Mental Health During the Holidays

Derek Hiebert: Hey everyone, welcome to another episode of Bronco Health Talk here with the College of Health Sciences, where we talk about, just like the name says, all things health, healthcare, and health sciences. In these episodes, we try to keep it short, brief, and concise. So, it’s a really good conversation, but we don’t ask you to hang around a long time.

And so we’re really excited for this one today. With me here is Dr. Raissa Miller. She’s an associate chair and associate professor in counselor education here at Boise State University. Counselor education is one of our graduate programs. Then I have my cohost here, Sam Butler, who’s one of our health sciences students, who helps to produce the show. And we also have here in the background, Danya Lusk, our communication specialist at the college, who is also a producer of the podcast. 

So, you know, Raissa, thank you so much for being here today. We’re really glad for this conversation that we’re gonna talk about depression and anxiety around the holidays. As we–you know, quickly head into this holiday season, it’s a very real thing that goes on for a lot of people. So, this can in some ways be a hard topic, but it’s also a very important topic for all of us. And so, just wanna start out with this question of helping to understand what depression and anxiety is. We know that there are those two things, and maybe sometimes they can go hand in hand or go together in terms of things that people feel and deal with, but what are the differences between those two? 

Raissa Miller: Yeah, well, we have whole classes about this. So, I do think it’s important to stay right up front that there is not a singular anxiety or a singular depression. There’s, you know, there’s the clinical diagnoses that if you were to look in the diagnostic manual that mental health professionals and medical professionals use, there are those definitions.

And then I think when you talk about the holidays and experiences in the holidays, a lot of times it is some of those symptoms. And it may or may not meet the full criteria of the diagnosis. So, we’ll kind of talk across both of those, if that’s okay. But I just want to let listeners know that, especially if any of the symptoms that we mentioned or talk about are interfering with normal life functioning to a persistent degree, more than a bad day, more than a bad week, you know, if it persists for a couple of weeks and is interrupting your life functioning. It is time to seek care from a mental health professional, so I just kind of put that out front.

But other, less clinical experiences that are still very real and hard. When we think about depression, just that sense of sadness, hopelessness, maybe not enjoying the same activities you used to enjoy, maybe sleeping too much, sleeping too little, eating too much, eating too little, you know, those kinds of groups of symptoms. And again, most people don’t experience all of them at once, but some variety of them and an added severity, thoughts of suicide. And again, that goes back to when to seek care from a mental health professional. 

Anxiety is more of the worry emotion. So worried about future events, overthinking them, it can also accompany a lot of what we call somatic symptoms. So, increased heart rate, muscle tension, you know, just breathing rapidly, stomach aches, and then mood, like some irritability. A lot of times, people recognize irritability as a symptom of both anxiety and depression. They do interrelate. I think a lot of times our system revs up with anxiety, and then it burns out into depression. So, those can certainly coexist. Yeah. And then around the holidays, all of those things are exacerbated because we tend to experience more stress. Whether or not you might have had pre-existing, you know, diagnoses or experiences with depression and anxiety, you can still experience some of those symptoms because of the various factors that we’ll probably get to that happen around the holidays. 

Derek Hiebert: That’s a helpful distinction. 

Sam Butler: Yeah, I know it varies, but do you think most of it is before the holidays, during like peak holiday, or after, you know, kind of as we exit the holiday season? 

Raissa Miller: Well, there are a lot of people who experience anxiety and depression. I mean, those are two of the most common mental health conditions outside of the holiday season. I would say they do worsen during the holiday season and not just–I would say I did a little bit of research ahead of this, and there’s a statistic by the National Alliance of Mental Health, NAMI, that found that 64% of individuals living with a mental illness reported that their condition worsened around the holidays. So, yeah, I think it’s safe to say that it can exist in us always, but it can be worse during the holidays.

There’s also another more recent poll that looked broadly at–from the American Psychological Association that looked broadly at individuals’ experiences with the holidays, and 89% of U.S. adults, so most of us, reported that there’s increased stress around the holidays, which again, I mentioned, stress can exacerbate anxiety and depression. 

Derek Hiebert: Right? It’s really interesting with that because typically–you know, what I mean, like around the holidays, everything that we–I think, experience in America and maybe other parts of the world that celebrate the holidays around this time, it’s a season of joy. It’s a season of peace and hope and belonging and, you know, all of the happy feelings. So, it seems a little bit ironic that people can struggle with this or that these things are heightened, right? With depression, anxiety, what do you think it is about the holiday season that tends to heighten those things? 

Raissa Miller: Oh, it’s fresh on my mind because it’s here, right? And I’m living it too, right along with everyone. So yes, this is a time that a lot of people look forward to. I mean, how many Christmas lights have we seen up on houses like before Halloween, even? So, there are a lot of efforts and enjoyment in this season, but let’s talk about some of the factors that can contribute to stress and exacerbate anxiety and depression.

One is just like the shorter days. I mean, we have a lot less light. The weather’s colder, so people stay inside more. And we know from other research that being inside and not being exposed to natural light can increase symptoms of anxiety, depression. So, just environmentally, and I didn’t mention this earlier, but there is a subtype of depression, seasonal affective disorder. That research has been shown to kind of have some signs around changes in serotonin, melatonin, and vitamin D deficiencies that are part of that seasonal kind of experience because, in large part, the light that we have less of. So, that’s like a real practical thing, but more socially, there’s family dynamics. 

A lot of people travel home to spend time with their families, or are obligated to travel home to spend time with their families. And families can be warm and fuzzy, but families can also be full of conflict. Especially, you know, thinking about a college student age population and where you’re differentiating from your family of origin. And maybe you’ve gone off to college and are kind of forming this new identity or maturing in different ways, but then you go back to your family system that will always see you as like a 17-year-old child. So, it can bring up a lot of feelings around that, and individuals may not know how to manage that conflict.

I think another really big stressor is financial, this time of year. People have a lot of expectations on themselves and others to buy presents, to get new outfits for the awesome parties, to buy food for those parties, and to not you know–feeling financial strain can really worry people in a practical way.

Another big one is grief and loss. The holidays tend to be a time when we’ve lost loved ones, we feel that loss even bigger. Maybe some of the traditions we used to do with them or things we used to do, memories will come up. Or even if we haven’t lost someone, sometimes we just can’t be with our loved ones because they live across the country and back to finances, we can’t afford to get there. And so feeling lonely, you know, and feeling isolated from our family.

I’m sure they’re, well, and in fact, I do have a list that I can glance at and kind of make sure I’ve covered them. Oh, I guess the last piece worth mentioning is just the unmet expectation. There are a lot of cultural narratives around what the holidays should be. I mean, you’ve seen the Hallmark movies, right? If we’re not drinking hot cocoa by the fire while trimming the tree and having sugar cookies and then throwing snowballs with somebody that we are falling in love with, then we are not doing the holidays right.

And so, you know, being able to recognize what the cultural narratives are around holiday expectations and our experience of meeting them or not meeting them, and really can cause us to feel left out or like we’re not doing the holidays right. So those are a few, I think, of the top reasons why this time of year is a little extra. 

Derek Hiebert: Yeah, I think that’s important. I was kind of thinking about that expectation factor as well, you know, and I just–I’m like the older I get and the more that I’m with my family, I’m sensing those expectations. Then, there’s–and sometimes maybe oftentimes, the letdown, you know, because we had certain expectations about certain things or the way we want the family to be together, and then there’s conflict or things like that. You’re just like, oh my gosh, what’s going on? 

Raissa Miller: Yeah, and it somehow feels extra disappointing when things don’t meet those expectations this time of year. 

Sam Butler: Yeah, Derek, you bring up a good point also. You kind of mentioned some of the lead-up to the cause of depression and anxiety in the holidays, and then there’s also some that are more sudden, kind of like that let-down type event. Do you think most of it stems from kind of prior symptoms that have let up and are just culminating around the holidays, or more of a sudden cause? 

Raissa Miller: I would say more times than not, it’s that these are things that are happening in a person’s life, and the holidays bring them to the surface. Not that it can’t be sudden. But the reality, I mean, most of us know the things that are going to feel a little more stressful, disappointing, or discouraging. I mean, we’ve lived holiday after holiday after holiday. And, so if it feels like a surprise, it probably shouldn’t, because if you reflect on years past, oftentimes you’ll see that these patterns continue to emerge. Yeah. 

Derek Hiebert: Yeah. Do you think there’s a particular age range affected most by depression or anxiety during the holidays or is it across the board? 

Raissa Miller: Yeah, it does seem to be across the board, but in different ways. So, thinking about the factors that we just went over, research has shown that young adults in particular tend to be impacted most by the family and social dynamics and the financial stressors that can come up during the holidays. Whereas older adults tend to be more isolated, have mobility issues that limit their ability to engage in some of the holiday events, and they’re the most likely to be impacted by grief and loss during the holiday season.

And then other ages and stages, you know, you think you mentioned like your family and parenting, that can be a rather stressful time, you know, as you try to create those magical memories for everyone that you love, and then take on often other responsibilities at work, and, you know, in other life. So, I think it’s across the lifespan, but often in different ways. 

Derek Hiebert: Okay, yeah, that’s interesting. 

Sam Butler: What are some things, and I know this won’t be an exhaustive list, but to help combat some or as much as you can, depression and anxiety, kinda any of the feelings that come with holidays?

Raissa Miller: That’s good, right? Here we’ve just spent a few minutes detailing how difficult this time of year can be. 

Sam Butler: Yeah, we’ve got to fix it. 

Raissa Miller: Yeah, but it’s not hopeless. All is not lost, right? There are things that individuals can do both before and during the holiday season to try to cope with and or ward off some anxiety and depression experiences. The first and most important thing, and this is going to be a giveaway that I’m a counselor, is that you need to be aware of what you’re feeling. 

Acknowledging that I’m having an experience of feeling sad or feeling overly worried, it’s very important to just recognize and acknowledge versus avoid. And that’s what a lot of people tend to do is avoid, ignore, distract, or use what we call auto-regulation, like use substances or other compulsive behaviors to detract from the feelings that they may not even be aware they’re having. They just know they feel uncomfortable or they don’t like what’s going on for them. And, so they seek to feel temporarily better, but obviously, often create more problems in return. 

So, there’s an acronym that individuals can look up if they want to kind of get a way to manage those emotions. We call it RAIN, and it stands for recognize, acknowledge, or accept, investigate, which is just looking at, like, what am I feeling? And kind of being curious, having curiosity without judgment. And then the N is nurture. So what do you need? What do you need right now? What’s within your control to do to support yourself? So that’s just kind of around the initial emotions of it. But a couple of other practical strategies are one, move. Like this is a health sciences podcast, so it’s not gonna be a surprise to anyone in this audience that being active helps our emotional state. 

So the thing I would like to say, though, and this kind of comes from my counseling and therapy background, is sometimes we have to act our way into better feelings rather than feel our way into better actions. A lot of times, people are like, I don’t feel like it, so I’m not gonna do it until I feel like it. And if you wait to feel like you want to do something, you might be waiting until, oh, I don’t know, like June, when the sun comes back out, and it feels nice outside.

So truly, truly, like this sounds like probably old advice, but get outside, move your body. It’ll be an amazing kind of boost that you get from that, even when you don’t feel like it. And then even better, do it with others. The more that you can connect with others during this time in fun and relaxing ways, the better. 

Another really important point, a lot of times when we’re feeling kind of sad or worried, we don’t think about, oh, what can I do for someone else? But that can really help shift our mindset and emotional state as well. So look around you. Do you have neighbors, friends who need support during this time, whether it’s breaking leaves or putting up decorations, because maybe they can’t, or their community organizations? There is so much need in our community right now, from basic things like food to clothing. I mean, there are a lot of wonderful organizations that need volunteers. So just get out there. Again, regardless of how you’re feeling, just get out there and think about ways that you can contribute to others. 

Last but not least, plan ahead. Connect with a mental health professional before it’s a crisis. See what you could do to get ahead of some of these feelings, evaluate your priorities, and decide what you can let go of. A couple of years ago, again, humans also experienced stress during this time of year, trying to think about what I can let go of to reduce my stress. 

And, I decided to let go of Christmas cards, which I still kind of feel bad about because I love receiving them. I love giving them, but out of all the things, spending a day and the money and the time that goes into cards that probably just end up in someone’s trash, and no one needs another picture of my family. You can see those, you can see them, text me if you want it, right?

So, I just had to think about what I can reasonably let go of, and then truly let it go. Not hold onto it, thinking, oh, I really should have, I really would have wished I could have, just truly letting it go. So I think everyone, maybe it’s Christmas cards for me and completely something else for you, but thinking about what it is during the holidays that kind of contributes to your overall stress, and what of those could you let go of. 

Derek Hiebert: That’s the yeah–that’s really good. You know, a couple of thoughts just to tell off that I know someone who gave up on Christmas cards because she was just basically look, I’m on Facebook and social media, I’m gonna post a picture of my family, say here’s our family, here’s our Christmas card. Well, it takes minutes, you know, it’s easy, it’s cheap. And, I think that it just feels like there are these obligatory things that we sort of feel like we have to do at times during the holidays that like–you know, maybe if this is stressing me out, I should just let go a couple of these things. 

Raissa Miller: And, it doesn’t have to be forever. I have this quote in my office because I need reminding of it often, but I can do anything, but I can’t do everything, and not everything now, right? Like maybe I can’t do Christmas cards at this phase in my life, but I bet there’s a time in my life where things are slower and I can pick that tradition up again and make it meaningful for me. And, I think that goes for the range of activities you might envision yourself doing or want to do during the holidays. You might not be able to do it all, and not doing it this year doesn’t mean you can’t ever do it again. It’s just you got to be real with what’s going on in your life right now and pick and choose what you’re going to take on. 

Derek Hiebert: That’s so good. And another thing you said, too, that got me thinking was when you talked about spending some time out with people giving or serving, giving of yourself. That’s something I’ve heard before that if you’re feeling down or you’re feeling depressed, go do something–especially around the holidays, bake some cookies, take them to your neighbor and surprise them, something like that. Because there’s just that natural thing in us that it feels good to give, right? And even if we’re in a place where, like, man, I just, I don’t know if I can–I’m feeling down. I’m feeling depressed or whatever. I’m feeling anxious, but it does feel good to give and to see the smile on someone’s face. 

Raissa Miller: It does, yeah. And if you can engage in that service to others with others, I think that gives it a double boost because we are social creatures. Even as I’m an introvert, I can appreciate some solitude, but I also can’t deny that spending a little bit of time doing something for others with others gives me a boost. Maybe I need to go into my closet and read a book afterwards to recharge. Again, an introvert here, but yeah, you’re right. There’s something very human about that need and the benefits we get from it. 

Derek Hiebert: So good. Well, Raissa, thank you so much for this conversation. It’s very important, and it’s a significant thing around the holidays. I’m glad that we could spend some time talking with you about it, and your expertise and all of that. 

Raissa Miller: Absolutely. I mean, I love that we’re normalizing it. I think that’s part of what can make us feel really terrible, too, is that sense of like, I must be the only one that can’t enjoy this joyous, wonderful time of year. No, you’re not the only one. Like, you’re probably in the majority. Let’s figure out how to acknowledge that and to support that, but maybe also do some things to reduce that. So yeah, thanks for having me. 

Derek Hiebert: Absolutely. All right, thank you all for listening to another episode of Bronco Health Talk.