In this episode of What the Health, we delve into the often-overwhelming stress many feel during the holiday season. Host John Salak speaks with Dr. Ken Duckworth, Chief Medical Officer at the National Alliance on Mental Illness (NAMI), about the various causes of holiday stress, from unrealistic expectations set by Hallmark movies to seasonal affective disorder. Dr. Duckworth offers practical coping strategies tailored to individual needs, emphasizing the importance of being kind to yourself, limiting social media exposure, and seeking support when necessary. Tune in to learn more about managing stress, finding joy in the season and maintaining mental wellness during the holidays. For more insights and Dr. Duckworth's book, 'You Are Not Alone,' visit NAMI.org.

00:00 Introduction: The Joy and Stress of the Holidays

01:24 Understanding Holiday Stress with Dr. Ken Duckworth

01:53 Individual Experiences and Coping Strategies

02:53 The Impact of Idealized Holiday Expectations

04:33 Seasonal Affective Disorder and Other Stress Factors

07:40 Social Media’s Impact on Holiday Stress

14:29 Recognizing Serious Mental Health Symptoms

21:42 Coping Strategies and Seeking Help

26:43 Conclusion and Final Thoughts

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Connect with NAMI (National Alliance on Mental Illness):

• Website: https://www.nami.org/ 
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Learn More about Ken Duckworth, M.D.:

• Website: https://www.nami.org/about-nami/who-we-are/meet-our-leadership/ken-duckworth/ 

Additional Resources

• You Are Not Alone Book Series: https://www.nami.org/support-education/publications-reports/you-are-not-alone/ 

The holidays are a joyous time for many, and they should be. But it is also a time that many find stressful, even dangerously so. The reasons vary, but they often involve trying to do too much in too little time. Many also stress out over trying to create the perfect holiday event, even though that's usually not possible or unrealistic.

Hallmark movies are not an accurate reflection of life. The good news is that holiday stress doesn't have to be overwhelming. There are ways to avoid it, but the approaches vary by person. What's important is to find a coping strategy that works for you. It's also essential to be kind to yourself during this period.

Our next guess is the right person to lay out why this stress occurs and what strategies can and should be used to deal with it. Listen up and learn to relax.

This again is the favorite part of our podcast, when we get to speak with an authority on the topic that we're dealing with, and that of course is dealing with holiday stress. And today we're speaking with Dr. Ken Duckworth of the National Alliance on Mental Health. He is the Chief Medical Officer of the Alliance.

So Dr. Duckworth, thank you very much for coming on board and talking to us today.

Thanks for having me, John.

All right. So the holiday season, let's assume that's Thanksgiving through New Year's Day. Is that the most stressful time of year for many people, at least on a calendar basis?

You know It really, this is a pretty individual business. I have met people who absolutely love the holidays and they start decorating the day after Labor Day, right? For them, it's a joyous opportunity. For some people, the hardest days are the anniversary of a death of someone they loved. And, I have found that people who've lost people around the holidays, Thanksgiving, Christmas, or, you know, it's common to feel those losses during those holidays. I think the holidays are a stress for some people. I do think it's relevant that you can learn from your prior experience of holidays.

Right? So you keep getting a chance to attend to this year after year after year. So if you've learned that you drink too much at holiday parties and that hasn't gone well for you, or if you learned that uncle Bobby is not the kind of guy you want to engage with for a lot, you can learn from that too.

I think fundamentally the problem comes from living in a society that has idealized how a happy family should be. And many of us fall short of that. And, many of our lives are imperfect. Not all of our relationships meet Hallmark criteria. But I ask people to remember that the Hallmark movies are made from people who aren't related to each other.

They are actors and actresses. They're total strangers, playing parts, you know, primarily to sell items related to the holiday season. So I just think it's important not to buy into an idealized version of what the holidays are.

Is that the main cause of stress? Is that we're trying to match something that's impossible to match?

I lost both my siblings to cancer and the holidays are still not a great time for me because I adored them. And I think of them, I have a nice life. I have many other people in my life. The holidays can be positive for me, but you know, they happen to have been born in November and both of them.

And so, you know, lost, lost. So, you know, some of these things are just inherent to the stress. Some of them are due to factors like people have had ruptures in their relationships, or they don't communicate with someone they care about. And the holidays are the idea that you should be able to give. Things to people, you should be able to, have beautiful holiday moments with people. It's not always possible, but it doesn't mean it will never happen. It's an opportunity to raise your expectations for oneself, right, about how things should be.

But if you can let that go. Another thing I would say is in the northern latitudes, the northern part of the country, it corresponds to shorter days. And that does add to people's vulnerability for seasonal affective disorder, if that's a thing you live with.

Shorter days, you know, do generate less activity in your little pineal gland. Some people experience that as a depression. It's a depressive disorder with a seasonal component. Much less common in Key West than in Boston. I went to Alaska in the dead of winter to do a consultation of some sort. Virtually every person I met there had lights.

These are special kind of lights. This is not like turning lights on in your kitchen. You know, they were special lights designed to replicate the brightness of the sun. And I was impressed by that. I'm like, that's pretty proactive here. Like, well, we don't really see the sun. So we need to, you know, kind of generate some of it. Cause I happen to have a mood disorder. A person told me, and this is the best way that I can regulate that. That doesn't mean it's the only thing I do, but I also do that. So the holidays have a couple of different. Cross cutting patterns, you know, for me, it's grief and loss for the next person.

It's this idealized version of how they should be for the next person. It's seasonal affective disorder, vulnerability in Northern climes. So I think it's different things for different people. And, I think it's okay to respect that. This may be a time of vulnerability for you, but there are other vulnerabilities in life. The day you get laid off, right? The day you lose someone. These are big hits in life. And I think that, you know, it's important to acknowledge them and then also develop coping strategies for yourself as you come upon the anniversary of them.

And if we talk about the holidays, you talk about the impact of weather related, especially in the northeast or upper Midwest.

Go in the north, north period. Yeah. just

And so you have these factors coming together. If we're talking about holidays, just because a lot of people think about it. A lot of people like the holidays that may dread going into the holidays because of expectations? Is the stress around the holidays, whether it's related to weather or anything else getting worse or better, too many Hallmark movies out there.

Yeah, I think that people who don't have resources and who do watch Hallmark movies do experience a lot of stress. We live in a consumer driven culture. You've never listened to an economic podcast or conversation without them saying the consumer is holding up the entire economy. Well, that consumer is you and that consumer is largely through the holiday season.

And if you don't have the capacity or you've lost your job. or some medical thing has befallen you and you have a series of bills, there's not a ton of Hallmark movies about the person who didn't give any presents and didn't create any, magical transactions. Now You can do other things.

You can bake for people, you can create songs, you can have all kinds of fun, but we live in a pretty commercial society and I think it's just important to recognize that, particularly if you're at a place where you don't have a lot of resources.

Right. Does social media then also play into this? I mean, not just Hallmark, but social media, because there's a lot of look at me on social media.

There's a lot of FOMO, a lot of look at me. I'm just waiting for a person to put on Instagram their worst day, their worst moment, their flat tire, their projectile vomiting, you just don't see a lot of that. And we don't have idealized lives. And of course, I had a student, I teach at the BU School of Public Health, I had a student tell me that she got off of social media. And she said, I realized it was adverse for my mental health because I was comparing myself with people who were presenting amazing things. And all I was doing was studying to get a master's degree. And I wasn't living an amazing life..

Right. Right. I wasn't in the Caribbean. I wasn't on a sailboat. I don't look great in a bathing suit anymore. Whatever it is, this was her experience.

And I was really the first person who gave me this window. Into, kind of the adverse impact of seeing more idealized transactions for people

Right. Interesting. And you wonder if the people who are projecting those images are as happy or as satisfied as they may be too. But that's probably an issue for another podcast.

These are different questions, but what I would remind you is they are two humans. They too are flawed. They too have vulnerabilities. They too have made mistakes. They too have had failed relationships. These are human beings. They're not an idealized version of you. They're not a better version of you.

They're just making a decision to post 17 seconds of a 24 hour day that went particularly well or funny or creative.

I'm not against a an adorable Instagram pic of a dog or a video of a baby doing something. I'm not against that. But it's not the same thing as that person has it together and I don't.

So I'm very minimal in my consumption of social media. So I'm on it to follow one of my daughters who loves to post. I took her and her sisters on a trip down the Colorado river and the Grand Canyon, and she had no access to a phone for a week and I asked her what it was like, and she said, this was the best week I've ever had.

Because she didn't feel the pressure participate it. But certainly social media and how much you consume is a source of great interest in terms of the teen mental health crisis. Right? Which was already happening before COVID.

And it's not just related to teens. If we talk about the pressure that social media may cast on people or the comparative pressure, correct?

That's right. So I encourage people just to lower your dose. This is just like uncle Bobby at the holiday, lower your dose. Right. If you ask him an open ended question about, vaccines and conspiracies, you might get a long answer from uncle Bobby. But if you just, talk about other things that are, of shared interest and hopefully you have something, whether it's craft beer or football or, the inadequate quality of turkeys today, whatever it might be, find something else to talk about and limit your dose of something, may not be good for you know yourself, right?

We had spoken just before we, we turned on the podcast live about a recent interview we did on election stress and a doctor from the University of Texas who advises people to advise people rather to cut down on their social media intake because they were overloaded with news on the election and it just was frying people out.

So it makes sense around the holidays.

Is there a demographic that you've seen that may be particularly susceptible to holiday stress? I, mean, are moms more susceptible or dads more susceptible?

I think it depends on the social inputs of a consumer society that you take in. So if you're the parent who, loves Christmas, and you've decided, you're the person who starts decorating the day after Labor Day, and you've decided everything has to be just so, and you're going to get all the right presents and all the right things, many people would find that stressful.

I would ask them about that. They may say, I love this, I live for this, my mother did this for me. So it's a connection to an idea in the past. So I don't think it's easy to generalize. About that. But I think just remembering that, we live in a consumerist society and it's kind of one more thing for busy people to attend to. If you can imagine this, my parents when I was a boy, used to put up the tree, decorate the tree, put the lights on the tree and have all the presents for Christmas morning. So they were suffering. Somehow they had incorporated this idea, that, they had to provide a perfect experience. And so they were pulling all nighters every Christmas. So, I don't do this. I don't recommend people do this. Involve the kids in picking out a tree, if you celebrate christmas.

Find some other way to involve the kids in decorating, if this is something you want to do for your particular holiday. But, overall be gentle with yourself, is what I encourage people to do. More nature, less social media, more connection with real people, less social media, just this broad strokes. Take a long walk in the woods and enjoy yourself, calm yourself.

But if you do have a vulnerability to a mental health concern, and it does get worse around the holidays, it's your bipolar disorder and alcohol vulnerability and people around you drink and you know that's going to be hard for you. Plan for that. Think that through.

I realize that, the term, Christmas disorders is something we talk about the perfect Christmas. And from what I understand, it's not a popular dis, uh, I think.

It is not a mental health disorder. It's mental health disorder. So obsessive compulsive disorder, this is a common, very treatable mental health condition where people have recurrent obsessive thoughts and then they discharge the anxiety through an action. The action could be washing or checking or something like that. I think you could imagine perfectionism and expectations leading to distress around things like a birthday. going off to college, right? The holidays. But I think in general, this reflects the fact that conscientious people want to do things for other people, right? So think of it through a lens of strength.

And just remember that a lot of the magic moments aren't because of the presents you bought. Right? There because of the interactions you've had or the jokes you told or the football you threw in the backyard Whatever it may be that you can't actually perfect things All right. These are human beings and complicated things and somebody's flight will get delayed and somebody will lose their luggage and you know, this is also called life.

There's stressors, throughout the year. There can be more stress at the holidays because of weather and a lot of other elements. How do we know when this becomes serious, or what of the symptoms? Is it okay? This is more than, you know, you're a little tired because you're going to five holiday parties and you're trying to get a few gifts and stuff like that. What are indications that this is really going off the rails forsomebody?

That's a good question So, you know one of the things you can say about most mental health conditions if you are sleeping through the night, you are unlikely to have many mental health conditions, including depression, mania. So that's just like the most simple thing. If you go to bed at 10 o'clock at night and you wake up at six 30 in the morning, pretty much every day without interruption, without problems, you're likely to not have a clinical depression.

If you have, you know, there are symptoms that are associated with major depression, lack of interest in things and ability to get going, suicidal thinking, concentration problems. So if I lose interest in college football, my daughters, and the natural world, you know, people around me would say, what is different?

Like something's going on with you, right? And if you've had a history of, let's say depression, you have a 50 percent chance of having another episode in your lifetime. So people have a true depressive episode. This could include suicidal thoughts, this could include sleep problems, appetite problems, energy problems, concentration problems, guilty negative thoughts.

This is one of the reasons that cognitive behavior therapy, which works on your thinking, is helpful to treat depression, So the idea would be if you're having persistent thoughts like that, contact your primary care doctor and, you know, just check in with them. Most people, these experiences pass.

Right? But if you have a history of a depressive episode that was diagnosed and treated, you should know that you have a vulnerability in this area. And if some confluence of life events contributed to you being incredibly stressed and falling into another episode, You wouldn't be the first person. So knowing those symptoms, knowing what you went through the previous time, people with bipolar disorder are very likely to have very similar symptoms.

Waking up at 3 in the morning, singing the same songs, and in an advanced conversation with people, again, this is manifested in part by stress. I interviewed people who did this for NAMI's first book. I wrote a book where I asked real people who use their names what they did to deal with mental health problems in their families and in themselves. Incredibly, John, no psychiatrist had ever asked real people what they had learned.

And my dad had bipolar disorder and I felt like I learned a few things from loving him. And in our relationship, and so I went to become a psychiatrist in part to help him, but also, you know, to kind of maximize what I could learn in traditional scientific ways.

But I never forget this idea that real people, and NAMI is full of real people, the National Alliance on Mental Illness, 700 affiliates all across the nation, wherever you are. Where are you, John, today?

I'm in the Western Catskills.

The Western Catskills. There's undoubtedly a NAMI group. You go to nami. org and you put in your zip code, it'll tell you your local group. But what you'll do is you'll find a group of like people who've been through this experience of having a mental health condition or having a family member who has a mental health condition and feelingfeeling like you're the only person this has ever happened to is very hard on people.

So this is the idea why going to our support groups or to our education programs is so helpful to people and why we're the biggest mental health group in America is because so many people want to be part of solving problems and sharing their experience with others because it might help them.

What happens if you don't deal with these issues? What are the consequences like saying, Ah, you know what? I'll just get through this. Physical, mental, emotional.

That's very traditionally one approach. That's still an approach in many other societies. Men tend that per square inch more than women.

If you look at the people who seek help and the people who don't. So let's say you live with a depressive disorder, right? Some of the coping strategies that people might use involve , alcohol, substances, term fixes that typically lead to a worse outcome, So, brute force denial can be useful if that's coupled with some kind of outlet. It could be pastoral counseling if you don't believe in therapy. Finding a place where you can talk about some aspect of your distress, in a place that you feel safe. And of course, seeking a NAMI group, you know, you don't have to be in treatment. You to be taking meds to be part of our community.

Sooner or later, there may be a consequence, a relationship injury, a challenge with a professional role, and more and more employers are encouraging people to get help. So it's, you know, there's employee assistance plans. People are actively working in the problem.

To make it so that they know employers know that people with depression are the number one cause of people who don't show and people show up and don't work.

They know that. So employers are coming around to the idea. Wait a minute. I wonder if we should think proactively about it easier for people to get help.

Do companies recognize the impact of mental health on their productivity, on their employees. Do you see companies sensing this particularly around holidays that it may be particularly stressful and there are ways to help navigate that?

They may not have an open bar at their holiday season. Many problems correlate with alcohol.

In our society, if you were to talk to an HR professional on your podcast, if you asked the question, how many of your problems relate to parties and alcohol at company events, I'm going to say 70 of them are related to that particular thing.

Some employers are trying to be mindful. They may set out things. This could be a stressful time. You may be having, You know, electoral agita. You may have holiday stress. Here's an employee assistance program. It's completely confidential. We don't know anything about who uses it. It's your free resources that people can use. an enlightened company might send that out. You know, as the days get shorter in the North, for example, say, Hey, by the way, it's just consider. If you need mental health services, here's our benefit. You can contact such and such a person. If you need to find therapist, it is hard to find a therapist in our modern society. So I think that's the idea of companies are evolving on this. It used to be never talk about it, never mention it.

I think there's more and more recognition that employees who are untreated with mental health concerns are not very productive. And in our society, employers are interested in productivity.

We are focused on the period around the holidays. What can be done on a societal level to improve this or to lessen stress, and what would you recommend individuals do?

Go light up. Go, you could, decrease your dose of a difficult person who you find activating upsetting. Yep. reduce your dose. If social media makes you feel you're missing out, reduce your dose. If being in nature the Japanese call it forest bathing. If being in nature soothing to you, make sure you get that in.

matter how crummy the weather is, if you have children or grandchildren that you could enjoy, find a way to be with them at some point. Right.

Lower your expectations. Go easy on yourself. Learn from your prior holiday experience. If you have a mental health vulnerability, a mood disorder, which can, bipolar disorder, or major depression, which can be activated by shorter days, plan for that. Talk to your caregiver. You can buy one of light boxes. And so that's think my relative prescription for that.

Do we see a lot of stress, depression come right after New Year's, after the holiday's over, Is there some sort of, I don't know, it's over, let down?

Oh, Well health club membership explodes and then people have expectations that they're going fit and look amazing. And then by the middle of January, some percentage of people have already realized it's going to work. And then by March 15th, probably, half the have just given up.

It's really very individual. Some people get more stressed season, right? Because they don't have the money pay their taxes. So, it's a very individual game. I do think the holidays can be stressful if you buy into our consumer culture. If you can remember that not everyone has perfect relationships and any weaknesses or challenges you face in your own life or your own family, that makes you an ordinary person. That doesn't make you less than. You're not failing at anything, you're living.

What you see as the biggest misconception when it comes to stress triggers around the holidays that makes it worse, or is not an effective way to deal with it?

Well, you know yourself, right? As an adult, you've had chances to learn things. dialectical behavior therapy called DBT is largely a rehearsal of your best coping strategies. And this treatment, which has, which saves lives, was designed for people who are quickly dysregulated. They have a condition called borderline personality disorder.

But I like this idea. Have a playlist you find soothing. Have a park you go Have a buddy you connect with whether it's your Mahjong group or your book club, maintain your supports. Don't give up on things. We're very social creatures and most of these experiences are shared by others. And respect the idea that stress, whether it's holiday stress. Tax season stress, grief anniversary stress, could impact your mental And then just use your coping strategies that you've developed to attend that. And if you need professional help, please try to get it.

Before we go just tell us again the name of your book and where people can get it?

Yeah, so this is the National Alliance on Mental Illness first book. It's called, You Are Not Alone, The NAMI Guide to Navigating Mental Health with Expert Input and Wisdom from Real People. I wrote this book to basically create the space that involved that you may be an expert. If you've lived with a mental health condition or loved someone, you've also learned something.

And I was impressed as a psychiatrist that nobody really had emphasized this radical idea that we're all learning as we're living.

And people can get that through NAMI?

Anywhere books are sold, Amazon, Barnes and Nobles, all the royalties go to NAMI.

Okay. Thank you for participating. We hope you enjoy your holidays. And they're, stressless and fun and enjoyable.

They'll be whatever they are. wish you the same, John.

Before we move on, we want to again encourage our listeners to take advantage of the hundreds of exclusive discounts WellWell offers on a range of health and wellness products and services. Now, these cover everything from fitness and athletic equipment, to dietary supplements, personal care products, organic foods and beverages, and more.

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So, let's be clear. There is undoubtedly lots of joy in the holiday season. Unfortunately, for many, there's a lot of stress too. But you can work to overcome debilitating stress. Start by finding coping strategies that work for you. This may mean limiting your exposure to certain people, finding pleasure in the season that doesn't focus exclusively on gifts, Or, perhaps, just taking a walk in nature to replenish yourself.

Also, don't compare yourself to others, or even seek out the perfect but possibly unrealistic or attainable holiday. Hallmark's version of the holidays is far from accurate. It might also be wise to lessen your intake of social media during the season, especially if you're susceptible to depression or strain.

But perhaps most important is to be kind to yourself. Give yourself some time to relax. and enjoy a guilt free holiday season. Ultimately, if you are feeling overwhelmed, having trouble sleeping, are depressed, etc., don't be afraid to talk to someone. A therapist, a pastor, a friend, anyone who can help. This includes one of the many NAMI support groups that Dr. Duckworth mentioned. With this in mind, we'd like to thank Dr. Duckworth. His insights and advice are extremely valuable. If you'd like to learn more, please visit the National Alliance on Mental Health at NAMI. org. That's NAMI, N A M I dot org. You can also secure a copy of his book, You Are Not Alone, The NAMI Guide to Navigating Mental Health, on the site.

Well, thanks again for listening. Enjoy the holidays, and we hope you'll join us again soon on What the Health.