Mask wearing might have unique effects on people who struggle with social anxiety

A new scientific review published in the journal Anxiety, Stress & Coping outlines some of the challenges that people who struggle with social anxiety might experience amid the COVID-19 pandemic.

After the outbreak of the novel coronavirus in 2020, governments and health organizations around the world urged people to wear masks in public to prevent the spread of COVID-19. But how the widespread use of masks has impacted those with social anxiety remains unclear.

“Mask-wearing mandates/suggestions had only recently begun to be implemented in many places at the time we started writing the paper; I think masks were a topic that most people were already thinking about. It was interesting to research how mask-wearing might have unique effects on people who struggle with social anxiety,” said study authors David A. Moscovitch, a professor of psychology at University of Waterloo, and Sidney A. Saint, an undergraduate psychology student. ​

Moscovitch and Sidney conducted an exploratory review to examine three aspects of social anxiety that they believed could be significantly impacted by mask wearing: hypersensitivity to social norms, a propensity for self-concealment, and biases in social and emotional feedback.

Those with social anxiety tended to experience heightened concerns that their appearance or behavior will fail to conform with social expectations and, consequentially, draw unwanted attention to themselves. Given the highly politicized nature of mask-wearing in some regions, Moscovitch and Sidney said, this hypersensitivity to social norms might pressure some people to either wear a mask or forgo wearing one.

“Research has shown that social anxiety is driven by the desire to behave in ways that conform to perceived social norms in order to avoid negative evaluation from others. When it comes to mask wearing, social norms around how we are expected to behave have begun to shift and are often unclear or uncertain,” the researchers explained.

“We found that this struggle may be amplified for people with higher social anxiety because shifting norms heighten the fear of making a mistake and being judged negatively by others. In this respect, it is important to note that mask-wearing norms can differ community by community.”

The review also demonstrated that those with social anxiety have a heightened tendency to conceal information about themselves from others, including signs of their anxiety. In addition to preventing the spread of COVID-19, those with social anxiety may view masks as a convenient way to hide perceived flaws.

“Our review also suggested that people who struggle with social anxiety may feel reluctant to take their masks off even if it’s crystal clear in certain contexts that masks are unnecessary, because masks may have made them feel safe during the pandemic, not only as a way to prevent contagion but as a way of concealing their visible signs of anxiety or perceived flaws in physical appearance. Without the mask, they may experience greater fears that those flaws will be on full display again for other people to judge them,” Moscovitch and Sidney told PsyPost.

Previous research has also indicated that people with social anxiety have difficulty detecting ambiguous social cues and are more likely to interpret them negatively.

“Finally, although people with higher social anxiety may be tempted to keep wearing masks, our research suggests that masks make it more difficult for others to identify people’s facial cues that tell us what they’re thinking. Are they being friendly or critical or something else?” Moscovitch and Sidney explained.

“In our review, we highlight research suggesting that people with social anxiety often experience difficulties interpreting ambiguous social cues and are likely to fill in the ambiguity with negative interpretations.”

The review provides clinicians with insight into how the new cultural phenomenon might be impacting their patients with social anxiety. However, Moscovitch and Sidney emphasized that empirical research is needed to directly study the issue. The findings from the review help to provide a roadmap for that future research.

“A major caveat of our paper is that it is a review paper, meaning that it is based on prior research and is therefore speculative in nature (we did not assign people to wear a mask or not wear a mask and then measure their levels of social anxiety),” the researchers said. “Amongst other things, what the ultimate effects of mask-wearing on social anxiety are — including their direction, magnitude, and timeline — is a question that remains to be addressed experimentally.”

The researchers also noted that people with social anxiety may have taken comfort in the relative lack of social interaction during the COVID-19 pandemic. But they cautioned that engaging in unnecessary stay-at-home behaviors could exacerbate anxiety.

“For the past year and a half, we’ve been in this weird period of forced avoidance and distancing and isolation from others. Avoidance is the best friend of anxiety — the two go hand in hand and the relationship goes both ways,” Moscovitch and Sidney told PsyPost.

“Although coming out of this period of forced avoidance and adjusting to the new normal may feel anxiety provoking for all of us, it may feel especially anxiety provoking for people who have struggled with social anxiety, as the period of forced avoidance from the usual social obligations and pressures may have felt especially comforting for them.”

“Our advice is ‘as long as it’s safe to be with others, don’t avoid it.’ As long as public health guidelines allow for it, people should try to push themselves to get out there and be social again. Try to do something social every day, intentionally. Expect that it may be hard, so begin by easing into this challenge and starting small, for example by making eye contact with others and smiling,” the researchers said.

“Most people who try this will discover that most other people will return their eye contact and smiles and will want to connect after this long period of isolation. From there, people can move on to tackling more anxiety provoking situations like meeting up to have face-to-face conversations with others in person, attending a party, or going on a date. The more you practice, the easier it will get. Of course, all of this advice is contingent upon following public health guidelines.”

The study, “Effects of Mask-Wearing on Social Anxiety: An Exploratory Review,” was published June 1, 2021.