Illustration by Victoria Borges
Last December, few of us could have imagined that the COVID-19 pandemic would continue to cast its shadow on the 2021 holiday season, but here we are. Though infection rates are trending downward — for now — and vaccinations have been approved for 5- to 11-year-olds, the uncertainty and trauma of the ongoing pandemic make it difficult for some to fully celebrate.
The pandemic has greatly affected people who were already suffering from anxiety and depression, and even if you have not been diagnosed with these medical conditions, the upcoming holidays in the lingering age of COVID may aggravate seasonal anxieties that recur each year.
According to the National Alliance on Mental Illness (NAMI), 24% of people with a diagnosed mental illness find that the holidays make their condition “a lot” worse, while 40% say it gets “somewhat” worse. The stress, uncertainty and isolation of the pandemic have exacerbated what was already a bad situation.
“COVID has added another layer of anxiety to the holidays,” says Carol Jacobs, an Ashland-based licensed clinical social worker specializing in treating young adults and adults.
Clinical depression is one of the most common mental health disorders in the U.S. and the leading cause of disability. According to the American Psychiatric Association, 10.3 million adults in the U.S. had depressive episodes in 2016 that fit that description; just over 2 million people with mental health disorders were receiving federal Supplemental Security Income or Social Security Disability Insurance benefits, 14% of all beneficiaries.
According to a recent Boston University study, 32.8% of U.S. adults experienced elevated depressive symptoms in 2021, compared to 27.8% of adults in the early months of the pandemic in 2020 and 8.5% before the pandemic.
It’s important to distinguish between temporary “blues” — which a lot of people experience during the holidays — and clinical depression, which can be the source of a variety of emotional and physical problems.
Learning to say no and lowering expectations may be the most important resolutions for the holidays.
Richmond psychiatrist James E. Sellman has been treating children and adults since 1978. “You’re the head of your health care,” he says. “It’s up to you to implement your care.” He advises looking at the triggers — things that cause anxiety and depression during the holidays — so you can work with and around them.
Becoming more aware of our behavior and thoughts is what he termed “the philosophical intervention” involved in cognitive behavioral therapy, which enables clinical psychologists and psychiatrists to help individuals without medication.
“Antidepressants are often more of a problem than a solution,” Sellman says, “and sometimes they’re handed out like candy. Sure, I prescribe antipsychotic drugs when they’re required — but so many people don’t need heavy-duty drugs. That’s why it’s important first to teach patients [cognitive behavioral therapy], so they stop believing what they think. I know that phrase sounds strange, but we have to alter people’s negative thoughts so they learn to think and act differently, more positively.”
Popular literature sometimes refers to this treatment as “talk therapy.” Jacobs says psychotherapy involves “conversation as an empowering experience that is effective over time. A therapist helps you make positive changes in your thoughts and behavior.”
Sellman also suggests checking online resources offered by NAMI. “Anxiety and depression are highly individual,” he says. “Journaling might be very helpful to one person and not at all for another.”
In terms of medication for depression and anxiety, Sellman says, “There’s been a huge improvement in drugs since Prozac was first used in 1986.” He praises the “new ketamine series, which has been shown to have low toxicity and works by blocking a chemical that creates depression through promoting inflammation of cells.”
The following tips from Sellman, Jacobs and other mental health professionals can help us deal with negative feelings if they arise during the holidays:
Acknowledge your feelings.
We need to pay attention to ourselves and our behavior so we can determine if our feelings go beyond “feeling down,” Sellman says. If they do, the first step is to acknowledge those feelings and see a professional for an evaluation; don’t let your holiday schedule interfere with a therapist or psychiatric appointment.
When looking for a therapist, be aware of the different kinds of professional help.
Psychiatrists are medical doctors who can prescribe medications for mental health as well as provide non-drug therapy.
Psychologists and licensed clinical social workers provide therapy but cannot write prescriptions.
Sellman says his practice saw a 50% increase in referrals during 2020. He found himself doing Zoom appointments as late as 10 p.m., but he couldn’t bear not helping families with suicidal children as young as 8 to 12 years old.
Suicidal behavior peaks after the holidays because “people are expecting to feel better, but once they’ve opened the gifts and consumed the wine, reality sets in,” he says. This is the best reason for acting now on anxieties so that we avoid being disappointed when “reality sets in.”
Practice self-care.
Sellman, who keeps a book of jokes in his office, agrees with Oscar Wilde’s quote, “Life is too important to be taken seriously,” but he offers some serious daily advice from a graduation speaker he heard years ago: “Get up and plan your goals for the day. Ask yourself, ‘What am I going to learn today? What did I learn yesterday to help me get through today?’ A spirit of curiosity helps us in self-care.”
Jacobs agrees that the best way to maintain mental health during the holidays — in fact, at any time — is to practice good self-care.
“If we determine our emotions are the annual holiday anxiety of ‘How will we ever get everything done?’ we need to stop and take a deep breath,” she says.
This would be a good time for a resolution — before the new year. If we take better care of ourselves on a regular basis, Jacobs and Sellman say, we’ll be better prepared for any crisis before it arises.
Sellman says walking, yoga and working out are good ways to slow down; Jacobs practices “mantra chanting,” she says, “which causes the body to re-regulate so we can learn not to be on full throttle all of the time.” She chooses calming music to help her slow down her mind and body.
Chanting requires breathing correctly — from the belly, not the chest — which is important to the good health of our minds and bodies.
Alter expectations.
Sellman and Jacobs agree that learning to say no and lowering expectations may be the most important resolutions for the holidays.
Sellman cites his mother doing so much during the holidays that she couldn’t enjoy them. Jacobs says her daughter asked a few years ago why they couldn’t use paper plates for holiday dinners as opposed to getting out the family china and silver so they didn’t have as much to clean up.
“It all comes back to how we live our lives — and whether our expectations are exterior, such as having to buy 15 gifts in two days,” Jacobs says. “Your body drives your energy, and you don’t remember to go take a breath if you’re busy thinking, ‘Oh, I have to do this and then get that.’ You have to learn to override what you might have been feeding yourself in the past.”
Cultivate resilience.
We need to ask ourselves, Jacobs says, “Where is our resilience?” This is closely related to expectations: internal vs. external. If the body has a process in place to deal with stress, it can respond automatically when we feel anxieties, a process sometimes referred to as autogenetic. We can do what Jacobs calls “a reset,” in which the body responds to our verbal commands to relax; this helps control breathing, blood pressure, heart rate and body temperature.
Navigate relationships.
After more than a year of relating virtually to most of the people in our lives, we all want to feel a connection now and not feel as though we’re talking to a machine. Once again, we should set realistic expectations.
We need to know for our individual selves what really matters — in our daily lives, not just during the holidays. A follower of Jungian psychology, in which the analyst and patient work together to bring unconscious elements of the psyche into a more balanced relationship with our conscious awareness, Jacobs asks, “Are we [subconsciously] afraid we’re not good enough if we don’t do certain things? We need to tease out what our subconscious is telling us.”
Anxieties that might have lived under the surface before the pandemic were elevated with the lockdown in 2020. “When you take socialization away from people, it’s like taking fish out of the sea,” Sellman says. “We’re social creatures.”
At the same time, relationships can be difficult, especially when we are returning to more togetherness during the holidays. By thinking ahead, we can plan for time alone, such as taking a walk, and look for ways to get to know new people or send visiting relatives out for pizza while we regroup or finish wrapping gifts.
Accept and forgive.
Relationships have many ups and downs. Friends and relatives likely feel as stressed by life in general and by the holidays as we do. This is a good time to try to see situations from their perspectives, even when they don’t meet our expectations. If we’ve experienced failures with a relationship in the past, a new approach might be worth trying and might make the holidays easier on everyone.
Experience joy, love and peace.
The unwelcome holiday guests of anxiety and depression won’t be ushered out via repetition of musical holiday messages, even if they’re about love, joy and peace. If our anxieties are running high, Jacobs says, it’s difficult to deal with negative feelings, let alone feel the peace of the season.
Having worked in Macedonia, where Albanians fled prior to the Yugoslavian war, and then in Kosovo after the war, she taught self-regulatory/self-care skills in both places as vital to calming the mind and body so that trauma could be dealt with and ultimately healed.
“Being human means that we suffer and also experience trauma,” Jacobs says. “It is compassionate to care for ourselves. ... When we learn how to thrive, we can help others live more fully.”
If you or someone you know needs help, call the National Suicide Prevention Lifeline at 800-273-TALK (8255). You can also text a crisis counselor at 741-741.
