In Spite of All the “Danger”

One of my favorite things about working in dentistry is helping fearful patients through the process. For me, it hits so close to home because once upon a time, I had a dental phobia.

Well, I didn’t just have a dental phobia. I had many phobias. I was one nervous Nellie.

Who am I kidding? I really struggled with anxiety for many years.

I saw a few doctors over the years and tried some of their recommendations to help, but nothing worked. It wasn’t until about 5 years ago that I met with a cognitive behavioral therapist named Roger, who completely changed my life. His very simple, but profound advice rocked my world. I find myself repeating his words to our more fearful patients and have seen positive results.

Let me explain.

One day I went to see him and he asked how I was doing. Immediately I launched into this:

“Oh my gosh. This snow is killing me! What if I get into an accident? There’s nothing worse than driving in the snow! I go crazy when I get in my car after work to go home. I hate it so much. Seriously, is it ever going to stop snowing?”

Roger took a deep breath and said, “Do you liked getting worked up about the snow?”

My eyes got wide, “Are you kidding me? I HATE getting worked up about the snow!!”

“So then why are you?” was his quick reply.

I stopped. I didn’t get it. In fact, I felt a little offended. Of course I didn’t like getting worked up about the snow. What the heck was he talking about? Where was the sympathy?

He kept on me, “Right now, you are CHOOSING to get upset about the weather. You can just as easily CHOOSE to NOT get upset about the weather. You are doing something called, “Awfulizing”.

Huh?

Roger continued, “Let’s review what you said when I asked you how you were doing. The first thing you said was that the snow is killing you. It’s time to stop exaggerating and start using more accurate and truthful words. Unless you are being buried by an avalanche, the snow isn’t killing you. The truth is that snow can make your life a little inconvenient, right? Maybe it makes your drive a little longer?” I nodded. “But it most likely isn’t going to kill you. You are a safe driver right? The chance of something happening to you is pretty slim. Don’t get wrapped up in the “What If’s. Those “What If’s” will get you in trouble.  You said there isn’t anything worse than snow. Are you kidding me? I can think  of a lot of other things that are worse than snow. September 11th is one of those things. Wouldn’t you agree?” Of course. “You also said you go crazy when you get in the car. That seems a bit dramatic, and I don’t think that’s what you really mean. Would it be fair to say that you get nervous when have to drive in the snow? Maybe your stomach gets a little upset or your palms get sweaty? But crazy? That seems a bit of a stretch. You say you hate the snow. Hatred is a pretty strong word. If you really feel that way, why have you lived in this snowy area for your entire life? You know that here we have seasons and that in a few months, the snow will be gone until winter comes back. When you think things are awful, you are “awfulizing” them. The bigger deal you make it, the bigger deal it will become.”

Roger didn’t hold back. “The truth of this conversation is that you were looking for my sympathy. I can’t give you any. To have agreed with your earlier statements would have been to feed into your frenzy. I’m not going to do that because it isn’t going to help you. I’m here to call you out on your exaggerations and to help you train your brain to go down a different path.  When you exaggerate like that, your brain is the first thing to get all worked up. Once your brain starts going, physical responses will follow. You may get lightheaded, experience shortness of breath, get an upset stomach, or have clammy hands. However, you can PREVENT the physical symptoms by not using exaggerations. Speak TRUE words-not irrational ones. Don’t say that things are awful or terrible unless they ACTUALLY are. Driving in snow can be inconvenient, but it isn’t terrible. September 11th  was terrible. See the difference?”

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Roger was on a roll. “We need to change your perception of things. Are you ready?” I was. “Ok. Imagine a number line from zero to ten. When something you view as stressful comes up, I want you to put it on that number line and act accordingly. Here’s what I mean. Think of 7, 8, and 9 as being the equivalent to someone you love or yourself, as getting cancer, a heart attack, or stroke. Let’s say that 10 is September 11th. If your loved one has a heart attack, because that’s ranked pretty high on the number line, you can react to that at that level. Where does driving home from work in the snow fall on that line?”

I was a little embarrassed at this point. “Well, when you put it that way, it’s probably less than a 1.”

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Roger smiled, “Ok then. Act like it. Speak in truths, and not in exaggerations and your brain and body will follow. It will be a habit to break, but you will find your anxiety lower over time. For years, your thoughts have taken you down one path. We’re going to give you a new path to start going down. That old path isn’t doing you any favors. Pay attention to what happens to you. First you will FEEL more calm. Over time you will BECOME more calm.”

You know what? Roger was right.

For many years, I was the cause of my anxiety, and I didn’t even realize it. I was my own worst enemy. That was tough for me to accept at first because it’s hard to admit when you’re wrong. But I was, and I can admit that now. It’s not like I’m skydiving everyday or anything like that, but I’m able to comfortably do the things I want to do, things I never thought were possible before. I’m a work in progress, and I’m definitely moving in the right direction.

Looking back, I’m kind of glad I went through all of that because I feel that it allows for a deeper understanding of human behavior as it relates to fear.

It’s pretty common for a new patient to tell us about their dental fear when they come into the office. “I hate dentists. Being here is the worst. I hate needles. I hate everything. My heart started racing when I walked into the door here.”

I take this as an opportunity to gently explain the difference between “awfulizing” and the truth. “The truth is that sitting in this chair is not your favorite thing to do, and that’s ok, but it doesn’t help to exaggerate and say it’s the worst thing that could ever happen. Here’s the truth of the situation. There may be some new sounds, smells, or sensations that you will experience, but that doesn’t mean anything is wrong. Remember that when the time comes. The truth is that the dentist and the assistant are very good at their jobs and they’ve done this procedure many times before. Focus on the end result which is you being healthier. When you believe the truth, you will notice that the physical symptoms won’t start.” If a patient truly wants to have a successful visit, he will listen with an open mind.

It’s because of Roger that I don’t “awfulize” situations anymore. I don’t exaggerate anymore. I speak in truths. I trust in facts. I also think about that number line a lot.

I’m extremely grateful for having known Roger. His wise words have helped not only me, but countless dental patients in my office. images-4

About Missy

Comments

  1. That’s an awesome lesson! “Awfulizing” is a great term. You are right, we have patients like that frequently. Another thing I learned a few years ago from someone much smarter than myself, along the same lines, is to ‘de-emphasize’ things, by thinking of a word that you usually use to describe a bad experience, and then using a word with less emotion or emphasis. So, instead of saying ‘that experience was just horrible’, you might instead say, ‘I didn’t really like doing that’. Having a similar effect to extract the drama and bring things back to reality.

    Great post Missy! It adds nicely to what I was taught a few years ago.

  2. Thanks! This is one of my favorite topics!

  3. Great article Missy. I’ve heard the term “doing stress” before. This term “awfulizing” is so much more descriptive. How do patients respond when you call them on it? I can imagine some don’t want to let go of their story of drama and blaming the dentist approach.

  4. You are correct. I’ve found that when some people are in their “awfulizing spiral” it is hard to pull them out of it. Sometimes I truly think that they don’t WANT to be pulled out of it. Those people can only be helped when they are ready.
    I know enough about anxiety to know that a lot of it is about losing the feeling of being in control. So, before I begin, I ask their permission to share my story and by doing so, I am giving them a sense of control.
    As I describe some of my past anxieties, I also put a lot of the blame on MYSELF, in hopes that they will realize that maybe they are creating a lot of unnecessary stress on themselves as well. I tell them about Roger’s advice and how I didn’t want to accept it at first, because I imagine that some of the patients feel the same way about what I’m telling them.
    It also really helps to speak calmly and look the patient directly in the eye. If I can capture their eyes, I can usually capture their ears and mind.