Coping with Stress in the Time of COVID-19: Strategies to Enhance Resilience in Biomedical Graduate Students

June 8, 2020

Pursuing graduate school in the biomedical sciences can be stressful, and the COVID-19 pandemic may be adding additional stress to graduate students’ lives. As stress levels increase during these difficult times, it is important to ensure that students have access to resources that will provide guidance in reducing stress.

We are a team of highly trained professionals in psychology, psychiatry and the biomedical sciences who have combined our expertise to provide recommendations for coping with stress and enhancing resilience for biomedical graduate students during the time of COVID-19.

Burnout and Mental Health Problems Are Prevalent

Mental illness is a developing concern in graduate education. As a group of scientists interested in understanding the mental strain on biomedical graduate students, we recently carried out a study and learned that currently, and two-thirds in their lifetimes. These findings mirrored other widely-cited scientific studies in the and , as well as broad surveys ( and ). The referenced research provides empirical support for the fact that the that should be addressed. Leading governing bodies (National Academy of Science, National Institute of General Medical Sciences and the NIH Office of Intramural Training and Education) and academic news sources (, and ) have also highlighted the urgency of intervening in this mental health crisis.

The create a perfect recipe for students to feel overwhelmed. The following are possible sources of stress:

Difficulties with advisers.
Gaps in institutional support.
Few to no opportunities for career progression.
Extreme competition for academic positions and an .

Such stressors can lead to burnout, mental health problems, poor science, attrition and increasing costs to institutions.

COVID-19 Is Increasing the Risk to Biomedical Graduate Students

and has created significant disruptions in the biomedical workforce’s capacity to conduct ongoing experiments. Many graduate students are understandably worried about their ability to and (e.g., schedule lab rotations, pass preliminary exams and complete their dissertations). In addition to the chronic stressors associated with graduate school, is giving way to a surfeit of unstructured time, anxiety and uncertainties about the future. The large shift in everyday life can seem daunting and increase the risk of mental illness and burnout.

We pooled recommendations to assist in coping with this shift and enhancing resilience.

Ways to Reduce Stress and Build Resilience

Stress is a multifactorial experience, and it is important to . Some of these stressors may come from the adviser, laboratory, program, department, institution or national level. Here are practices to reduce stress and build resilience:

Foster community. Don't allow your relationships to flounder in the era of social distancing. Make time for online gatherings and happy hours with colleagues, invite friends for online games, enjoy communal exercise, cook with friends and check in regularly with your mentors.
Avoid avoiding. In —the stuff that has been on your daily to-do list for months, but keeps getting bumped to the next day or week. These work- or home-related items can weigh on you, decrease your sense of self-efficacy and drive up burnout. Here’s how to tackle that seemingly never-ending list:
1. Take that giant task and break it down into small goals. It may be especially helpful to create tasks you can achieve in 5- to 30-minute blocks. Spoiler alert: “finish your dissertation” will not cut it. However, “download the dissertation template from my school’s website” is a goal that you can achieve in 5 minutes. Do that. Then do the next thing.
2. Set yourself up for success. When in doubt, make your goal smaller. Make it something you absolutely will do, and do it before you do the other things in your day. Anticipate what barriers will get in the way, and then create a plan. For example, if you are worried that you will forget, set a reminder on your phone. If you are worried that you won’t have the motivation to get it done, write yourself a note about why finishing that task will make you feel better.
3. Take one small step every day. When the inevitable panic of “this is not enough” or “I’m never going to be able to do this” sets in, remind yourself that doing that one small thing is so much better than sticking your face back in the avoidance pit. Five small steps every day will look like a big step at the end of the week.
4. Bring in an accountability buddy. Sometimes, we need a little help from an accountability buddy—a trusted other who can celebrate your small wins and help you solve problems when you don’t meet your goals.
Build a rewarding life. Borrowing from one evidence-based treatment called , we know that when we are struggling with stress, burnout, depression and/or anxiety, we tend to avoid doing the very things that are healthy for us. Avoidance makes things worse because we are missing out on the things that give us pleasure, meaning or pride. The way to break this cycle is to identify and perform activities that are meaningfully aligned with core values, pleasurable or bring a sense of mastery and accomplishment.
Cultivate acceptance. A lot of things are rapidly changing, and you are likely going to feel stressed or anxious, especially as there may be a range of stressors outside of your control in the time of COVID-19. Practice having patience for the things you may not be able to control. Lean in with self-compassion and self-validate that the emotions you are experiencing are normal and appropriate. There are a number of that can provide tangible ways to develop your abilities in this area through guided meditation. You may also work on this with an individual therapist.

The Lines Between Burnout and Mental Health Problems Can Be Blurry

can be characterized by a subjective experience of feeling fatigued, helpless, trapped, detached, unmotivated and/or cynical. These feelings can at times lead students to change their behaviors in ways that are counterproductive. They may avoid responsibilities, isolate, procrastinate and spend less time on research. Both depression and burnout can include low mood and/or a lack of pleasure or interest in things that are normally pleasurable or interesting. In contrast to burnout, depression may include such symptoms as thoughts about suicide, difficulties with sleep or changes in appetite. As a psychiatric disorder, depression also includes significant impairment in social, occupational or other important areas of functioning. If you aren’t sure whether you are experiencing depression or burnout, then ask yourself these questions:

Do these thoughts/feelings interfere with my work?
Do these thoughts/feelings keep me from doing things that I enjoy?
Do these thoughts/feelings cause me significant distress most of the time?

Regardless of whether you meet the threshold of having a diagnosable mental health problem, one thing is clear: it can be damaging to dismiss distressing thoughts and feelings related to graduate study as being a normal part of the graduate school experience, especially when those experiences can reflect an underlying and treatable problem.

We know it can be difficult to make the decision to pursue mental health services. However, found that it was not uncommon, with one-third of graduate students receiving some type of mental health services in the past year, and those who did rated therapy as highly effective. Since the initiation of shelter-in-place orders, most mental health care providers have started to offer telehealth appointments, and there are several sources offering flexible, private online therapy, making it relatively easy to find a therapist on your own terms.

It is our sincerest hope that the information that we have included here equips you with strategies and resources to help you face the COVID-19 pandemic. This article is positioned as a starting point. Keep in mind that if your experiences with burnout, stress, depression or anxiety symptoms begin to impair your functioning, we recommend seeking out care from a mental health professional. See the resources we have listed below for additional ways to obtain help during this time.

Contributors

Gabriela A. Nagy, Ph.D. is a clinical psychologist and assistant professor at the Duke University School of Medicine and the School of Nursing. Her research is funded by the National Institutes of Health and internal grants and primarily centers on reducing health disparities.

Alexander Hish, M.D. completed his medical education at the Duke University School of Medicine and is completing a combined residency in Pediatrics, Psychiatry, and Child and Adolescent Psychiatry at Mount Sinai Hospital in New York.

Caitlin Fang, Ph.D. is a clinical psychologist and clinical associate at the Duke University School of Medicine. Upon completion of her postdoctoral fellowship in July 2020, she will be starting a community private practice.

Christopher Nicchitta, Ph.D. is a professor in the Departments of Cell Biology, Biochemistry, and Pathology at Duke University. He has previously served as the Associate Dean for Research Training at the Office of Biomedical Graduate Education and Director of Graduate Studies for the Department of Cell Biology in the School of Medicine.

Kafui Dzirasa, M.D., Ph.D is a psychiatrist and National Institutes of Health-funded brain researcher at Duke University. He is also a Public Engagement Fellow of the American Association for the Advancement of Science.

M. Zachary Rosenthal, Ph.D. is a clinical psychologist and associate professor at Duke University Medical Center and Duke University. He has previously served as the Vice Chair of Clinical Services for the Department of Psychiatry and Behavioral Sciences.

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