Tag:

stress

Advice on How To Cope With Burnout

{Napa, California}

Hello my blog friends! For those who aren’t on Instagram, I wanted to share what I wrote on my post today about coping with burnout:

One of the hallmarks of burnout is that taking time off from work doesn’t renew your energy/interest in the work you do. After a relaxing Thanksgiving break, I felt super motivated to return to work and start seeing my patients today, yet the way I felt at my previous job during this exact time 2 years ago was a different story. There are numerous factors that contribute to burnout (many are difficult to pinpoint & identify, which is why people often feel they were blindsided by it).

There are different ways to deal with burnout, and though the hope would be that your employers quickly make changes to improve your situation, the likelihood of that can be pretty low. Therefore, you must be PROACTIVE and take action if you want your quality of life to improve. Depending on your situation, this can be anything from taking an extended time off, working out issues with your employer, cutting back on work hours, or finding a new job/career. One of the 1st things to do is get support (from a trusted friend, family member, union, mentor, colleague, therapist, etc). And definitely ADVOCATE for yourself (I can’t stress this enough!). Often in our careers, when we are given unrealistic expectations that challenge our values/views/identity, we are left with feelings of failure and self-defeat, but the only way to improve our situation is to stand up and recognize our value and worth.

Thought of the Day: Have you ever experienced burnout from your job? If so, what did you find to be most helpful at overcoming it?

November 30, 2016 4 comments

Personal therapy

Recognize Your Limit

written by freudandfashion

(Unflattering sick post from my Snapchat)

Well, in addition to the stress of the holidays (which I wrote about here), among other stressors, was also the added stress on my body having made an impulsive decision to switch from a high protein (mostly animal-based) diet to a Vegan diet practically cold turkey. I watched several Netflix documentaries that turned me off to carnism and found myself repulsed at the thought of even eating my daily hard-boiled egg for breakfast (those who know me know this has been my routine to start my morning for the last 2 years). Well, in addition to also getting a stomach bug, all the combined stress culminated a few nights ago when I experienced the symptoms listed above (see photo) and was out of commission the following days. I welcomed the opportunity to rest (fortunately it was my day off, then had the weekend) especially since I haven’t been sleeping well in the last few weeks.

{more Snapchat (username = freudandfashion) posts}

Well, I guess my quick (because I really want to go out for a run since I have more energy today) and main point of this experience is the importance of listening to our bodies and being aware of the need for self-care when we’re overwhelmed and approaching our limit. I could’ve forced myself to sleep earlier (but I didn’t), could’ve more properly planned a better way to ease into eating more plant-based protein (but I didn’t), and could’ve allowed myself to relax rather than stress about the perfect gifts to buy (I’m still not done with my Christmas shopping, but whatevs), but sometimes we get so wrapped up in the moment that our own needs become an afterthought.

If any of you identify with me and the stress I’m experiencing, then it’s nice to know I’m not alone. And if so, I hope you start this week being kinder to yourself and take the proper measures to maintain your sanity for the remainder of the year (and thereafter).

December 20, 2015 9 comments

Psychiatry

The “No Bullsh**” Guide For Getting Through The Holiday Season

written by freudandfashion

Ahhh yes, the television commercials convey cheerfulness and joy with the contrived images of gift giving and preparing for a massive holiday feast, but the reality is that people probably identify more with Ebenezer Scrooge than Martha Stewart. If a part of you feels too guilty and ashamed to admit that you’re not filled with holiday glee, then consider the following questions:

Do you want to roll your eyes when asked how excited you are about spending the holidays with your in-laws?
Do you feel obligated and forced to buy gifts for everyone?
Have you lost loved ones and the holidays serves as a reminder that they’re not present to celebrate with you and the family?
Did you recently go through a divorce or breakup and feel even lonelier now that you have nobody to drag to holiday parties or kiss on New Year’s Eve?
Are you struggling financially and can’t afford much of anything except to spend a quiet, typical night at home?
Are you trying to stay sober and the holidays tend to trigger using again?
Do the holidays cause more anxiety and depression because you’re expected to be happy even though you’re really not?
Do you hate dealing with annoying crowds of shoppers trying to get those last minute gifts?
Do you beat yourself up for waiting until the last minute to buy gifts (and then tell yourself that you’ll get all your Xmas shopping done early next year, yet repeat the same pattern. I’m raising my hand for this one)?
Have you been good about diet and exercise, but worry that Thanksgiving, Christmas/Hannukah/Kwanzaa/”insert celebrated holiday here” and New Year’s will test your discipline and make you gain all the weight you’ve worked so hard to lose?
Would you much rather say “screw it” and purchase an extravagant gift for yourself instead of trying to find the perfect gift for everyone else?

If you answered yes to any of the questions, then you’re definitely not alone. The above questions are just a few of the common issues that I heard from my patients and friends within the last few weeks. I’d say that the majority of my patients and people that I know perceive the holidays as far more stressful than joyful. I recall the holidays being so much fun as a child due to getting time off from school, receiving Christmas presents, building sticky gingerbread houses that were actually made of graham crackers, and going on trips with the family, but the holidays are definitely not as fun when you’re the adult responsible for planning the festivities. If you are one who tends to struggle during the holidays, then the following are a few tips to help you get through the next few weeks until New Year’s Eve is over (then you at least have some time to breathe until Valentine’s Day comes around):

1. Set boundaries, boundaries, boundaries. If you’re a “Yes Man/Woman” (someone who always says “yes” and has a hard time saying “no”), then you not only have to deal with the stress of planning for the holiday, but also the overwhelming pressure to please everyone since you’re the reliable person whom everyone depends on (or the schmuck whom everyone takes advantage of), which leads to internal feelings of guilt, exhaustion, anger, and resentment if you can’t carry out all the duties expected of you, but then blame everyone else for not helping you (you probably also don’t feel comfortable asking for or accepting help, right?).

If you fit some components of the description above, here are a few ideas to try:

Talk to your therapist (and if you don’t have one, you might want to consider getting one because your issues with setting boundaries probably aren’t limited to the holiday season).
Use the Yes/No Method.

2. Don’t overexert yourself if you don’t want to attend so many holiday gatherings. As mentioned in #1, the key is learning to say “no.” Weigh the risk/benefit of attending each event, and attend the ones where the benefit outweighs the risk (ie, attending your boss’ holiday gathering may have more benefit than attending a coworker’s potluck dinner/white elephant gift exchange). And if for some reason you actually have to attend a party that you can’t get out of, then stay for a bit and come up with an exit plan (I used to make up excuses such as “I promised to dog-sit for a friend” or that I’m not feeling well, but now tell the truth because I find that people are generally pretty understanding or can tell when you’re lying).

3. If you know you’re going to eat a feast and have a hard time avoiding all the amazing holiday desserts and egg nog, then plan ahead yet also be realistic. Stressing out about your exercise regimen and what you’re going to eat causes even more stress. Weight gain and disease is not caused by one or a few days of eating unhealthy during the holiday, but rather the trajectory of your lifestyle choices over time. If you eat a lot during Christmas dinner, then utilize those carbs with a good workout the following day, or plan on making healthier food choices thereafter. It’s truly better to move on after a day of indulgence rather than perseverating on the guilt (trust me, it took me over a year of living with my brother, who is a personal trainer/unofficial psychotherapist, for me to get over the guilt of eating unhealthy a few days at a time).

Here’s another article that might be useful for managing your diet/fitness goals during the holidays.

4. Make sure you set up appointments with your therapist or psychiatrist during the holiday for preventative measures. Although many health professionals are away on vacation during the holiday, plan ahead by setting an appointment before your therapist or psychiatrist leaves to make sure you have enough med refills or to check-in for support and maintenance. There should be coverage in case any urgent issues arise while they’re away, so make sure you have the contact information handy. And, of course, if safety becomes a concern, then call 911.

5. If you have a known seasonal component to your mood, put into action what has typically helped your mood to get you through the year (med and non-med approaches). I wrote a previous post on Seasonal Affective Disorder (SAD) and another post on how to cope with Summer seasonal depression, though the general principles apply to Winter seasonal depression as well.

6. Plan on staying sober during the holidays. Similar to #4 above, I always ask my patients if they’ll need a follow-up appointment with me during the holiday season to check-in and provide additional support to maintain sobriety. The holidays can be quite triggering for relapse, especially if everyone around you is inebriated by the plentiful cocktails, champagne, and spiked egg nog. The following resources provide great tips for getting through the holidays sober:

5 Ways to Survive The Holidays Sober
HOME Podcast by Holly (of Hip Sobriety) & Laura (of I Fly At Night): The Holidays

7. Coping with grief. I found this post quite informative for the bereaved during the holiday. One tip that I found most valuable was the importance of surrounding yourself with those who support you the most rather than undergo the exhaustion of trying to suppress your grief and sadness at numerous social gatherings.

8. Treat yo self. Okay, I admit it — the first few items I bought while Christmas shopping were for myself, but I couldn’t help it! It’s far more anxiety-provoking trying to come up with which item to buy for someone else than it is for myself (I mean, at least I know that I’ll appreciate what I bought for myself, whereas I have to risk feeling butthurt (this word is actually in the dictionary) if someone returns an item that I bought for them). To some degree, buying myself a gift is a form of stress relief in addition to a reward for getting through the entire year. And if buying something for yourself is not within budget, then deduct the cost from the gift you planned to buy the person you like the least.

If you have any other tips to cope with the stress of the holiday season, would love to hear from you! And rather than saying the generic “have a happy holiday,” I’ll end this post by saying “Hope your holiday is low-stress and may you enjoy (or tolerate) the season as much as you possibly can.” 🙂

Photo by Marlon Santos

December 11, 2015 9 comments

Psychiatry therapy

Tips To Control Your Angry Mood

written by freudandfashion

{Monterey, California}

Up until I graduated medical school, I used to be irritable and impatient on a regular basis. Not many people would think I had anger issues (particularly due to the way my anger manifested, which was mostly unassertive and passive, see below) except for those who received the brunt of it, which is often the case for most people. I also used to feel guilt and shame for having an angry temperament as a child, until I opened up about the issue during individual and group psychotherapy. It was quite therapeutic to hear that several group members (whom I least expected given their present demeanor) reported being angry during childhood as well, and even more helpful to gain the insight needed to identify triggers for my anger, in addition to more productive ways to express and cope with it.

We’ve all experienced anger before, and there’s various ways it can present itself. The spectrum of anger can manifest as brief, subtle annoyance to full-fledged rage. Though anger can be constructive (ie, used as motivation to create change or solve a problem), the more problematic expressions of anger are more outward via yelling, physical aggression (punching and throwing things, etc), or violence. Others may also express anger in an unassertive way (which can also be quite volatile) by isolating, holding it in, and not expressing the anger at all which often leads to more passive-aggressive and pathological forms of coping such as taking it out on others via hurtful comments, putting people down, being vengeful by indirectly trying to get back at people without communicating the reason why, etc.

Developing healthier ways to express anger has many benefits, which include health (anger is known to be associated with increased risk of having a heart attack, hypertension, diabetes, migraines, self-medicating with substances such as alcohol, etc), improved communication in relationships, and a gained sense of control over your emotions. Though the origin and persistence of your anger can be quite complex to fully understand (I tend to formulate my patients’ issues psychoanalytically, which can be theoretically confusing to many (including myself) except Sigmund Freud, who first laid out the theory), the following are some concrete strategies that can help keep your anger in check, which I also teach my patients and use on myself:

1. When your anger gets triggered, slow your response rather than reacting on impulse.

When anger gets triggered, our brain perceives the situation as a threat and automatically reacts by going into fight or flight mode and the response is believed to last less than 2 seconds. Therefore, since we can go into a rage from 0 to 100 instantly, we can take control of our behavioral response by using tactics that allow us to regroup and think through how to respond. Some tactics include the following: take a couple of deep breaths, count to 10, step away and excuse yourself briefly, grab a drink of water, etc.

Another similar example/situation — Have you ever received an email or text message that was so upsetting that you immediately started aggressively typing a hostile reply? I’ve reacted this way many times (and have also typed blogpost drafts out of anger), yet the rule of thumb is do not send content that is typed in a heated, angry state of mind, but rather to wait and respond when you’ve cooled down because you might send something you’ll regret (and an email/text message is a permanent record that you can’t take back).

2. Recognize your initial signs of anger.

I often ask my patients to identify the initial signs they experience when anger gets triggered because being mindful can put a stop to the progression to an outburst or response they might regret. Utilizing Tip #1 above is even more useful if we can quickly recognize our body’s initial response to anger.

To give an example, the following is my usual pattern of response that occurs when my anger gets triggered: eyes get wide, chest tightens, heart races, facial muscles tense, fists tighten.

I’ve practiced this technique numerous times and have become far more mindful and self-aware in the last few years (therapy and yoga helped) to the extent that once I notice my chest tighten and heart race, I quickly take deep breaths to calm down. So next time you get angered, pay attention to how your body responds.

3. Once you’re in a calm state of mind, express your anger.

When people hold in and suppress their anger, it often becomes internalized (and may experience depression by directing the anger inward) or builds up to the point that it leads to an eventual huge, uncontrollable outburst. I used to cope this way with anger as well where I’d yell and scream hurtful things and bring up anything and everything that upset me in the last few months. Once you’ve calmed down in the moment, try to assert and state your concerns in a clear, direct way rather than waiting until you’ve reached your boiling point.

I admit that I used to also react by either saying nothing or passively turning to someone next to me and saying mean, hurtful things that were loud enough for the person who upset me to hear (yes, I know this response is sooo high school circa Rachel McAdams in Mean Girls), so I felt awkward at first when practicing to be more direct at communicating my anger. However, just like with anything in life, you have to keep practicing and eventually you’ll learn to successfully express yourself and get your point across in order to feel understood and heard.

4. Identify the underlying cause of your anger in the moment, and if the issue is minutiae, let it go.

Numerous things can trigger anger (a negative comment, criticism, lack of sleep, not getting your coffee fix, drugs, depression, medications, anxiety, stress, grief, kids not doing their chores, your sports team losing, bad luck with fantasy football picks, a friend wearing the same outfit as you, a pimple, tardiness, misinterpretation of a text message, someone lying to you, PMS, delayed flight, someone cut you off on the freeway, etc, etc — I think you get the point). If the trigger is something small and trivial (ie, getting cut off in traffic), recognize that reacting in anger won’t solve the issue (that’s right — stepping on the gas and tail-gaiting the SOB will not make the situation any better…I only know this through experience) and expends so much energy that can be more productively utilized elsewhere. However, if the underlying cause might be a major issue you’ve struggled with throughout your life (for example, having social phobia and being extremely sensitive to judgment and criticism) then please refer to #6 below.

5. Diffuse your anger by getting some exercise or channeling that energy into a workout.

This point is pretty straightforward — anger triggers increased stress and exercise is always a good way to lower stress and expel the anger from your system.

6. Seek professional help.

If your anger is causing substantial impairment in your life (work, relationships, etc), then don’t be afraid to seek help from a professional (psychotherapist, your regular medical doctor, psychiatrist, anger management, etc). I mention numerous times in my blog how much psychotherapy has helped me personally and those I’m closest to can vouch for the noticeable improvement in the way I manage stress and anger.

November 13, 2015 13 comments

Medicine Psychiatry

Reach Out And Connect With Someone

written by freudandfashion

{Rancho Cucamonga, California}

I’m approaching a new phase in my life by moving on to a new practice, which will be my second job out of residency. As excited and hurried as I was to leave my first job and move on to the next, with this being the last week in clinic, I’d have to say that I’m quite sad. I’ve had several friends tell me that they don’t get along with their coworkers, that they haven’t developed friendships with anyone on staff, that they mostly are “in and out” of clinic to see their patients and get all the documentation done while minimally interacting with their peers. How fortunate am I to have developed a sense of family and strong teamwork with those whom I work with?

I hear that one of the drawbacks of going into private practice is a sense of isolation not having a team of professionals to bounce ideas off of or interact with on a daily basis. However, I do know that the practice I’m joining will provide valuable experience learning what it’s like to practice psychiatry in a different clinical setting. And even cooler is that the actions and morale of the group I’m joining have given me enough confirmation to prove that I’ve made the best choice for myself and my career.

If you notice a theme in several of my posts, it’s the concept of “family” and teamwork. I have several patients whose stress levels and depression gets triggered or exacerbated by a sense of loneliness and isolation due to lacking the friendship, camaraderie, sense of belonging, and the support we as humans need. Numerous studies have found that social relationships provide emotional support and contribute to stress relief and better quality of life. The following are some examples of how social support enhances mental and physical health:

Addiction
- Recovery from substance use often leads to the dissolution of former friendships that were associated with an individual’s propensity to use drugs or alcohol. Therefore, recovery-oriented support (such as 12-step programs) are critical early in treatment as someone begins to build and develop a healthier network of support. Higher levels of social support are linked to decrease in substance use whereas lower levels of social support prospectively predicted relapse.

Post Traumatic Stress Disorder (PTSD)
- for childhood sexual abuse survivors, a combination of self-esteem and appraisal support (an individual’s perception of being valued by others and that he or she is capable of getting advice when coping with difficulties) was useful in preventing the development of adult PTSD.
Cancer
- Supportive group intervention for women with metastatic breast cancer has been associated with lower mood disturbances and less maladaptive ways of coping with terminal illness.
Work Stress
- Social support at work has been shown to have direct benefit on workers’ psychological well-being and productivity.

THOUGHT OF THE DAY: Identifying and building your own support network can take quite some time and effort, but the enhancement on your quality of life will make it well worth it. Which supports do you identify as being most integral in your day to day life?

October 22, 2015 21 comments

Featured Guest Blogger

Why A Social Worker Turned His Passion for Bicycling Into a Mission

written by freudandfashion

One of the best things about blogging is the opportunity to meet like-minded, motivated people in the mental health field who are passionate about making a greater impact in the community. When I first came across Bike and Brain on Facebook, I was impressed by Matt Ryan, LMSW (the founder of Bike and Brain) and his selfless goal to successfully blend his career as a social worker and love for bicycling into a mission that promotes bike riding’s benefits on mental health. What started as a blog one year ago has evolved into an active operation that organizes group rides, provides free bicycles to New York City residents, and is expanding its efforts by becoming a nonprofit organization (continue reading to learn how you can support his cause and enter to receive a free bicycle below). Therefore, I am excited to feature Matt as my first guest blogger as he discusses bicycling and its positive impact on mental health.

———————————————-

Life can quickly become chaotic. We deal with stress from work, relationships, children, and health, to name a few. Too much stress can cause us to feel out-of-control, which can be extremely uncomfortable. In fact, excess stress can be detrimental. As life stressors build, we may experience anxiety and even depression. We may feel like giving up when life appears too much to handle. We may begin to neglect our priorities. Unfortunately, giving in to this feeling only exacerbates the situation. So how do we regain our sense of control?

Whether you’re in control of your own company or the TV clicker, control can be a great feeling. People exert a great deal of effort in life to gain control. You can certainly argue that having too much control may be problematic, but possessing a certain level of control is crucial in order to lead a fulfilling life. It’s important to be in control of your emotions, diet, exercise regimen, sleep patterns, relationships, etc. Furthermore, it’s key to be aware of your role in all of these facets of life. There are obviously things that we can’t control such as when we are mistreated by a friend, loved one, or a rowdy neighbor who keeps us up all night. However, we can control how we respond or how we choose to handle these situations. Learning to control yourself within the important facets of your life can help build confidence, which in turn can make life more enjoyable.

I am a social worker in NYC and it’s safe to say things can feel pretty out-of-control. One of the things I do to stay grounded, motivated, and focused is ride my bicycle. I ride daily and can truly say it plays a crucial role in my life. Bicycling gives me a feeling of control and confidence that transcends into the other compartments of my life. You may be asking how this could be possible — how can riding your bike help any other area of your life?

First off, riding the bicycle provides me with a tangible feeling of control. I determine how fast the bike travels, where it goes, what gear it’s in, and when it stops. The ability to manipulate the bicycle is a reminder that I do have the ability to control things. Merely having the knowledge that I can be in control is beneficial to my daily life. If all else fails, I can utilize my experiences on the bike as a reference point.

Second, riding the bike forces me to direct all of my attention on one thing, which is the road. I am in the moment while on the bike. There is no time to dwell on the stresses of life since distractions could potentially cause an accident. All five of my senses are engaged and my mind is focused. I can feel the wind in my face, the pedals on my feet, and the bars in my hands. Being completely focused on the moment is an extremely powerful tool also known as mindfulness. Essentially, I am putting aside my stress for the duration of the bike ride. This does not eliminate the stresses I may be experiencing. Rather, it is creating free space in my mind so that I may deal with the stress in a more constructive way once I am off the bike.

Finally, cycling makes me happy. Not only does the physical activity release endorphins, but it is the one hobby that provides me complete joy. When everything else may feel out of control, I know that I can hop on my bike to re-charge. In essence, my bicycle acts as my safety net. Cycling will always reinstate a level of confidence and control that is needed to regain my motivation.

And for the record……

I am in the process of creating a nonprofit organization in NYC. We work to provide functional bicycles to people who may not have any other means to obtain one. We believe that there is no reason why we can’t provide people with a FREE bicycle in a city as wealthy as NYC. We have donated a handful of bicycles to date. Each donation has an amazing story attached (Check them out here!).

We will also be giving away a free bicycle (pictured below) on Thanksgiving. Anyone can win this and we will ship it anywhere in the USA. Completely free. All you have to do is like our page on Facebook to enter.

For more information on Bike and Brain, check out their website here.

Photos courtesy of Matt Ryan

October 13, 2015 7 comments

Psychiatry therapy

The Crucial Transition From Work to Home

written by freudandfashion

{Beverly Hills, California}

One of my patients told me that the most frustrating part of his day occurs the moment he arrives home from work when his family accuses him of being isolative and uninterested (due to his first activity upon arrival consisting of sitting in his parked car in the driveway and/or watering the lawn instead of immediately engaging in family affairs). When my patient told me this, I actually thought about my own behavior upon arriving home from work, and to be honest, I can be pretty bitchy. That is, unless I allow proper time to switch gears from work mode to home mode. Those who live with me have observed that my mood typically goes from snappy/serious/irritable to talkative/cheery/joking over the course of 30 minutes.

Not much research exists on this topic, but I assume that there are various reasons that the lingering effects of work can have a negative impact upon arriving home. Here are a few factors to consider that may contribute to the tough transition:

Traffic congestion – feeling trapped in your car, moving inches on the freeway, dealing with aggressive drivers, running behind in your schedule due to delays, and the potential threat of car accidents are all factors that can easily raise one’s heart rate, blood pressure, level of arousal, and automatically trigger you to go into a protective/defensive mode.
Work stress – having an extensive to-do list, meeting project deadlines, dealing with coworkers’ differing personalities, tolerating conflicts in opinions of supervisors or administration, etc, are all situations in the work environment that require excess mental energy to deal with, leaving incomplete tasks and unresolved issues that may carry over into the home environment.
Home responsibilities – in a perfect world, we might be able to come home after a stressful day and be able to relax and worry about absolutely no other responsibilities. Yet, in reality, leaving work means moving from one set of responsibilities to another (children or a spouse demanding your attention, chores to complete, dinner to prepare, bills to pay, friends’ events to attend, etc).

How to make the transition:

Establish a routine that works for you. This involves evaluating your current routine going from work to home and incorporating practices that help you eliminate or get around triggers and negative thoughts. The Wall Street Journal published an article about “rethinking your after-work routine” and I definitely agree with Cali Williams Yost‘s recommendation to think about the transition from work to home in terms of three stages: leaving the workplace, getting home, and walking through the door.

Stage 1: Leaving the Workplace
- To ward off negative feelings, consider a routine that acknowledges your accomplishments of the day or think about positive things that occurred during your day.
  - I make sure to leave 10 minutes at the end of the workday to look at my list of accomplishments (ie, the items I checked off on my to-do list) and prioritize tasks left to complete the following day. This routine works for me because I’m left with a sense of accomplishment focusing on the tasks that I actually DID complete, rather than focusing on what I did not complete. I also like to organize and tidy my desk so that upon arrival to work the next morning, I feel as if I’m starting new rather than being left with a sense of disorganization from the previous day. I also try to check in with the nurses and thank them for all their hard work from the busy day.
Stage 2: Getting Home
- As mentioned above, the commute from work to home can evoke excess stress, so consider methods to minimize aggression.
  - I always admired one of my mentors during residency because he’d bike home from work (something I’d consider doing if I still lived in Oregon rather than southern California), but since it’s far easier for me to drive, I make sure to blast uplifting music on the radio or talk on the phone with one of my close friends (who is also a psychiatrist that commutes home around the same time of day). I also may volunteer to make a stop at the grocery store, which allows additional buffer time before arriving home.
Stage 3: Walking Through The Door
- Identify triggers that may set you off upon arriving home (ie, your children demanding your attention, the need to cook dinner, a messy home in need of cleaning, etc) and figure out ways to get around the triggers.
  - For example, I suggested to my patient above that he communicate to his family the need for a few minutes of alone time each day after work to water the grass or sit in his car.
  - For me, I am easily triggered when I come home to a messy kitchen, so in the morning I try to empty the dishwasher and load any dirty dishes left on the counters or sink.

Thought of the Day: What are some practices that you can incorporate into your routine to ease the transition from work to home?

October 1, 2015 12 comments

Personal

Brighter Days

written by freudandfashion

{Napa, California}

I am so appreciative of the supportive comments I received after sharing my personal experience of physician burnout. I’ve had similar experiences, especially during medical school and residency, but never felt comfortable enough to share until recently. In my practice, I work with so many patients who suppress their emotions. I identify with them wholeheartedly because I am just like them. During residency, I made excuses to avoid meetings with my supervisors because rather than discuss patient cases, the meetings would somehow turn into therapy sessions where I’d cry and feel embarrassed for exposing my vulnerabilities. At the time, suppression and isolation were the only ways I knew how to cope, but it’s a pattern I am actively trying to break ever since I started seeing a psychotherapist during my fourth year of residency.

A common phrase that I mention to my patients (which was told to me by my amazing sister, who is a marriage and family therapist) is that “if you suppress yourself, you depress yourself.” We all suppress ourselves to some degree, but once able to overcome the barriers {our own internal barriers (i.e. cultural, self-criticism, etc), in addition to external barriers (such as the immense pressures and expectations placed on physicians)}, then we have a better chance at achieving wellness and exerting more control in our lives and our careers.

June 27, 2015 6 comments

Medicine Psychiatry

Out of Isolation

written by freudandfashion

{Calistoga, California}

I noticed that my latest posts convey far less emotion than usual. My reserve for tolerating stress had reached maximum capacity, which I realized upon my first day back at work from vacation three weeks ago as exhaustion immediately erased any sense of relaxation from my trip. Perhaps I should have requested two weeks off instead of one? Either way, I’ve felt numb in the past (as I wrote in previous posts), but my current state of numbness also included fatigue and the need for multiple naps throughout the day. At first, I blamed my tiredness on multiple potential causes (overexerting myself during workouts, not eating enough, lack of sleep). I returned to clinic with a massive inbox full of emails, prescription refill requests, and patient messages, but the one message that impacted me the most was a note documenting that one of my patients (whom I least expected to have a suicide attempt) was in the psychiatric hospital due to an attempted suicide by overdose. Normally, I’d breathe a sigh of relief knowing that my patient was alive, safe, and receiving care in a secure environment, however, something triggered me at that moment to feel even more anxious than usual, which led to a massive headache. Did I develop a headache because my mind can’t tolerate the thought of experiencing even more patient loss and grief?

Fatigue continued to hit me on a daily basis. And how ironic that I recently wrote a blog post on tiredness and neither of the reasons I listed seemed to fit my case. However, I neglected two important, plausible causes (one that I even listed in my post) — Burnout & Depression. One of my closest friends asked if I might be depressed and I quickly replied, “no, I just need to eat better.”

I thought to myself, “How can I be depressed? I make a good living, I chose to enter this field, people respect me and tell me I’m a great doctor, I have amazing family and friends…”

Yet, after fighting the idea that I may in fact be burned out and depressed, I became more accepting and relieved at finally pinpointing the cause — yes, I was burned out and depressed. I was experiencing loss of interest, fatigue, poor concentration, lack of motivation, and increased naps during the day. How dumb of me not recognize the signs, especially since I’m a psychiatrist??? (Depression obviously impacts cognitive abilities as well)

Later that day, I randomly thought of one of my patients whom I haven’t seen in clinic for quite some time. He missed his last two appointments with me and never returned follow-up calls. I quickly searched for his name and confirmed my biggest fear once I saw the word “obituary” next to his name. Tears filled my eyes, which led to uncontrollable sobbing. I seriously wanted to quit my job that very moment.

My attempt at self-care and setting healthy boundaries:

Whereas in the past, I would’ve dealt with the news by isolating, throwing myself into work as a form of distraction, or having several glasses of wine once I came home, I knew that I’d eventually hit rock bottom unless I sought help from others. I reached out to my close friends, sought support from my clinic manager, opened up about my issues in my therapy group, and talked to other staff members who knew my deceased patient. I allowed myself to cry rather than holding in the tears.

Feelings of detachment had also replaced my propensity to engage with others, which made practicing psychiatry and being fully present for my patients much harder. I scheduled a trip to visit my family in northern California for Father’s Day because I knew that visiting home would alleviate my detachment and make me feel like myself again. Also, in further effort to prioritize self-care, I requested a two-week long vacation in the following month because I knew that more time off was necessary to fully recover my emotions, energy, and drive.

Why am I sharing my experience? We may read research, statistics, and articles about physician burnout, yet the majority of people in the medical field still do not feel open nor comfortable enough to share due to fear of stigma, criticism, and feelings of guilt and shame. A part of me even feels somewhat embarrassed posting this, but if someone out there can identify with my experience, then why not share? Physician burnout is more common among physicians than other workers in the United States and has been linked with the following: negative impact on patient care, more likely medical errors, depression, and increased risk of suicide among physicians and medical students.

Staying silent about our struggles and trying to cope on our own does not solve the problem, especially since the rate of physician burnout is on the rise. If we can’t advocate and stand up for ourselves, then who will?

June 25, 2015 26 comments

Psychiatry

7 Ways Exercise Improves Mental Health

written by freudandfashion

{Rancho Cucamonga, California}

Not a day goes by where I don’t ask myself the following question: Should I, or shouldn’t I go to the gym today?

You don’t have to be lectured by a doctor to know that exercise is good for you. We all recognize that exercise provides positive benefits on our overall health and mood, yet do we religiously incorporate physical activity into our regular routines? Trust me, even as a physician who preaches the importance of incorporating non-medication alternatives such as exercise into wellness plans, I empathize with the struggle to prioritize physical activity in our busy schedules. Yet, if you’re interested in even more specific ways that exercise can enhance your mental health, I compiled a list of information that I often provide to my patients:

1. Target your mood. Exercise has been shown to be just as effective as antidepressants for the treatment of depression. A study led by Dr. James Blumenthal found that an exercise program provided equal benefits in mood as regular doses of Zoloft (a commonly prescribed antidepressant). Also, a Cochrane review (which is a systematic review of all high quality research relevant to a specific research question) found that exercise is associated with a greater reduction in depression symptoms compared with no treatment.

2. Alleviate anxiety. I can attest to this, for my ability to manage stress (especially when in clinic) declines after missing several workouts, though my coworkers say I mask my anxiety fairly well (which is hard for me to believe!). Aerobic exercise has been shown to be an effective treatment for several anxiety disorders. One study found that exercising at 70-90% of maximum heart rate for 20 minutes 3 times a week has been shown to significantly reduce anxiety sensitivity.

3. Boost concentration. Exercise elevates the brain’s levels of dopamine and norephinephrine, which are important chemicals involved with focus, attention, and our executive functions (planning, analyzing, prioritizing, organizing, initiating, and completing tasks/activities). Some people with ADHD are able to manage their symptoms with exercise alone, though many find the ideal treatment regimen includes medication plus exercise. For more helpful info, I often refer my patients to ADDitudeMag.COM.

4. Sleep better. Though the most common method utilized to treat insomnia is via pharmaceuticals, I am always on the lookout for ways to improve sleep without the risks of dependency and tolerance that many sleep aids have. Regular, physical exercise raises core body temperature, which can benefit the initiation and maintenance of sleep.

5. Improve heart health. People living with mental illness tend to have higher risks of cardiovascular disease. Over 50% of adults with serious mental illness are obese. Among individuals who are overweight, losing 5% of body weight can improve risk significantly and one way to accomplish this is through lifestyle modifications such as increased exercise.

6. Connect with others. Social connectivity has been found to be one of the factors that contributes to happiness and well-being. Whether you have a walking buddy, join an exercise class, or join a meet-up group for hiking, etc, physical activity may provide an opportunity to socialize and engage with others.

7. Sharpen your memory. Studies on exercise and prevention of dementia were mostly limited to studies performed on rats, but I did find one promising study which found that older adults involved in a 6-month aerobic training program positively impacted cognitive functioning.

I often tell my patients that they don’t have to be marathon runners to experience the benefits of exercise. The most important aspect to keep in mind when choosing your preferred form of exercise is sustainability — your chosen form of exercise should be something congruent with your interests, goals, and can be easily incorporated into your routine, whether it’s walking, running, playing basketball, yoga, dancing, etc.

Thought of the Day: Which type of exercise have you found to improve your mental health?

Photo by Marlon Santos

May 28, 2015 10 comments

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