What kinds of chronic illnesses can develop or be aggravated from stress during the holidays?

In terms of chronic illnesses that can develop, I am not sure that the holidays themselves necessarily are a risk factor, and chronic illnesses can develop at any time of the year. However, if you do have a chronic illness, it certainly can be worsened from stress during the holidays, whether it is emotional stress or the actual stress from trying to do too much, eat too much, use excessive alcohol, etc. During stressful times, those who have a chronic illness often let down on their usual care routine, which can certainly aggravate the illness.

How much does SAD contribute to holiday stress?

This is an excellent question. The presence of seasonal affective disorder (SAD) or seasonal mood change may, in fact, be the underlying difficulty for many people who feel down and depressed during the holidays. We start to notice the shortening day length in the early fall but, of course, right in the midst of the winter holidays in December, is when we actually experience the greatest loss of daylight, with short days and long nights. If you think back on past experience, and realize that typically you do have feelings of low mood, fatigue, appetite changes, increased irritability, low energy, you may, in fact, be suffering from seasonal mood disorder, which can be treated in several ways. Most frequently, we encourage people to increase their exposure to sunlight, preferably getting outside during the daylight hours or trying a special light that is called a phototherapy light. In other cases, people may actually use an antidepressant medication during this time of the year. And, if their mood normally improves in the spring and summer, they may be able to discontinue the medication and then restart it in the early fall. Other people who have depression at other times of the year, but find that it is markedly worse during the winter months, may need to talk with their treating professional about supplementing with a phototherapy light or possibly increasing the dose of medication temporarily for those few months.

I don't have tons of money to buy Christmas presents--but the kids don't really understand. How can I explain this to them without adding to their level of stress?

I think that comes up very frequently: How do you cope with children who want or expect everything for Christmas or another holiday and have no sense of what things cost? Our society fuels this because we are absolutely bombarded with store displays, advertisements and web sites, and I think parents need to help their children to be realistic. It is okay to say to your child that a certain toy is too expensive and even Santa Claus has limited funds and has to pick and choose as he has a very long list. You can also tell your children that moms and dads and Santa Claus will try to choose the most suitable present for the child. Children have to learn that their wish is not necessarily someone's command and that we can't always have everything we want but that parents and Santa Claus will try to find something special for that child.

Every year I tell myself I'm not going to buy into the whole holiday thing--but each year I do and my level of stress goes through the roof. Any strategies for coping? There is just so much to do with so many people's expectations on the line!

I think you have lots of company out there and many people who often are afraid to admit that they share your feelings. I think stress, during the holidays, certainly comes from several sources: I sometimes actually refer to holiday stress as being the result of what I call "The Terrible Too's" and it stands for too many visitors, too many obligations and too many unrealistic expectations.

One of my colleagues, Dr. Bruce Pfohl, has come up with what he calls "The Tinsel Holiday Strategy" and I will share that with you. "T" stands for telling others what you want and what is important to you as part of your celebration of the holidays. "I" stands for inquire about what is important to others' celebration. "N" is negotiate how you will celebrate. Recognize that the holidays often bring together people with different family traditions. "S" is for share the work and responsibility. Some people are very good at seeing what work needs to be done, others need a reminder or some scheduling. "E" is one of the most important letters in our strategy: it is enjoy the reality. Rather than dwelling on the ways that your holiday does not fit the fantasy. Find ways of enjoying the reality. Again, keep expectations for the holiday season manageable. "L" is for limit. Respect the limits and boundaries of others and be clear to yourself and others about your limits.

Are there any healthy, quick-burst-of-energy foods to eat while on the run during the holidays?

When we look at energy foods to eat during the holidays, especially when you do not have a lot of time to fix meals, it may not sound very exciting, but remembering that fruits and vegetables often provide a good source of energy while, at the same time, helping to control your weight. Generally speaking, foods with high fat and sugar may give you a very quick burst of energy, which is quickly followed by a drop in energy. Also protein foods like meat or beans provide a feeling of energy, while other foods that are recommended as part of a healthful diet such as pasta may actually be better saved for a meal when you are trying to wind down because you will often find that you will feel somewhat more relaxed after eating high carbohydrate foods. Also, it is very important to be sure that you are drinking enough water, because a lack of energy is often due to dehydration. Cold winter days and overheated air inside may, in fact, increase your requirement for water. Even though it is not a food, one of the best energy boosters is exercise. Oftentimes, exercise is one of the first activities that slide when people get caught up in holiday activities.

I often find I have little patience during the holidays, and I get really angry over really little things, and then when the holidays are over it goes away. I feel crazy!

While these may seem like emotions that are not congruent with the holiday season and you may have even been accused of being a scrooge, it is not unusual for people to have these feelings. Remember that the holiday season does not automatically erase those kinds of feelings, but if they are very strong and are interfering with your relationships and enjoyment, you may want to think about whether they reflect your disappointment with past holidays or the feeling that everyone around you is having a much better time than you are. Perhaps you can find an enjoyable activity or a stress relief such as exercising, spending time with people who lift your spirits, or starting some kind of new tradition during the holidays, such as volunteering to help deliver gifts through an organization that is providing gifts for people having difficulties in the community, or delivering meals to senior citizens, etc. Often, reaching out to others can be very satisfying and pull you away from some of those negative feelings.

I have a friend who is going to be alone at Christmas, I've asked her over to my place but she says no. How much should I push? She was alone last year and hated it.

I think your friend is very lucky to have someone who is concerned about helping her. However, your friend does have the right to turn down an invitation. You might gently remind her that you remember her talking about the difficulty of being alone last year and that you want her to know that she is welcome to spend time with you, but ultimately the decision is hers. Perhaps she feels that she will be imposing on you or your family. If that is the case, perhaps the two of you could find a time during the season when you could do something special together, such as going out to lunch, or looking at decorations, going to a religious service, a special movie, etc. Again, the choice must be your friend's. You can let her know that you are available, but you cannot force her to participate.

My boyfriend's father died last year during the holidays, how can I help him this year?

Around the holiday season, it is often difficult and can feel very awkward when you are with someone who has died during a previous holiday season or this is the first holiday without that person. You can be helpful to your boyfriend by letting him know that you accept that he may have some sad feelings, may not want to celebrate as heartily as you may have in the past. Perhaps the way to be most helpful would be to ask him what he would like from those around him, since they may not know how to be helpful, and that you will let him take the lead in deciding how to celebrate the holidays. One of the most difficult things, I think, is when people try to pretend that the person is not gone or worry that expressing feelings of sadness will somehow ruin the entire holiday. As I said before, negative human feelings do not disappear just because the calendar says it is holiday time, and we need to allow people to have all of their feelings regardless of the time of year.

I just lost my job, and I'm dealing with holiday stress. Any suggestions to not get the blues while being with friends and family?

That is certainly a difficult situation at any time of the year when you lose a job, and particularly painful at this time of the year. I think there will be times when, despite your best efforts to be cheerful, you will feel sad or blue. Sometimes the best way to deal with this is to be honest with your friends. Perhaps you will need to call a friend and say that you are feeling a bit down and will not be attending their party this evening, or telling them that you would like to stop in for a while, but that you may not stay as long as you might under other circumstances. I think it is very important to be honest with friends and family about your situation and that you want to join in the celebration as much as possible, and you want to share your good wishes, but that this year you will not be participating in buying gifts and you will also understand if they do not buy gifts for you.

I don't have family, and Christmas has always been hard. I've had people invite me over, but I always feel as though I am imposing. Is there anything I can do to make the holidays better?

It is difficult when you do not have family, and everyone around you seems to be very focused on theirs. However, family does not need to be just people to whom you are related, and friends can be family as well. When people invite you over, it is usually because they genuinely want you to share their celebration. I find that people generally do what they want to do, and if someone has invited you, I would accept the invitation at face value. You may actually find that many people prefer to add a non-family member or members to their family celebration, because having a non-family member present, often markedly improves the behavior of families that may have some stress or difficulties in being together for a long period of time! If you find it is too painful to be with someone else's family, you may look for some other ways to enjoy the holidays, such as taking a trip or finding out about others in your community who also may be without family and celebrate together.

My mother gets very depressed when the holidays come around and nothing I do cheers her up. What do I do to help her and not lose my sanity myself? I enjoy the holidays except for when I have to be with her.

The first thing that I would check out is whether, in fact, your mother actually is experiencing a seasonal depression that just happens to coincide with the holidays. If she would not consider seeing a mental health professional, you could perhaps accompany her for a checkup with her family physician, who is very likely quite able to recognize and suggest treatment for depression. If, however, her "depression" is due to feelings of loneliness, feeling that she is no longer useful to others, perhaps you can find some other ways to interact with her that would focus on a common activity rather than just simply having to mark time and make conversation. Perhaps she could help you with some shopping, gift wrapping, making cookies, or other things that she did in the past that make her feel useful and engaged. If your mother is somewhat of a social person, perhaps you could find out if she has other friends who are alone at this time or get her involved in some kind of activity that would help to lift her spirits. I am not sure if you have ever asked her directly about what seems to bring her down at this particular time of the year.

Every year my sister and I get into this "who can buy the best gift for Mom and Dad" thing. I've tried talking with her about it, but she says I'm just being silly, but it really bothers me. How can I express myself to her?

This sounds like a very painful situation. However, it does sound as though you have already expressed yourself to her and you have not gotten the response you would like to have. The only behavior you can control, in this situation, is your own, and you can decide not to participate in the "contest." You can perhaps talk with your parents about your fondness for them and your desire to give them a gift that will be enjoyed and appreciated, but that will not necessarily be as expensive as flashy as the one your sister gives.

What kinds of mental exercises can be done to de-stress when you can't leave and be by yourself for a few minutes?

One of the most helpful things that I find is to "leave" by going someplace in my mind that represents a very calm and peaceful place, such as imagining that I am walking on a warm beach with blue skies and sunshine, or that I am with a different group of people. You can take yourself on a little trip even while others are around you. If you need to, sometimes you can head for the bathroom and be assured of a few moments of peace and quiet.

I keep reading about deep breathing to relieve stress. Does this really work?

Deep breathing is a wonderful stress reliever and the best part is that it is completely portable and can be done any time and any place. One of the contributors to stress is actually shallow breathing and that decreases the oxygen that is available to the brain. When you breathe deeply, you will find an increased feeling of relaxation and often feel that you are more clear-headed. Do not wait until you feel stressed to try the deep breathing, but actually practice this several times a day so that it becomes more automatic. The best way to practice is actually to lie down on a hard surface such as the floor, on your stomach with your arms stretched out over your head. Take a slow, deep breath in through your nose, and then slowly exhale through your mouth, taking as long as possible to exhale. You will know that you are doing this properly when you feel your stomach press against the floor as you breathe in through your nose, and you will feel your stomach retract from the floor as you exhale. Try to do ten deep breaths at a time using this technique, and you will find that practicing on a daily basis will help you to breathe more deeply on a regular basis.

Family arguments always seem to come up during holiday dinners. How do I keep the peace?

This is a question that I am asked frequently. I think it is important to remember that families who argue at other times of the year are going to argue at the holidays as well. It is also important to remember that family members may all be experiencing a higher level of stress at this time and are reacting perhaps more strongly than they might at other times. It may also be the expectation that the holidays will automatically make your family into the one we see on TV or smiling up at us from magazine covers. It is important to remember that those are not real people. As I said earlier in the TINSEL strategy, there are limits as to how much time family members can share time and space. You may want to look at finding ways to shorten time family members have to spend together in a short period of time. As I said earlier, a helpful strategy is sometimes to invite people from outside the family to "neutralize the situation." Even though we think that our holiday celebration should take place in someone's home around the dining room table, you may actually find that going out to a restaurant may improve everyone's behavior. Family arguments can often be fueled by the presence of alcohol and if this is the case, you may want to look at decreasing the availability of alcohol if that is a predictable catalyst to family arguments. If, despite your best efforts, family arguments erupt, you may have to make yourself very busy in the kitchen or elsewhere in the house and not be a participant.

In addition to this dinner, I have several conditions that are affected by stress. What are your suggestions for minimizing flare-ups?

I think it is very important for you to identify what conditions are going to aggravate your situation and be very honest with yourself and others about what you can and cannot do. If attending the dinner is very stressful, perhaps you will let them know that you would like to see them for the meal, but that you will only be able to come for dessert. If you need to rest, you need to let people know that this is what they are going to do. If you are the one who has always hosted the dinner, it sounds like it may be time to pass the gavel, and perhaps you can volunteer to make one item to contribute to the dinner. Alternatively, perhaps it is time for others to share by doing a potluck dinner, or considering going out. In the perfect world, other people would notice when we are feeling sad, physically run down, or overwhelmed, but in the real world, it is up to us to recognize when we are having difficulty and to communicate that to others, but not expect them to take care of the problem.

I would like to leave you with some closing tips as well as my sincere wishes that all of you will find a way to enjoy the holidays in a way that is meaningful for you. As a reminder, let's keep expectations for the holidays manageable. Be realistic about what you can and cannot do. Remember that the holiday season does not automatically erase reasons for feeling sad or lonely. Let go of the past. Do not be disappointed if your holidays are not like they used to be. If your holidays have not been what you would like them to be, remember that each holiday season is different and can be enjoyed in its own way. Again, I wish you all a happy holiday season in whatever way is meaningful to you.