of mask-wearing on social anxiety: an exploratory review, is available online and will be published in the journal Anxiety, Stress, & Coping.