Tuesday, November 27, 2018

When The Holidays Aren’t Happy; How Do We Help Our Patients?

Last week I was working with a patient when she started getting emotional about the upcoming holiday season.  She was struggling enjoying her 8 month old’s first holidays and the sadness that she was also feeling.  “Why am I not just happy and enjoying this time?” she asked me.

I perked up for a variety of reasons.

One, I knew she struggled with postpartum depression immediately after her daughter’s birth.

Two, it is not unusual for people to have feelings of sadness and stress during the holidays, and then guilt for feeling that way!

So I listened; why was she feeling this way?  She was overwhelmed by demands from family to see the baby, juggling an infant’s sleep schedule while keeping them happy, and starting traditions of her own.  I told her this was completely normal, but also reminded her that she only needs to be responsible to herself, her daughter and her husband.

“How do I do that?!?” she responded a bit exasperated at the idea of telling the in-laws that no, they were not staying for 12 hours on Thanksgiving Day.

Every year I have similar conversations with patients. 

So what do we tell them?  While we all need to stay in our scope of practice, and our own comfort zone, the following will help us navigate the conversation.

There are many reasons why people experience a range of anxiety/depression/stress during the holidays.  Symptoms can be anywhere on the spectrum from “holiday blues” to a more serious depression.  The good news is, the vast majority of people will have a mild case of the blues.  In spite of long-held beliefs and even occasional media coverage, suicide rate and depression-related hospital admissions do not go up during the holiday season.  The U.S. Center for Health Statistics shows that November, December, and January actually have the lowest daily suicide rate.  However, that does not mean that the holiday blues are not a real concern.  

No systematic reviews exist regarding mental health around the holidays. 

However, the American Psychological Association has conducted surveys with some interesting information:

  • While the majority of people report feeling happy, loved and in high spirits during the holidays, they also report feeling fatigue, stress, and irritability.
  • 38% of the people said their stress level increased during the holidays.
  • 56% of people said their stress was the worst at work, while only 29% said the stress was experienced at home.
  • 53% of people said their stress had a financial component. 

So what do we tell our patients? The American Psychological Association recommend several coping strategies:

  • Most importantly, remember the holiday season does not banish reasons for feeling sad or lonely. There is room for all feelings and anything the person is feeling should be acknowledged and validated.
  • If they have experienced a recent loss or a loss around the holidays, grieving may be strong and surprising, even years later.  Reassure them all feelings are valid and sharing them is the best way to positively grieve.  Encourage them to share with trusted friends or a counselor and prepare to celebrate their loved one’s life in a positive manner.
  • Spend time with supportive and caring people.
  • Save time to take care of themselves. No guilt. Do whatever activity they wish.
  • Be aware of excessive drinking and excessive junk food.  There isn’t consistent evidence that one particular food staves off depression, but there is some research to suggest an overall healthy diet is helpful in treating depression.
  • Go to bed! Getting plenty of sleep will help manage anxiety and stress.
  • Get some light. Exposure to light, especially in the morning is important to anybody at risk for depression.
  • Exercise.  There is a lot of research that movement, any kind, can help with general mood.
  • Identify the source of the pressure and make priority lists. Don’t feel bad if something doesn’t make the list. 
  • Don’t be afraid to say “No” if occasions are not on your priority list.  Or say “Yes, but” as in “Yes I would love to see you but right now is not a good time and I really want to be fully engaged. How about we arrange that end of January?”
  • If feeling lonely, reach out or try other activities to make friends.
  • Finances are often the source of stress.  Set a budget, communicate intentions well ahead of time with loved ones and concentrate the larger reasons for the seasons.  Do a group outing or volunteer for a charity as a family instead of focusing on gifts.

It is important we know and recognize the signs for a more serious depression.  Past posts on The Massage Therapist Development Centre have done an excellent job of describing the signs and what we can do.  Find the link here.  For most of our patients, listening, validating, and giving them permission to be a priority will help them thrive, not just survive the holidays.  Reassuring them all feelings are normal and the stress is short-lived goes a long way to have the happiest of holidays.  And remember—that goes for us caregivers as well!  Remember to not just take care of your patients, but take care of yourselves and have the happiest of holidays!




Day-Calder M  How to beat the post-holiday blues. Nurs Stand. 2016 Sep 14;31(3):37-38.

Hirthler MA  Change of shift. Holiday Blues.  Ann Emerg Med 2010 Dec, 56(6);690

from Beauty Salon, Spa, Massage https://themtdc.com/when-the-holidays-arent-happy-how-do-we-help-our-patients/

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