How to use this guide

Go to the section that fits what you are dealing with. Each one says what the experience is, what the research shows and what you can do.

When this guide says something helps, that rests on a systematic review or meta-analysis, or on matching results from at least two independent research groups. Where the evidence is weaker, it says so. Practical steps that have not been tested in trials are labelled as such: they are sensible places to start, not proven treatments.

This guide is information. It cannot assess you or replace care. If you are struggling, good first steps are your GP (family doctor), your employer’s Employee Assistance Programme (confidential short-term counselling that many employers pay for, usually contacted directly without going through your manager), your occupational health service if your workplace has one, or your place of study’s counselling service.

Overwhelm

Most people in healthcare training go through a stretch when there is too much to learn, too much to do and not enough time. In interview studies of newly qualified nurses, common themes were feeling they did not know enough, a workload that felt overwhelming, and how much support from colleagues mattered (See 2023).

The start is often the hardest part. In studies of newly qualified nurses, stress and exhaustion were highest in the first months and eased over the first year; lower stress went with a sense of mastery, acceptance by the team and a clear role (Jarden 2021). Depressive symptoms rise when people start medical school and again when they start residency (Rotenstein 2016; Mata 2015). No similar reviews were found for radiographers, sonographers or technologists.

What helps

Mindfulness courses reduce stress in health-profession students by a small to moderate amount (McConville 2017; da Silva 2023). Cognitive, behavioural and mindfulness programmes also reduce stress and anxiety in university students generally (Regehr 2013). Ask your place of study or employer whether they run one.

Impostor feelings

The sense that you are less capable than people think, that your successes do not count, and that you will be found out has a name: the impostor phenomenon, first described in 1978 (Clance and Imes 1978). It is an experience, not a diagnosis (Mak 2019).

Studies of medical, nursing and other health students and staff consistently find it common in both men and women, though the share affected depends heavily on which questionnaire is used (Bravata 2020; Salari 2025; Chua 2025). It tends to show up at transitions: starting placements, qualifying, taking on a new role, being the most junior person in the room, and wherever support is thin (Chua 2025; Edwards-Maddox 2023). It often comes with anxiety, low mood and burnout (Bravata 2020). If it does, those deserve attention in their own right.

Burnout

The World Health Organization describes burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed. It has three parts: exhaustion; mental distance from your job, or feeling negative or cynical about it; and a sense of ineffectiveness and lack of accomplishment. WHO classes it as an occupational phenomenon, not a medical condition, and the term applies only to work (WHO ICD-11; WHO 2019).

Reviews of radiographers, radiation therapists and radiology trainees all report burnout symptoms (Ramalho 2026; Guerra and Patrício 2019; Wan 2024). In radiographers, the stressors reported most often are workload and staffing, role demands, worry about radiation exposure and limited recognition (Ramalho 2026). Medical and nursing students report them too (Frajerman 2019; Kong 2023). Published rates vary too much between studies to quote a single figure.

Burnout or depression?

The two often go together (Koutsimani 2019; Meier and Kim 2022), and researchers still disagree about whether they are separate conditions (Bianchi 2015; Koutsimani 2019). WHO’s classification lists depression, anxiety and stress-related disorders separately from burnout. Either way, if what feels like burnout also includes low mood most days or losing interest in things outside work, see a doctor. It may be depression, and depression is treatable. If you are having thoughts of harming yourself, see a doctor soon. If you are not safe right now, use the numbers at the top of this page.

What helps

Programmes to reduce burnout help on average, but by a small amount (West 2016; Panagioti 2017; Tamminga 2023). In a Cochrane review of 117 trials in healthcare workers, stress-management programmes, whether they worked on the stress itself or on switching off through relaxation or exercise, may reduce stress symptoms in the short term. The certainty of that evidence was low, it is not clear which type works best, and long-term effects are unknown (Tamminga 2023).

Because burnout comes from the work, the work matters too. WHO’s guidelines say employers of health workers may consider reducing workload, changing schedules and improving communication and teamwork; should train managers to support staff; and may offer stress-management training (WHO 2022). Raising workload, rosters or recognition with your manager or union is a legitimate part of dealing with burnout.

One way to find where it is coming from is Maslach and Leiter’s six areas of worklife: workload, control, reward, community, fairness and values (Maslach and Leiter 2016). Ask which one has slipped furthest for you. It is a framework for thinking, not a proven test.

Exam stress

Exam anxiety is common, and higher anxiety goes with somewhat lower scores (von der Embse 2018). It also responds well to help. A review of 44 randomised trials in university students found that structured programmes reduced test anxiety substantially, and grades improved as well, though the authors found signs of publication bias and poor reporting (Huntley 2019). Behavioural approaches had the most support, and study-skills training worked best when combined with behavioural or cognitive approaches (Huntley 2019; Ergene 2003).

If exam anxiety is severe, or is stopping you sitting or preparing for exams, your student support or counselling service can offer structured help. For the exams themselves, see Exam Prep.

After a mistake

Being involved in an error or an adverse event can hit hard, whether or not it was your fault. Across studies of clinicians, the common reactions are troubling memories, anxiety, anger at yourself, regret, guilt, fear of making another error, embarrassment and poor sleep (Busch 2020; Seys 2013). Students are affected too (Mira 2024). These are human reactions to a serious event. Having them does not, on its own, mean you are unfit to practise. Some call this the “second victim” experience, though the term is debated (Clarkson 2019).

Asked what they want afterwards, staff most often name a peer to talk to, practical guidance on what happens next, and access to professional support (Simms-Ellis 2025). Ask for those. Support programmes are widespread but not yet proven in controlled studies. Ask for support anyway while organisations keep testing them.

Distressing cases

Imaging staff see injuries, deaths, abuse and post-mortem images. The US diagnostic criteria for post-traumatic stress disorder count repeated or extreme work-related exposure to details of death, serious injury or sexual violence, including through images at work, as exposure to trauma (APA DSM-5, via SAMHSA). Exposure is not a diagnosis.

Radiographers interviewed about trauma and forensic imaging describe emotional saturation, distancing themselves to cope and a lack of support, and also finding meaning in the work (Wahid 2025; Camilleri 2023). These are small interview studies, and no review has measured how common this is in imaging. Across health professions, compassion fatigue and secondary traumatic stress have been reported in every group studied, and they rise together with burnout (Cavanagh 2020; Ulaş and Seçer 2025).

When to get it checked

If, about a month after a hard case, you still have intrusive memories or nightmares, avoid reminders of it, or feel constantly on edge, see your GP or Employee Assistance Programme. If symptoms are strong, do not wait that long. UK guidance suggests follow-up within a month for milder symptoms after a traumatic event, and recommends trauma-focused CBT for stronger ones (NICE NG116).

Moral distress

Moral distress is the strain of knowing the right thing to do and being unable to do it, often because of staffing, resources, hierarchy or rules (Lamiani 2017; Beadle 2024). Moral injury is a deeper wound from taking part in, failing to prevent, or witnessing something that goes against your values (Litz 2009). Moral distress is linked with emotional exhaustion and with people leaving their jobs (Orgambídez 2025; Lamiani 2017), and moral injury with anxiety, low mood and burnout (Coimbra 2023). Both mostly come from the situation rather than the person (Beadle 2024). No specific fix is proven (Morley 2021). Talking it through with colleagues you trust, using ethics support where your organisation has it, and raising the system problem are reasonable steps.

Shift work and sleep

Shift work, including irregular rosters, is linked with more depressive symptoms (Torquati 2019; Zhao 2019), and sleep and mood tend to get worse when people first start shift work (Harris 2024). New graduates starting nights or on-call are at exactly that point.

If you cannot sleep

For insomnia that persists, the American College of Physicians recommends cognitive behavioural therapy for insomnia (CBT-I) as the first treatment for adults, and the American Academy of Sleep Medicine gives it a strong recommendation (Qaseem 2016; Edinger 2021). It works well for adults with chronic insomnia, including working adults on day schedules (Trauer 2015; Takano 2023). Sleep-hygiene tips on their own are not recommended as a treatment (Edinger 2021). For shift workers, CBT-I helps less clearly, and adapted versions are still being tested (Reynolds 2023). Ask your GP how to get it where you live.

Bullying and incivility

Bullying, harassment and incivility are common in healthcare training and work. Doctors in training most often named senior clinicians as the source, followed by patients or their families (Fnais 2014). Being bullied is linked with distress, depression, burnout, poor sleep and sick leave (Lever 2019). It is not a normal part of training. Abuse from patients or their families is not OK either.

In two simulation trials, rude comments made clinicians perform worse (Riskin 2015; Katz 2019); a third, with nurse teams, found no difference in its main scores but more serious errors (Johnson 2020). In hospital studies, incivility is linked with weaker safety culture and more errors (Freedman 2025), so it is a patient-safety issue as well as a staff one. In a large NHS study, staff’s reasons for not reporting bullying included thinking nothing would change and not wanting to be seen as a trouble-maker (Carter 2013).

What helps: the evidence at a glance

Effects in research are averages across many people. They show what tends to help; your own result may differ.

When to get more help

See your GP, or contact your Employee Assistance Programme, occupational health service or student counselling service, if:

• low mood, hopelessness or loss of interest is there most days, or is spreading beyond work;
• you cannot sleep most nights and it has gone on for weeks;
• distress after a hard case has not eased after about a month, or is strong;
• exam anxiety is stopping you preparing for or sitting exams;
• you are using alcohol or other drugs to get through;
• you are worried your health is affecting how safely you can work.

If you are having thoughts of harming yourself or ending your life, or you are not safe, use the numbers at the top of this page now.

What help can look like

For less severe depression, UK guidance lists guided self-help, such as a structured CBT programme with support from a trained practitioner, as a first option (NICE NG222). Online CBT programmes reduce depressive symptoms, and versions with a practitioner’s support do better for moderate or worse symptoms in the short term (Karyotaki 2021). Your GP can tell you what is available where you live.

Why health workers put it off

Health professionals are among the groups most put off seeking help by stigma (Clement 2015). Doctors name confidentiality, fear for their career and lack of time among the barriers (Zaman 2022), and among medical students who screened positive for depression, only a small minority sought treatment (Rotenstein 2016). If confidentiality at work worries you, many of the services listed below sit outside your workplace, and some, such as NHS Practitioner Health in England, exist for that reason.

Deeper work: counselling and therapy

Some struggles are recent and specific: a hard placement, an exam, a mistake. Others run deeper: a harsh inner critic, a sense that you are only as good as your last shift, or low self-worth that was there long before training. Those long-standing patterns are recognised targets for counselling and therapy, not a fixed part of who you are.

• CBT designed for low self-esteem looks helpful, from a small but consistent set of studies (Kolubinski 2018).
• Approaches built around self-compassion reduce self-criticism by a moderate amount (Wakelin 2022). Compassion-focused therapy is promising, but not yet shown to work better than other therapies.
• Guided online CBT can work about as well as face-to-face CBT for common problems such as anxiety and low mood (Hedman-Lagerlöf 2023), and can be a first step while you look for the right person.

Through work or study

Many employers and universities pay for an Employee Assistance Programme (EAP): free, confidential, short-term counselling that you can usually contact without going through your manager. In many schemes the problem does not have to be about work. Studies of EAPs mostly report people functioning better at work afterwards, but most had no comparison group, so they cannot show that the counselling caused the change (Joseph 2018).

EAPs usually offer a small number of sessions. That can be enough for a recent, specific problem. For a long-standing pattern, ask the EAP counsellor to help you plan the next step, such as a referral or a longer-term therapist. Occupational health and your place of study’s counselling service are other free routes.

Finding someone who suits you

The relationship matters. Across hundreds of studies, people who feel understood by their therapist, and who agree with them on what they are working on and how, tend to do better, whatever the type of therapy (Horvath 2011; Flückiger 2018). It works both ways: feeling better early on also strengthens the relationship (Flückiger 2020), so treat it as a sign to watch rather than a guarantee. Therapists also differ. Which therapist you see makes a real, if modest, difference on average, and more in some settings than others (Johns 2019).

So it is reasonable to choose. People who get the kind of therapy they prefer are a little more likely to stay and do slightly better (Swift 2018). Professional bodies suggest asking questions like these before or at a first session:

• Are you registered, and with whom?
• What approach do you use, and how would it help with what I want to change?
• How many sessions do you expect, and what will it cost?
• What is confidential, and what would you have to share?
• How will we check whether it is helping? Short progress questionnaires each session, looked at with the therapist, slightly improve results and reduce drop-out (Lambert 2018; de Jong 2021).

If it is not working, you can change

Not every practitioner will suit you, and as in any profession, a few are not good for the people they work with. Professional bodies and health services in each country covered here say it is fine to decide a therapist is not right for you. The UK Council for Psychotherapy says that many people do not find the right therapist the first time, and that this is not their fault. Stopping early is common, about one in five people who start (Swift and Greenberg 2012), so if you are thinking of stopping, raise it with the therapist or switch, rather than giving up on help altogether.

Working on painful things can feel hard at times. In trials of therapy for depression, people having therapy were less likely to get worse than people on a waiting list or in usual care, but a minority still did (Cuijpers 2021). If you feel steadily worse over several weeks, or at any point feel unheard, judged, pressured or unsafe, say so, and move on if nothing changes. If you are not safe right now, use the crisis lines at the top of this guide.

Checking registration, free routes and complaints

In most of these countries “counsellor” is not a protected title, so anyone can use it. Check that the person is registered with a regulator or belongs to a recognised professional body with a code of ethics and a complaints process. Services and rules below were read on official or professional-body websites on 11 October 2026.

Will getting help affect my registration?

Worry about what getting help could mean for their career is one of the barriers doctors name (Zaman 2022). For the regulators checked below, the published health rules turn on whether a condition affects, or could affect, your ability to practise safely. Having a diagnosis or seeing a counsellor is not, on its own, what those rules ask about. US state licences, other Canadian provinces and some application forms could not be checked, and may ask differently.

How clearly each regulator says this varies a lot. Below is what each one publishes, read on its own website or in the legislation on 10 October 2026. This is general information, not legal advice. If you are worried about a declaration, a union, professional body or professional indemnity insurer can often advise you in confidence before you decide what to do.

Helping a colleague

If a colleague or classmate seems different, you do not need training to help. You need to notice, ask and point them to support.

Practical steps (sensible, not tested in trials), except where a source is given.

1. Ask privately, and say what you noticed. “You’ve seemed a bit different lately. How are you doing?”
2. Listen more than you talk. You do not have to fix anything.
3. If you are worried about their safety, ask directly whether they are thinking of harming themselves or ending their life. Reviews by four separate research groups, mostly of research questionnaires and clinical screening, found that asking directly about thoughts of ending their life does not increase those thoughts or behaviour (Dazzi 2014; DeCou and Schumann 2018; Blades 2018; Polihronis 2022).
4. If they say yes, thank them for telling you, stay with them, and help them contact a crisis line or their GP now. If they are in immediate danger, call the emergency number and do not leave them alone.
5. Help them connect with support: their GP, Employee Assistance Programme, student counselling, or a service in the list below.
6. Look after yourself afterwards. Supporting someone takes something out of you too.

Mental health first aid courses improve people’s knowledge and confidence (Morgan 2018). Whether they improve outcomes for the people being helped has not been shown (Richardson 2023).

Your own story

This section is perspective, not research.

Everyone in healthcare arrives with their own story. Some people always knew this was the work they wanted. Others came to it through a family member, a friend, a course that had places or a job that needed filling, and have grown into it to different degrees. There is no right way in, and how you got here does not decide how much you can give.

Those stories can also shape how people act. What someone has lived through can show up at work: in how they handle pressure, criticism, mistakes and other people’s feelings. A colleague who is defensive, sharp or easily overwhelmed may be carrying something you cannot see. Knowing that can help you take an ordinary sharp moment less personally. A possible reason is still no excuse for bullying, and changing a colleague is not your job. If someone’s behaviour is hurting you, the steps in Bullying and incivility still apply.

The same goes for patients and families. People who are frightened, in pain or grieving can react strongly, and that reaction may have more to do with their situation and what they have lived through than with you. On its own, a strong reaction does not mean you are bad at your job, and it may not be personal at all. If it points to a real problem with care, take that seriously and pass it on through the usual channels. Not every situation can go the way anyone would want, and they, like you, have to come to terms with that. If a reaction turns into abuse or a threat, that is not OK, whoever it comes from, and you do not have to accept it as part of the job: step away if you can, call for help if you need it, and report it.

Health services can act on it too. In England, the NHS Standard Contract 2026/27 (clause SC7) says a provider does not have to provide or continue a service to someone whose behaviour is abusive, violent or threatening, as long as it acts reasonably and takes account of any health condition that may be affecting their behaviour, and never where refusing would be against the law. NSW Health’s violence policy allows treatment to be made conditional on an agreement about behaviour, or, rarely and as a last resort, deferred if it is not life-threatening. These are decisions for your organisation, made through its policy, so report what happened and let a senior clinician or manager decide. Do not withhold urgent or life-threatening care on your own: get help, and let the senior team decide how it can be given safely. Check your own organisation’s policy, as rules differ between services and countries.

The same can be true of you. Your own reactions may make more sense in the light of your story. If there are patterns you would like to change, noticing them, being kinder to yourself and, if you want to go further, working with a counsellor are ways to start. Struggling is not a sign that you have failed.

Sometimes what wears people down is the gap between what they value and what they do day to day: agreeing to keep the peace when they value honesty, or a week full of things they feel they should do and few they want to. Noticing that gap can be a useful first step (see Burnout). You may never feel completely ready to ask for help or to change something. Many people start while they are still nervous.

When a harsh thought shows up

This is a simple version of techniques used in cognitive behavioural therapy and acceptance-based therapies. Rethinking what a situation means reduces negative feelings in the moment in laboratory studies (Webb 2012). Treat it as a skill to practise, not a cure. If harsh thoughts are constant, or include thoughts of harming yourself, use the crisis lines at the top of this page.

1. Notice it. Put a little distance between you and the thought: “I am having the thought that I am not good enough.”
2. Name what is underneath. Fear, shame, disappointment, tiredness.
3. Question it. What is the evidence? Would you say this to a colleague in the same position?
4. Let it pass. You do not have to push the feeling away. Let it be there, and do not let it decide who you are.

Look back as well as forward

Training and work in healthcare keep the next goal in view: the next exam, the next competency, the next rotation, the next role. Each time you reach one, the goalposts move, which makes it easy to see only the distance still to go.

Every story is different, so comparing yourself with the people around you rarely tells you much. They started somewhere else, carry different things and are good at different things. One colleague is calm with frightened patients, another spots the subtle finding, another explains things well to students. You have your own mix too, even if it is hard to see on a bad day. There is no right or wrong mix, and you can contribute in your own way. Healthcare has room for many kinds of people. Many of us find our place at some stage, and for some it takes longer than for others. If you have not found where you fit yet, a different team, specialty or setting can feel very different from where you started. And if, in time, you decide this work is not right for you, that is not a failure either.

So now and then, look back. Compare yourself with who you were on your first day, or a year ago. You probably know and can do things that you could not do then, and you have kept going.

Looking after yourself comes first

Your own health, and the people you love, come first. Looking after yourself is not selfish. It does not mean leaving a patient mid-task. It means your health should not be the thing that always gives way. It is hard to keep caring well for others when your own needs go unmet for too long, so taking care of yourself is part of how you keep giving. The doctors’ pledge in the World Medical Association’s Declaration of Geneva (2017) makes the same link: “I will attend to my own health, well-being, and abilities in order to provide care of the highest standard.” When your own needs are met, it can be easier to find the energy to give others your full attention. Many people come into healthcare to help others, and it is easy to forget that you have needs too.

In practice that can mean taking your breaks, using your leave, saying no to an extra shift when you are running on empty, and asking for help early. If some of these are not possible where you work, that is not your failing, and it is worth raising with a manager, supervisor or union.

Support services by country

Every service below was checked on its own website or a government health website on 10 October 2026. Hours and numbers change, so check the service’s site if something does not connect.