“If they only knew … I am a total fraud and everyone is about to find out.”

If you have ever felt this way, you are familiar with imposter syndrome — that gnawing feeling of self-doubt and incompetence coupled with the dread of being exposed as a fraud.

People with imposter syndrome feel inauthentic, question their ability to be successful and are convinced that they do not belong in the roles they hold, even when they experience success. Women are especially vulnerable to imposter syndrome, though I know a number of wildly successful men who suffer from it too. As a male patient once commented during a session: “When are they going to pull the curtain back and realize that I just got lucky?” He had just made partner at a highly competitive New York City law firm and was in his early forties. “Unworthy” was the adjective he used to describe himself.

There is evidence that men and women experience imposter syndrome differently — men who feel like imposters have more anxiety when they receive negative feedback and as a result, exert less effort, whereas women who feel like imposters do the opposite. Both live in constant fear of being “discovered” and, rather than proud or accomplished, feel undeserving of the recognition or respect they receive.

My mother-in-law loved music, art, and food. Her hearing was selective at the dinner table. If a guest dared to decline a dish, she ignored them. She would place the food in front of the person and say, “I am just going to leave it here. Just in case. You never know….”

She died last week at the age of 87. While expected, her passing was still a blow. My husband spent months preparing for it but to paraphrase Kathryn Schulz one’s unresponsive and dying parent is, in some extremely salient way, still alive. Imagining her gone is not the same as living in a world without her breathing in it.

To make better use of our time and to crawl out from under the mound of French Fries, Harvard professor Arthur Brooks in a New York Times article suggests approaching each day as if you had one year left to live. If an activity doesn’t pass the “last-year test,” don’t do it:

It takes a great deal of courage to make an appointment with a psychiatrist. Oftentimes there is a lag between obtaining a therapist’s number and making the call to set up an appointment. I can only imagine how many crumpled up pieces of paper with a psychiatrist’s name and phone number are buried in coat pockets and at the bottom of handbags representing a fleeting moment of intention.

People usually make an appointment to see a therapist during periods of change or transition — in between relationships, in between jobs, in between the known and the unknown. Turning points bring people to the threshold of a therapist’s office. The psychiatrist inquires about symptoms and tries to help them figure out ways to successfully navigate their way through this difficult time. “So, tell me, what is bothering you?” is a common icebreaker.

The focus is on what is going wrong in their lives. After all, that is what brings them in the door. It makes sense.

Or does it? A few years ago a patient, let’s call her Claire, made me question this approach. I had been seeing her for several weeks when she abruptly terminated treatment.

All we do is talk about the bad stuff in my life — what I worry about, what’s upsetting me. I sit in your office and complain for 45 minutes straight. Even if I am having a good day, coming here makes me think about all the negative things.

I never saw her again but her words stayed with me. They stung. She was right. All we did was talk about what was wrong. I had spent years studying damage, deficit and dysfunction in the human mind. It never occurred to me to focus on what was right.

Research suggests it might be time to turn this strategy on its head. Instead of focusing exclusively on repairing a patient’s negative thinking and behavior, therapists may want to consider spending some time building upon their patients’ strengths.

In a study, patients with depression were divided into two groups — half received a classic “deficit-based” treatment that was tailored to work on their weaknesses and symptoms. The other half participated in a strengths-based treatment that targeted the patient’s capabilities and the skills the patient was already good at.

The researchers found that deliberately capitalizing on an individual’s strengths outperforms treatment that focuses on an individual’s weaknesses. This challenges the assumption that we need to fix problems before focusing on anything else.

Today, instead of exclusively troubleshooting with my patients, I also look for bright spots. I inquire about what they are like at their best. I recommend the write down what went well at the end of each day. We explore their strengths and I ask them to use them in new ways. I ask them to consider how they might creatively use that strength to help them navigate their way through a challenging situation. I suggest they look for strengths in others. Thinking about what they admire in someone provides a shift in perspective. Rather than focusing on what they don’t like about the person or their negative qualities, they are reminded of what they appreciate.

We can all benefit from a similar shift in perspective. Catch your child doing something right today. Give a compliment to a friend. Congratulate a co-worker on a job well done. Thank a loved one for a gesture you take for granted. Focusing on what’s right in yourself and others may be just what the doctor ordered.

Are you sad, worried or stressed? If you answered yes to any of the above, please know you are not alone. In 2021, four in 10 adults worldwide said they experienced a lot of worry (42%) or stress (41%), and more than one in four experienced sadness (28%) according to a Gallup survey.

Women are having the hardest time

In 2021, they were more stressed, worried, and sad than they were in 2020 — or at any point in the past decade. Stress and worry each increased by three percentage points within the span of a year, while sadness notably rose by six percentage points according to the Hologic Global Women’s Health Index.

What’s going on?

Women, particularly mothers, are still more likely than men to manage a more complex set of responsibilities on a daily basis — an often-unpredictable combination of unpaid domestic chores and paid professional work. So much is expected of women and this invisible labor takes an emotional toll.

Women have disproportionately shouldered the emotional burden of the pandemic as many families faced job insecurity, unstable housing, and interruptions to medical and childcare services.

The pandemic is not entirely to blame for the uptick in negative emotions. The negative trajectory has been trending for over a decade.

The mental and physical consequences of toxic stress

Living in a chronic fight or flight takes a toll. Ongoing stress can lead to or aggravate insomnia, family conflict, depression and anxiety. It is also linked with physical conditions such as hypertension, heart disease, obesity, and diabetes.

What can we do?

I have written a great deal in the past about individual strategies to boost positive emotions and combat stress. Spending time in nature, prioritizing sleep, eating a healthy diet, and building more movement into everyday life are all data-driven strategies to improve mental health. However, individual interventions are not enough.

If we want to tackle toxic stress, we need to zoom out and consider the bigger picture and zoom in to get to the root of the problem. Reducing stress levels is up to us as a society as a whole, not the responsibility of a single person. As Wharton Professor Adam Grant observed, “Burnout is not a problem in your head; it’s a problem in your circumstances.”

Grant suggests utilizing the Demand-Control-Support model to help manage toxic stress.

Demand

Make structural changes that lighten the load. If you are an employer, encourage breaks, honor downtime, weekends and family time, and respect work/life boundaries. Create Zoom-free days if your company is still working from home. Zoom fatigue is worse for women and can lead to “mirror anxiety.”

Control

When you can’t eliminate demands, you can at least give people the autonomy and skills they need to handle them. If possible, allow for flexibility. Encourage personal goal setting and the pursuit of individual interests. A Harvard Business School study found that engaging in learning activities can buffer workers from detrimental effects of stress including negative emotions and burnout.

Support

Cultivate a culture that makes it easy to request and receive help. As Dr. Elizabeth Fitelson, director of the women’s program in Columbia University’s psychiatry department, observed, “Focusing on improving the social supports for basic needs would have a far greater intervention than any specific mental health intervention.”

Other tools

Screening and access to treatment are essential tools to combat the extraordinary stress levels people are facing. A panel of experts now recommends doctors screen all patients under age 65 for anxiety. The intention is to help prevent mental health disorders from going undetected and untreated for years or even decades.

Bottom Line: Individual interventions can be helpful but culture and community are essential for building resilience and managing stress.