On the surface, promoting your own mental health may seem simple and straightforward. In fact, it can be complex, and physicians — like everyone else — can benefit from information and education about how to improve their mental health.

As discussed in previous chapters, cultural myths may distance us from a real understanding of our mental health. Myths are embedded ideas that are typically unconscious, but have been stated and promoted so often in popular culture that people have come to accept and believe them. They often guide our thinking and behaviors.

It's essential to recognize myths and refute them directly so that they don't unconsciously control us. Common myths may include:

• Physicians are less likely than others to develop negative mental health symptoms.

• Because physicians are smart, they can handle stress more easily than others.

• Physicians are more skilled than others with handling mental health symptoms.

• All physicians understand mental health diagnoses and treatments.

None of these are inherently true. The truth is that most physicians don't recognize the difference between "not feeling right," "burnout," normal stress, and a diagnosable mental health condition.

Frequently, physicians who feel that something is not quite right try to diagnose themselves. They may look for information online or reach out to close friends and/or colleagues to sort through and better understand the symptoms.

Although seeking and receiving support from friends and family is a good strategy for promoting mental health, it's not the best way to reach conclusions about your mental health. The same goes for the internet. Relying on personal acquaintances and online information may give you a sense that you understand your mental health, but that "understanding" is often based on limited, anecdotal, one-dimensional information that may be inaccurate.

We are living in a time when "labeling" is perceived to be equivalent to "promoting" our mental health. But labeling symptoms is only helpful in so far as it suggests a pathway for intervention, reducing negative symptoms, and generating feelings of self-efficacy.

It's common to hear people announce their self-diagnosed mental disorders: "I have anxiety." "I am anxious." "I have OCD." Very often, these diagnoses are based on limited and perhaps faulty information about a perceived symptom rather than an accurate analysis of below-surface symptoms.

The concept of developing a working relationship with our mental health may be unfamiliar, but it's important to maintaining optimal health.

Promoting or improving your mental health involves establishing some new habits and routines. This process requires time and energy, which can appear to be barriers, because most physicians feel they can't add one more thing to their day. Finding time for others is one of the many physician skills required for success, but the shift from finding time for others to making time for yourself may seem daunting. Think of it as developing new habits, which takes time and effort.

Because your mental health must be a top priority, you must make time every day to learn about it. Mental health awareness is akin to learning a new medical procedure. It requires desire, practice, and repetition with feedback from others.

Mental health — like physical health — is fluid. We live within a spectrum of health and unhealth that requires awareness and practice to create balance.

The activities that promote mental health are numerous and specific to the individual. A common menu of evidence-based activities includes:

• Journaling

• Meditation

• Exercise

• Establishing a new hobby or activity

• Volunteering

• Setting aside unstructured time to do whatever you want

Change is often difficult and brings feelings of discomfort. Tolerating and working through this discomfort increases our ability to understand our behaviors.

From a psychological perspective, small changes in routines and habits can lead to more profound change. For example, exercise is known to give a mental health boost. A busy physician may find it impossible to get to the gym on a regular basis, but a small change in your routine — say, walking for 10 minutes during your lunch break — may be doable. Your mood may then improve sufficiently that you'll incrementally increase your activity, maybe by walking longer after work or on the weekend.

Creating new habits that promote mental health can reduce negative feelings or symptoms and prevent the onset of new symptoms. In other words, positive mental health habits inherently fuel positive mental health.

Keep in mind that the first step in forming new habits — performing the new activity consistently — is the most important.

Journaling sometimes gets a bad rap, but decades of research document that expressive writing can improve physical and mental well-being. One study found that people diagnosed with clinical depression who wrote for 20 minutes a day for three consecutive days had significantly lower depression scores the following day than did those in a control group. Four weeks later, many people in the journaling group still had significantly lower depression scores, and some no longer met the criteria for clinical depression.

The purpose of journaling for mental health is to know ourselves better by asking simple questions that are difficult to answer. One such question: "How do I feel?"

A good way to explore that question is to use "I" statements. Write down as many statements beginning with the words "I feel" as you can think of.

Here's what that might look like:

• I feel mad when my partner yells at me for falling asleep on the sofa at 8 PM.

• I feel exhausted by all the things I have to do.

• I feel like I work harder than other people I know.

• I feel like I get mad easily.

• I feel undervalued at work.

• I feel overburdened at work.

• I feel unseen.

• I feel like I am stuck on a hamster wheel and every day is the same.

• I feel like I am alone.

This activity — writing how you feel — can be incredibly powerful but most people find it very difficult. To ease the difficulty:

• Accept emotions. This exercise usually elicits very strong emotions. Just sit with them and let them pass.

• Learn from this exercise by underlining the feelings you wrote down. This will help you recognize those feelings more easily in the future.

• People tend to have certain "preferred" feelings. If you see the same or a similar word multiple times, circle it.

Next, flip the page and write a list of things you are grateful for. Be sure to include your gratitude even for things that seem minor.

• I am grateful for my colleague who says "Good morning!" to me every day.

• I am grateful for my patient who finally stopped smoking.

• I am grateful when the line at Starbucks is short.

• I am grateful that I don't have call duty this weekend.

• I am grateful my partner folded that load of laundry.

• I am grateful it is fall and the leaves are so colorful.

• I am grateful that my child said "I love you, Mom."

• I am grateful for the healthy food I will eat for dinner tonight.

This activity should be done daily for at least 2 weeks. If you skip a day, don't abandon the effort. Return to the exercise as soon as you can and keep with it for at least 14 days. Your goal is to collect 14 days of data about your feelings.

After 14 days, look through your circled words and write them down. These are the feelings you are looking to reduce. Contrary to pop-culture advice about gratitude, negative feelings do not go away just by thinking of all the things we are grateful for. Rather, everyone has negative feelings and sources of gratitude. It is simply essential to separate for yourself your negative experiences and your gratitude.

With a better understanding of your negative feelings, you can target specific actions that can reduce those feelings. The "feelings" list reveals several themes, including mad, overworked/overtired, lonely, and stuck.

• I feel mad when my partner yells at me for falling asleep on the sofa at 8 PM.

• I feel exhausted by all the things I have to do.

• I feel like I work harder than other people I know.

• I feel like I get angry easily.

• I feel undervalued at work.

• I feel overburdened at work.

• I feel unseen.

• I feel like I am stuck on a hamster wheel and every day is the same.

• I feel like I am alone.

Feeling are also symptoms. Once you have identified how you feel, ask yourself this question: Do these feelings have a negative impact on my ability to meet the demands of my work and my life outside of work?

Without giving proper attention to their feelings, many people attempt to reduce negative feelings with behaviors that elevate mood and energy in the short term. Alcohol, food, caffeine, and video games are examples of distractions that people use to cope with negative feelings, and all of them can cause us to fall out of balance.

When negative feelings or symptoms are hurting cognition and behavior to the degree that they affect your performance at work, home, or both, it's time to seek support from a trained professional.

There are many mental health resources to choose from. Asking a trusted colleague in psychology is a good way to get recommendations for mental health providers with the experience and skills needed to work with physicians.