For so many people who are grieving, getting from November to January every year seems practically impossible.  People would oftentimes just rather skip the whole thing and hibernate the season away.  The impulse is certainly understandable, since this is a time of year where family and happiness are emphasized everywhere around us.  While it is certainly very difficult and heartbreaking, you can make it through the holidays.

You can find a previous blog with 10 holiday survival tips for grievers here: It's (Not Always) the Most Wonderful Time of the Year: Grieving Through the Holidays 101.  I also wanted to share a beneficial article on ways to honor a loved one during Chanukah, which you can find ​on Aish.com.

This year, I wanted to share some more information on actual ways to plan for the holidays (including escape plans).  These recommendations are just that, only recommendations and may not be right for you or your situation.  Every family tradition is different and has a different importance to them.

To begin, consider what aspects of the holidays seem to be the most difficult.  It is also important to communicate with others in your life about potentially making changes.  While not every loved one’s opinion carries the same weight, it may be a good idea to communicate with children (adult or otherwise) or others who are grieving the loss as well.  It may be beneficial to talk with others about being open to the possibility of changing traditional holiday plans for yourself or your family, that way they are aware and can possibly help you make some decisions about what to do.

There is no rule stating that making a change for this year’s holidays will result in a permanent change.  You can do something different this year and then return to previous traditions next year, it is up to you/your family.  You may decide that you want to make a large change for the holidays, such as going on a vacation to somewhere new and not having your usual holidays at all.  You may choose to keep some elements the same (or feel like you have to) and change others.  It is completely up to you, as there are no right or wrong changes.  The only caution that I have is to use substances in moderation during a time of year where access can be plentiful.  In addition, it can result in increased depression to completely remove yourself from all activities and from your support network.

It may be beneficial to consider all of the tasks that you traditionally do for the holiday season and then decide if these things matter for each area:

• Why that tradition exists or how it began?
• When it is done?
• Where it is done?
• How it is done?
• Who does it or participates?
• If you want to change it?

For example, if you traditionally have hosted a holiday for your family in your home.

• Why did that start?  You liked to host the holiday in the past.
• When?  It was always on Christmas, but your family would be open to moving it to a different day.
• Where?  It took place at your house, but others have hosted in the past.
• How?  It was previously a dinner and then gift-giving with a large number of family members.
• Who?  Immediate and extended family, some family friends invited.
• Change it?  This year, you don’t have the energy to host but you have another family member that is willing to host instead at their home.  Or maybe it can be a very casual gathering at a restaurant earlier in the month.

Some suggestions that others have used in the past to get through the holiday season:

• Going on vacation as a family and getting away from the area completely.
• Putting up a tree with alternative holiday decorations on it (ex. Valentine’s, Halloween).
• Doing very minimal decorations that do not have sentimental value.
• Take any decorations down immediately after an event or the holiday.
• Decorate for winter and not the holiday itself.
• Not listening to holiday music.
• Using headphones while shopping to avoid holiday music.
• Listening to a different variety of holiday music (ex. rock, reggae, jazz).
• Giving only gift cards for the holidays.
• Shop online and have it delivered.
• Sending holiday cards to only a select few people or those who sent one to you.
• If you typically send holiday cards with information about what happened during your year, consider typing up a synopsis of what happened and print it out to add to your card so you don’t have to write about your loss over and over again.
• Maybe your loved one’s favorite food(s) will not be made this year.
• Making only your loved one’s favorite food(s).
• Store bought is fine this year.
• Order groceries or items for pickup to minimize time in the store.
• Choosing not to go to holiday parties this year.
• Letting your loved ones know that your plans will be highly flexible and you may not make it to various activities/holidays.
• Letting your loved ones know that you may leave early.
• Watching a religious service on tv this year.
• Muting holiday commercials or watching a streaming service that does not have them.
• Making a donation in your loved one’s memory.
• Hanging their stocking.
• Not hanging any stockings.
• Leaving an empty chair for your loved one.  You may even choose to have a plate with their favorite foods on it.
• Asking family/friends to share happy memories of prior holidays with the person who is gone.
• Taking part in a local or online memorial service.
• Having a private memorial (small or large) around the holiday for your loved one.
• Lighting a candle for your loved one.
• Making holiday plans with people in your life who are supportive in your grief.
• Making an escape plan for any activity that you plan on attending.

Making an Escape Plan
This is a topic that has been addressed before, so feel free to skip it or skip to the parts that are helpful for you.  If this is a new concept for you, go ahead and keep reading.  An escape plan can be a good idea if you feel worried about “breaking down” or “not being able to handle” something that comes up at a gathering during the holidays.  Even if you feel comfortable being open in your grief, sometimes we just want some alone time.  Creating an escape plan ahead of time can help reduce some of the anxiety you may be feeling about upcoming events.

Some escape plans ideas:

• Take your own transportation to an event.
• Ride with someone else, but make sure that they are willing to help you leave when you are ready…even if that is shortly after you arrive.
• Come up with a code phrase you can use with a friend, family, or partner to allow you to take some time away.
• Think of a quiet spot that you could go in or out of the home/location.
• Excuse yourself to the bathroom.
• Park somewhere you can leave easily and not be stuck waiting for others to move their vehicles.
• Let your host know that you will need to leave early, if you decide to stay longer that will most likely not be an issue.

There are many other suggestions out there with ways on getting through the holiday season and feel free to get creative with what you would like to do.  Not all of these suggestions will work for everyone and that is completely fine.  There is no wrong way to get through this, just know that you will get through.  Be gentle with yourself this year and don’t feel like you “should” or “shouldn’t” be doing something.  Take it day by day and be flexible in your plans.  Not everyone will understand, but they don’t have to because this is your journey through grief.  Do what you can to take care of you during this difficult time.

Social Anxiety Disorders is defined as persistent, intense fear or anxiety about specific social situations for fear of being judged negatively, embarrassed or humiliated. Individuals with Social Anxiety Disorder will either avoid anxiety-producing social situations completely or endure them with intense fear or anxiety, often using safety behaviors as a way to cope with their distress.

Individuals with Social Anxiety Disorder are thought to experience anxiety in response to social situations because they assume that they will be evaluated negatively and catastrophize about the implications of negative evaluation. More specifically, individuals with Social Anxiety Disorder assume that they will be evaluated negatively because they think that their abilities will fall short of others’ expectations, that there are high expectations for social performance, have unconditional negative beliefs about the self, and assume that acting in certain ways will result in negative consequences (Clark & Wells, 1995).

There are a number of maintaining factors in Social Anxiety Disorder that are targeted in treatment as a way to stop the cycle of anxiety and to help ensure individuals with social anxiety are able to overcome their fears.

Negative Thoughts/Beliefs

Individuals with social anxiety engage in thinking patterns that tend to reflect “cognitive distortions” or thinking errors that put them at risk for anxiety. For example, an individual with social anxiety may predict that others will think that they are incompetent or stupid, or that others will be able to tell that they are very anxious, and that these negative evaluations from other’s will result in disasterour consequences (e.g., “everyone will laugh at me and I will be shamed and have to leave”). These are typically referred to as catastrophic likelihood and cost estimates, and treatment specifically works to target these thoughts/beliefs and alter them to reflect healthy predictions. This can be done either directly via cognitive restructuring, or indirectly via the use of exposures or behavioral experiments. 

Avoidance/Safety Behaviors

Passive Avoidance (complete avoidance of a situation, people, or places) and safety behaviors (behaviors done to help the person feel more safe) can actually create and perpetuate thinking errors because they can: exaggerate physical symptoms of anxiety (e.gripping a podium tightly will increase shaking), prevent an individual from learning that they overestimate the likelihood and severity of their feared social consequences, maintain self-focus of attention and self-monitoring (see below) and potentially increase the likelihood that others will notice symptoms of anxiety. Therefore, treatment aims at helping individuals with Social Anxiety Disorder approach their fears without the use of safety behaviors.

Common safety behaviors in social anxiety are always needing to bring a “safe” person to social events, avoiding eye contact, not asserting oneself, prefacing interactions with excuses such as “I’m not really myself today so excuse me if I seem off,” being a “wallflower,” exiting conversations as quickly as possible, only engaging in social situations with the use of benzodiazepine medications such as Xanax, perfectionistic preparations (e.g., practicing what one will say over and over again), etc.

Internal Self-Focused Attention and Observable Self

Individuals with social anxiety engage in detailed monitoring of themselves which then enhances the individual’s awareness of anxiety symptoms and hinders their ability to gather disconfirming information from their environment (Clark & Wells, 1995). In addition, the individual is then thought to use this internal information to construct an impression of the self (perceived observable self) which they assume is also the impression that observers will construct (when in fact, a socially anxious individual's perceived observed self often significantly differs from what others perceive). For example, a socially anxious individual may assume that others can tell they are terrified and shaking and sweating when others may not notice, or not notice to the same degree. 

Anticipatory and Post-Event Processing

Anticipatory Anxiety refers to the tendency for a socially anxious individual to hyperfocus on an upcoming feared social event and worry intensely about it. For many individuals with social anxiety, their anticipatory anxiety is described as being either equally as anxiety provoking or even more anxiety provoking as the event itself. Some individuals describe this experience as a sense of dread or doom. 

Post-Event Processing is a kind of repetitive thinking pattern that is negative following a social event. For example, an individual that just finished a social interaction may focus on one or two specific incidents that occurred during the social interaction where they felt they failed or embarrassed themselves or didn’t live up to their expectations or the perceived expectations of the other individual(s). They may think to themselves “why did I say that, I’m so stupid, now they think I’m selfish.” The individual will then ruminate about this perceived failure/embarrassment/confirmation of their fears over and over again. In fact, I work with many socially anxious individuals that can recall in great detail a long list of past social events/interactions that they still feel ashamed of and ruminate and think about many years and decades after it took place. For many socially anxious individuals, thinking about these past events can feel very shameful and painful. 

In treatment, individuals with social anxiety are taught several tools to inhibit the use of Anticipatory Anxiety and Post-Event Processing. Some examples include using present-focused attention, de-catastrophizing, self-compassion exercises, worry/possibility exposures, and fact-based evidence processing. 

References

Clark, D. M., & Wells, A. (1995). A cognitive model of SP. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), SP: Diagnosis, assessment, and treatment (pp. 69-93). New York, NY: Guilford Press.

Chronic, persistent worry, exhibited in individuals with generalized anxiety disorder tends to fall into two categories (American Psychiatric Association, 2013): Worries about solvable problems and worries about unsolvable problems. Often my patients with Generalized Anxiety Disorder (GAD) are incredibly good at managing solvable problems. If you are reading this and you have been diagnosed with GAD, I bet you have been called an effective problem solver by people who know you well. Worrying about unsolvable problems similarly is often an attempt to solve a problem that has not yet occurred. In this sense, it should be emphasized that healthy worry serves as an important cognitive function. Healthy worry helps us prepare for the future, plan for navigating challenges, and keep our lives in order. If you know someone who doesn’t worry often, you may know the problems that sometimes result from never engaging in the cognitive process of worrying. They may not be the best at planning, timeliness, or remaining organized and vigilant of what tasks need to be managed. However, chronic and excessive worry often fuels catastrophic thoughts and endless “what ifs'' that cycle through your brain (Zinbarg, Craske, & Barlow, 2006). It can be very difficult to stop and/ or to control these “what ifs.'' Therefore many worriers lose a tremendous amount of time and energy thinking about future catastrophes that could happen and struggle to remain in the present moment (Zinbarg, Craske, & Barlow, 2006). 

So what can you do to stop trying to solve the unsolvable problems and catastrophes of the future (sometimes called hypothetical worry)? First, I recommend that my patients determine which worries reflect solvable problems and which worries reflect unsolvable problems (Zinbarg, Craske, & Barlow, 2006). Not only can it be helpful to sort out solvable vs. unsolvable worries, but also it can be helpful to start asking yourself “do I need to solve this problem today?” We are bombarded with endless problems in our lives that need solving. Chores will always need to be completed, new work will keep piling up at your job, and family gatherings will continue needing planning. But does the task need to be managed today? Most problems can actually be solved tomorrow; however, some must be managed today. Start with those. Zinbarg, Craske, and Barlow (2006) recommend doing as follows to manage solvable problems that warrant immediate attention: 1). Identify the problem; 2). Consider all solutions; 3). Rank solutions from the best solution to the worst; 4). Create a plan to carry out the best solution; 5). Do it! Implement the solution and try again if it doesn’t work. Essentially, fix what you can in the most effective and efficient way possible. 

After recognizing which problems need solving today, the unsolvable problems may still seem well… unsolvable. I argue that is simply not the case. Unsolvable problems can be managed in two ways. The first is by “sitting with” the “what-if” long enough to see that the “what if” has not happened yet and likely won’t. Most of our catastrophic fears actually do not come true or are unlikely to come true. With the assistance of a mental health professional who specializes in anxiety disorder treatment, you can learn a variety of tools for sitting with catastrophic thoughts. The goal is to desensitize yourself to such thoughts because the reality is, they are simply thoughts. If you repeatedly expose yourself to scary “what if” thoughts, eventually you will no longer be afraid of them and/or learn to tolerate them without having to do anything about them (e.g., unhealthy worry). In treatment, we will help you do so in a systematic way. In addition, we will help you learn how to become a scientist. We will encourage you to ask questions such as, what evidence do you have that this is truly going to happen? Oftentimes, it seems  to be difficult for my patients to believe such evidence until after they have “sat with” their anxiety for a period of time. In other words, rational thinking can be difficult until the emotion brain has been exhausted. 
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Another strategy we will assist with is called decatastrophizing (Zinbarg, Craske, & Barlow, 2006). Catastrophizing can be defined as considering potential future events as awful and intolerable (Zinbarg et al., 2006). If you are a chronic worrier, you may often say “I could never deal with that” when certain “what-ifs” pop into your head. For instance, if you have recently had the thought “what if I make a mistake at work and then appear incompetent and then I lose my job and then I am without income and then I am homeless,” you may then state, “well, I could never deal with that, that would be too terrible.” You may try to leave it there, push the thought out of your brain, and try to avoid the thought for the rest of the day. But oftentimes, that doesn’t work because that terrible “what if” keeps intruding into your thought processes. For this reason, you will learn to decatastrophize in treatment. If that “what if” persists, it is important to actually take a look at it and consider several things. First, would you survive it? If you would, how would you cope with it? How long would it last? How bad would it be? Essentially, you will realize that you will live through even the most catastrophic events and somehow cope with them. Of course, it would be difficult. It would not be easy to make a critical error at work and to get fired and to go on unemployment. But would you get through it? Yes. You could go on unemployment and start looking for new jobs and find a new job and start working at your new job. It would be a hassle. It would be hard. But you would get through it. Negative, sometimes devastating, events will happen in all of our lives but we will survive and deal with them because unpleasant emotions and circumstances do not last forever (Zinbarg, Craske, & Barlow, 2006). 

In sum, managing worry entails becoming an effective problem solver. Solve the problems you can. Sit with or de-catastrophize the problems you can’t. Solve the unsolvable problems by recognizing you will be able to handle/ cope with even catastrophic problems, even if we can’t solve the unsolvable. 

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 

Zinbarg, R. E., Craske, M. G., & Barlow, D. H. (2006). Mastery of Your Anxiety and Worry: Therapist Guide (2nd ed.). Oxford University Press.

(from Mastering Your Adult ADHD: Cognitive-Behavioral Treatment Program by Steven Safren, Susan Sprich, Carol Perlman, and Michael Otto, 2017) 

Individuals with attention deficit/ hyperactivity disorder (ADHD) struggle with focus, attention, and/ or hyperactivity and impulsivity (American Psychiatric Association, 2013). ADHD can therefore often lead to difficulties organizing tasks, focusing on tasks, and completing tasks (American Psychiatric Association, 2013). Because of these difficulties, someone with ADHD may be more prone to procrastinate and wait until the very last minute due to feeling overwhelmed and unable to complete a task (Safren et al., 2017). They also may generally struggle with keeping life organized and taking care of responsibilities. In part, this is due to the prefrontal cortex abnormalities associated with ADHD, or abnormalities in the part of the brain involved in rational thinking, planning, organizing, and impulse control (Vaidya, 2012). 

Safren and colleagues (2017) have created a Cognitive-Behavioral Treatment Program for Adults with ADHD. In this program, they suggest some strategies for overcoming difficulties with organization. They first provide suggestions for prioritizing tasks by creating daily task lists:  What is it you are hoping to accomplish today? Individuals with ADHD may be prone to complete the easy and less important tasks first. However, this may then halt progress towards important, more challenging goals. Therefore, Safren and colleagues (2017) suggest that, after a daily task list is created, the level of importance of tasks on the list should be considered. 

Specifically, they suggest labeling tasks as A, B, or C tasks. The A tasks should be the most important tasks that must be completed today or tomorrow. The B tasks are less important and the C tasks are of lowest importance (Safren et al., 2017). After the most important A tasks have been determined, they recommend mapping out when you will have time to complete the A tasks and adding A tasks into a daily schedule/ planner. 

They further emphasize that it is important to create daily goals that are realistic (Safen et al., 2017). If the plan for the day or completion of a task feels too overwhelming, the plan or task may need to be reconsidered. They suggest breaking overwhelming tasks into more manageable steps if a task feels too large. In other words, write out steps of a complex task/ break the complex task into smaller steps. These smaller steps can then be placed into the schedule/ plan for the day. 

Although these strategies may seem simple, they can be critical for organizing and prioritizing task completion which in turn can improve productivity, reduce frustration, and reduce self criticism for “not accomplishing enough today.” Many other strategies can be helpful in cognitive behavioral therapy for ADHD for organizing tasks, reducing procrastination, improving focus, etc.. Reach out today to work with a trained mental health professional for additional support in applying these and additional strategies! 

References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Safren, S. A., Sprich, S. E., Perlman, C. A., & Otto, M. W. (2019). Mastering your adult ADHD: A cognitive-behavioral treatment program: Therapist Guide (2nd ed.). Oxford University Press.
Vaidya, C. J. (2012). Neurodevelopmental abnormalities in ADHD. Current Topics in Behavioral Neuroscience, 9(1), 49-66. https://doi:10.1007/7854_2011_138