The high chronic stressors within Dentistry have been long established, prior to the pandemic. The literature in this area is extensive, spotlighting 4 key components (Collin et al, 2019; Kay et al, 2005): strict professional regulation, leading to high levels of fear of litigation and the practise of defensive dentistry, organisational factors, such as time pressures, staffing issues, administrative duties,high workload, isolation and contract frustrations, dentistry factors, such as challenging management of patients and individual factors, forexample type A personality traits, perfectionism, imposter syndrome and poor worklife balance.

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These stressors translate to a picture of poor mental health within the profession, with increased levels of burnout (Rada et al 2004; Alexander et al 2001), often starting at undergraduate level. In a recent study in UK dental students, 35% of students experienced burnout, psychological distress, perfectionism and ineffectivecoping styles (Collin et al, 2020).  Alarmingly, 10% of UK GDP’s had suicidal thoughts, much greater than the general populationof 5% (Toon et al, 2019).

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Sadly, this upwards trend magnified during the stressors of the pandemic.

In the recent Dentistry Census 2022, 68% of dental professionals felt that their relationships, both within the clinic and at home, suffered as a result of work-related stress. 77% of dentists felt they were practising defensive dentistry. Over30% of dental professionals felt routinely depressed as a result of their workand 49% felt nervous. The DDU in 2020 reported similar statistics: 68% ofdental professionals felt that their stress and anxiety levels had elevatedsince the pandemic. 52% felt they were time poor with patients, 49% unable towork effectively and 47% felt they would go into work despite feeling unwell.

Chronic stress on mental health, resilience and thriving

Our brains were evolved to manage acute stressors. And a certain amount of stress can aid in making us feel focused and energised to take action. However, chronic stress dental professionals report dangerously interferes a system built only to manage short term responses. This has many detrimental impacts on our brains. The neuroscience research illustrates how high levels ofcortisol cause psychical and functional changes as a result: from shrinking our hippocampus, decreasing our ability to remember and learn, reducing our pre-frontal cortex which impacts our concentration, decision making, judgement and socialinteraction to our amygdala going into overdrive, levels of dopamine and serotonin dropping and an increased risk of depression and Alzheimer’s disease.

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Chronic stress also mediates our ability to be a positive leader, our capacity to thrive at work and achieve our optimal potential. It mediates the highly vital positive well-being markers that make our lives happier and healthier: from resilience (the ability to navigate adversities and grow through them), compassion satisfaction (the pleasure clinicians derive from being able to help patients asopposed to caregiver fatigue), work engagement, happiness to the abilityto go into ‘psychological flow’ states, self-confidence and the readiness toutilise a growth mindset.

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The high pressures Dentistry demands requires individuals with high psychological well-being and resilience.

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The optimistic news is that both occupational hazards of burnout and compassion fatigue, that we are so prone to experiencing working so closely with patients,are preventable. Clinician well-being training can help to empower us with tools we can utilise to prevent illness and increase well-being. Recommendations made by literature recently spotlight the need for curriculum changes that incorporate psychological well-being training, including stress management and self compassion training (Collin et al, 2020; Toon et al, 2019) in addition to organisational changes, with interventions focusing on changing the working conditions of dental professionals (Toon et al, 2019).

The benefits of Positive Psychology

Positive Psychology factors can play an enormous role in buffering against stressors and mental illness, through building positive processes and capacities that can help to strengthen future mental health (Waters et al, 2021). This beautiful branch of Psychology can be defined as the scientific study of what makes individuals and organisations thrive, and live a life of happiness and purpose. Below summarises the research on the key ways Positive Psychology can buffer, bolster and build greater mental health. Wherever possible, I start with the research on medical professionals.

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Resilience

·        Sood et al, 2011 reported in medical professionals,  increases in resilience and quality of life with decreases in perceived  stress and anxiety after a 90 minute Stress Management and Resilience Training (SMART). The SMART training incorporated many facets of Positive  Psychology; attention, gratitude, compassion, acceptance, meaning,  forgiveness and components of mindfulness based stress reduction.

·        The Penn Resilience Programme for Chinese medical  students reported increases in resilience and positive emotions after  training (Peng et al, 2014).

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Mindful  Self-compassion

·        Neff’s  recent study with medical professionals receiving a 6 week Mindful  Self-compassion programme reported increases in self-compassion, well-being  and reduction in burnout (Neff et al, 2020).

·       Mindful Self-compassion has numerous transformative effects, in  the general public population, from reducing negative well-being states, such  as reducing our stress levels over time (Stutts et al., 2018) and reducing  imposter syndrome thoughts (Macbeth & Gumley, 2012; Neff, Long et al,  2018; Johnson & O’Brien, 2013), to increasing positive well-being states.  The latter include increasing our engagement with health related behaviour  (Biber & Ellis, 2017; Homan & Sirois, 2017), better relationships  (Neff & Beretvas, 2013), greater self confidence and motivation (Neff et  al, 2005).

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Positive emotions

·        Positive Psychological Capital (characterised by  positive emotions of hope and optimism) meditate stress and fatigue in  Chinese doctors (Tian et al, 2020). These emotions have also been shown in  the literature to be a protective factor to avoid or reduce turnover, job  dissatisfaction, and job burnout in nurses (Avey et al, 2011, Frey et al,  2018).

·        Positive emotions change the way the brain works to  broaden our thinking and build psychological resources, such as resilience, and  physical resources that can help both individuals and organisations cope with  challenges (Fredrickson, 2013; Gloria & Steinhardt, 2014; Ong, Bergeman,  Bisconti & Wallace, 2006; Meneghel et al., 2016).

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Leveraging  character strengths

·       The use of character strengths in 1st year medical students  increased mental well-being and decreased burnout (Hausler et al, 2017).

·       Positive effects of character strengths on well-being and work  engagement in medical professionals. Strengths of fairness, honesty, judgement,  kindness and love rated the most often (Huber et al, 2020).

·       Character strengths can mitigate poor mental health, for example  depression (Schutte & Malouff, 2019), anxiety (Freidlin et al., 2017;  Huta & Hawley, 2010), work related stress (Harzer & Ruch, 2015),  hopelessness (Huffman et al., 2013) and alcohol consumption (Logan et al.,  2010).

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Gratitude

·        A gratitude intervention (90 minutes workshop  followed by 8 week daily gratitude journaling) in medical professionals  improved clinician stress and professional satisfaction (Caragol et al,  2021).

·        Gratitude serves as both buffering and bolstering  through decreasing stress and increasing positive emotions, life satisfaction  and resilience.

·        It also mediates positive relationships  (Algoe et al., 2019) and strongly predicted happiness during the pandemic  (Watkins et al. 2021).

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Meaning

·       Thousands of research studies validate that high levels of meaning in  individuals creates happier people, healthier immune systems, more satisfying  relationships, longer lives, and slower advancement of cognitive decline and  Alzheimer’s disease (Cohen el al, 2016; Roepke et al, 2014; Steger, 2012).

·       Meaning has both buffering and building effects when it comes to our  mental wellbeing. Recent research shows that meaning in life during the  pandemic buffers against COVID-19 special stress (Trzebinski et al, 2020) as  well as depression and anxiety (Chao et al, 2020).

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Coping skills

·        Coping may help to build positive skills to create  personal resources and maintain psychological well-being (Waters et al,  2021).

·        Interventions focus on helping participants notice  positive events, savouring, gratitude, mindful awareness, positive  reappraisal, personal strengths, acts of kindness, and self-compassion  (Cheung et al., 2018; J. Moskowitz et al., 2014; Verstaen et al., 2018)

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High  Quality Connections (HQC)

·       High quality connections (HQCs) act as social boosters that  strengthen our capacity to cope and   even thrive during adversities.

·       HQCs cause physiological changes in our body, for example  decreased cardiovascular reactivity, improving our immune response to stress,  and release of oxytocin (Heaphy & Dutton, 2008).

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Applying Positive Psychology through Mind Ninja

I founded Mind Ninja as a result of experiencing both burnout and depression. I was surprised to find only services available to me at crisis point and no preventative solutions. This led me on a deep dive into the literature on evidenced based strategies that could help not only prevent poor metal health but also help us feel happier, engaged at work, connected withothers and living a life of purpose. Although interventions in Dentistry in theresearch are limited, the literature for medical and healthcare professionals is vast. It spotlights mindfulness, thinking and behavioural and resilience based interventions (Astin 1997; Shapiro et al 1998; Teasdale et al 2000; Mache et al 2016; Goodman MJ, Schorling JB 2012). This spurred me to developing my expertise in sharing evidence-based mind tools from Positive Psychology, neuroscience and mindfulness. I gained my accreditation in mindfulness teaching, Acceptance and Commitment Training and my Master’s in Applied Positive Psychology.

During the pandemic, through Mind Ninja, I have helped to support dental professionals directly through well-being coaching in addition to working closely with organisations, in both public and private sectors, such as NHS Oxford Health, King's College London, Acteon, BDA, Tipton Training, Dentinal Tubules, Cephtactics and the Royal College of Physicians and Surgeons of Glasgow, delivering Positive Psychology online workshops (on topics such as resilience training, growth mindset, goal setting and motivation, science of thriving, using strengths) and well-being programmes.

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In 2020, I wrote the Level 7 well-being online programme for Acteon and in 2021, led 2 cohorts of a 4 week Positive Psychology Intervention, providing a balance of empirical research and practical tools for greater resilience and well-being.

Last September, I branched into well-being products, launching the ‘Mind Flossing’ toolkit: a deck of well-well-being cards to help dental professionals practise mindfulness, self-compassion, gratitude, growth mindset and use their strengths, with patients and at home. The vision was to create a self-intervention toolkit that could help increase positive emotions, thoughts and actions. Since its launch 6 months ago, 352 dental professionals have benefited from practising the well-being tools with 4 amazing organisations (Acteon, NSK, Practice Plan and the mental health charity Confidental) supporting the profession through purchasing the toolkits.

The future for Mind Ninja

The pandemic has certainly brought mental health and well-being for clinicians to the forefront. My deep passion is to keep innovating in this space: pushing the boundaries from single one off webinars to engaging workshops that help dental professionals explore tools and integrate habits that stick. I am looking forward to the release of my book ‘Resilience And Well-being For Dental Professionals’ by Wiley-Blackwell in Autumn 2022.

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