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Navigating holiday stress and expectations to be happy

 December 12, 2023 at 11:23 AM PST

S1: Welcome in San Diego , it's Jade Hindman. The holidays aren't always happy. So what are some of the best ways to cope with anxiety , grief , or substance abuse ? Today , a therapist and a medical expert join us to share their advice. This is Midday Edition , connecting our communities through conversation. The holidays can be a time where friends and family come together to celebrate , but they can also bring about feelings of loneliness and stress , or they can just be overwhelming. So this season can be particularly challenging for people coping with mental health challenges or recovering from substance abuse. We wanted to have a conversation about how to navigate those challenges. I'm joined now by Professor Juan Camarena , a licensed marriage and family therapist and professor at San Diego State University. Juan , welcome to you.

S2: Thank you so much , Jade.

S1: Thanks for being here. Also , Doctor Jim Dunford joins us. He is the medical director of the McAllister Institute in El Cajon. Jim , welcome. Thanks.

S3: Thanks. I appreciate being here.

S1: So glad to have you both. Juan , I'll start with you. The holidays can come with these expectations , right ? For us to be happy and joyful. But that's not everyone's reality.


S1: So what are some of the biggest challenges you see your clients dealing with right now ? Juan.

S2: Geez , I have to say stress and expectations. I think expectations , silent and overt are really , really tough to think about. Do you need to do I have to go to all of the social events ? Do you have to make everything from scratch if you're going to attend them ? And I don't want to leave out folks who may not be celebrating holidays around this time , and the kind of stress that happens when you don't celebrate Christmas or Hanukkah or any of the other holidays that are that are popular for us , and the feelings of being left out or having to sort of this compulsory nature of participating in holidays in that way.

S1: And Jim , first tell us about the McAllister Institute and what it is that you do there.

S3: We are a 46 year old organization that is a nonprofit that's dedicated to taking care of individuals in San Diego who have addictions. We are 26 programs strong , ranging from residential to outpatient settings adolescents , teenagers , even the withdrawal management programs and the sobering center in San Diego. And we have 400 employees , and we probably touch the lives of about 1 in 3 people who actually intake in in San Diego County for addiction related problems.

S1: And some of your clients are away from their families during the holidays.

S3: I mean , there's nothing worse than being isolated. The lack of a support system , particularly family members , rekindles a lot of issues , both good and bad. And so that longing to be home sometimes , home wasn't always the happiest place to be , but there may be no substitute. And so this is a special time right now when all kinds of organizations kind of redouble their efforts to make sure that people can keep their focus. Yeah.

S1: Yeah. And , you know , and I would imagine , too , that the holidays can be a difficult time for that. Like you mentioned , sometimes home may not have been the best place for someone. And part of I guess the recovery from substance abuse would be to sort of remove yourself from certain social situations and in social circles.

S3: We call them triggers. They're all different kinds. There are people and there are events and places and smells and sounds that all can kind of resonate either good or bad. And people have to learn to identify those. That's part of the whole process of recovery , and to realize that it's okay to say no to certain invitations and certain opportunities , because it's just not going to be the right thing for them to do. They have to keep their rudder in the water and aim the boat in the direction that they know it needs to go.

S1: This question is for both of you.

S2: And so 89% of any survey for folks to respond in specific ways is a lot. So while we might not have a specific diagnosis in the Diagnostic and Statistical Manual , the DSM , I would. Say that we definitely have folks that experience a whole cluster of symptoms around this time.

S3: And I think that , you know , we know that there is seasonal affective disorder that does affect a percentage of individuals as the sun is less with us than previously. And so there are multiple biological and kind of emotional issues that are factoring in to create this phenomenon. And we see it reflected in all kinds of statistics. You know , drug use goes up , uh , DUIs go up dramatically. And so use during the holiday season , unfortunately , is a time when the highway patrol and everybody is especially busy and vigilant.

S1: And , Juan , the holiday season is one where , you know , there's this built in expectation , as we just talked about.

S2: And we know with a lot of the recent economic , uh , stressors that have been happening that folks don't have as much money as they used to or don't feel like they have as much , as much money as they used to. And so how can you how can we be really intentional about what are the things that I really want to do that I'm willing to save , for , that I'm willing to sacrifice something else for ? And what are the things that I can let go of , including expectations , to be somewhere to buy something or to follow whatever what you perceive as everybody else is doing. So financial , I think , is one of those really big stressors right now that can also lead to , uh , to Doctor Dunford. He was talking about addictions , right , in ways that we soothe and cope and try to disconnect from some of those uncomfortable feelings of not being able to do something that we want to do. Right.

S1: Right.

S3: Of course , when I was a kid , that was the most important thing is how many presents was I going to get to open right. And the bigger the better. But that's really a child child's memory of things. And we have to rethink exactly what are we celebrating. So I think one of the most important things is just sit down with yourself and others and say , hey , let's let's redefine what the intention of this holiday season was , um , and build strength in the relationships that you have with the key people in your life , because isolation really leads to kind of a , you know , black hole. And that's what people have to avoid is reinforcing their all of their social , uh , relationships at this time of year. And it's bidirectional because sometimes reaching out to other people that are really lonely actually serves as a kind of a therapeutic process for that person , and vice versa. So that's one of the very first things people , I think look toward. That could be an AA meeting , Narcotics Anonymous meeting , attending multiple meetings , connecting back with a sponsor. All these kinds of things are important , and we remind our clients to do those things.

S1: And Juan , food is often central to how we celebrate the holidays as well.

S2: I'm Mexican , Mexican , American. And so I think about these times of being around a big table , making the my list , uh , helping my , my aunts with the masa , integrating all these different parts , talking , sharing. And for me , those are the really important parts of food and the holidays. Less so the the gift buying and sort of the compulsory things that you have to do and thinking about. Also the psychological , the physical impact of when we overeat , when we overindulge , when we do just a little too much because we feel pressured to do so. So I think it's this balance of how can I engage with food in a way that feels good , in a way that is a marker of celebration , that is connecting , and not so much in a way that's going to leave me feeling terrible , full , and wishing I might not have gotten to that party.

S1: And along with all the food , can also mean being around alcohol and other substances. As Jim , we just talked about that.

S3: And if it's your family , I think that's especially important because a lot of people are coming back , and we're trying to remind people that that's a more intimate , small , uh , brief encounter sometimes are the best. And so keep holiday planning very simple. Number one , um , communicate to the people that are coming , your intentions. It's your party. So you should be setting the rules. If you'd prefer that people not have any alcohol , they're , you know , the family ought to be able to get by like that , that there shouldn't be any reason unless they themselves have a problem with alcohol and celebrating if they're really intent on , you know , helping somebody. I'll make sure that there's space available for the person who comes. Uh , you know , some people need to have a private place where they can make a phone call , uh , you know , sometime in the event or just get away just to think about it. Um. And then you yourself have to kind of be keep it light , keep breezy. Um , maybe the most important thing about addictions , remembering it's not a moral failure. You know , we're constantly dealing with stigma and that notion that somehow this is somebody , you know , they're weak when in fact it's a disease. And sometimes the parallel of , hey , this you wouldn't do this if they had diabetes or hypertension , I think can be an apt , you know , quick reminder that you wouldn't treat anybody that way with another chronic disease. Right.

S4: Right.

S1: And this question is for both of you , because , you know , whether it's an environment that triggers you or , you know , a certain social situation with the family that triggers you.

S2: I love that you said that. That's my number one suggestion to folks all the time for a variety of situations is schedule an a break. If you are attending a family event , a social event , a work event that you feel like you have to go to that you may not be looking forward to , then I would put a couple of breaks in your phone to where you might get an alarm , so you can make a call to that supportive friend , maybe your sponsor , maybe someone who can really be there for you. You can connect with , maybe take a walk around the block. Maybe walk the dog. If the person has a dog in the place that you're going , look for a reason to get some fresh air and get some perspective. And I think then you can make a good decision about a how much longer you want to stay. Uh , b if there is someone that you want to talk to and connect with that you haven't gotten to yet , or c bow out gracefully and say , thanks for inviting me , I appreciate it. I do have to go. I have a work obligation. I have to go home to do anything right , come up with a reason to be able to leave. But I think that getting a break allows us to have some perspective on how how we want to participate and how much more we want to participate.

S3: That's those are all great tips , great ideas. We sometimes say , hey , you know , I I'd love to stay longer , but I do have another obligation. You don't have to go into the details of it. I'm the designated driver. Nobody's going to , you know , that's enough set. That's enough to be able to say , you know , and even at the party , you know , it's okay to get a ginger ale and drink it. Nothing , no matter with that. But the main thing is , is maintaining a self controlling and a comfort zone. And and again , not over overdoing what you think is responsible. And that comes from kind of pre-planning , you know , what do I want to get out of this ? I want to see a couple of really important people. I want to make sure they know I love them and vice versa. But it doesn't have to hang on and go on for a long time.

S1: Yeah , no , that makes sense. I mean , and , you know , there there's so many pressures , um , around the holidays. And so this is advice is good for not only people who are dealing with mental health challenges or substance abuse issues to take heed of , but also people who are hosting these things as well. So you're listening.

S3: Be afraid , by the way , to ask the person what they'd like to do ahead of time. If you're hosting an event , incorporate what their ideas are ahead of time. They don't want to be the albatross , you know , being thought of or singled out. So I think a good conversation ahead of time can be very therapeutic.

S1: If you or someone you know are experiencing a mental health emergency or need resources , call 988. Coming up , more advice on how to manage holiday stress.

S2: Most of us aren't going to change people's minds. At a family dinner , at a work event.

S1: You're listening to Kpbs Midday Edition. I'm Jade Hindman , speaking with professor and therapist Juan Camarena and Doctor Jim Dunford about navigating added stress during the holiday season. Jim , I assume you have clients that are able to go spend the holidays with their family members and have to navigate difficult relationships. That part right there.

S3: Um , just imagine that you've left , gone to college , and now you're returning. But maybe there were things that were happening in that home that you were sort of just as glad to get away from. There was that guy that , you know , that didn't treat your mom right , or there was somebody that you just didn't like. So , you know , these kinds of things , you have to plan a little bit ahead. You don't want to have too much free time on your hands. The more you can kind of build in structure and also avoid certain people , you know , uh , to the extent that you can. But while being cordial , that's all part of the , the , the strategy for how to kind of cope with these , um , situations. Obviously you want to demonstrate love to your family and , and hopefully the host will kind of be there to kind of guide you , particularly if you've talked about these concerns ahead of time.

S1: Juan , you work with a lot of members of the LGBTQ plus community.

S2: I really am appreciating what Jim said about having these conversations. And part of what I love about working , being a member of and working in LGBTQ plus community is not only some of the struggles , but the ways in which we can celebrate and the ways in which we have families of origin and family to come back to. And when I use family , I mean this this term of people that love us and accept us and so we can make the holidays a time where we also celebrate and connect and vibe and go out and experience gay and queer joy , that that can be 100% a part of what happens during the holidays. And we also have to get real about what are the things that we would like to participate in , and what are the things that we just cannot participate in because it's not good for our own mental health. And so the pre conversation that you mentioned earlier , Jim , is can you talk with a family member , maybe your parents a loved one , if it is a blood family type of situation and just double check. Hey , are you still good with using the pronouns that I'd like you to use ? Hey , is it still good for me to bring my partner , even though I know not everybody in the family approves of my relationship ? And that kind of conversation can give you some good data on whether or not you want to participate. And you can be 100% open. And I think it'd be a lot easier to do that in a pre conversation rather than in the middle of a social event. Catching people off guard with a stress , the substances , all the things that happen at parties. And so really being intentional and thinking about what is in my best interest , can I attend this and still be okay and or can I attend for just a short period of time , see people , and then go to my family of choice to where I feel loved and nurtured and to sort of counterbalance maybe some of that other stuff that we took in.

S1: I mean , you know , for some people , there is no family of choice. And the family that they do have is just it's really too toxic for them to be around.

S2: And so connection can look a lot of different ways. I think ideally it would be with somebody outside of yourself that you can talk with that can you can feel understood by. We'll cover resources probably later in the broadcast. But thinking about connection also to self. So how can you connect with yourself in a way that feels good if it is eating things that help you feel good , if it is getting a workout in , if it is being really deliberate about your schedule , giving yourself time limits which you talked about earlier , participating in cultural spiritual things that also fill your cup. Right. So looking for ways that you can also connect internally. And we live in a beautiful city. I mean it's still great weather here in San Diego around this time of year.


S2: And I can't think of another time of year when stress and expectations are higher than now. And really , there's so much to do and a lot of for heterosexual relationships. A lot of this falls on women. The gift buying , the cooking , some of these things that even in the most modern relationships tend to. Fallen women. And so I think it's being mindful , regardless of your type of partnership , how much heavy lifting is each partner doing ? How can you support your partner better ? How can you make a plan about what you will attend , what you won't attend ? If there is one person that just ends up doing a lot of the caretaking , a lot of the stressful things , a lot of the gift buying , maybe then you as a partner can do something that would help alleviate that afterwards. Post-holiday , a little post holiday vacation , a one day staycation. Maybe you stay with the kids while she is able to do something fun or that she enjoys. So it feels like that. She also has something to look forward to at the end of this month.

S1: Also life changes. I mean , whether it be the death of a family member or moving to a new place , or maybe even a divorce , um , it can have an impact on a family's holiday traditions.

S3: Um , definitely the idea of reaching out to people when you see those sorts of things happening , it can't be more important. Um , you know , we've spent a lot of time thinking about the kinds of things that might happen at a party , but remember that in isolation , a lot of things happen , too. And when you think of the fentanyl overdoses and things of that nature , these are accidental events that are happening. A lot of times when people have too much free time on their hands and they're not as likely to happen at a party as maybe as an alcohol related problem , particularly , you know , in somebody who's who's trying to maintain their abstinence. So all of these life skills basically come into play to kind of support people at this time and friendships and family , which are the kind of like the things that bind us all together have are the that's what we have to mimic. If they don't have their own , we have to somehow surround people with those sorts of things. Even just a quick call and a checkup to say , how's it going ? Yeah.


S1: And how can people better support family members who are in recovery ? Earlier you mentioned that sometimes family members can make moral judgments on people. How can families just do better.

S3: Just by being considerate of the person ? Again , by realizing in particular that they have an illness and that whatever that illness is , is unlikely to be changed in a in a dressing down at a dinner , or through the advice of someone you know in the in the context of a social event , and that the person's doing their best until proven otherwise to be able to make their way. So , you know , open communications , kind of promoting the piece , reducing stigma , educating other people around them about , you know , the expectations and , and really the science of what comes down to this whole thing in terms of trying to help people to recover. Um , you know , we're kind of coming out of a dark ages. Now , we know that that what these diseases are all about and the mind is , is not well , and it takes time. And you can watch on functional MRI scans how long it takes to recover recovers entirely. Possible. It doesn't happen in a weekend or 30 days of sobriety. So we have to be forgiving for people and offer them some space.

S2: What I love about your question , Jade , is this idea that how do we look out for one another ? We think about community care beyond family and and if you think about someone , if you know someone going through a life change , really simply asking , hey , I see you went through a job change. I see you went through a divorce. How can I be helpful ? Would you like to touch base in a week ? Can I text you tomorrow ? Really simple , concrete things so we don't have to wonder. Walk on eggshells. Uh , not one interfere , but just check up on each other. How are you doing ? How can I be helpful ? And then listen. Listen for the answer and and do , if you can , what they ask.

S1: The other question that I have is , you know , uh , there's always these conversations about conversations that perhaps you should avoid around the dinner table. You know , whether it's about politics , what's happening in the world. I mean , so many people are divided on issues.

S2: There is so much going on in the world at the moment and there has been last year. That was a tough time. There's a lot going on in the world , but the year before that , my rule of thumb that I talk to my clients a lot about and students is what's your line thinking about planning for this , this event , planning for this family gathering , planning for this religious ceremony ? What is your line ? At what point do you feel like you want to say something ? At what point do you feel like you need to just back away from the conversation , but having an idea of of where you want to either. Jump into the conversation. Stay out of a conversation leaves you feeling more in control than feeling like you're just reacting to things. So if you can think about ahead of time. All right , so I know I'm going to this thing and it it may not be okay for me. Here's my line I will stand up for myself in these ways. And if the conversation goes this other way , then that's my time to take a break. Take a work phone call , step out and get some air.

S3: Those are great tips , I think. And and just for the people at the party , if they can possibly think it through , you know , let's let's not provide advice unless there unless advice is sought. You know , that's kind of a big one. And let's really avoid triggering conversations. If you know something that gets somebody's goat , that's the last thing that needs to be discussed , right ? So , you know , we and then there has to be on the other side the person who's basically has to have their own boundaries , like we said. And now it's time to go outside and , you know , watch the sunset.

S2: And be real with yourself. Right. What is my intention in arguing back ? Is it to change their mind ? Is it to stick up for myself ? Is it to stir the pot some more ? So be real about what it is that you think is going to happen in this conversation. Most of us aren't going to change people's minds at a family dinner , at a work event. So kind of getting real with yourself about what is my intention and how can I keep a relationship , rather than how can I get my point across ? Um.


S1: And Juan , going back to something you said earlier , just about , you know , checking in with with people asking , you know , can I be of some help to you , you know , checking in about changes that are happening in their life ? Sometimes that can be challenging , right ? Because you don't want to bring up something that might be triggering to them around the holidays. A lot of people like to escape their stresses.

S2: So I tend to use the word activate. And I don't know that I have very much control of that. All the time. But can I keep it simple ? Can I check in with you in a way , in a text message that says , hey friend , thinking about you , period. It doesn't have to be a whole long sentence , doesn't have to be like , tell me about this dramatic thing or traumatic thing that you just went through. Hey friend , thinking about you , I'd love to be there for you. Can I buy you lunch next week ? Can I send you some , uh , some Postmates , some DoorDash ? Can I send you dinner ? Can I send you lunch ? Something really nice and concrete and short that would allow somebody to say , sure. Rather than , hey , if there's anything you need , let me know that often time doesn't work so well. So I tend to think of really concrete interventions that don't take a lot of time , that don't involve the person having to tell you a whole lot , but that show that you care.


S3: That's nine , eight , eight. I used to be the medical director of the city of San Diego , and 911 was my go to number to teach everybody. But nine , eight , eight is the number for crises that are emotional , mental health related. There are trained , licensed personnel that are on call that are spectacular. I've had the opportunity to call them , you know , for reasons of my own. And that's a number that everybody should memorize. The other is that kids aren't necessarily going to call a number like that. And there is a Nami National Association of Mental Illness Teen and Young Adult Hotline , and they have trained teens and they can communicate in different ways. There's a text , there's chat and there's formal phone call. But as we know , a lot of teenagers prefer to text. And so that's something because it's particularly tough to get kids to talk. Right. And that we could spend an hour talking about that one because of the , again , issues related to communication as one of the most important things to prevent overdose in young people. But this is something that all kids ought to know about and have no threshold to say , I need to call somebody for help. Well , here's here's an anonymous person who's trained to be able to talk to you who's actually a teenager.

S4: All right. Juan , do.


S2: I also think about the warm line , which is also run through Nami here in San Diego. That's (619) 295-1055. If you just want to have someone to talk to , uh , to touch base with , it doesn't have to be a mental health clinician. Sometimes you may not want to talk to a therapist , and that's okay that you would have some other peers to talk with and also not be afraid to look online for Trevor Project , specifically for LGBTQ people and youth , the Trevor Project maintains both a hotline and a texting line. If you are a member of the queer community and want to touch base with somebody else in the queer community , that might understand your struggles as well.


S2: Uh , we know that Covid is not over. And that myself and lots of others of us lost people during Covid , and we didn't get to properly grieve them. Right. So , uh , I had a two grandparents passed away and we couldn't gather during that time. And so there's still ways in which I think that grief is stuck in some of our families and relationships and making a little space for that. Uh , if you're celebrating holidays , even if you're not celebrating holidays to remember , folks and to include folks that , uh , may no longer be physically here and to acknowledge that grief is a part of it. And my hope is by acknowledging it , having a ritual , lighting a candle , saying a prayer , or doing a meditation , that we can stay away from some of the ways , some of the numbing behaviors that Doctor Dunford and I were talking about. Um.

S4: Um.

S1: And I would imagine there's also a lot of anxiety around that , too.

S3: And a lot of a lot of our clients actually , without adequate attention to anxiety or depression , grieving being a particularly important one. Um , you're really not going to get to the heart of the one of the most important parts of what's driving the addiction. So you have to really look holistically at at what , where people are coming from. Why are they doing this ? A lot of times addiction is self-treatment. And again , great point without really focusing on grieving. Um , there are I know very well examples of people who are unable to kind of move on. So if you've lost a father , a dad , a boyfriend , a girlfriend , whatever , these things are very key and they can come back , right ? This is the time of the year when you think about those people. So you might have grieved that a year ago , but guess what ? It's back again. And that's just the way our mind works. So we all have to remember that , that these annualized events really mean a tremendous amount to people who've had great loss.

S4: Um , a lot of.

S1: Great advice here today. I've been speaking with Doctor Jim Dunford , the medical director of the McAlester Institute. Jim , thank you so much for joining us.

S3: It's a pleasure.

S4: Thank you.

S1: And also , Juan Camarena is a professor with San Diego State University and a licensed marriage and family therapist. Juan , thank you very much.

S4: Thank you.

S1: And again , if you or someone you know needs mental health help , the number to call is 988.

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Passengers from United Flight 2066 wait at baggage claim before heading off into San Diego for the sunny holiday, San Diego International Airport. Dec. 23, 2022.
Matthew Bowler
Passengers from United Flight 2066 wait at baggage claim before heading off into San Diego for the sunny holiday, San Diego International Airport. Dec. 23, 2022.

People enjoy spending time with their families over the holiday season, but it can also be a difficult time for individuals who suffer from what some refer to as the the holidays blues. It can be an especially challenging time for those coping with their mental health or recovering from substance abuse. The Surgeon General of the U.S. declared loneliness an epidemic earlier this year. Meanwhile, overdose deaths have increased in recent years, reaching over 111,000 in the U.S. in 2022.

There may be a variety of reasons why someone may feel more alone than normal during the winter months. Life events like losing a family member or relocating to another city can influence a family's holiday traditions. We speak with professionals to get tips on how to navigate the holidays and deal with loneliness during this time of year.


  • Professor Juan Camarena, assistant professor, San Diego State University, licensed marriage and family therapist
  • Dr. James Dunford, medical director of the McAlister Institute