Therapy & Self-Care
The last step in the SMART wellness framework is Therapy & Self-Care. The mindfulness-based activities and structure in SMART can help you manage stress in school, but they do not replace therapy. There may be times when therapy with a therapist could be the support that you need. Self-awareness is a strategy for determining your needs and the need to engage with a therapist. Therapy is also a form of self-care. However there are many other aspects to self-care that can get lost during medical school, such as basic self-care. There are also a variety of ways to incorporate more self-care into your daily routine that adds balance and can be preventative as well.
Several research studies have shown that therapy is an effective intervention for medical students, such as psychotherapy, cognitive behavioral therapy, mindfulness-based stress reduction, and mindfulness-based cognitive therapy (Noor et al., 2025; Yin et al., 2023; Xu et al., 2019). Below is a link to one example of this research. Engaging with a therapist, especially during medical school, is beneficial because they are a neutral and accepting person who can you help you manage stress, emotions, and challenges more effectively than trying to do it on your own.
This step is crucial because sometimes medical students will feel stigma around reaching out to a wellness program or therapist. Avoiding care when you need it can lead to increased symptoms of psychological distress, which can also lead to a decrease in performance. It may also feel like it's going to be a burden, however you will be building rapport with a confidential and non-judgmental professional who can help you manage stress on an ongoing basis.
Xu, Y.Y., Wu, T., Yu, Y.J., Li, M. (2019). A randomized controlled trial of well-being therapy to promote adaptation and alleviate emotional distress among medical freshmen. BMC medical education, 19(1), 182. https://doi.org/10.1186/s12909-019-1616-9
Therapeutic Support
SMART is a practical wellness approach that combines mindfulness with structure and routine for managing stress in medical school, but it does not replace therapy or traditional therapeutic approaches. Sometimes students need a therapeutic approach with a therapist to help them manage disruptive symptoms such as extreme anxiety, panic attacks, insomnia, imposter phenomenon, and emotional distress.
Often times, medical schools will have therapeutic supports in place for these situations such as student wellness programs, access to a psychiatrist, and health insurance that covers mental health treatment. Therapeutic treatments that can help you with these symptoms are psychotherapy, cognitive behavioral therapy, and mindfulness-based cognitive therapy.
There are a few ways you can find the therapeutic support you need. You can start with the student wellness program that is offered by your school. These programs provide therapy with licensed clinicians, and they can also help you connect with therapists outside the school for more specialized treatment. You can also find therapists through popular sites such as Psychology Today or Headway. These sites will allow you to filter out for your insurance as well as other preferences. Many licensed clinicians have evenings and weekends as well as virtual appointments making it easier for clients to participate in treatment. It's also important to note that it is common to meet with more than one therapist until you find the right fit, so don't be discouraged if you meet with a therapist for several sessions and don't feel as if it's a good match.
PSYCHOtherapy
Psychotherapy can help resolve past challenges and rewrite narratives
cognitive behavioral therapy
CBT was developed by psychiatrist Aaron Beck and works to reframe automatic negative thoughts
mindfulness-based stress reduction
MBSR was developed by Jon Kabat-Zinn and uses meditation and mindfulness to manage stress
mindfulness-based cognitive therapy
MBCT was developed by Jon Kabat-Zinn and combines mindfulness techniques with CBT
Watch Dr. Miller, an expert in cognitive behavioral therapy and mindfulness-based cognitive therapy, explain the difference between the two approaches
Self-Care
During medical school, it is important to maintain self-care. Recent studies have found that self-care and balance are essential coping strategies for the medical profession in order to deliver effective care to patients (Picton, 2021). Self-care can be described by several different practices and activities. The most common are taking care of basic needs, such as eating healthy, drinking water, getting enough sleep, taking medications as prescribed, and maintaining hygiene. Often times medical students will be so focused on studying that they forget to take care of these basic needs, which can then affect your ability to stay focused, positive, and prevent burnout.
Self-Care Activities
In addition to ensuring your basic needs are being met, there are other self-care activities that are important to discuss. For example, mindfulness-based self-care activities, some of which were described in Step 2 of SMART, consist of reading, stretching, and journaling.
Many self-care activities are as simple as taking 5 minutes to mindfully drink your favorite hot beverage, engaging in aromatherapy when you get home, taking 5 minutes to meditation, taking a rest, spending time in nature, or spending quality time with friends or alone watching an episode of your favorite show.
These simple self-care activities may sound trivial, but they aren't when you are practicing them mindfully. Practicing self-care mindfully reinforces the cognitive behavioral benefits of positive reframing. When you are mindfully engaged in a simple, pleasant activity you are sending the message to the body that you are worthy of a 5-minute break and you are in fact taking one. This reduces defeating and negative self-talk such as 'I never get a break.'
Other self-care activities consist of setting boundaries for yourself and others, such as in your relationships. Sometimes medical students may need to set boundaries or use clear effective communication with friends and family who aren't familiar with the challenges of medical school. Recognizing your limits is also important in preventing feeling overwhelmed and burnout. Learning ways to self-regulate negative emotions is also a form of self-care that will work towards achieving emotional resiliency and flexibility. These self-care strategies can all be achieved through therapy.