Episode 9 - Managing stress and anxiety while in pharmacy school with Dr. Lori Mills

This episode features Dr. Lori Mills, a clinical psychologist who is an expert on mood and anxiety disorders, as well as positive psychology. In addition, she provides counseling services to our student pharmacists at ETSU Bill Gatton College of Pharmacy. Dr. Mills shares valuable advice on how to manage stress and anxiety in order to thrive in pharmacy school.

Transcript:

Michele Williams
Welcome to White Coat Radio, a podcast from East Tennessee State University Bill Gatton College of Pharmacy in Johnson City, Tennessee. Each episode, we cover a wide range of topics about the pharmacy school experience, from study tips to deep dives with faculty and student pharmacists. I'm your host, Doctor Michele Williams. In this episode, we'll be talking with Doctor Lori Mills, a licensed clinical psychologist in the state of Tennessee.

Michele Williams
She's an expert on mood and anxiety disorders, positive psychology, and counseling. She's a professor at Milligan University. And fortunately for us, Doctor Mills provides counseling services to our student pharmacists here at Gatton. Doctor Mills, welcome to White Coat Radio.

Lori Mills
Thank you very much. I'm glad to be here.

Michele Williams
Well, I'm really glad we have this chance to talk to you today because you are an amazing resource for our students. But you and I rarely have a chance to chat this way, and so there are a lot of things I've always wanted to ask you. So before we begin talking about students, can you tell us a little bit about your background and what led you to a career as a psychologist?

Lori Mills
Sure. I am probably one of those rare people who decided in high school that I wanted to be a psychologist. And I'm from a very small town in Illinois, very small high school. So I never had a psychology class in high school, but I went to Milligan University—actually was where I did my undergrad—and I was a psychology major from day one. Never changed my major, never veered off of that. And then as I prepared to go to graduate school, I didn't know whether I wanted to be a licensed clinical social worker, like a professional counselor, marriage and family therapist, whatever. But one of my professors just kind of steered me towards clinical psychology, and that's where it went. And I think sometimes I say I had a friend who had a very traumatic accident the summer before my senior year, and that kind of solidified my senior year in high school. That kind of solidified that I can be around people going through really difficult things and enjoy—maybe the wrong word—but giving support in that kind of situation. So that sort of solidified, I think, my interest in psychology and doing therapy in particular.

Michele Williams
So you had that sense that you had that skill, that ability in you to support people in that way. Well that's awesome. I'm really glad that you do. How long have you worked with pharmacy students again?

Lori Mills
So it has been about six years. I was thinking about this. It's been since the spring of 2016.

Michele Williams
Okay. And what has that been like?

Lori Mills
It's been very fulfilling. I have really enjoyed it. I'm like a lot of other people who go into clinical psychology. I thought, oh, I'm going to have my own private practice. That's what everyone thinks they're going to do. And then you realize how tough that is to build your own client base and all that kind of thing. So anyway, I fell in love with teaching undergraduate psychology, and that really has been the bulk of my career. But later in my life, I really think I've gotten better at doing therapy. I had to kind of get comfortable in my own skin and I think more confident and self‑assured. And I think I'm a better therapist than when I was a younger person.

Michele Williams
You never think about that with therapists. I don't think that they have a learning trajectory too. And they have to get comfortable as well. So being accepted into pharmacy school is a huge achievement, obviously, but it comes with stressors and responsibilities and demands that are not always easy to cope with. If I'm a student pharmacist who's starting to feel pressure in pharmacy school, how do I know it's time to reach out to you?

Lori Mills
Well, I think the first thing I would want to say is any time is a good time to reach out to me. I'm always happy to meet with any students. But more to the point of your question, I guess this question made me think of a common theme that runs through mental health and mental illness: when something becomes a problem is when it causes impairment or distress. And so how I would say that is impairment is if this thing that you're dealing with is interfering with your life or interfering with your academic performance, interfering with your relationships, interfering with getting out of bed in the morning. So that would be the impairment piece. And then the distress piece is just, you know, like, I'm feeling really sad. I'm feeling really anxious. I'm feeling irritable all the time. I'm having trouble controlling my anger. Those kinds of things would be the distress. So when either of those—you feel like, yeah, this isn't just something that's been going on for a couple of days, this is lingering and it's causing me problems—that would be a time that I think you say, okay, now's the time to reach out.

Michele Williams
That makes so much sense. So to just sort of use that as a kind of measure of, you know, how long has it been going on, and is it interfering?

Lori Mills
Yeah. And I think, for example—and I know we'll get into things like test anxiety probably later—but maybe a typical situation would be that someone might feel like, wow, I get anxious at test time. Well, most people do, okay? I mean, there's some degree. Yeah. So you are going to feel anxious around tests. But if it's: I can't sleep at all the night before I have a test, I vomit every morning when I have a test, and I have isolated myself from all my social contacts… okay, those are things that are saying this is not sustainable. This is taking away from the quality of your life. Like those kinds of things would be indicators that yes, this has gone beyond what you want to keep happening and something that you might want help with.

Michele Williams
So beyond just wanting to do really well, and I'm nervous.

Lori Mills
Right. Because I think the vast majority of people have some of that.

Michele Williams
Yeah. And what can a student expect when they make that first appointment with you? What is that going to be like?

Lori Mills
Okay. So generally they would have contacted me—and you go straight to me. You generally call me and let me know that you'd like to meet. And I work with you to make an appointment that works for you and for me. And then ETSU owns a house that is probably maybe a mile from the pharmacy school, and it's just in a neighborhood. And so I give you the address of that house, and you come there and meet me. And we meet for 45 or 50 minutes, something like that. That first appointment I generally ask more questions than I would at any other time, just trying to get to know students, asking them what brings you in, tell me a little bit about your family. I ask specific symptom questions to know sort of what they're dealing with. And by the end of the session I get around to, okay, let's try to narrow this down: what are your goals, what do you hope to get out of meeting with me? And then we talk about, okay, yes, that's definitely something we can work on. Because it's one thing to sort of go and pour out a lot of information, but then it's like, well, okay, we have to get some kind of focus to what we're doing and see how we can proceed from there.

Michele Williams
And so the goal setting, that's where you sort of figure out what the plan is—what you're going to do.

Lori Mills
Yeah.

Michele Williams
So one area of expertise—and you alluded to this just a minute ago—is anxiety. And just in the most general sense, what is anxiety? I mean, you hear people say I have anxiety, or test anxiety, or just, you know, I feel anxious. But actually, from your point of view, from an expert point of view, what is anxiety?

Lori Mills
I think the closest maybe synonym or word that we use interchangeably with anxiety would be worry. And I would call this anxiety excessive worry. It's funny because we use the word anxiety, or we say anxious, but then there's diagnosable anxiety that rises to the level of disorder. So anxiety—I think a certain amount of it is okay and actually preferable. If you had zero anxiety about starting pharmacy school or zero anxiety about starting your rotations or zero anxiety about a test, you're not going to prepare, you're not going to study, you're not going to perform at the level you need to. But that's not what most of us are dealing with. Most of us are dealing with: my anxiety has gone too far. It's too much. So that's when we sort of say, okay, what can we do to take the edge off of this? We're not trying to remove anxiety. Therapy is just not that magical to do that anyway. But that's not even what we're trying to get to. We're trying to bring it down to a manageable level—a level that's appropriate to the situation. So excessive worry about maybe a specific situation that then takes on these different physical symptoms—shortness of breath, muscle tension, fatigue—and then also cognitive and emotional symptoms like difficulty concentrating, irritability. When it starts to gather in those other kinds of symptoms, I think that's when it becomes more anxiety that's problematic, not just “I feel a little worried about my test.”

Michele Williams
Right. That makes sense. And just based on your experiences working with pharmacy students, what role do you see anxiety playing in the lives of pharmacy students?

Lori Mills
So I think for some people who maybe again, it's not super problematic, it plays the role of pushing them to work hard. So that's when anxiety is manageable and in check.

Michele Williams
It seems almost to me like conscientiousness. You know, if someone is conscientious, they worry what the professor thinks of them or how they're going to perform on an exam, and it seems to just come with the territory of someone who's a conscientious student.

Lori Mills
Well, even to put this in another context—if you think about, for example, a school teacher. A lot of people would say a school teacher should have anxiety their first day of school every year. And if they don’t, maybe it’s time to retire or something. If it’s the first day of school and you don't even worry—you just say, oh, I'll just take out my lecture from last year—you might not be invested. So I think yes, that level of anxiety: most people don’t need to worry about having enough. But you’re right, it’s more conscientiousness.

But anxiety also unfortunately plays a very different role for some students. It causes difficulty studying, causes them to be preoccupied with negative thoughts, causes them to underperform, to second‑guess themselves on tests. Even more broadly, thoughts like: should I even be doing this, am I smart enough, do I belong here? So unfortunately I think it plays that role for some students.

Michele Williams
And it’s interesting you say that. Because when I talk with students and they're having difficulty performing on an exam or on a clinical rotation, I often hear them say, “I just drew a blank,” or, “I froze,” or, “I knew the answer but I couldn't say it.” And then after the exam they remember it. I sometimes suspect that might be anxiety.

Lori Mills
I think so too. For sure.

Michele Williams
Okay. And why do you think it's so common? Working with many different types of students over the years, I feel like anxiety is a pretty large part of some pharmacy students' lives.

Lori Mills
Yes. Let me say something about pharmacy students in particular, and then something broader.

Pharmacy school involves high‑stakes testing. Other types of educational programs may spread grades across papers, presentations, projects—but pharmacy school is very heavily weighted toward tests. And you know you have to get a certain score to pass. Even licensing exams add to that pressure. Financial pressure also lingers in the background.

Then on a broader level, I think our culture feeds anxiety. We live in an “age of anxiety.” We hear about every bad thing happening in the world and feel powerless. The 24‑hour news cycle has been widely discussed as harmful for mental health.

And culturally, we're told we should be happy—and if we’re not, something’s wrong. If we just bought the right product, used the right planner, ate the right diet, decluttered the right things—we’d be happy. This pressure to be perfect contributes to anxiety.

Michele Williams
Yes, you're right. We feel pressure for everything to be going great, and life doesn't always work like that.

Lori Mills
I think we have—this is going off‑script—a cultural narrative that says we should work ourselves to exhaustion so that “one day” we can finally enjoy life.

Like the story of the Mexican fisherman. He already had the life he wanted—simple, meaningful—but the Harvard MBA tried to convince him to build an empire so that someday he could retire and do exactly what he was already doing. That’s so much like American thinking. And it's unfortunate.

Michele Williams
It is. And it's easy to fall into that pattern, especially in pharmacy school.

Lori Mills
Yes.

Michele Williams
So we talked about anxiety in general—but what is test anxiety? And what tips do you have for helping with it?

Lori Mills
Test anxiety is extreme distress in testing situations that interferes with performance.

There is a very high correlation between procrastination and test anxiety. It becomes a chicken‑and‑egg situation. If you procrastinate, you will feel unprepared, which leads to anxiety, which makes you feel overwhelmed, which leads to more procrastination.

Sometimes underperformance gets labeled as test anxiety when lack of preparation is the real issue.

I like to think of it like pain medication: doctors say “we have to get ahead of the pain.” You need to get ahead of the anxiety by preparing early.

Michele Williams
That is a great analogy. And you had some tips?

Lori Mills
Yes. The first is preparing a sufficient amount and studying over time rather than cramming. Spreading out studying reduces anxiety.

Studying effectively is also important—Michelle helps students with that. Not just studying more hours, but studying in ways that actually work.

Self‑care is crucial—sleep, nutrition, exercise, relationships, doing enjoyable things. This is a marathon, not a sprint. You can't deny yourself all self‑care for four years.

Something I found recently that I like is a calming worksheet. On one sheet, you list meaningful quotes, reminders like “breathe deeply,” your goals, your supporters’ names—things that ground you.

Deep breathing helps. Even taking one minute before a test to breathe in through your nose and out through your mouth slows you down.

And refuting negative thoughts. When you’re really anxious, you're probably telling yourself extreme things like “I'm going to fail” or “I can’t do this.” These thoughts are not helpful. You need to have prepared statements like “I can do this,” “I’m prepared,” “I know this material.”

You’re not trying to wipe out all negative thoughts or pretend everything is perfect—just nudging yourself away from the negative extremes.

Michele Williams
I love that. Being ready to respond to those thoughts makes so much sense.

Lori Mills
Right. I come from a cognitive‑behavioral perspective. A lot of people get anxious about having negative thoughts, which makes it worse. Sometimes you can just say, “I'll think about that later. Right now I need to look at this question.”

Or, “That thought isn’t true because I’ve passed every other test.”

Or, “Another way of seeing this is I won’t know every question, but I will know a lot of them.”

Michele Williams
That makes so much sense. So what advice would you give pharmacy students with regard to taking care of their psychological well‑being?

Lori Mills
One thing is: not everything should be about pharmacy school or the career of pharmacy. You need interests outside of that. You need friends outside of that. If your whole life is pharmacy school, everything will feel catastrophic when something goes wrong.

Another thing is stepping back and taking a long‑range perspective. Yes, this is hard. It’s supposed to be hard. But you can get through it.

Another important thing is seeking other people's feedback. Students get locked into their own narrative. They’re often afraid to talk to professors because they think the professor will judge them. But professors genuinely care. They want to help. So does Michelle, and so do many others.

Don’t lose connections to people outside pharmacy school. Those relationships remind you who you are beyond grades.

Michele Williams
Yes. I think students don't always realize how many of us are willing listeners. If they see an open door, they can come talk to us. Ninety‑nine percent of the time, we'd be happy to talk.

Lori Mills
Students are more than their grades and test scores. One of my own students once implied that professors only liked the top performers best, and I thought, that's simply not true.

Reaching out—even when it's scary—is important.

Michele Williams
Doctor Mills, thank you so much for the conversation today. It's been terrific—really helpful. A lot of things I don't think students realize about the resources they have here. Are there any other things you'd like to add?

Lori Mills
I would just add—doing things outside of school, like volunteering, is incredibly healthy. One of the most consistent findings in psychology is that helping others makes us feel better.

Getting outside, participating in something bigger than yourself, doing life‑giving things… whatever those look like for you. Identify the activities that energize you and make sure you keep doing them throughout pharmacy school.

Michele Williams
I think that's great advice. And thank you so much for talking to us today and giving us great tips on maintaining good mental health, and what to do when the pressure is on and we may need a little extra help. Thank you so much for chatting with us.

Lori Mills
Appreciate you asking.