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Holiday Season During COVID-19

Who’s stressed, depressed, or anxious about the holidays this year? Well, everyone.

But this is especially true for people with chronic illnesses who are worried about being at increased risk of COVID-19, yet at the same time are missing family and friends and feeling more lonely and isolated than ever.

In a recent poll of our COVID-19 Patient Support Program members (it’s free to join and you can sign up here), among nearly 500 people who responded, only 5 percent said they weren’t planning to change their holiday plans at all. Nearly 44 percent said they would celebrate with just those in their household (no outside family or friends), while nearly 18 percent said would celebrate virtually. Almost 25 percent said they weren’t sure what they would do — it was still an ongoing discussion and/or they would make a decision closer to the holidays.

Public health recommendations are pretty clear. The U.S. Centers for Disease Control and Prevention (CDC) discouraged people from traveling for Thanksgiving. In guidance about the holiday season, the CDC says: “If you are an older adult or person with certain medical conditions who is at increased risk of severe illness from COVID-19, or live or work with someone at increased risk of severe illness, you should avoid in-person gatherings with people who do not live in your household.”

While many in the Global Healthy Living Foundation and CreakyJoints community are more than willing to sacrifice their usual holiday season for health and safety, this decision doesn’t completely negate feelings of sadness, grief, frustration, and other emotions. And this is all coming at a time of spiking COVID-19 cases and rising death rates — after nearly a year of life already significantly disrupted from the pandemic.

In other words, things may feel harder than ever right now. So we talked to mental health experts for support and advice about how to get through this year’s very unusual holiday season.

Adjust Your Mindset

1. Remember that this is temporary

“Our lives have all been disrupted in an unprecedented way by this pandemic. The grief and stress you’re feeling is real, and it matters,” says neurologist and pain specialist Vernon Williams, MD, Founding Director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. “However, I am also confident that this, and the restrictions due to the pandemic, are temporary. This holiday season will be tougher than most, but we will get through this — together.”

2. Try to reframe this year as an escape from typical holiday stress

If you’re feeling sadness or grief about smaller gatherings or skipping holiday events, it may help to remember that for those with chronic illnesses, the holidays are usually rougher than classic Hallmark movie depictions. Behind traditional recipes, sparkling lights, and family singalongs, there’s also inflammatory foods that trigger flares, family drama and trauma, overstimulation, and fatigue.

“The holidays usually mean increased activity, commitments, responsibilities, and spending — all at a time when your energy may be lower than ever,” says Katie Willard Virant, MSW, JD, LSCW, a psychotherapist in St. Louis, Missouri and author of the Psychology Today column Chronically Me: The Emotional Landscape of Chronic Illness. Virant lives with Crohn’s disease, a type of inflammatory bowel disease.

Perhaps COVID-19-related changes could actually be a blessing in disguise for people with chronic illnesses.

“COVID-19 restrictions are good and bad for people with chronic illness,” says Stephanie Mihalas, PhD, a board-certified psychologist and Founder of The Center for Well Being in Los Angeles, California. Dr. Mihalas has several chronic illnesses herself. “On one hand, there are a lot fewer social gatherings and you have a guilt-free reason to excuse yourself from any that are still happening,” she says. On the other hand, this may exacerbate feelings of loneliness, depression, and isolation.

Rest assured: It’s perfectly acceptable to crave a “return to normal” while realizing that a typical holiday season is challenging because of your underlying illness.

3. Own a positive mantra

Expectations, both from yourself and from others, can feel extra heavy during the holidays. When you start to feel overwhelmed, it can help to have a mantra you can repeat to yourself that will help ground you and bring you back to a place of equilibrium, Virant says.

Your mantra should be something that feels personal to you. Keep it short so it’s easily remembered. Some good examples are “this too shall pass” and “peace, love, and light.”

4. Feel your feelings

“The holidays are a stark reminder to people with chronic illness that we are different and it can feel like being left behind,” Virant says.

Instead of trying to talk yourself out of these feelings — which can only make you feel more hurt — allow yourself to feel the sadness, loneliness, and anger. Then you can move past them.

People often worry that if they let themselves feel sad then they’ll be overwhelmed by it, Virant says, but you’re not giving yourself enough credit to cope and recover. “It’s a real grieving process and the feelings are real, but you won’t drown,” she adds.

Communicate Your Needs

 5. Let loved ones know how much contact you need

Take a step back to figure out  your needs this season and then communicate them clearly to your loved ones, Dr. Mihalas says. For instance, would you like people to come and check up on you in person? (Perhaps a masked and socially distanced outdoor chat or walk, for example.) Would you prefer a daily text message, or a weekly phone call? Do you want to be invited to things even if you probably won’t attend — or would that make you feel worse? Which get-togethers are the most important to you and what do you need in order to participate (either virtually or in person)?

Don’t expect others to read your mind or know what you need. Being clear about your needs and expectations can help make the holidays easier and happier for everyone, she says.

6. Talk to your family about special events

For many people, travel and large family gatherings are not going to happen this year. This may feel like a relief to you in some ways and sad in others, as you miss out on beloved traditions.

Your loved ones can add to your mental stress by feeling upset or disappointed that you’re not coming. “All of those feelings are valid and everyone is entitled to feel the way they do,” Dr. Mihalas says. “But you aren’t in charge of managing their feelings.”

Be candid about what you can and can’t do, give people plenty of notice, and stick with that plan, she says. Discuss ways you can still participate in some way. If you normally make a beloved recipe, for instance, perhaps you can still make it and share samples with family or friends who live close by. Or if family is gathering in another state, add a video chat to the get-together so you can join in.

7. Set firm boundaries

People may not be trying to be demanding, but the truth is that the holidays often bring out boundary-pushers like no other time of year. “You have to come — this might be Grandma’s last Christmas with us!” “Just try this [unhealthy inflammatory food]. One bite won’t hurt, and I made it especially for you!” “Please just stay another hour; you can sleep in tomorrow!”

The solution to this is to not make the decision in the moment — when there is more temptation to cave in — but to decide on your boundaries and your response in advance, Dr. Mihalas says.

Practice Self-Care

8. Simplify what ‘self-care’ means

“Self-care is key to maintaining your mental health but that doesn’t mean it has to be lavish or overwhelming,” Dr. Mihalas says. People with chronic illness are often tired of hearing they need to be “taking care of themselves” because it can feel like one more thing to add to the list of stuff they’re failing at, she says. Instead, look at self-care as taking time each day to do one thing you enjoy — and that’s it.

9. Do a nightly self check-in

A good way to prevent or manage mental health issues before they get overwhelming is to take time each night to do a self check-in, Dr. Mihalas says.

“Ask yourself, ‘How do I feel?’ and ‘What do I need right now? Tomorrow?’” she says, adding that this is similar to how you would check in on a friend who is struggling.

Set a timer on your phone to remind yourself to do the check-in each night before bed, she says.

10. Start a meditation habit

“Meditation is not just some passive breathing exercise; it is actually a significant brain training resource,” Dr. Williams says. “Achieving control of your thoughts so that your thoughts don’t control you can be a superpower for people with chronic illness.” Not sure where to start? There are a variety of free apps, online videos, and websites. Dr. Mihalas recommends the resources provided by the UCLA Mindful Awareness Research Center. You can start with a five-minute practice a day to see how it feels.

11. Take a hot bath

Heat plus water is comforting and restorative in a way nothing else is, particularly if you have chronic pain, Virant says. Make time for a good soak daily or as needed. This can also double as your meditation or quiet time, bringing mental relief along with the physical.

12. Prioritize sleep

Getting a good night’s rest is already difficult for many people with chronic diseases thanks to painsomnia. Higher levels of sleep disturbances related to the pandemic — known as COVID-somnia — may be making things particularly rough these days.

That said, getting enough quality sleep is one of the fastest ways to help lift your mood, Dr. Williams says.

“Your brain uses sleep as fuel and you need at least seven to eight hours per night to stay mentally healthy,” he says. “During sleep, your brain performs the ‘housecleaning’ of clearing toxins and waste products while improving memory and mood.” Sleep is especially critical for people who have brain fog or depression as a symptom of their illness, he says. For starters, set a bedtime and a wakeup time and stick to it each day. The pandemic has thrown daily routines, which can mess with sleep.

13. Schedule brain breaks

Brain fog and mental exhaustion are common symptoms of many chronic illnesses and many people find themselves totally mentally burned out at the end of a long day.

This is especially true during the holidays (when may you have more on your plate) and during COVID-19 (when there’s so much going on the world generally to worry about). Mental breaks are just as important as physical breaks and you should schedule a few each day, Virant says. What counts as mental rest for you could include a nap, watching funny videos, meditating, or taking an evening off from housework or other obligations.

14. Move every day

“With anxiety and mood-related symptoms skyrocketing, exercise is your secret weapon,” Williams says. Whether you take a walk, do some yoga or gentle stretching, do an online fitness video, or ride a stationary bike, try to do some type of physical activity each day.

Exercise has a host of protective benefits that people with chronic illness need right now, including a stronger immune system, more energy, and less inflammation. What’s more, exercise is also a proven way to cope with depression and reduce anxiety, he says. You don’t have to push hard to get these benefits either — just a 15-minute walk in the sunshine is enough to lift your mood and boost your health.

Resist the Temptation to Isolate and Hibernate

15. Schedule social time

Even without the extra burden of COVID-19, people with chronic illness often feel more alone than others due to the ways their health issues impact their lifestyle. But the pandemic has added a whole other layer, as people with chronic conditions have been following public health guidance and isolating more strictly. If people around you seem like they’re having a “normal” holiday season — shopping in person at stores, getting together for holiday parties, etc. — it can make you feel loneliness even more keenly.

Look around for people who have a similar COVID mindset as you. If anyone is local and you can see them safely in person — with masks, social distancing, and being outdoors — make plans to get together. If there’s no one nearby, reach out to others by phone or video chat. Ideally, you can make plans on a regular basis (at least once or twice a week) so you have something to look forward to.

16. Get involved in online support groups

You are not alone. There are many, many people going through similar struggles during the holidays and thanks to the internet, it’s easier than ever to find others with chronic illnesses to talk with and relate to, Virant says. There are online support groups or chat rooms for every type of condition where you can go to vent, get information, and receive empathy in a way people in real life may not be able to. Start by following CreakyJoints on Facebook, Twitter, and Instagram for daily content and conversations. Search for your condition plus “support groups” on Google or on your preferred social media platforms.

17.  Try teletherapy

If you’re not currently seeing a therapist, consider whether seeing one via virtual visits could help you cope with the emotions and issues you’re struggling with right now. Your therapist can help you figure out how often to check in throughout the holidays (and beyond). You can search for therapists who specialize in treating people with chronic illness on sites like PsychologyToday  or check out teletherapy apps like BetterHelp and Talkspace.

Do the Holidays Your Way 

18. Get a tabletop tree

Nothing can brighten a dark winter day like a sparkling tree but setting up a Christmas tree requires a significant amount of strength, travel, time, money, and energy — all things you may be feeling short on right now. Depending on where you live, you may also worry about whether venturing to buy a tree in person is safe, COVID-wise. If the tradition of a tree helps you stay positive and feel connected to loved ones, then it’s worth finding a way to get it set up and decorated, like asking loved ones to help, Virant says. However, if it’s just a nice decoration to you, consider getting a small tabletop tree. You can still get the mental health benefits without the stress.

19. Rethink gift giving

Giving gifts is a fun and rewarding part of the holidays. Doing acts of service is one of the best things you can do to ameliorate depression and loneliness, Virant says.

The key is to find a way to give in a way that won’t exacerbate your mental or physical challenges during the pandemic. For instance, consider:

  • Making simple homemade gifts
  • Setting up a gift exchange with your family and friends where you only purchase one gift
  • Doing a Secret Santa gift exchange
  • Donating to a charity in loved ones’ names
  • Giving something that has a lot of value but costs no money, like a letter full of compliments or a poem you write.

“It’s a win/win. You feel happier and so do they,” Virant says.

Get Free Coronavirus Support for Chronic Illness Patients

Join the Global Healthy Living Foundation’s free COVID-19 Support Program for chronic illness patients and their families. We will be providing updated information, community support, and other resources tailored specifically to your health and safety. Join now.

Interview with Katie Willard Virant, MSW, JD, LSCW, a psychotherapist in St. Louis, Missouri and author of the Psychology Today column Chronically Me: The Emotional Landscape of Chronic Illness

Interview with Stephanie Mihalas, PhD, a board certified psychologist and Founder of The Center for Well Being in Los Angeles, California

Interview with Vernon Williams, MD, a neurologist, pain specialist, and Founding Director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles