WELLNESS CALENDAR FOR THE BUSY PHYSICIAN: HOW TO “SURVIVE” THE HOLIDAY BLUES
Vol 6 #6
Giroux C1,*, Hategan A2, Eppel A3
1 University of California, Davis Medical Center, Department of Psychiatry and Behavioral Sciences, Sacramento, California, USA; *Corresponding author: [email protected]
2 McMaster University, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, Department of Psychiatry and Behavioural Neurosciences, Hamilton, Ontario, Canada
3 McMaster University, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, Department of Psychiatry and Behavioural Neurosciences, Hamilton, Ontario, Canada
As psychiatrists, the holidays can be emotionally difficult for many of us. This is also particularly true for certain populations we serve: those who live in poverty, those who are currently isolated, those who have lost someone and deal with an anniversary reaction, or those who had adverse childhood experiences. This comprises the intangible losses, including the lost sense of normalcy typically conferred by the winter holidays such as Christmas, Hanukkah, or Kwanzaa.
The stats may be surprising regarding the holidays, and it poses the question whether this holiday season really is the hardest time of the year. We know that the winter holidays are a risk factor for death [1, 2]. Cardiac mortality is higher around Christmas and New Year’s than at any other time . Moreover, in the two weeks starting with Christmas, there is an excess mortality from natural causes above the normal winter increase; therefore, Christmas and New Year’s appear to be risk factors for all-cause mortality . Regarding our psychological health, are we faring better? Studies have found that psychiatric ED visits decrease immediately before the Christmas holiday, with a corresponding increase in psychopathology immediately following the Christmas holiday . Furthermore, studies suggest that Christmas may exhibit a generally protective effect with regard to psychopathology, with the exceptions of mood disorders and alcohol-related substance use disorders .
Extra stress, unrealistic expectations, or even sentimental memories that accompany the season can be a catalyst for what we refer to as the “holiday blues,” which are emotions that emerge this time of year and that are generally unpleasant such as anxiety, tension, irritability, or sadness. In one survey, 38% of respondents reported their stress level increased during the holiday season . The respondents listed the top stressors as being time, money, commercialism, gift-giving pressures, and family gatherings . But it is possible to be pro-active, prepare oneself for the holidays, and even find joy in what seems potentially overwhelming. In fact, experiencing holiday blues does not impact one’s functioning as much as depression, which is a more severe condition, and holiday blues dissipate once the holiday season is over.
The authors herein would like to propose a wellness toolkit, or a “self-care calendar,” for the busy physician to not only “survive” but thrive during the holiday season. The sequence can be changed depending on individual needs and certain steps should be repeated regularly.
- Basic needs first: sleep and eat healthy (and enjoy the tasty food, too!). Hydrate yourself and monitor alcohol use to avoid excesses (and hangovers).
- Pace yourself at work: in anticipation of a busy social schedule, try to keep your work duties light, if you can. If you are on duty during the holidays and must work, create some reboot and fun, wellness activities at work (e.g., potluck, gift exchange, games) whenever possible.
- Make room for your emotional experience: not being thrilled about celebrating this year is okay. Do not force happiness. Joy might emerge if you take care of yourself and honor where you are, without pressure.
- Keep it simple: a “switch, steal or unwrap” gift exchange with your co-workers or even your family is less time-consuming (and more fun!) than buying something to everyone (especially if everyone has everything). It is also more sustainable, especially if reusing through a “white elephant” (everyone finds a household item they no longer want and wrap it). For example, during a game of rolling the dice, each person getting a six can pick a present and the next one can choose to either steal from someone else or unwrap a new one. But remember, your time or presence is often the most meaningful gift.
- Your way is more than good enough: you are not a legendary baker, a creative decorator, or you feel out of tune when caroling. How about card-making, or entertaining the old and the young with games, or inviting people to a silent gratitude event with candle lights.
- Laughter is therapeutic. Do not underestimate the power of humor (especially when shared). As a healing and defusing practice, select some comedies or hilarious shows ahead of time. Cartoons that you enjoyed in childhood might be good to reconnect with. Or the movie based on “How the Grinch Stole Christmas” can be good family entertainment for Dr. Seuss’ fans.
- Singing can also help become more aware of one’s own breathing and is a good stress relief.
- Screen detox: allow yourself to not check emails, social media, or work-related files on any device on a predetermined period of at least 24 or 48 hours. Instead, try to move and inhabit your bodies, do yoga, and switch to vagal or parasympathetic nervous system mode (as opposed to sympathetic or “fight or flight” responses like when under stress), play in the snow if you can, or dance at a party to break the ice!
- Spend some time outdoors to breathe fresh air. Spending time in nature, like walking on the trails, will expose you to phytoncides, the natural fragrance of trees that may help boost the immune system (by increasing the number of natural killer cells) . Nature’s therapeutic psychological benefits have been shown to reduce stress and mental fatigue, as well as reduce symptoms of anxiety and depression . Meditation and mindfulness have well been in existence for centuries. Generally, mindfulness practices can also lead to stress mitigation and reductions in psychological distress . A sense of awe from practicing mindfulness may even have the potential to reduce the inflammatory biomarker C-reactive protein, especially in populations at risk for systemic inflammation (stressed midlife and older adults and stressed adults with high BMI) [6, 9].
- Nurture yourself and the planet: refuse overconsumption and waste and use dishtowels, pillow covers or other reusable items as wrappings. If you are hosting a celebration, offer bamboo, reusable containers, no plastic, no straws of plastic but metal, etc. And at the end you can lead a little exercise for your guests to take home, thinking what the New Year is like for them, reflect on their space in the universe and how they wish to help mother Earth.
- Remember to practice gratitude and see the good in you and in others.
- Find meaning through giving or volunteering. Organize a food or toiletry drive at work or in your neighborhood or be that supportive presence and listening to hear for a suicide hotline. Make this meaningful to you and your loved ones.
- Create new traditions that are aligned with your values (e.g., try planning a family outing or vacation). Some people prefer to have guests donate to charity instead of receiving host gifts from them.
- Make peace with the past and with what is not currently ideal. Acceptance is one of the mindfulness qualities and consists of clearly perceiving the present that informs our actions.
- Embrace your solitude: even when family dynamics are harmonious, some people (especially introverts) need down time to recharge. For those who feel estranged from relatives or previous friends, the concept of chosen family can be comforting. If you are alone by choice or because of family tensions, find others like you, or develop your special tradition of “celebration by myself”. A Danish concept called “hygge” can be incorporated easily into your life at low cost. It means finding pleasure in simple activities like reading a good book, enjoying a cup of tea, or petting a cat.
- Create your “ikigai”: this can be a fun activity done alone or with others. It consists of creating a diagram that enhances what you love (your passions), what you are good at (your talents), what the world needs (altruistic opportunities) and what you can be paid for (potential compensation to remain financially sustainable). It can be completed over an extended period of time (it might require some reflection).
- List realistic projects or fun challenges for the next year. Choose a life hygiene practice or change a habit to improve your health, consider a different pattern of behaviors to help the planet (consume less, reduce carbon footprint), a motivating project that could make you leave your comfort zone (singing up for a class or visiting a foreign country), 12 books to read, and a person you would like to reach out to or reconnect with.
- Practice minimalism. Select one room or a section of your house or your life to declutter.
- Decorate your home with elements of nature (e.g., acorns, rosemary branches). Make cards with recycled paper.
- Take a picture of yourself to compare with your former self and see if self-care is effective.
- Record a message with positive affirmations (or favorite poems, or lyrics of uplifting songs) to boost your mood when you need encouragement.
- Start journaling and write about your observations, thoughts, and feelings on a regular basis. Writing such as journaling and diary has been practiced for centuries, and is thought to be beneficial and considered to be one of the most effective creative outlets that help to lessen psychological distress [10, 11].
- Allow yourself to let go of the outcome: be open to the unexpected and pride yourself in being flexible, trusting that you are now so relaxed that creative solutions will emerge easily if you are faced with challenges.
- Make room for your spirituality, whatever it means for you (meditating, praying, singing, caring for someone who is ill, connecting with others, and connecting with nature to create a sense of belonging and partaking in something bigger than us; look at volunteering opportunities).
We believe that all of the above may have the potential to buffer the holiday blues or stress associated with the winter holidays. These suggestions can be adapted to your needs or expanded to help solidify and boost your resilience.
This time of year, just like any other period, does not have to be painful. Follow what comes from within rather than obeying societal expectations that are not aligned with your core values. There are as many ways to celebrate as there are people. May you find health, peace, and joy in this holiday season.
Conflict of Interest and Source of Funding:
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- Phillips D, Barker GE, Brewer KM. Christmas and New Year as risk factors for death. Soc Sci Med. 2010;71(8):1463-1471.
- Hillard JR, Holland JM, Ramm D. Christmas and psychopathology: data from a psychiatric emergency room population. Arch Gen Psychiatry. 1981;38:1377-1381.
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- What We Know About the Holiday Blues. https://www.psychologytoday.com/us/blog/evidence-based-living/201712/what-we-know-about-the-holiday-blues#comments_bottom. Accessed December 10, 2019.
- The New Mindfulness. TIME, Special Edition, Dec. 2018
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- Ullrich PM, Lutgendorf SK. Journaling about stressful events: effects of cognitive processing and emotional expression. Ann Behav Med. 2002;24(3):244-250.