Set boundaries for a safe holiday season

During the COVID-19 pandemic, some members of Becky Lenning’s extended family continued to hold in-person gatherings. She, her husband, and two sons received invitations, but they politely declined. The youngest of their sons, Christian, then a teenager, has a primary immunodeficiency (PI).

Still, family members insisted he’d be fine because he receives immunoglobulin (Ig) replacement therapy. They didn’t understand his condition and the risks involved with socializing, said Lenning.

“We told them this is something we're not compromising on. It can be a battle with people sometimes, because they’ll say, ‘He’s on treatment,’ or ‘He hasn't been sick in a while.’ They haven't had to contend with him being sick. They've never even been to the hospital with him. They don’t know what a simple infection could do, much less COVID,” said Lenning, a licensed clinical therapist who treats clients with chronic illnesses through her practice, Yellow Lotus Clinical Services for Healing and Wellness.

“Some people in my family weren't vaccinated, and we told them we’re not coming around non-vaccinated people, and that's really challenging. Those are very sensitive topics for some people, but they're non-negotiables for us,” Lenning explained.

“It’s hard to assert yourself in that way. But one of the things I learned most about this journey is you have to be assertive for yourself and for your loved ones if you're a caregiver, because there's no one else who's going to do that for you.”

With the holidays approaching, it’s the time of year for large family dinners, parties with friends, out-of-town visits, special worship services, and a host of other activities. How to navigate attending—or not attending—these events is of particular concern for people with PI, and for their families.

According to Lenning, common PI stressors during the holidays include:

• Not “looking sick.”
• Increased social and family obligations.
• Financial stressors.
• Navigating cold/flu season.
• Family dynamics and expectations.

Some people with PI already feel lonely and isolated in the winter because they stay home to try and avoid infection. The holiday season adds even more stress by making us feel anxious, depressed, guilty, and inadequate, said Lenning. Add fatigue and burnout from holiday preparation, and job demands leading up to the winter break, and it’s overwhelming.

“All of these things have a direct impact on how we function emotionally, mentally, and physically,” said Lenning. “Chronic stress exacerbates symptoms of anxiety and depression, straining family relationships and friendships. And stress hormones like cortisol can suppress the immune system.”

To manage holiday stress, change how you interact with family and friends, incorporate activities that calm your mind and help you prioritize what is important, and seek support, recommends Lenning.

Set boundaries in relationships when people refuse to accept that you need to avoid social gatherings to keep yourself and your family safe. Hold firm in your commitment to make choices that benefit you, not others.

“Boundaries make me think about how you can’t pour from an empty cup. If we are drained and have no energy, and are burned out and we don’t feel very well, yet we are trying to give to other people, it becomes difficult when our cup is empty. As I’m sure many of you know, if we try to push beyond what our body is telling us, we often end up feeling sick,” said Lenning.

Set boundaries with simple phrases like:

• I’d love to, but I need to rest.
• I can’t host this year, but I’d love to help in other ways.
• I think it’s best you don’t come over since you’ve been ill.
• I’m not feeling up to it.
• I have another obligation.

Some boundaries might be easier to set than others. For example, you may feel guilty if you can only attend one (of many) family functions, versus feeling less concerned by not attending a work event.

“We are not obligated to do anything, though I know we feel that stress and pressure. ‘I don’t want to’ is a perfectly OK response. Whether somebody accepts that or not, it’s their responsibility to manage their feelings about that; we don’t have to carry those with us,” said Lenning.

Choose quality over quantity and prioritize events where you feel supported and safe. Avoid focusing too much on items to bring; remember, your presence is the most important part of the visit. Shopping, cooking, and gift-giving should be secondary to spending time with others.

“Be more selective about what you give your time and attention to. If we spread ourselves so thin, we're not present. If we measure ourselves or our expectations of ourselves against somebody else's measuring stick, we're always going to fall short,” said Lenning. “The holidays don’t have to be perfect to be meaningful.”

Limit your time on social media or avoid it altogether. Social media contains the 5% of highlights or the 5% of lowlights in a person’s life, presenting skewed perspectives on reality, said Lenning. Most of us spend our day-to-day life working, caring for children or adults, and running errands.

“It can feel mundane, but that's our 90%. So, if you care about what others are doing, you are missing out on your own joy in your 90%,” said Lenning.

To decompress when the holiday stress becomes overwhelming, explore strategies such as mindfulness, meditation, and self-compassion. When practicing mindfulness, focus on the task at hand, like cooking or washing dishes, through your senses of touch, sight, smell, and sound. Follow a guided meditation, many of which are available online. Treat yourself with kindness and understanding, especially when faced with challenges and difficulties.

“All of us are doing the best we can, given the circumstances that we have in our lives. Not everybody understands that, or can see that, or knows what we are dealing with. If you have to decline going to a holiday function, for example, instead of feeling critical about yourself, you might say, ‘That was my circumstance and I made the best choice I could for me or my loved one, and that’s OK and that is good enough,’” said Lenning.

Keep a stress inventory, said Lenning, and brainstorm aspects of your life you can and cannot control. For example, you can control your words, mindset, free time activities, boundaries, and focus, but you have no control over the actions or opinions of others, the future, what happens around you, past mistakes, outcome of efforts, what others think of you, and others’ boundaries.

For a quick decompression, try one of these wellness practices:

• One-minute reset: Close your eyes, breathe in deep for four counts, hold your breath for four, and exhale for four.
• Gratitude check-in: Name three things you are grateful for, making a new list each day.
• Movement: Perform simple stretches like arm reaches to the sky, shoulder rolls, or neck tilts.

Lenning recommends seeking mental health support for anyone living with chronic illness. Even if the therapist doesn’t have experience working with people who have health issues, most are willing to listen and do their best to help.

“It’s nice to talk to somebody other than those with a vested interest in your life, like your spouse or mother. A therapist is someone who can be impartial and whom you can vent to and hash things out, especially around the holidays,” said Lenning.

If visiting in person at the holidays is not an option, stay connected through technology. Do crafts with others online, attend a family event through Zoom, or watch a movie together virtually. IDF also offers Thanksgiving Day and Christmas Day online support meetings, as well as virtual Get Connected Groups and one-on-one peer mentor assistance.

“Remember, you are not alone. There is a community of support out there for you, especially at the holidays,” said Lenning.