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Young GI angle: Imposter syndrome: What a young GI should know

2023; Wiley; Volume: 11; Issue: 7 Linguagem: Inglês

10.1002/ueg2.12444

2050-6414

Ahsen Ustaoglu, Marianna Arvanitakis,

Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Most of us have experienced self-doubt at some point in our lives. We may not feel as competent or knowledgeable as colleagues and friends perceive us to be, or may frequently attribute our success to chance. This destructive state of being is sometimes referred to as the imposter phenomenon, and almost 70% of people have felt some degree of imposter syndrome.1 It particularly affects high-achieving individuals in academic settings, such as PhD students, postdoctoral scientists, and clinicians at all levels of training. Prevalence appears to be increased among people from minority backgrounds who are underrepresented in medicine and academia.2 Studies have shown that imposter syndrome is associated with maladaptive perfectionism, depression, and even suicidal risk.1 Imposter syndrome is pervasive self-doubt and insecurity which creates a cloud over everything you do, a constant nagging feeling of stress and anxiety which affects both your work and relationships and pushes you to reach for perfection. As perfection does not exist in this life, you rarely feel pleased with your achievements or with who you are. Your family and friends see you as capable and accomplished, meaning that your inner turmoil often goes unnoticed. To them it seems that everything is okay, or better, they think that you are doing well. When you receive positive feedback, you think it is just because people like you and they are being nice, not because you actually deserve their appreciation. No matter how much evidence there is against the idea that you are not good enough, you hold on tightly to this belief and methodically, internally build up an argument to make yourself believe this. You fail at internalising your accomplishments and feel uncomfortable when praised.1 The only way forward is to keep attention away from yourself, work hard, and never make a mistake. You work for long periods of time to hide the fact that you struggle, not submitting any work that is short of perfect. When drowning in these thoughts, you are in a very lonely place. By most people's standards, you would be considered successful, but the problem is that you don't see yourself in this way. The more success you achieve, the more pressure you feel as the visibility and responsibility increases. Instead of feeling a sense of accomplishment, you feel a sense of relief that you managed to succeed this time round, as well as guilt because you feel that it is not deserved. This feeling ruins the moments when you achieve your goals or simply do something great. You quickly sweep this away—a process that leaves you feeling exhausted at the prospect of doing it again. Imposter syndrome is not a disorder that people feel all the time but is a series of symptoms which runs on a continuum; from occasional worry that you are not capable of completing a task to full blown fears of being ‘found out’, the imposter suffers from chronic self-doubt and fear, making it hard to live in the moment.3 It can be triggered by any achievement or approval-related task or can result from feeling insecure about your knowledge or skill, particularly when you work in a competitive atmosphere and when responsibilities increase. It tends to be exacerbated at times of transition or change or when you are faced with new challenges. This pushes you out of your comfort zone into new routines and puts you under increased scrutiny. There are new codes to learn, a new role to play, and a new way of being. These feelings of insecurity can often occur when there is a conflict between the standard that you set yourself and how you measure yourself to be doing. When the image of yourself and what others see do not match up, you wrongly conclude that they must have an inflated idea of your abilities. When faced with a new challenge, this anxiety increases because you lack belief in yourself and worry that you might not be up to the challenge. Fear of failure and self-doubt drive this vicious cycle. The high standards that you set yourself as well as the negative voice that you use to motivate yourself are part of the problem. The imposter does not see that failure is a normal part of life… Imposter syndrome is highly common in work settings where competition is encouraged, and work output is constantly scrutinised. It can also occur when you feel different from the core group, if for example, you are one of the few women in a male-dominated sector such as medicine or an ethnic minority who does not match the dominant group, causing you to feel illegitimate despite your qualifications and accomplishments.2 You may feel that you have a lot to live up to, and this can bring different expectations. You are representing not just yourself but a whole social group – if people have a negative view of your social group, this pressure is increased even more. It can also lead to thoughts such as only being there thanks to positive discrimination and cause you to dismiss your success, making you feel that you are not as good as your colleagues/friends. This is a mind trap that can affect you physically with bursts of adrenaline, increased heart rate, a creeping sense of dread, or general tension. These thoughts and sensations exacerbate the problem, adding to your feelings of inadequacy and clouding how you think. When you feel this way all the time, it leads to a terrifying existence, and even depression. Compassion is the key to overcoming imposter syndrome, acting like a mortar which holds everything together so you can confidently rebuild the bricks of who you are and how you operate. We have never really been taught to be kind to ourselves, to give ourselves positive self-motivation, encouragement, reassurance and the ability to take on board our achievements. There is a widely believed misconception that you need self-criticism to ensure that you do not become complacent and have learned to motivate yourself in this way. This negative internal monologue with yourself can make it harder to achieve your goals and puts you at a higher risk of stress and depression, making you less effective at implementing coping strategies. Rather than motivating you, speaking to yourself in a negative way all the time paves the way for anxiety and low self-esteem. By comparison, self-compassionate people are more resilient, bounce back more easily from setbacks, are more likely to learn from their mistakes, take steps to improve themselves and reach their potential. The perfectionist – You set excessively high standards for yourself and believe that you should deliver a perfect performance 100% of the time. Perfectionists have a very specific vision of what they want and a very precise plan to reach it-there is no room for a detour. When perfection is the aim, everything is always going to fall short, and success is seldom satisfying. The natural genius – You judge yourself on whether you got things right on your first try. For this group, true competence means having inherent competence and ability. They are often overly optimistic about how much they can get done in the time available and when progress is slower than expected, they feel disappointed in themselves. The soloist – You believe that to do well, you must be able to do things on your own, typically turning down help so you can prove your competence. If you need help, you see it as a sign of failure, which brings about feelings of shame and triggers imposter feelings. The expert –You need to know it all, and believe true competence means knowing absolutely everything. When experts do not know the answer to every single question, they blame themselves for being incompetent instead of acknowledging their skill gaps and learning as you go. The superwoman/man – You measure competence by how many tasks you can both juggle and excel in. If you fall short in any of your designated roles, you feel shame. You have an unrealistic view of how much is possible and are switched on all the time, unable to enjoy down time and non-achievement-based activities. Once you have identified your competence type, you must try practical strategies to overcome these imposter traits. First, put an end to avoidance through overworking. Stop telling yourself that when you get ‘there,’ you will make more time for friends, family, or fun. This is like an alternate reality-a place you need to be before you can start enjoying life. Your new approach should be to accept that this future life of satisfaction and contentment will never exist, allowing you to make room to live a daily life that fulfils you. This will let you live your life now. Set realistic weekly goals by incorporating time you need for eating, checking e-mails, and how much time you need for yourself. Work to a sustainable level and not a burnout-inducing level. Do not overload your diary, otherwise you are just running from one thing to the next, without being present in any of them. We have a limited time on Earth and need to focus our time on doing the very important and meaningful things.5 Be transparent about your other commitments and do not say yes to everything-avoid overcommitting. Second, adjust your standards. Admitting that you are not up to a certain task shows a higher degree of self-awareness. We continue learning throughout our lives and it is one of life's greatest gifts. Understand that it is impossible to know everything and the discomfort that comes from not knowing certain things are not a bad thing. This is a feeling that everyone experiences when stepping out of their comfort zone. Reframe it being aware of these fears means you can maintain your curiosity and evolve by learning more, questioning and growing, and this is what helps us thrive. If you are a student, intern or apprentice, think of what these titles mean-you are not a professor but a trainee who is on a journey to learn and progress-not someone who is expected to know everything. Third, have a daily approach to caring for your mind, combat anxiety and low mood. Stop thinking that looking after your mental health needs a big change, such as taking a holiday, spending a day at a spa or moving to a different location away from your responsibilities. A daily approach makes a difference: happiness is linked to our intentional every-day activities and is not a destination we reach after doing certain things. To regain control, you need to remember that feelings pass; anxiety is normal; it is your body preparing you for what is ahead, helping you concentrate and sharpen the mind. It is a sign that you are outside your comfort zone and not a sign that you are not good enough. Anxiety does not feel pleasant but is not infinite, so remember that feelings are like clouds-they are not permanent and will pass to allow the Sun to break through. Although we prefer the good feelings, experiencing the full range of emotions is important and what makes us human. When you have darker feelings, remember that they do not necessarily reflect how things are. Use the mind-body link, using breathing techniques or exercise to reduce cortisol levels in your body. Uncertainty feeds anxiety, so increase your tolerance to uncertainty by reminding yourself that uncertainty is not something bad, just something that you do not yet know the answer. Fourth, get used to saying what you think! Stop worrying about saying the wrong thing. Tell people your opinion, speak up, question the status quo-differing options are vital for the growth of an organisation into fruition. Do not hide behind an apology when you do speak up as this shows you think of yourself as inferior. It is also important to avoid making comparisons. Do not make assumptions about others that are not true, such as them being inherently clever, never doubting themselves, or that they are managing everything. This way of comparing is unfair as it means we hold up the best parts we see in other people, cherry-picking from parts of their life and not seeing the whole picture. From this we invent a way of being that we should follow, which can leave us feeling that we are not good enough. Be aware of comparing what you feel on the inside with what people show on the outside. Often the image we portray is very different from what we feel inside. Remember that no one has it together all the time. Social media can feed this, so make sure you surround yourself with people whose opinions you value, those who support you, and only connect with people who lift you up. Use other people's success as inspiration and motivation, not as ammunition to beat yourself up. If you are struggling to recognise your strengths, you could take the VIA institute’s free strength test, which gives you a breakdown of your top five signature strengths. Knowing and applying your highest character strengths is the key to developing self-worth.6 Ask at least 3 family members or friends to describe five of your top character strengths. This might make you cringe, but it is worth doing. Going through what those closest to you see to be your biggest strengths is a special moment which helps reinforce the aspects of yourself that you ignore. This process makes such a difference to self-belief, and usually there are overlapping themes which help to internalise and validate these qualities. Summarise your key strengths and skills. Then, make a note of all the reasons why you deserve your current position or a promotion. You can refer back to this when you feel anxious. Spend 5 minutes at the end of each day thinking about all the good things that happened that day, no matter how small. Keeping a journal or digital log of these creates a virtuous circle. Reflect on anything that is going well or that makes you smile and feel good: work, personal, or social. Take compliments on board; stop minimising achievements. Record your role in making things happen. Accept praise without giving excuses. Look back at your lists at the end of the week and give them the attention they deserve. Celebrate your accomplishments and reward yourself for doing well – this is a positive reimbursement. Too often, we move onto the next task without rewarding ourselves for what we have done. Being comfortable in your own skin means letting go of control and recognising that you cannot be responsible for how everything goes. The imposter is the vulnerable part of you, and it needs compassion and care. The more you build on these new ways of thinking and incorporate healthy coping strategies into your daily life, the easier it will be to hold onto this new view, allowing you to continue to flourish and build trust in yourself. Remember, life is an adventure not a race…and enjoy the ride! The authors have no conflicts of interest to declare. Data sharing is not applicable to this article as no new data were created or analyzed in this study.