When the Holiday Cheer Gets You Down: Eight Tips for Coping with Difficult Emotions

Pictured: Wendy Lichtenthal

Clinical psychologist Wendy Lichtenthal with one of her patients.

If you have cancer or are caring for a loved one with the disease, seasonal wishes such as “Merry Christmas” and “Happy Holidays” may ring as hollow as an empty Salvation Army kettle. Anxiety, stress, grief–even anger–are normal feelings accompanying a cancer diagnosis, and listening to Christmas carols or remembering more carefree holiday seasons from years past may not help things.

“The holidays are painted as an especially joyful time, yet when you’re feeling a set of emotions that doesn’t seem to fit this ideal picture, the contrast between what you’re feeling and the merriment around you can leave you feeling disconnected,” says Memorial Sloan Kettering clinical psychologist Wendy Lichtenthal, who specializes in counseling breast cancer patients during all stages of their disease and treatment. She also focuses on helping caregivers of cancer patients who are coping with the loss of a loved one as Director of the Bereavement Clinic.

You might even feel you’re supposed to savor every moment with family and friends, but your thoughts aren’t cooperating, Dr. Lichtenthal notes.

“People tell themselves, ‘I need to be more in the moment and enjoy this time,’” she says, “but then they find they aren’t really up for it, or perhaps scary thoughts intrude, leaving them feeling frustrated and a sense of guilt. Whenever possible, try not to feel badly about feeling badly—give yourself permission to feel whatever it is you’re feeling.”

How much a cancer diagnosis will affect your holiday celebrations will depend on your particular diagnosis and stage of treatment. But to cope with difficult emotions that may arise in a situation that so often feels beyond your control, Dr. Lichtenthal says it can be helpful to focus on what you do have control over. She offers the following tips:

Take inventory.

The holidays can mean a flurry of activity–shopping, cooking, decorating and entertaining. Put your energy, which may be a precious resource right now, toward those activities or traditions that mean the most to you.

It can help to make a list, writing down what you normally do, what you feel you should do, and the things you genuinely want to do because they give you a sense of satisfaction or meaning. Try to focus on the “want to dos.”

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What’s most important is unique to you.

There is no universal prescription for coping with the holidays; what is important to one person may be less so to another. Maybe, for example, holiday shopping is a chore and you’re fine with telling your relatives you can’t do it this year. Or maybe you love giving gifts and you want to keep doing it, just like always.

In that case, shop if you can, or perhaps come up with a list and either order online or ask others to get the items for you. Doing things that were important to you before the diagnosis can help you feel like yourself and can help keep your spirits up.

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Accept offers of help.

If friends, relatives, or neighbors ask if there’s anything they can do, suggest something specific. You might wish they could read your mind and know what would be most helpful without you having to ask, but they probably won’t.

Tell them you’d appreciate it if they would pick up your Christmas tree or drop off a batch of their famous chicken soup. Giving is a theme of the season, and those who care about you will cherish the opportunity to be there for you.

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Keep traditions, even while breaking them (a bit).

The best traditions help us feel connected to the people we care about. But it’s OK to change traditions to accommodate your energy level, treatment schedule, caregiving responsibilities, and so on.

Maybe you usually host a big holiday dinner. Turn it into a potluck or ask someone else to host so you can still be together.

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Manage family members’ expectations.

They may not understand how fatigued you feel, or they may be experiencing their own distress. Try to be clear about your limits.

That sounds good, right? Everyone knows that family can be, well, family. If that conversation is going to cause you even more stress, then you may decide it’s better for you to keep the peace and agree to some of those “should dos.”

Just make sure you’re not taking on too much and you’re still taking care of yourself.

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Leave your options open.

The cancer experience can sometimes feel like a rollercoaster. Some days you may feel energetic; others you may not feel up to doing much at all. Allow yourself to decide at the last minute if you’ll attend a party or if you want visitors.

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Try to spend time with people who are good for you.

That person may be a compassionate listener, or a chatterbox who will distract you by talking about everything but cancer. You know what you need. Reach out to those people.

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Don’t go it alone.

If you’re struggling, reach out for professional help. Memorial Sloan Kettering social workers, psychologists, psychiatrists, and chaplains are here to help cancer patients and their families navigate emotionally trying times.

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How do you handle Christmas when odds are this May well be your last one?

Dear Walter, thank you so much for your question. We have reached out to Dr. Lichtenthal for her thoughts.
If you are in the New York area, you may wish to consider making an appointment with one of the therapists from our Counseling Center: http://www.mskcc.org/cancer-care/counseling-support/counseling-outpatie…. In particular, meaning-centered therapy is something you might look into. Thank you again for reaching out to us.

Walter, we reached out to Dr. Lichtenthal, and here’s what she said:

“I think it’s important to acknowledge that this is for many people an incredibly difficult and painful thought to process, and so I would reiterate what was said in the blog about first giving yourself permission to feel whatever range of emotions you may be feeling. These are likely to vary, even within a given day, and you may have feelings that seem at odds with one another at times, such as simultaneous joy and sadness. This is normal and of course very understandable.

In addition to those other points in the blog about taking inventory of what’s most important to you during this time and reserving the right to focus your energy on those things, another thing that may be important to consider is what you might need from others at this time (which again, may vary from day to day). Do you want those around you to keep traditions? Do you want to enjoy and “be in the moment”? Do you want to speak candidly and openly about this with those close to you? Do you want to give them permission to feel whatever they are feeling? Do you want to think about their future? A word that often comes up is legacy. The holidays can be a time to reflect on one’s legacy and how they would like things to be in the future during the holidays and otherwise. If open discussion is a possibility, talking about traditions that you’d like to see continue or letting those in your life know that, for example, you don’t care what they do, just as long as they are taking care of their own needs, could be a great gift to give. Quite often, though, family members want to protect one another from discussing difficult topics and so avoid them. Open communication can be very helpful in a family that generally functions well. In some families, however, these topics bring significant tension, and it might be important to get professional support to facilitate such conversations.

Another helpful approach mentioned above may be Meaning-Centered Psychotherapy, developed by Dr. William Breitbart at MSKCC and based in part on the work of Viktor Frankl who wrote, Man’s Search for Meaning. Part of what’s involved with this approach is to think about those things that are most meaningful to you. If energy is limited, think about less physically active ways that you can connect with those things that are most important to you, whether it’s roles you hold, activities you do, or experiences you savor. Central to this approach is thinking about how, when circumstances are beyond your control, you always have the freedom to choose the attitude you take toward these circumstances. And, the very attitude you take toward life’s challenges and limitations can be a source of meaning in and of itself. How you choose to face a given predicament can be something very important to you, even a source of pride and perhaps a model for how to face hard times to those around you—another form of legacy.

Regardless of exactly what you choose, rather than thinking about the “right” or “wrong” way to cope in this regard, consider “helpful” versus “unhelpful” ways of coping, again keeping in mind that this might change from day to day, even hour to hour.”

Also, Dr. Lichtenthal let us know that Dr. Breitbart has a clinical trial looking at Meaning-Centered Psychotherapy for advanced cancer patients, which you can read about here: http://www.mskcc.org/cancer-care/trial/11-021. For more info on the trial, you can call 646-888-0053 or 646-888-0057, or e-mail [email protected] or [email protected].

Thank you for the thoughtful response. Even though I am a patient of MSKCC,I live in Virginia Beach, Va and there are no support groups here for AML. I actually am more concerned about my wife who cries often because of my cancer. I have never been angry or felt sorry for myself. I simply pretty much accepted the fact that I had AML and odds of survival were very low right from the beginning. Of course I still have some hope that I may well be that one guy in 200 that does survive or that one of the clinical trials would prove to be the cure suitable for elderly application. As a retired U.S. Navy Aviator flying jet aircraft, I had a number of very close calls and often wondered why I survived while so many of my fellow jet pilots perished. It almost seemed as if God had a plan for me and it did not include dying in a plane crash. But if that was true, why have me die from cancer?

Walter, since you are not based in New York, we encourage both you and your wife to take advantage of our Virtual Groups program. These online support groups, conducted over the phone and by computer, will allow you to connect with other leukemia patients and allow your wife to connect with other caregivers. You can learn more about the program by going to http://www.mskcc.org/cancer-care/counseling-support/virtual-groups or emailing [email protected].

Hello. My mother was a patient at Sloan...Dr. Norton was her doctor...she passed away June 2005..I struggle every single day and I feel as though I'm never going to fully recover...is this normal? There are days I'm angry, anxious, nervous, sad, etc. I've never spoken to a therapist but thinking it might be time...

Dear Kelly, people move through their grief in all different ways/times so we keep our services open to our caregivers. You are welcome to call our Counseling Center at 646-888-0100. If your anxiety has other sources, our counselors can also refer you to a private therapist or clinic. Thank you for reaching out to us.

I have a late stage cancer where I have to go every 4 months for a petscan. I have a very hard time moving forward because of all these tests along with the estrogen blockers which give me daily depression. I worry most about the effects of all this on my 22 year old son who has seemed to shut down about my cancer. He is my only child. Prior we had a close relationship and was my best friend. As Christmas approaches I want to create happy memories for him but there's just so much wellness you can fake. My greatest fear is that these cancer memories will wipe out all his wonderful childhood memories.

Dear Judy, we’re very sorry to hear that your family is going through this. We recommend that you talk to your son about your worries, if you think he would be open to that kind conversation. You might also want to get out photo albums or other mementos to remind you of past holidays and help to open up conversations with your son.

If you are interested in getting advice from other people who are going through this, you may want to join Connections, our online support group. You do not need to be an MSK patient to join. You can go to https://www.mskcc.org/experience/patient-support/counseling/groups/conn… for more information.

Thank you for your comment. We are sending our best wishes to you and your family this holiday season.

I find that I really relate to Kelly’s comment above. My dad was a patient of Dr Slovin at Sloan. He passed away two years ago, and while I still struggle immensely on a daily basis, I find holidays even more depressing. My family carries on the same traditions as always, but his absence is glaring. This year, my dad’s wife stopped spending holidays with our family to spend them with her new boyfriend. As a result, we don’t see my little sister which has made everything even more difficult. I’ve finally started seeing a therapist, but I’m still really struggling.

Dear Shaina, we’re sorry for your loss. Thank you for sharing your story. Best wishes to you and your family this holiday season.

I started with over a in 1994 and have done well, now it's progressed to mylofibrosis and an considering bmt. I am frustrated with the cost. Don't know if Medicare will help and I may not 've able to afford to try living. I feel I have been fighting a long time. I'm getting tired and depressed. Holidays do not help. I don't know what to do, don't feel like thinking any more

Dear Jo Ann, we’re sorry to hear about what you’re going through. We recommend that you speak with a therapist or social worker who can help you with these feelings. We’re wishing you peace this holiday season.