Self-Care

Managing Stress in Medical School

Keeping stress levels manageable and addressing mental health issues while in medical school seems like an impossible goal. So much so that many medical students assume they are going to have to white-knuckle it through medical school. Doing so without giving genuine attention to any pre-existing mental health issues and whatever stressors arise during their time as students can have serious consequences. Keeping mental health and stress in medical school in check isn’t easy when the pressure is high and your spare time is low. But putting in some effort now, and having safeguards in place for when you need them (and spoiler alert, you will) is certain to pay off in the short and long-term during your time as a student and throughout your career.

Some Stress is Good

Hearing that some stress is good can feel dismissive, reductive, or just plain annoying. But it bears a mention. Low or mild levels of stress can help us to remain competitive, improve performance, and do things like meet deadlines or study with purpose. Once stress becomes chronic and reaches unmanageable and unhelpful levels, it begins to be detrimental to both physical and mental health.

Negative Effects of Stress

It seems that there is an endless list of problems that can be associated with stress. Seeing a physician or therapist with any number of complaints is often met with questions about your levels of stress. But there is research to back up the link between stress and many physical and emotional problems¹. Headaches, insomnia, irritability, depression, anxiety, increased blood pressure, gastrointestinal problems, lowered immunity and hormonal problems top the list. Of course, other problems can certainly be blamed, at least in part, on stress.

Preparation is Key

Imagine needing to drive somewhere during a snowstorm. Your car is probably fine; it knows what it needs to do. So you head out without knowing how much gas is in it, wearing shorts, flip flops, and also realizing you left your phone at home. You would probably never do this – at least not all of this. You know that you can’t control the conditions you will experience during your drive, and you can’t be sure that something problematic won’t happen with your car. But to the best of your ability, you have likely kept up with your car’s maintenance and you would do the minimum to prepare yourself to be out in the weather.

In the same way, planning for the inevitable stress of medical school by cultivating a toolbox that can support your wellbeing can set you up for successfully navigating the course of your academic career. Knowing what you can do to prevent unnecessary stress, having a support system in place and available, and having techniques for acute issues is one of the best things you can do for yourself. Please feel free to read that last sentence again, because it cannot be overstated.

Tools You Can Use For Stress in Medical School

The term stress can seem ambiguous, and the topic of managing it has been frequently covered, so I would like to offer the following for consideration: When students hear that keeping stress at manageable levels is important, the most common reaction is that this is a nearly impossible goal. Yet when evidence based methods for stress management are given, the reaction is that they already know these things, they’ve been covered repeatedly. This discrepancy illustrates that while stress management seems like a lofty goal, we don’t need to start from scratch to be in an optimal position to meet it head on.

Here’s how^2,3:

Nutrition – A diet rich in nutrients can promote health and give you the physical energy you need to deal with stress. There’s no need to adhere to radical diets, simply increase healthy foods and decrease the junk and highly processed foods.
Exercise – Besides improving sleep, physical activity can directly combat stress. Adults who get moderate amounts of physical activity reported half of the perceived level of stress as those who did not get an adequate amount of exercise. No expensive or involved routines needed here; something as simple as a brisk 30 minute walk can do the trick. Try ClassPass to drop in on workouts at one of thousands of studios near you.
Peer support – A strong support system can improve your ability to handle stress. You have shared stressors and challenges. But all peer support is not created equal: make sure that the peers you choose to lean on have your best interests at heart, you’ll know if this is quality support if you feel better after you’ve spent time with them than you did before.
Outside friends – The time you have to socialize is sure to be limited, and the support of your medical school peers is important. But so is keeping in contact with family and friends who are not in medical school. New moms often seek other new moms to share their experiences. But if they adhere too tightly to only this group, they forget that there is a whole other part of society that isn’t consumed with feeding schedules, diapers, identifying the mushy substance they just found sticking to their hair, and constant crying jags (of both mom and baby). The point is, being around people who are experiencing your same circumstances has a lot of benefits, but it can become an echo chamber. Spending time with or checking in with people outside of this group can widen your perspective and remind you that there’s a big world out there beyond medical school, and this can be really refreshing!
Muscle relaxation – Stress can cause muscles to tense, and the result can be tension headaches, backaches, and fatigue. Stretching, warm baths, massage, or progressive muscle relaxation can go a long way toward reinvigorating your mind and body.
Meditate – Research continues to grow indicating that meditation can reduce stress. Even just a few minutes of meditating can have a positive effect. Apps like Breethe make it super easy. There are guided meditations provided in amounts as short as three minutes and focused on whether you are starting your day, just need a break, or are ready to go to sleep.
Sleep – The stress you feel during the day affects your sleep at night. A lack of sleep can affect your mood as well as your cognitive abilities. The demands of medical school may make your quality sleep seem like, well, a dream. But there are things you can do to try to prioritize some solid shut eye. Keeping your sleep schedule as consistent as possible, avoiding caffeine and alcohol in the late afternoon and evening, staying away from screens before sleep, and making sure you have had plenty of physical activity during the day can all help develop a restorative sleep routine.

When It’s More Than Just Stress

When dealing with the rigors of medical school, financial responsibilities, and relationship and life issues, it can be difficult to recognize when the line is crossed from excessive stress to a mental health issue that requires immediate attention. Latent mental health issues may surface, or you may develop mental health issues during your time as a medical student. None of this is uncommon, and none of this is your fault.

When It’s Time to Ask For Help

There is quite literally a book of mental health conditions (the DSM-5-TR), so it would be impractical to list every possibility. But anxiety, depression, ADHD, and PTSD are examples of conditions that could present themselves during the medical school years. In fact, one study of medical students in the United States found that 30% screened positive for anxiety and 24% screened positive for depression³. Notably, these numbers are higher than previous studies done before the Covid-19 era, suggesting that there needs to be a heightened awareness of the impact of the pandemic. However, studies of medical students have almost always found higher instances of mental health issues when compared to the general public⁴.

Guidelines

So how do you know it’s time to seek out help from a professional? There are a few guidelines that make sense to follow to make this distinction.

First and foremost – you want to! You think you will benefit from sorting some things out.
If trusted friends and family are suggesting that you should see someone, it’s worth listening to them. They know your baseline behavior, and if they are seeing a marked difference in how you are navigating this time in your life and changes in your personality, they are advocating for you. Though it may be humbling, their care for you deserves some attention.
If you have been trying approaches to stress management and they either aren’t working or have stopped working, you would benefit from working with someone to help you find more specific techniques, and perhaps uncover any underlying reasons for this issue.
Your responsibilities are beginning to suffer. Your school performance is declining and your daily tasks and deadlines are not being met, with no resolution in sight.
Unhealthy habits are becoming a problem. Beyond just escalating drinking and/or drug use, this includes eating and sleeping habits, or any type of risky behaviors, excessive shopping, gambling, etc.
You have had thoughts of harming yourself or others. These thoughts don’t always mean hospitalization or other involuntary action, but they should always be evaluated by a professional. For this one, if you are hesitant to disclose this to a therapist, at the very least begin by placing a call to a suicide hotline where they can further assess and guide you. The National Suicide Hotline number is 800-273-8255; they are available 24 hours a day by phone call or text.

Taking the Next Step

If you do decide to seek professional therapy, make sure to do so in a way that meets your time and financial limits. Traditional therapy means about an hour of face to face or virtual time with a therapist on a somewhat predictable schedule. There can be a more involved onboarding process, but the rapport you build with your therapist can be very empowering.

Newer therapy models for those with less predictable schedules and time constraints are also available. Apps such as Talkspace provide an option to be involved with a licensed therapist but to do so in a different way. The entire process can be accomplished on your phone. After completing an assessment, you choose your provider and begin therapy. With this format, you send your therapist a message at any time that is convenient for you, and they respond within a guaranteed time. There are options for phone/web messaging, phone calls, and video calls. Additionally there are psychiatric options available for evaluations and medication management.

Gauging Success

Removing stress altogether from our lives is not possible. And small levels of stress can actually keep us motivated to focus on our goals. Still, it is helpful to find ways to assess how we are doing along the way as we strive to keep stress and mental health in check. All you need to know as you go along is that every effort counts. Taking one walk won’t suddenly bring every issue back to a manageable state, but it’s a start. Building new routines and habits will net improvement, some that may be seen quickly and some that will surface over a longer period. Give yourself credit for every positive step, and remember that stress management and mental health is a journey, not a destination.

As with many things in life, stress management and mental health care have a lot of ebb and flow. Some stress and mental health issues will improve as you create a new outlook, but new stressors are always right around the corner ready to throw your life into disarray. Having created your toolbox to meet these challenges will help you feel confident and empowered to meet each change rather than feel blindsided and unprepared. Making this way of life a priority will help you successfully manage medical school, your professional practice, and just about every area of your life.

References

https://www.healthline.com/health/stress/effects-on-body. Medically reviewed by Timothy J. Legg, PhD, PsyD. Written by Ann Pietrangelo. Updated March 29, 20.
Varvogli, L., Carviri, C. (2011). Stress management techniques: Evidence-based procedures that reduce stress and promote health. Health Science Journal, 5(20), 74-89.
https://www.apa.org/topics/stress/tips
Halperin, S., Henderson, M., Prenner, S. (2021). Prevalence of anxiety and depression among medical students during the Covid-19 pandemic: A cross-sectional study. Journal of Medical Education and Curriculum Development, 8.

Debi Smith-Racanelli, MA, NLC, CAGS

Debi Smith-Racanelli, MA, NLC, CAGS has been a psychotherapist in Colorado for over 20 years. Her passion when working with clients is to help them discover the strengths they already possess and use those to empower them to boldly face all of life’s challenges. She enjoys spending time with her family and credits reality television with providing her brain the break it so richly deserves from the demands of being in the helping profession.