Coping with Grief During the Holidays
Can we feel joy, longing, and grief at the same time? For many, the holidays bring up this bittersweet mix of emotion.
The holiday season can be a particularly activating time when we are mourning the loss of a loved one. Specifically, experiencing grief (and all of its related emotions) while others are in “holiday cheer” mode may prompt us to try and match that joyful energy, even if superficially. And sometimes it feels too hard, and we feel compelled to actually isolate ourselves from others (e.g., turning down party invites). Or we might at least perceive ourselves as being isolated from them (e.g., “no one at this party understands what I’m going through.”).
Holidays can also be tied to meaningful memories and traditions with our lost loved one. And depending on where you are in your grief work, the thought of even participating in those traditions is too provocative. Additionally, trying to manage the anticipatory anxiety of various challenges these days may bring is emotionally draining and can leave you feeling further unmoored. This can also be mixed with breakthroughs of joy.
So if you are one of the many people currently coping with grief and struggling to find your footing this holiday season, here are some guiding points:
Identify and honor what works for you: Define how you want to personally navigate your holiday and entitle yourself to enact your plan regardless of what other people think you should do. Some people feel more comfortable skipping the holidays altogether, while others find it helpful to either engage in their familiar traditions, create new rituals that honor their lost loved one, or some combination of both. The bottom line is that there is no right or wrong way to grieve; decide instead what feels right to you and empower yourself to enact it.
Plan ahead to cope with the hard days: Learning when and how grief may show up for you can help you better manage your pain in a healthy way. In contrast, living in a state of perpetual anxiety about how awful your upcoming holidays might be can in fact distract you from effectively planning for them or enjoying them. As a result, you may be more vulnerable to engaging in unhealthy coping strategies that will likely make you feel worse in the long term.
Instead, by actively looking ahead at the days, traditions, memories, etc. that might be the toughest for you to experience, you are giving yourself an opportunity to navigate those challenges more adaptively. In other words, taking stock of your struggles can help you make a specific plan for how to best contend with them. By compiling an inventory of your own available coping strategies and reflecting on which situations they are most suited for, you will feel more anchored and confident in your ability to weather the stormy holiday season ahead.
3. Set boundaries: Once you have identified which holiday coping plan works best for you, the next step is to effectively communicate that plan to others. Being as transparent as possible with family and friends is an important way to ensure that your plan is respected, even if it is initially challenged. Remaining consistent about your boundaries is an important part of your grief work. Because after all, being empowered to both mourn (and celebrate!) the holidays in accordance with your own core values offers you the healthiest method of coping possible.
If any of this resonates with you this holiday season, or if you would like some support with taking any of these steps, our team at CTWPS is ready to help!
Hidden In Plain Sight: The Female ADHD Experience
Between 2020 and 2022, the population of adult women diagnosed with ADHD nearly doubled. Often considered a “boys disorder,” girls are significantly less likely than boys to be diagnosed with ADHD. But this is by no means saying there is a lower prevalence of attention disorder in girls or women. Instead, girls with ADHD tend to present differently than boys and teachers and practitioners often overlook their symptoms.
From a young age, women face difficulties receiving a diagnosis of ADHD. Disorders that go hand-in-hand with ADHD in girls, like anxiety and depression, can overshadow ADHD symptoms and lead physicians to misdiagnose their young female patients. Inward behaviors, like inattentiveness, are more common in girls with ADHD than outward behaviors, such as hyperactivity. In the classroom, hyperactive boys are noticed and dealt with by teachers, while inattentive female students remain ignored because their behavior is manageable. As a result, women learn strategic coping skills for their ADHD throughout their lives, further mitigating the external appearance of their disorder. Researchers Arcia and Conners (1998) determined that the self-perception of adult women with ADHD is poorer than that of men with ADHD or women without an ADHD diagnosis. Learn more
Studies have shown differences in dopamine release, cognitive function, and sensation seeking between men and women in response to stimulant drugs like amphetamine, often used to treat ADHD (Quinn & Madhoo, 2014). The effects of amphetamine in women vary based on their menstrual cycle, with greater euphoric and stimulating effects observed during the follicular phase, when estrogen levels are higher, compared to the luteal phase. This research suggests that the response to ADHD medications might need to be adjusted throughout the menstrual cycle for better symptom control for women.
Cognitive therapy can be a helpful tool in your ADHD arsenal. Some cognitive therapists specialize in working behaviorally with clients to improve executive functioning skills which may be helpful for aspects of ADHD. While we here at CTWPS do not specialize in executive functioning coaching, we do support our clients in managing the anxiety and isolation that often surrounds their ADHD experience. If that is something that you’d like to explore more in depth, reach out to us to learn more!
References
Arcia, E., & Conners, K. C. (1998). Gender Differences in ADHD? Journal of Developmental & Behavioral Pediatrics, 19(2), 77. https://journals.lww.com/jrnldbp/Abstract/1998/04000/Gender_Differences_in_ADHD_.3.aspx
Quinn, P. O., & Madhoo, M. (2014). A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls. The Primary Care Companion for CNS Disorders, 16(3). https://doi.org/10.4088/pcc.13r01596
Russell, J., Franklin, B., Piff, A., Allen, S., & Barkley , E. (2023). Number of ADHD Patients Rising, Especially Among Women. Epic Research.
The Sex-Mind Connection
Understanding how your sexual and mental health are interconnected is integral to taking care of your well-being. Research has shown that sexual activity has a direct impact on mental well-being. A healthy sex life can improve the way you feel and express emotions. But what happens when menopause, illness, pain, or other factors get in the way?
Sexual dysfunction and other issues related to sexual health can often lead to common mood disturbances in women. Many women may experience feelings of anxiety, low self-esteem, or depression. These symptoms usually appear in a cycle; sexual dysfunction impacts the mood, and mood disturbances further impact sexual health. Link here
Common sexual health concerns in women include a low sex drive (aka hypoactive sexual desire disorder), painful intercourse, difficulty reaching orgasm, and menopausal changes. Women facing these concerns should speak with their healthcare provider or gynecologist. Many of these issues are treatable, but can still be frustrating.
Stress and anxiety even have a biological impact on the body that can affect one’s sexual health. Your body is programmed to react to stressful environments by producing a hormone called cortisol. Usually, it provides you with a short burst of energy to tackle an immediate problem in front of you. But, importantly, when your body is producing cortisol, it cannot release the essential hormones needed for sexual arousal. In a population study conducted by researchers Dunn et al. (1999), sexual concerns were affected by psychological issues in women more than men. Problems with arousal, inhibited enjoyment, and painful sex were strongly related to anxiety and depression measures in women. For men, sexual health concerns were connected to age and physical health more significantly than emotional issues.
Your gynecologist, a sex therapist, and a cognitive behavioral therapist can each be critical resources for women experiencing sexual dysfunction. The role of cognitive therapy can be to promote a healthy change in attitude around sex, reduce anxiety relating to sex, and improve a woman’s self-image in the context of dysfunction.
We are not separate from our bodies. Sexual health is crucial to your overall health. Despite the stigma surrounding sexual dysfunction, please don’t go it alone.
About Those New Beginnings
In the Northeast, we are pretty much programmed to anticipate new beginnings in September. We may feel a surge of inspiration and energy that catapults us out of the last vestiges of summer.
Changes in season often reflect in our mood, at least temporarily. A key aspect of managing our moods is recognizing the transience of mood. Everything - including our mood - changes. And while external factors, like a seasonal shift, might impact us briefly, we don’t always have to make a larger negative story out of it. Sometimes our meta-story about our mood is the culprit in worsening it. For example, a client might say “Every winter I get depressed”, and the result of that belief is that she feels anticipatory anxiety and dread as the winter approaches. But a further examination of that statement reveals that most winters (not all) she feels a brief but significant drop in her mood that signals her to then anchor herself in her coping skills, and shift herself out of that low mood. So a reframe of that statement could be “I typically feel a significant mood drop in late November. I am going to try to get ahead of that by being proactive and practicing my repertoire of coping skills to either prevent, or move more quickly out of a depressed mood if it arises.”
Changes in mood are inevitable. But our power lies in our willingness to directly influence the meaning we give to those changes. If you would like support in doing just that, we’d love to help!
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Shining a Light on Perinatal Mood and Anxiety Disorders
As a clinician whose practice focuses on all aspects of maternal mental health, I was motivated to write June’s blog after reading a tragically resounding story that recently made national news. Among other reactions I had, this story reminded me that the information I hold as a specialist in this area is not common knowledge for the majority of women in this country. As such, through this month’s blog I hope to educate, normalize, and destigmatize a disorder that affects so many American mothers and their loved ones.
Arianna Sutton had a history of postpartum depression after the birth of her first child. But after her second pregnancy, her symptoms returned more quickly and stronger. Nine days after giving birth to twins, Arianna died by suicide. Tragically, Ariana’s story is not uncommon. Moreso, it underscores the importance for awareness of and knowledge about the most common pregnancy related complication: perinatal mood and anxiety disorders (PMADs).
What are PMADs?
PMADs include a variety of disorders and symptoms that a woman may experience during both her pregnancy and the year following birth. Postpartum depression is the most commonly known among them, but it is just one experience that fits under the PMAD umbrella. Specifically, additional disorders include anxiety, panic disorder, postpartum bipolar disorder, obsessive compulsive disorder, post-traumatic stress disorder, and postpartum psychosis.
According to Postpartum Support International, approximately 15 to 20% of women (or approximately one in seven) will experience symptoms consistent with PMADs. Additionally, women with a history of clinical depression or anxiety are at a significantly greater risk for developing PMADs, and those who have experienced PMADs during pregnancy are more likely to experience recurring symptoms in subsequent pregnancies. But important to also note is that a woman can be diagnosed with PMADs even if she did not experience symptoms during previous pregnancies.
Although it captures most of the PMAD-related headlines, postpartum psychosis is a rare experience that occurs in 0.1% of women with onset two to four weeks postpartum (Postpartum Support International). Symptoms include, elated high mood, overactivity, racing thoughts, confusion, mania, suicidal or homicidal thoughts/actions, hallucinations and delusions. Though postpartum psychosis is a medical emergency that often requires hospitalization and medication, with early intervention, symptoms can typically resolve within weeks (Postpartum Support International).
In contrast, the so-called “baby blues” is a very common postpartum experience that occurs within two weeks of birth and whose symptoms include weepiness, fatigue, anxiety, and difficulty sleeping. Though the baby blues are typically resolved with simple self-care practices, if symptoms persist beyond three weeks postpartum, a diagnosis of PMADs may be considered.
Additional PMADs symptoms to be aware of include
Feeling sad or depressed
Irritability or increased anger
Difficulty bonding with your baby
Feeling high or elated above and beyond what is typical
Reduced need/desire for sleep
Anxiety of feeling panicky
Upsetting thoughts that you can’t get out of your mind
Feeling as if you are “out of control” or “going crazy”
Feeling like you should never have become a parent
Worries that you might hurt your baby or yourself