The holiday season can be especially triggering for many people, but LGBTQ people are more likely than their non-LGBTQ counterparts to experience stress, anxiety and depression during this time of the year. Research shows that LGBTQ people are more likely to experience these symptoms year round, but numerous mental health providers say that the holiday season, especially returning home for the holidays, can exacerbate these symptoms.

“During the holiday season, I notice that many of my LGBTQ clients have even more difficulty handling the challenges they face in their daily lives and the negative impacts of these challenges, such as stigma and rejection, are much more acute,” TJ Walsh, a psychotherapist and faculty member at Eastern University in the graduate school's Counseling Psychology department, explains.

Psychologist Dr. Logan Jones, head of NYC Therapy and Wellness, echoes those same conclusions. “While experiences vary by individual, most of my LGBTQ and non-binary identifying clients report similar feelings of tension and stress during the holiday season,” Jones says. “Common struggles range from anxiety and depression, to feelings of rejection for freely expressing their authentic selves. For these clients, going home for the holidays is not always a time of bliss, but a painful reminder of moments of their ‘otherness’ within their families.”

Kristina Furia, psychotherapist and owner of Emerge Wellness in Philadelphia, adds: “The tradition of joining together with family can be the cause of much apprehension and anxiety and, for many LGBTQ-identified individuals, it may also mean dealing with passive or even overt homophobic sentiments and rejection by family members.”

And while some LGBTQ people may choose not to return home for the holidays, the season can still be triggering for them as well. “Even for LGBTQ people who are not going home, the meaning of family is something that is brought up at the holidays,” Julian Sambrano, an art therapist based in Los Angeles, told NBC News BETTER in an email. “This happens consciously or even on a subconscious level, and can be difficult to avoid.”

Research suggests that when compared to people that identify as heterosexual or cisgender, LGBTQ individuals are three times more likely to experience a mental health condition. They are two and a half times more likely to experience depression, anxiety and substance misuse.

In 2015, the Substance Abuse and Mental Health Services Administration’s National Survey On Drug Use and Health (NSDUH) found that 15 percent of LGBQ adults had an alcohol or drug use disorder in the past year, compared to eight percent of heterosexual adults. That is nearly double.

A 2016 Centers for Disease Control and Prevention study found lesbian, gay and bisexual youth are five times more likely to attempt suicide than their heterosexual counterparts. Dr. Arnold Grossman of New York University and Dr. Anthony D’Augelli of Pennsylvania State University noted in a 2007 study in "The Official Journal of the American Association of Suicidology" that nearly 50 percent of young transgender people have “seriously” considered suicide. In a 2016 national study, 40 percent of transgender adults reported having made a suicide attempt.

And while none of this data specifically deals with the holiday season, the American Psychological Association conducted a survey on holiday stress on the general population in 2006. They found that more people are inclined to feel that their stress increases (38 percent), rather than decreases (8 percent), around the holidays.

“Any rejection can cause distress, and sadly, statistics show that overtly aggressive statements and behaviors, as well as microaggressions negatively impact the emotional health of the LGBTQ community on a daily basis,” Jones explains.

“When one’s psyche is contaminated by the shadow of prejudice and internalized homophobia, it can result in depression, anxiety, psychological distress and other problems with self-esteem. Oftentimes, these issues manifest at a young age and are carried into adulthood. These distressing feelings and the ‘flashbulb’ memories that are formed in childhood are often unconsciously triggered when returning home for the holidays.”

Here are 7 practical tips to help you protect your mental health this holiday season.

1. ASK YOURSELF SOME QUESTIONS

Self-reflecting on what you actually want to get out of the holidays or a visit home helps frame your own expectations for your upcoming trip. Furia suggests to ask yourself: “What do you need to do, or perhaps more importantly, not do to feel good about yourself when the holidays are behind you?”

2. CREATE A MANTRA OF SELF-ACCEPTANCE

Going home for the holidays shouldn’t mean that LGBTQ people have to revert back to the older versions of themselves they once were. To prevent this from happening, Sambrano recommends creating a simple mantra. “This can help reframe your mind from going backwards in time,” he says. “Tell yourself something like, ‘I am exactly who I am supposed to be and do not need to change for anyone.’ Repeat this, silently or out loud as much as needed.”

Jones, who refers to this as “The Bill of Rights as an LGBTQ Person,” suggests: “I have the right to be me, I have the right to be treated with dignity and respect, I have the right to distance myself from people and places that feel toxic.”

3. TAKE CALM-DOWN BREAKS

When things become too much, it’s OK to remove yourself from what's triggering you, especially to prevent a break down to happen later. “In a stressful moment, it's great to take quick relaxation breaks of one to five minutes to calm yourself down,” Walsh suggests. “When you begin to feel as though things are becoming too much, close your eyes, take several deep breaths, meditate or just relax. Imagine yourself in your favorite place, think of a happy memory or visualize yourself succeeding at a goal.”

4. BE MINDFUL OF MICROAGGRESSIONS

Jones says that much of the discrimination LGBTQ people face at the holidays aren’t necessarily with insults and slurs, but microaggressions. Psychology Today defines microaggressions as “verbal, nonverbal, and environmental slights, snubs, or insults, whether intentional or unintentional, which communicate hostile, derogatory, or negative messages to target persons based solely upon their marginalized group membership.”

Jones lists, “‘It’s fine, I just don’t want to hear about it,’ ‘that’s your issue,’ ‘why aren’t you married yet?’, ‘this is my gay cousin,’ all as examples of microaggressions that call a person’s “gender or sexual identity into question in a subtle, but harmful manner.”

“Do not allow family to get a pass on discrimination just because it is not threatening or violent in nature," he advises. “Microaggressions are still an affront on your right to feel comfortable, seen and respected for your full, authentic self.”

5. GET MOVING

It can be hard to work out over the holidays, but doing so may reduce tensions later, helping you deal with toxic behavior from family members without melting down. “One of the best ways to overcome stress during the holidays or any other time is to exercise regularly,” Walsh suggests. “Research shows that physical activity not only boosts your fitness and energy levels but can also elevate your moods and increases production of endorphins, your body’s feel-good neurotransmitters.”

6. PRACTICE ASSERTIVENESS

While there are many things to do prevent confrontation, Jones recommends speaking up and setting boundaries. “When insensitive statements or actions cross the line, speak up for yourself,” he says. "'Please don’t make comments like that - they’re painful and make me feel unwelcome here.' A simple statement like this demands respect, establishes gentle, yet firm boundaries, without spreading further toxicity.”

7. STAY CONNECTED WITH ALLIES

“If you choose to go home for the holidays, inform your friends and allies that you’ll be needing some extra emotional support during this time of the year," Jones concludes. “Text or call your support system if at any point you feel overwhelmed by your family, and upon your return, surround yourself with people who make you feel loved and remind you that you’re perfect just the way you are.”

HOLIDAY SURVIVAL GUIDE

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