Doctor of Physical Therapy (DPT) students, in common with other health professions students, are under considerable pressure, navigating rigorous academic and clinical demands while preparing for their future roles [1]. The focal article of this commentary, "Relationship Between Anxiety, Coping Strategies, and Perfectionism in Entry-level Doctor of Physical Therapy Students", sheds light on the significant levels of anxiety experienced by these students, particularly in relation to perfectionism and coping strategies [2]. The findings emphasize the need for educational institutions to adopt a more holistic approach to student mental health, integrating support systems that address the psychological challenges inherent in healthcare programs.

 This commentary builds on insights from the focal article, expanding the discussion to include anxiety in other health disciplines and how recent mental health initiatives in higher education, such as campus-based cognitive-behavioral therapy (CBT) and mindfulness programs, are being employed to address anxiety in students. These initiatives are crucial, especially for high-pressure health-related fields, where untreated anxiety can lead to burnout and a diminished capacity to provide quality patient care and offer a model for health professions programs to incorporate mental health initiatives within their curricula [3]. It further explores the implications for educational practice and suggests strategies for creating a more supportive learning environment that prioritizes mental health.

Most healthcare students are expected to meet exceptionally high academic and clinical standards, which can contribute to chronic stress and anxiety. The focal article reveals that both state and trait anxiety are prevalent among DPT students, with significant predictors including gender, year in the program, and the type of coping strategies employed. These findings align with broader research indicating that healthcare students, particularly those in demanding programs like medicine, experience higher levels of anxiety compared to the general population [4].

Prolonged untreated anxiety can predispose students to long-term mental health challenges, including depression, substance abuse, and burnout. There is also evidence to suggest that chronic anxiety during training can impact cognitive functioning, such as memory consolidation and decision-making skills [5]. Psychiatrists and associated mental health providers working with college students report that high academic expectations, financial strain, and imposter syndrome are frequent contributors to anxiety in healthcare students. Furthermore, evidence-based interventions such as Acceptance and Commitment Therapy (ACT) are increasingly being utilized to help students in these fields develop resilience and healthier coping mechanisms. Such interventions emphasize psychological flexibility, allowing students to handle stressors without getting overwhelmed by perfectionism or performance pressures [6].

The transition from classroom learning to clinical practice introduces additional stressors, including the need to apply theoretical knowledge in real-world settings, interact with patients, and manage the expectations of clinical supervisors. These challenges, coupled with the financial burden of education and the pressure to perform, create a fertile ground for anxiety and burnout. It is essential for healthcare education programs to recognize these stressors and proactively address them through comprehensive mental health support systems. In response, some educational programs have started offering workshops focused on 'performance anxiety' management, teaching students relaxation techniques and the importance of setting realistic personal goals to combat perfectionist tendencies [7].

Perfectionism is a well-recognized trait among high-achieving students, particularly in healthcare fields, where precision and attention to detail are critical. However, as the focal article demonstrates, not all perfectionism is beneficial. The distinction between adaptive and maladaptive perfectionism is crucial, with the former associated with positive outcomes and the latter linked to higher levels of anxiety and psychological distress [8].

Maladaptive perfectionists are characterized by a relentless pursuit of unattainable standards and a tendency toward excessive self-criticism. This mindset can lead to chronic stress, as students continually perceive themselves as falling short of their own expectations. Self-critical perfectionism has been linked to burnout within the medical profession [9]. In fact, studies suggest that individuals with perfectionistic tendencies are more prone to developing anxiety disorders, including generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD). This highlights the need for early intervention and psychoeducation on healthy goal setting in academic environments [10]. Psychiatric interventions, such as CBT, are effective in helping students manage perfectionistic thoughts by challenging distorted thought patterns and promoting self-compassion. Early intervention can also focus on other adaptive characteristics, such as setting high but realistic goals can help students be less likely to experience debilitating anxiety when they encounter setbacks.

Recent research suggests that even adaptive perfectionism can become maladaptive under sustained pressure, as students struggle to maintain their high standards in the face of mounting demands [11]. Research in educational psychology has further shown that providing students with feedback focused on effort rather than outcomes helps reduce perfectionist pressures and supports the development of a growth mindset [12]. This underscores the importance of fostering a balanced approach to perfectionism within health professions programs, where students are encouraged to strive for excellence without compromising their mental health.

The focal article highlights the significant impact of coping strategies on anxiety levels among DPT students. Students who primarily use maladaptive coping mechanisms, such as avoidance or denial, are more likely to experience heightened anxiety. In contrast, those who employ adaptive coping strategies, such as problem-solving or seeking social support, tend to fare better psychologically.

For mental health providers in the college setting, the challenge is early identification of students who may be using maladaptive coping strategies, as avoidance often leads to academic procrastination and escalating anxiety. Counselors can help these students by integrating cognitive-behavioral techniques to challenge avoidance behaviors and promote proactive coping skills [13].

Given these findings, it is vital for healthcare programs to incorporate training in resilience and stress management into their curricula. Resilience training, which includes techniques such as mindfulness, cognitive-behavioral strategies, and stress inoculation, has been shown to reduce anxiety and improve coping in healthcare students [14]. These programs help students develop the skills necessary to navigate the challenges of their education and future careers without succumbing to burnout.

Psychiatrists working with this population should also consider the role of pharmacotherapy when anxiety is severe or unresponsive to psychotherapy alone. Selective serotonin reuptake inhibitors (SSRIs) and the benzodiazepines are often used to manage anxiety disorders in the general population, for persons who exhibit significant impairments due to their symptoms. However, it is important to weigh the benefits of medication against potential side effects, particularly in a population that requires high cognitive and physical functioning [15].

In addition to formal resilience training, both formal and informal social support systems are vitally important. Studies consistently show that students with strong social networks are better equipped to handle stress, are less likely to experience anxiety, and even have improved health outcomes, such as blood pressure [16,17]. Healthcare programs should foster a sense of community among students, providing opportunities for peer support and mentoring. Moreover, group therapy sessions, which offer students a space to share experiences and build community, are effective in reducing feelings of isolation and improving mental health outcomes [18].

The focal article identifies gender as a significant predictor of anxiety, with female students reporting higher levels of both state and trait anxiety compared to their male counterparts. This finding is consistent with broader research showing that women are generally more prone to anxiety disorders, a trend that has been observed across various populations, including students in other healthcare programs and fields [19].

The reasons for these gender differences are multifaceted, encompassing biological, psychological, and sociocultural factors. Women are often socialized to internalize stress and may feel greater pressure to succeed in male-dominated fields. Additionally, female students may face unique challenges, such as balancing academic responsibilities with family obligations, which can exacerbate anxiety.

Addressing these gender disparities requires targeted interventions that consider the specific needs of female students. Mentorship programs that connect female students with experienced professionals in the field can provide valuable support and help mitigate some of the gender-specific stressors that contribute to anxiety.

The focal article reports a decrease in anxiety levels as students progress through their DPT program, with third-year students experiencing the lowest levels of anxiety. This finding is somewhat surprising, given that previous research has suggested that stress and burnout tend to increase as students approach the end of their programs [20].

One possible explanation for this decrease in anxiety is the increased confidence that comes with experience. As students gain more clinical exposure and become more familiar with the demands of the profession, they may feel more capable of handling the challenges they encounter. Additionally, the completion of significant milestones, such as passing exams or completing clinical rotations, may alleviate some of the anxiety associated with the uncertainty of the early years.

However, this trend should not lead to complacency. While third-year students may experience less anxiety, they are still at risk of burnout, particularly as they transition from student to practitioner. Healthcare programs should continue to provide support throughout the entirety of the program, ensuring that students have access to resources that can help them manage stress and maintain their mental health as they prepare to enter the workforce. This is particularly significant because prior experiences with anxiety may predispose an individual to burnout syndrome, especially as they enter the workforce, where over 50% of healthcare providers report experiencing burnout [21,22].

The findings of the focal article have significant implications for how DPT programs and other healthcare programs should approach student mental health. It is clear that anxiety, perfectionism, and coping strategies are deeply intertwined, and addressing one of these factors in isolation is unlikely to yield significant improvements in student well-being. Instead, a holistic approach is needed, one that integrates mental health support into the core of the educational experience.

One of the most effective ways to achieve this is by embedding mental health and resilience training into the healthcare education curriculum. By teaching students how to manage stress, cope with setbacks, and maintain a healthy work-life balance, programs can help reduce the incidence of anxiety and burnout. Additionally, fostering a supportive and inclusive learning environment is crucial. This includes promoting a culture of openness around mental health, where students feel comfortable seeking help when needed.

Faculty development is another critical component. Educators should be trained to recognize the signs of anxiety and use of poor coping strategies in their students and be equipped with the tools to provide appropriate support. This might include offering flexible deadlines, providing additional guidance on assignments, knowing the process for referrals to a mental health provider, or simply being available to listen to students' concerns. Referrals to mental health providers have significantly increased since the Covid-19 pandemic, with access becoming a potential barrier. Telehealth and digital interventions can help the field of psychiatry increase access to their services and increase students’ abilities to gain access to early intervention, potentially decreasing anxiety and later burnout [23].

The findings in this commentary are particularly relevant to psychiatric practice, as they underscore the critical role psychiatrists play in addressing the mental health needs of healthcare students. Psychiatrists are well-positioned to provide early intervention, offering a combination of psychotherapy, pharmacotherapy, and educational resources to students struggling with anxiety, perfectionism, and maladaptive coping. Collaborative efforts between psychiatrists and educational institutions are crucial in ensuring that mental health services are easily accessible to students. This may involve embedding mental health providers within educational settings, offering telepsychiatry services, and creating a stigma-free environment where students feel comfortable seeking help.

Additionally, psychiatrists can contribute to the development and implementation of comprehensive mental health programs within healthcare education curricula. By working closely with educators, they can ensure that mental health education and support are integrated into all levels of training, providing students with the skills they need to manage stress and anxiety throughout their careers. The long-term mental health of future healthcare professionals is essential not only for their personal well-being but also for the quality of care they will provide to patients.

None of the authors (or author’s institutions) have any relationship that might cause a conflict of interest or bias in their work.

This study was not funded by an agency with a financial interest in the outcome.