This is a time of year when some trainees may have more than one opportunity/offer to choose a medical school, graduate program acceptance, or job offer. 

Sometimes, trainees are clear about their top choice right away and sometimes the decision is harder.

Ruth Chang from the University of Oxford has given a thoughtful TED talk about situations like these.

When options are close, and as Ruth Chang, says “on a par”, then you have the opportunity to reflect and decide how you want to shape your life, what values are important to you.

Here is the link to the short TED talk on Hard Choices and the transcript if you would rather just read it. 

transcript  https://www.ted.com/talks/ruth_chang_how_to_make_hard_choices/transcript

As suggested via the OITE Career Blog, another way to consider your options would be to use a prioritizing grid.  There are also many resources on our OITE YouTube channel with videos about career decision making, graduate school, medical school, etc.  If you are an NIH trainee, it can also be helpful to talk with trusted mentors and a career counselor when making these important decisions.

Waiting for news about our future, whether that be about grad or med school, a new job, or a health diagnosis, can be hard to tolerate. With it often comes feelings of anxiety, fear of the unknown, or worry about potential news we’re not hoping for. These feelings are often intense and highly uncomfortable so we can find ourselves coping with them by distracting, numbing, avoiding, or constantly checking our devices for any new information that may have come in the last few minutes. This can sometimes feel like a new-found anxiety. But instead of disconnecting from those unhelpful responses, we often find ourselves pulled in even tighter towards them because our persistent pattern of worry and checking becomes an allusion of control, giving small reinforcements that subdue our anxiety or fear, even if only momentarily. We all know this is not helpful, and in some instances it even causes significant strains on wellbeing, relationships, and productivity at work. So, what can we do better manage the discomfort that comes with waiting for important news:

1. Focus on your locus on control. Note where you have control and where you don’t. When you notice yourself naturally being pulled toward the worry of what you can’t control, come back to yourself and practice statements such as: “I may not like what I’m feeling right now but this will pass and I will get through this.” Ask yourself: “What is in my control that I can shift my attention toward in this moment?” It is normal to feel at a loss when asking ourselves this question. However, this  can be something as simple as how we’re caring for our mind, body, spirit and relationships
2. Connect with supportive people. Engage with people you see and treat you as a whole human; not someone who focuses on your work, productivity, or the outcome of what you’re waiting on.
3. Prescribe yourself "worry time". Schedule in deliberate time where you allow your mind to worry and think through the worst-case scenarios that keep you up at night. Journal about these thoughts or share them openly with a trusted other but save them for a specific time and place. You will find that if you stick to your prescribed time that the persistent worrying throughout the day that hinders attention and focus may decrease. 
4. Rest, nourish, and move your body everyday. Schedule in and prioritize these actions the same way that you schedule important meetings in your workday. There are on-going benefits of prioritizing your wellbeing in this way.
5. Reconnect with the present through a PAUSE, RESET, NOURISH Exercise below or Grounding Skills
   • Pause - Check in with your internal experiences or how your body is feeling at the present moment.  Practice square breathing, 7-11 breathing, 4-7-8 breathing to activate your parasympathetic nervous system. 
   • Reset - Actively do something to help you feel steadier, more calm, confident or focused on your next task. Be kind to yourself and remember that waiting is difficult and unsettling at times.
   • Nourish - Soak in something positive that replenishes your mind-body-heart-soul-or spirit. Turn your focus towards something that helps you remember your own strength and resilience or reminds you to take time to tend to yourself. You may ask yourself, “What do I need to nourish myself right now?”

Performance anxiety is defined as the fear of performing a specific task. Many of us have experienced some physical and/or psychological distress before a major event in our life.  These events can include speaking in front of people, taking an exam, an interview for a new position, or a presentation at work. Performance anxiety is extremely common, affecting roughly 40% of all adults in the U.S.  Many famous performers have been open about their struggles with performance anxiety, for example, the late actor Paul Newman, international singers Adele, Rihanna and Katy Perry, and Olympic gymnast Simone Biles have spoken publicly about their fears.

Some people may experience mild symptoms of nervousness while for others it can be quite debilitating. Common symptoms include excessive sweating, heart palpitations, stomach disturbance (including nausea), shaking, dizziness, dry throat/mouth and panic attacks. These symptoms may lead to poor performance or refusal to perform.  There are techniques that help mitigate performance anxiety. If symptoms are severe, it can be helpful to speak to a therapist as treatment can significantly improve one’s ability to perform.

Performance anxiety can trigger our sympathetic nervous system’s fight, flight or freeze response; utilizing the below strategies will help activate the parasympathetic nervous system’s rest and digest response.

Mental/Cognitive Strategies:

• Utilize process visualization; visualize completing the specific goals or steps of the performance. When we visualize achieving these small, manageable steps we can decrease stress and increase our motivation.
• Focus on the act of performing rather than those in the audience.
• Label your anxiety and normalize the feeling by recognizing many others also struggle with this fear. Labeling your emotions creates a distance between you and the feeling, giving yourself space to determine how you would like to respond.
• Practice positive self-talk: remind yourself of why you will do well, for example, talk through how much you have practiced, how well you know the material or activity, etc.
• Practice self-compassion: remind yourself that if you make a mistake, you are in good company as everyone makes mistakes periodically.  

Behavioral Strategies:

• Utilize relaxation techniques such as deep-breathing and meditation/guided meditations. Extending your exhales can quickly activate the parasympathetic nervous system. Inhale through your mouth for a count of 4 and exhale out of your mouth for a count of 6.
• Practice progressive muscle relaxation. To do this, start either at your feet or head, clenching your muscles and then fully releasing. Continue the tightening and releasing of each muscle as you move up or down your body, ending at the opposite end. Progressive muscle relaxation has stress-alleviating effects, and research demonstrates it has a positive influence on anxiety. 
• Smile. Research has shown that smiling while experiencing stress can help to reduce the intensity of the body’s stress response; this happens even if you don’t feel happy and manufacture the smile.
• Focus on preparation and practice often. We build our confidence with each practice.
• Do some movement before you perform (jumping in place, take a brisk walk, shake out muscles). This type of movement can ground us and take us away from the rumination or fear in our head to focusing on our body and send quick bursts of endorphins.

Lifestyle Strategies:

• Exercise regularly as this helps mitigate overall anxiety. Exercise has been shown to decrease overall levels of tension, elevate and stabilize mood, improve sleep, and improve self-esteem. About five minutes of aerobic exercise can begin to stimulate anti-anxiety effects.
• Monitor/limit caffeine intake before you must perform.
• Maintain healthy sleep hygiene in the days leading up to the performance.
• Eat a healthy meal before your performance, one which incorporates protein, healthy fat and fiber.
• Hydrate.

Finding the unique tools that work for you to manage performance anxiety can make the difference between a distressing situation and a manageable one. Working with an OITE wellness advisor or a therapist can help you manage this anxiety. You can find OITE’s wellness resources here.

Each person’s mental health exists on a continuum, often fluctuating due to a variety of factors, including but not limited to, the state of our physical health, the stressors we’re navigating, or typical life changes like loss or gain of a relationship, a move, or job change. It’s no surprise then that most of us will experience mental health concerns at some point in our lives. As a result, it’s necessary to begin building awareness and language that empowers us to effectively support a colleague or friend who may be struggling or seek support for ourselves when needed. This post will briefly outline effective strategies to help you prepare for, start, and engage in supportive conversations about our mental health. Then it will close with relevant resources.

I. PREPARING FOR A CONVERSATION: While we cannot predict the outcome of a conversation, we can prepare ourselves for difficult conversations by answering the following:

What is the relational hierarchy and how may that impact comfort level and amount of information shared? You can often effectively share or address concerns without having to disclose all details.

What context and timing is most conducive to this conversation? Ensuring there is adequate privacy and time as well as physical and emotional safety.

What culture influences may be informing your/other’s presentation, communication, and support seeking? Be careful not to make assumptions or judgments and recognize that our culture influences not only how we may communicate but also our internal processing as well as support seeking behaviors and goals. What feels helpful to you may be different from a colleague and that’s okay. There is not one right way to navigate this issue.

What is your goal(s) in having this conversation? When we’re supporting someone, remember that you job is not to “fix” the situation but rather to LISTEN, be present without judgement, and support with resourcing with appropriate. When we’re the one seeking support, is helpful to understand what we hope to get out of the conversation. Do we want to just be heard or do we need help finding resources?

How will you regulate and manage discomfort or distress that may show up while having the conversation? Some people fear saying or doing the wrong thing which can heightened our stress response and discomfort in these conversations. Plan for how you will regulate your own stress response in these situations so that you can truly listen and communicate effectively.

What relevant resources are available to your/your community? See end of post for NIH and community resources.

II. STARTING A CONVERSATION: Knowing how and where to start is sometimes the biggest barrier in having important conversations about our mental health and wellbeing.

Open with nonjudgmental observations and open-ended questions when approaching someone about whom you’re concerned. Keep this succinct and remind them, especially if you notice a shift at work, that you care about their overall wellbeing, not just their productivity. “I have noticed you have (fill in with behavioral observation) lately and I am concerned. I care about your and am here to listen if you’d like. What has been going on?”

Consider using “DEAR” statement to communicate concerns and/or needs.

D – Describe your concern(s). This is an objective/fact-based reflection of what is going.

E – Express how this impacts you emotionally, behaviorally, cognitively, relationally by providing concrete examples. This is subjective expression/experience-based.

A – Ask for what you need. And if you’re not sure, that is okay. You can simply ask for someone to listen without judgment. Or if you’re communicating a concern, ask how you can support the person.

R – Revisit the conversation. You don’t have to have it all figured out in this moment. Simply starting the conversation is important!

III. ENGAGING IN A CONVERSATION:

Actively listen. Demonstrate you’re listening through body language, like head nods, as well as verbal expressions of understanding, such as prompting (ex: help me understand how this impacts you specifically, tell me more…), summarizing what’s being communicated, and asking clarifying questions when needed. Avoid jumping to problem solving or minimizing struggle in effort to rid yourself and others of discomfort you may feel in the moment.

Empower the person to seek resources that match their needs, preferences, and culture. Be patient and supportive through the change process as it doesn’t usually happen as quickly as we’d like. Continue to follow up and check-in after the initial conversation.

Regulate your own internal response. It’s okay if you sense yourself feeling some discomfort during a difficult conversation, but it’s important that you manage your internal distress so that you can remain present. Simple strategies like grounding or deep breathing can help regulate our stress response in these moments so we can remain fully present and engaged.  

Our mental health is a key component of our overall wellbeing, and much like tending to our physical health, it requires on-going attention and care for all of us. Please reach out to OITE at OITE-wellness@nih.gov if you have questions or need support.

IV. RESOURCES

NIH Resources:

• Office of Intramural Education (OITE): oite-wellness@nih.gov
• Employee Assistance Program (EAP): 301-496-3164
• Civil: 301-402-4845
• Office of the Ombudsman: 301-594-7231
• Occupational Medical Service (OMS): 301-496-4411
• Talkspace therapy and psychiatry (for trainees that participate in FAES health insurance)
• Connecting with Community: https://www.training.nih.gov/you_are_not_alone

Community Resources: Available 24 hours/day, 7 day/week, 365 days/year

• National Suicide Hotline: 988
• Trans Lifeline: 877-565-8860
• Trevor Project: https://www.thetrevorproject.org/get-help/
• Veterans Crisis hotline: 1-800-273-8255

Therapy Resources:

• https://www.psychologytoday.com/us
• https://www.goodtherapy.org/
• https://www.inclusivetherapists.com/
• https://openpathcollective.org/
• https://www.betterhelp.com/