References:
January 2021 • DALLAS MEDICAL JOURNAL 15
strategies to help you navigate this journey.
Psychotherapy - If anxiety is the worst
use of the imagination, psychotherapy
helps us reestablish psychological safety
and dial down the trauma response. There
are numerous evidence-based therapies
to help address anxiety, depression, and
burnover, such as cognitive behavioral
therapy, acceptance and commitment
therapy, psychodynamic psychotherapy,
and mindfulness-based stress reduction.
The undertaking of knowing oneself might
be the most challenging yet rewarding experience
of one’s life, with lasting results.
In fact, suffering often brings with it the
opportunity to drive emotional growth for
a more mentally fit self. As with anything
worthwhile, this process requires time and
commitment.
Medications and More - We enter the
medical profession with many underlying
vulnerabilities, including personal and family
medical and psychiatric history, chronic
stress from childhood, personality factors,
social determinants of health, and much
more. Moreover, the stress from medical
training is associated with systemic
inflammation, telomere shortening, and
oxidative stress, findings which have often
also been reported in major depression.
Antidepressant medications, in particular,
are associated with not just mood recovery
but also recovery from oxidative stress
on a cellular level. There are also several
medication and non-medication augmentation
strategies that can help you with your
mental recovery. Most importantly, a good
psychiatrist can blend psychiatric medication
management and psychotherapy while
empowering you with skills for self-management
over time.
If the body keeps the score of chronic
stress, then the symbiotic relationship
between the mind and body becomes a
critical target for recovery.
Mind-Body Strategies - We all know the
benefits of exercise as a healthy coping
skill to build our mental and physical fitness.
However, when we are exhausted,
the last thing we might want to do is run
laps around the neighborhood with a mask
on. Fortunately, recovery from stress does
not require us to train like an athlete. In
fact, routine and less-intense activities,
such as walking a pet, doing the laundry
and dishes, gardening, and washing your
car, can be just as effective and give you a
sense of accomplishment. One of the best
strategies to facilitate traumatic release
from the body is to engage in an intentional,
slow, and mindful activity like yoga,
which you can easily access over the internet
from the comfort of your living room.
If you’re suffering from burnover from
another discussion about mindfulness,
you’re not alone. I had similar skepticism
about mindfulness when I first took the
eight-week mindfulness based stress
reduction course. In fact, around the
third week, I recall being quite frustrated
with the process of completing the same
body-scan meditation every day for an
hour or more, but I stuck with it. Around
week six, a sense of calmness came over
me. My movements and actions became
more intentional, and I felt less exhausted,
without any change in the rigor of my
clinical schedule. My relationship with
nourishment also changed as I learned
to chew my food instead of my thoughts,
which saved me precious mental energy to
devote to other aspects of my life. When I
wavered from this intentionality, I returned
back non-judgmentally to the task at
hand. One of the greatest misconceptions
about mindfulness is that it helps us fight
distressing thoughts. Quite the contrary,
mindfulness allows us to change our
relationship to the distressing thoughts
that are a part of living.
Reimagine “Work”
As physicians, our careers have been
shaped by the expectation of conformity
married to the assumption that resilience
and professionalism are in endless supply,
particularly during a pandemic. Fittingly
then, 2020 has been the ultimate test
of our professional status quo. While the
long hours and medical culture might
make it seem that your personal identity
is inextricable from your professional one,
this is a perfect recipe for burnover. Along
with recalibrating normal, Turning 2021
mentally fit requires that we reimagine
work as an extension of what we do, rather
than as an extension of who we are. You
are a person with many gifts, values,
dreams, and talents, and one of them
just happens to be being a hardworking
doctor. This could be a variety of things,
including spirituality, advocacy, mentorship,
leadership, and other activities outside
of your profession. Also, as much as
possible, release yourself from the myth
and burden of multitasking. Focusing
on one task at a time and being mindful
of the task at hand will improve your
concentration and help you to be more
mentally fit. Spreading ourselves thin
depletes our batteries faster than working
on tasks individually. Like any of your
devices, the more programs you have
running simultaneously, the harder it is on
the system. It is the same for our body
and mind.
Reclaim Joy
Mental fitness is not merely the
capacity to endure, but also the capacity
to recharge. Most of us forget the latter.
Take the time to slow down and explore
other aspects of life that fill your bucket
and keep you mentally fit. Recreation,
humor, daydreaming, connection with
nature, your partner’s touch, and the
simple act of doing absolutely nothing at
all can all be ways to recharge your mind.
Rather than spending your time on passive
activities like binge-watching shows, find
a book or a podcast that teaches you
something new. Monitor your screen time
and disconnect digitally to give your mind a
digital holiday. Be it while on a walk around
the neighborhood or on your walk from the
parking lot to your office—put down your
phone, pull down your mask, and stop to
smell the roses. New experiences and new
ways of doing old things can also set you
on the path to mental fitness.
Most of all, remember that mental
fitness is not a checkbox; it’s a moving
goalpost practiced over time with
intentionality. If at first you fail, get up and
try again. And again. And again. Join me
in the commitment to “Turn 2021” happy,
healthy, and mentally fit! DMJ
van der Kolk, B. A. (2014). The Body Keeps The Score: Brain,
Mind, And Body In The Healing Of Trauma. Viking.
Hough CM, Bersani FS, Mellon SH, et al. Leukocyte telomere
length predicts SSRI response in major depressive disorder:
A preliminary report. Mol Neuropsychiatry. 2016;2(2):88-96.
doi:10.1159/000446500.
Hartzband, P., & Groopman, J. (2020). Physician Burnout,
Interrupted. The New England Journal of Medicine, 382(26),
2485–2487. https://doi.org/10.1056/NEJMp2003149.
Dr. Aekta Malhotra is a private practice psychiatrist at
Apollo Psychiatry (www.ApolloPsych.com). She specializes in
treating mood disorders, anxiety, and burnover, with a focus
on caring for physicians.
Fortunately, recovery from stress does not require
us to train like an athlete. In fact, routine and lessintense
activities, such as walking a pet, doing the
laundry and dishes, gardening, and washing your
car, can be just as effective and give you a sense of
accomplishment.