Waking up to hypnosis

21 December, 2011 / Infocus
 

One in three people fear the dentist.

Fear of dental procedures is a very common and distressing condition and, according to the BDA, affects one adult in three. The problem also exists in many children. People may neglect their dental health so much that oral disease seriously affects their general health and quality of life. Some people are so afraid of the dentist that they seldom or never attend, with serious health consequences.

Hypnotic techniques can help many anxious and seriously phobic patients. Patients who experience gagging, bruxism, temporomandibular joint problems and excessive salivation can also benefit. Simple hypnotic techniques can be used in the chair while some patients may require a longer course of hypnosis, conducted either by a dentist trained in hypnosis or a consultant hypnotherapist.

For people with a severe phobia, whose extreme anxiety makes it impossible for them to enter a dental surgery and talk to a dentist, the initial consultation is likely to be held away from the surgery and carried out by a hypnotherapist or the patient’s GP. In the longer term, the aim is to enable the patient to cope with dental treatment with greatly reduced anxiety.

A brief history of modern hypnosis

General interest in science and such things as gravity and magnetism influenced the beliefs of Franz Anton Mesmer (1734-1815) who undoubtedly became the most famous, or perhaps infamous, of early hypnotists. After a French government commission largely discredited Mesmer’s work, a number of pioneers toned down and refined Mesmer’s techniques. Notably, the Marquis de Puységur and the Abbé Feria hypnotised large numbers of people. They replaced the theatrical mesmeric passing of hands or wand over the body with verbal suggestion.

The most interesting results came from India in the 1840s where Dr James Esdaile, a Scottish surgeon, used hypnosis as an anaesthetic in hundreds of operations, including amputations and the removal of scrotal tumours. This work was further advanced by James Braid, another Scottish doctor. As well as popularising the term ‘hypnosis’, he developed the modern eye-fixation techniques.

His favoured method of inducing the state was to hold a shiny scalpel case in front of, and slightly above, his patients’ eyes, bringing about visual fatigue, eye closure and then trance. All of this had come a long way from the days of Mesmer. Hypnotism was made even more popular when physicians with the eminence of Jean-Martin Charcot in Paris took up its practice. The first reference to an extraction being performed under hypnosis was in 1836 when a Parisian dentist by the name of Oudet carried out the procedure.

The discovery and development of inhalation anaesthetics in surgery, including dental surgery, led to a decline in the popularity of hypnosis by the end of the 19th century. However, by the middle of the 20th century, doctors and dentists were rediscovering the benefits that hypnosis could offer their patients. By the 21st century, a general medical and scientific consensus has been reached that hypnotherapy can benefit patients suffering from a wide range of conditions and this is backed up by thousands of scientific studies. To take only one example, hypnotherapy is now the treatment of choice for patients with irritable bowel syndrome as recommended by NICE in England and Wales.

What is hypnotherapy and how does it work?

Hypnosis is defined by the British Psychological Society as: “…an interaction between one person, the ‘hypnotist’, and another person or people, ‘the subjects’. In this interaction the hypnotist attempts to influence the subjects’ perceptions, feelings, thinking and behaviour by asking them to concentrate on appropriate ideas and images. The verbal communications that the hypnotist uses to achieve these effects are termed ‘suggestions.’ Suggestions differ from everyday kinds of instructions in that they imply that a ‘successful’ response experienced by the subject has a quality of involuntariness or effortlessness. Subjects may learn to go through the hypnotic procedures on their own, and this is termed ‘self-hypnosis’.”

Hypnotherapy is simply the application of hypnosis for the benefit of the patient. Almost everyone can be hypnotised and, in fact, several times each day we will all find ourselves in a natural hypnotic state, particularly first thing in the morning when neither fully asleep nor fully awake, or when reading an engrossing book and losing track of time.

Dental anxiety and phobia

The term ‘hypnodontics’ was coined 60 years ago to describe the application of controlled suggestion and hypnosis to the practice of dentistry. Much can be done to reduce anxiety levels in patients from the moment they arrive at the surgery. It has even been suggested that something as apparently minor as the doorbell volume and tone can have an impact on anxiety.

Many dentists and their staff are well aware of the importance of creating a welcoming atmosphere and give careful attention to the layout and décor of the reception area and the waiting room. It is also very important to recognise the impact of the language used with the patient. In using hypnosis for weight loss, for example, many experts recommend avoiding the use of the word ‘heavy’.

During hypnotic induction and suggestion, the language used is carefully selected to obtain the most positive outcome. It is just as important to be aware of the potential for invoking anxiety attached to certain words, such as ‘pain’. Words like ‘pressure’ or ‘discomfort’ may be less worrying to the patient. When discussing a patient’s feelings about an imminent procedure the dentist might talk about ‘concern’ rather than ‘fear’.

Hypnotic treatment of the phobic patient

Probably the most effective treatment for the phobic patient is systematic desensitisation, as described by Joseph Wolpe. This is a gradual process best carried out away from the surgery and is likely to require several sessions.

Under hypnosis, the patient is first taught how to quickly reach a deep state of relaxation. The anxiety-provoking stimulus is then broken down into a number of steps or stages starting with the least frightening and graduating to the most frightening in around five steps. The response to each stimulus is rated by the patient using the subjective feelings of distress scale (SUDS) with zero representing no fear at all (perhaps sitting in a comfortable chair at home) and five representing frank terror (perhaps hearing the sound of the drill). Clearly frightening stimuli will vary for each individual, reflecting their personal history of dental treatment.

Under hypnosis, each stimulus, starting with the least challenging, is rated by the patient both before and after, triggering powerful relaxation images. This may need to be repeated several times until the anxiety subsides significantly. The next most challenging stimulus is then introduced and the process is continued with desensitisation being achieved at each stage until the whole anxiety-provoking scenario has been worked through.

The relaxing image and sensations can also be ‘anchored’ to a covert gesture such as fist clenching or pressing the thumb and index finger together. The patient can then use this when presented with the actual anxiety-provoking stimulus in the waiting room and then in the dentist’s chair. A posthypnotic suggestion can also be given that each and every time the worrying situation is encountered the patient will feel more and more relaxed about facing the scenario.

It is also very useful to teach the patient how to quickly and easily self-hypnotise and to suggest that, after practising this technique, it should be used the night before going to the dentist and while sitti
ng in the waiting room. It is essential that the dentist is aware the patient will be using hypnosis and can allow the patient time to prepare.

Use of hypnosis for specific conditions

Hypnosis has been used to help with the treatment of a number of specific problems and conditions:

Bruxism

Many patients with clenching and tooth-grinding are very tense and stressed individuals and the relaxation obtained through hypnosis and particularly self-hypnosis has been found to be very successful in treating this condition, often bringing relief.

Temperomandibular joint dysfunction

Hypnosis has been found to be an extremely useful adjunct in the treatment of this problem. Hypnosis can be used along with traditional treatment and can help improve pain control and relaxation.

Analgesia, bleeding control, gagging and excessive salivation

Pharmacological analgesia and local anaesthesia can be enhanced by hypnosis and, in some patients, the need for local anaesthetic can be lessened or eliminated. The problems of excessive bleeding, gagging and copious salivation can also be addressed using hypnosis in suitable patients.

Conclusion

Weiner says that “unless dentists broaden their diagnostic skills and management abilities, dental fear will remain as prevalent in the future as it has been in the past. All the modern equipment and technical skills are useless, if the practitioner does not get and keep the patient coming for regular care.” Hypnotherapy has proven to be a valuable adjunct to the expertise of the dentist.

About the author

Lindsay Howden, PhD CBiol GQHP GHR Reg. is an analytical hypnotherapist who is on the General Hypnotherapy Register. He is also a chartered biologist and practiced as a pharmacist for many years in both hospital – where he ran a medicines information centre – and in the community. He first became interested and involved in hypnotherapy many years ago. He has a private practice in the new town of Edinburgh.

Further reading

Heartlands Medical and Dental Hypnosis. Fourth Edition. Churchill Livingstone 2002

Weiner. The Fearful Dental Patient: A guide to understanding and managing. Wiley-Blackwell 2011

Hammond. Handbook of Hypnotic Suggestions and Metaphors. Norton 1990

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