Psychologist shares coping mechanisms in support of Mental Health Awareness Week

Clinical Psychologist, Dr Bridget Hanley at Lead Employer, Mersey & West Lancashire Teaching Hospitals NHS Trust shares advice and support following reports that 62% of junior doctors are suffering from mental health concerns*.

Here, Bridget walks us through different conditions, how to identify the symptoms, positive coping mechanisms and when to seek support.

She said: “It goes without saying that training as a medical doctor is demanding and high pressured, perhaps more so now than ever. Many of you will have been motivated to choose this career path because you enjoy a challenge, whilst others of you may have chosen to work in a medical profession, having experienced your own psychological difficulties and trauma and are motivated with a wish to ‘make things better’.

“Intensive medical training programmes, challenging working conditions and substantial financial burden can place significant strain on medical students’ mental health and research evidence increasingly indicates the prevalence of anxiety, depression and stress is higher amongst medical students than the general population.”  

The BMA reported in 2022 that 62% of junior doctors said they were currently suffering from depression, anxiety, stress, burnout, emotional distress, or another mental health condition, relating to or made worse by their work or study*. If these psychological difficulties are ignored or minimised, it can impact detrimentally on academic achievement and in some cases, result in severe mental health difficulties and suicide ideation and pose a risk to patient care.

Bridget continued: “As this week is Mental Health Awareness Week, what better time to consider how you are going to manage and develop ways of coping that will help you through the numerous challenges and pressures you are sure to meet during your training. Here are some of the common psychological difficulties that medical trainees and junior doctors are likely to experience during their training. Try to become more aware of these symptoms and notice how you are feeling or how things are affecting you so that you can start putting some strategies in place to help you cope.

Anxiety:

Anxiety is a feeling of unease, like worry or fear, that can be mild or severe. It can cause a change in your behaviour and the way you think and feel about things as well as physical changes.

• restlessness
• a sense of dread
• feeling constantly “on edge”
• difficulty concentrating
• irritability
• dizziness
• tiredness
• a noticeably strong, fast or irregular heartbeat (palpitations)
• muscle aches and tension
• trembling or shaking
• dry mouth
• excessive sweating
• shortness of breath
• stomach ache
• feeling sick
• headache
• pins and needles
• difficulty falling or staying asleep (insomnia)

Burnout:

This is a psychological syndrome that is characterised by overwhelming exhaustion, depersonalisation and reduced personal efficiency.  It is particularly common in health care jobs when you are expected to put others’ needs first, work long hours and do whatever it takes to help. A recent survey undertaken by the BMA indicated medical trainees and junior doctors were to at high/very high risk of burnout (91%).

• Emotions feel blunted.
• Helplessness / hopelessness
• Becoming tearful
• Irritable
• Numbness
• Feeling unfulfilled
• Feeling unappreciated
• Disengagement
• Social withdrawal
• Loss of commitment
• Uncharacteristic mistakes
• Lack of holiday planning
• Being inconsistent with work
• Muscle pains
• Headaches
• Tiredness / lethargy
• Sleeping problems
• Memory problems
• Lack of concentration
• Weight gain / loss

Depression:

The symptoms of depression are variable, you frequently experience sadness or hopelessness. These feelings can continue for weeks or months and may interfere with your work, social life and personal life as you no longer want to participate in activities you used to enjoy.

• continuous low mood or sadness.
• feeling hopeless and helpless.
• having low self-esteem.
• feeling tearful.
• feeling guilt-ridden.
• feeling irritable and intolerant of others.
• having no motivation or interest in things.
• finding it difficult to make decisions.

PTSD

Trauma sadly is something that health professionals experience face daily in their work role and research has demonstrated that rates of PTSD amongst staff is higher than the general population. The symptoms of post-traumatic stress disorder (PTSD) can have a significant impact on your day-to-day life. In most cases, the symptoms develop during the first month after a traumatic event but for some there may be a delay of months or even years.

Re-experiencing:

A person can often involuntarily and vividly ‘relives’ the traumatic event in the form of:

• flashbacks
• nightmares
• repetitive and distressing images or sensations
• physical sensations, such as pain, sweating, feeling sick or trembling.
• constant negative thoughts about their experience, repeatedly asking themselves questions that prevent them coming to terms with the event.
• Questioning why the event happened to them and if they could have done anything to stop it, which can lead to feelings of guilt or shame.

Avoidance:

• Trying to avoid being reminded of the traumatic event is another key symptom of PTSD (avoiding certain people or places that remind you of the trauma or avoiding talking to anyone about your experience).
• Trying to push memories of the event out of their mind, often distracting themselves with work or hobbies.
• Emotional numbing (not feeling any emotions)

This can lead to the person becoming isolated and withdrawn, and they may also give up pursuing activities they used to enjoy.

Hyperarousal (feeling "on edge")

Anxiety is a common symptom of PTSD/ Trauma, and a person may be constantly aware of threats and easily startled often termed ‘hyperarousal. This can lead to people experiencing:

• irritability
• angry outbursts
• sleeping problems
• difficulty concentrating

Positive Coping Strategies:

Peer support: Talking and sharing your experiences with others (particularly those who have been through similar experiences) can help you to feel less alone and can often be a great way to find positive ways of managing any difficult feelings and emotions.   Find out what peer support there is already set up in your training organisation or look at developing your own support network.

Self-Care: Take breaks! It’s important you recognise you are not a machine and consider the effects stress and anxiety are having on your body and mental health. Try to make a ‘toolbox’ of strategies and activities which help you to switch off whether it’s getting out in nature and going for a walk, have a relaxing bath, listen to music, enjoying your hobbies.

Mindfulness and Breathing Exercises: Mindfulness based interventions focus on acceptance and non-judgemental, self-awareness in the present moment. These can take different approaches such as meditation, body scanning and breathing activities and has been shown to have successful outcomes in reducing stress, anxiety and low mood.  Some exercises are available online – please look at the wellbeing resources provided via our resource sheets.

Sleep, Exercise and Diet: exercising regularly, stopping smoking, cutting down on alcohol and drinking less caffeine will all have a positive effect on your wellbeing.

When to seek support?

If you start to notice these symptoms are increasing or worsening, then it is important that you recognise it is the time to reach out and ask for professional support and seek psychological therapy or trauma intervention – please look at the wellbeing resource sheets for services/organisations.

*BMA survey highlights state of junior doctors' finances and morale (clinicalservicesjournal.com)