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End – Stage Renal Disease (ESRD) – Diversity, Mental Health Conditions, Social and Economic Impact (part 2)

Diversity and Difference in Practice

Culture, age, sexual orientation, socio-economic status and gender all must be taken into consideration when working with patients suffering from ESRD. The African-American population is four times as likely to develop ESRD compared to Caucasian individuals suffering from the same condition (Atkinson, Neu, Fivush, & Frankenfield, 2008) (Crews et al., 2010). Additionally, African-Americans have poorer intermediate outcomes when compared to Caucasians. In reference to gender, previous research shows that the outcomes for women diagnosed with ESRD are also generally poorer compared to males, especially when it comes to anemia and nutrition (Atkinson et al., 2008). If patients fail to meet their targeted goals (hemoglobin goals in particular), their risk of hospitalization and mortality rates has been shown to steadily increase (Atkinson et al., 2008).

In reference to age, research has found that African American children struggle more to reach the desired hemoglobin goals compared to Caucasian children (Atkinson et al., 2008). Additionally, the effects of low socio-economic status has been linked to African-American patients, but not Caucasian patients (Crews et al., 2010). Access to medical treatment should also be taken into consideration. Patients diagnosed with End-Stage Renal Disease have legitimate concerns when it comes to meeting Medicare Part D coverage and the gap that exists when it comes to the purchasing of dialysis related medications (Kovacs, Perkins, Nuschke, & Carroll, 2012). Since 2010 Medicare Plan D is structured in such a way as to pay for at least 75% of the first $2,830, and 95 % of the medications exceeding $6,440 in cost (Kovacs et al., 2012).  The plan however provides no cost coverage for expenses that fall in-between the lower and higher spending limits. Not having access to medications due to the inability to afford them financially leads half of the studied participants in Kovacs et al.’s (2012) study to discontinue taking their medications altogether.  Vocational status has been found to have an impact in reference to patients’ adjustment and coping with ESRD (Billington et al., 2008)

Mental Health Conditions and ESRD

Individuals diagnosed with ESRD are treated by an interdisciplinary team to address the issues and concerns that have. Generally, a two-fold approach is needed in order to assist clients with their physical condition as well as evaluate any potential concerns relating to their mental condition. According to Cukor (2007), patients diagnosed with ESRD receive limited psychiatric services. Billington et al. (2008) report that ESRD clients often struggle with anxiety and depression. Research shows that 20 to 30% of patients diagnosed with ESRD suffer from depression (Cukor, 2007). Depression is the second most common co-morbid disorder with ESRD patients, second only to hypertension (Cukor, 2007).

Anti-depressants are an option and even though they are safe enough for ESRD clients, medical professionals and patients themselves are generally apprehensive to add depression medications to their course of treatment (Cukor, 2007). New Selective Serotonin Reuptake Inhibitors (SSRI) have shown less aversive side effects when treating depression, however they may influence some uremic symptoms (Chilcot, Wellsted, & Farrington, 2010). Patients are generally hesitant to take anti-depressants for fear of the side effects and potential interactions with the variety of drugs they are already taking (Duarte, Miyazaki, Blay, & Sesso, 2009)

A variety of evidence-based interventions have been attempted throughout the years with the renal population. Cognitive-behavioral therapy (CBT) has been established as the leading therapeutic intervention with clients who suffer from ESRD (Duarte et al., 2009). Clients with a depressed mood typically exhibit an avoidant behavior; they lose interest in doing things and their treatment compliance decrease (Duarte et al., 2009). According to Cukor (2007), CBT is an effective approach with the ESRD clients as it attempts to address and minimize the issues they are facing, doing so in an efficient, time-limited manner.

The goal of CBT with patients diagnosed with ESRD is to assist them in modifying the activities they previously enjoyed (Cukor, 2007). Cukor (2007) reports that clients often held the negative belief that depression comes with ESRD and is “part of the package”. This view is not only erroneous but also exemplifies the dysfunctional thinking that is prevalent within this population. Cukor (2007). The CBT approach helps patients to identify this negative thought pattern and make appropriate and healthy changes in their behavior.

A study performed by Cukor (2007) shows significant reductions in the depressed mood of patients who underwent 15 weeks of individual CBT sessions. The study aimed to address the restructuring of clients’ negative thought process as well promoting behavioral activation (Cukor, 2007). The results were significant, not only at the end of the 15 week treatment program (there was a 10 point decrease on Beck Depression Inventory), but after a three month follow up the results remained steady and even dropped slightly (Cukor, 2007).

Research has also shown that joining a peer support group has been very helpful for patients suffering from ESRD. Hughes, Wood and Smith (2009) report that patients benefit greatly when they can be a part of a group where they can interact and learn about their kidney disease. Invariably the patient also gains strength from this interaction. Research performed by Patel et al., (2005) with Canadian participants show a 4.6 month delay prior to the initiation of renal replacement therapy when a social support intervention was implemented.

Although evidence-based practice is very important, timing is also key. Research has shown that the most suitable time for a psychosocial intervention is during the actual hemodialysis treatment for those patients receiving in-center dialysis (Cukor, 2007). Since hemodialysis lasts on average four hours per treatment, a portion of this time can be allocated for psychosocial interventions.

Being diagnosed with ESRD is a traumatic and often scary experience regardless of the individual’s cultural background. It should be noted that CBT has been the primary choice of treatment not only in the United States, but also in Brazil and even Taiwan (Duarte et al., 2009). For instance, renal patients in Brazil have shown significant improvement in their depressive symptoms after months three and nine when compared to the control group (Duarte et al., 2009). A study conducted in Taiwan shows that through CBT sessions ESRD patients were able to improve the quality of their sleep (Duarte et al., 2009). Hence, this treatment modality has shown effectiveness not only in the Western world, but also in countries where the quality of live and patients’ socio-economic status differs significantly when compared to the United States.

 Social and economic impact

When healthcare access is limited, health disparities will be imminent (Williams, 2015). Research has established that African-American individuals are less likely to have access to medical insurance which in turn leads to less access to qualified medical care (Williams, 2015). According to Williams (2015). This inadequate access to care has been linked to an increased probability of developing chronic kidney disease. Moreover, low socio-economic status in addition to increased costs and the manner in which ESRD rapidly develops have all been attributed to delayed referrals to nephrologists (Williams, 2015).

As Nicholas, Kalantar-Zadeh and Norris (2015) reports; diabetes and hypertension are the main risk factors associated with chronic kidney disease which is believed to be attributable to ethical, racial and gender differences. In recent years however, SES has shown to have a greater influence with ESRD. For instance, a study evaluating almost 80,000 Caucasian and African-American participants found that those who made less than $15,000 a year had a 50% chance of developing ESRD (Nicholas et al., 2015). This number was 3.5 times greater for the African-American participants (Nicholas et al., 2015).

In addition to low SES, homelessness is another factor associated with developing ESRD (Nicholas et al., 2015). A study examining 15,000 individuals living in urban areas with mostly SES found that 858 of them were homeless, with high depression and rampant substance abuse. (Nicholas et al., 2015). After a three year follow up and thorough research it was determined that they had a 28% probability of acquiring ESRD and dying (Nicholas et al., 2015).

Lack of insurance is another independent risk factor that contributes to the development of ESRD especially in the low-income populations (Nicholas et al., 2015). Additionally, having health insurance does not necessarily ensure that all medical costs will be covered. For instance, Williams (2015) argues that a high deductible and high premiums are significant concerns for low-income individuals.

Individuals who are undocumented and who do not meet the eligibility criteria to enroll in a public health care exchange program generally do not have access to quality medical care (Williams, 2015). Data suggests that foreign-born residents living in the Unites states are three times as likely to not have access to insurance compared to United States residents (Williams, 2015). The same author reports that Medicaid eligibility criteria varies from state to state with foreign born residents having risk factors for ESRD and other health related disorders (Williams, 2015).



Atkinson, M. A., Neu, A. M., Fivush, B. A., & Frankenfield, D. L. (2008). Disparate outcomes in pediatric peritoneal dialysis patients by gender/race in the End-Stage Renal Disease Clinical Performance Measures project. Pediatric Nephrology, 23(8), 1331-1338. doi:10.1007/s00467-008-0832-z

Billington, E., Simpson, J., Unwin, J., Bray, D., & Giles, D. (2008). Does hope predict adjustment to end-stage renal failure and consequent dialysis?. British Journal Of Health Psychology, 13(4), 683-699. doi:10.1348/135910707X248959

Blake, A., Toker, S., Dickerman, R., & Dunn, E. (2002). Trauma management in the end-stage renal disease patient. The American Surgeon, 68(5), 425.

Brown, E. A., & Johansson, L. (2011). Epidemiology and management of end-stage renal disease in the elderly. Nature Reviews Nephrology, (10), 591.

Chilcot, J., Wellsted, D., & Farrington, K. (2010). Depression in End-Stage Renal Disease: Current Advances and Research. Seminars In Dialysis, (1), 74.

Crews, D. C., Charles, R. F., Evans, M. K., Zonderman, A. B., & Powe, N. R. (2010). Original Investigation: Poverty, Race, and CKD in a Racially and Socioeconomically Diverse Urban Population. American Journal Of Kidney Diseases, 55992-1000. doi:10.1053/j.ajkd.2009.12.032

Cukor, D. P. (2007). Use of CBT to Treat Depression Among Patients on Hemodialysis. Psychiatric Services, (5), 711. doi:10.1176/ps.2007.58.5.711

Duarte, P. S., Miyazaki, M. C., Blay, S. L., & Sesso, R. (2009). Cognitive–behavioral group therapy is an effective treatment for major depression in hemodialysis patients. Kidney International, 76(4), 414-421. doi:10.1038/ki.2009.156

Hackett, A. S., & Watnick, S. G. (2007). Withdrawal from Dialysis in End-Stage Renal Disease: Medical, Social, and Psychological Issues. Seminars In Dialysis, 20(1), 86-90. doi:10.1111/j.1525-139X.2007.00249.x

Hughes, J., Wood, E., & Smith, G. (2009). Exploring kidney patients’ experiences of receiving individual peer support. Health Expectations: An International Journal Of Public Participation In Health Care & Health Policy, 12(4), 396-406. doi:10.1111/j.1369-7625.2009.00568.x

Jansen, D. L., Heijmans, M., Rijken, M., & Kaptein, A. A. (2011). The development of and first experiences with a behavioural self-regulation intervention for end-stage renal disease patients and their partners. Journal Of Health Psychology, 16(2), 274-283. doi:10.1177/1359105310372976

Kovacs, P. p., Perkins, N., Nuschke, E., & Carroll, N. (2012). How End-Stage Renal Disease Patients Manage the Medicare Part D Coverage Gap. Health & Social Work, 37(4), 225-233

Low, J., Smith, G., Burns, A., & Jones, L. (2008). The impact of end-stage kidney disease (ESKD) on close persons: a literature review. NDT Plus, 1(2), 67-79. doi:10.1093/ndt-plus/sfm046

Nicholas, D. B., Picone, G., & Selkirk, E. K. (2011). The lived experiences of children and adolescents with end-stage renal disease. Qualitative Health Research, 21(2), 162-173. doi:10.1177/1049732310382789

Nicholas, S. B., Kalantar-Zadeh, K., & Norris, K. C. (2015). Article: Socioeconomic Disparities in Chronic Kidney Disease. Advances In Chronic Kidney Disease, 22(Socioeconomics, Disparities, and the Kidney), 6-15. doi:10.1053/j.ackd.2014.07.002

Patel, S. S., Peterson, R. A., & Kimmel, P. L. (2005). The Impact of Social Support on End-Stage Renal Disease. Seminars In Dialysis, 18(2), 98-102. doi:10.1111/j.1525-139X.2005.18203.x

Wells, J. R., & Anderson, S. T. (2011). Self-Efficacy and Social Support in African Americans diagnosed with End Stage Renal Disease. ABNF Journal, 22(1), 9-12 4p.

Wells, J. R., & Walker, C. A. (2012). Factors Influencing Adherence in African Americans with End Stage Renal Disease. Journal Of Theory Construction & Testing, 16(2), 52-56.

Williams, A. W. (2015). Article: Health Policy, Disparities, and the Kidney. Advances In Chronic Kidney Disease, 22(Socioeconomics, Disparities, and the Kidney), 54-59. doi:10.1053/j.ackd.2014.06.002

Marriage and Relationships – Do’s And Don’ts

The Need to Feel Loved

The desire for a soulmate and longing to be in a relationship are instinctive, hardwired needs that we all have. To be loved, desired and admired with all of our imperfections and flaws, sounds so romantic, doesn’t it? Most little girls dream of becoming princesses anxiously anticipating their prince charming to sweep them off their feet with gallant behavior, good manners and financial security.  Similarly, men typically desire an appealing, sexy yet smart, funny but not obnoxious, overall well-put together woman who will make for a loving partner.  And while each side of the relationship looks into these, and many other “must haves”, often people dismiss the fact that relationships can be quite difficult and at times, make us question our reasons for participating in them. Vowing to be with someone in “good and bad, health and sickness” is easier said than done – simply check the most recent divorce rates. Many couples hit a standstill when they face difficulties and indeed, there’s no faster way to test a relationship with its carefully imagined “picture perfect” ideal than the frustrations of day-to-day life. Couples these day prefer to live together rather than tying the knot, and the reasons are many.

The Do’s And Don’ts In Relationships 

Identifying and exploring the cause of a couple’s uneasiness often brings meaningful insight into the state of the relationship. A variety of situations can present themselves:

  • Lack of communicationIt sounds like cliche but it’s true. People have expectations, sometimes realistic, often times not. When there’s not a two-way line of communication problems will arise. You don’t want to burden your loved one with the issues you’re dealing with so you keep quiet? That’s great and that may seem kind to spare your loved one the anxiety you’re experiencing only he/she may interpret your well meaning intentions as a lack of attention, withdrawal from the family unit and having trust inadequacies.
  • Dating or marrying “an ideal” – This is a definite No – No. During my clinical practice, I have had the opportunity to work with couples who have pursued relationships with unrealistic expectations of their significant other. The problem with this approach is that people are not stagnant – we don’t see them as they are when we are in love. Additionally, people don’t remain the same, they change – sometimes rapidly, sometimes more slowly. In other words we all undergo a metamorphosis with time! The prince charming from our fairy tale may actually turn into an ugly frog with time.
  • Inability to accept criticismThere’s nothing worse than when one side is consistently critical of the other but is unable to accept even the slightest feedback. Both men and women can be guilty of this behavior. The results of such persistent criticism amounts to a life of hell for the other person. Manipulation in pursuit of one sided reward, verbal and emotional abuse stemming from such behavior is a relationship killer. So by all means Do Not Do This.
  • Finances  – Although money doesn’t buy you happiness, short finances are one of the primary reasons for quarrels and fights among couples. Relationships can encounter differing situations when it comes to their financial well-being – one of the individuals not providing or trying to provide enough for the family unit or overdoing it due to fear of being poor. And while the second option seems like the better of the two evils, working hour after hour, day after day, week after week, month after month may improve your finances, but could also wedge a space between you and your love one. “You said you were not going to work this weekend”, ” You always have to work”, “You never have time for me”  – sound familiar? Try making the time, communicate and share your dreams, goals and inspirations. Both individuals working towards a common goal can overcome the frustrations along the way.
  • Cheating – It falls into the “Don’t Do” category. Not just the physical but also the emotional damage caused by cheating can cause self-doubt, trust issues, co-dependency issues, and the list go on. Honesty and openness although difficult is way better compared to lies and deceit.
  • Faith/ Spirituality/ Religion –  When love and passion hit, everything else seems insignificant, only to appear later like an elephant in the room. The world has become a small village yet, couples often realize that their religious or spiritual  upbringing is in strong contrast to that of their significant other. Love can and does overcome many things in life, but sometimes differing core beliefs can seem to be an insurmountable obstacle. With a willing heart however; communication, love, patience and willingness to understand the “other’s” perspective, these challenges can be resolved.

For these and more helpful suggestions, please feel free to drop us a line, follow us on Facebook and Instagram, share our comment and comment. Freedom Counseling offers assistance for individuals and couples in need of counseling. If you feel now is the right time and you’re ready, feel free to schedule your next appointment.

The Pressure of Competing and Succeeding after College Graduation: 5 Helpful Tips!

graduation college university success career

Getting to graduation … 

Graduating college – Not an easy task! If you recently graduated you know exactly what I’m talking about. Many grads have subjected themselves to year after year of constant, self-inflicted “punishment” to get there.  To get to graduation day often means working full-time or part-time while also attending college in the evening, studying for exams and various tests. Let’s also not forget about everyone’s favorite “group projects” on a topic that you couldn’t care less about while simultaneously attempting to complete an internship so you can satisfy your degree’s requirements. Now imagine doing that to yourself day after day, week after week, semester after semester and its easy to see that graduating is no small task! An achievement that should come with a sense of accomplishment and relief, but can also induce a loss of purpose and in some cases, depression. The objective has finally been met, your mind and body are absolutely exhausted, but in terms of a career, all you did was get yourself to the starting line!

Under pressure …

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Any fans of Freddy Mercury? His song comes to mind with its catchy tune. Why these feelings of pressure? You graduated after all! You wore the cap and gown and received a ton of congratulations by your professors who just made your life a living hell for the last couple of years. You did it! 

You finally got that precious degree and made your parents proud!

You should feel accomplished and content with yourself after all those years of hard work, right? Perhaps not…Recent grads report that the initial sense of euphoria tends to quickly fade and a new and troubling reality settles in.

The responsibilities that comes after graduation …

“What now?” is the million dollar question that many start asking themselves. If you were a driven individual during your years of hard work perhaps you scored a decent job proposal. However, many young individuals are unable to land that “dream job” they fantasized about in college. In fact, graduation was 2 months ago and they’re still looking for a job while competing with all of the other college grads fighting for the same opportunities! 

Those student loans are not going anywhere either. Recent grads are reminded of this “new” responsibility fairly quickly, typically via mail. The payment plans kick in around the 6 month post-graduation mark. So before the first payment hits your bank account (and please make sure you don’t default on your loans!), a college grad has about 2 quarters to hopefully find a good job opportunity in their studied major. 

The freedom of choosing your life …

The post-graduation period is the beginning of an era in self-exploration not only in one’s career development but also in their personal and intimate life. The following techniques can keep your journey moving forward on the road of success:

  1. Decide what it is you want to become – This is a tough one, probably the most difficult step in the process after graduation. You may not be able to specify it exactly, but if you have at least an idea you’re already on the right path. Recent graduates find themselves disillusioned with the real world, there’s a real and inevitable clash between the college life vs the 9-5 work life! As long as you have some sort of a vision, you will be able to design a game plan. There are hundreds, if not thousands of life and career coaches who can assist you in identifying your passion and vision for yourself.
  2. Clearly define your goals – I have spoken on this topic in the past and firmly believe that without specific and measurable goals, the desired outcome will be unreachable. How can you pursue something if you don’t have a map? Create the map first, then follow the required steps in order to get to the end destination. And if your goals change, that’s just fine and dandy, but at least you have already achieved one, two, or three steps which allowed you to get to the point of deciding to shift your end goal! Aim for progress!
  3. Be ready to relocate – If you are at a stage in your life where you are not settled yet and are able to move to another part of the country (a stage many new grads finds themselves in) – then do so! Highly specialized jobs are generally located in highly specialized areas, that’s a no brainer! So if you are determined to rise above your competition you have to follow the jobs and make the necessary adjustments. Many people do not like change, they fear the unknown and are not willing to loose their social networks. While there’s nothing wrong with that per se, you might be out of luck in the area where you live in. There are many young individuals out there who are willing to take the chance and get their feet wet in a new city creating new friends, meeting new co-workers and making new memories. Choose, but choose wisely! Whatever you decide to do, make sure to consider the pros and cons of each situation. Sometimes a new job offering $20, 000 or even $30, 0000 more in San Francisco may equate to the same salary in Florida after considering the cost of living in each area! Put that into perspective!
  4. Be flexible –  when searching for jobs try to forget the expectation others have for you. If you decided that you actually don’t like to work what you studied for – that’s OK. In fact, many do! If your family is disappointed  by your decision, so be it. It may not be ideal – after all, now you have to repay those student loans you borrowed, but what’s the point to pursue a miserable job, one that you’d only despise? Use the skills you have acquired during college to specifically describe how you could be of value to your prospective employers. Show purpose and determination – some (many) jobs are won by character and confidence!
  5. Create a healthy lifestyle – yeah, yeah, I know you’ve probably heard that a million times but it’s true. Exercise, sleep and diet are important tools for your success. As a matter of fact, this trio is key in your career and personal development. Lack of sleep, eating fast food and idle work/ life regime will stifle your ambition and drag your energy level to a new low. Time and time again research has shown how this trifecta has the immense power to impact individual’s physical and mental capabilities. Therefore, take care of your mind and body!

If you’re interested and would like to learn more on this or similar topics, make sure to follow us!

 Become Who You Are!


New Year, Same Old You? Why setting New Year’s Resolutions has not shown to be effective.

Happy New Year to our wonderful followers !!

It is indeed the year 2018, and most likely many of you have already started working towards your New Year’s Resolutions. As  January 1st approaches, most people focus on such goals as loosing weight, exercising (Hello gym memberships!) and finding a new job. By the end of week 2 however, all that enthusiasm is  likely forgotten as the routine and mundane work and life troubles return in full force. Why are New Year’s Resolutions ultimately ineffective?

It starts with a thought…

Setting goals take some time. Most people tend to make a list of the top 5 or 10 ideas that have been circulating in their mind (for like the last 10 years). Instead, why not take the time to dive deep within and actually figure out what drives you? Who are you now? Who don’t you want to be? Who do you want to be?  How can you get there? What actually makes you happy? What is your passion? What brings contentment and joy to your soul? These are questions worth pondering. Start there. You may not like the answers to some of them. But even though it may be scary to experience a sense of vulnerability when truly assessing oneself, the act will serve as motivate to take the next step. Be specific when answering the above questions. When your goals are generic and abstract in nature, the chances you will follow though are slim to non-existent. So look within, and be specific when determining your goals.

It starts with a plan…

OK, so you have set those goals. Awesome! You have the list in front of you. But actually achieving these goals can be challenging. The idea behind New Year’s resolutions is that individuals can start on a clean slate: New Year, New You –  forget the mistakes of the prior year and focus on your best future self. And while this may look great on paper, in reality it creates a few difficulties for those who actually attempt to implement their resolutions. You have to start with a plan and you must execute it, but more on that later. Planning means that you have to purposely decide to stick to your agenda despite the daily  life and work anxieties that you’ll encounter. Planning also should include your resolve to stick to agenda despite your mind trying to sabotage you into abandoning your goals. You have to outsmart yourself, so plan wisely.

      It starts with an action…

“Breaking the Habit”, the famous Linkin Park song might serve as an inspiration . The unhealthy or unwanted behaviors that individuals perform each and every day, week after week, month after month, year after year are difficult (yet not impossible!) to break. People have their go-to daily routines which become deeply ingrained in them.  It takes a lot of effort to change such behavior. What is amazing though, is that once an action is implemented, then another action follows, then another, and another…pretty soon the goal is within reach! Implementing your plan takes bold moves and action in order to change a routine. It takes discipline, determination and drive. Determine what you want/need to achieve (dig deep and be specific), make a comprehensive plan (and plan to stick to your plan when the going gets tough), and take action! It may be difficult but the reword is more than worth it.



So how are your New Year’s resolutions coming along? Are you holding strong or have you taken a temporary break? Drop us a line and share your experiences. We would love to brainstorm with you, support and encourage you to Become Who You Are!!

Are you feeling “blue” during the holidays?


How the holiday season promotes commercialism and negatively impacts our mental health.

Is it really that bad you may ask? Well, Christmas and New Year’s are just around the corner folks! We have officially rolled into the final week before Christmas. And while many people joyfully anticipate the approach of holidays, the statistics show an entirely different reality for many families in the U.S.

Not so merry after all…

By the now you have probably grown tired of the endless Christmasy commercials consistently flashing from your TV screens presenting us with perfectly wonderful families, dinners, gifts and unexpected encounters. And if that wasn’t enough, we also have social media to top it off! Just in case our moods were not already sufficiently altered with negative feelings (for more info regarding social platforms please check out my recent blog post).  What you wont see in the commercials or posts is the fact that many, and I mean many people struggle psychologically during the holidays. For instance, strained family dynamics, the stress and anxiety of financial burdens including credit card debt, and the inability to meet the expectations of others all contribute to feelings of depression and negativity.

What can you do about it?

Set realistic expectations of yourself – This one is specifically for you perfectionists!  The world is not going to end if your house is not decorated as shown on Pinterest or Instagram. As long as you feel comfortable and at peace in the comfort of your home you should be able to enjoy the holidays. After all, it’s the people, not things that matter most, right?

Set realistic expectations for others – I know this is a tough one. What will people say if you don’t shower with them with expensive gifts? Well, do you want to go into debt over the anxiety of saying “No” to others? Feeling disliked and rejected is not pleasant, but the reality is that those who truly love you will love you no matter what. Set a firm budget, and only buy what you can afford. And if a family member is giving you a list of presents they want, you can give it back to them carefully revised to be within budget!

Don’t compare yourself to others – This applies to every aspect of life, not just the holidays. It is almost as an automatic thought process. It can be challenging to witness how others seem “to have it all” while you’re barely making ends meet. So I say it again, do not compare your life to others. Remind yourself that you’re at a different stage in your life; your path is your own, and your timing is different than theirs.

Take care of yourself – Bubble baths are a nice options but I have something different in mind. What does your soul need most? What brings you inner fulfillment and contentment? Reading, walk with your pups, chat with a long distance friend, see your grandchildren, whatever makes you happy, do more of it. This will not only alleviate your stress, but will also center you and remind you of the more important things in life.

Double down on your appointments with your therapist – if the holidays are negatively impacting your mood, and you sense that your depression is worsening, be sure to seek professional help. Remember, your mental health is important and is not “a phase that will pass”. Mental health is real and has a significant impact on individuals’ day-to-day life as well as their relationships, aspirations and general life goals.

How are the holidays affecting your mood? Feel free to share and comment!

And if you feel you may benefit from therapy, Freedom Counseling LLC would be happy to assist.

Merry Christmas!!

Find your joy during this holiday season!