DEALING WITH DENTAL PHOBIA & ANXIETY PRACTICAL GUIDE€¦ · DEALING WITH DENTAL PHOBIA & ANXIETY PRACTICAL GUIDE . Helping you get a Better Deal from Your Life 2 CONTENT ... Performance

CHANGES WELCOME, Suite 253, 179 Whiteladies Road, Bristol, BS8 2AG. Tel: 0117 214 0724

DEALING WITH DENTAL PHOBIA & ANXIETY PRACTICAL GUIDE

Helping you get a Better Deal from Your Life 2

CONTENT

Introduction ................................................................................................................ 3

1 – How the Mind Works ........................................................................................... 4 The Intellectual Mind. ........................................................................................................... 4 The Primitive Brain & The Limbic System ............................................................................ 4 Pattern Matching .................................................................................................................. 6 How we do our Thinking ....................................................................................................... 6 Model of the World (Map) – Our Subjective View ................................................................ 6 Primitive Mind = Negative Mind ............................................................................................ 7 How we Create Anxiety……………………………………………………………………………7

2 - What is a Phobia? ................................................................................................ 9 What is Dentophobia? .......................................................................................................... 9 Making the Diagnosis Wrong ............................................................................................. 10 Types of Phobia ................................................................................................................. 10 Who Suffers from Phobias? ............................................................................................... 11 Factors for Risk .................................................................................................................. 11 Causes of Phobia: .............................................................................................................. 12 Prevention vs. Cure ............................................................................................................ 13

3 - What can we do about it? .................................................................................. 15 Overcoming Fear & Phobia ................................................................................................ 16 Meet or Beat Dental Anxiety & Phobias ............................................................................. 17 Building Rapport ................................................................................................................. 17 Matching & Mirroring .......................................................................................................... 18 Factors of Influence ............................................................................................................ 19 Character Types ................................................................................................................. 20

4 - The Role of Hypnotherapy for Dental Anxiety, Phobia & Life ........................ 21 Hypnosis aka Trance ......................................................................................................... 22 Phobia Treatment ............................................................................................................... 22

References & Acknowldegements ......................................................................... 23


INTRODUCTION

This guide has been produced to help anxious dental patients and members of the dental profession to support patients, who do have a considerable fear of the dentist. It is for anybody who wants to do better in life by understanding how they can change their thinking, in order to get better results.

It is produced by Clinical Hypnotherapists at Changes Welcome, and includes notes from This Clifton Practice Hypnotherapy Training in Solution Focused Hypnotherapy.

Changes Welcome Specializes in Solution Focused Hypnotherapy, Performance Hypnosis & Coaching, and runs regular CPD (Continuous Professional Development) training courses for the Dental Profession, lead by Clinical hypnotherapists Sam Little and Liane Ulbricht-Kazan.

Our aim, and indeed the aim of these course notes, is to help people get a better deal from their life, their profession, and their interactions. This is why we do not only teach dental professionals about about how to help their patients, but also what they can do to manage their own personal challenges and limitations.

Feel free to use the accompanying relaxation resources with your patients, and to refer them to us for individual help with their Anxiety, Phobia or similar Clinical or Performance Issues.


1 – HOW THE MIND WORKS What many people don’t know is that, although we have one Brain, for all intensive purposes we actually have two minds – The Intellectual Mind, and the Primitive Mind……

THE INTELLECTUAL MIND1. This is to the bit you know as you. It is your conscious part. The part that interacts with the world. The part we are using to be aware of our interactions together. It is attached to a vast intellectual resource.. This part we don’t share with other animals. The development of the intellectual part came about as part of a ‘genetic accident’, giving human beings the ability to daydream. This immediately put man on the evolutionary fast track that quickly distanced him from his nearest neighbours. Being able to forecast a positive outcome tomorrow based on what he did yesterday gave him unequalled incentive to be inventive. Beforehand, man had certainly been able to learn instinctively. Now he was able to learn intellectually from experience and imagining outcomes. He was able to continually improve his performance and he was programmed to do so. From an evolutionary perspective, the more successful he was as hunter-provider, the more the human race flourished. He survived and his family survived. When we operate from this part of the brain we generally get things right in life. It will always come up with answers based on a proper assessment of the situation and is generally very positive.

THE PRIMITIVE BRAIN & THE LIMBIC SYSTEM While the development of the intellectual brain continued at pace, the much older, instinctive part has remained just as active. In the physically dangerous world of early man vigilance and strength were valuable commodities. Without doubt, the intellectual progression led to more and more ‘sophisticated’ danger. Day-dreaming, while continuing as a force for good, inevitably acquired a negative aspect to it. This increased the sensitivity of the limbic system response as the amygdala responds to thoughts, or imagination, in the same way as to actual events. The centre and influential bit of the primitive brain is the amygdala. This is generally referred to as the fight/flight/depression area of the brain. It is associated with two other very primitive parts. The hippocampus, which holds all our primitive and sometimes inappropriate behavioral experiences and patterns, and the hypothalamus which regulates chemical responses in the body and mind. CORN FIELD EXAMPLE: Imagine you are walking down a road and you come to a dead end. In front of you there is a large cornfield. All the corn is up to at least shoulder height. From where you are standing you cannot see the edges or sides of the field other than the section directly in front of

1 CPHT, 2015.


you. It’s not possible to walk around the edges of the field as the thickly growing corn has filled the field tightly up to the edges. The best decision to reach the other side of the field seems to be to plough on through and trample a direct trail through the centre. It takes some doing, and after great effort you eventually manage to reach the other side. Well done you. Next day you arrive again at the end of this same road and again need to cross that cornfield. This time is much easier, as you can simply follow the path you have already carved out the previous day. This then becomes your daily path and route to arrive consistently at your destination. The first time we do something, we form a new neural pathways (connections) in the brain, and it actually takes some effort to pull it off. Once a pathway has developed, there is a tendency to follow that same route the next time the same or similar situation comes about. This tendency is reinforced time and time again, until the response becomes a habit, and a road is built through the cornfield. LION EXAMPLE: So, let us imagine that when you next go outside you run into a Lion. What would happen? Your anxiety would go up. You would lose intellectual control and move from the intellectual brain to the primitive emotional brain, go ‘sweaty’, increase the heart beat, churn the stomach and you would be off like a shot. In the circumstances this response would be entirely appropriate. You would be pleased. Unfortunately it is the same in life. When our anxiety goes up, and it can be a gradual process, we lose intellectual control and to a greater or lesser extent the primitive mind takes over and this mind always operates within the primitive parameters of the fear/ anxiety, depression, and anger or a combination of all three. There is a direct relationship between anxiety and intellectual control. When we do encounter that Lion or whatever – something that constitutes extreme danger - the alarm system is activated. Responsibility moves immediately from the pre-frontal cortex to the limbic system. The human body prepares to deal with the physical danger. In the case of a lion a hasty ‘flight’ might well be the best option. If our primitive mind thinks that, for one reason or another, our life is in some sort of crisis or emergency it will step in generally to help. Depression, anxiety, and anger are all primitive opt out clauses.

THE FEAR, PANIC & PHOBIA DRAMA2 Here are the main cast of the show, who can always give a good performance even when they only meet up by fluke. Whenever they get together there’s sure to be a big song and a dance.

• Amygdalae - Guardians of emotional memories & deployers of the fight/ flight response, by alerting the hypnothalymus.

• Hypnothalymus - the releaser of hormones, which control the pituitory gland. • The Pituitary Gland - Master Gland and director of the endocrine glands. • Adrenal Glands - Pair of glands, which secrete stress hormones, such as adrenaline and

noradrenaline. • Cortex - Usually the guy in charge but not this time - his role has changed to unwilling

bystander and witness to the panic experience - a somewhat passive part whilst the amygdalae are in control.

2 Furness-Smith, 2014. (p.79)


PATTERN MATCHING So, information is held in the intellectual part of our brain as well as the primitive part. Pattern matching is the process by which the brain habitually organises experience and endeavours to make sense of it. Throughout our lives our brains are constantly seeking to match up given patterns, or templates, some of which we are born with, to stimuli in the environment. The intellectual part of the mind seeks to progress and improve and in the process change templates for our betterment. The limbic system constantly scans the environment for potential threats. It compares all incoming stimulation supplied by the various senses with survival templates, or fear memories, to decide if they are life-threatening or life-enhancing. A crackle of twigs or a sudden silence in the forest may trigger the alarm system, because previous experience of a crackle or silence has signaled a predator, thus setting in train the flight, fight or freeze response. An experience is formed into sensory, sometimes emotional memory and is passed to an adjacent and also primitive part of the brain, the hippocampus. Recent experiences are stored here before they are transferred to the neo-cortex as a narrative memory. When a deeply traumatic event occurs, the emotional reaction is so strong that the memory is retained in the limbic system. The event itself and various aspects surrounding it are now seen as having ‘life- threatening’ potential. A template is formed containing all the necessary information to ensure that a similar event is avoided at all costs3. Thereafter whenever there is a match, or even a partial match, the amygdala fires off the alarm reaction. Because this happens at a subconscious level, and sometimes is metaphorical, the experience is often an incomprehensible state of alarm.

HOW WE DO OUR THINKING It is not the events in our lives that necessarily cause the perception of crisis. No, if that were the case then everyone who needs to see a dentist would be suffering from the same anxiety issues and panic attacks and we know that is not the case. So, it must be our thought patterns surrounding the events of our lives. When the cave man looked out of the cave and there was snow or ice or danger and he couldn’t go out to hunt, he pulled the rug up over his head and didn’t interact until the situation changed. We have adapted this to all the modern day symptoms of phobias, fears & anxiety etc. If we were still in the jungle it’s unlikely that we would be too far away from our panic button at any given time. Anger is merely a primitive way of increasing our strength to defend ourselves against wild animals and other wild tribesman.

MODEL OF THE WORLD (MAP) – OUR SUBJECTIVE VIEW The world as it is and the world as we see it are not the same thing. In the NLP (Neuro Linguistic Programming) world there is a phrase - THE MAP IS NOT THE TERRITORY! In the same way that it doesn’t serve us to be overly optimistic when we meet a lion, being overly pessimistic can lead to fear, anxiety and misery. The main reason we don’t end up with the same subjective view or model of the world is that our model is governed by certain restrictions or

3 Le Doux J.E. 1992.


constraints. According to Bandler4 these are:

1) NEUROLOGICAL CONSTRAINTS: We receive information about the world through 5 sensory input channels – Visual, Auditory, Kinesthetic (feelings), Olfactory (smell) & Gustatory (taste). Rather than each sense being given equal weight, each of us favours one or two above the others.

2) SOCIAL CONSTRAINTS: The language we’re born into. Also, the more specific the language is, the more distinctions we can make, and the richer our experience will be.

3) INDIVIDUAL CONSTRAINTS: Our Individual experiences are all unique, and lead to our

likes, dislikes, habits, beliefs & values. The richness and poverty of our maps are created by three filtering mechanisms: Deletion, Distortion & Generalization. These are all processes we need to carry out in order to manage the information that is coming at us so we are not overwhelmed. The problems occur when the wrong information is deleted, distorted, or generalized, creating patterns that either don’t support our well-being or actively diminish it. Here it is important to point out that our communication is only 7% Words, the rest is in out 38% Tone, and 55% Body Language.

PRIMITIVE MIND = NEGATIVE MIND The primitive mind is a negative mind. It will always see things from the worst possible perspective. If you think about it, it has to for our own self-preservation. When you run into that lion it won’t say ‘ah it has probably eaten’. No, quite rightly it will say ‘it will snaffle you.’ This response is great when we run into lions but not so good when our tooth starts to ache or we are facing redundancy or we’ve had an argument. It is an obsessional mind If you did have a polar bear in the back garden you would be reminded of it constantly. You would keep checking. It is a vigilant mind. If the perception is that danger is all around then it is wise to stay on red alert. And, because the primitive brain is not an intellect it can’t be innovative. It has to refer to previous patterns of behaviour. If what we did yesterday ensured our survival then we are encouraged to do it again. Here we can reflect on the behavioural patterns of the client who keeps cancelling appointments, or fails to turn up, etc. etc..

SO HOW DO WE CREATE THIS ANXIETY?

Anxiety is created by negative thinking. Every negative thought we have is converted into anxiety. We can create anxiety by negatively forecasting the future, big things; “we will never be able to afford that”, I’ll never find another girlfriend”, “I’ll never have a baby” etc. It can be small things; That check up. Here we should remember that the mind can’t tell the difference between imagination and reality. Intellectually you know the appointment is going to go OK, they generally do, but you start thinking about things going wrong. You think about it 50 times? The actual appointment goes quite well but you have attended 51 check-ups and 50 have been disasters.

We can also negatively introspect about the past. We can beat ourselves up about something we should or shouldn’t have done or said etc. Putting off that dental appointment, failing to show up, etc… will add to the anxiety. There’s a lot to be said for Nike’s slogan – Just do it! 4 Bandler, 2008. (p25)


THE STRESS BUCKET Every negative thought that we have is accumulated and stored. We say it is stored in a stress bucket, which is actually a metaphor for the Hippocampus. The stress bucket is a wonderful concept as it illustrates perfectly how the creation of a certain amount of anxiety and stress is totally manageable. Things happen, and things certainly will go wrong, but we can get ourselves onto an upward spiral by limiting the amount of stress in our buckets, simply by altering the way we think about the event or situation. However, when the bucket overflows, this is when we start to get into real difficulties.

R.E.M SLEEP (RAPID EYE MOVEMENT) Thankfully, we do have a method for emptying our bucket and it is known as R.E.M sleep, rapid eye movement. At night we re-run events of the day and change them from being an emotional memory to a narrative memory. Everyone is familiar with how R.E.M works. Someone upsets you in the afternoon and you really are upset. You tell your partner or friend about it ahe/she says forget about it, but you really can’t. You’re thinking about it when you go to bed. During R.E.M sleep we re-run the event either in clear or metaphorically (dreaming), and move it from the primitive brain to the intellectual brain were we have control over it. So when you awaken in the morning you might well have forgotten about the wretched person, you might no,t but you will certainly be saying something like “how do I allow these people to upset me so”.

Perhaps the primary function of R.E.M is related to our early programming. To assimilate information, particularly new information, we need the ability to enter a R.E.M state. R.E.M is restricted to about 20% of our overall sleep patterns. If we try and overdo that, for example when we DO have too much in the bucket, then the mind will respond in one of two ways: 1 – It will wake you up. You know when it is your mind waking you up because you wake up wide awake and often feel quite miserable. Often we can’t get back to sleep again. You know the difference between that and the baby waking you up for instance 2 – It has enormous energy in that effort to diffuse that anxiety. Sometimes we can overdo it and this exhausts us and makes us even more depressed and anxious, even after a long night’s sleep. In an attempt to empty our bucket we are encouraged to sleep more and more, sometimes all day, which makes our depression and anxiety worse and worse. Now we find ourselves in the grip of a vicious circle, the more we sleep or can’t sleep, the greater the tendency will be to put more things in the stress bucket the next day. But once we’ve reversed this process, life starts to improve exponentially. Just imagine always waking up in the morning with your stress bucket emptied so that you can start the day without anxiety, anger or depression!


2 - WHAT IS A PHOBIA?

“A phobia is usually defined as a persistent fear of an object or situation, which the affected person will go to great lengths to avoid, typically disproportional to the actual danger posed5”

People often say they are “phobic”, when in actual fact they are instead suffering from some other kind of anxiety disorder. Anxious people have to work themselves up to an anxiety attack, whereas phobic people do not. Regardless of the terminology, the ultimate aim for us as practitioners in helping the client avoid or overcome their dental anxiety or phobia, is for them to be relaxed. We cannot be relaxed and anxious at the same time, nor can we be stressed whilst feeling completely relaxed. But we can be confident whilst in a state of relaxation.

Because a phobia is based on a false threat in the first place, and arousal caused by anxiety can all too often only be dissipated by avoidance (flight), which only makes the anxiety stronger, as this is a form of negative future forecasting, or introspecting.

When the stress bucket is empty, moreover not immediately flooded with anxiety, then we can have a sensible conversation about what we will decide to do. The methods open to us to help with situation are explained in section 3.

WHAT IS DENTOPHOBIA?

Dentophobia is not as specific as you might think. In the case of a phobia, this will be something very specific within the context of the dental visit. It may also be a broader form anxiety disorder, which is causing the problem, and what you are presented with is an accumulation of stress in the stress bucket.

In any case it’s useful to know what the specific issue relates to. It may be a simple matter of removing that one aspect from the experience, and all is well again.

Social Anxiety

Agoraphobia

Gagging

Needles

Vomiting

Pain

Numbness

Choking

Anaesthetic

Dental Drills

Embarrassment

Diagnosis

Authority (White Coat Syndrome)

Infection/ Sickness

Being restrained

Includes items like Buttons

or Cotton Wool

The list goes on……

5 Wikipedia


MAKING THE DIAGNOSIS WRONG

Whatever the diagnosis for the problem might be, it’s our job to make it wrong. Expanding a client’s experience by broadening the limits of his or her subjective world view is central to the methods of effective therapists. This may be done by looking for exceptions.

Broadly speaking, we can divide the adversity we may see amongst these patients into five main categories. These are:

1) Fear - Fear requires input. There are only 2 innate fears, that of falling, and loud noises. All the rest are learned.

It’s fear of a kind that keeps people in a prolonged high alert that accounts for a whole range of mental and behavioral problems. Learning is also the route to personal freedom – People need to have better choices available other than the one that they experience as the problem.

2) Anxiety Disorders - Phobias are the most common type of anxiety disorder.

3) Stress - Huge role in the creation of phobias (See Causes of Phobias).

4) PTSD – Post-Traumatic Stress Disorder. Also known as Shell-Shock, Stress Response Syndrome.

5) Phobias - Anxiety can be alleviated by a rational thought & conversation. Phobia, not so.

All phobias are essentially the same in terms of brain function. They are learned responses, which can affect anyone, regardless of social background, sex and age. The most common appear to be Arachnophobia (spiders), Claustrophobia (closed spaces), Emetophobia (vomiting), Agoraphobia, and Social Phobias. These last two are significant enough to have their own sub-categories.

TYPES OF PHOBIA

Phobias can be divided into three groups.

• Social Phobia – Very general, and include any kind of social situation. These can even extend to the telephone and these days to social media. This is a lonely world, but one with some personal freedom to enjoy ones own company.

• Agoraphobia – Typically described as a fear of the outdoors, this is very general indeed. It involves anything that might go wrong, and can leave the sufferer with no peace at all. Having no safe place to go, sometimes even at home, this is the worst kind of phobia.

• Specific Phobias - Here we are talking very specific things. The term Dentophobia is probably not specific enough.


WHO SUFFERS FROM PHOBIAS?

It is estimated 10 million people in UK have phobias and that women are more prone to phobias than men6. Some reports say twice as likely, which also seems to be the case for panic disorder, post traumatic stress disorder, and generalised anxiety disorder.

That said, women are probably more likely to admit they are afraid, whilst men will often avoid the issue, so statistics are likely misleading. Literally any social group can be affected. This can change for the better or for the worse in any individual, and this has not only to do with the dental professional, but the total amount of anxiety experienced by the patient at the time.

Other reports and studies state that with regard to dental anxiety, some 25% (1988 study 60%) of patients have some anxiety surrounding their dental appointment, and of these 12% of cases are extreme7.

The main cause of high dental anxiety or phobia is some kind of previous bad or horrific experience. We all know how important it is to introduce children to dentists in a fun and calm way, and this is probably the area where we can do most in terms of avoiding the issues in the first place. There is certainly a lot already being done right.

FACTORS FOR RISK

Factors for risk are not the same as the causes of anxiety, although there is a certain amount of overlap, as indeed there is also a synergy at times with social and individual constraints described in Section 1. Furness-Smith (2014) identifies the following 8 factors for risk:

Gender – See above..

Temperament – People with a low stress tolerance will be more susceptible. For example, sadly in the case of more introverted children who are prone to worrying, they will more likely be the victim of bullying from somebody who has a less sensitive fear response mechanism.

Genetics – Twins raised in separate environments have been shown to have some similar fear and phobia tendencies.

Culture – Certain phobias are more prevalent in certain cultures. For example, Japanese people can suffer a huge amount of embarrassment for failing to conform to social etiquette, because they appreciate that their shortfalls can cause considerable offence. This phobia is known as ‘Taijin Kyofusho’. Students have even committed suicide to avoid the disgrace of attaining less than top exam grades.

Nurture (Family Environment) – Because phobias are a learned behaviour, and we learn from our environment. Like all social contraints that affect our model of the world, they can also be a risk factor in culture and environment. All else being equal, a confident outgoing family environment will leave a child growing up less susceptible to developing a phobia.

6 www.dentalphobia.co.uk/fact-sheets/dental-phobia.html 7 http://www.bbc.co.uk/news/health-12182855


Social Factors – There is evidence that our generation is more prone to phobias than previous. It’s very easy to point the finger of blame to the demise of social structures, and the fact that many people have fewer social connections than we did in tribal days.

Life History – Here we are talking again about our individual constraints. For example, there have been a number of cases after 9/11 where people who witnessed something of the horror later developed a severe anxiety issue surrounding any sudden loud noises.

Age – Age plays a very important role, and the development of a specific phobia is far more likely in small children than any other age group. This is greatly due to the fact that small children have a more limited reference library with which to compare an event or stimulus. They are more prone to black and white thinking. For example, an adult can more easily put an encounter with an aggressive dog into the context of all other positive experiences with his own beloved ‘best friend’. A small child will also feel a lot smaller and more prone to injury than a grown adult.

CAUSES OF PHOBIA:

“The criteria for creating a fear response appears to be the total level of emotion/anxiety [=stress] experienced at the time of the event.8 "

This explains why only a small number of people exposed to traumatic events develop fear responses.

It also explains why children, because they are generally more emotionally reactive to events, especially when too young to have an understanding of the actual ‘danger’ involved, are prone to being predisposed to fear creation. Here we can again refer to the process of pattern matching.

Children react to the world emotionally, not intellectually, until about five years of age. Therefore their perceived patterns of danger are very much taken notice of by the subconscious. Being an unthinking, uncritical mind, the subconscious does not evaluate the actual danger, or otherwise, of these patterns of behaviour (losing our temper, crying easily, feeling helpless) and leads to a whole range of irrational responses, often based on precedents laid down in our childhood.

The precise way in which the amygdala and the hippocampus interact is not yet completely clear. This is particularly so in the area of newly ‘discovered’ fears. One will often hear in the consulting room ‘I never used to be afraid of flying but I am now’, ‘I used to enjoy lecturing but not now’. Whatever the ambiguity of this, the common theme is invariably that the person’s general stress has increased and this will always be in concert with the fear response. It is as if the pre-frontal cortex is losing control of more and more aspects of that person’s life – which is, in fact, exactly what is happening.

Since, nowadays, people are rarely in the presence of life-threatening events and yet still suffer from ‘anxiety’ and ‘panic attacks’, it is clear that the trigger is a progressive rising in the person’s general anxiety level. It does not matter whether it is a single event, like meeting a Lion, or a series of smaller fearful happenings, that raises the level. As soon as the level reaches what is seen by the amygdala as ‘danger-level’ then the survival, fight or flight, response will be triggered. We simply react.

Sadly it is the same in life, even when our anxiety/stress levels have risen gradually. As the level rises the influence of the primitive mind increases. Ultimately, a person can maintain an almost constant state

8 Wilson J.P. and Kean T.M, 1997


of panic. Even when the source of the high stress level is, in fact, the result of a person’s negative thought patterns, the primitive mind will paradoxically add to the pain and confusion by scanning the environment to find the source of alarm- the Amygdala noting all kinds of possible panic ‘situations’ and storing them for future reference.

Not surprisingly then, for many people, the association is often with the environment where the panic attack happened – the supermarket, the lecture room, the motorway etc. It is possible that there is a dormant template, often created in childhood, which was ready to be activated by the over vigilant, over sensitive mind. What we know is that the noose tightens as the primitive mind increases its control, often restricting that person’s ability to continue with any normal life.

According to Furness-Smith9, there are 5 types of causes for the onset of a phobia:

1) Excessive Stress – This is the overriding feature within all causes of phobia, and is a direct consequence of how we do our thinking.

2) Frightening Personal Experience (aka Trauma) – When thrown from the horse it is understandable that we can become fearful of getting back on, especially if you allow time for the fear to grow before attempting to ride again. It’s far better to get back on as soon as possible. Frightening personal experiences can also include vicarious situations, because the trauma can also be experienced indirectly. For example, witnessing a parent choking on a fish bone can be a frightening experience for a small child.

3) Modelling – i.e. Observational Learning such as witnessing our parent’s fear is again

something, which children are prone to. They can easily come to accept a parents fear of something such as spiders as being perfectly normal.

4) Misunderstanding – There are many cases where the facts are simply misinterpreted, and a

phobia develops. Witnessing Guy Fawkes on Bonfire night is an example, and misinterpreting the creaks in an old house, can be just as chilling when the imagination plays it’s vivid games.

5) Indoctrination – Unlike witnessing (modelling) personal traumatic experience and

misunderstanding, we can also become phobic due to being convinced of the fear by other people. For example, children who’ve been overly warned about stranger danger, may become socially phobic.

PREVENTION VS. CURE There is a lot, which can be done, and which the dental profession is already doing to help people with dental anxiety and fear. Outside the dental setting, there is a great deal, which can be done in terms of therapeutic intervention to prepare people for their trip to the dentists. As we’ve mentioned, we will in most cases be dealing with a situation of excessive anxiety, rather than an actual phobia, and it’s here where a patient may be able to help themselves quite easily through the right anxiety avoidance methods. It’s great to cure a phobia, but it’s better to not create one in the first place. And this is certainly an area, where dentists and their staff do some hugely positive work, and this starts with children making their first visit.

9 Furness-Smith, 2014.


For the child, the experiences surrounding this visit are crucial to establishing a positive expectation of the dental practice, and must be made as relaxed and fun as possible. This begins with the parents getting relaxed, and not pressuring the child on the day, taking time to allow things to place more at a natural pace. Professionals will recognise that there is more at stake than the urgency of the next appointment, when a child does not immediately cooperate. It’s all about keeping it positive for the child, as much as possible. Granted, this is easier done on their first check-up than on a day when they’ve just had an accident, and need some work doing on their first visit. The police at road traffic accidents give out trauma teddies to children, to distract them from horrors and give them something to look after, so positive distraction is a great tool, as are rewards (e.g. stickers). We have already said that we cannot be relaxed and anxious at the same time. So, in all cases of anxiety, the best thing we can do is learn to relax and relax, and relax and relax, and relax. This goes for the time leading up to the appointment, as well as on the day.


3 - WHAT CAN WE DO ABOUT IT? Early man and early women were given quite definite rewards for carrying out certain evolutionary processes. They got a reward when they hunted and gathered, and successfully supported themselves and their families. We are better as a tribe rather than individuals, so they got rewarded when they interacted with others. The reward they got they quite definitely recognised and scientists are adamant about this. They felt motivated. But most of all was a coping mechanism

• It helped them cope with day to day activities • It helped them cope better with physical fear • It made them braver • It even helped them cope with physical pain

No doubt they were pleased. Now we know what that reward is. It’s a chemical response in the brain that produces various neurotransmitters that act as catalysts for that sort of mentally healthy behaviour. Furthermore, the neurotransmitter we talk about most, simply because it is the most important, is serotonin. When we produce a constant flow of serotonin we are happy and brave and can cope with any situation. So we need to operate within these positive parameters like early man, and although we do not have to go out to hunt, we do have to interact in a positive way, be active in a positive way, and think in a positive way. Because when we do, we produce patterns in the brain that give us that constant flow of serotonin.

WHAT STOPS THE FLOW OF SEROTONIN? When somebody is down at the miserable and depressed end of the scale, they won’t be producing any chemicals at all to speak of. On the other hand, anybody operating up at the anxious end will be producing an overload of stress hormones and adrenalines, which are great for when we run into Lions, but not so good for running our daily lives. For this reason, any anxiety or phobia prevention or cure must ensure that people get into the intellectual part of the brain, where they will again have the control they need to do well in life.


As anxiety in life is reduced the intellectual mind regains control. This is brought about by a reversal of the exact process that caused anxiety in the first place. Learning to think positively will, in due course, reverse all depression, anxiety and anger related negative processes. THE RATEY METAPHOR – THE CEO10 John Ratey, in his book ‘A User’s guide to the Brain’, sees the brain as three main functionary areas. He refers to the pre-frontal cortex as the Chief Executive, the CEO, or the Boss. Another area (the Anterior Cingulate) he describes as being in so many aspects like the Boss’s secretary. The Amygdala, heading up the ‘Health and Safety division, he sees as the Fire and Safety officer. We can elaborate on this – we are aware that when the going gets really tough, a fire emergency for example, the safety officer will take control and follow pre-determined procedures. The Boss will no doubt go along with this although he or she will have the ability, albeit sometimes a difficult option, to reassume overall command. The Anterior Cingulate, the Secretary, like all good P.A’s, will try to have to hand the best information available for the Boss at any given time. He, or she, has an incomparable resource asset to work with in the main cortex of the brain, the ‘library’. As is the way with all good P.A’s, the information and advice provided will be up to date, relevant to the task, and ahead of the game. It will also reflect, in many ways, the likes, dislikes and personality ‘foibles’ of the Boss. At times too the Anterior Cingulate will accept the authority of the Fire and Safety Officer, and his often continuing advice will be allowed passage through to the Boss.

OVERCOMING FEAR & PHOBIA

According to Bandler11, there are three steps, which people have to take, in order to get over a phobia. These steps would also apply to most fear and anxiety issues discussed here. The three steps are:

1) People must become so sick of having the problem that they decide they really want to change. 2) They have to somehow see their problem from a new perspective or in a new light. 3) New and appealing options must be found or created, and pursued.

Ultimately, whatever the situation, the pre-frontal cortex appears to have the ability to take control, or regain control from, the limbic system. The mind will generally respond to the most dominant thought. If that emanates from the intellectual mind then that has the priority, even in the most desperate situations. This explains how individuals can show exceptional abilities to remain calm, in control, and brave when faced with a life-threatening situation, particularly where a member of the family faces the danger, such as in a burning building. They can overcome the survival response that insists that they keep away from the danger. Secondly, it is possible, with modern techniques, to reduce anxiety and to move memories that have become locked into the emotional, primitive brain.

10 Ratey, 2001. 11 Bandler, 2008. (p.9)


RUDOLFO LLINAS METAPHOR – THE CLOTHES STORE 12 Imagine the scene within a clothes store before you enter. You (the stimulus) might look through the window. If you did you would see a group of assistants talking to each other. There could be considerable activity and communication. You enter the store, making yourself a new incoming stimulus. At first the assistants keep chatting, they may have sensed you but they are not yet paying attention. You clear your throat loudly. One, or even two, will look at you. You now have at least part of the brain’s attention. If you say ‘I want to buy a coat’ suddenly all are attentive. You now have the brain’s attention. Having become conscious of the stimulus a few assistants take action. One goes to the racks, after checking sizes etc. Another might go to the cash register. Yet another might go to the storeroom to fetch a size 14. Some of those remaining will continue with store duties, rearranging the shirts, changing prices etc. Still others might be on another floor, or in the front window rearranging the display, probably unaware of what is happening in the overcoat department.

MEET OR BEAT DENTAL ANXIETY & PHOBIAS The first thing we must do in meeting a patient is to get ourselves into the left pre-frontal cortex of the brain. It’s our next job to get our patients also operating from the left pre-frontal cortex also. We do this all the time by making the right first impression, and following this up with a good amount of upbeat inconsequential language, chit chat, light humour, kindness and responsiveness. We can influence other people in many ways. General niceties, warmhearted friendliness and genuine compassion are a good place to start. Put yourself in their shoes, and make it about helping them. When you are talking about the nice weather outside, or the journey there, you are likely to avoid any anxiety triggers, and indeed you can begin to build rapport.

BUILDING RAPPORT None of us are born with great rapport skills, these are learned. Have you ever watched two friends in conversation and noticed when one friend moves position the other will make a similar movement, when one sips their drink the other soon sips theirs, if one leans forward so will the other, even the level and tone of their voices and the speed at which they speak are similar. This is rapport, which you can think of as a relationship of commonality. People tend to like people who are like themselves, or are how they would like to be, but this doesn’t mean that you can only have rapport with people who are like you are. It is perceived likenesses that create rapport, and when it is good, similar body posture, gestures, speech and tone patterns can be noticed.

12 Head of Neuroscience at The New York University School of Medicine


MATCHING & MIRRORING One of the world’s greatest if not the greatest Hypnotherapists was a man called Milton Erikson. He was a medical doctor, and a psychologist. Erikson was a genius of a man who suffered from polio, and as such spent a lot of time in a wheel chair. He was also very astute in observing people. He was the one who first noticed and coined the skills of matching and mirroring. Of course, we’ve al been doing this all our lives, but he was the one that made it a tool for helping people. What we are referring to here is the manner in which rapport can be developed by matching, mirroring, or pacing the behaviours of those we wish to influence. If we bear in mind that 93% of all communication is down to the tonality of our voice and our body language we can see that if we improve our non-verbal skills our clients will feel comfortable and trust us, even before any work begins. We can see, therefore, that the likelihood of successful treatment is greatly increased. Any observable behavior can be mirrored and matched, for example:

Tone of Voice

Tempo of Voice

Volume of Voice

Language*

Terminology

Posture

Gestures

Facial Expressions

Eye Contact & Blinking

Breathing

Proximity

Touch

* Some people think in pictures and use visual words to relate their thoughts and feelings. Some people listen to the world and auditory words will resonate with them. There are others who are feeling oriented and kinaesthetic words will help to build a firm foundation with them.

IMPORTANT: Mirroring & matching should be subtle and respectful or it will look like mimicry and could lead to offence. People who are in distress or have severe mental issues should not be mirrored as this could lead to them feeling more distressed.

First impressions always count and if you wait until you have the client in the room with you to build rapport you may well be too late.

Rapport is built from the first point of contact with the client, from your style of advertising, the building and room that you practice in, the way you answer the telephone, the way you dress etc. All things must be considered to make your client feel comfortable and enable you to work at the highest level with them. As always practice makes perfect so it is probably best to practice rapport building on friends and family before working with clients.


FACTORS OF INFLUENCE

As programmable beings who have adapted to the various constraints and limitations through which we see life and subsequently respond to it, there are some consistencies between us which appear on the whole to be universal across out species.

• Contrast Principle - If a second offering is fairly different form the first, we will tend to see it more differently than it actually is. E.g. If we offer some worst news first (we can make this up), then the real negative seems comparatively less negative.

• Reciprocation Principle - This rule has it that we feel obliged to return favours already, even when we didn’t want the favour in the first place. The rule can produce a ‘yes’, which would never have otherwise followed.

• Reciprocal Concessions – This refers to a feeling of obligation to make a concession to somebody, who has made a concession to us, and is used in negotiations.

• Commitment & Consistency Principle – People want to appear to look and act consistently with what they may have already said and done. This works by getting people to make a commitment, or series of smaller commitments.

• Social Proof Principle – All other things being equal, people generally conform to what social proof tells us. We use the actions of others to decide on proper behaviour. This is increased in ambiguous situations. This rule increases with similarity, such that we are more likely to follow suite with somebody we like.

• Liking Principle (incl. Physical Attractiveness) – Here we are referring to a ‘halo effect’ which may surround a person, especially when we find them attractive.

• Authority Principle – Responding automatically to authority comes about once we realise that obedience to authority is mostly rewarding. Moreover, it is easy to allow ourselves this obedience, as it removes our need to think.

• Scarcity Principle – Although less relevant in the practice room, scarcity is the final significant factor of influence discussed by Cialdini. This applies to Quantity, Time, Availability, and Prohibition. This principle has it that our desire for something scarce will be increased, compared to the same thing abundantly available. It works especially well when news of the scarcity is also scarce.


CHARACTER TYPES

We can apply an interesting model known as the Warriors, Settlers, and Nomads to determine differences and good mirroring and matching protocol to different personality types. Here, a brief description taken from Terence Watt’s book on the subject provides more detail13:

WARRIOR Experts tell us that rapport is built more on the relation level than on the content level, however a warrior needs good factual content and this is more easily accepted if it is delivered at a steady even tone and pace without too much smiling. Also, as the warrior is the least animated of the group, hand and head movements should be kept to a minimum.

SETTLER Rapport is easily built with the Settler who is pleasant, intuitive, and likes to fit in and make others feel at ease. Settler personality types are responsive in conversation and tend to be expressive about their feelings so kinesthetic words will help you build a close bond with them. They will probably need a lot of support and encouragement, delivered with warmth and a smile, as they can easily slip down into depression and feelings of low self-esteem.

NOMAD The most animated of the group. The generally fun loving nomad will be drawn in by the use of visual language, enthusiastically delivered with the aid of expressive hand and head gestures. They can tend to over dramatic, with a low attention span so a lot of encouragement delivered with a friendly smile will move them forward.

13 Watts, 2000.


4 - THE ROLE OF HYPNOTHERAPY FOR DENTAL ANXIETY, PHOBIA & LIFE

In almost all cases of anxiety, depression and anger related issues, the common need as previously mentioned is relaxation. This is why we needed to have a common understanding of what relaxation actually is.

We have a need to be in intellectual control to determine the correct course of action in our lives. This includes making informed choices, which may lead us into unfamiliar territory with the aim of meeting new challenges and conquering old bad and unhelpful habits as we do so.

Habits are key to the effectiveness of every human being. We can think of habits as skills on autopilot. They are reactions, and pre-programmed automatic actions that are very much within our zone of familiarity. But here’s the problem, they don’t always support our goals, and sometimes even sabotage our best intentions extremely effectively.

So, if we want to change an old habit, whether that be a fear response pattern or anything else for that matter, we must first get intellectually clear about what exactly it is that we are asking of ourselves, what that looks like, and what that feels like, to build new connections that support our worthwhile goals.

Whenever the primitive mind is in charge, we will not be able to come up with new answers and responses to old questions or situations. Instead, we need to get our anxiety down, and the stress bucket emptied, which is done first and foremost through practicing the opposite of the negative cause.

For these reasons, we must always be aiming at increasing our relaxation and confidence, and this applies equally to the dental professional as it does to the patient. With less stress in the bucket comes greater acuity to the needs of others, and greater self-control, which allows us to choose how to conduct ourselves. This allows us to create rapport and be more mindful about the way we do our interactions.

We will also be happier, more motivated, and more productive when we have a constant flow of serotonin, and we will get a much better deal from life, and all of life’s opportunities. We will be able to overcome new challenges, and have more freedom in how we live our lives…… How will things look when they are great…..


HYPNOSIS AKA TRANCE

Trance is useful and essential. In the trance state we can hand things over to the subconscious mind when we want to perform an automatic function, leaving us room to think about other things. For instance, once driving a car becomes largely automatic, or subconscious, we can concentrate on the unexpected and changing situations that occur. So the automatic part of us is in a trance state, and very useful it is when we need an emergency stop! However, if it becomes necessary to alter one of those automatic actions - imagine the brake and the accelerator were switched - we know how difficult it is to change.

In the hypnotherapy practice setting, trance is when the two minds come together and focus on the same thing and when we are in that state we have access to the subconscious mind, steered by our intellectual choices and decisions.

When we put a person into a good hypnotic state we create R.E.M. We are, in fact activating the same processes that the brain itself uses during dream sleep. R.E.M above all is a focus. During R.E.M the brain will respond to suggestion, and it’s the best state for learning.

PHOBIA TREATMENT

Effective phobia treatment occurs when the client successfully becomes disassociated from the problem, and the fight or flight response can be calmed down. We have a modern, very effective and comfortable technique called ‘Rewind’ (aka ‘The Fast Phobia Cure’), which does not involve any kind of exposure therapy, and usually takes around 4 sessions.

The assessment for suitability of this approach will inevitably involve deciding, whether the fear issue is a phobia, or a more general form of anxiety.

In session we use the natural technique of REM to our upmost advantage. The Fast Phobia cure can be used for all forms of trauma, or any event where people have been overwhelmed by fear and have not recovered from it. It can also be used with OCD patients particularly when the fear is of not performing the obsessive behaviour. When necessary it can also be used to deal with fear related addictions and more often than not the client will feel exhilarated after the detraumatisation process.

Another advantage of this approach is that it is non-voyeuristic way. This negates any need to drag up the terror of the situation and shine a light on it. It also means that fears or phobias of a personal nature do not need discussing in any detail whatsoever.


REFERENCES & ACKNOWLDEGEMENTS This document draws heavily from training, materials & course notes in the area of Solution Focused Hypnotherapy produced by The Clifton Practice in Bristol. Credit is due to David Newton, who’s insights as well our own professional experience form the basis of these notes. Other Sources: Bandler, R. (2008). Guide to Trance Formation: Make Your Life Great. London: Harper Collings Publishers Ltd. Cialdini, R. (2008). Influence – The Psychology of Persuasion. London: Harper Collings Publishers Ltd. Furness-Smith, P. (2014). Overcoming Phobias: A Practical Guide. London: Clays Ltd. Ratey, J. (2001). A User’s Guide to the Brain. London: Little, Brown & Company. Watts, T. (2000). Warriors Settlers Nomads – Discovering Who We Are & What We Can Be. Bancyfelin: Crown House Publishing Limited.

DEALING WITH DENTAL PHOBIA & ANXIETY PRACTICAL GUIDE€¦ · DEALING WITH DENTAL PHOBIA & ANXIETY PRACTICAL GUIDE . Helping you get a Better Deal from Your Life 2 CONTENT ... Performance

Documents