PTSD: National Center for PTSD

Increasing Veterans' Comfort with Wearing Face Masks During Coronavirus (COVID-19): Tips for Providers

Veterans are being asked to wear masks over their noses and mouths to help stop the spread of the virus that causes COVID-19. Even as Americans are being vaccinated, the recommendation to wear masks to prevent the spread of COVID-19 might last a good deal longer. If Veterans find it difficult, there are some things providers can suggest to help them become more comfortable.

Possible Reasons for Discomfort with Masks

• Physical reactions. Veterans may have physical reactions when wearing masks, such as lightheadedness and changes in breathing. They may feel claustrophobic—especially if they are not used to covering their nose and mouth. Veterans may become frustrated, feel unsafe, or feel pain due to wearing a mask for a long period of time. This may be especially true if their mask makes their eyeglasses fog up, blocks their vision or irritates their skin.
• Difficulty communicating. Masks can muffle voices and make reading facial expressions challenging. This might make the Veteran feel frustrated, confused or potentially unsafe.
• Novel experience or social pressures. Veterans may feel anxious or strange wearing a mask because it is new. They may also worry about what other people think of them.
• Questioning requirements or expectations for wearing face coverings. Veterans may feel upset or resistant because they, or those they care about, believe masks are unnecessary. Or Veterans may feel having to wear masks infringes on personal rights.
• Concerns about bias. If Veterans feel they face cultural bias due to their race, ethnicity or for other reasons, they may believe wearing masks will make it worse.

What Happens When Veterans Feel Uncomfortable or Distressed Wearing a Mask?

When people are uncomfortable wearing masks, they may feel the need to totally or partly remove them. They may even leave the situation where masks are required. Avoiding situations where wearing masks are recommended or required may make wearing a mask even more challenging over time. If many people avoid using masks, it raises the risk that COVID-19 will spread. On a personal level, it may prevent Veterans from doing things they need to do, like grocery shopping or going to work or the doctor.

Strategies to Help You Feel More Comfortable Wearing Masks

Practice wearing masks

Create a plan and schedule for Veterans to wear their mask in order to gradually learn to become more comfortable. Over time, Veterans can transition from wearing a mask while sitting at home for a few minutes to wearing it in public settings for longer periods of time. Some suggestions providers can make to Veterans are as follows:

• Gradually transition to wearing your mask securely. At home, start by holding your mask to your face. Next, gradually transition to putting it on loosely and eventually to attaching it securely.
• Gradually increase time. Wear your mask for 5 minutes and then increase the time by 5 minutes. Do this step by step until you can wear your mask comfortably for as long as you need to wear it.
• Gradually change location. Wear your mask at home for your first few practices. Gradually transition to your neighborhood and other public areas.
• Gradually increase activity. Wear your mask while sitting still initially. Over time, increase your activity (sitting, standing, going for a walk, talking with others).

If the Veteran finds a practice session difficult, repeat that session or lower the intensity and try again.

Choose meaningful and reassuring thoughts to help with any difficulty wearing a mask

Thoughts are powerful and directly influence emotion. Have Veterans notice when they have negative thoughts about wearing masks and practice using positive thoughts instead. For example:

• "I am breathing all of the air that I need while wearing my mask."
• "Wearing a mask can be difficult for anyone. It will start to feel more normal over time."

Remember there are larger values and goals for wearing a mask

Focusing on Veterans' larger values and goals for wearing a mask can help them to shift perspective and wear masks more comfortably. For example, providers can suggest Veterans consider the following thoughts:

• "Wearing a mask is a two-way street. It helps protect me and my community from COVID-19."
• "Wearing a mask will allow me to go grocery shopping and take care of my family."
• "Wearing a mask might be easier if you think about it as part of your mission."

Use distraction, relaxation, or mindfulness techniques while wearing a mask

Examples include suggesting that Veterans:

• Do something distracting to shift their focus, such as listening to music, planning their next meal, or intentionally focusing on the task in front of them.
• Learn and practice a relaxation or mindfulness exercise that they can use while wearing their mask. For example, practice slowed breathing: take a normal inhale breath and exhale slowly over 5 seconds while thinking of the word "calm."
• Try a mobile app like COVID Coach or Mindfulness Coach to help them practice self-care. Veterans can learn more about free mobile apps that they may find helpful.

Check the fit of their mask and try different types of masks made from breathable material

Suggestions for Veterans are to:

• Consider buying a cloth mask using a design or fabric they enjoy.
• Try masks with head ties and ear loops to see which they prefer.
• See CDC's Guide to Masks.

Seek support

Suggest to Veterans that they talk with support networks about difficulties wearing masks. Remind Veterans they can contact their health care provider if they are having trouble with wearing masks, especially if they have any medical or mental health conditions.