This story originally featured on Mel Magazine.
After Mark got his second Pfizer shot at the end of April, he was excited to celebrate with his fully vaccinated friends. But when the 34-year-old in Chicago finally went out to a bar, he felt a type of anxiety he had never experienced before. “It wasn’t a panic attack or social anxiety, but no masks, crowds and everything was too much all at once,” explains Mark, whose name has been changed for privacy. He soon found himself cancelling plans with fake excuses and feeling a sick sense of relief when vaccinated people started testing positive. “I know that sounds terrible, and I don’t want anyone to get sick. But a part of me just wants to go back inside,” he says.
Mark isn’t a total asshole and he’s in good company, according to psychiatrist Arthur Bregman. Over the last year, Bregman started to see patients experiencing feelings of heightened anxiety around getting back to “normal.” And while those experiences can seem like a combination of agoraphobia and seasonal affective disorder (SAD), there was really no term to adequately describe the unique condition caused by the prolonged isolation and panic of the pandemic. “I soon realized that almost half my patients were struggling with leaving the cave and that it was a syndrome,” he tells me. “The lightbulb came on, and I decided to call this behavior ‘cave syndrome.’”
Cave syndrome isn’t an official medical diagnosis, but rather a casual moniker for a set of symptoms that many are experiencing as we slowly emerge from quarantine. These symptoms can include general anxiety about COVID and its variants, over-washing of hands, obsessing about germs, resistance to leaving the house, depression from the long-term isolation and “all the pressures of navigating through a new normal and how to re-enter society without getting sick,” Bregman says.
Vaccinated or not, many of Bregman’s patients have begged him for a doctor’s note to get them out of returning to the office—a trend that’s made him genuinely concerned for their careers. But instead of doing so—or immediately prescribing medication — Bregman believes the best treatment for this affliction is all in the name: Get out of the cave.
Other experts suspect that literally leaving the cave (or house or apartment) may be equally important for preventing cave syndrome as it is for managing it. There’s ample scientific evidence that the simple act of going outside improves individual mental health. “Being outside in nature has been associated with reduced rumination and activation in the subgenual prefrontal cortex,” explains Dorlee Michaeli, a psychotherapist trained in EMDR. Since this is the part of the brain that handles rewards and emotions, it “is likely to be playing a positive role in emotional regulation.”
While being around nature is important, for people who live in cities, natural light still decreases stress hormone levels and boosts feel-good neurotransmitters like serotonin. “Sufficient exposure to natural light helps people cope with anxiety by warding off seasonal affective disorder, improving sleep, as well as reducing rumination and decreasing cortisol,” Michaeli notes. The most compelling evidence for why people need sunlight is SAD, a type of depression linked to a lack of exposure to natural light in winter months that leads to a drop in serotonin.
Daily exposure to sunlight, particularly “in the morning, can help regulate sleep cycles and improve mood,” adds psychiatrist Gail Saltz. Other studies similarly show that the more sunlight office workers received between 8 a.m. and noon, the more likely they were to sleep well at night, and experience less stress and depression as a result.
On the flip side, laying around in a proverbial cave with smartphones and laptops can have the opposite effect. A growing body of research has demonstrated how blue light erodes our mental health over time by disrupting our circadian rhythm. And yet, for many of us, the screens in our caves were all we had when quarantine hit.
Michaeli and Saltz agree that the sooner people started going on walks and doing other outdoor activities in lockdown—and the more consistent they were with these activities—the less prone they were to getting stuck in their caves. There is an important caveat, however: only if they had agency in that choice. Those who were forced to go to work and take risks they weren’t ready for might experience higher levels of anxiety regardless of getting out due to “the reasonable fear of contracting the virus and their relative higher exposure risk,” Michaeli explains.
That’s the most challenging part of treating cave syndrome, Bregman explains, because a lot of this anxiety can stem from valid concerns about scientific uncertainties regarding COVID. The problem is, when such anxiet