A winter of discontent?

This article originally appeared in HIV Treatment Update, a newsletter published by NAM between 1992 and 2013.
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New year can be difficult, with pressure to keep resolutions, the cold return to work and, this year, warnings about austerity ahead. But midwinter can be the perfect time to turn our lives around, says Jane Common from Living Well.

Big Ben, fireworks, and then, bang, bleak January. For many, the first two months of the year are hard. It’s almost official now, with a dubious mathematical formula designed to calculate the most depressing day of the year: a toxic stew of cold, gloom, failure and debt, ‘Blue Monday’ (some say it was January 17th this year, some say January 24th) has been seized on by the media and by mental health charities, recognising a good opportunity to encourage people to make positive life decisions.

Who’s singing the blues?

There’s agreement that people living with HIV can be particularly susceptible to feelings of depression in January and February.

Glossary

anxiety

A feeling of unease, such as worry or fear, which can be mild or severe. Anxiety disorders are conditions in which anxiety dominates a person’s life or is experienced in particular situations.

depression

A mental health problem causing long-lasting low mood that interferes with everyday life.

psychology

The study of the way people think, behave and interact. Psychological therapies are based on talking and working with people to understand the causes of mental health problems and develop strategies to deal with them. Psychologists have specialist training but are not medical doctors.

log

Short for logarithm, a scale of measurement often used when describing viral load. A one log change is a ten-fold change, such as from 100 to 10. A two-log change is a one hundred-fold change, such as from 1,000 to 10.

hormone

A chemical messenger which stimulates or suppresses cell and tissue activity. Hormones control most bodily functions, from simple basic needs like hunger to complex systems like reproduction, and even the emotions and mood.

Dr Dimitri Spiliotis, a specialist psychologist in HIV and sexual health at Barts and the London NHS Trust, says: “Christmas has often been a challenging time, and many people living with HIV enter the new year feeling depressed and anxious. Newly diagnosed men and women could have just gone through the stress of disclosing their condition, or maybe they’re finding the courage to do so.

“They might be feeling lonely and isolated – invitations can decrease as social networks adjust to the news. Another challenge is the weather. Feeling unwell and being blighted with colds and flu can cause stress and anxiety.”

David Stuart, 43, diagnosed 24 years ago, agrees: “A lot of people don’t have families they’re bonded with, and live alone so, over the festive period, they can feel isolated.

“This sense of estrangement can stay with them and deepen; it’s so easy to hibernate indoors, instead of going out and seeking social support. There are often financial woes too, especially if people are on benefits and feel concerned about having gone into the red. I’m from Australia and the end of winter is a big blues time for me – I miss my family and the sun.”

Beating the blues together

“People at this time of year should be compassionate with themselves rather than self-critical,” says Dr Spiliotis. “Take it a bit easy and, instead of setting long-term goals, set up a short-term, realistic one. It’s important too that people living with HIV do things that connect them with others, to ease feelings of isolation.”

Anna Newent*, 30, was diagnosed with HIV in January 2010. Although she was devastated, she immediately told her friends what had happened.

“Everybody started crying,” she remembers. “In a way, that made me stronger as I had to comfort them.”

But, supportive though Anna’s friends and family were, she found that she needed peer support. “I was frightened and confused. I thought HIV was an automatic death sentence,” she says. “And there was no one I could talk to as no one understood.”

So Anna turned to a local HIV support service for advice – and, through them, found the strength that she needed. A year on, she’s an outreach worker with them.

“This time of year is hard,” Anna says. “My old group of friends are complaining about diets and going to the gym; I’m dealing with much bigger questions and challenges. But, because I’ve found a support group of people living with HIV, it improves my relationship with my old friends. I have an outlet to talk about HIV, so I don’t grow impatient with my old friends for not understanding.”

*Not her real name

Turning the blues into something positive: the Positive Self-Management Programme

For those living with HIV, social support from peers can be key. The Positive Self-Management Programme (PSMP), offered by Living Well, Body Positive North West and Terrence Higgins Trust, helps people cope with the day-to-day challenges of living with HIV in a supportive group setting, examining a whole host of issues.

Some are especially relevant at this time of year, such as techniques to deal with isolation. PSMP offers exercises for improving strength, nutritional advice and information on evaluating treatments. All these are often the subject of New Year’s resolutions when, post-Christmas, people decide to take their health more seriously.

Even though David Stuart was diagnosed over 20 years ago, he still found becoming a PSMP facilitator last year an immensely fulfilling experience.

“I feel that I’m coping fine, [but] learning to be a facilitator reminded me that I can benefit from peer support – as everyone can,” David says.

“For anyone considering PSMP, the new year is a great time to get involved. Yes, it can be a frightening period but it’s also a time to address issues that might have held people back during the previous year. People might have decided that this year is going to be the one they start looking for a serious relationship. PSMP will help you prepare for that and the inevitable disclosure conversation.”

Life coaching

So now is the perfect time to learn from your past and create a new future. Life coach Carole Gaskell, in her book Transform Your Life,1 says: “Being low in late winter is common. But, rather than pushing your feelings to one side, allow yourself to acknowledge them so you can resolve them.”

If you want to stick to those New Year’s resolutions, life coaching could be the answer. It helps you identify your goals, work out a plan to stick to them and plot your progress. Clients at Living Well have used life coaching to establish relationships, build support networks – even relocate abroad.

So whatever you hope to achieve in 2011, life coaches and group facilitators can help.

Blue Monday…is a myth

Bad-science debunker Ben Goldacre investigated the Blue Monday equation and found it didn’t stack up.2 If you look at indicators of unhappiness, there’s no consistent seasonal variation.

So winter may not be so bad after all. Even if we break our New Year’s resolutions, the sobriety and determination forced on us by these dark days may end up making us happier and more confident. Happy 2011!

Five quick mood-boosters

Get active. Studies have shown that exercise can reduce anxiety, stress and depression3 – as well as all the other health benefits it has. Something that can make you healthier, make you feel better and help you sleep – what’s not to like?

Log on to www.beatbluemonday.org.uk. It has a list of the top ten ways to beat the winter blues and a blog where people have shared their own tips.

Nuts! A handful of walnuts, brazils or seeds such as sunflower or pumpkin will give you a boost of the feel-good hormone serotonin as they’re rich in selenium, which boosts its production.4

Get involved. Phone a friend, arrange to go out, join a group or a club, take up a hobby, volunteer…there are lots of ways you can help yourself to feel less isolated or bored.  

Help someone else. “The best way to cheer yourself up is to try to cheer somebody else up.” So said Mark Twain, and the Church of England agrees, with tips for Lent including leaving money in someone else’s shopping trolley or giving up your place in a queue for a stranger.

Positive Self-Managment Programme (PSMP)

Living Well empowers people to improve their quality of life through services such as PSMP, one-to-one and group life coaching and Stressless (workshops that help people focus and relax): www.livingwellcic.com; 020 3137 3373.

Terrence Higgins Trust’s ‘Learning Plus’ PSMP: www.tht.org.uk/howwecanhelpyou/livingwithhiv/learningplus

Body Positive North West’s PSMP: www.bpnw.org.uk/services/positive-self-management

References
  1. Gaskell C Transform your life. Thorsons, 4th edition, 2000.
  2. Goldacre B Blue Monday? That’s just too depressing Guardian, 24 January 2009
  3. Neidig JL et al. Aerobic exercise training for depressive symptom management in adults living with HIV infection. J Assoc Nurses AIDS Care 14:30-40, 2003.
  4. Mind Guide to Food and mood. Available online at www.mind.org.uk. 2010.