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Episode Notes

Source / episode info

  • Episode: 634
  • Title: DIP Ep 634: Curbing Anxiety (Medical Students/Residents)
  • Published: 2026-02-19
  • Source: Episode page

One-liner

This episode provides comprehensive strategies for combating anxiety in medicine, emphasizing preventive mindset, setting personal quality standards, applying task triage, decluttering both physical and mental space, avoiding over-control, and focusing on daily manageable goals.

High-yield summary

  • Preventive Mindset: Combatting pressure requires distributing effort over time (e.g., studying early) rather than concentrating it into a short, intense period ("cramming").
  • Personal Standards & Contentment: Do not compare yourself to others; establish and adhere to self-defined quality standards. Contentment is an anxiety reducer, while greed/comparison are anxiety builders.
  • Task Triage (Curating Life): Systematically filter daily activities by asking: Is it high-yield? Is it non-negotiable? Strip life of "fluff" and extraneous tasks to reduce cognitive load.
  • Decluttering: Minimize screen time, social media use, and digital input; maximize analog/physical experiences to prevent brain overload from excessive data consumption (pop-ups, notifications).
  • Focus on Controllables: Practice accepting what you cannot control ("let it go") and concentrating effort only on variables within your sphere of influence.
  • Evolutionary Mindset: View transitions (e.g., student -> resident) not as setbacks, but as necessary evolutions that build mastery over time.

Learning objectives

  • Identify common psychological stressors unique to medical training (e.g., comparison, transitions).
  • Apply principles of task prioritization (triage) to manage overwhelming academic or clinical workloads.
  • Differentiate between controllable variables and uncontrollable circumstances in stress management.
  • Understand the importance of establishing personal quality standards over external benchmarks.
  • Implement strategies for mental decluttering by minimizing digital input and maximizing routine/analog activities.

Board exam buzzwords

ConditionKey FindingAssociationBoard Exam Tip
Burnout SyndromeEmotional exhaustion, depersonalization, reduced sense of accomplishmentChronic stress; poor work-life balance; lack of perceived controlRecognize that burnout is a syndrome related to systemic failure and chronic stress, not just individual weakness.
Imposter SyndromeFeeling like a fraud despite evidence of competenceComparison anxiety; high achievement environments (academia)Treat comparison as an emotional trap; focus on internal growth metrics rather than external scores.
Task TriageFiltering daily activities by necessity/yieldPrioritization matrix (Urgent vs. Important); "Fluff" removalWhen faced with a massive workload, immediately categorize tasks to identify the highest-impact items.
Cognitive OverloadDifficulty concentrating due to excessive data inputDigital media; constant notifications; lack of routineAnalog methods and structured routines help regulate cognitive function by limiting sensory input.

Rapid review table

TopicKey PointContextExam Relevance
Anxiety CausesPressure, comparison, loss of control, transitions, future worry.Medical training; high-stakes environments (USML Es, residency).Helps identify the source of stress when a patient presents with anxiety symptoms.
Preventive MindsetDistribute effort over time; avoid cramming.Studying for board exams or mastering complex skills.Shifts focus from acute crisis management to long-term, sustainable preparation.
Task TriageFilter activities: High-yield vs. Low-yield; Non-negotiable vs. Optional.Daily life/work routine optimization.A practical tool for time management and reducing feelings of being overwhelmed.
Decluttering MindMinimize screens/social media; maximize analog methods.Modern information environment; digital fatigue.Highlights the physiological impact of constant, unstructured data input on brain function.

Board-speak -> diagnosis

Board-speak / Vignette phraseDiagnosis / ConceptWhy it fits
A medical student feels overwhelmed by the sheer volume of material and struggles with chronic fatigue.Burnout Syndrome/Chronic Stress ResponseThe core issue is an inability to manage workload, requiring structured prioritization (task triage).
A resident constantly compares their performance metrics (e.g., USMLE scores, publications) to peers, leading to severe anxiety.Imposter Syndrome / Comparison AnxietyThis highlights the danger of external validation and comparison as a primary source of psychological distress in medicine.
A patient with Generalized Anxiety Disorder (GAD) is advised to focus on immediate, manageable goals rather than worrying about future outcomes.Cognitive Behavioral Therapy (CBT) Principle: Focus on Present MomentTeaches that anxiety often stems from catastrophic thinking about hypothetical future events.
A physician struggling with a complex new procedure finds it overwhelming until they break the task down into sequential steps and create a checklist.Task Breakdown / ManualizationDemonstrates how reducing complexity (miniaturizing) makes difficult, nebulous tasks manageable and reduces performance anxiety.
A patient suffering from chronic stress reports difficulty concentrating due to constant digital notifications and information overload.Cognitive Overload / Digital DeclutteringEmphasizes the physiological impact of excessive data input on mental bandwidth and focus.

Differential diagnosis / distinguishing features

Imposter Syndrome vs. Low Self-Esteem

Key FeaturesDistinguishing FindingsNext Step
Imposter Syndrome: Fear of being exposed as a fraud; attributing success to luck/external factors.Often occurs in highly competent, high-achieving individuals; focus is on performance failure.Validation and reframing: Acknowledging competence while challenging the belief that success must be perfect.
Low Self-Esteem: General negative self-view across all life domains (personal worth).Affects non-academic areas of life (relationships, hobbies); generalized feeling of inadequacy.Therapy focusing on core self-worth and unconditional positive regard.

Management pearls

  • The "Less is More" Principle: In both lifestyle and academic planning, reducing the number of commitments or tasks can significantly decrease anxiety levels.
  • Structured Routines: Establishing predictable daily routines (e.g., morning meditation, fixed study blocks) helps create a sense of control and reduces decision fatigue.
  • The "Anchor": Developing a core belief system or relationship (spiritual/philosophical anchor) provides stability when external circumstances are chaotic or unpredictable.
  • Miniaturization: When faced with an intimidating task (e.g., ICU rounds), break it down into the smallest possible, sequential steps and create a manual/checklist to regain mastery.

Don't miss

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Comparison is a trap: Never use others' achievements (scores, publications) as your personal metric for success; focus on self-defined quality standards.
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The power of "Letting Go": A major source of anxiety is dwelling on things outside one's control; consciously practicing acceptance and non-attachment to outcomes is crucial.
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Analog vs. Digital: Recognize that the constant, unstructured data flow from screens leads to cognitive overload, which elevates baseline anxiety levels.
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The "Novice -> Master" Mindset: View all transitions in medicine (student -> resident) as inevitable evolutionary steps rather than insurmountable challenges.

Integration & clinical reasoning

  • Psychology & Medicine: Understanding the psychological mechanisms of stress and anxiety is critical for treating burnout, managing chronic illness, and improving patient adherence to complex regimens.
  • Cognitive Science: The principles of task triage and decluttering directly relate to optimizing working memory capacity by minimizing cognitive load from extraneous stimuli.
  • Lifestyle Medicine: Incorporating structured routines, physical activity (analog engagement), and mindfulness practices are core components of managing chronic stress in both patients and providers.

Concept connections / cross-references

  • For detailed information on the pathophysiology of burnout and occupational stress: [Connection to a general Internal Medicine/Endocrinology episode].
  • For understanding the physiological impact of sleep deprivation and chronic stress hormones: [Connection to an Endocrine/Neuro episode].
  • For strategies regarding managing complex, multi-systemic diseases: [Connection to a General Clinical Reasoning episode].

High-yield association table

ConditionAssociationMechanismClinical Significance
Burnout SyndromeChronic stress; emotional exhaustionProlonged exposure to stressors without adequate recovery/control.Requires systemic changes in workload, not just individual coping mechanisms.
Imposter SyndromeHigh achievement environments (academia)Fear of being exposed as incompetent despite objective success.Often requires validation and reframing of self-worth away from metrics.
Task TriagePrioritization; resource allocationIdentifying the highest leverage activities that yield the greatest results with minimal effort.Essential for managing complex, multi-faceted patient care plans or academic workloads.
Cognitive OverloadExcessive digital input (screens, notifications)Exceeding working memory capacity due to unstructured data streams.Suggests a need to limit stimuli and favor structured, analog learning methods.

Key terms glossary

TermDefinitionContextExample
Task TriageThe process of prioritizing tasks by determining their necessity and potential yield.Time management; workload optimization.Instead of studying 10 topics equally, triage to focus on the 3 highest-yield areas for an exam.
Preventive MindsetProactively addressing potential stressors or problems before they become acute crises.Academic planning; skill acquisition (e.g., starting USMLE prep early).Instead of cramming all knowledge in the last month, spread study efforts throughout preclinical years.
ContentmentA state of peaceful satisfaction with one's current circumstances and achievements.Mental health/Psychology.Recognizing that achieving a goal (e.g., residency) does not guarantee continued happiness or eliminate future worries.
Cognitive OverloadThe inability to process new information because the working memory is already saturated by too much input.Digital media consumption; complex decision-making under stress.Limiting screen time and focusing on single, deep tasks (analog learning) can prevent this overload.

Study optimization

TopicStudy ApproachPriorityResources
Stress/Anxiety ManagementBehavioral modification; cognitive restructuring.High (Applicable to all stages of medicine).CBT principles; Mindfulness techniques; Structured planning tools.
Workload PrioritizationImplementing the Eisenhower Matrix or similar triage methods.Medium-High (Especially during rotations/exams).Practice applying "high-yield" filtering to clinical scenarios and study material.
Burnout PreventionEstablishing boundaries, routines, and self-compassion.High (Long-term career sustainability).Self-reflection; Time management techniques; Recognizing signs of emotional exhaustion.

Question pattern recognition

  • Pattern: Feeling overwhelmed by volume/complexity -> Task Triage. The solution is not to work harder, but to filter the tasks into essential, high-yield components and break them down (miniaturization).
  • Pattern: Chronic stress leading to poor function -> Lifestyle intervention. The solution involves regulating the nervous system through routine, physical activity, and limiting digital stimuli (decluttering).

Test yourself

Common mistakes to avoid

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Mistake: Assuming that achieving one major life milestone (e.g., residency match) will eliminate all future worries. Correction: Anxiety is persistent; worry simply shifts to the next challenge.
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Mistake: Believing that "more" effort or more knowledge acquisition always equals better outcomes. Correction: Sometimes, less input and greater focus ("less is more") leads to higher quality output and lower anxiety.
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Mistake: Treating all sources of information (digital/academic) as equally valuable. Correction: Must apply triage; not all tasks or pieces of information are high-yield or necessary for immediate action.

Common traps

⚠️
Trap 1: The "All or Nothing" Trap. Thinking that if you don't study 12 hours a day, your efforts won't count. (Reality: Consistency and distribution are more effective than unsustainable bursts.)
⚠️
Trap 2: The Control Illusion. Believing one can control external outcomes (e.g., board scores, attending decisions). (Reality: Focus only on the controllable inputs—your effort, preparation, attitude.)
⚠️
Trap 3: Digital Dependency Trap. Assuming that all information must be consumed digitally. (Reality: Overload from screens is a major source of anxiety; analog methods are often superior for deep focus.)

Original transcript with highlights

Original transcript with highlights

Welcome, my name is Divine. This is episode 634 of the Divine Intervention Podcasts. And in today's podcast, I'm going to be addressing the topic of titled, Combating Anxiety. Combating Anxiety. Anxiety is a very, very common problem amongst people in medicine. So in today's podcast, my goal is to walk you through what are the causes of anxiety and then give you some very practical tips on how to combat anxiety. Anxiety is at pandemic levels in medicine, amongst medical students, amongst undergrad and pre-meds, amongst people that are resident, amongst attendants. I mean, if we're being honest with ourselves, a lot of people even outside of medicine have anxiety. So if you want to combat this problem, right, or if you want to get some advice on how to deal with this problem, this podcast is going to be very helpful for you. But again, I make no claims that I'm a psychiatrist or anything like that. But I'm just based on experiences I have, I've worked with tons of people, and also just understanding this problem. I'm trying to contribute my own quarter to helping with solving this issue. So the first point I want to establish today is that anxiety is a very common issue. Anxiety is not uncommon in any sense of the word. It is very, very common. And the amount of people that are anxious is rising every single year. And the second thing I will say is that if you can understand the things that feed into anxiety, then you can, excuse me, you can understand the solutions. Right?

Because the thing is it is very hard to deal with a problem when you don't know the path of physiology behind that problem. Right? So what are the things that classically cause people to be anxious? Actually a bunch of things, right? Like number one, for example, in no particular order. Right? Anxiety is caused by that pressure to perform, feeling like, oh, I'm under a lot of pressure. I need to bring home the bacon. Right? Another thing that causes anxiety is when you feel like you're not measuring up to standard. You feel like you're not hacking it. You feel like you're not being as good as other people are. And then another thing that causes anxiety is when you compare yourself to other people. In medicine, we run this comparison game a lot. Compare US Emily scores, compare class rank, compare how many publications you have. Another thing that causes anxiety is when there is too much to do. When you literally have way too much on your plate, there's too much to do. Another cause of anxiety is when you feel like there is too much going on all at once. Literally too much going on all at once. Too much going on all at once. Right? And then another thing that can also cause anxiety is when you feel like things are out of your control. You just feel like, wow, things are going here. I literally have no control over the situation. And then another thing that also causes anxiety is an intense worry about the future. Worrying about, hey, how am I going to get into residency?

How am I going to do well on my practice tests? How am I going to do well on my rotations? How am I going to do well in this and that and this and that? And let me tell you this, if you think that, oh, after you get that thing you're worried about, worries will disappear. That's a huge lie. Right now many people are worried about if they will match or not. After match day starts, the next worry is going to be, how am I going to succeed in residency? After you start succeeding in residency, the next worry is going to be something else. The next worry is going to be something else. There's always going to be a next worry. Right? And then another cause of anxiety is transitions. Literally being able to deal with transitions. Medicine is filled with transitions. There's always something new that is happening. There's always something new that is popping up. Right? And then another thing that also causes anxiety is knowing that you have to deal with difficult tasks. You have to deal with difficult tasks. And the thing is medicine is filled with a lot of difficult tasks. There is a reason why not many people want to go to become physicians. It is not an easy job. It is certainly not an easy career. And then another thing, and maybe the last thing I'll mention that causes anxiety is that people have no sense of direction. Many people just feel like they're kind of musing through life. They feel like they literally have no sense of direction. Like, you know, what do I do?

What do I anchor my life on? Many people don't seem to have that. Right? So guys, all these things that I'm sure other things I've not mentioned can cause anxiety. But I think if you understand that, hey, these are the causes of anxiety. Hey, these are the things that feed into anxiety. Then you can start doing things to deal with it. Right? I'm going to give you some very practical steps and tips for combating anxiety. So how do you combat anxiety? Well, the very first principle I'll talk about is the preventive mindset, the preventive mindset. Right? The preventive mindset. Right? So what exactly does this mean? Well, the thing is many people they deal with self-inflicted problems that are just largely preventable. Self-inflicted problems that are largely preventable. Right? The thing is, again, I said that one of the causes of anxiety is like just having this pressure to perform. Well, what is the formula in physics for pressure? Pressure is literally force over area, force over area. So what can cause high pressure? High pressure is caused by having too much force exerted in too little an area. Right? So how does this apply to anxiety? Well, the thing is when you wait till the last minute, you will feel pressure. Right? So the thing is, in terms of combating anxiety, you don't want to concentrate the deployment of your efforts. You don't spread them out. That will go a very, very long way in curbing anxiety. Right?

You're going to feel less anxious when you're not distributing too much work into too little period of time. Right? Like you see many people, they believe that they have to study for 10 to 12 hours a day to do a little medical school, to do it on the USML Es. You don't have to. Like literally, just start early, distribute the deployment of your efforts and you'll be good. I remember, you know, I took step one back in the day when it was still scored. And this is like really back in the day. I took step one like probably more than a decade ago, about a decade ago at this point. Right? And I remember, I was already scoring around the national average or higher months before my exam. Do you know why? Because my efforts were distributed. I did not wait till my dedicated period to start studying for 12 hours a day and risking intense burnout in studying for step one. No, what did I do? I spread out my studying over my preclinical years of medical school. Right? So I did not have to exert too much force in terms of studying for a very short period of time. Right? Because the thing is that is what the dedicated period ends up being for many people. All that force of studying that they could have exerted in the preceding years, they did not. So they have to concentrate all their studying for a USMLE exam into a defined like four week or six week or eight week period or whatever that you have. Right? So guys literally distribute your efforts.

If you distribute your efforts, that will really reduce your anxiety. All right. Now what's the second principle? The second principle for criminal anxiety is to ask yourself, what standards do you use? Literally what standards do you use? Right? So what's the practical step here? Literally create your standards. Create your own standards. Don't copy the standards of others. Don't imitate the standards of others. Right? Create your own standards. I mean make sure that they are quality standards. Make sure that they are quality standards. Let your standards be quality. Right? And then stick to those standards. Like literally write down your quality standards and then stick to them. Right? One thing I've actually noticed that helps with curbing anxiety is just literally journaling and writing things down. Right? So the thing is comparing yourself to other people is usually not wise. Right? In fact, in the overwhelming majority of situations, it's not wise. There's this Bible verse that says that comparing themselves with themselves are not wise. Right? So comparing yourself to other people is usually not wise. Right? Let me tell you something that you need to accept. There will pretty much always be somebody that is better than you. You need to accept that. There will pretty much always be someone that is better than you. Right? But if you construct quality standards for yourself and you meet those standards, then guess what? Be content with your outcomes.

Be content with your outcomes. Right? See guys, greed is a builder of anxiety. Greed is an anxiety builder. Contentment is an anxiety reducer. Right? So please don't let your life be driven by the success of other people. Right? You see many medical students literally live their lives in the shadow of other people. Don't. Don't. Don't. Right? Challenge yourself. Right? So don't make your life incredibly easy. Don't say, okay, I'll make my own standards. But your standards are like very low. No. Challenge yourself. Right? Make said goals that are somewhat lofty. Right? Right? So challenge yourself. Right on your own standards. But if you meet those standards, just be content with them. Right? Don't put on you pressure on yourself to start shooting for more. Right? Because in that shooting for more, that's how you start becoming anxious. Right? That will start raising your level of anxiety. Right? So for example, if you want to do neurosurgery, figure out what you need to do to become too much as a, you know, too much into neurosurgery, to be a competent neurosurgeon. Right? Set standards and then align yourself with those standards. Right? But the thing is many people in medicine are not content. See guys, be content with what you have. I'm telling you this, your level of anxiety will go down and your level of happiness will go up when you start practicing contentment. Right? Many people in medicine are just not content. Right? Be content with what you have. Right?

The thing is we always seem to have this more, more, more mindset. No, guys, more is not better. More is not better. In fact, in many situations of life, less is more. Less is more. Right? A minimally life style, you know, basically just dealing with exactly what you need and nothing else. Is a low anxiety lifestyle. See, live a low anxiety lifestyle. Stop piecing yourself with the many sorrows of having too much. Just be mindful of that. Okay, so what's the third principle for curbing anxiety I want to talk about? The third principle I want to talk about is something I like to call task triage. What exactly do I mean by task triage? Task triage just means basically curating what you do on a daily basis. Curating what you do on a daily basis. Right? Guys, don't feel your plate with too much. Do not feel your plate with too much. Feel your plate with what matters. Feel your plate with what matters. Right? The thing is people seem to take a lot of pride. And they actually feel very productive when they feel like they have 20 things on their plates. No, guys, do you know what they should be doing? So, if you want to make your anxiety, strip your lives of fluff. Literally strip your life of fluff. Right? Because the thing is those things that all those extraneous things that are on your plate, they weigh you down in running your race of life. Right? They weigh you down in running your race of life. You know, there's this part of the Bible that says, lay aside every weight.

And that's send us so easily beset you. Right? The thing is strip your life of fluff. Right? Those things are going to weigh you down in running your race. Right? Like literally I want to extend an invitation to you today. Literally write down everything you do on a daily basis. Write down every single thing you do on a daily basis. What is your routine of life? Write it down. Right? And then run it through these filters. Run it through some filters. Am I spending excessive time on this? Is this activity? It might spend like seven hours on it every day. Right? Is this a high-yield activity or a low-yield activity? Is this non-negotiable? Is this something that is nice to do, but not necessary to do? Right? The thing is if you can boil down your daily schedule, if you can boil it down to a very limited number of meaningful items, your anxiety is going to go down significantly. Right? And one thing I want to say here is be very wary of the temptation to start adding back tons of stuff after you've whittled things down. No, don't recreate the problem that you've just solved. Right? Don't come back and reclutter what you have already decluttered. Right? Because the thing is clutter creates anxiety. Clotter creates anxiety. But decluttering minimizes anxiety, decluttering minimizes anxiety. Right? And let me tell you this. Apply this role to your physical species. Apply this role to your physical species. Right? Keep clean, minimalist physical species. Right?

This can actually really help with curbing anxiety. When your home looks like a lion's den or like a pig's thigh, you're definitely going to feel more and more anxious. Now principle number four, I'm going to talk about is decluttering your mind, decluttering your mind, decluttering your mind. Right? Let me tell you something that here folks, a decluttered mind is less anxious. A decluttered mind is less anxious. Right? See, heavily minimized literally stay away from the clutter creator of screens. Screens are a form of their big time clutter creator. And I'm going to explain why that is the case. Right? The thing is you really don't want your mind becoming like a web of pop-ups. You don't want your mind becoming a web of pop-ups. Right? That's literally how some people's minds work these days. Right? It's almost like something is always popping up in their minds. Right? So the thing is how can you declutter your mind? Well, minimize screen time. Minimize screen time. Minimize social media use. Maximize physical things. So what are the things you want to minimize? Screen time. Social media use. What are the things you want to maximize? Maximize the use of physical analog things. Of physical analog things. Right? So ask yourself, is this thing I'm doing every day? Can it be done with pen and paper or be experienced in a more analog way? If you can find a more analog way to experience something, spring for that instead of the digital method.

So you may be wondering divine, why are you recommending analog over digital? Let me explain. See, guys, ads, pop-ups, they cannot manifest themselves on a piece of paper. I don't think any tech company has figured that out yet. Notifications cannot show up on a piece of paper. It is only what is there and only what you write that can show up literally. Right? Only what is there, only what you write that can show up. Right? So that way you don't overload your brain with too much data to consume. Right? Because the thing is brain overload from all this data that you consume from screens and social media. It's very subliminal, but it really raises your level of anxiety because you're literally choking your brain. It's almost like you're feeding your brain a hundred hard dogs. Right? Many people don't understand this, but people's brains are too overloaded. Right? When something is regulated, it is more likely to be sustainable. But when something is overloaded, it is more likely to blow up. Right? So, guys, declutter your minds. Declutter your minds. Right? The thing is, most screens, most social media platforms, there's just way too much going on all at once. So your brain is literally struggling to deal with all that data that it's seeing. All right. Now, what's principle number five? Principle number five is to avoid over-control. Avoid over-control. Too much control. What exactly do I mean by this? Well, control what you can and ignore what you can't.

Control what you can and ignore what you can't. Right? If you cannot control something, literally trash it out of your mind. Trash it out of your mind. Right? The thing is, many people, especially many of the type A personalities we see in medicine, they're intensely controlling. I want to give you some piece of advice this morning. Give up. Literally give up. Give up. Right? You cannot control everything. But there are some things you can control. Your level of effort is within your control. Right? So why don't you control? Why don't you concentrate your efforts in things that you can control? And stop wasting physical and mental strength in things you cannot control. Right? Concentrate your efforts in things that are within your control. Right? But you see many people they concentrate their efforts, they concentrate their brain power literally in things that they cannot control. Right? And since they cannot do anything about these things that they cannot control, they feel helpless and then guess what? Anxiety builds up. When you are in a state of helplessness, anxiety begins to build. Right? You may notice that a kind of a fairly common thread through many of these principles I'm talking about today is to basically remove things you don't need. A thing that you don't need, a thing that you don't have control over. Remove those things from your life. Right? So please keep this in mind that a life with less anxiety is a life that is streamlined. Right?

So when something comes your way, just ask yourself the following, hey, can I do something about it right now? If yes, then do something. That's probably something within your control. But if the answer to that question is no, or at least you cannot do anything at that time, guess what? Let it go. Let it go. Let it go. Don't let that thing even linger in your mind because let me tell you this. A big source of anxiety is left in things that are out of your control, linger in your mind. Literally guys, watch what you let linger in your mind. Watch what you let linger in your mind. All right. Now what is the sixth principle for Kirby and anxiety for dealing with anxiety? Well, the sixth principle is to have long term plans, but worry about today only. I'm going to say that again, have long term plans, but worry about today only. Guys, see, just focus on today. That's your job. Just focus on today. Right? Because the thing is you need to realize this. Your future is literally the cumulative effect of how your individual days go. Right? So as long as you focus on having strong days, or you know, every day is not going to be a strong day, but as long as most of your days are strong days, then guess what? Your long term future will work itself out. Right? Because you see many people they paralyzed themselves in the present by being overtly worried about tomorrow. They literally paralyzed themselves in the present. Right? See, guys, every day has enough trouble on its own. Right?

If you even look at the book of Matthew chapter 6 verse 34, it's a book in scripture, right in the Bible, you're going to see this every day has enough trouble of its own. Right? So why don't you focus on the staring you in the face problems of today instead of wasting brain energy on what may be hypothetical problems of the future? In fact, have you noticed that many times things that people heavily worry about, those things end up never coming to pass. They end up never showing up. Right? They end up never showing up. But then you've wasted time dealing with hypothetical problems that never popped up. Right? So the thing is those future problems, they may not even show up at all. Right? But you've literally burned mental energy. You've literally raised your anxiety thinking about them in the present. Right? So please, guys, don't steal peace from your present by being unnecessarily worried about the future. That is not a smart way to live your life. All right. Now, what is the seventh principle I want to discuss for dealing with anxiety? Well, it's this statement and I'm going to say twice. This two shall pass. I am currently a novice, but I will become a master in due time. This two shall pass. I am currently a novice, but I will become a master in due time. Right? The thing is, as long as you're working hard and doing what you need to do in life, this statement will very likely be true for most circumstances that you face. Right?

Let me tell you this because I told you earlier that one of the causes of anxiety is transitions and there is lots of transitions in medicine. Right? The transition from being pre-med to being met student transition from being a pre-canico medical student to being a clerkship student transition from being a clerkship students to becoming a resident or the transition from being a resident to becoming an attendant medicine is filled with transitions. But if you have this mindset that I've just proposed, it's an excellent way to handle transitions. Because think about this. Do you remember when you started medical school and did not know much? Are you still that same person? Right? Or remember when you started third year, are you were terrible at writing notes, interviewing patients, pre-rounding? Have you not changed since then? Right? Have you not changed since then? Right? So just remember, as long as you may not be able to control the transitions you're dealing with, well you can control your approach to transitions. Right? Just remember that hey, as long as I'm working hard, these processes will ultimately work themselves out. And over time, you will become better. You need to have that believe that I'm in Amanovis now, but I'll become a master in the process of time. Right? So how should you look at transitions? Basically look at the transitions you face as evolutions of you, as a you evolution in going from being a novice to being a master.

In fact, let me tell you this, be excited about transitions. That's how you grow. Right? Think of it as a new opportunity to accumulate mastery, to accumulate expertise in something you did not know about. Alright, now what's principle number eight for dealing with anxiety? Well, principle number eight is creating detailed manuals. Creating detailed manuals. Why am I talking about this principle? Well, I told you earlier that one of the causes of anxiety is handling a lot of difficult things. And the truth is, there's a lot of difficult things in medicine. Right? But let me tell you this, almost everything in life, regardless of the level of difficulty can be surrounded by taking it and breaking it into a series of steps. That's why I said create detailed manuals. Right? I'm telling you this, guys, this is something that has helped me tremendously a lot in life. I take something that I know is difficult and I create my own divine manual for it. Right? The thing is, guys, difficult tasks are bound to create anxiety. That's why they are difficult in the first place. Right? Reduce this anxiety by creating a checklist, creating a manual of some sort for handling these tasks. Right? And then once you've created this manual, you've created this checklist. You've created this checklist is literally like you've created a roadmap, follow this manual, follow this checklist, follow this roadmap. Right? See, that task that you've broken down, it will not seem as nebulous anymore. Right?

I remember when I started my time in the ICU, you know, during a residency slush, being a medical student, it caused me a lot of anxiety. Right? The ICU is a very, very intimidating place. Very, very intimidating place. What did I do? I took the difficult tasks. Hey, how are not written in this ICU? Hey, how is pre-rounding done in this ICU? Hey, how is rounding done in this ICU? Right? How are patients interviewing this ICU? How are patients checking on in this ICU? Right? I started taking the difficult tasks and I literally made manuals. I literally made checklists. I literally made roadmaps out of these complex tasks. And the thing is literally within a few days, I was very much at home within the ICU. I started crushing it in the ICU. Right? I got hyper efficient in the ICU. I got very excellent in the ICU. Right? So let me tell you this guys, if something scares you, break it down. Literally, if something scares you, miniatureize that scary thing. Right? When something scary and nebulos is miniatureized, it gets less scary and less nebulos. Right? And just one side point I want to say is that whenever you have life routines, whenever you leave your life by routine, it actually reduces your anxiety because it's almost like you're literally running your life on autopilot. Right? So creating routines is actually a very good way to curb anxiety. All right. Now let's go to principle number nine. What is principle number nine?

Well, principle number nine is having direction by believing in something. Right? Having direction by believing in something. Right? The truth is anxiety for many people is caused by going through life with no sense of having an anchor. Right? And see, I'm not here to tell you what to believe. Right? But many of you that listen to my podcast, you know that I'm a Christ follower. Right? You know, my relationship with God, it provides a very big foundation for my life. And someone and something I always run to when things are good or when things are tough, it's a foundation for my life. Right? So the thing is by having a relationship with God, you know, by having a relationship with God by being a Christian, I have some sort of guide as to how I should live my life, you know, aka the Bible. And how I should relate with other people. Right? It literally gives me something to go on to go on, you know, to go off of when I feel like every other thing has failed. Right? And the thing is there's, you know, many of us I know we're scientists, right? There's literally scientific studies that bear this out. Right? That doing things like reading scripture, meditating on scripture, thinking about scripture, right? Singing songs of worship, praying, they all help with calming the mind. And let me tell you this guys, that's actually one of the secret weapons I have. Right? Right?

Before I start my day, probably like 99.9% of the time, I go through these activities, reading scripture, meditating on scripture, singing songs of worship, praying, they all help with calming my mind. So I literally start off my day with things that are literally built to curb anxiety. I do this every morning before I do practically any other thing. The only time I don't do this, in fact, whenever I start a day and I've not done these activities, can I tell you this? That day usually ends up not going well. I end up feeling very anxious in that day. So like, believing something, it can really, really help with curbing anxiety. Right? Although one thing I'll just say as a caveat here is be careful of what you meditate on. Right? Some people meditate on things that actually ends up building up anxiety in them instead of curbing anxiety. Right? So again, just remember that the things you are thinking about, the things you are meditating on, make sure that they are not things that will build anxiety. Right? Even the Bible says, whatever things are true, whatever things are lovely, whatever things are of a good reports, you know, there's all this criteria, the Bible talks about. Right? He says, think on these things. What would you think about? Right? What you think about can literally control what your life is about. I'm going to say that again, what you think about literally is heavily related to what your life will be about. Right?

So if you spend your time thinking about things that will trigger anxiety, guess what? You're going to become an anxious person. As a man thinks in his heart, so he is. All right. Now let's talk about principle number 10. Principle number 10 is actually a very simple principle. And I like to call it, and I learned this. I mean, it's something I've always, I've, let me not say I've always done, but I try to do. But there is an attending that I work with right now that basically simplified this principle for me. And you know, this principle number 10 is, follow your AB Cs. What do I mean by AB Cs always be calm always be calm. Let me tell you this guys. Calmness is a conscious decision. Calmness is a conscious decision. Again, you may not have control over your surroundings circumstances, but you have control over your response to those circumstances. Right? Being calm helps to slow down life so that you can be constructive in your thoughts and you can be constructive in your actions. Right? When there is chaos around you calm down stay calm. Right? When you stay calm, it builds up wisdom. And then it keeps you in very, very sharp focus. It makes your mind hyper focused so that you can mount a strong offense to the problem that is staring you down. Right? So just remember, hey, you know, when I'm at the Prometric Center calm down when I'm in Tervino patient calm down when you're doing with high stick stones calm down always be calm.

It is very helpful in killing the anxiety associated with difficult things in killing the anxiety as we do with high sticks moments. And then the last thing I'm going to say principle number 11 is seeking professional help. Okay. We all need help at some point in our lives. Right? We all need someone else that can sometimes help us bear burdens. Right? So if you're really struggling with anxiety, there's nothing wrong with seeking professional help. Okay. So if you love the way I teach, I'm going to stop here. If you love the way I teach, you're going to love either getting one or one to learn from me or attending my classes. I'm a person that is very big on calmly explaining things well for people to understand showing you the way it's going to present on you exams, showing you how to integrate things from multiple perspectives. Right? I do want to want to learn but also have a series of classes I teach right for step one to three. I teach a test taking class that's two and a half hours long a bio stats class that is four hours long and a social sciences quality improvement ethics hospital medicine class that is five hours long. Right? Those are for step one to three and then for step two and three specifically I have a last mini review that's three hours long actually have one taking place this evening over zoom all my classes over zoom.

And I'm the one that teaches all my classes and then I have a 20 hour class that runs over five days that's also for step two and step three and also obviously for level two and three. And then I have a 50 hour class that's held once a year that one has very limited spots available and it's a class where we go through 500 multiple choice questions and a lot more in just making you like a step two step three level two level three genius. In fact, I have some people that are preparing for a residency that about to start residency that literally attend that class just to help them bring back everything from medical school so that they are ready to step into residency with a lot of confidence and then they notice that wow I'm crushing it as a resident. So if you're interested in any of my classes or my one on one tutoring or the work I do with people for errors applications, mock interviews, personal statements and all those things shoot me an email through the website and I can give you some more information. Again, my classes and the one that teaches all of them my tutoring and the one that does it I don't subcontracted out to somebody else.

There's no like teaching assistant that I work with is just me so that's why my availability is limited right so I don't have unlimited time there is only so many hours in a day right so if you know you need help or you know that you want to take advantage of any of these things reach out to me early so you can get something on the schedule. And then I have these podcasts on Apple Google and Spotify so check those out. I have a You Tube channel where I post the videos that I make so check that out and then I have another website called divine intervention life lessons dot com. Divine intervention life lessons dot com actually have almost 400 podcasts on there and actually there's an Apple podcast associated with that called the divine intervention life lessons podcast but basically every week I post one or two podcasts where from a biblical perspective address a life lesson. So I think I'm going to go ahead and stop here today but again I can really assure you that if you follow the steps and the tips that I'm propounding in this podcast it can really really help with curbing anxiety right they may always be some baseline level of anxiety but you know what bring it down to as close to zero as possible or completely zero if possible right again there's this statement from the Bible as I kept this of that says be anxious for nothing be anxious for nothing right. Be anxious for nothing try to not let anything get to you right that is the higher way to live your life.

So until episode 635 have a wonderful day.

Practice questions — USMLE style

Question 1 — Behavioral Science

A medical student, highly anxious about upcoming board examinations, feels overwhelmed by the sheer volume of material and struggles with test preparation. She tends to cram all her studying into a few intense weeks leading up to the exam, believing that this concentrated effort is necessary for success. Based on principles of learning science and anxiety management discussed in cognitive behavioral therapy (CBT), which strategy should she adopt to reduce performance anxiety?

  • A) Increasing her study hours by dedicating 12-hour days to maximize immediate knowledge retention.
  • B) Focusing solely on high-yield topics identified by peers, ignoring foundational material.
  • C) Spreading her learning efforts consistently over the entire preclinical years rather than concentrating them just before the exam.
  • D) Creating a detailed manual for every single topic and memorizing all minute details to ensure comprehensive coverage.

Answer: C. The core principle discussed is that intense concentration of effort (cramming) creates high pressure, which exacerbates anxiety. Spreading efforts over time (distributed practice) allows the material to be absorbed more effectively and reduces the acute feeling of being overwhelmed by a short deadline. This aligns with principles of optimal learning curve management.

Question 2 — Psychiatry/Psychology

A resident physician frequently compares their performance metrics—such as USMLE scores, publication count, and class rank—to those of their peers. When they fall short of these perceived standards, they experience significant anxiety and feelings of inadequacy. A mentor advises the resident to shift focus away from external comparisons and instead establish personal, quality-driven goals. This advice primarily addresses which psychological mechanism contributing to professional burnout?

  • A) Cognitive load theory, by reducing the amount of information processed simultaneously.
  • B) The tendency toward catastrophic thinking regarding future career outcomes.
  • C) External locus of control, leading to dependency on others' validation.
  • D) Social comparison theory and perfectionism driven by external standards.

Answer: D. The resident is engaging in social comparison (comparing self to peers). This behavior, when coupled with the pressure to meet unattainable external benchmarks, fuels anxiety and perfectionism. The intervention—setting personal quality standards—aims to shift the locus of control internally and reduce reliance on others' metrics for self-worth.

Question 3 — Cognitive Behavioral Therapy

A primary care physician is struggling with "decision fatigue" and feels overwhelmed by the sheer number of non-essential tasks, administrative duties, and minor patient complaints that accumulate in their daily schedule. They feel they must address every single item to feel productive, leading to chronic anxiety. To implement a structured approach to managing this workload and reducing cognitive overload, which technique should the physician utilize?

  • A) Implementing "massed practice" by dedicating long blocks of time solely to complex tasks until mastery is achieved.
  • B) Utilizing task triage to filter daily activities, prioritizing only high-yield, non-negotiable items while eliminating low-value fluff.
  • C) Increasing screen time for research and reading online forums to gather more information on potential solutions.
  • D) Adopting an "over-control" mindset by attempting to manage every variable in the patient's life to ensure optimal outcomes.

Answer: B. Task triage involves curating daily activities—filtering out non-essential or low-yield tasks ("fluff") and focusing only on what truly matters. This process of decluttering the schedule minimizes cognitive load, which is a direct intervention for reducing anxiety associated with feeling overwhelmed by too many demands.

Question 4 — Cognitive Psychology

A medical resident who experiences high levels of anticipatory anxiety about future career milestones (e.g., "Will I get into residency?" or "How will I succeed in my first year?") often spends mental energy worrying about hypothetical problems that may never materialize. To mitigate this chronic, forward-looking worry and improve present functioning, the most effective psychological intervention is to teach the resident to:

  • A) Engage in rumination by repeatedly analyzing past mistakes to prevent future errors.
  • B) Practice "mindfulness" techniques focused on anchoring attention solely to the immediate tasks and current environment.
  • C) Increase reliance on external validation (e.g., peer scores, mentorship praise) to feel secure about the future.
  • D) Develop a rigid schedule of activities to eliminate all potential sources of uncertainty in their life.

Answer: B. The principle discussed is focusing on the present moment ("worry about today only"). Mindfulness techniques train the individual to anchor their attention to the here and now, thereby reducing the mental energy wasted on hypothetical future problems (anticipatory anxiety). This prevents the "paralysis of the present" caused by excessive worry.

Quick fire review

What is a primary cause of anxiety in medicine?

Comparison to peers (e.g., USMLE scores, class rank) and the pressure to perform.

If I feel overwhelmed by too many tasks, what principle should I apply?

Task triage—strip my life of fluff and focus only on what matters.

What is the concept of "distributing efforts" in studying?

Spreading study time over a long period (preclinical years) rather than concentrating all effort into a short, intense period (cramming).

When facing difficult tasks that cause anxiety, what should I do?

Create detailed manuals or checklists; break the task down into smaller, manageable steps ("miniaturization").

What is the core advice regarding future worries versus present actions?

Have long-term plans, but worry about today only. Focus on strong days in the present to build a good future.

How can I reduce anxiety related to transitions (e.g., student to resident)?

Adopt the mindset that "this too shall pass" and view transitions as opportunities for evolution and mastery.

What is the relationship between greed and anxiety?

Greed is a builder of anxiety; contentment is an anxiety reducer.

Which principle advises controlling my response to circumstances rather than trying to control the circumstances themselves?

Following your AB Cs (Always Be Calm). Calmness is a conscious decision.

What does "decluttering the mind" primarily involve in modern life?

Minimizing screen time and social media use, and maximizing analog experiences.

If I feel anxious because of things outside my influence, what principle should guide me?

Avoid over-control; control only what you can and ignore what you cannot.

What is the benefit of having a strong personal belief system or anchor (e.g., faith)?

It provides a foundational guide for life decisions and helps calm the mind when other things fail.

When dealing with anxiety, why is it important to write down daily activities?

To run them through filters (high-yield vs. low-yield) and identify areas where time can be cut or streamlined.

Quick recall / Anki-style questions

What is the relationship between greed and anxiety?

Greed is a builder of anxiety; contentment is an anxiety reducer.

Which principle advises controlling my response to circumstances rather than trying to control the circumstances themselves?

Following your AB Cs (Always Be Calm). Calmness is a conscious decision.

What does "decluttering the mind" primarily involve in modern life?

Minimizing screen time and social media use, and maximizing analog experiences.

If I feel anxious because of things outside my influence, what principle should guide me?

Avoid over-control; control only what you can and ignore what you cannot.

What is the benefit of having a strong personal belief system or anchor (e.g., faith)?

It provides a foundational guide for life decisions and helps calm the mind when other things fail.

When dealing with anxiety, why is it important to write down daily activities?

To run them through filters (high-yield vs. low-yield) and identify areas where time can be cut or streamlined.