By Ulrike Klenke, Laurie Chaikind McNulty, Annie Scheiner and Sharon Milgram, Office of Intramural Training and Education, National Institutes of Health, Bethesda, MD, USA
Reported rates of depression and anxiety in biomedical trainees, which fall around 39–41%, are more than six-fold greater than in the general population (6%) (Abbott, 2020; Evans et al., 2018). Rates are greater still in marginalized graduate student populations (Abbott, 2020; Chirikov et al., 2020). This situation is not limited to trainees. A 2020 study of researchers from entry level to late career, primarily from the UK and 90% in STEM fields, commissioned by the Wellcome Trust reports that 52% of respondents have sought, are seeking, or would have liked to receive professional help for depression or anxiety during their research careers. Finally, a survey by the Student Experience in the Research University (SERU) Consortium determined that the prevalence of major depressive disorder and generalized anxiety disorder among graduate and professional school students increased by a factor of 2 and 1.6, respectively, between 2019 and 2020 (Chirikov et al., 2020).
These findings are not surprising given the significant challenges and stressors faced daily by members of the scientific research community. Scientific prestige is determined largely by numbers of publications and grant income, while the peer review process is based on scientists finding fault with their colleagues’ work. Researchers compete for funding and the best students. Graduate and professional schools put a premium on working long hours, a single-minded focus on research projects, and persistence in the face of challenges. Of note, groups such as women and underrepresented minorities, who are leaving the sciences in disproportionate numbers, experience even greater stress (Sheltzer and Smith, 2014; Gibbs et al., 2016). Until the scientific research and academic communities address these challenges in systemic ways, the burden will continue to fall on biomedical trainees to cope as best they can on individual ad hoc bases.
The Office of Intramural Training & Education (OITE) at the National Institutes of Health (NIH), USA has begun a multipronged effort to transform this culture by introducing trainees in biomedical research and their mentors to resilience and well-being skills. Dr Sharon Milgram, director of OITE, along with staff and mental health professionals who serve as wellness advisors to OITE, have created both wellness/resilience content and an educational model to share it effectively.
The model includes a series of workshops (virtual at present), spread over a period of weeks or months, each with an associated facilitated small-group discussion. This approach allows trainees to listen to the content, process it on their own, and later explore it with their peers in a facilitated group to expand their understanding and apply pertinent skills and strategies in their own lives. Each webinar and related discussion group is designed to stand alone, but trainees who attend more than one can refine and integrate the insights and skills they learn.
Each of the six units in the resilience series focuses on a novel concept (outlined below), with several basic themes underlying the entire series. These themes include cultural awareness, the role of ethnicity and identity in the scientific community, the critical role of community support, the importance of learning and practicing resilience skills, and the ongoing nature of resilience-building. In addition, the series seeks to highlight the potential benefit of therapy and mental health care for trainees, while acknowledging possible barriers, such as stigma, identity issues, and the fear of losing productive work time. Therapy is framed as a nonjudgmental space to explore beliefs that impact our emotional health, help us identify maladaptive coping strategies, and work to replace the latter with productive skills.
The first unit introduces resilience and wellness. Trainees learn that self-care involves attending to all aspects of themselves; mental, emotional and spiritual components are highlighted, as is physical well-being. Attendees are encouraged to use resilience tools such as mindfulness, journaling, community support, and, when appropriate, psychotherapy. Journal prompts proffered in this and subsequent webinars encourage increased insight into patterns and triggers, awareness of helpful and hurtful strategies, cultivation of more resilient responses, and thoughtful approaches to daily setbacks. In the discussion groups, students share their experiences with using resilience tools and strategies and the resulting positive impact on personal wellness and workplace productivity.
The series then turns to cognitive distortions and imposter fears. The second unit explores how our thoughts, attitudes and mindset determine how we think, feel and act. Trainees learn to consider both whether their expectations are realistic and their goals reasonable and ways to adopt a growth rather than a more rigid, fixed mindset. Specific strategies for challenging negative self-talk such as HATS [Hear (your negative self-talk), Appreciate that you have a choice and fact check it, Talk back (to your negative self-talk), Seek support and guidance when needed] are introduced and practiced.
The third unit deals with emotions and emotional intelligence in the workplace, a topic often ignored in the scientific community. It explores both the role that emotions play in our lives and the four domains of emotional intelligence (self-awareness, self-management, social awareness and relationship management) and strategies for increasing insight into one’s own feelings, as well as emotion regulation, anger management, and frustration/discomfort tolerance. The acronym RABBITS helpfully sums up some of these strategies [Recognize (emotions), Acknowledge them, Breathe deeply, Be with them (don’t suppress them), Interpret them, Take action (or not), Seek support and guidance when needed]. Units two and three together increase trainees' awareness of their own internal cognitive and emotional processes and offer them self-regulation and self-management strategies, which are particularly relevant in the face of widespread anxiety and depression in this community.
Unit four addresses self-advocacy and assertiveness as well as different communication styles. Trainees learn to reflect on and request what they want or need in the workplace. They explore useful communication strategies including using I-statements, listening empathically, and setting appropriate boundaries.
Unit five addresses feedback resilience, which helps trainees understand their mentors’/PIs’/supervisors’ styles of giving feedback in terms of four distinct feedback styles and recognize their own strengths and discomforts when receiving feedback. They build a foundation for hearing and integrating both neutral and difficult feedback. As in all the units, the effects of complicating factors such as race, ethnicity and identity are highlighted.
The resilience series ends with a unit on cultivating a positive network of personal and professional mentors. It describes differences between supervisors, advocates and mentors, and reviews differences in communication and conflict styles. Strategies for managing up, learning from senior scientists, and changing your situation if needed are developed.
Resilience is a foundational skill for educational, career and life success. Resilience training normalizes a focus on resilience and wellness and empowers trainees to refer to the material whenever they need a resilience boost. By introducing resilience concepts and skills to high school and college students, postbaccalaureate trainees, graduate/medical students and postdoctoral fellows, the NIH aims to encourage the next generation of scientists to prioritize their own well-being and resilience, which will result in stronger scientists, stronger science – and a more resilient, collaborative and well community.
We thank Dr Patricia Sokolove and Dr Anna Han for valuable discussions and editing support for this article, and our colleagues in the OITE who supported the development of the program.
Abbott, A. (2020) Huge Survey Reveals Pressures of Scientist’s Lives. Nature 577 (7791), 460–461; [original report: What Researchers Think about the Culture They Work In (2020) https://wellcome.org/sites/default/files/what-researchers-think-about-the-culture-they-work-in.pdf, Wellcome Trust]
Chirikov, I., Soria, K.M., Horgos, B. and Jones-White, D. (2020) Undergraduate and Graduate Students’ Mental Health during the COVID-19 Pandemic, eScholarship, https://escholarship.org/uc/item/80k5d5hw
Evans, T.M., Bira, L., Gastelum, J.B., Weiss, L.T. and Vanderford, N.L. (2018) Evidence for a Mental Health Crisis in Graduate Education. Nature Biotechnology 36 (3), 282–284
Gibbs, Jr, K. -D., Basson, J., Xierali, I.M. and Broniatowski, D.A. (2016) Decoupling of the Minority PhD Talent Pool and Assistant Professor Hiring in Medical School Basic Science Departments in the US. Elife 5, e21393
Sheltzer, J.M. and Smith, J.C. (2014) Elite Male Faculty in the Life Sciences Employ Fewer Women. Proceedings of the National Academy of Sciences 111 (28), 10107–10112
Top image of post: PublicDomainPictures from Pixabay