December 1st, 2012

Strategies can help holiday challenges

By Phyllis Hanlon

Mention the holidays and some people immediately think food, festivities, families, friends and fun. But for those diagnosed with a mental illness, these very factors may evoke dread, anxiety and a host of other negative responses. Regardless of diagnosis, psychologists agree that applying some fundamental therapeutic tactics can make the holidays enjoyable for everyone.

Individuals with an addiction, whether to alcohol, drugs, food or some other substance, face challenges year-round, but the holidays can be particularly trying, according to Rick Barnett, Psy.D., private practitioner in Stowe, Vt. “Substance abusers’ brains are wired to over-indulge. These are the times of year when this is more socially acceptable,” he says.

A specialist in working with individuals who have alcohol and drug abuse problems, Barnett finds that basic cognitive behavioral strategies can be useful for a person at any stage of recovery. He encourages clients to create goals to help them maneuver the pressures that come with the holidays, taking into account personal circumstances. For instance, isolation can be detrimental to individuals with no close friends or family. “They may get caught up in self-pity and depression, leading to unhealthy behaviors,” he says. On the flip side, those with extensive family may be inundated with gatherings and may need to schedule downtime to rebalance. Honestly assessing a situation can help create realistic expectations, Barnett adds.

Barnett finds that his appointment calendar becomes full during the holidays and speculates that the unbiased, non-judgmental environment helps provide a safe retreat for his clients. “They look at it as a time-out from getting feedback from family and friends. Therapy becomes more valuable at this time,” he says.

For individuals with eating disorders, office and house parties can become a minefield this time of year, according to Kathleen Hart, Ph.D. of the Hart Foundation in Falmouth, Maine. She says five million Americans have an eating disorder, which traditionally stems from low self-esteem, an underlying mood disorder, insecure parental attachments or as part of normal social development. “You need an aggressive intervention,” says Hart. “At holidays we tend to shift away from self care. For those with eating disorders, this is non-negotiable. The first step is to normalize your eating pattern. You can’t be passive, but must constantly be planning.”

Hart further explains that meal planning can be a coping skill for surviving the holidays. “Some people use eating disorders as a maladaptive way to cope with stress. You have to replace [this behavior] with an adaptive way to deal,” she says.

Holidays usually come with high expectations, which tend to exacerbate anxiety and anxiety-related diagnoses, such as obsessive-compulsive disorder, notes Hartford-based private practitioner Joseph Brown, Ph.D. “People with anxiety disorders, as a whole, are hyper vigilant. Those with OCD are very detail-oriented and tend to lose sight of the overall big picture,” he says. Recording those anxieties and related circumstances, such as intensity level; date, time and circumstances; thoughts and feelings during the anxious times; and any actions/consequences helps the individual self-monitor, Brown says.

Families, especially those with children diagnosed with ADHD, run a high risk for meltdowns during the holidays, as Elaine Ducharme, Ph.D., well knows. This public education coordinator for the Connecticut Psychological Association, adjunct professor at the University of Hartford and private practitioner in Glastonbury, says. “During these times, there’s not a lot of structure. Children might be staying up late and not sleeping well. They are also eating differently,” Ducharme says. To effectively manage their child’s behavior, she advises parents to be mindful of behavioral changes and be prepared to defuse a situation before it has a chance to escalate.

Ducharme also treats clients with seasonal affective disorder, which typically arrives concurrently as the days shorten and holiday decorations overtake department store shelves. She indicates that these individuals, who already experience deep sadness and depression, often believe they alone are not having a perfect holiday. As difficult as it may be, Ducharme recommends joining a support group, whether in person or online and refocusing attentions on others. “When you volunteer, you feel so much better,” she says.

Although some believe the “perfect” celebration should reflect a happy holiday movie, reality often differs from this scenario. Hart says, “No one will remember your ‘perfect’ dinner table. It’s about closeness and celebration.” She recommends “dropping perfectionism” and replacing it with “good enough.”

By Phyllis Hanlon

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