TOOL # 1: Relaxation Skills
Feeling anxious can be very uncomfortable. Anna learned about various relaxation strategies that could help her "turn down the volume" on anxiety, which could make it easier for her to face going to the dentist. She learned about calm breathing, which involves taking slow, regular breaths through her nose (see How to do Calm Breathing). She also realized that the goal of calm breathing was not to eliminate or avoid anxiety (because anxiety is not dangerous, and part of overcoming fears involves allowing yourself to experience anxiety rather than fight it), but to make it a little easier for her to ride out the feelings she experienced while approaching and entering the dentist’s office and when sitting in the chair.
In addition, Anna learned how to lower her overall tension and stress levels (which can contribute to anxiety) using a daily muscle-relaxation exercise that involved tensing various muscles in her body, then relaxing them (see How to do Progressive Muscle Relaxation). She felt that a quick version of this exercise might be a helpful to do while in the dentist chair.
TOOL #2: Realistic Thinking
An important step for Anna was to learn how to develop more helpful, realistic ways of thinking about her dental fears (see Realistic Thinking). Although it caused Anna some anxiety, she decided that an important first step was to write down her anxious thoughts about going to the dentist. In order to help identify these thoughts, she asked herself, "What am I afraid that I am going to do? What am I afraid the dentist is going to do? What else am I afraid is going to happen?" Anna wrote down:
"I'm going to pass out the minute I walk through the door. I'll be panicking, crying or shaking uncontrollably."
"My teeth are definitely the worst the dentist has ever seen; he is going to lecture me. I'm worried that the dentist will berate, humiliate or judge me."
"I won’t be in control when I am lying down in the chair."
"What if the dentist starts doing things to me and I have little or no say in the matter. I'm scared of not knowing what's going on or what to expect."
"The procedure will be too painful; I can't handle that amount of pain. Going there is not safe."
Anna realized that the main themes of her worries were that she wouldn’t feel in control, that she was worried what the dentist would think and say, and that she wouldn’t be able to handle the pain.
The next step involved Anna learning to evaluate her thoughts by asking herself if her thoughts were based on facts and whether they were helpful. Her goal was to try to identify more realistic and helpful thoughts. To do this, she asked and answered the following questions about a visit to the dentist:
What am I afraid will happen?
I’m afraid that the dentist will just start doing some procedures while I’m in the chair and my mouth is clamped open and I can’t talk. I won’t have a say in what he is doing. I’m anxious about not knowing what to expect.
What is the evidence that supports my thoughts?
Last time when I was at the dentist, I didn’t really understand what was going on and the dentist did several painful procedures without telling me what was happening. I felt out of control.What is the evidence that does not support my thoughts?
I’m an adult now, and the dentist would probably legally have to tell me everything he is going to do beforehand, even if just to make sure I can afford it!What’s the worst that could happen?
The dentist might get annoyed by my questions. The dentist could also tell me I have to come back many more times to finish all the work that needs to get done.How can I cope with it?
I could remember that I am paying for the visit and he wants to make a new patient happy. If I’m not comfortable I could ask the dentist to write down the procedures he is recommending, and I could think about it. Or, I could go to another dentist who is more open and willing to talk to me.Is there another way of looking at this situation?
Going to the dentist might not exactly be enjoyable, but it doesn’t have to be the worst experience in the world. I’m not a little girl anymore, and I am in control this time.Anna repeated this process for all of her anxious thoughts. By re-evaluating her anxious thoughts, she was able to "turn down the volume" on her anxiety when thinking about going to the dentist.
Anna also found it helpful to remember why she was going – to save her teeth and to be a good role model for her daughter. She knew that these were powerful motivators that would be important to remember when she started to feel anxious. She decided that she would bring a picture of her daughter with her to her first appointment, to remind her of one of the reasons she was facing her fears. Anna also realized that it might be a lot less anxiety-provoking for her to find a young female dentist, so she made this part of her plan as well.
After thinking more about her anxious thoughts, Anna was able to come up with some specific questions to ask the dentist, such as:
"Do I have to lie all the way back in the chair, or can I sit up a bit more?"
"Can I have a "stop signal" with my hand if I am feeling too overwhelmed?"
"Can you explain to me each procedure in detail before you do it, and can you tell me what any alternatives are?"
"Can you keep the tools out of my sight as much as possible?"
"Can I listen to some relaxing music?"
Knowing that she could get answers to these questions before starting any procedures helped ease her anxiety.
TOOL #3: Facing Fears
It is normal to want to avoid the situations that make us anxious. Unfortunately for Anna, this avoidance had come at a cost, and now she faced fairly extensive dental work. Armed with her relaxation tools and new helpful ways of thinking, she felt ready to start facing her fears (see Facing Fears: Exposure).
First, Anna made a list of different aspects of a dental appointment that made her feel anxious (e.g., calling to make an appointment, driving to the appointment, entering the office). Once she had her list, she rated them according to how much anxiety they caused her, from 0 (no anxiety) to 10 (extreme anxiety). Next, she ordered them from the least scary at the bottom to the most scary at the top. Here are some of the situations on Anna’s list:
Starting with the least scary step, Anna called to make an appointment with her new dentist. She explained to the receptionist that she hadn’t been to the dentist in a long time and was feeling quite nervous. Anna also asked if she could come in, just to see the office, meet the dentist and ask her some questions. The receptionist warmly replied that this is quite a common request, and that she is welcome to take a gradual approach.
Anna worked her way through her steps, taking care to repeatedly enter and stay in each situation until her anxiety decreased to at least half the amount. For example, Anna drove to the dentist’s office and sat in the waiting room on several occasions until she felt less anxious doing it. The receptionist was a big help to Anna, even letting her visit an empty treatment room and sit in the chair. After meeting the dentist and asking her questions, Anna felt confident enough to make a real appointment.
Anna found that using CBT skills really helped to better manage her dental phobia. However, she needed to remember that learning to manage anxiety effectively is a lot like exercise – she needed to "keep in shape" and practice her skills regularly. Anna tried to make practicing her new skills a daily habit and used them for other situations. However, she learned that sometimes during times of stress or transition (e.g., when she accidentally chipped her tooth), it’s possible to slip into old patterns. This is normal. It just means she needs to get out her anxiety toolkit and start practicing the tools again (see How to Prevent a Relapse). Anna learned that coping with anxiety is a lifelong process. The good news is now she has the skills to do it!