According to a recent opinion poll, over 60 per cent of the population are anxious about the prospect of lifting the Covid-19 requirement to wear masks in community settings. Despite evidence that face coverings do not reduce the risk of viral transmission in real-world situations, and are associated with a range of negative consequences, it appears many people remain afraid of returning to a normal life with their face exposed.

While initiatives like the Smile Free campaign push for the removal of all mask mandates, how can we ease the widespread apprehension about re-engaging with our fellow human beings without hiding behind pieces of cloth or plastic?

Persisting with a face covering will prolong, rather than lessen, people’s anxieties

It has sometimes been suggested that continuing to wear face coverings can reassure people that they are safe to return to shops, restaurants, and other community venues. In their response to an anti-mask petition, the government argued that masks can give people “more confidence” to return to the high street, and stated that the British Retail Consortium held a similar view. Labour’s shadow education secretary, Kate Green, recently made a similar claim when she stated that masks provide “reassurance”. But as any psychological therapist knows, persisting with a face covering will prolong, rather than lessen, people’s anxieties.

Masks act as a crude reminder that danger is all around, that we are all potential biohazards. So, on a common-sense level, continued wearing of them will exacerbate anxieties rather than reduce them. But there is another, less obvious reason why the continued use of face coverings is counterproductive as a means of promoting confidence and encouraging people to return to normality: masks will act as a “safety behaviour” that will prevent disconfirmation of anxious beliefs.

Let me explain.

Fear is the emotion that follows from a perception of threat. When a person believes that a situation is dangerous, or that something bad is about to happen, anxiety will ensue. If the perceived threat is an imminent and catastrophic one — “I’m about to die”, for example — extreme panic will follow. If the threat is less immediate and of lesser proportion — such as, “I might have cancer” — the subsequent emotion will be anxiety at moderate to high levels.

When patients with anxiety problems seek professional help, the therapists they see will usually try and identify these specific anxiety-laden thoughts of threat and collaboratively examine the evidence for and against them. In addition, the patient will be encouraged to stop avoiding the feared situations. This approach is usually effective, unless the patient is engaging in “safety behaviours”. A couple of examples — taken from my many years of work as a NHS clinical psychologist — will illustrate the power of these safety behaviours.

A 30-year-old man (I’ll call him Tom) suffered recurrent panic attacks when outside his home — such as when in busy supermarkets — underpinned by the thought, “I’m about to faint”. The anticipated humiliation of collapsing in front of many other people was very frightening to Tom and, as a result, he had stopped going out and had adopted an agoraphobic lifestyle. We worked together to test out his thoughts about fainting and found a wealth of evidence to refute it: he’d had a recent medical examination and was given the all clear; his doctor had repeatedly told him his blood pressure was fine; and we calculated he’d had the “I’m about to faint” thought on more than 300 occasions and it had never come true. In our sessions, Tom had also bravely worked at leaving his home more often. But despite these efforts, Tom continued to endure intermittent panic attacks associated with the thought he was about to pass out.

When talking in my office, he was convinced there was no likelihood of him fainting, but for a few seconds when outdoors in a crowd the threatening thought of imminent collapse continued to torment him. The breakthrough in therapy was when he divulged to me that he always put an extra couple of teaspoons of sugar in his tea prior to leaving his home so as “to reduce the likelihood of fainting”.

People who are uneasy about life returning to normal will only prolong their fears by continuing to wear masks

A 50-year-old university lecturer (I’ll call her Jenny) suffered high levels of social anxiety when teaching her students. When stood behind her lectern, she intermittently had a threatening thought — “I’m about to lose control” — and had scary images of her talking gibberish, flapping her arms around wildly and becoming unsteady on her feet, while visualising her student audience watching her crazy behaviour with amused amazement. These anticipated bouts of losing control had never occurred and she had — bravely — continued to deliver lectures several times per week. While talking to me in the therapy room, she recognised these episodes of losing control would never happen. Despite this knowledge, there were times mid lecture when she was convinced she was on the cusp of displaying crazy behaviour and she would suffer high levels of anxiety. Improvement in her social anxiety only followed once we explored in detail what she did when standing behind the lectern: she purposely gripped the sides of the lectern very tightly, while planting her feet — “like trees” — into the floor.

Tom and Jenny were purposefully deploying “safety behaviours” intended to avert their dreaded outcomes. Doing so was maintaining their fears because they prevented disconfirmation of the key beliefs underpinning their anxiety. When Tom didn’t faint in the supermarket he attributed this desired outcome to the extra sugar rather than concluding that he was at no greater risk of fainting than anyone else. When Jenny didn’t lose control in the lecture theatre, she believed it was because she had tensed her limbs.

In the same way that reductions in anxiety were achieved only after ditching the sugar (Tom) and stopping the deliberate tensing of muscles (Jenny), those people who are currently uneasy about returning to a normal lifestyle will only prolong their fears by continuing to wear masks. Those who mix with their fellow human beings, yet persist with this “safety behaviour”, will attribute their survival to the face covering rather than concluding that the risk of serious harm from Covid-19 is now within an acceptable-everyday range of a normal, worthwhile life.

All the more reason to join the Smile Free campaign to remove all mask mandates: to empower people to drop a safety behaviour — wearing a mask — that is maintaining widespread, irrational fear.