Mental Health During the Holidays and Pandemic Fatigue

December 7, 2020

For many people, the holiday season can be a time of stress, loneliness and grief. This year, feelings of anxiety and depression may be more prevalent because of COVID-19.

People report that they are weary of the pandemic and that it is painful to have to abandon social rituals during the holidays, like family gatherings and events.

Dr. John Burkhardt, a clinical psychologist at University Medical Center, said without family gatherings, it is easy to feel isolated. That, coupled with the loss of loved ones or a job due to the pandemic, can exacerbate feelings of stress and anxiety.

Burkhart, also an assistant professor of psychiatry and behavioral medicine at The University of Alabama College of Community Health Sciences, spoke recently about mental health during the holidays and COVID-19 fatigue with Dr. Tom Weida, chief medical officer at UMC, which is operated by CCHS. Burkhardt said people need to make sure they take care of their mental health during the holidays by eating right, exercising, getting plenty of sleep and reaching out for counseling when needed.


TW: We’ve been in the COVID-19 pandemic since March. Has it changed your practice at all?

JB: I don’t know if it’s changed it per say, but it has changed the things we talk about. We’ve had all kinds of different diseases that have come up in my time of practice, but this is one that always seems more prominent. It tends to be the subject of many patients throughout the day, and there’s not a day that goes by that somebody doesn’t mention the effects of it.

TW: What are you commonly seeing?

JB: It varies by person, but one thing that we know since this has happened is that anxiety and depression have gone up. But then you also see other factors such as loneliness and boredom or even grief if somebody has lost somebody, whether it be due to COVID or something else. It’s (COVID) just another stressor that comes up in somebody’s life.

TW: What, exactly, is anxiety?

JB: It’s different things for different people. We naturally know it as somebody who shakes or gets nervous or maybe they have shortness of breath and sometimes they might pass out. Those are some physical symptoms of anxiety. But then there’s also the cognitive piece, where maybe you’re worried about something. The hardest part is that you can’t control that worry or stop it no matter how much you’re trying to. So, you’re constantly going over and over it again and it can keep us up at night.

TW: Are there things people can do for anxiety?

JB: One of the things that I’ve been using with some of my patients are apps. Lately, I’ve gotten a lot of positive response from people using the Calm app. If you don’t like technology, good old fashion journaling is another thing you can do, especially when you’re trying to relax your brain at night before you sleep. Sometimes if we’re too anxious or wound up, as much as we would like to deep breathe or meditate that can be a little bit more difficult, especially if you’re not very practiced at it.

TW: Are there things you should avoid doing before you go to bed if you’re having anxiety?

JB: Yes, anything that has a stimulant, like coffee. When you’re going to bed, part of good sleep hygiene is thinking about winding down. I often think about when I was a child, and I would visit my grandparents and at night they would slowly start to turn off lights and it got darker and darker and noise got less and less in the house. It’s the same way in your home. You want to start preparing for sleep around the same time every evening. Look at the temperature in the room and the light in the room. All those factors can play a part in how easily we can fall asleep.

TW: Can watching TV in bed help you go to sleep?

JB: In general, you don’t want any extra noise going on because sometime people don’t realize the different volumes and rhythms of a (TV show or) movie can kind of snap you out of sleep. When you’re going to bed you want to have all of that out of the way so that when you climb into bed, you’re signaling to yourself that it’s time to go to sleep.

TW: Are you seeing other increases in mental health care needs in addition to anxiety?

JB: Yes. Stress, coping with loneliness, loss of connection and grief. There are all kinds of things going on in our world today, in addition to COVID, and those stressors are starting to play more of a role in people’s lives as well.

TW: How can somebody cope with grief if a loved one passed away because of COVID, particularly since they may not have been able to visit that person in the hospital?

JB: That makes it the most difficult. Sometimes we have somebody that we care very much about and they get taken from us and we don’t feel like we’ve gotten a chance to see them or say goodbye. That’s so difficult. We always would like to have that last moment with someone before they pass, but then we’re always going to want one more. It’s difficult to get to that point where you learn to appreciate the last moment you had with that person as a way to help celebrate their life.

TW: How can people achieve closure with these kind of life events?

JB: It can depend on how recent the loss is. If it’s really recent, you expect the typical grief reaction – they’re sad, they’re upset, they’re withdrawn. Maybe a little bit later on, months maybe even sometimes year, they’re still having some of those feelings. There are different stages of grief, but they don’t follow a straight line, they kind of bounce back and forth. Sometimes people think they should feel bad and if they don’t feel bad, they’re doing something wrong. I don’t think that’s necessarily the case. There are different ways to attack it. It just depends on what the person is experiencing at the time.

TW: Is there healthy grief and unhealthy grief?

JB: That’s a great question. Grief is a personal experience, and sometimes what’s healthy for one could be unhealthy for another. It’s our way to cope and most people are just trying to find their way to manage it. Sometimes it hits you unexpectedly. You might think you aren’t as upset as you should be, or maybe you’re more upset than you thought you should be. I would say unhealthy grief is that after a bit of time, you start engaging in other behaviors that aren’t good for you. Maybe you’re isolating yourself more, taking more substances, not taking care of yourself.

TW: What are some of the symptoms of depression? What should you look out for, or what should a family member look out for if someone in the family might be depressed?

JB: There are many symptoms. People can be sad, they can have a change of appetite, they may no longer have an interest in doing things they liked to do, they might not be thinking as clearly as they used to. But maybe they are still going to work, and they are still being a parent, so they are functional. They are having some areas of deficits but, overall, they are doing well. When those main life areas start to go down, when you start to notice that the person is missing work more or is late or maybe because of that depression can’t think as clearly, that’s when people really need to take notice.

TW: If you recognize that a family member is depressed, is it OK to ask them if they’re thinking of hurting themselves?

JB: I don’t know if I would necessarily ask it in that way. I like to think of it as asking people, ‘How do you feel?’ Or ‘Do you feel safe?’ When someone is going through depression but they’re still talking about the future (that’s good). When you start to lose hope, or you can’t see the future, then there’s something more going on there that you have to look at.

TW: What things can help to bring someone out of depression?

JB: I always start with the simple things – eat well, sleep, drink water and exercise. Those are things you can solve a lot of problems with. COVID is no different than that and neither is depression. Plus, the best thing is that it empowers people to do it on their own. And then looking at returning to other activities. If the person has been withdrawn, I try to get them to spend a little more time with the family. If they used to go to the gym, I get them back to the gym. You pick little things, and you build slowly. Expecting someone to go out and just put it all back together at once is not realistic. It might make it worse for them before it makes it better.

TW: Some people might just say, ‘Get over it.’ Is that a good strategy?

JB: It’s not. People do it because they’re trying to be helpful. They’re seeing a loved one or a family member hurting (so they) tell them, ‘If you can push through it, it’s going to be OK.’ But what the person hears is ‘Nobody understands me, you’ve completely minimized my problems and I wish I’d never told you because now I actually feel worse because don’t you think if I could get over it I would?’ It has a little bit more of a negative push than we would like.

TW: Let’s look at the flipside of COVID-19. Have there been good things that have come out of the pandemic with regard to mental health?

JB: I really think one of the best things, if you can look at it this way, is people started learning very quickly what was important again and to reassess life. People were thinking more about how to take care of their health, so they are walking more and exercising more. They were thinking about how to spend more time with the family and the value of the nuclear family comes back or being in touch with extended family or grandparents. From my point of view, I thought those were positives, if you can find a positive in something like this, because those are important things in life. We always knew it and acknowledged it, but we were never forced to do anything about it.

TW: Do you see similarities between COVID-19 and 9/11?

JB: I think one thing they had in common is that both were a threat to our safety. There are two big psychological factors that we talk about – one is chronic stress, and one is that degree of uncertainty, and those can really negatively affect your wellbeing. Our body doesn’t do well with constant, chronic stress. It does good with short-term stress but over long periods of time, it does not do well with constant stress. And when our safety is threatened, which, if we think about it, it has been ever since (the pandemic) started, and we’re worried about it, it’s not a good thing. Same thing with 9/11. Once it happened, we weren’t really sure if it was going to happen again.

TW: Why do some people seem to deal better with stress than others?

JB: Sometimes I think it’s perception. As human beings if we’re struggling with something, we tend to look at others and say, ‘Well, they’re doing better at it than me.’ But you never know. I also think it depends on what the person doing. Are they spending time more with people? Are they doing the things they like to do? Are they not engaging in mindless distractions?

TW: We’re approaching the holidays, where we usually get together with family and friends, and the Centers for Disease Control and Prevention is saying don’t go. How is that going to affect us?

JB: It’s been a topic of conversation when people have come in to see me, and they’re still trying to figure it out. One of the things I believe is the most difficult (now) is trying to stay connected with people. There are decisions that have to be made.

TW: Are there any techniques that might be helpful in this situation?

JB: When there’s agreeance it’s so much easier. Everyone can get on board with the plan. When there’s not, you have to talk to the family about it and see where you stand. We have people who say, ‘I love to see my family but my spouse or myself is a little bit more vulnerable because of a medical condition. So, as much as I love my family, I’m not really sure because during this time I’ve really tried to keep myself safe and away or just limit my exposure.’ And that’s a struggle because (holidays are) family time – real family time.

TW: Do you anticipate an increase of depression during the holidays because of this?

JB: We already know it’s increased. Is it going to increase more? Gosh, I hope not. Do I know for sure? No. Could we guess that it will? Yes. People can still remain socially connected in different ways, but they’re going to miss gatherings and they’re going to miss seeing families and traveling and all those things.

TW: We’ve been in this pandemic since March. Is there something known as pandemic fatigue?

JB: Yes. I think you see it now. I think it comes up more with people being frustrated and having to deal with the unknown. We have still this sense of loss of control and we’d like to see an end of it. People want a return to normal.

TW: Is this the new normal – having to isolate, do things on our own, or if we do get together, we have to do so outside?

JB: I don’t know. Hopefully, vaccines will change the outlook. It’s all very fluid.

TW: Do you hear people telling you that they have pandemic fatigue? And can you give them some ways of combatting that?

JB: Yes. You don’t want to isolate as much. You want to stay connected with other people. Interestingly, people try to do distracting activities. So, if you think about binging TV shows or movies, which I love to do, you have to be careful how much you do that because it still doesn’t completely distract you from what’s going on. It’s better to find an activity that’s more engaging. One example is hiking. You can mark your progress, which gets you a little bit more engaged and takes your mind off of (COVID). Another thing I do to help people cope is go through the safety precautions the CDC puts out. It gives them something to anchor to.

TW: Do you feel there might be some optimism now that vaccines look promising?

JB: It’s been a little bit of a mixed result. There are people who are hopeful because they want to return to normal, even though we know that what we knew before is gone and we’re moving forward. There are some people who are skeptical. And then there are some people, and the comparison I often get is the flu shot. You have some people who say, I’ve never taken the flu shot I’ve never gotten the flu I’m good.’ Or ‘I’ve taken the flu shot and it gave me the flu.’

TW: Do you see that COVID-19 has highlighted a need for more mental health care services?

JB: Yes, absolutely. I think not only has it highlighted the need, but it’s forced people to recognize the need in themselves. As you and I know, physical health is just as important as mental health because they’re locked together. But as a society we’ve always valued physical health more than mental health, and in some cases that makes sense. But now people are starting to understand how one can affect the other.