‘Caution fatigue’ could dent our efforts to stay safe

• Link to: Northwestern Now Story

As people enter what feels like the umpteenth week of social distancing and isolation with no end in sight, they may find it more difficult to stay on high-risk alert as “caution fatigue” sets in, says a psychologist from Northwestern University Feinberg School of Medicine.

A constant state of high alert floods the body with the stress hormone cortisol and can take a toll on our health, says a Feinberg integrative medicine expert. 

Jacqueline Gollan, associate professor of psychiatry and behavioral sciences at the Asher Center for the Study and Treatment of Depressive Disorders at Northwestern University Feinberg School of Medicine, and Dr. Melinda Ring, executive director of the Osher Center for Integrative Medicine at Northwestern University, are available for comment. Contact them via marla-paul@northwestern.edu. 

Q & A with psychologist Jacqueline Gollan and Dr. Melinda Ring:

What is caution fatigue? 

Gollan: “Whether it’s wearing masks or standing six feet away from people, caution fatigue is low motivation or energy to comply with safety guidelines. You could consider caution fatigue to be similar to a AA battery. Initially you may have been energized and positively focused on following pandemic-safety behavior. But as the virus has continued on, you may start to focus on the negative and feel physically or mentally depleted.

“Our lives are defined by our habits and routines, and thus, are hard to change. They connect us to a sense of normalcy and it is important to maintain a semblance of your previous schedule so as to not lose sight of your health goals. The things we miss, like playing and exercising, can still be rewarding but need to be redefined to meet pandemic safety guidelines.”

How does loneliness, stress and depression affect our decisions?

Gollan: “Emotions such as loneliness, depression or anxiety can blur our judgment on important safety-based decisions. Sadness is a common feeling in situations of dire circumstance and can produce problems in motivation, concentration and energy. Taking precautions for yourself or others seem like daunting tasks and could be ignored to cope with your situation.

“The COVID-19 pandemic has amplified our natural fears and we detect that things are uncertain. When we feel unsure, our predictions of the future are flawed. We underestimate threat, ignore situational hazards and we refuse to change our routines and goals. In a good decision, we seek to update and learn from current sources to optimize our rewards and minimize our losses. But uncertainty or fear push against our efforts to make good decisions. It is crucial that we recognize the threat of virus exposure accurately and adapt our lives to meet evolving safety standards.”

How do we combat caution fatigue?

Gollan: “Try to make a decision that maximizes your rewards (health) and minimizes your risk (exposure). Ask yourself, ‘What’s my goal? Can it be delayed?’ If not, what are the risks of this decision for myself and others?’

“Consider the value of being a good member of collective society, preserving health for yourself and family. It’s value-driven behavior and has an ultimate reward in caring for others and yourself.

“For some people, it’s hard to keep safe behavior in mind because they are either anxious, stressed, tired or depressed. Make sure you are doing things in your life that give you physical, emotional and spiritual energy. This is an unusual situation and it’s normal to feel upset. If you are feeling depressed, call your doctor for consultation.”

How does constant stress, and the resulting flood of the stress-hormone cortisol, affect the body?

Gollan: “Fear and stress can feel scary and raw.  All the systems of the body are affected by the stress-hormone cortisol, including the brain, the cardiovascular system, the gastrointestinal tract. Some symptoms include chest pain or tightness, insomnia, headaches or migraines, loss of sexual interest, weight gain or muscle tension. Changes can occur all over the body.”

Dr. Ring: “The human nervous system functions on a continuum between our sympathetic (fight or flight) and parasympathetic (rest and digest) systems.  A balance between sympathetic and parasympathetic activity is critical for our long-term physical and psychological health. 

“Cortisol is an essential hormone released daily, with levels peaking in the morning to facilitate waking and declining gradually throughout the day. Cortisol has diverse critical functions including maintaining blood glucose, ensuring energy gets to vital organs and acting as an anti-inflammatory chemical. It is also, notably, one of the key players in the stress response. 

“In the presence of a physical or psychological threat, our cortisol levels surge to provide the energy and fuel necessary to be able to cope. This stress-induced increase in cortisol secretion is adaptive in the short-term. Think of needing to cram for an exam or run away from a vicious animal. The problem is when we send repeated and prolonged signals to our body that we are in distress. Over the long term, excessive or prolonged cortisol secretion may have destructive effects, both physically and psychologically.

“Chronic activation of the stress response and repeated surges of cortisol result in cortisol dysfunction. Studies have shown that recurrent negative thoughts, rumination or worry, and helplessness in response to stressful situations may prolong cortisol secretion, contributing to ultimate dysfunction.

“Our current situation in the COVID-19 era, in which the world is dealing with uncertainties and fears with an unclear end in sight, is a set-up for cortisol dysregulation and its sequelae, including depression, immunocompromise and a poorer overall quality of life.” 

How can we quiet our chronic stress response reduce the negative effects of chronic cortisol activation? 

Dr. Ring: “Fortunately, there are strategies we can implement to quiet our chronic stress response and reduce the effects of chronic cortisol activation. Some science-based strategies include:

1. Shift your mind and body through gratitude practices. The simple act of acknowledging the good in your life can have profound impact, modulating our heart rhythm and brain activity in ways that promote positive mental and physical well-being.
2. Physical activity generally helps to cope with harmful stress and thus contributes to better health and quality of life. Regular movement-- whether going for walks or doing all-out boot camps-- improve resilience, mood and our ability to cope with stress.
3. Mind-body practices are the antidote to balance out the ongoing activation of our stress response by nurturing the parasympathetic side of our autonomic nervous system. There is a potpourri of options so you can experiment to find what feels like the best fit. Examples include mindfulness or mantra meditation, guided imagery, tapping (Emotional Freedom Technique), breathwork and moving meditations like Tai Chi and yoga. 
4. Feed your zen. Fueling your body with amino acids, healthy fats and vitamins and minerals helps the body bounce back when under attack. Processed foods, sugar and overall excess (of calories, caffeine, alcohol) on the other hand creates more oxidative stress and hormone swings in the body.”