4 Med School Anxiety Questions, Answered By An Expert

  • /Reviewed by: Amy Rontal, MD
  • This week is anxiety awareness week, so we thought it would be an opportune time to sit down with Meredith Meyer, an LMFT who has extensive training in DBT (dialectical behavior therapy) and CBT (cognitive behavioral therapy). We asked her some questions that we hear from med school students about anxiety. Here is an excerpt from our conversation:

    Q: As a therapist, what is one thing you tell your clients about anxiety that you wish was more widely understood?

    A: Culturally, it seems that anxiety is being more openly talked about today than it was say, 10 – 20 years ago which I think is a great thing. The more we openly talk about mental health and how symptoms impact us, the greater the chances are that we will find support and solutions for helping us manage our hurdles versus isolating and feeling alone. At the same time, you have to be careful with what you read and who you go to for advice, as there is a lot of misinformation out there about how to cope with anxiety. In particular, one of the most commonly advised methods I see on social media for managing anxiety is to simply avoid the things that make us anxious. Sure, avoiding things may work in the short term but in the long term, and if used solely as our coping mechanism, that would wreak havoc on our lives. One of the things I wish people more readily understood is that anxiety is an emotion stemming from fear. All emotions, especially fear, show up for a reason and we need emotions in our lives to survive. Therefore, anxiety is not something to simply try to get rid of, rather it is something to learn to listen to and learn how to manage effectively.

    Also, I wish we could eradicate the labeling of emotions as “good” or “bad.” Emotions are neither, they just are; by naming your experience as something “bad,” it increases your suffering versus lessening it.

    Q: That’s an interesting way of looking at anxiety. Can you say more on that piece of learning to listen to it? Being someone who has experienced anxiety myself, I can empathize with others who wish to get rid of it right away because it can be so unpleasant, how does listening to our emotions and learning about them lead to ultimately reducing their impact on our mood?

    A:  Everything in life, including our emotions, has a cause and effect. Whether we are aware of it or not. For example, let’s say you started to notice a shift in your mood right now. Suppose you felt your heart rate rising, maybe your chest tightening, your mouth beginning to dry, and you label this as anxiety or the beginning of panic… If we paused and did our best detective work to figure out what in the world just happened, we would find something, a prompting event, either internally or externally, that created the start of those sensations.

    By learning to recognize what elicits these physiological changes, which are a part of how we experience emotions, we can then learn ways to manage them.

    For example, we could learn how to manage our thoughts that exacerbate the feelings we are experiencing in the moment. Often (and this is commonly overlooked) what really sets off our emotions is our interpretation of what that prompting event means or how we believe it will impact us. For example, I used to have a fear of public speaking and trust me, I wanted to do anything in the world to get rid of that feeling! When I took on this “detective” mentality to try and truly understand what was going on, I came to realize that it wasn’t just the action of going in front of people and speaking that elicited my fear response. Rather, it was when I imagined giving that talk, or on the day of, when I would begin moving toward the front of the room to speak, that my brain would start sending all sorts of thoughts like “you’re going to fail”, “you don’t know what you’re doing”, “you’re unprepared”, “you shouldn’t be doing this… get out of here!” and those thoughts are what intensified my fear and lead to panic.

    Learning to manage the train of thoughts that would come and continuing to give talks in front of others, ultimately is what lead to the greatest relief from that fear because I was able to show my brain that those worry thoughts were invalid and unwarranted. This practice also taught me how to recognize and see my thoughts as just that, thoughts constructed from my mind, not necessarily absolute truths about the world. If I would have just avoided public speaking all together, that fear would still be alive and well today.

    Also, another thing that people often overlook are our vulnerability factors. If we’re not taking care of our mental health hygiene through balanced sleeping, eating and exercise habits, or if we’re relying on drugs or mood altering substances to get through the day, then we’re setting ourselves up to be more biologically reactive to prompting events. Self care is a very important piece of overall emotional well being.

    Q: I want to go back to something you said about recognizing that sometimes our thoughts are unwarranted. What if the thoughts creating fear are valid? For example, what if a med student comes to the realization that the medical path is not for them, but quitting would mean telling and disappointing their family who encouraged them to take this path and have invested a ton of resources, time and energy in helping them pursue this field. Since the fears are valid, is it best to just stay the course?  

    A: Putting our detective hats back on, let’s break it down with what we know so far, the prompting event is: acknowledging that a medical career is not for them. Now, the thoughts and interpretations of that event are: “I will disappoint my family” and I would imagine a whole slew of other extreme thinking and self-judgments like, “I’m a failure,” “I’ll never be happy with myself if I quit,” “I’m a terrible person.” While it may be accurate (and I don’t know this for sure) that the family will be disappointed, remember how I mentioned a minute ago that our thoughts can add to our emotional pain? This is a great example of how that would be so: it’s one type of pain to recognize that we may disappoint someone or a group of people; it’s a whole other type of suffering when we believe that behavior then equates that something is wrong with me, or I’m a failure or will never be happy, which is all distorted thinking.

    Now in regards to what to do about this situation, let’s look at their options. They could reject reality by: ignoring the misery completely and spending the rest of their life distracting away from it. They could bury that pain away… far, far away. They could try to positively think their way out of it, “I’ll make myself like it!” “It will be fine!” “Mind over matter.” Or, more effectively and what I would recommend, they could radically accept that this painful situation is a part of life and make changes to help reduce their suffering.  

    Q: Wouldn’t there be a lot of sadness or emotional pain with accepting something like that?

    A: Absolutely. Radical acceptance, radical meaning fully and completely, typically comes with a lot of sadness and grief. And at the same time, many people also describe those emotions coming with a sense of relief, or as if a burden has been lifted and once we experience that we can then move on with our lives.

    There is this equation that I teach my clients, especially when life is particularly difficult, that goes: pain + non-acceptance = suffering. I think we can all agree that pain in life is inevitable and cannot be avoided, suffering on the other hand is optional.

    The main take away here is that radical acceptance/acknowledging all of the causes and effects of things that have added up to equal where we stand today allows us to see things as they truly are. It doesn’t mean that we like it necessarily or approve of it but it is what it is and then, we can make changes that ultimately can set us free from suffering or living life according to false beliefs about how things “should” or “ought” to be. So yes, in this example, it will be painful, my family may be disappointed, I may lose people close to me but I remind people to look at that pain as short term, something to “ride out” as the other side is free from that suffering.

    Meredith Meyer is an LMFT who has extensive training in DBT (dialectical behavior therapy) and CBT (cognitive behavioral therapy). She obtained her Masters in Marriage and Family Therapy from the University of San Diego, and her B.S. in Business Administration with a minor in Psychology from the University of San Francisco. www.meyermft.com