Cognitive Behaviour Therapy Karen Clark CBT Nurse Birmingham Community Healthcare Trust

What is CBT……. Some people call it a talking therapy Understanding how our fears develop and what effect fear has on our reactions. These are our learnt responses our automatic thoughts Understanding these learnt responses, help us mange our fears differently

What causes dental anxiety Traumatic experiences Single event – flashbulb memory Vicarious learning from friends / family /media

THREE SYSTEMS OF FEAR Lange 1969 Physical Cognitive Behavioral 4

Cognitive Feeling out of control Feeling trapped Distortion of events Catastrophic misinterpretations Heightened fear response

Physical Perspiration Increased heart rate Increased respiratory rate Shallow respiratory function Pins and needles Palpitations Feeling nausea / faint

Behaviour Avoidance/poor attendance Co –operation reduced Aggressive/ unfocused Escape/ritualised behaviour

Case History – Alan 62 year old Requested to be ‘knocked out’ for treatment Bad experiences as child and adult ++ Last had treatment 15 yrs ago Treatment ‘always painful’ even with anaesthetic MDAS Pre 31/25 Post 6/25

The CBT process Formulation – history, timeline, MDAS Collaboration – working together, empathy Planned gradual / guided exposure Systematic desensitisation

Modified Dental Anxiety Score MDAS score above 19 = CBT intervention 1 Not anxious 2 Slightly anxious 3 Fairly anxious 4 Very anxious 5 Extremely anxious

How would you feel if ……. 1 – 5 scores you were going for treatment tomorrow you were in the waiting room, waiting for treatment you were about to have your tooth drilled you were to have your teeth scaled you were about to an injection

Catastrophic thoughts are real !!!!

Grading exposure A = Situation B = Response C = Consequence 0 = Extremely relaxed 10 = Extremely anxious

Remember…… The patient exposes themselves to the fear I don’t expose the patient to fear

Attention switching Relaxation - zone out / ‘their place’ Breathing exercises / Diaphragmatic Personal journey / music / aromatherapy Applied tension

Limitations of CBT Age Unable to commit Time just not right Pain / infection

Case Study – Janet 54 year old Last attended GDP 40 yrs ago Multiple medical interventions for Hydrocephalus as a child (while conscious) Anxiety – vibration / sounds / smells MDAS Pre 22/25 Post 7/25

Janet’s comments I cannot thank CBT enough. I have been scared of the Dentist for 40 years. My CBT Nurse made me feel at ease and I was able to open my mouth for a check up, something I thought I would never be able to do. I cannot thank you enough to rid me of these terrible fears

Case Study - Harriet 16 year old Needle phobic – unable to have any vaccinations (Mum also needle phobic) Previously attended Dental Hospital for 4 years – no treatment achieved MDAS 21/25 Post 10/25

I am going to have my vaccinations soon too Harriet's comments I am so pleased I have been able to have two fillings done I have even had my noise pierced. Mum loves it. I still have to have a tooth extracted but I think I will be able to do it. I am going to have my vaccinations soon too

Build trust not dependence

Feedback - Callum I cannot thank you enough for helping Callum overcome this trauma and I must tell you he has conquered another fear by going on climbing courses and abseiling for his GCSE, it took four attempts but he did it. He is much more confident and looking forward to having his brace fitted.

CBT - 45 pts referred so far

Referral information 5 Male / 23 female Average age 31 Ranging from 15 – 72 yrs Average number of CBT apt 5.56 Ranging from 4 - 9

Outcomes so far

Mandatory Psychological Supervision

Contact details Karen Clark Karen.clark2@nhs.net 0121 612 2385