As dental professionals you are fully aware that pressure is part of the job. And that feeling of pressure may be there from the start to the end of your career. Given this, it’s obvious that prevention is key, as is knowing how to manage the repercussions of stress and acquiring the tools that will help when new issues arise.

Fortunately, society has developed to such an extent that we are now in a position where discussing mental health issues is acceptable. This is unequivocally good news for the millions who suffer, especially those who in the past would have done so in silence. In fact, one in four people in the UK experience mental health problems each year and one in six in England report a common problem such as anxiety or depression in any given week. According to MIND, the UK’s leading mental health charity, mental health issues include anger, anxiety, loneliness, stress, seasonal affective disorder (SAD) and self-esteem concerns. With so many commonly-encountered issues impacting on our mental health, it’s essential that we recognise and deal with these issues as early as possible.  Highlighting the extent of the problem even further, the independent Mental Health Taskforce, formed in 2015, brought together healthcare leaders to produce a five year forward plan for mental health care in the NHS in England. They reported in their first year that £105 billion was being lost by the UK economy annually as a result of mental health; that a sum similar to the total annual cost of the entire NHS. Mental health issues in the medical professional, and specifically with dental professionals, are well documented; many of the top 10 lists of the UK’s most stressful jobs include dentistry and the Office of National Statistics (ONS) last year stated that dentists, amongst a small number of other professions, had an increased risk of suicide. Mental health issues can present themselves from a young age and there are numerous studies that have documented the pressure dental students are under. One recent study noted the high occurrence of depression, anxiety and stress. This highlights the importance of providing support programmes and implementing preventive measures at an early stage. If not recognised and dealt with, once in practice, regulation, patient expectations and the fear of being sued could cause a perfect storm for stress to occur. Following this path, dentists could find themselves in a position where they have to retire early due to ill health. And the link between one’s professional status and sense of ‘self’ is already well established.

Last year nearly 15% of all claims paid by Dentists’ Provident were for psychiatric disorders which cover a range of conditions such as work-related stress, fatigue, neurosis, depression, and anxiety with over £650,000 paid out in claims for these issues that dentists have had to take time off work for.  Examples of recent claims include a young dentist in their early 30s who experienced work-related stress and an older member who began suffering from depression as a result of selling their practice. Dentists’ Provident supported both of them for nearly three months before they could return to work.

Prevention and solutions How you deal with feeling overwhelmed or stressed with life and work can be very personal; from taking the dog for a walk, going for a run, having a relaxing bath, reading a book, listening to music or trying to get more sleep. Some people try more pro-active techniques that can offer stress prevention, such as yoga, the Alexander Technique, meditation and mindfulness. But when things aren’t working so well on a preventive front, you know only too well in your profession that you have to start intervening. If you visit a GP they may suggest a more active approach, some prescribing anti-depressive drugs, while others may recommend the NHS approved Cognitive Behavioural Therapy (CBT). The NHS describes CBT as ‘a talking therapy’ that can help you manage your problems by changing the way you think and behave. It’s most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.’ CBT is highly structured and needs the complete commitment of the participant to effectively deal with the issue at hand. Sarah Bradbury from Dentists’ Provident, keen to explore potential ways to support dental professionals, spoke to Trevor Collins, a clinical hypnotherapist, about the various approaches and what he recommends for dental professionals. Trevor said: ‘What you choose to do and what works for you can be very personal, and talk therapies such as CBT are very useful, as talking about an issue, whether it is to a friend, family member or therapist, in itself, can be very therapeutic. ‘The advantage of talking to a professional and stranger is the chance for objectivity, without opinion, within a more structured framework for your thought processes.

It can be very valuable for you to be assisted in seeing things from a different point of view
and putting it into perspective. However, its true value can be limited when you are addressing issues of the subconscious that are deeper and more embedded and you may not be aware of the cause.’ Hypnosis, is a practise that is becoming more popular and being offered in some dental practices with many practitioners undertaking courses to provide the service for patients suffering conditions such as fears and phobias, gagging and bruxism. Hypnosis has been around for centuries with its scientific history beginning in the late 18th century with Franz Mesmer, a German physician who used hypnosis in the treatment of his patients. His methods, called ‘mesmerism’ continued to interest medical practitioners. Then in the middle of the 19th century, the English physician James Braid studied the phenomenon and coined the term hypnosis, after the Greek god of sleep, Hypnos. Trevor explained its working in more depth. ‘Hypnosis is essentially focused relaxation, where the therapist can employ hypnosis ‘suggestion’ or ‘analysis’ to the client in a subconscious state, in order to assist them resolve their presenting problems or unwanted habits’, he said. ‘Habits such as nail biting and smoking have an estimated 70% success rate. More complex issues such as extreme anxiety or panic attacks respond very well with hypno-analysis. ‘Its downside is that it can be a very lengthy
process that is then costly to the client and it also can be a bit hit and miss. When a client is in their relaxed state the therapist has no true control over what they are thinking. It
could be what to have for dinner or about a difficult patient tomorrow which means they
could lose focus and therefore the benefit of the hypnotherapy.’ Trevor then moved on to explain a newer therapy, Brain Working Recursive Therapy (BWRT) and how it was discovered. ‘It was pioneered by Terence Watts, a UK-based hypnotherapist with his research partner psychologist, Rafiq Lockhat. Terence was aware that the brain has an ability to identify stimulus in the form of ‘brain patterns’, that if we recognise a situation
our subconscious triggers an automatic response, a third to a half a second before you actually become consciously aware of it; that’s assuming your brain was going to make you consciously aware of it. If this automatic response is an erroneous or out of date response to a ‘perceived threat’ from a much earlier time in your life, then again before you have a chance to make a conscious decision about how to respond, your brain has already triggered the ‘fight, flight or freeze response’, commonly experienced as stress, anxiety, fear, anger, frustration self-doubt, panic attacks, sweating, shaking, generally unwanted functioning, thinking and or behaviour. ‘Most of us tend to have picked up some reaction or behaviours that we aren’t quite happy with by middle age, especially if we are put in a stressful situation in our lives or careers, and if left unresolved could have potential repercussions. Terence found a way of ‘interrupting’ this automated response and exchanging it with a more rational and desired response.’ Trevor quoted one case of a young woman who developed a phobia of needles and this caused a great deal of concern as she was diabetic and had to inject daily, after one session she was able to do so with no fuss whilst also attending her doctors for regular blood tests.

Trevor finished by saying: ‘In my professional opinion, this is the most important and impressive psychological therapy for generations, and it is staggering how effective it has shown to be in the seven years it has been practised. ‘Results are shown time and time again after only one to three sessions. It is commonly used in South Africa but as yet the
NHS still only supports CBT. The good news is that there are currently two PhD papers
being undertaken along with an NHS Health Research Authority controlled study which
should assist with hopefully a wider national study in due course. Proof is in the pudding
at the moment in the extensive results being achieved in therapy sessions worldwide now.
BWRT doesn’t rely on a specific state of mind. All you need to do is answer a number of
questions, follow simple instructions and see the results yourself!’

As published in VOL 31 | ISSUE 10 | BDJ IN PRACTICE

  1. 1.
  5. DPS claims stats 2017/2016