As clients come in this winter, complaining about feelings of depression and anxiety, it can be easy to chalk it all up to the on-going pandemic. But, as if 2020 was not difficult enough, the darker months also promised to bring a rise in seasonal affective disorder (SAD).
For those suffering from SAD, a cyclical depression, shorter days and longer nights can bring about a desire to go into a sort of hibernation, with isolation, low energy, depression, and anxiety being the hallmarks. Of course, with the pandemic, isolation, depression, and anxiety have become the norm for us all.
“It takes a person with SAD a few years to recognize a seasonal pattern,” said Kelly J. Rohan, Ph.D., professor and director of clinical training at the University of Vermont, who has spent the past 20 years studying SAD. “So that would also be true for a clinician to see this kind of thing to come to light, excuse the pun. I would start by looking for negative thoughts and comments about winter, like winter being full of obstacles. That is one way that a therapist might hear these kinds of automatic thoughts come out.”
Ask the client about their feelings about winter other years to ascertain if this is an on-going issue or an expected result of the isolation and stress of the pandemic.
“I am always busy this time of year but this year it has been overwhelming,” said Martin H. Klein, Ph.D., a clinical psychologist based in Westport, Connecticut, who specializes in the treatment of seasonal affective disorder. “I call it Pandemic Affective Disorder (PAD), or SAD on steroids, but it’s not really a disorder. I think everyone is stressed out and anxious and it is really a difficult time.”
There are also factors that can make the problems worse, like living alone, being at greater risk from the virus, and a lack of self-care.
“The main thing to look out for is isolation, which is a big problem especially for seniors,” said Klein. “And ask if people have ways of connecting with others and healthy habits.”
“I see a real increase in overeating with carbs and sugar and an increase in alcohol consumption,” he added. “People tend to do a lot of destructive stuff rather than reach out and do things that help them.”
Encourage patients to get outside even on the coldest days, sit by a window indoors and be sure to exercise, eat well, and stick to a sleep schedule.
Beyond self-care, there are treatments proven to work that include medication, light therapy, and cognitive behavioral therapy. Some therapists shy away from treating SAD, Rohan said, but don’t need to.
“It puzzles me as a professional,” she said. “Our skills are completely amenable to this. Using CBT, for instance: if you know how to do this, you already have the skill set. And light therapy is not rocket science; psychologists can do it with just a little bit of training.”
Rohan has published a training manual and workbook for therapists to use with clients that outlines best practice treatment using both light therapy and CBT (“Coping with the Seasons” Oxford University Press, 2008).
“My research has been testing CBT for SAD for 20 years,” Rohan said. “We have been finding the same patterns across trials. Both treatments work really well. But when we follow up in future winters, we see a lower recurrence following CBT than following light therapy.”
In Rohan’s studies, CBT in addition to light therapy had a 60 percent success rate a year out from the treatment, compared to a 100 percent relapse rate for light therapy alone.
“I would like to see more psychologists treating this,” Rohan said, “It is an important public health challenge. If your practice is in a northern latitude, you are seeing these people whether you realize it or not.”