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In this episode, we welcome Stephanie Straeter, a clinical psychologist. The holidays are often portrayed as a time of joy and thankfulness, but for many people, this is not the case. In fact, 3 percent of individuals struggle with seasonal affective disorder (SAD) during the holidays. This episode explores the unrealistic expectations placed on individuals during the holidays and how to successfully manage emotions during this time. Stephanie provides five simple steps for finding peace and tranquility during the holidays, including recognizing and accepting negative emotions, practicing deep breathing and mindfulness, expressing gratitude, being mindful of substance intake, and seeking help if necessary. She also offers helpful tips for those who struggle with SAD, including developing a self-care plan, seeking wellness coaching or therapy, and taking advantage of available mental health services through insurance. Join us for a valuable discussion on navigating the holidays with SAD.

Stephanie Straeter is a behavioral health and wellness program developer.

She shares her story and discusses her KevinMD article, “5 tips for treating seasonal depression during the holidays.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show, we have Stephanie Straeter. She’s a psychologist and a behavioral health and wellness program developer. Her KevinMD article is titled “5 tips for treating seasonal depression during the holidays.” Stephanie, welcome to the show.

Stephanie Straeter: Thank you, Kevin. It’s a pleasure to be here with you today.

Kevin Pho: So we’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.

Stephanie Straeter: Well, I’m a licensed clinical psychologist in Florida, California, and New York, and a board-certified wellness coach. This spring I will have been with Uprise for 15 years, where I’m a senior clinical reviewer as well as a behavioral health case manager and wellness coach. And I also maintain a private practice where I treat adolescents, adults, and senior citizens with mood disorders, depression, anxiety, and ADHD. For more information about my private practice, people can go to drstephaniestraeter.com.

Kevin Pho: All right. So you wear many hats. You have a private practice, and you also work with behavioral health programs as well. So talk about the different things that you do as a psychologist. And how did you get involved with things outside of your clinical practice?

Stephanie Straeter: Well, I was given an opportunity. I was a clinical supervisor at an eating disorder facility in California, and I was given the opportunity to create a wellness program, which required me to move to Florida, and I embraced the opportunity. It was the lifestyle that I pursued. I loved working out and being outdoors, and I know the benefit to someone’s mental health when they are physically active as well as mindful of their nutrition. So that’s how I got into the wellness field and program development initially.

And the owner of our company, she was also a psychologist, and we really saw a need in the market for more advocacy when it came to behavioral health. Many people don’t know that if they have medical coverage, they have mental health coverage, and since 2010 there’s no limit to that coverage, as long as they’re working with a licensed clinical professional who feels those services are warranted.

Kevin Pho: The reason I asked that is I always like to ask clinicians, especially if they work with industry or have a non-clinical job per se, how they got involved with that, because one of the themes that we have on the show is that we are more than our degrees. We are more than just seeing patients in the exam room or in the office. So do you have any special training to go into some of your non-clinical roles, or is this something that you just took advantage of and learned on the job for this other opportunity?

Stephanie Straeter: Yes, actually, I attended Wellcoaches. It’s a Harvard-affiliated wellness coach training program, where I took a deep dive into motivational interviewing, the stages of readiness to change, and positive psychology, and then personally studied what makes wellness programs work, what the aspects of these programs are. But no, I pursued certification in wellness coaching to prepare myself to create these programs.

Kevin Pho: All right. And my last question on wellness before we go into the article: When one is evaluating a wellness program, just from your perspective, what makes wellness programs work? What makes one better than the other?

Stephanie Straeter: I would say having coaches that are board-certified. So there’s the National Board for Health and Wellness Coaching, and they give their stamp of approval to any wellness coach training program out there. So if someone is interested in becoming a coach, they should look for their approval. So I would say it starts with the coaches, because they are the behavior-change experts, teaching people how to approach change in a different way.

When an employer can offer their members an incentive to engage, that does help, like a health care premium credit or a pharmacy credit, because a number of the people in the population are in the early stages of readiness to change. They’re precontemplators or contemplators, and they’re not thinking about making a change. But the coaches are so good at establishing rapport with these people that eventually, there’s still work they can do with someone in the early stages that will get them further along to being ready to change. So I would say it’s the training of the coaches, and looking for that nationally board-certified health and wellness coach, that they went to a school that was approved by that board, and that they are certified.

Kevin Pho: All right, so let’s transition into your KevinMD article. It was written last fall. It’s titled “5 tips for treating seasonal depression during the holidays.” Now, how did this article come together?

Stephanie Straeter: Well, you know, it occurs at this time of year. Seasonal depression, or seasonal affective disorder, most often occurs in the winter and late fall months, when we have shorter days and less light, and it’s a condition that I’ve helped my clients to better manage. And the goal of the article was really similar to our goal as coaches at Uprise, to provide the reader with the strategies and tips to help them better manage the condition. Because if someone has the awareness of what they want to manage and they’re motivated, then, our philosophy at Uprise is all about prevention, we want to give them the knowledge and tools that they need to do this.

Because, you know, Kevin, in this lifetime, the only thing that we really can manage is our feelings. Of course, when we’re grieving, that’s something different, or if we have a mental health diagnosis, it can be more difficult, but not impossible. And we don’t have an escalation of emotion without something going on in our mind first. So if someone is aware of that experience and they’re motivated to manage it, and if we can give them the tools and knowledge to do this, they may be able to do this without psychotropic medication or therapy.

Kevin Pho: So for those who aren’t familiar with seasonal affective disorder, can you tell my audience what differentiates that from, say, clinical depression?

Stephanie Straeter: Well, they think that it’s chemical. I mean, both clinical depression and seasonal depression are due to chemical changes in the brain, but with seasonal depression, they feel it’s due to the change in light. And melatonin, a sleep hormone, has also been implicated with seasonal depression. When it’s darker, the brain produces more melatonin. But the presentation will look the same.

Kevin Pho: So just give us an idea. Let’s say in your private practice, someone comes in with what you suspect is seasonal affective disorder. What would that person look like to you in your office?

Stephanie Straeter: They could have a lack of motivation. If they’re coming to see me, then they have a lack of motivation. So they may be sleeping more, they’re not following through with self-care, they’re isolating.

Kevin Pho: So take us into your office. What are some of the techniques that you would introduce to a client who comes to you with seasonal affective disorder? What are some of the treatments that you would offer?

Stephanie Straeter: So for example, I had a single mother who had seasonal depression, and she was having a hard time leaving the house. Then she started to have panic attacks, which was problematic, because she had a five-year-old son that she had to take to school. So she was motivated enough. What we started to work on was her awareness of when her negative emotion started to rise, and she knew that when it was a five or higher, it was time to use her box breathing. So I taught her box breathing.

And of course, when you’re practicing breathing, the goal is to take whatever was in your mind, write it down, leave it there, and just focus on the breath to bring down the elevation of negative emotion, and to practice that skill at least 10 minutes a day so that when you need it, it’s effective. So she was able to prevent a panic attack by utilizing those skills before leaving the house. It became a regular routine for her, about 15 minutes before she left the house, to do an emotion check, and if it was a five or higher, then use her box breathing to bring down that elevation.

Kevin Pho: Sure. So when you mention box breathing, for those who aren’t familiar with that, what exactly is that technique?

Stephanie Straeter: That’s holding it for four and exhaling for six. And box breathing is good for stress, anger, anxiety, and sleep. And what happens, Kevin, when our negative emotion is a five or higher, well, as you know as a medical professional, your mind’s telling your body, “Danger, danger,” and then your body’s releasing neurotransmitters to kick off that fight, flight, or freeze response. And that’s when people start to have physical reactions, I mean, palms, you know, a beating heart, and then their thoughts get even more severe. They start to panic even more because they’re experiencing this autonomic arousal. So box breathing is so effective. The hold in the box breathing is what reverses that autonomic arousal.

Kevin Pho: Now, what proportion of people do you see who can be treated solely with non-pharmacologic treatments? Do you see a small proportion who eventually have to be prescribed medication, or do you see that the majority of people with seasonal affective disorder can be treated without medications?

Stephanie Straeter: Well, you know, I’ve treated in my lifetime three people, I would say, with seasonal affective depression. So I would say out of those three people, two people were able to do it without medication, and one person came to me and she was already on medication for a while. So catching it early, I would say, is key, you know, catching it early and not being so debilitated by the depression, so that you’re motivated enough to work on these skills.

Kevin Pho: So I’m a primary care physician, as you know. So if I’m talking to someone in the exam room, what would be some signs, tip-offs, that would make me suspect seasonal affective disorder? What should I be on the lookout for?

Stephanie Straeter: Yeah, well, I’d say the time of year. So first off, the fall, the late fall and winter months, and if you’re a doctor where it’s cold and dark out, that’s where this happens, where there’s not that much sunlight. And a person who comes in, and when you saw them in the spring and in the summer, there were no symptoms of depression. So it’s really the time of the year, knowing their history, and realizing that, hey, this person, when he comes in when it’s darker out and there’s more rain and snow outside, he’s grumpier, because depression can come out as anger, being grumpy. Or he or she may not make their appointments. They may not show up.

Kevin Pho: How about a potential connection with substance abuse? Seasonal affective disorder, of course, happens during the winter months. Is there a connection with substance abuse and these mental health issues, especially during the holidays?

Stephanie Straeter: Yeah, I mean, I would say if someone has an addictive propensity and they already have a problem with drugs or alcohol, then yes, and you could expect to see that they might be using more during these months.

Kevin Pho: And if someone knows that they have seasonal affective disorder, what are some things that they can do to help prevent these symptoms from spiraling further, especially during the holidays? Anything that they could do on a preventive basis?

Stephanie Straeter: Well, I would say, especially during the holidays, it’s important for them to not be so caught up with the media, because there’s a lot of pressure for their holidays to look a certain way. It’s really about them deciding what’s important to them during the holidays, what this is going to look like, and who they want to see, and making plans to stay connected to the people that they love.

And then additionally, technology. There’s a lot of technology today that’s wonderful. There are lights that they can use in the home. The Apple Store uses it for their people that work 24/7, you know, to help them with the overnight shift work and helping them to adjust to that. So I would say there are lights that they can use. And then additionally, the tips and techniques in my article: having an awareness that you’re having a frequency of negative emotion, being curious about it, and then utilizing deep breathing and meditation, seeking out a couple of stress management techniques that you’re willing to practice a couple of times a day, like exercise, deep breathing, and meditation.

Kevin Pho: We’re talking to Stephanie Straeter. She’s a clinical psychologist and a behavioral health and wellness program developer. Her KevinMD article is titled “5 tips for treating seasonal depression during the holidays.” Stephanie, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Stephanie Straeter: I would say how important our self-care is as mental health and medical professionals, so that we can continue to be curious and present with our clients and treat the client and not the condition. So I would say, undeniably, the more experience that we have with the condition is an asset, but when that’s coupled with poor self-care, we may fall victim to top-down processing, which is a psychological term for how our prior knowledge, expectations, and experience with the condition can influence what we’re hearing from the client. So instead of being present and curious about what our client is saying, we may be quick to jump to conclusions and assumptions about the client that aren’t accurate.

Kevin Pho: Stephanie, thank you so much for sharing your time and insight, and thanks again for being on the show.