How do I cope with anxiety while my manuscript is under review?

Congratulations! Finishing your first paper is a happy thing. Whatever the result, you started from zero and went through data collection, statistics, figures, the full text, references and journal formatting. The whole process is an achievement in itself.

If it is published, of course that is wonderful. If, because this is your first paper and your writing is still developing, the journal sees things differently, don't be discouraged. You are getting closer to success.

As for the anxiety while you wait, and the feeling that checking the system is a waste of time, don't worry. Every established scholar you see today went through this early in their career; they just no longer talk about those green early days.

Some people not only keep logging in to the submission site, but also search their own names on PubMed again and again. The funny thing is that the paper has not finished review or been published, so the result is of course zero, and searching again and again will not suddenly make our paper appear.

Once you know this reaction is normal, how do you deal with the anxiety? I suggest the best way is to start writing the next paper.

Once you are into the next paper, you will quickly feel your own progress. The first time, everything was hard because you started from zero. This time you will find you know better what to do, and with a clear goal to move toward, your attention shifts effectively to productive work. In my own experience, while I am writing the next paper, an email suddenly arrives with news on the earlier submission.

If you get a revision, revise and resubmit as soon as you can. If it is rejected, that is fine too: pick the next journal, change the format, and submit again the same day. Then continue writing your second paper.

For the second paper, you might also switch to a different type of work for a change of pace. If you wrote a clinical study, try a meta-analysis. If you wrote a meta-analysis, try a case series. If you feel tired and want something lighter, an image report or a letter to the editor is a nice change.

In general, more productive authors have two main lines of work: clinical studies and meta-analyses. When they have less time and energy, they write letters to the editor, case reports, images or case series, like afternoon tea between main meals.

Productive authors usually have three to five papers under review at different journals at the same time. For them, as soon as one paper is finished and sent out for review, they start preparing the next.

I wish you a smooth and successful start to your career.