Tuesday, June 14, 2022

The Imposter Phenomenon and Burn Out

 


The Imposter Phenomenon and Burn Out in Veterinary Medicine

DH DEFORGE, VMD



Veterinary medicine has one of the highest drug addiction rates; alcoholism rates; and suicide rates in comparative medical professions.  Studies are on-going to determine why this is the case.  

Recently, the Imposter Syndrome [Phenomenon]  has been postulated as a possible root marker in burnout in the medical field.  Can all of this be connected?  In the following literature review, Dr. DeForge has brought together experts to define and characterize Imposter Syndrome.  Those who read this review should not be negative if they have been or are a hostage of the Imposter Syndrome! On the other hand, identification of this connection can change their lives!  Read on and discover if you are a victim of the Imposter Phenomenon.

If you live with anxiety and self-doubt, you are at risk for developing Imposter Syndrome. In fact, people who live with imposter syndrome may have had feelings of pervasive self-doubt going back as far as they can remember.  85-95%% of medical students live with a fear of self doubt that continues through medical school; internships; and residency.  It usually continues into their careers in the medical field.  As high achievers, Imposter Syndrome individuals are constantly doing more and more to hide their self doubt cultivated from a young age by this Imposter Syndrome.  Keeping busy seems to prevent the acknowledgment of their fear!

Are you always looking for approval and validity of your actions? A person with imposter syndrome tends to look for validation in authority figures such as a boss, teacher, or family member.  Sometimes that person is not around.  Other times they are around but self-doubt prohibits the initiation of a conversation to discuss their pain.

Another way to know if you have Imposter Syndrome is to think over your reaction when you are successful at something. If you have Imposter Syndrome, you tend to attribute your success to luck or think of it as a fluke.  You tell others that you are not responsible for success or discovery in your actions.  To admit this would remove self-doubt.  Sadly, you cannot accept you are special. Rather than feel happiness and pride, you might feel relief or even distress when you succeed at something.  You ask yourself while are people staring at me?  Did I make a mistake?  Why are they laughing?  Did I do something stupid?  What is wrong with me? I just cannot stand being judged behind my back.........it a constant feeling that overcomes you each day.



85-95% of medical students are affected by Imposter Syndrome  They live a fear of self doubt.  They are always concerned they will be exposed as a fraud  Each day they are possessed by an internal barrier that will prevent them from achieving empowerment and achievement.  They question themselves and can never recognize their worth and expertise.  Examination success cannot come to you readily because of your self-doubt. This leads to a "blind" work ethics.  You say to yourself if I do not entrench myself I will fail.  Yes-your peers who suffer from Imposter Syndrome are caught up in the same inadequacy!

Imposter syndrome (IS) – also called imposter phenomenon - manifests differently in different people, but commonly leaves someone with the unshakeable belief they are an intellectual fraud, despite all evidence to the contrary.

When you see an individual who's suffering from imposter syndrome, they're more likely to burn out. And the folks who are burned out are more likely to be suffering from imposter syndrome - Sahar Yousef

People with IS often feel they need to over-work and over-deliver on projects to avoid being found out. Though they might be high achievers, they might avoid taking on challenges so they can’t publicly fail. They attribute success to luck or hard work, rather than ability, and fear it will only lead to being given other chances to trip up. 

Studies suggest up to 70% of people have experienced imposterism at work at some point.  While some research suggests IS might sometimes help motivate people to achieve, there is also ample evidence that the stress it generates can be so draining that it places intense pressure on mental health

One 2016 study, for example, showed that US medical students with feelings of imposterism also tended to demonstrate “increased levels of exhaustion, emotional exhaustion, cynicism, and depersonalization”, symptoms very similar to the World Health Organisation’s (WHO) definition of burnout

And a recent international survey of 10,000 knowledge workers by US-based work-management platform Asana showed 42% believed they had experienced both IS and burnout at the same time. 

“When you see an individual who's suffering from imposter syndrome, they're more likely to burn out. And the folks who are burned out are more likely to be suffering from imposter syndrome,” says Dr Sahar Yousef, a cognitive neuroscientist researching workplace productivity at UC Berkeley’s Haas School of Business in California, who contributed to the research.   

Yousef says it’s important to note that the survey relied on people making their own assessment of burnout, a serious clinical syndrome from which recovery can take months. But even if some people might be overly quick to label themselves as burned out, rather than very tired and stressed, it’s notable that so many identified with both syndromes at the same time. 

It’s not entirely scientifically clear why the two are increasingly overlapping, says Yousef, but  one key factor is that IS manifests in a similar way to the third dimension of burnout, as defined by the WHO: “feelings of professional inefficacy”. As Fiona is finding, when someone is experiencing burnout, “you feel like no matter what you do, it’s not enough. You are the ineffective person on your team”, says Yousef. This is notably similar to the definition of imposter syndrome, she says. 

The perfectionist tendencies of someone with IS can mean every interaction becomes intensely stressful, she says. Burnout can then set in after “hundreds, maybe thousands, of uncompleted stress cycles”, where the individual never has a chance to mentally recover from moments of pressure.

Clare Josa, founder of an IS Consultancy, and author of Ditching Imposter Syndrome, says she sees a clear link between IS and burnout, something she attributes to “the body’s fight, flight or freeze mechanism getting stuck on”. 

Her recent year-long study of 2,000 workers in the UK and US found that 62% of people struggled with feelings of imposterism on a daily basis, and 18% described themselves as being “on their knees” from stress. Based on their responses to a series of assessment questions, 34% of respondents were judged to be at high risk of imminently burning out. She concluded that IS is “one of the most important predictors of whether or not someone is at risk of burning out”. 

Josa believes the correlation largely stems from tactics people develop to compensate for or mask their imposterism, such as taking on work they don’t have time for to win approval, or avoiding promotion because they fear exposure. As one contributor to her research said: “I feel like if I'm in the spotlight, everyone will see if I make a mistake. So I do my best not to go there.” 

Someone who is so “wired to look for threats” will quickly find it affecting their wellbeing, pushing them towards burnout, says Josa. 

Prevention is key 

Right now, says Anne Raimondi, COO and head of business at Asana, their research shows it’s Gen Z workers who are most likely to say they’re struggling with both imposter syndrome and burnout. 

She attributes this to the unique challenges for young people of launching careers during the pandemic. Unable to observe colleagues in person and adjust to workplace dynamics, with no clear boundaries between work and personal life; and without the “moments of feedback and reassurance” that are crucial to building professional confidence, she says it’s easy to see how junior staff could begin to feel they don’t belong in their role and become overwhelmed.

I feel like if I'm in the spotlight, everyone will see if I make a mistake. So I do my best not to go there – Contributor to Clare Josa’s research

Josa says while younger workers may be more vocal about their struggles, older generations are suffering, too. One of the biggest triggers she’s identified for imposter syndrome is the menopause for women, or for men getting promoted into senior positions. Working mothers, meanwhile, are a high-risk group of both IS and burnout, she adds. 

There’s also a body of research suggesting people from minority backgrounds can be more acutely affected. Dr Kelly Cawcutt, from the University of Nebraska Medical Center, says Imposter Syndrome has long been noted as a factor in high burnout rates among medical workers. But her research suggests “ingrained biases and a lack of diversity” in the profession can mean under-represented and ethnic minority groups are particularly affected. Black physicians, for example, are known to face higher risk of burnout, partly because of the stress of discrimination. 

“If we are told we are not good enough, not smart enough, or do not belong – or are made to feel this way through microaggressions – those extrinsic biases can be internalised,” she says, fueling both imposterism and in the longer term, burnout. 

“Although there are many efforts to address this now, these biases still exist,” says Cawcutt, creating what her research calls a “substantial negative cycle” for the individual. This, she says, shows the importance of treating IS and burnout – and indeed ingrained biases – not as siloed issues, but as connected phenomena which, if they’re to be resolved, need to be addressed together. 

Josa says when it comes to the individual, the starting point is to tackle the imposter syndrome by rewiring the brain’s response to stress, “so you don't get that unconscious firing of the fight, flight, freeze response”. 

But to address the issue of IS spiralling into burnout, she says companies need to do more to tackle cultures where “everything has become an emergency”, and where people feel compelled to over-perform and grit their teeth through adversity rather than being honest about their wellbeing.   

Yousef and Raimondi agree it’s critical for workers to be encouraged to build cognitive boundaries around their work so they leave time to mentally reset after stressful periods, breaking those stress cycles. Younger workers, says Yousef, need help engaging with mentors at work so they learn how to fit in, arresting those feelings of imposterism early on. “Prevention should be the key here,” she says. “I would just love it if we educated our kids even as early as high school about what happens when you overwork.”   

But for people like Fiona, solving the problem is easier said than done. She’s been advised by her doctor to take time off work, but is afraid that doing so will let her team down or will only prove to herself and others that “I was promoted above my grade”. 

Instead, she finds herself battling each day to “wade through the treacle of work”, envying people who seem to be coping fine. “Wouldn’t that be a nice feeling,” she says, “knowing that you’re not fretting about heading into work each day?”

How To Fight Back Against Impostor Syndrome

Impostor Syndrome is one of the many challenges professionals confront and wrestle with daily, but don’t openly talk about. It's a pernicious psychological phenomenon that makes you feel inadequate, like a fraud, undeserving of your position and that you don’t belong in the job you hold. There's incessant worry and fear that you’ll be found out, exposed and fired. 

It could wreak havoc on your emotional and mental well-being. You can become plagued by unrelenting ruminations, anxiety, stress and possibly depression. 

The cruel irony is that while you’re experiencing these harmful feelings, the reality is that you actually possess all of the right skills, experience, education, background and talents perfectly suited for the role. Your boss and co-workers think the world of you and believe that you’re wonderful, highly successful and constantly exceed expectations.

Extensive research has been conducted on this important matter. The experts point to certain personality types that are particularly impacted by Impostor Syndrome. These include people who may self-identify with being a perfectionist, superwoman/man, a natural genius or expert, among others.

Acknowledge Your Feelings

The first thing you should do is acknowledge these feelings when they arise. There’s no need to hide it from others or feel badly about harboring these thoughts. By confronting your self-defeating thoughts, it's the start of taking proactive steps to change your mindset. You’ve isolated the enemy and now you can go to war and battle against it.

Develop Coping Mechanisms

To turn things around, you’ll need to develop some coping mechanisms. It's easy to succumb to the voices that constantly run through your mind repeating that you don't possess the appropriate skills and talents to do your job. The voices may say that you’re only in your position due to pure luck or someone was just being kind to offer you the opportunity.  

As this starts to happen, swiftly acknowledge the thoughts and work toward stopping the negative feedback loop. Replace these ruminations with stories of all of the great things you’ve accomplished in your career and life. Maintain a mental ongoing list of your accomplishments. 

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Most people sprinkle their success all over the place, but pile up their mistakes and misfortunes that grow into a mountain. Then, they look at that mountain and feel that this confirms their own internal beliefs. Instead, stack all of your successes on top of each other—no matter how small or trivial they seem. Soon, they’ll turn into a Manhattan skyscraper. You can then run a mental loop optimizing all of the times you’ve triumphed over adversity. Keep playing that over and over again when you feel a wave of insecurity washing over you.

Share Your Feelings

By sharing with others, it will release the pent-up burden. 

You’ll quickly find out that you're not alone and this is shared by many other professionals. You will feel a big sense of relief once you find out that it's commonplace, you're in good company and it's not just you. You can then share your feelings and commensurate with like-minded people wrestling with the same challenges. Knowing that you’re not alone will take a weight off of your shoulders.

Nobody Is Great At Everything All Of The Time

It's normal to feel that you’re a little out of your element at times. When an athlete tries to take herself to the next level of competition, there’s always the chance of failure and facing setbacks. Nobody succeeds at everything they try to accomplish. Failure and mistakes are all part of learning from these experiences, growing, developing and taking yourself to the next level. The most successful people have had to contend with great difficulties, bad breaks and periods of desperation. They didn't give up and kept on pushing ahead without letting the previous losses stand in their way.

The Power Of Positive Self-Talk

Self-talk yourself through the tough times. If you’re worried about assuming new responsibilities at the office, say to yourself, “I’m embarking upon a new project and mistakes will be made. I’ll drop the ball and maybe get some criticism, but that’s okay. It's all part of the growth process!”

A baseball player can strike out one-out-of-every-three times at bat and still end up an all-star. The best football players drop passes and fumble the ball. World-class golfers miss easy putts. Keep in mind that this happens to everyone—and quite often.

Don’t Be Too Hard On Yourself

The trick is to catch yourself when you are stumbling. Remind yourself that this happens to the best of us. So, you made a mistake. It's not the end of the world. Your family and friends will still love you. Your boss understands that things happen. If they don't, then  it's not you. You're just surrounded by the wrong type of people.

You shouldn't beat yourself up. Extend the same compassion to yourself that you would to a stranger. We tend to talk harshly and critically of ourselves and sometimes we are our own worst enemies. Treat yourself like you would do to someone you really care about. Be empathetic, understanding and non-judgemental when things don't go your way.  

Reach out to co-workers and people you trust. Ask them what they think about your work. It's risky, but the odds are that they will say much nicer things about you then you think about yourself. It will be a much-needed, positive reality check.

Overcoming impostor feelings:

Seven strategies that can help!

1. Learn the facts

As with all negative emotions, one of the best ways to manage impostor feelings is to address the cognitive distortions contributing to them. Jessica Vanderlan, PhD, a clinical instructor of psychiatry at the Washington University School of Medicine in St. Louis and a psychologist at Siteman Cancer Center, leads small groups of medical residents in discussions about impostor phenomenon. The hospital launched these seminars because impostor feelings among new physicians are common and often lead to burnout. 

A common suggestion she shares with psychology and medical residents is to take a step back to look at the bigger picture. What facts support that you deserve to be in your role?

“Becoming a psychologist or physician takes years of work, education, and accomplishment,” she said. “It can help to zoom out and consider how where you are now compares to where you were last year or five years ago.”

In the process, monitor your internal dialogue. Vanderlan recommends a simple exercise of asking yourself how you might support a friend who minimizes their accomplishments and then applying the same supportive language to your own narration.

2. Share your feelings

If you don’t trust your own “facts,” Vanderlan recommends enlisting other people. Sharing your impostor feelings with others can not only reduce loneliness but also open doors for others to share what they see in you.

3. Celebrate your successes

People who struggle with impostor feelings tend to brush off their successes, which Orbé-Austin said only exacerbates the experience. If someone congratulates you, don’t move on too fast. Pay attention to how you respond and aim to speak more positively about yourself. Orbé-Austin said taking time to applaud yourself, whether you gain a new credential or publish a paper, or just have a good client session, can help you internalize your success.

You could simply reflect on your efforts, but external, concrete reminders are also important. For example, if you receive an email with positive feedback, save it or print it. Vanderlan said she keeps a few emails from reviewers and past supervisors near her desk so she can look at them and remember how others see her. The accomplishments don’t have to feel significant. “It can also be little things that, taken together, show you to be an incredibly competent, high-functioning professional,” Cokley said.

4. Let go of perfectionism

You don’t have to lower the bar, but adjusting your standards for success can make it easier to see and internalize your accomplishments. Vanderlan suggests focusing on your progress rather than aiming for perfection. “In clinical work, there may not be a perfect way through a patient scenario, but we have to be OK with being good enough,” she said.

And when you don’t meet your standards, resist the urge to see your failure as an exposure. Instead, Orbé-Austin suggests reframing failures as opportunities to learn and grow––which will ultimately move you toward the success you’re seeking.

It may help to release yourself from rigid roles. For example, Orbé-Austin said people with impostor phenomenon often see themselves as helpers––people who come to the rescue. “Breaking free from those roles so you can be someone who doesn’t know it all or someone who can’t always help can allow us to be more robust people and professionals,” she said.

5. Cultivate self-compassion

Self-compassion—as Ervin describes it, using mindfulness to shift from an external locus of self-worth to an internal one—can help you let go of perfectionism. Try to observe when your impostor feelings surface and how you respond to them. “Whereas impostor phenomenon is unconscious and mindless, mindfulness can help you move in a different direction,” Ervin said. “It’s about learning to recognize those feelings of fear and learning to truly be OK as you are, without your accomplishments.”

That may be more difficult for underrepresented individuals, who historically have to work harder because of systemic barriers. In that case, Hill suggests bearing in mind the systemic factors contributing to your impostor feelings, while reminding yourself that your accomplishments aren’t tied to your value. 

6. Share your failures

Hearing what other people think of you isn’t the only way to grow out of impostor phenomenon. Gardner said discussing failures in a group can help paint a more realistic portrait of what other people are struggling with.

For example, you can look at your CV and see all the papers you’ve published, but you are also aware of all of your papers that were rejected. But when you see a colleague has published a paper, you don’t know what happened behind the scenes. Seeing your worst and someone else’s best can spark comparison, which can aggravate impostor feelings.

To combat this, Gardner and other junior professors in his field occasionally share their failures in a Facebook group, including critical review comments on research papers and admitting if they didn’t get tenure. “These things happen to every single person, even if they’re top of their field,” he said. “Sharing the learning moments in those failures can be a really good organizational culture practice.”

7. Accept it

As you learn to work through impostor phenomenon, it will probably interfere less with your well-being. But taming impostor feelings doesn’t mean they’ll never show up again. Vanderlan said it’s common for them to arise at any career shift: from school to internship, internship to postdoc, postdoc to career, and so on. This may be exacerbated when a person’s social reference changes, Gardner said. For example, if you were valedictorian in high school but go to a prestigious university with dozens of other valedictorians, you might not feel like you’re at the top anymore.

“We’re always going to be faced with new experiences or roles, and that’s when this will really come out,” Vanderlan said. “So it’s good to recognize even if you’re making progress, you might be in a position next year where these things come up again.” 

Remember that impostor feelings can arise at any career shift, especially if the people you are surrounded by have different achievements.

Be strategic about who you share with. Gardner said airing impostor struggles with peers can promote comparison and increase impostor phenomenon, but venting to trusted individuals outside your professional circle can provide a more helpful picture of your accomplishments and value.

For people with underrepresented identities, Salazar-Nuñez said it can be helpful to connect in empowering spaces and communities, which can provide support and, more important, validation and empathy for navigating impostor phenomenon in oppressive systems. 

Hill suggests underrepresented individuals focus on fostering relationships that feel safe and in which you don’t feel like a fraud. That may be easier, Cokley said, with people from similar backgrounds. “There’s a lot of solace in knowing there are others out there experiencing what you are,” he said. “You can share your insecurities and in turn gain new ways to cope.”

If your impostor feelings rise to the level where they negatively impact your functioning, then Cokley suggests working through these thoughts in therapy.

From the Journal of the American Psychological Association
"Find a mentor......this person can change your life!

There’s no need to feel that you have to be awesome and an expert at everything. It's natural to be good at some things and not others. Don’t beat yourself up just because you aren’t the best at everything you do. Keep in mind all of the things you’re great at.

This isn’t meant to be a cure-all. View this as the first step toward fighting back against the feelings that you’re an imposter and not worthy of the job and life you're living.

Once you recognize that you might have imposter syndrome, seek out an advisor or mentor. It is important to gain perspective as you will realize that you are not alone. Almost everyone at some point in their lives or in certain situations feel like imposters. Another tip is to recognize that a student is NOT expected to know as much. Embrace being a novice and focus on developing a growth mindset. Each student enters medical school with different strengths. Comparing yourself to your peers is unhelpful, but sharing expertise among colleagues lifts everyone’s performance.

Your school did not make a mistake. You do not need to be someone perfect. You are enough.

Yesterday is gone.  The future is filled with wonder.  I have conquered the Imposter Syndrome.  I look forward to the excitement and challenges of each day!


 

The Imposter Phenomenon and Burn Out

  The Imposter Phenomenon and Burn Out in Veterinary Medicine DH DEFORGE, VMD Veterinary medicine has one of the highest drug addiction rate...