The COVID-19 pandemic has been global adversity for the past few years, affecting the world with its noxious symptoms, drastic changes, and extensive psychological impacts. The current study aimed to explore the lived experiences of Metathesiophobia or fear of change in the adult population of Pakistan during the COVID-19 pandemic. Participants were recruited within three categories, namely: i) participants who were themselves infected with COVID-19 (participants diagnosed; PD), ii) participants who were not infected themselves but their family members were infected with COVID-19 (participants with diagnosed family members; PDFM), and iii) participants who were neither themselves infected with COVID-19 nor their family members (participants not infected; PND); total six participants (two participants for each category) through purposive sampling technique were interviewed. Semi-structured interview approach was employed for data collection. Interpretative Phenomenological Analysis was undertaken to analyze the interviews. The super-ordinate themes that emerged from the analysis included: Challenges during COVID-19, fears during COVID-19 diagnosis, fears after recovery from COVID-19, and prospective concerns of trauma. The findings also revealed that lived experiences of people in the three categories of participants are almost the same. The implications of the study have been discussed.
Keywords: Fear of change, metathesis phobia, COVID-19 impacts, concerns after trauma, phenomenology
COVID-19 is a new, highly infectious coronavirus that has never been seen in humans before and causes potentially fatal respiratory problems (Rothan & Byrareddy, 2020). People's everyday lives have significantly and unexpectedly changed in a relatively brief time span during the COVID-19 pandemic. This has an impact on people's emotional and physical health (Schippers, 2020).
Like COVID-19, the pandemics of the past [Influenza A (H1N1; 2009), Avian Influenza A (H5N1; 2005-2006), and severe acute respiratory syndrome (SARS; 2003)] have triggered fears in people (Kelloway et al., 2012). Fear stems from a feeling of potential damage from an object, creature, or scenario (Oatley & Jenkins, 1996). According to Wenar and Kerig (2000), fear can be defined as “a normal reaction to an environmental threat. It is adaptive and even essential to survival because it warns the individual that a situation may be physically or psychologically harmful” (p.171). Metathesiophobia is the long-lasting, unusual, and unwarranted fear of change (Wordsense, 2020). Individuals naturally fear change, and when change is required, they sense a lack of control (Evans 2001). Eagle (1999) noticed that dread of the unknown significantly explains that people don’t change at all, or else don’t change rapidly. They are fearful about certain consequences of change, including threat, anxiety, and suffering. Senge and Kaeufer (2000) note that change initiatives can generate fear. Specifically, change processes that raise doubt about deep-rooted convictions, perspectives, and constant methods of conduct can be frightening. Uncertainty related to change can lead individuals to cling to old patterns of doing things (Kets de Vries & Balazs 1999).
People experienced changes regarding mental health (Brooks et al., 2020; Hawryluck et al., 2004; Mukhtar, 2020; Reynolds et al., 2008), physical health (Mao et al., 2020; Ren et al., 2020; Yang et al., 2020), daily lifestyle (Park et al., 2021), social life (Venuleo et al., 2020), personality traits (Brooks et al., 2020), financial status (Khan et al., 2021), occupation (Bai et al., 2004), and education (Okoloba et al., 2020), etc. during past pandemics and also during COVID-19 pandemic. Moreover, this research has highlighted that change initiatives can prompt fear. Specifically, change processes that raise doubt about deep-rooted convictions, perspectives, and constant methods of conduct can be frightening (Senge & Kaeufer, 2000). However, there is a lack of research on the fear of change that developed during or after the past pandemics or the COVID-19 pandemic as people experienced changes at different levels in different domains. Therefore, the current study aimed to explore the fear of change experiences of the people of Pakistan due to enormous changes during the COVID-19 pandemic.
The development of fear in relation to changes brought about by COVID-19 can be explained by the collaboration of certain theories (see Figure1). The Preparedness Theory (Seligman, 1971) postulates that fear develops when specifically only source/traumatic
incident of fear is a threat to the survival of the human species throughout evolutionary history. In the current study, the aim is to explore the fear of change experiences during the COVID-19 pandemic, and it was evident in the literature that this big change of COVID-19 impacted the survival value of humans.
The classical conditioning perspective of behaviorism also guides through its assumptions that learning can occur by associating a neutral stimulus with a natural stimulus (Pavlov, 1927). In the case of the current study, the natural stimulus which provokes fear is the virus of COVID-19, and hence the change that was brought about by the situation of COVID-19 also became fearful for the individuals, which was otherwise a neutral stimulus. The cognitive Vulnerability Model (Armfield, 2006) also stated that fear could be linked to the vulnerability schemas, i.e., perception of unpredictability and uncontrollability of the event, which can result in an undesirable outcome, which can then lead to disgust and danger. In the current study context, fear can be understood by the unpredictability and uncontrollability of the changes brought about by the COVID-19 pandemic and the feeling of disgust due to not being able to control the changes and uncertainty about the recovery from the situation.
Figure 1
Schematic Presentation of Theoretical Framework
Method
The current study is qualitative research, and phenomenological research design was employed in the current study to explore the experiences of people regarding Metathesiophobia (fear of change) during COVID-19. Phenomenology is concerned with individuals' subjective interpretation and perception (Stan, 1999). The qualitative research method was chosen for this study because it is particularly significant in exploring the meanings people give to the events they experience (Merriam, 1998). The qualitative researcher's concern is discovering clarification, understanding and exploring experiences in similar situations rather than looking for cause-and-effect relationships, prediction and findings’ generalization (Hoepfl, 1997). Particularly, the study aims:
- Exploring the experiences regarding Metathesiophobia or fear of change during the COVID-19 pandemic.
- Determining the differences in the Metathesiophobia (fear of change) experiences of people who directly and indirectly experienced COVID-19 virus
Participants
Six Participants with age ranged 20 to 39 years were recruited within three categories i) participants who were themselves infected with COVID-19 (participants diagnosed; PD), ii) participants who have not infected themselves but their family members were infected with COVID-19 (participants with diagnosed family members; PDFM), and iii) participants who were neither themselves infected with COVID-19 nor their family members (participants not infected; PND); the total number of six participants (two participants for each category) through purposive sampling technique. Literature provided evidence that this number of participants in studying the lived experiences in an emergent situation is appropriate (Pietkiewicz& Smith, 2014). In qualitative research, the sample size is usually small because the qualitative methods are mostly concerned with an in-depth exploration of the phenomenon or its meaning. Hence, an in-depth interview aims not to generalize the population but to make categories from the data and explore their relationship to understand the participants' lived experiences (Charmaz, 1990, p. 1162). The inclusion criterion was set only as those individuals who fell within the three categories mentioned above and were adults.
Semi-Structured Interview Guideline
An interview guide was established for the purpose of data collection because interviews are significantly used for “studying people’s understanding of the meaning in their lived world” (Kvale, 1996, p. 105). The interview guide consisted of 13 open-ended questions, which were formed based on the past literature and theoretical models and validated by Ph.D. experts in the relevant field. Probe questions were also included along with the main questions, as they seemed essential during the pilot study. A consent form and demographic sheet were attached with the interview guide to take consent from the participants and collect information about the participants, respectively.
The semi-structured interview approach was used to interact with the participant during interviews. The semi-structured interview consists of open-ended questions, giving participants more room to describe what they consider important (Strauss & Corbin, 1998) and partial control over the direction of the interview (Mishler, 1986). The interview started with more general questions and then moved toward specific questions related to the situation. The interview was opened with the question, “How do you generally view changes in your life?” Then the questions were included about the type of changes that the participants had experienced during the COVID-19 pandemic, such as “Have you noticed any changes in your daily life due to COVID-19?”, “Have you noticed any changes in yourself during COVID-19?” as well as similar questions were added regarding occupation, education, social relations etc. Then questions were added inquiring about the feelings of transferring the virus, such as “If you yourself were infected with COVID-19, what were your feelings about the virus being passed on to someone else?” In the end, a future-oriented question was added, i.e. “When the COVID-19 situation gets better, would you like to live your life like it was before COVID-19, or do you want to continue the same life you are living right now?”
Procedure
At first, the interview guide was developed based on past literature and theories. After formulating the questions, their relevance was reviewed by two Ph.D. experts in the field of Psychology. Then a pilot study was conducted to assess the validity of the research instrument. Three participants, one for each of the three categories, were approached in the surroundings for the purpose of a pilot study. Based on the pilot study, some of the questions were removed, which seemed repetitive or irrelevant; also, some new questions were added, which seemed necessary while taking the interviews. After making these changes, again, the feedback was taken from the same Ph.D. experts in the field. Then the interview protocol was finalized in consultation with the supervisor; after that, permission was allotted to conduct interviews.
Interviews were taken face to face as well as on the phone, as some of the participants requested because they were uncomfortable in face-to-face interaction due to the COVID-19 pandemic. Initially, the participants were informed about the purpose and nature of the study as well as other ethical standards such as confidentiality, the right to withdraw, and permission for audio recording and then consent was taken from them. Additionally, their demographic information was collected. After that, the interview questions were asked of the participants. The interviews were almost 25-30 minutes long. At the end of the interview, the participant was appreciated for his/her participation in the current study. All the interviews were audio recorded with the permission of the participants.
Results
For the analysis of the results, the phenomenological method was used. This approach is useful in studying a small number of subjects, as in the current study, it is 6 participants to determine the core of their experiences regarding the phenomenon under study (Creswell, 2003; Pietkiewicz & Smith, 2014). The aim of interpretative phenomenological analysis (IPA) is to explore in detail how participants make sense of their personal and social world. The main currency for an IPA study is the meanings particular experiences, events, and states hold for participants. By following the Interpretative Phenomenological Analysis (IPA) method, the interviews were first transcribed, read again and again to gain an understanding of the verbatim, and then the participants' verbatim were given initial meanings by the researcher. In the next step, the initial meanings which appeared to give the same meanings were merged to form combined meanings. The combined meanings were then arranged based on their similarities to form subordinate themes from the data. Finally, the subordinate themes which appeared to fall under one perspective were joined to develop superordinate themes of the data. For establishing the validation of the themes, the study's participants were again contacted for their feedback regarding the interpretation done and themes developed by the researcher to match their relevancy with the participants' verbatim. This process is called respondent validation. The articles were then reviewed by the same Ph.D. experts who validated the interview guide (peer review). The themes were then finalized in consultation with the supervisor.
Role of the Researcher
The researcher is the primary research instrument in qualitative research. As qualitative research requires the interpretation of data as part of the analysis, the researcher's biases, assumptions, and beliefs can interfere with the analysis of results (Strauss & Corbin, 1998). Hence, social researchers should take responsibility for disclosing their biasedness in the study to neutralize and distinguish its effects (Altheide & Johnson, 1994). The researcher of the present study acknowledged that her personal and work background could influence her interpretation of data. The researcher’s experience of having family members infected with COVID-19, going through the situation of complete lockdown, and experiencing changes in life herself could bias her interpretation of the study results.
To minimize the researchers’ bias regarding the results of the current study, the researcher constantly paraphrased and summarized the information to ensure accuracy. Then, the transcription and initial meanings of the interviews were rechecked by other fellow students. In addition, throughout the study, the researcher takes consultation from a supervisor, faculty advisors and other resources. The researcher developed the themes from the data with the help of the supervisor, who guided the researcher to focus on relevant details of the interviews and participants for this purpose.
Findings and Discussion
The analysis of adults’ experiences regarding Metathesiophobia during COVID-19 yields various themes. Major or super-ordinate themes emerged from the analysis of experiences, including challenges during COVID-19, fears during cOVID-19 diagnosis, fears after recovery from COVID-19, and prospective concerns of trauma. These major themes further consist of various sub-themes which are clustered together based on similarity in domains (see Figure 2).
Figure 2
Figure Showing Major Themes Emerged from the Study
Challenges during COVID-19
The participants of the study reported that they experienced several challenges during the COVID-19 pandemic. Some of the significant challenges for people during COVID-19 were related to problems faced by people due to following SOPs as they have to be away from their friends, annoyed by wearing masks and sanitization, and concerned about ways of greeting others and maintaining a social distance. As one of the infected participants (PD1) stated:
“It was problematic that you can't go out withfriends because of corona.”Also, one of the participants with a diagnosed familymember (PDFM1) explained:“It was always difficult to sanitize all the time. Ontop of it; its smell was so bad”.Another participant who was not infected (PND1) stated:“When the situation got a little better, I startedgoing out and was very concerned about how to meet everyone, whether to shakehands or not.”“Despite that, I had a realization, but I stillcouldn't control myself because we weren'tused to social distancing. It just happensunintentionally that we can't keep up.”
These findings align with a previous study reported in Italy, which indicated that people experienced anxiety following the execution of lockdown measures (Rossi et al., 2020). A study also supported these findings of the study during COVID-19 by Fura and Negash (2020), which determined that people experienced detachment from social gatherings. A previous study concluded that the health care workers during the pandemic of Influenza were always affected by wearing protective kits (Corley et al., 2010). Social distancing, self-isolation, quarantine, and many other factors affect the psychological and mental health of the population (Banerjee & Rai, 2020; Mukhtar, 2020).
Another challenge for some people was the worsening of their pre-existing problems. Such as a diagnosed participant (PD1) narrated:
“I had insomnia before COVID-19, but what is happening now is severe. Things are getting severe day by day”.
Similar findings were reported by previous studies indicating that patients with a previous disorder, for example, anxiety, may worsen their symptoms during the pandemic (Bystritsky et al., 2020). Similarly, Varshney et al. (2020) concluded that individuals with previous physical illnesses were much affected by the COVID-19 pandemic in India.
Similarly, some people face problems related to their education. As one of the non-diagnosed participants (PND1) said:
“I had a hard time dealing with studies. I could not concentrate at all”.
This current study's finding is in accordance with a study by (Fura & Negash, 2020), indicating that anxiety enhances in students due to the altered academic methods and activities.
Another significant challenge for people was their concern about their vulnerability to COVID-19 infection. The participant who was not diagnosed (with PND1) reported:
"When my father or someone at home had to go to the hospital, I was very worried that my family or I would not be infected.”
Previous research also indicated that people reacted to epidemics with avoidance and safety behaviours, including avoiding going to crowded places, hospitals etc. (Lau et al., 2010).
Moreover, recovery from the COVID-19 situation was also a challenge for people in Pakistan. The participant with diagnosed family member (PDFM2) stated:
“Then suddenly, they changed shifts and opened universities and colleges. When we went to school after a time, it became very difficult to teach children face to face.”
This finding can be explained by the fact that people had feelings of uncertainty about recovery from the COVID-19 pandemic (Gunnell et al., 2020; Rahman et al., 2020) and its revival in the form of some new variants, and they found it difficult to repeatedly change their habits, so people want to be on the save side and did not make much effort to return to normal ways.
Fears during COVID-19 Diagnosis
People experienced certain fears during the COVID-19 diagnosis. The fear was not only experienced by the people who were infected but also by the people whose family members were infected and also by those who did not directly experience the situation of infection. The people were fearful about getting infected by COVID-19. People were afraid of touching anything due to the fear of contracting the virus. Due to the fear of infection, people feared taking their masks off even when they felt suffocated. Moreover, people feared going to the hospital because they feared contracting the virus, as the hospital was the most vulnerable place during the pandemic. As one of the participants with a diagnosed family member (PDFM1) said:
“It is frightening to touch somewhere due to fear of getting infected.”
The participant who was not diagnosed (PND1) stated:
“It was scary to take off the mask, so even if I took it off in a situation like I had suffocation, then it felt like I would get COVID virus, so I was very scared to go out.”
“In the days of COVID-19, whenever someone went to the doctor, when he came back, there was a panic in the house because the hospital was a very vulnerable place.”
These results are in line with previous research indicating that fear of being infected with COVID-19 infection and passing it on to other family members was the reason for people’s poor well-being during the COVID-19 pandemic (Khan et al., 2021). Moreover, this current study finding is supported by the preparedness theory of phobia, which postulates that individuals develop a fear of objects and situations that threaten human survival (Seligman, 1971).
Some people also developed a fear of death during COVID-19. Also, people were afraid of breathing difficulties which were the symptoms of COVID-19 infection. One of the participants who was infected with COVID-19 reported:
“I was scared for my life. Before going to bed; I was afraid of whether I would wake up or not”.
Another participant with diagnosed family member (PDFM1) stated:
“The breathing problems made me very scared.”
In accordance with this finding, Gardener and Moallef (2015) concluded in their study that after the pandemic of SARS, the fear of survival was present among people, along with many other symptoms. Similarly, Bortel et al. (2016) explored the impacts of the Ebola virus and concluded that death anxiety among people affected them psychologically.
Some people were following SOPs only because of the fear of COVID-19 infection. People developed the habit of hand washing and sanitizing because of the fear of COVID-19. People avoided going out even when necessary and limited their work due to this fear. As the participant with diagnosed family member (PDFM1) stated:
“There was a little bit of fear in everything inside me; I was scared, so these two habits have developed a lot, washing hands and sanitizing.”
Similarly, one of the non-diagnosed participants (PND2) reported:
“Going out creates a generalized fear in me. We have limited the work for the same reason”.
These findings of the current study are supported by the previous research of Balkhi et al. (2020), which indicated that the Coronavirus had caused psychological problems such as increased anxiety, fear and behavioral changes in order to maintain their safety.
Fear after Recovery from COVID-19
The people were not only afraid during the COVID-19 diagnosis but also fearful after recovery from it. After recovery from COVID-19, people were afraid of their changed physical states, energy level and stamina. People were concerned about their persisting weakness after COVID-19, as many people suffered from trembling and sweating even after recovery from COVID-19. The non-infected people also got fearful by seeing the physical conditions of infected others. Another significant fear of people after recovering from COVID-19 is related to long-lasting breathing problems. As one of the diagnosed participants (PD1) reported:
“Three-and-a-half months after recovery from COVID-19, I travelled for the first time outside the city to meet a friend, and I had to climb the stairs to the third floor, so by reaching the third floor, the pain started in my chest, and my breath was heavy. I used to enjoy cycling and to hike a lot - so I was very worried about whether I would be able to do it again.”
Another diagnosed participant (PD 2) said:
“I was afraid of what would happen if I kept breathing with this difficulty.”
Similarly, one of the participants with a diagnosed family member (PDFM 1) reported:
“The weakness that remains after that, I have never seen such weakness in my life.”
“I was not afraid about myself, but it was painful to see others suffering physically.”
Another participant with a diagnosed family member (PDFM 2) stated:
“Our mindset has changed totally that now we don't want to meet anyone and shake hands. So the eating is affected because of the fear of contracting COVID-19 as someone would have already touched our food and we would be infected if we eat that”.
Previous studies also indicated that the people infected with COVID-19 experienced fatigue even after recovering from the infection (Carfì et al., 2020; Menges et al., 2021). Another research indicated that people experienced post-COVID-19 syndrome with symptoms including fatigue, chest pain, sleep, and memory problems and disturbed concentration (Mahmoud et al., 2021). Rachman’s (1998) perspective of vicarious acquisition of fear states that fear of an object or situation can develop by only looking at other people's emotional reactions to the stimuli without having direct experience with it. This perspective is in accordance with the current study's finding that people were afraid of seeing the physical conditions of those affected with COVID-19 infection.
Moreover, people were also fearful about their changed social life and relationship patterns after recovery. People were fearful of the thought that they would never meet the people who were far away. People feared that social life would not be every day again and that they would all die like this without meeting others. Moreover, people now remain fearful of COVID-19 during travelling also. Such as a participant with a diagnosed family member (PDFM 1) narrated:
“It seemed to me that we can never meet those who are far away from us. It was as if those who were far away would always remain distant, and we had to die like this”.
The participant who was not diagnosed with COVID-19 (PND 1) stated:
“Now we remain afraid of corona even during travelling.”
A previous study by Alzueta et al. (2021) supported this finding by suggesting that separation from close friends and family members was anxiety provoking for individuals. Another research has revealed that the actions by the government concerning spatial distancing could cause psychological distress and fear (Ahorsu, 2020).
Prospective Concerns of Trauma
As COVID-19 was a traumatic situation for those who were infected as well as those who were not infected with it, so all people had various concerns about their way of living after the end of the COVID-19 traumatic situation. Different people have different concerns, but there were some issues which all the participants faced, such as after passing through the traumatic situation of COVID-19, the reaction or feelings of people regarding change got altered. People become fearful of any negative change in future. People would not be able to survive any negative change in the future, and it would affect their mental health. According to participants, future positive changes would not be long-lasting due to experiencing negative changes during COVID-19.
Moreover, changes after COVID-19 would be depressing and anxiety provoking for some people. Any change after being infected with COVID-19 affects mood and temperament. As one of the diagnosed participants (PD 1) stated:
“If there is a big change and I can't contribute to it, or it’s not in my control, then I try to ignore it. I used to do it before, but now the intensity is more”.
Also, another diagnosed participant (PD2) mentioned:
“I have to be very defensive for any negative change that comes now. It gives depression and stress.”
Similarly, a participant with a diagnosed family member (PDFM 1) also reported:
“To be very honest, we are so fed up with Covid that we do not have the courage to imagine another worst change. If something like this happens, then I don't think I will be able to survive."
The work on the alterations in reaction to change after trauma is scarce, but still, there are studies that can be supportive. Center for Substance Abuse Treatment (US; 2014) suggested that people’s beliefs about their future get affected by trauma, such as losing hope, fear that life will end shortly, their expectations from life get limited, and expect that the normal way of life will not return etc.
Another perspective concern of people after COVID-19 trauma was about the return of social gatherings. The people want social gatherings to be part of their life again. They want to meet others without being afraid of getting infected with the COVID-19 virus. As the infected participant (PD 1) reported:
“Social gatherings are a very important part of life, and I think they should come back.”
Also, one of the participants with a diagnosed family member (PDFM 1) stated:
“We want to meet others without fear.”
This finding of the current study can possibly be explained by the fact that people could no longer follow the measures of restricting social gatherings, as it was indicated in the previous research that social alienation had impacted the psychological and mental health of the population (Mukhtar, 2020), so the people want to freely meet their loved ones to make their mental health better.
Another main concern of people had their previous lives back. People want to spend their lives as they used to before COVID-19. People wanted to have a life without fear of corona, in which they were energetic and social. As a diagnosed participant (PD 1) mentioned:
“I would like to return to my previous state.”
Similarly, a participant with a diagnosed family member (PDFM 2) stated:
“I want the previous life to be returned. The self of mine, which was energetic, happy, and social, should come back."
Life with COVID-19 was not preferred by people. They consider life with COVID-19 as unfavorable. People consider life with COVID-19 very different from the previous one. Life with COVID-19 had restrictions like jail. People wanted to eradicate COVID-19 time period from their lives. People want to live fear-free life again, which was not possible during the COVID-19 pandemic. As one of the participants with a diagnosed family member (PDFM 1) stated:
“This life is like jail. It’s very difficult to spend life like this”.
Another participant with a diagnosed family member (PDFM 2) narrated:
“I want to eradicate these two years of COVID-19 from my life”.
These findings of the current study are in accordance with past research, which indicated that people are most likely to persevere in old patterns of thinking and behaviour because of the insecurity due to change (Kets de Vries & Balazs, 1999).
Comparison
The result of the current study shows that the three categories of participants, i.e., the diagnosed participants (PD), the participants with diagnosed family members (PDFM) and non-diagnosed participants (PND), reported different experiences in relation to the themes of the study.
The significant findings of the current study indicate that the challenges during COVID-19 were reported more by the participants whose family members were infected and those who were non-infected as compared to infected participants. Such as the educational problems faced by non-diagnosed participants and those with family members infected. Another significant finding of the current study indicates that only the non-diagnosed participants were concerned about their vulnerability to infection. Moreover, the difficulty in recovery was only reported by participants with diagnosed family members. A survey posted in South China Morning Post (Jen-siu Michael, 2003) indicated that people who have seen their friends or family members being infected with SARS infection and those who live in high-vulnerability areas were reported to have developed more problems. However, in the current study, the diagnosed participants only experienced the severity of previous illnesses.
Another significant difference between sample categories is that the fears during COVID-19 were reported most by the participants whose family members were infected and those who were non-infected as compared to infected participants. The fear of getting an infection was most prevalent in participants with diagnosed family members, followed by non-diagnosed and, as a result, followed precautions. Previous studies indicated that people who have acquaintances affected with COVID-19 reported more depression and anxiety (Mazza et al., 2020; Majeed et al., 2021; Passavant et al., 2021). However, the fear of death was only prevalent in participants who were infected with COVID-19 themselves. Previous research indicated that the people who were quarantined in the past pandemics and outbreaks reported to have experienced more depression, anxiety and other psychological problems as compared to non-quarantined people (Brooks et al., 2020, Hawryluck et al., 2004; Holmes et al., 2020; Jeong et al., 2016). Moreover, the breathing difficulties were fearful for the infected individuals as well as people with infected family members. Also, both the infected and non-infected participants were concerned for vulnerable populations in society.
Another significant finding of the current study indicated that infected people reported fear about changes in physiological state after COVID-19 but not about social life; however, the non-infected people were fearful about changed social life after COVID-19 and not the physiological conditions. This finding of the current study is supported by the fact that the infected people have gone through the physiological symptoms of COVID-19, which are persistent even after recovery. The non-infected people were concerned about the environmental and social conditions that were the consequences of the worldwide COVID-19 pandemic.
The participants of all categories reported altered or negative reactions toward future changes after passing through COVID-19 trauma. Participants of all the categories reported that life with COVID-19 was unfavorable, and they wanted their previous life back. However, unlike non-infected people, the people who have infected themselves and those with infected family members reported that they want the return of social gatherings in their lives.
Limitations and Suggestions
There are certain limitations of this study. The mode of the interview taking was not the same for all the participants. Interview with three of the participants was done face to face, but the other three participants did not allow to meet in person due to the prevailing situation of the COVID-19 virus. Additionally, the sample of the study consisted of participants living in the urban area of Pakistan and not from rural areas, as it was feasible for the researcher. So, future researchers should consider people from different areas of living in terms of Metathesiophobia experiences during COVID-19. Moreover, comparisons based on other demographics and cultural contexts can be carried out.
Furthermore, the research should also focus on the post-traumatic growth of people in reference to COVID-19, as it is evident through literature that people become more spiritual after surviving traumas. Also, COVID-19 is itself a traumatic experience, and people’s attitudes and habits have changed a lot during this period.
Implications
The study yields very informative findings, which can be a basis for future research. This study will enhance the present body of literature on fear of change experiences during pandemics and compare the different categories of people. The study was required to better understand the psychological mechanism operating during COVID-19 i.e., how people were affected by this phenomenon and how they were dealing with it. This exploration will provide a proper direction to mental health professionals in developing the intervention plans that are required to deal with the issues faced by people during this pandemic and similar situation in future. It can help counsellors develop prevention strategies to psychologically protect people in case of future encounters with pandemics, outbreaks, and similar situations. The other unique aspect of this study is that it also provided information about the participants' concerns after the pandemic ended, which can help the government policy-making process to ensure the type of living conditions that the members of society expected after the end of the COVID-19 pandemic.
Conclusion
People experienced several challenges and fears during and after the trauma of the COVID-19 pandemic. In the current study, people reported developing certain fears while passing through the period of COVID-19 as well as after this period ended. Moreover, people have also developed fear in relation to future negative changes after passing through the traumatic situation of the COVID-19 pandemic. People want to have their previous lives back without the changes brought about by the pandemic of COVID-19. Furthermore, there was little difference in the types of experiences of people who were directly infected with COVID-19 and of those who were indirectly affected by COVID-19 virus as having family members infected and those who have neither infected themselves nor their family members.
References
Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M., Griffiths, M. D., & Pakpour, A. H. (2020). The fear of COVID-19 scale: Development and initial validation. International Journal of Mental Health and Addiction, 1-9
Altheide, D. L., & Johnson, J. M. (1994). Criteria for assessing interpretive validity in qualitative research. In N. K. Denzin, & Y. S. Lincoln (Eds.), Handbook of qualitative research (pp. 485-499). Thousand Oaks, CA: Sage Publications, Inc.
Alzueta, E., Perrin, P., Baker, F. C., Caffarra, S., Ramos‐Usuga, D., Yuksel, D., & Arango‐Lasprilla, J. C. (2021). How the COVID-19 pandemic has changed our lives: A study of psychological correlates across 59 countries. Journal of Clinical Psychology, 77(3), 556-570.
Armfield, J. M. (2006). Cognitive vulnerability: A model of the etiology of fear. Clinical Psychology Review, 26, 746-768. doi:10.1016/j.cpr.2006. 03.007.
Bai, Y., Lin, C. C., Lin, C. Y., Chue, C. M. & Chou, P. (2004). Survey of stress reactions among healthcare workers involved with the SARS outbreak. Psychiatric Service, 55(9), 1055-1057.
Balkhi, F., Nasir, A., Zehra, A., & Riaz, R. (2020). Psychological and behavioural response to the Coronavirus (COVID-19) pandemic. Cureus, 12(5), e7923.
Banerjee, D., & Rai, M. (2020). Social isolation in COVID-19: The impact of loneliness. The International Journal of Social Psychiatry, 66(6), 525-527.
Bortel, T., Basnayake, A., Wurie, F., Jambai, M., Koroma, A. S., Muana, A. T., Hann, K., Eaton, J., Martin, S., & Nellums, L. B. (2016). Psychosocial effects of an Ebola outbreak at the individual, community and international levels. Bulletin of the World Health Organization, 94(3), 210-214.
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet, 395(10227), 912-920.
Bystritsky, A., Vapnik, T., Maidment, K., Pynoos, R. S., & Steinberg, A. M. (2000). Acute responses of anxiety disorder patients after a natural disaster. Depression and Anxiety, 11(1), 43-44.
Carfì, A., Bernabei, R., Landi, F., & Gemelli (2020). Persistent symptoms in patients after acute COVID-19. JAMA, 324(6), 603-605.
Center for Substance Abuse Treatment (US). (2014). Trauma-Informed Care in Behavioral Health Services. Rockville (MD). Substance Abuse and Mental Health Services Administration (US); (Treatment Improvement Protocol (TIP) Series, no. 57).
Charmaz, K. (1990). 'Discovering' chronic illness: Using grounded theory. Social Science & Medicine, 30(11), 1161-1172.
Corley, A., Hammond, N. E., & Fraser, J. F. (2010). The experiences of health care workers employed in an Australian intensive care unit during the H1N1 Influenza pandemic of 2009: A phenomenological study. International Journal of Nursing Studies, 47(5), 577-585.
Creswell, J. (2003). Research design: Qualitative, quantitative and mixed methods approach (2nd ed.). Thousand Oaks, CA: SAGE Publications.
Eagle, M. (1999). Why don’t people change? A psychoanalytic perspective. Journal of Psychological Integration, 9(1), 3-32.
Evans, E. A. (2001). Executive commentary. Academy of Management Executive, 15(4), 94-95.
Finlay, L. (2011) Phenomenology for psychotherapists: Researching the lived world. Wiley-Blackwell, USA.
Fura, D. L., & Negash, S. D. (2020). A study on the living experiences of people during the COVID-19 pandemic: The case of Wolisso town home stayed university students. Journal of Psychology and Psychotherapy, 10(3), 84. doi:10.35248/2161-0487.20.10.3 84
Gardener, P. J., & Moallef, P. (2015). Psychological impacts on SARS survivors: Critical review of the English language literature. Canadian Psychology/Psychologie Canadienne, 56(1): 123-135.
Gunnell, D., Appleby, L., Arensman, E., Hawton, K., John, A., Kapur, N., Khan, M., O'Connor, R. C., & Pirkis, J. (2020). Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatry, 7(6), 468-71.
Hawryluck, L., Gold, W. L., Robinson, S., Pogorski, S., Galea, S., & Styra, R. (2004). SARS control and psychological effects of quarantine, Toronto, Canada. Emerging Infectious Diseases, 10(7), 1206-1212.
Hoepfl, M. C. (1997). Choosing qualitative research: A primer for technology education researchers. Journal of Technology Education, 9(1), 47-63.
Holmes, E. A., O'Connor, R. C., Perry, V. H., Tracey, I., Wessely, S., Arseneault, L., & Bullmore, E. (2020). Multidisciplinary research priorities for the COVID-19 pandemic: A call for action for mental health science. The Lancet Psychiatry, 7(6), 547-560. Doi: 10.1016/S2 215-0366(20)30168-1
Jen-siu Michael. (2003). Medics caution against bogus remedies. South China Morning Post.
Jeong, H., Yim, H. W., Song, Y. J., Ki, M., Min, J. A., Cho, J., & Chae, J. H. (2016). Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiology and Health, 38, e2016048.
Kelloway, E. K., Mullen, J., & Francis, L. (2012). The stress (of an) epidemic. Stress and Health: Journal of the International Society for the Investigation of Stress, 28(2), 91-97.
Kets de Vries, M. F. R., & Balazs, K. (1999). Transforming the mindset of the organization. Administration and Society, 30(6), 640-676.
Khan, A. A., Lodhi, F. S., Rabbani, U., Ahmed, Z., Abrar, S., Arshad, S., Irum, S., & Khan, M. I. (2021). Impact of coronavirus disease (COVID-19) pandemic on psychological well-being of the Pakistani general population. Frontiers in Psychiatry, 11, 564364.
Khan, A. H., Sultana, M. S., Hossain, S., Hasan, M. T., Ahmed, H. U., & Sikder, M. T. (2020). The impact of COVID-19 pandemic on mental health & wellbeing among home-quarantined Bangladeshi students: A cross-sectional pilot study. Journal of Affective Disorders, 277, 121-128.
Kvale, W. (1996). InterViews: An introduction to qualitative research interviewing. Thousand Oaks, CA: Sage Publications, Inc.
Lau, J. T. F., Griffiths, S., Choi, K. C., & Tsui, H. Y. (2010). Avoidance behaviors and negative psychological responses in the general population in the initial stage of the H1N1 pandemic in Hong Kong. BMC Infectious Diseases, 10, 13.
Li, J., Yang, Z., Qiu, H., Wang, Y., Jian, L., Ji, J., & Li, K. (2020). Anxiety and depression among general population in China at the peak of the COVID-19 epidemic. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 19(2), 249-250.
Magdy, D. M., Metwally, A., & Magdy, O. (2020). Assessment of community psycho-behavioral responses during the outbreak of novel coronavirus (2019-nCoV): A cross-sectional study. AIMS Public Health, 9(1), 26-40. Doi: 10.3934/public health.2022003
Mahmoud, M. H., Alghamdi, F. A., Alghamdi, G. A., Alkhotani, L. A., Alrehaili, M. A., & El-Deeb, D. K. (2021). Study of Post-COVID-19 Syndrome in Saudi Arabia. Cureus, 13(9), e17787.
Majeed, S., Schwaiger, E. M., Nazim, A., & Samuel, I. S. (2021). The psychological impact of COVID-19 among Pakistani adults in Lahore. Frontiers in Public Health, 9, 578366.
Mao, R., Qiu, Y., He, J. S., Tan, J. Y., Li, X. H., Liang, J., Shen, J., Zhu, L. R., Chen, Y., Iacucci, M., Ng, S. C., Ghosh, S., & Chen, M. H. (2020). Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol, 5(7), 667-78
Maunder, R., Hunter, J., Vincent, L., Bennett, J., Peladeau, N., Leszcz, M., Sadavoy, J., Verhaeghe, L. M., Steinberg, R., & Mazzulli, T. (2003). The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. Canadian Medical Association Journal, 168(10), 1245-1251.
Mazza, C., Ricci, E., Biondi, S., Colasanti, M., Ferracuti, S., Napoli, C., & Roma, P. (2020). A nationwide survey of psychological distress among Italian people during the COVID-19 pandemic: Immediate psychological responses and associated factors. International Journal of Environmental Research and Public Health, 17(9), 3165.
Menges, D., Ballouz, T., Anagnostopoulos, A., Aschmann, H. E., Domenghino, A., Fehr, J. S., & Puhan, M. A. (2021). The burden of the post-COVID-19 syndrome and implications for healthcare service planning: A population-based cohort study. PloS One, 16(7), e0254523.
Merriam, S. B. (1998). Qualitative research and case study applications in education. San Francisco: Jossey-Bass.
Mishler, E. (1986). Research Interviewing: Context and Narrative. Cambridge, MA: Harvard University Press
Mukhtar S. (2020). Mental Health and Psychosocial Aspects of Coronavirus Outbreak in Pakistan: Psychological Intervention for public mental health crisis. Asian Journal of Psychiatry, 51, 102069.
Oatley, K., & Jenkins, J. M. (1996). Understanding emotions. Malden, MA: Blackwell.
Okoloba, M. M., Ogueji, I. A., Darroch, S. J., & Ogueji, A. M. (2020). A multinational pilot study on the lived experiences and mental health impacts from the COVID-19 pandemic. Global Psychiatry Archives, 3(2), 211-226. doi:10.52095/gpa.2020.1378
Olff, M., Bakker, A., Frewen, P., Aakvaag, H., Ajdukovic, D., Brewer, D., Elmore Borbon, D. L., Cloitre, M., Hyland, P., Kassam-Adams, N., Knefel, M., Lanza, J. A., Lueger-Schuster, B., Nickerson, A., Oe, M., Pfaltz, M. C., Salgado, C., Seedat, S., Wagner, A., & Schnyder, U. (2020). Screening for consequences of trauma - an update on the global collaboration on traumatic stress. European Journal of Psychotraumatology, 11(1), 1752504.
Park, K. H., Kim, A. R., Yang, M. A., Lim, S. J., & Park, J. H. (2021). Impact of the COVID-19 pandemic on the lifestyle, mental health, and quality of life of adults in South Korea. PloS One, 16(2), e0247970.
Passavanti, M., Argentieri, A., Barbieri, D. M., Lou, B., Wijayaratna, K., Foroutan Mirhosseini, A. S., Wang, F., Naseri, S., Qamhia, I., Tangerås, M., Pelliciari, M., & Ho, C.-H. (2021). the psychological impact of COVID-19 and restrictive measures in the world. Journal of Affective Disorders, 283, 36-51.
Pavlov, I. (1927). Conditioned reflexes. London: Oxford University Press.
Pietkiewicz, I., & Smith, J. A. (2014). A practical guide to using interpretative phenomenological analysis in qualitative research psychology. Psychological Journal, 20(1), 7-14.
Qiu, J., Shen, B., Zhao, M., Wang, Z., Xie, B., & Xu, Y. (2020). A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. General Psychiatry, 33(2), e100213.
Rachman, S. (1998). Anxiety. Hove, East Sussex, UK: Psychology Press
Rahman, M. A., Hoque, N., Alif, S. M., Salehin, M., Islam, S., Banik, B., Sharif, A., Nazim, N. B., Sultana, F., & Cross, W. (2020). Factors associated with psychological distress, fear and coping strategies during the COVID-19 pandemic in Australia. Globalization and Health, 16(1), 95.
Ren, L. L., Wang, Y. M., Wu, Z. Q., Xiang, Z. C., Guo, L., Xu, T., Jiang, Y. Z., Xiong, Y., Li, Y. J., Li, X. W., Li, H., Fan, G. H., Gu, X. Y., Xiao, Y., Gao, H., Xu, J. Y., Yang, F., Wang, X. M., Wu, C., Chen, L., & Wang, J. W. (2020). Identification of a novel coronavirus causing severe pneumonia in humans: A descriptive study. Chinese Medical Journal, 133(9), 1015-1024.
Reynolds, D. L., Garay, J. R., Deamond, S. L., Moran, M. K., Gold, W., & Styra, R. (2008). Understanding, compliance and psychological impact of the SARS quarantine experience. Epidemiology and Infection, 136(7), 997-1007.
Rossi, R., Socci, V., Talevi, D., Mensi, S., Niolu, C., Pacitti, F., Di Marco, A., Rossi, A., Siracusano, A., & Di Lorenzo, G. (2020). COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. Frontiers in Psychiatry, 11, 790.
Rothan, H. A., & Byrareddy, S. N. (2020). The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of Autoimmunity, 109, 102433.
Salman, M., Asif, N., Mustafa, Z. U., Khan, T. M., Shehzadi, N., Tahir, H, & Mallhi, T. H. (2022). Psychological impairment and coping strategies during the COVID-19 pandemic among students in Pakistan: A cross-sectional analysis. Disaster Medicine and Public Health Preparedness, 16(3), 920-926.
Schippers M. C. (2020). For the greater good? The devastating ripple effects of the COVID-19 crisis. Frontiers in Psychology, 11, 577740.
Seligman, M. E. P. (1971). Phobias and preparedness. Behavior Therapy, 2, 307-320.
Senge, P. M., & Kaeufer, K. H. (2000). Creating change. Executive Excellence, 17(10), 4-5.
Stan, L. (1999). An introduction to phenomenological research. Stan Lester Developments, Taunto.
Strauss, A. M., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (3rd Ed.). Newbury Park, CA: Sage Publications, Inc.
Varshney, M., Parel, J. T., Raizada, N., & Sarin, S. K. (2020). Initial psychological impact of COVID-19 and its correlates in Indian Community: An online survey. PloS One, 15(5), e0233874.
Venuleo, C., Marinaci, T., Gennaro, A., & Palmieri, A. (2020). The meaning of living in the time of COVID-19. A large sample narrative inquiry. Frontiers in Psychology, 11, 577077.
Wenar, C., & Kerig, P. (2000). Developmental psychopathology. New York. McGraw-Hill, Inc.
Wong, L. P., & Alias, H. (2021). Temporal changes in psychobehavioural responses during the early phase of the COVID-19 pandemic in Malaysia. Journal of Behavioral Medicine, 44, 18-28.
Wordsense Dictionary. (2020). Metathesiophobia. Retrieved from https://www.wordsense.eu/metathesiophobia/
Yang, J., Zheng, Y., Gou, X., Pu, K., Chen, Z., Guo, Q., Ji, R., Wang, H., Wang, Y., & Zhou, Y. (2020). Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. International Society for Infectious Diseases, 94, 91-95.
About Author
Kinza Javed and Saadia Dildar
Clinical Psychology Unit, Government College University Lahore, Pakistan1, 2
Correspondence: kinza.javeed812@gmail.com saadiadildargcu@gmail.com
