Notwithstanding the difficulties of pharmacy school’s academic and clinical requirements, fellowship, and particularly the recruitment process, can be detrimental to mental health. The fellowship process can often seem relentless due to many more applicants than available fellowship positions. This simple fact leads candidates to assume a very competitive behavior amongst their peers, which can be a double-edged sword because it leads to high levels of effort and unhealthy stress levels. 1

In addition, the fellowship recruitment season starts in September and approximately ends around the beginning of December, which coincides with fall/winter Seasonal Affective Disorder (SAD), which is defined as “recurring major depression with a seasonal pattern.” The etiology of SAD is uncertain, but the available models focus on neurotransmitters, hormones, circadian rhythm dysregulation, genetic polymorphisms, and psychological factors. 2 Therefore, it is essential to prioritize mental health during stressful times to experience a higher quality of life.

1. Develop a More Forgiving Coping Style

“Forgiveness is the release of negative—and the potential enhancement of positive—feelings, emotions, and behaviors”.3 

During the early stages of my fellowship application process, I often found it difficult to accept rejection even though it was not at all personal. However, as my experience with the application process progressed, I realized that I had to develop healthy coping strategies to be successful.

Developing a healthy coping strategy is vital because greater cumulative lifetime stress severity and lower levels of forgiveness are associated with worse mental and physical health. A study conducted on 148 college students in the Midwest assessed lifetime stress exposure using an online stress assessment system and forgiveness using the Heartland Forgiveness Scale. The study found that greater lifetime stress severity uniquely predicted more mental health symptoms, and higher levels of forgivingness predicted fewer mental health symptoms. 3

2. Develop and Maintain a Solid Social Support Network

Numerous studies have indicated that social support is essential for maintaining physical and psychological health. Social support is defined as a “network of family, friends, neighbors, and community members that is available in times of need to give psychological, physical, and financial help.” 4 Fortunately, the fellowship offers a strong network of not just peers but lifetime friends. Thus far in the fellowship, social activities have included networking at Charles Riverboat Company, team building at Lucky Strike – Fenway, and community relations events such as Bringing Hope to Haiti at Coppersmith. After all, the definition of fellowship is friendship, especially with people who share one’s interests.

3. Regularly Practice Mindfulness Meditation

Mindfulness meditation is a mental training practice that teaches you to slow down racing thoughts, let go of negativity, and calm your mind and body. While there are many forms of meditation and mindfulness, of particular interest to healthcare professionals are those with an evidence base, such as mindfulness-based stress reduction (MBSR).5

How to Practice Meditation to Reduce Stress 

  1. Position your body in a comfortable position (Upright-relaxed spine, relaxed shoulders, hands supported on your lap, or resting on a cushion, with the back of your neck and face calm)
  1. Firstly, count your breath and continue counting your breath for about five minutes. If you find your mind wandering, gently bring it back to the sensation of breathing.
  2. Next, instead of counting, allow your breath to come naturally, and pay attention to the sensations of breathing.
  3. Next, notice the tiny sensations that come with each breath, like the slight breeze on your lip. from each breath, or the feel of air moving down your throat and into your lungs. 6

4. Practice Self-Compassion

“Self-compassion means being gentle, kind, and understanding with yourself; accepting that you are not perfect; and understanding that there is potential for learning and growth in every mistake you make.” 7

Emotional fatigue in high levels of stress is related to higher emotional reactivity and difficulties with emotional regulation. Interestingly, women are more likely than men to experience emotional exhaustion due to excessive empathy. Any professionals, who have more difficulty identifying and regulating their unpleasant emotions, are more frustrated. In contrast, those with more self-awareness obtain more satisfaction, which is at the core of developing self-compassion. 8 

Therefore, when an incident occurs that you do not rise to your expectations, take a moment to pause and reassess. Take awareness of the difficult emotions, forgive yourself and recognize that you are only human. Most importantly, make it a learning experience and have the persistence to continue.

5. Recognize and relieve symptoms of SAD or “winter blues”

SAD is depression with a seasonal pattern which includes having depression that begins and ends during a specific season every year. It is believed to occur due to an increase in levels of SERT, a serotonin transporter that is kept naturally low during summers due to sunlight. But as the daylight decreases in the fall, a decrease in serotonin activity also occurs. SAD is four times more prevalent in women than in men; the onset is between 18 and 30 years and occurs most frequently in those living furthers from the equator. Symptoms include sadness, irritability, frequent crying, lethargy, difficulty concentrating, lack of energy, increase in sleep, withdrawal from social situations, and craving sweets and carbohydrates. Treatment approaches typically include combinations of antidepressant medication which offer some relief, but light therapy, Vitamin D, and counseling are also emerging as effective treatments. 10

Tatjana Djakovic is a first year Global Scientific Communications fellow with MCPHS/Sanofi Genzyme.

 Citations:

  1. Gilbert, Paul, et al. “The dark side of competition: How competitive behaviour and striving to avoid inferiority are linked to depression, anxiety, stress and self‐harm.” Psychology and Psychotherapy: Theory, Research and Practice 82.2 (2009): 123-136.
  2. Roecklein KA, Rohan KJ. Seasonal affective disorder: an overview and update. Psychiatry (Edgmont). 2005;2(1):20-26.
  3. Enright RD, Freedman S, Rique J. The psychology of interpersonal forgiveness. In: Enright RD, North J, editors. Exploring Forgiveness. Madison, WI: University of Wisconsin Press; 1998. pp. 46–62.
  4. Ozbay F, Johnson DC, Dimoulas E, Morgan CA, Charney D, Southwick S. Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont). 2007;4(5):35-40.
  5. Behan C. The benefits of meditation and mindfulness practices during times of crisis such as COVID-19. Ir J Psychol Med. 2020;37(4):256-258.
  6. How medication can help with stress. https://www.wildmind.org/applied/stress/how-meditation-can-help-with-stress. Published September 1, 2015.
  7. Neff, Kristin D. “The development and validation of a scale to measure self-compassion.” Self and identity 2.3 (2003): 223-250.
  8. Pires FBC, Lacerda SS, Balardin JB, et al. Self-compassion is associated with less stress and depression and greater attention and brain response to affective stimuli in women managers. BMC Womens Health. 2018;18(1):195. Published 2018 Nov 27.
  9. Melrose S. Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Depress Res Treat. 2015;2015:178564.

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