Managing Holiday Stress: Some Tips for Persons Living With HIV/AIDS

David Fawcett Ph.D., LCSW

Getting through the holiday season is stressful for everyone, but even the most resilient person living with HIV/AIDS (PLWHA) may experience situations and complications that have the potential to turn what should be a festive time of year into one marked by sadness, loneliness, and an overall feeling of discontent.

The impact of stigma, strained family relations, financial or housing insecurity, and chronic loneliness are just some of the factors impacting PLWHA during this time of year. While living conditions for PLWHA have improved significantly, there are still thousands who live in fear and isolation or who struggle with chronic medical problems that limit their social networks. The idealized version of warm holiday gatherings and loving support from families, much hyped by media, often only increases the level of emotional pain of those for whom such ideals don't reflect their lives or their living situations.

The stressors of the holidays are not just mildly uncomfortable; for many PLWHA they can present actual threats to their physical and emotional well-being and dramatically reduce quality of life. This article provides some practical tips and skills to lessen the negative impact of the season and to promote healthy connection and enjoyment of the holidays.

Maintain Balance

Balance in all areas of one's life is essential to maintain health in the face of stressors, especially those that are chronic. During the holidays, it is important to avoid overindulgence in food, drink, drugs, and spending, despite the heightened pressure to do so. Finding time each day for self-care -- such as taking some quiet moments by yourself, engaging in a creative project, or just having fun -- is essential and provides a much-needed respite from the pressures of the season. Sleep and adequate rest are critical for PLWHA, and we must be careful not to push ourselves until our bodies finally say "enough." Be mindful of getting an adequate amount of sleep and carefully manage your exposure to things that you know may push you off balance, like being out in crowds, having too much social contact, or uncomfortable family gatherings. This season is all about self-care and making the best, healthy choices for ourselves.

Remain Socially Connected

During this season, the media confronts us with images and ideals of what we should be experiencing. This is especially true for social media, which may lead us to compare ourselves to other people's loving families, material abundance, travel, or just apparent happiness. This is a trap for everyone, but it is especially so for PLWHA, for whom this may simply remind them of what they have lost to HIV or of the warm, supportive relationships they may have never had. The result can be a feeling of intense loneliness, along with abandonment and alienation. It is important to stay as socially involved as possible. Friends, peers, and family (natural or chosen) are as critical as antiretroviral therapy in keeping PLWHA alive. Plan an activity with another person every day. Reach out to others, remembering that they may also be experiencing loneliness and disconnection. If you are active in support groups, get more involved during this season and remember that through our social networks, we have the power to create a "family of choice" so that we don't ever have to be alone.

Manage Your Expectations

Sometimes our best strategy to avoid being thrown off balance is to anticipate situations that might be problematic for us and create a plan to minimize their impact. For example, if there is a gathering of family members with whom relationships have been strained or judgmental, it might be a good strategy to bring along a friend for support. It could also be perfectly appropriate to decline the invitation. During this season, it is important to be clear on your own needs and honor them, and it is also important to proactively plan your time. Sometimes people avoid making plans for Christmas or New Year's and then suddenly find themselves confronted with being alone on those days. This can awaken old feelings of emotional pain and can be a real trigger for acting out behaviors, whether with substances, sex, overeating, overspending, or other means of escaping feelings. With some advance planning, however, we can improve our resilience in such situations. This might include a telephone list of friends who will be home and whom you can call at any time, carefully choosing where and with whom you spend your time, or "sandwiching" a stressful event between calls or visits to people in your support system.

Manage Your Attitudes

It sometimes seems that feelings of depression and anxiety are just "in the air" this time of year. In fact, they originate from within, and with some self-reflection it's possible to identify the trigger for these feelings as shame, fear of discrimination, or the painful reality of alienated families. No matter what their origins, we can help ourselves by becoming aware of these thoughts and actively counteracting them with more affirming thoughts and actions. For example, if someone is anticipating stigmatizing comments from someone at a gathering, they could practice reminding themselves that they are fine and loveable just the way they are, and consciously choose their behavior, whether correcting someone's mistaken beliefs or dismissing someone's judgment without internalizing it. Notice when you are feeling like a victim or becoming angry or lonely, and take a few minutes to be mindful of what just happened that contributed to this emotion. At such times, it is often helpful to do something positive, like completing a brief gratitude list -- which may seem counterintuitive, but it actually has great power to quickly reverse uncomfortable emotions. During this season, it is especially important to know yourself and utilize all your skills to manage your thoughts and emotional reactions.

Be of Service

It is natural during the holidays to get very wrapped up in ourselves and our challenges. As a result, we lose perspective and forget that giving and receiving are really what the spirit of the season is all about. While service to others can benefit those served, we know that we ourselves receive far more through the act of helping someone else. Take time during the holidays to volunteer or, if you are able, consider sponsoring a Christmas dinner for a family that could otherwise not afford it. Only by getting out of ourselves through service to others are we able to maintain meaningful social connections.

The holiday season is, no doubt, a stressful period for any person living with HIV/AIDS, but through self-care, conscious choices, and a supportive social network, we can transform this time of year into one of affirmation and healing.