Today's blog post shares excerpts from my recent article in BDJ in Practice mental health issue published in June: The Transformative Benefits of Mindfulness in Dentistry

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Despite the limited intervention research targeting dental professionals currently, we can glean a considerable amount from our healthcare and medic colleagues. Research on burnout prevention and optimising mental health in healthcare professionals point to Mindfulness-Based Interventions (MBIs). The literature spotlights increases in positive well-being markers - from compassion satisfaction (the joy we get from treating our patients), resilience, positive emotions, meaning, improved interpersonal relationships to enhanced self-care behaviours (Kunzler et al, 2020). MBIs may empower dental professionals through nurturing the key attitudes of mindfulness; acceptance, gratitude and self-compassion (Krasner et al, 2009). It may also help in fostering a new relationship with challenging emotions at work, for example observing anxiety without interacting with it (Ospina-Kammerer et al, 2001). As a Positive Psychologist, this excites me tremendously! Here is a potentially life changing tool that can not only buffer us against stressors and reduce our occupational hazards of burnout and compassion fatigue, mindfulness could also help us feel more optimistic, connected to others and living a life of purpose. Who in Dentistry doesn’t want that? 

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Simply put, mindfulness is the ability to pay attention to the present, without getting lost in the story of our thoughts.

Our mind is constant chatter of anxious thoughts about the future, or thoughts ruminating about the past. Mindfulness allows us to react with our emotions and thoughts with kindness, equanimity and intelligently, so we aren’t jerked around by them.

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To be a mindful dental professional means consciously cultivating the 9 attitudes of mindfulness: non-judging, gratitude, patience, a beginner's mind, trust, non-striving, acceptance, letting go, gratitude and generosity (Kabat-Zinn, 1990). Just like any muscle of the body, mindfulness can be trained, strengthened and no matter how mindful you are currently, you can become more mindful tomorrow.  

Mindfulness works through allowing us to decentre from stress into a state of presence and awareness (Garland et al, 2015). This encourages us to cognitively reframe our life circumstances and reduce the negative emotions we feel. The process is further improved through individuals savouring positive aspects of their environment, encouraging actions driven by purpose in life and our values.

There are many misconceptions about mindfulness that can be a barrier to taking it up. The most prevalent one I find, when I teach mindfulness to teams and dental professionals, is the worry that mindfulness is a religious practice. Although originally having its origins in Buddhist culture, mindfulness is a secular practice. It was founded by Jon-Kabat Zinn in the 1970s to help a stressed population in the West. I certainly won’t be asking you to chant or change your religious views. Mindfulness also does not involve stopping our thoughts. The mindfulness meditation process centres on paying attention to our breath, catching the brain wander and gently nudging our attention, with kindness, back to our breath.

Another common misunderstanding is that mindfulness is solely meditation. Infact, mindfulness, can be infused in absolutely all of our daily activities, both as a dental professional and our home life. We can practise mindfulness as we cure composite, wait for the alginate to set, don PPE on and off, eat, listen to our patients or walk. This makes mindfulness a self-care tool that arguably elevates from others: it can be used in the moment we need it.

Benefits for Dental Professionals

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Mindfulness may empower dental professionals with the necessary tools to be resilient. A positive leader in Dentistry today requires considerable psychological resilience to weather challenges and grow through them.

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If we think of the mental health continuum, with one end representing low mental health and the other positive mental health, we know that where we sit on the continuum is continually shifting according to our life circumstances. We also know that protective factors can shift us towards greater resilience and positive well-being.

And the good news is mindfulness, along with positive relationships, meaning and positive lifestyle factors, is an important protective factor through its ability to help us with increasing our emotional awareness, emotional regulation and also in harnessing the power of positive emotions (Sood et al,2011).

Mindfulness indeed, may equip dental professionals in becoming more emotionally intelligent: that is the ability to be aware of their emotions and thoughts, to down regulate with stressed and be aware of the emotions of patients and work colleagues. This alone is so fundamental in building the resilience muscle.

Neuroscience of Mindfulness

No matter what our age is, or our past experiences, practising mindfulness may physically change our brain. Neuroscience research spotlights increases in the grey matter of the pre-frontal cortex, resulting in enhanced executive function abilities, for example problem solving and memory (Gotink et al, 2016). Mindfulness may also decrease the grey matter of our amygdala, allowing for less reactivity when we are stressed. Furthermore, mindfulness activates the Task Positive Network, a brain network that is associated with “flow” states linked with greater well-being and happiness, aswell as decreasing the activation of the Default Mode Network, associated with excessive worry patterns commonly found in depression (Brewer et al, 2011).

Mindful Self-compassion

One particular type of well-being intervention that is gaining considerable attention is mindful self-compassion training. This combines both mindfulness and self-compassion practices to help individuals counteract the harsh inner critic and respond to moments of stressor challenge with loving, kindness. Considering perfectionism may be a common trait amongst dental professionals, with 35% of UK dental students having maladaptive perfectionism associated with burnout and psychological distress, mindful self-compassion training may be the ideal antidote (Collin et al,2020).

Kristin Neff, one of the key researchers in this area, describes 3 components of mindful self-compassion: mindfulness, common humanity and self-kindness. Mindfulness allows us to react to emotions and thoughts with equanimity. Common humanity reminds us that we are all connected by our experience of stress and challenges. And self-kindness refers to using words of kindness for ourselves, similarly to how we would talk to our loved ones, as well as providing ourselves with psychical comfort through squeezing our arm or stroking our hand.

Neff’s recent paper spotlighted 2 studies, in a cohort of medical professionals, delivering a Mindful Self-compassion training programme of 1 hour over the course of 6 weeks (Neff et al, 2020). This intervention conveyed significant increases in self-compassion, well-being and a reduction of burnout, with results maintained over 3 months.

With a profession rightly focused on evidence base Dentistry, we could do with bringing that same approach to the well-being education we provide. Similarly to Neff’s study, last year I conducted 2 cohorts of a 4 week Positive Psychology Intervention programme with dental professionals, including a focus on mindful self-compassion practices in a group setting. The sessions were online workshops, with breakout spaces to further explore topics such as creating a compassionate inner voice and developing a compassionate mindset in Dentistry.

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This May, I ran a 4 week mindfulness-based programme (Mindful May), helping dental professionals integrate mindfulness both at work and at home. Both interventions have been a success, with participants reporting increases in their well-being. It is through evidenced-based interventions like these, we can help empower dental professionals with tools early on, to not only reduce or prevent mental illness, but also, and equally as importantly, to go beyond baseline and flourish in their dental careers.

Applying Mindfulness with Patients, Work Colleagues & at Home

Below are different mindfulness activities you can try to invite the benefits of this well-being tool.

Mindful Activity

Description

Mindful Check-in : What’s my inner  weather?

What's My Internal Weather? - YouTube

o    Enhance emotional-awareness through  this check-in. Use this before bringing your patient in or at different  points in your day

o    Take a mindful deep breath. Reflect  on what you are currently feeling, using the weather as a metaphor. Perhaps  you are feeling optimistic, and so a rainbow may be your ‘weather’ currently  or perhaps its more frustration and the weather report is a ‘stormy ocean’.

The  weather analogy is a great reminder that just like the weather changes, our  emotions and thoughts come and go. This can help us stay with difficult  emotions longer, rather than resist them.

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Mindful Break using Aromatherapy

o   Bring presence and awareness during moments of stress  using this short mindfulness micropractice

o   Place a couple of aromatherapy drops, such as  lavender, onto a tissue and take 3 deep breaths. Anchor to the scent as you  take a deep inhale and exhale. If you notice your mind wander, gently nudge  it back to the aroma.

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Mindful Listening

o    Improve your listening and empathy  skills through this mindful listening practice

o    For the next 5 minutes you are will  a dental colleague, give your entire attention to them. Listen not to answer  back, but to truly understand what they are saying. Exercise self-compassion  and non-judgement.

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Mindful Eating

o   Practice eating with presence rather than  mindlessly eating

o   During lunchtime, when you take your first 3  bites of food, hone into the experience of eating by slowing down and  noticing all your 5 senses: What do you see? Note the textures, shape and  colours in your food. What can you smell? What lastly can you taste? Notice  all the different flavours of your food

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Mindful Walking

o    Spend 5 minutes of walk outdoors  concentrating on the sensation of walking. Slow down. Hone into as many  senses as possible: what can you see? What can you hear? What can you smell?  What can you taste? What does it feel like to slowly take mindful steps? If  you notice your mind wander, gently nudge it back to the present by honing  back to your senses

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Self-compassion Break

Exercising Self-compasion Meditation - YouTube

o   Enhance self-compassion through using Neff’s 3  step process

o   When you next note you are stressed, or a harsh  critical though pops up when you are with a patient, take a mindful deep  breath. Remind yourself that you are not alone in your experience of negative  thoughts. Lastly, use words of self-kindness and physical gestures that  comfort you, for example you may say to yourself “I’m so sorry you’re going  through this. I’m here to support you. What can I do for you in this moment?”  and offer your arm a squeeze.

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Mindful Body Scan

Body-scan meditation - YouTube

o    Increase the mind-body connection  through this simple meditation

o   Start by getting in a comfortable position and  slowly close your eyes. Ground yourself by noticing the sensation of sitting,  how your spine feels supported against the chair and your feel against the  ground. Now bring your awareness to the breath, wherever you feel it. This  may be the nostrils or the chest for you. Notice the sensation of breathing  and your chest rise and fall. Next bring your awareness to each body part,  scanning slowly from the tipis of your toes to the crown of your head. Notice  any areas of discomfort or tension. If you notice your mind wander, gently  nudge it back to your breath.

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Loving Kindness Meditation

Loving Kindness Meditation - YouTube

o   Enhance self-compassion

o   This meditation combines imagery with positive  affirmations (mantras).

o    Follow the same steps as the  mindful body scan up until the focus on breathing. In this meditation imagine  a warm glow of self-compassion filling your entire body. Repeat the mantras:  ‘May I be happy, May I be healthy, May I be  filled with ease’. If these words do not resonate, swap them with  whatever words you long to hear. Now imagine a loved one in front of you and  extend the warm glow of self-compassion to them. Repeat the same mantras,  this time directed to them, repeating : ‘May  you be happy, May you be healthy, May you be filled with ease’.  You can then repeat the same process thinking of a person who you may not  connect with so well and lastly extending self-compassion onto the world,  repeating the same mantras:  ‘May all beings be happy, May all beings be healthy, May  all beings be filled with ease’.

Last year I launched the Mind Flossing Toolkit, a self-intervention designed for dental professionals and teams to integrate mindfulness and self-compassion into their clinical practice and at home. The vision was to help increase positive thoughts, feelings and actions through intentional well-being activities. I’m happy to report that all the dental professionals who have been surveyed report increases in mindfulness, self-compassion, positive emotions and mental health improvements since using the toolkit (n=31).

It is these small habits, the humble focus on our breath and relating to ourselves with kindness, non-judgment and warmth, that really has the capacity to make a meaningful impact to our well-being. It has certainly brought me immense benefits: from increasing my sense of engagement at work to enhancing my purpose in life and improving my relationships. Why not give it a go?

References

Brewer JA,Worhunsky PD, Gray JR, Tang YY, Weber J, Kober H (2011). Meditation experience is associated with differences in default mode network activity and connectivity. Proceedings of the National Academy ofSciences.108(50):20254–20259

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Collin V, O’Selmo E and Whitehead. (2020) Stress, psychological distress, burnout and perfectionism in UKdental students. British Dental Journal 229: 605-614.

Gotink, R.A., Meijboom, R., Vernooij, M. W., Smits, M., & Hunink, M. G. (2016).8-week Mindfulness Based Stress Reduction induces brain changes similar to traditional long-term meditation practice - A systematic review. Brain and cognition, 108, 32–41.

KABAT-ZINN, J. Full catastrophe living:using the wisdom of your body and mind to face stress, pain, and illness. NewYork, N.Y., Delacorte Press.

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Khwaja, M (2022). The transformative benefits of mindfulness in dentistry.  BDJ In Pract35, 26–28

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Peng, L., Li, M., Zuo, X., Miao, Y., Chen, L.,Yu, Y., Liu, B., & Wang, T. (2014). Application of the Pennsylvaniaresilience training program on medical students. Personality and Individual Differences, 61-62, 47–51

Krasner, M.S., Epstein, R. M., Beckman, H., Suchman, A. L., Chapman, B., Mooney, C. J.,& Quill, T. E. (2009). Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA, 302(12), 1284–1293.

Kunzler, A. M., Helmreich, I., Chmitorz, A.,König, J., Binder, H., Wessa, M., & Lieb, K. (2020). Psychological interventions to foster resilience in healthcare professionals. The Cochrane database of systematic reviews, 7(7), CD012527.

Neff K, Knox MC, Long P, Gregory K(2020). Caring for others without losing yourself: An adaptation of the Mindful Self-Compassion Program for Healthcare Communities. Journal of clinical psychology. Volume76,Issue 9Pages 1543-1562

Ospina-Kammerer,V., & Dixon, D. R. (2001). Coping with burnout: Family physicians and family social workers—what do they have in common? Journal of Family SocialWork, 5, 85–93.

Shapiro,S.L., Schwartz, G.E. & Bonner, G (1998). Effects of Mindfulness-Based Stress Reduction on Medical and Premedical Students. J Behav Med 21, 581–599 

Sood, Amit& Prasad, Kavita & Schroeder, Darrell & Varkey, Prathibha. (2011).Stress Management and Resilience Training Among Department of Medicine Faculty: A Pilot Randomized Clinical Trial. Journal of general internal medicine.

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