EP175: From Melanoma to Mindbody Medicine: Dr. Keira Barr's Story Artwork

Girl Doc Survival Guide

Young doctors are increasingly in ‘survival’ mode.

Far from flourishing, the relentless pressure of working in medicine means that ‘balance’ is harder than ever to achieve.

On the Girl Doc Survival Guide, Yale professor and dermatologist Dr Christine J Ko sits down with doctors, psychologists and mental health experts to dig into the real challenges and rewards of life in medicine.

From dealing with daily stressors and burnout to designing a career that doesn’t sacrifice your personal life, this podcast is all about giving you the tools to not just survive...

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Girl Doc Survival Guide

EP175: From Melanoma to Mindbody Medicine: Dr. Keira Barr's Story

July 16, 2025 • Christine J Ko, MD • Season 1 • Episode 175

Unveiling the Connection: Dr. Keira Barr on Stress, Skin Health, and the Mind-Body Paradigm

In this episode of The Girl Doc Survival Guide, Dr. Keira Barr, a dermatologist specializing in somatic psychodermatology, shares her personal journey of discovering early melanoma and the ensuing health challenges that led her to explore the mind-body connection. Dr. Barr discusses the critical role of stress in skin and overall health, highlighting the importance of recognizing and addressing body signals. She emphasizes the need for a holistic approach to wellness that includes proper diet, mindful movement, and adequate sleep. The conversation delves into adaptive strategies for handling stress, such as breath work and recognizing personal triggers, to maintain equilibrium in the face of the demands of medical training and professional life.

00:00 Introduction to Dr. Keira Barr

00:26 Personal Journey: From Dermatologist to Somatic Psycho Dermatology

01:09 The Wake-Up Call: Diagnosing Her Own Melanoma

01:56 Connecting the Dots: Mind-Body Medicine

04:12 Lifestyle Changes for Better Health

06:13 The Impact of Medical Training on Health

07:26 Understanding and Managing Stress

11:01 The Nervous System and Stress Response

17:10 Practical Tips for Stress Management

19:57 Final Thoughts on Skin and Mental Health

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. I'm very pleased to be here with Dr. Keira Barr. Dr. Keira Barr MD is a dermatologist who specializes in somatic psycho dermatology, and in particular, she helps women with stress related skin issues. She's the author of The Skin Whisperer, has taught at UC Davis, and has been featured in popular media.

Welcome to Keira.

Keira Barr: Thank you. Excited to have this conversation with you.

Christine Ko: Can you first share a personal anecdote?

Keira Barr: How I wound up doing what I'm doing is probably a helpful anecdote to share. It's like when your mess becomes your mission, right? As practicing dermatologist, the focus of my practice was skin cancer, melanoma, and being the dermatopathologist to look at the skin underneath the microscope. Having to diagnose yourself with early melanoma really was my wake up call. Everything I thought I was doing right wasn't right for me. That really led me down this entire path of [00:01:00] what I'm doing now in somatics and psycho derm. You gotta, in many ways, feel the pain to move through the pain.

Christine Ko: Thank you for sharing that. So you found and diagnosed your own skin cancer, melanoma. May I ask, when was that?

Keira Barr: That was in 2012.

Christine Ko: Okay.

Keira Barr: 2012. And it was one of those things where we were transitioning from UC Davis. We were gonna move to Washington State, and it was my going away party. Thank you for all my time here. We miss you dearly. And then I walked right into the OR suite and had my wide local excision.

Christine Ko: You had been at UC Davis, at that point, for how many years?

Keira Barr: About five years. We had moved around quite a bit. My husband's former military, so we had done training in the Midwest, then went overseas. Then came back to the southeast, did our fellowships, and then moved to UC Davis. What I realized with that diagnosis is I [00:02:00] thought I was doing everything right. But I was running ultra marathons, juggling toddlers, juggling academics, thought I was eating right. And I came to find out that the skin was the loudest expression of what was happening underneath the surface. But it was just the tip of the iceberg because after that diagnosis that it was gut issues, hormone issues and just a snowball and cascade of things. It wasn't until I landed in MINDBODY medicine that all the dots really started to connect: that it was stress and all its different forms that was taking hold and pushing all of my systems over their limit.

Christine Ko: Okay. And when did you finish training?

Keira Barr: I finished training 21 years ago.

Christine Ko: Okay. So then you were maybe 10 years out when that all that happened?

Keira Barr: Yeah.

Christine Ko: Okay. And up to that point, you mentioned that you felt like you were doing everything right. Once you'd ended up in MINDBODY medicine, what do you think that you should have been doing that you [00:03:00] weren't?

Keira Barr: Listening to what my body was trying to offer me. We have been conditioned to believe that the mind and body are separate, or all our systems are separate, right? We are sub-specialized, and it's hard to be a specialist in all the different systems. We tend to forget that all the systems are still connected, even if we're a dermatologist or rheumatologist or cardiologist, all our systems are still connected.

I was overriding and ignoring all the messages my body was trying to send me. I was having bloating and just wasn't sleeping well. I was like, oh, it's just 'cause I'm tired. I'm raising kids. I'm trying to juggle all these things. But all of those were my body's way of trying to communicate. All symptoms are communication, and I was just ignoring them. And that's exactly actually why I called my book The Skin Whisperer, because the hope is by sharing my story that others might be able to hear the messages that their skin, their bodies are offering when they're just a whisper versus having to shout. Because [00:04:00] the more we suppress, the more we ignore, the louder your body's gonna speak in service of your survival, right? Just to get our attention that it needs care or needs support in some way that we might not be offering it.

Christine Ko: So what are some of the changes you made to start listening to your body?

Keira Barr: It was a very long journey, I would say, and it changed everything. The easiest thing to start looking at was diet, right? So I started thinking I was eating healthy, but I realized, with young kids too, you're eating some processed stuff. So looking more at nutrient dense, whole foods, incorporating more colors into my diet. Really looking at the role that sleep plays and trying to prioritize sleep versus just doing that one more thing. And the way I moved my body. I had been running ultra marathons. I thought if a little was good, more had to be even better. One of the health debacles that unfolded after the diagnosis was I wound up tearing the labrum of my hip. And [00:05:00] so I couldn't run. I was literally non weightbearing on crutches for six weeks. I had never been so still and idle, I don't think in all my life. And at first I really fought it. I resisted it. And then it was like this kind of clouds parting, oh my gosh, I have so much more time available. Once I was able to recover, the way I chose to move my body was very different. Instead of punishing it in some ways, or moving my body to fit a certain shape or aesthetic or what others thought was right, I had to listen to what was right for me. Maybe it was just walking, maybe it was just stretching. One of the biggest things was movement.

Christine Ko: Yes. Not to oversimplify it, but it's what we eat, so our diet; what we do with our bodies, so exercise; and sleep. Those are all things that we learn during our training not to eat well. We [00:06:00] learn, we can get by with no sleep. Especially as interns, exercise often is the first thing to go out the window 'cause we get so tired. I realize, I think that our training makes us habitually unhealthy.

Keira Barr: Yes, these are the lifestyle factors, tactical, strategic things that we can do, right? Medical training forces us to override needs that we have, right? Attuning to that inner wisdom that we have, having more curiosity and care. Learning how to have compassion for myself versus always being critical, you can do more. You're not doing enough. You know, that not enoughness. And I think that's really what drew me to diving deep in traumatic stress studies and somatics. Because, medical training in and of itself is traumatic because we have to forsake what may be right for us in service of, this greater good. But at the same time, [00:07:00] sacrificing what's good for us.

Christine Ko: All doctors coming outta training have a certain amount of post-traumatic stress disorder, but we don't recognize it as such. No one really ever told me that. We don't really have a choice in how we train. We're told, this is where you need to be. This is how much you have to do. And there's not enough time really to talk about the things that I did find traumatic, like when my first patient that I was caring for passed away. You've been studying stress and mind body connection and mind body medicine, and do you have some tips or techniques related to what you think can help?

Keira Barr: The most helpful tip, and I'll actually be teaching about this, at the upcoming Academy is understanding what stress means for you. If we don't recognize how stress shows up in our own bodies, in our own lives, what the triggers might be, then we can't meet ourselves where we're at, and we can't offer the support that would be most [00:08:00] supportive. This whole idea of just calm down, just meditate, just breathe. Well, a lot of people think that they might be doing it wrong or meditation doesn't work for them, or breath work doesn't work for them, but it's all about right time, right tool. One of the biggest tips I can offer is getting to know your triggers. What does stress look like in your life? For some of us, it's feeling very anxious. Racing mind. The doing, right? Putting ourselves into overworking, over exercising, just keeping busy. And for others, stress may manifest as sacking out on the couch, scrolling on the phone, watching Netflix and binging because that's all that we have the capacity for.

For some of us it's hyper arousal. For some of us it's hypo arousal, right? But the impact is that what we're experiencing is too much for our system to adapt to in the moment. And that's really, in many ways, what trauma is understood to be. It's not the event itself, it's how [00:09:00] that event impacts us or what happens inside of us in response to that event.

If we've slept well, if we've moved well, if we've loved well and all of that, we might have more capacity to adapt to the circumstance, but if we don't, it might be too much and just throws us for a big loop. Knowing where you're at, finding what works for you, is really important.

Christine Ko: Yeah. Okay. I'm just gonna play devil's advocate. I actually don't disagree with anything you said, but medical training is inherently stressful. Learning in general is stressful because, especially for type A personalities that want to already know everything, to be unknowledgeable can be stressful. And in training, there is a lot of material that should and needs to be learned. The culture of medicine, it's like work and more work. A little bit of work is good, more work is even [00:10:00] better. You touched on this sort of overwork syndrome, but it's almost like it needs to be done because there isn't enough time to do and learn everything that we need to, even if we spent 24 hours a day doing it. In a way, there's not time for wellness. No one enjoys not sleeping and having overwhelming amounts of work, but still, if you're dedicated to becoming the best doctor that you can be, it's a process that you have to go through to learn what you need to learn during training. In a way, isn't it inevitable? is my devil's advocate question.

Keira Barr: I love your question. I love learning. I'm constantly learning because it's exciting and it's energizing. In order to keep going, the invitation is our presence. Moment by moment. Yes, the work needs to be done. So what do we need to do to support ourselves to be able to continue doing that work? That's where I teach tools of on the spot. Noticing, knowing what the triggers are, and how we [00:11:00] respond to it.

Our automatic nervous system really dictates our stress response, and I liken it to an elevator. So if you imagine each floor that the elevator stops on is a nervous system state, and it knows where to stop depending on the cues that it's picking up from our external environment, the noise, the lights, the smells; our internal environment, Are we tired? Are we thirsty? Are we hungry? And the in between, the relational. Depending on the cues that it's picking up, it's gonna stop. If it picks up cues of safety, it's going to go to the penthouse. This is where we feel present, connected. We can still experience stress, so to speak, like work deadlines, patient load, but we are present and grounded enough that we can ride the waves of stress activation without getting caught up, getting stuck. If the nervous system picks up cues of danger, that elevator is going to move to the middle floor. This is our mobilization. This is activation of the sympathetic nervous system. It's where fight or flight [00:12:00] happens: mind is racing, heart is racing. We can take action. If the nervous system continues to pick up cues of danger that feel untenable, we switch into conservation mode. The elevator moves from the middle floor into the basement. Things really slow down, conserving our energy so we may feel a little bit more sluggish, depressed. This is where we see brain fog, helplessness, hopelessness, and chronicity of disease.

The goal is not for the elevator to be in the penthouse all the time. It's to have the fluidity and flexibility to move between floors so that we can be ready to deal with whatever stressor comes our way. So the invitation is knowing what floor you're on. So that you know how to support yourself through it so that you can continue to do the work.

The goal is to get that elevator moving, and that's where the vagus nerve comes in, right? We can directly activate or intentionally activate the vagus [00:13:00] nerve on the spot. And that's where breath work comes in, because the vagus nerve originates at the brainstem, branches innervate the face, the throat, the chest the lungs and innervate organs of the belly. So as we are doing diaphragmatic breathing, it massages the vagus nerve so we can bring a little bit more ease, a little bit more calm; or you could do, on the spot, tensing up the muscles and releasing the tension if we've got that pent up energy 'cause we're on the middle floor. Or, if we're stuck in the basement, we could use breathwork techniques that add a little energy, right? Things that we can do moment by moment to support ourselves to keep going, knowing that we have a very important job to do that demands our focus and our attention. Knowing where you are moment by moments, you can meet yourself where you're at with the tools and resources that you might need to keep going.

That's how I make sense of all of this because medicine is a very demanding job, and I don't [00:14:00] think we owe it our lives, in terms of our health and our wellbeing. There are ways that we can support ourselves through it.

Christine Ko: Yes. I like that analogy. You can correct me if I'm wrong, but an elevator should go to all floors. So we should sometimes be in the basement, or in the middle of the building, and ideally at times in the penthouse. Levels of high stress and even overwhelm, being in the basement, that is part of life. And our elevator is gonna be there. And you're saying to each individual to know and recognize the signs of which floor you're on and develop techniques for each floor. Each individual is probably different for what to do in the moment. Is that what you're saying?

Keira Barr: In essence. Yeah, you're absolutely right. We do want to have the capacity to be at every floor. We want to be able to go to every floor. Stress is a normal biologic adaptation. There is no bad [00:15:00] state. There is no better or worse, it is just what is required to meet the moment. There are times that we wanna be sympathetically mobilized, right? This is where creativity and play and dance and fun comes in.

The challenge is for many of us, because of our earlier lived experiences, developmental trauma, childhood trauma, which could include neglect, what didn't get to happen in addition to what did happen in terms of physical abuse, emotional abuse, is that we may misinterpret the cues that are coming in. Cues that are dangerous, we may interpret as safe and vice versa. Cues that are actually safe, we may interpret as dangerous, so we might wind up on the wrong floor. Or for many of us, what happens, especially with chronic illness, especially with skin issues, is that the elevator just ping pongs between the middle floor and the basement, and we get stuck there. And then the body doesn't really have the full capacity or can't really cultivate the conditions for true healing. Trauma happens [00:16:00] when we outpace our capacity to adapt, and we can get stuck either on that middle floor or the basement or ping ponging between. The skin is part of that network, the nervous system, immune system, cutaneous, endocrine. If nervous system is Command Central, it's giving instructions to all those other systems how to proceed. And if the cues of danger keep coming in, then the immune system is getting messages that it needs to keep pumping out inflammatory cytokines, and hormones are getting signals that they need to keep pumping out stress hormones. So if we can learn how to help the body send the nervous system different signals, more cues of safety rest or breath or sparks of joy. Even if you're on a 24 hour shift in the hospital, drinking from your favorite mug or having your favorite tea. These don't have to be time consuming practices. Little things that Deb Dana, who's a mentor and known in the trauma healing space, [00:17:00] calls glimmers. Where are and what are the glimmers that we can add in to help our capacity to work through the stresses that we encounter all the time? They're unavoidable.

Christine Ko: I don't know much about breath work, but I am familiar with the physiologic sigh, where you breathe in twice and then exhale. I do think it helps me to immediately become calmer. It's supposed to activate the parasympathetic system. What do you think of the physiologic sigh?

Keira Barr: I think it can be very helpful. We can intentionally bring awareness to our breath and change the way we breathe to help change physiology. When we're stressed, oftentimes what happens? We hold our breath, right? Even just bringing awareness. Am I breathing? It's the fastest way to recalibrate the nervous system and bring it back into balance. So the physiologic sigh is one of those tools and techniques that we can use. The exhale activates the [00:18:00] parasympathetic nervous system. Our inspiration actually gives a little bit of sympathetic activation. So if we can extend the exhale just by a few beats, we can bring a little bit more of that rest and relaxation response in. If we're feeling depleted, we may spend more time on the inspiration. The breath of fire or the lion's breath where you stick your tongue out and you make an audible sound that discharges that stuck energy. The breath is like the fastest way that we can reset the nervous system, and it's so accessible.

My favorite recommendation is, before you walk into your next patient exam room, take maybe an extra long exhale. When you're washing your hands, tapping into the five senses, feeling the water, the temperature of the water on your hands, maybe even sniffing the scent of the soap. All of this is the intention of bringing us here into the present moment. Most of the worry and stress that keeps our nervous system in a state of dysregulation is in the past or in the future. So these little [00:19:00] practices invite us to be here right now, be present to what's here right now. That's where life is lived. It seems so cliche, but it's very true.

Christine Ko: That's a great point. A lot of my stress comes from remembering past things that happened and worrying about that and also worrying then about the future. If I can just focus on what's going on right now, a lot of those worries and concerns would not really exist.

Do you have tips of how you thrive today? I know you've gone over some of them. The breath work, eating well, sleeping well, exercising a different way.

Keira Barr: Yeah. Movement is medicine for me. It's literally movement to move just the energy of the day and the stressors, just move them through. Getting outside and walking on a daily basis helps me metabolize and process. Also just normalizing and naming what we are experiencing is really important.

Christine Ko: Do you have any final thoughts?

Keira Barr: Our [00:20:00] skin is our ultimate boundary. It's can be a billboard for what's happening beneath. It's a neuroendocrine organ, and it has its own stress response system. It has its own HPA axis. The skin is both a target and a source of the stress response. Skin health and mental health are not separate. They are intimately connected. And taking care of you and how you feel in your own skin is the most potent skincare advice and thought that I can offer, which is very different than how we were taught, or at least how I was taught.

Christine Ko: Thank you so much, Keira, for your time.

hristine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. I'm very pleased to be here with Dr. Keira Barr. Dr. Keira Barr MD is a dermatologist who specializes in somatic psycho dermatology, and in particular, she helps women with stress related skin issues. She's the author of The Skin Whisperer, has taught at UC Davis, and has been featured in popular media.