Wellness Wednesday POTD: Imposter Syndrome

As the academic year is coming to and we all adjust to our new roles within our residency programs or as new attendings or fellows, I thought this would be a good time to talk about this.

Imposter Syndrome

Originally described by psychologists Suzanne Imes, PhD and Pauline Rose Clance, PhD in the 1970s, it is defined as an "internal experience of intellectual phoniness". Essentially, this means that people with imposter syndrome feel that their achievements are undeserved and worry about being "found out"that they are less than adequate despite evidence indicating success and/or competence. 

Dr. Clance described six potential characteristics:

1. The imposter cycle
   The cycle starts with a task, which is then met with anxiety, lead to either over-preparation for the task or procrastination (which is over-compensated with frenzied preparation). When the task is completed, there is relief, but this is short-lived despite positive feedback. Instead, the person believes that their success is either due to their hard work or luck, but not due to their ability. 

   The result is a feeling of self-doubt, depression, and anxiety and a tendency to overwork. 

2. The need to be special or the very best
   Those with imposter syndrome are secretly comparing themselves to others, which leads to a feeling of inadequacy.  

3. Super(wo)man aspects
   Related to the need to be the best, people with imposter syndrome set unrealistic goals for themselves. 

4. Fear of failure
   This can also be identified as the main motivational factor for most people with imposter syndrome. 

5. Denial of competence and discounting praise
   Adding onto feelings of inadequacy, those with imposter syndrome have difficulty internalizing success and will even make excuses about why praise is not deserved. 

6. Fear and guilt about success
   Although people with imposter syndrome crave success, they also fear it because it makes them feel isolated in their success. They also fear taking on more responsibilities as they're more likely to be "found out" with higher expectations. 

This was further elucidated by Dr. Valerie Young who broke down the syndrome into five different personality types in her book The Secret Thoughts of Successful Women:

1. Perfectionists: people who set unrealistic goals and feel like failures despite the level of completion of these goals

2. Experts: people who need to know every piece of information and will overeducate themselves. They are also afraid of looking stupid and will hesitate to assert themselves

3. Natural geniuses: people that are used to achieve success effortlessly, which leads to feelings of inadequacy when any effort is needed

4. Soloists: people who feel that asking for help is a sign of failure

5. Super(wo)men: people who need to work harder than everyone else around them in order to succeed in all aspects of life
   

How to deal with imposter syndrome

As with any problem, the first step is identifying and recognizing the problem. From there, overcoming imposter syndrome requires a lot of self-reflection and much of this comes from reframing your mindset on what qualifies as success. Some potential methods:

• Seek help: this can be found in a mentor, a friend, or a therapist. Vocalizing feelings and concerns can help in several ways. First, it can help identify characteristics that are typical of imposter syndrome, which can lead to increased self-awareness. Talking can also help with the realization that imposter syndrome is not an uncommon occurrence, which helps to normalize the condition. 

• Lean to internalize validation: people with imposter syndrome tend to dismiss positive feedback. Learning to reframe your mindset by resisting this response to positive feedback can help put things into perspective.  

• Be realistic about expectations: the expectations that those with imposter syndrome set for themselves are unrealistic. It is important to realize that nobody is perfect and to properly reflect on one's own successes. Likewise, it's important to recognize that everyone has strengths and weakness and to reflect on one's strengths and not to see weaknesses as failures. 

• Figure out your true goals: it's possible the goals that you've set for yourself would not actually ones that would make you happy. Take stock in what really matters and that may also help to redirect your ambitions. 

Sources:
Abrams A. Yes, Imposter Syndrome is Real. Here’s How to Deal With It. Time Website. http://time.com/5312483/how-to-deal-with-impostor-syndrome/
Roche J. 10 Ways to Overcome Imposter Syndrome. The Shriver Report Website. http://shriverreport.org/10-ways-to-overcome-impostor-syndrome-joyce-roche/
Sakulku J, Alexander J. The imposter phenomenon. International Journal of Behavioral Science. 2011;6(1):75-97.
Weir K. Feel Like a Fraud?. American Psychological Association Website. https://www.apa.org/gradpsych/2013/11/fraud
Wilding M. 5 Different Types of Imposter Syndrome (and 5 Ways to Battle Each One). The Muse Website. https://www.themuse.com/advice/5-different-types-of-imposter-syndrome-and-5-ways-to-battle-each-one

POTD: Wellness. You Do You.

As we residents, ED attendings, medical students know, finding time for wellness can be a challenge, especially in the face of contiguous shifts, conferences, and multiple inversions of our sleep schedule. It can feel like the weight of Atlas’ world is resting on your shoulders. My intention with this POTD is to reflect on the lessons I have learned navigating self-care in residency, in the hopes that it will prove helpful to someone.  

After perusing articles by wellness gurus and our own PD, Dr. Arlene Chung, I realized that what I do for wellness is different that what many people do. At first, I thought that the difference between my experience and experts meant that I wouldn’t have anything to contribute, but then I realized that wellness is personal, and maybe my experience will prove helpful for someone who reads this POTD. The following are my tips for wellness: 

GENERAL:

First and foremost, approach all advice regarding wellness with curiosity and skepticism, including my own. It might be right for you.  It might not. My intention is not to write you a to-do-list, but to help you examine some areas of your life that may have potential for exercising self-care.  Experiment and see what’s right for you.  

FOOD:

Some residents don’t eat on shift. If this is a choice, either as an intentional approach to intermittent fasting, or because you don’t need to, then that's great. However, it needs to be a choice. Experiment, and learn who you are and follow what’s best for you. If you need to eat regularly, then prepare for this need. 

I bring hydration and food from home and eat before coming to shift. There is not always time to go out and grab something and I enjoy bringing food from home. Waking up early to prep food for myself is a form of self-care. I feel prepared, and loved by myself, when I can grab a frozen Tupperware meal from the fridge. The same is true when I can enjoy a nutella sandwich. I also enjoy prepping a meal/snack for my loved one.  We can go a few days without seeing each other on a long stretch, and knowing that we have that connection through a prepared food is like a lifeline to connect us when we can’t physically be together.

Also, I get hangry. Nutella keeps the Bruce Banner version of Allie in the ED, so no one has to get their rapid strep test from the 8 month pregnant Hulk version of Dr. Kornblatt.  

MEDITATION:

When I come home, I often will feel my brain racing and have thoughts of patient tasks zipping in and out, causing me to stress and have dreams about patient care. So before bed, I actively try and clear my mind to think of nothing at all. Sometimes if I’m having a rough time with this, I use a body scanning meditation technique so that I can focus. I recommend the free first ten guided medications on the app “Headspace.” (I am not paid to endorse Headspace, or a meditation expert at all). The more you practice, the easier it gets and I find in stressful situations, I can clear my mind so that I focus on the task at hand.

SCHEDULE ACTIVITIES IN ADVANCE:

If you see you have a weekend off, schedule something in advance. In my experience, if you wait until that weekend itself, you’ll just sit at home and not do anything. If you do need that time at home to recharge, then plan that, ahead of time. Planning for a weekend under the covers can make it feel intentional, and relieves any guilt associated. 

FINAL TAKE HOME THOUGHTS ON WELLNESS:

We often think of our accomplishments in numbers: test scores, numbers of procedures/requirements completed, class rank, etc. Sometimes this is helpful—comparison to our peers let’s us know if we are falling behind, or in a position to act as a leader and help our colleagues succeed. Not so with wellness. 

Wellness is not comparable, it is not a competition on who is the most well. Experiment and find what’s right for you. If you try to compare or adopt the habits of others, you are destined for disappointment.

So, go be well, whatever it means to you.

Your friendly TR this month,

Allie

POTD: Sleep Hygiene

The term “sleep hygiene” refers to a series of healthy sleep habits that can improve your ability to fall asleep and stay asleep. These habits are a cornerstone of cognitive behavioral therapy, the most effective long-term treatment for people with chronic insomnia. CBT can help you address the thoughts and behaviors that prevent you from sleeping well. It also includes techniques for stress reduction, relaxation and sleep schedule management.

Here are some general tips for good sleep habits from the CDC:

• Be consistent. Go to bed at the same time each night and get up at the same time each morning, including on the weekends (this one is admittedly hard for the ER doctor, especially as a resident!)

• Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature

• Remove electronic devices, such as TVs, computers, and smart phones, from the bedroom

• Avoid large meals, caffeine, and alcohol before bedtime

• Get some exercise. Being physically active during the day can help you fall asleep more easily at night.

If you’re still having difficulty falling asleep, consider keeping a two-week sleep diary to analyze your sleep trends.

In our modern-age of electronics, here are some tips to effectively manage electronic screen time in preparation for sleep:

• Set your iPhone to “Do Not Disturb”

  • This will prevent your phone from alerting you with text messages or phone calls while you’re sleeping. Critical calls will still make it through if you toggle the “repeated calls” setting (i.e. a second call from the same person within 3 minutes will not be silenced)

  • You can also have automatic message replies if people attempt to call you when “do not disturb” is turned on

  • You can schedule when “do not disturb” is turned on

  • You can ensure that certain phone calls will always go through

  • Essentially there is NO REASON why this button shouldn’t be turned on!

• If you have an Apple Watch, in addition to “do not disturb,” you can place your watch on “theater mode”

  • This will prevent your watch from lighting up with movement while you sleep

• Download sleeping apps:

  • Sleep tracking apps

    • Sleeptracker

    • Sleep Watch

    • Sleep Cycle

  • Sleep sounds:

    • Relax Melodies

    • Sleep Sounds by Sleep Pillow

    • White Noise Deep Sleep Sounds

What about melatonin?:

Melatonin production in humans has a pronounced circadian rhythm; nocturnal plasma melatonin concentrations are at least 10-fold higher than daytime concentrations. The nocturnal rise in melatonin secretion plays an important role in the initiation and maintenance of sleep.

Nocturnal melatonin plasma concentrations decline with age; many older adult individuals develop age-associated insomnia (eg, waking up during the night, diminished sleep efficiency). Physiologic doses of melatonin may be beneficial for these individuals. Exposure to light suppresses the normal nocturnal rise in plasma melatonin concentrations. Can use low, physiologic doses (0.1 to 0.5 mg) for insomnia or jet lag. High-dose preparations raise plasma melatonin concentrations to a supraphysiologic level and alter normal day/night melatonin rhythms. 

In a randomized, double-blind, replicated crossover trial performed on EM residents in 2018 regarding melatonin vs placebo in regards to sleep efficiency, it was found that there was essentially no difference in sleep quality between the groups, although a minor decrease in drowsiness was found in the melatonin group.

My take away is that good sleep hygiene practices supersede any supplements to promote healthy sleep.

References

https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html

http://sleepeducation.org/essentials-in-sleep/healthy-sleep-habits

https://www.uptodate.com/contents/physiology-and-available-preparations-of-melatonin?search=melatonin&source=search_result&selectedTitle=1~108&usage_type=default&display_rank=1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6117540/