HEALTH & FITNESS
GEORGE F. LEE / GLEE@STARBULLETIN.COM
Bart Pillen, clinical psychologist at the Kapiolani Behavioral Health Service of Kapiolani hospital, displays a visual from his Powerpoint presentation on how to combat holiday depression.
Holiday stress may depress
Are we having fun yet?
Christmas is designed as "the season to be jolly," an expectation that is probably attached to other seasonal observances that are now part of "the holidays" -- Thanksgiving, Chanukah, Winter Solstice, the Makahiki, Kwanzaa, New Year's Eve, and perhaps some others.
Signs To Watch For
You may be experiencing holiday stress or grief if ...
1. You're feeling a sense of limited time; too much to do, not enough time.
2. You're wishing for the "better days" of some time in the past.
3. You're anticipating future difficulties and losses.
4. You're feeling alone, isolated or without anyone to turn to for help.
5. You just want to "get through it all" and then collapse.
If you have five or more of the following symptoms for two weeks or more you could have clinical depression and should see your doctor or a qualified medial health professional for help.
1. A persistent sad, anxious or "empty" mood.
2. Sleeping too much or too little, including waking in middle of the night or early morning.
3. Reduced appetite and weight loss, or increased appetite and weight gain.
4. Loss of pleasure and interest in activities once enjoyed, including sex.
5. Restlessness or irritability.
6. Persistent physical symptoms that do not respond to treatment (such as chronic pain or digestive disorders).
7. Difficulty concentrating, remembering or making decisions.
8. Fatigue or loss of energy.
9. Feeling guilty, hopeless or worthless.
10. Thoughts of suicide.
In an emergency
» Department of Health Access Line: 832-3100 (24 hours )
» Aloha United Way Health Line for Social Services: 211
Although it can be a time of joy and excitement for children who anticipate getting "choke presents," the "season" can also be stressful for many teens and adults, and a time of potentially fatal depression for others.
For instance, this is the time of year when even simple tasks take longer than usual. Shopping mall gridlock exists even for those who aren't stressing out over their Christmas gift shopping list or preparing for finals, and the added congestion at the post office snares even folks who aren't shipping gifts off-island.
The ballooning number of seasonal social events that are squeezed into the five weeks between Thanksgiving and New Year's Eve makes it impossible to even "show face" at all of them, let alone have a good time, and the holiday schedule compresses two consecutive work weeks in December from five days to four.
It's also a time of year when many people find themselves fighting losing battles with the temptation to overeat, overdrink and overspend.
"The holidays" can be particularly difficult for people who are alone, for whom "Christmas" means memories of happier times in years past, or who are mourning the death of a loved one or the end of a relationship.
Although we as a society expect wonderful holidays, more people experience depression and stress during the holidays than at other times of the year.
The good news is that it is possible for most people to manage seasonal stress.
DR. Bart Pillen, clinical psychologist at the Kapiolani Behavioral Health Service of Kapiolani hospital, says that the secret of holiday well-being is to "pay attention to how valuable things really are.
"I'm not talking about sale bargains. I'm talking about what is going to be most meaningful to them and the people who they really care about during the holidays," he explained Monday while talking about the challenges posed by seasonal stress and depression.
"There's the 'Big Sale' that you might have at a retail store where you might save $10 (on a gift) but have $30 of grief and a whole lot of sleep difficulties and a lot of conflict (in being there). It's just simply not worth it.
"It may be more important and worth more to you if you scale back on the number of gifts, buy smaller, and do something more meaningful in terms of an activity or a ritual with somebody. It's what you do with one another that's more important than what you buy for one another."
Time spent doing something you enjoy -- alone, with family and friends, or with others -- can count for more than scheduling your life around fighting crowds at the mall or standing in line to beat shipping deadlines at the post office.
"Creating your own family ritual -- cookie baking and decorating is an example of one -- doesn't cost much, you can spend your time all afternoon doing it (because) there's no great rush, and yet those are the things that people will remember ... it's usually the things that people do together that are far more valuable than the sales."
Rethinking the holidays is easier said than done. Most people have favorite rituals or traditions they are loathe to give up, no matter how stress-inducing. There was a time when the Christmas season started on the day after Thanksgiving, but in recent years Christmas decorations have been going up several weeks before "Turkey Day" -- and stretching out the season can also stretch out the stress.
The important thing to remember, Pillen points out, is that striving for impossible standards of perfection in your holiday celebrating can be hazardous to your physical and mental health.
"You really can become much more vulnerable to having a lot more anxiety and depression when you work harder to have a good time at the holidays. People have a tendency to want these times to be perfect in terms of their own personal experience and also for other people in their family. Those expectations and kind of a judgmental attitude that it has to be just right -- a perfectionistic attitude -- really can be a big culprit."
Pillen warns that people who enslave themselves to expectations of perfection -- enjoying a perfect holiday, preparing a perfect meal, or hosting a perfect party -- are likely to miss out "on what is valuable or more important."
"Increased activity, a lot more stress, (the) financial pressures that a lot of people feel, and these expectations of our belief set around the holidays really are the things that make it difficult for us, and those things pile up."
Fighting traffic to get some last-minute addition for a party menu or an elaborate Christmas display can add less enjoyment to the season than spending time with loved ones or simply relaxing.
Pillen warns that stress and disruption of established patterns of eating, sleeping and exercising put the body through physiological and hormonal changes that increase the likelihood of illness. Many put their expectations of a perfect holiday ahead of their health and press on even while they're fighting a cold or the flu. Getting enough sleep is especially essential during the holidays.
"We know that a person who doesn't get enough sleep is more prone to gaining weight, having diabetic difficulties and also more illness. It is just much harder for them physically and emotionally."
It's also important to consciously decide "how much is enough."
"In my field we know that people can ward off a lot of anxiety and depression and stress if they do a simple thing -- catch the negative expectations and thoughts and beliefs that they have and begin to rewrite those in a more positive way and then attach a behavior to it. We know that a lot of holiday depression as well as a regular depression can be substantially reduced or prevented that way."
Pillen explains the process of catching negative expectations this way:
"If you have an event that you really dread about the holidays and you cannot avoid it, then imagine that someone caught a picture of you in that event and you were to write a label underneath it about yourself in that situation."
Negative expectations can be reduced or eliminating by labeling the imaginary photo in a positive manner.
"If you can attach a positive label or idea or thought about that experience and who you are in it, then a lot of times people will feel much more competent, much more secure, much more confident about the experience. The label and the meaning that you attach to things -- especially at the holidays -- is important."
A family ritual -- decorating the tree or singing carols -- may not be the same as years pass, but it can evolve and continue to be passed on from one generation to the next.
"What's healthy for people in the past and what's good for their relationships in the past -- those same things can be healthy now. You've going to half to adapt them to a new circumstance and new setting ... you can honor the way it used to be but also carry forth."
MAKING TIME for sufficient sleep, keeping holiday eating and drinking within reasonable limits, and not trying to find every item on your shopping list on "Black Friday" or Christmas Eve, will help make "the holidays" enjoyable for most people. Others face greater challenges and may need professional support. The first step to reducing seasonal stress and depression is recognizing that you may be vulnerable.
Anyone who finds themselves thinking that they'd be better off dead, or that life is no longer worth living, should get professional help immediately.
"There's plenty of help out there and money is not an issue because most of those services can get paid for through regular coverage, or free. So somebody (who feels this way) should not hesitate. If you know of somebody who's really being negative or suicidal, you need to take them very seriously."
For some, it's the first Christmas without a beloved family member; for others, the holiday season will always be associated with a tragedy.
"People who have gone through really upsetting events are almost automatically going to see the holidays in a negative way."
One way to address and possibly reduce those feelings is to look for things that could be positive or even enjoyable during the holidays. Another is the process of labeling an imaginary photo.
"We call this Cognitive Behavioral Therapy, which is a mode of therapy that can be very, very helpful for people with depression.
"It's no mystery that people go through difficult times in their lives. What helps them rise above it is (doing) more that just ruminating over negative things. There are a lot of people who kind of practice being depressed during the holidays -- they play sad songs (for example) ... If you spend two hours pining away about the past you've spent two hours practicing being depressed."
There are times, however, when cognitive thinking and positive visualization isn't enough. Pillen said that the best gift people who feel overwhelmed by stress and depression can give to themselves is getting "some assistance from people who know how to treat depression."
"It doesn't mean you're crazy. It doesn't mean you're weak. In fact, the biggest mistakes are usually made when people don't pay attention to these things and try to avoid it and just try to plow through the holidays."