Exposure Therapy

[CollegeBound]

I was reading in one of my Psychology books about different ways phobias are treated. One of those methods was exposure therapy. I thought this method was kind of interesting, and wondered if anyone has had experience with this, whether you received or administered the treatment, as well as what the results were.
Thank you!

 

[comfortdentist]

Yes can be highly effective when it's done well otherwise a potential disaster.

 

[CollegeBound]

Dr. Kimsey, what does this therapy involve? My book didn't give too many details. I just said the client is exposed to what they fear slowly.

 

[sleeplessinseattle]

This is basically what I am doing. I am part of the study at the Dental Fears Research Clinic here at the University of Washington in Seattle. They will provide me with anti-anxiety medicine and other pharmaceuticals but the purpose is to eventually alleviate my fears so that I do not suffer from panic attacks. I have a clinical psychologist (CP) assigned to me with whom I meet and we discuss triggers, strategies and coping mechanisms. I also have a dentist who has worked with the clinic for over 20 years. All of the staff is trained to specifically deal with patients that have phobias. Unfortunately, my mouth was in such horrid shape by the time I found them that I have had to rush through the extractions of my top four front teeth because of a massive abscess. My dentist did not want the problems to compound. The ideal is to start with cleanings, my hygienist (who is also assigned to me) does as much as I am comfortable with and my CP attends all of my appointments with me. My medical insurance covers my time with my CP and my dental insurance helps with the rest. I have been able to move forward and have begun to heal my mouth. I don't know what I would have done if I had not found this clinic.

 

[CollegeBound]

Thank you Sleepless! That is an amazing journey! You should be proud of yourself for coming so far. Thanks for the insight!

 

[FearfulInMA]

CB - there are a couple of different types of exposure therapy. The one I think you are looking at is systematic desensitization. If you google it, you should find very good info. When done properly by someone skilled, this type of therapy is incredibly effective at treating specific phobias (like dental phobia). But, when not done well, like Dr. Kimsey said, it can make things worse than they were to begin with.

 

[Gillian]

I think that the origins of any phobia need to be discovered and understood before any treatment can be effective.
I have undergone desensitization or exposure therapy for my very debilitating spider phobia and while it only provided 'some' relief for a brief period, it was ineffective overall. The reason is that my spider phobia, created in childhood, is really displaced fear, anger, or other negative emotion relating to my mother. Once I discovered this through therapy and severed ties with my mother, my phobia seemed to dissipate for the most part. As soon as I reconnected with her, it raged into a full blown phobia again. Hence, no more contact with her. My spider phobia was very serious- probably as bad as any phobia could ever be. My logical mind knew it was illogical but I couldn't control the fear. At certain times of the year, I would not leave my house! In college, I had to ask my Invertebrate professor if we were going to study arachnids and I had to clip that entire chapter with paper clips so that I would not see the pictures or touch the pages. Thankfully, my professor had enough compassion that he didn't cover that topic in any great depth and he excused me from any discussions without penalty. BTW, my mother has narcissistic personality disorder and she's also borderline so, I think it's interesting that as a child I created that association with spiders since spiders are often used as a metaphor for NPD...trapping their victims in their web.

My fear of dentists eases when I develop trust with my dentist and see him regularly. It's all too easy for my trust to diminish with long periods of absence. So, for me, I must schedule appointments months in advance and literally program them into my psyche so that by the time the appt arrives, I accept it as second nature as getting a cup of coffee in the morning. I never allow more than 3 months between visits. What does scare me is knowing that he will retire one day. So, I force myself to use another dentist in his office for minor visits just so I can establish trust with someone else in case I must need to use them at some point.
I have TMJ issues so, I also take 10mg of Valium before the appt to relax my muscles which also helps

I forgot to add that those of us with dental phobias who avoid dentists until there is a major crisis are not doing ourselves any bit of good in lowering our fear! So, the more often you visit the dentist, the less chance you have of needing an extreme treatment like root canal, extraction, etc..
Dentists, if you're reading, one thing that really makes all the difference in developing trust/comfort with my dentist is that HE calls me to check up on me from time to time. It really makes all the difference in the world to know that HE cares about me and that I'm not all alone. I also have his cell phone number in case I need to call him but actually, just having his number is comforting enough that I rarely ever need to call.

 

[Tink]

Hi CollegeBound -

I have some experience with this sort of therapy (as the patient) - comfortdentist is spot on!

Yes, it really can work, and yes, it has to be done right or it can go very wrong...

Things I would say, based on my experience:

- The most important thing of all is to find the right dentist/therapist. - they have to know what they are doing, and you must be able to communicate well with them and build up a trusting relationship. You would be working together through a process that involves facing your fears, so it's really important that you feel safe and confident with them. That relationship is the single most important thing about the whole process IME.

- You need to be prepared to put the work in. It will take time, and can be very challenging (if it wasn't you wouldn't need the therapy!) and there will be bumps in the road along the way - but it's worth it.

- Take it slow. No, slower than that! …even slower than you think. Baby steps, all the way. If you're sometimes thinking "ok, this is getting daft now, I can do this bit no problem at all" then you're getting it about right. My dentist was constantly having to hold me gently back from rushing on ahead and getting myself into a mess.


Re what's involved - it depends on exactly what you are afraid of really! But the general idea is, take the thing you are afraid of, and work up towards it in tiny, tiny steps. So for example, if you're afraid of the drill, then you might start with the dentist just showing it to you when it's not connected to anything, and talking you through how it all works. You might hold it yourself. Then they might run it for a few seconds at a distance, then maybe for a little bit longer, then you very very gradually work up towards them putting it in your mouth, and eventually running it in your mouth. (Note, this is just an example, and the actual process should be based on what's right for you.)

Everything is done very slowly, that process could take several appointments, and it's important not to progress on to the next step until you are comfortable with the previous one. Done right, it will never involve forcing you in to anything or pushing on too fast too soon - you're just very gently and carefully pushing at the edges of your comfort zone until it gets wider.



Hope that helps!

Tink

 

[JJones86]

Hi CollegeBound -

I have some experience with this sort of therapy (as the patient) - comfortdentist is spot on!

Yes, it really can work, and yes, it has to be done right or it can go very wrong...

Things I would say, based on my experience:

- The most important thing of all is to find the right dentist/therapist. - they have to know what they are doing, and you must be able to communicate well with them and build up a trusting relationship. You would be working together through a process that involves facing your fears, so it's really important that you feel safe and confident with them. That relationship is the single most important thing about the whole process IME.

- You need to be prepared to put the work in. It will take time, and can be very challenging (if it wasn't you wouldn't need the therapy!) and there will be bumps in the road along the way - but it's worth it.

- Take it slow. No, slower than that! …even slower than you think. Baby steps, all the way. If you're sometimes thinking "ok, this is getting daft now, I can do this bit no problem at all" then you're getting it about right. My dentist was constantly having to hold me gently back from rushing on ahead and getting myself into a mess.


Re what's involved - it depends on exactly what you are afraid of really! But the general idea is, take the thing you are afraid of, and work up towards it in tiny, tiny steps. So for example, if you're afraid of the drill, then you might start with the dentist just showing it to you when it's not connected to anything, and talking you through how it all works. You might hold it yourself. Then they might run it for a few seconds at a distance, then maybe for a little bit longer, then you very very gradually work up towards them putting it in your mouth, and eventually running it in your mouth. (Note, this is just an example, and the actual process should be based on what's right for you.)

Everything is done very slowly, that process could take several appointments, and it's important not to progress on to the next step until you are comfortable with the previous one. Done right, it will never involve forcing you in to anything or pushing on too fast too soon - you're just very gently and carefully pushing at the edges of your comfort zone until it gets wider.

Hope that helps!

Tink

Hi Tink.

I have a question. I'm still very new to this conquering my fear of dental phobia and anxiety. I realize that a good first step is to start therapy, which I will be this week.

I'm wondering though, my treatment seems to be rather urgent or rushed. The doctor actually wanted to see me this week to start the work because I have gingivitis now and need a deep cleaning. I told them that I need to wait until I get my braces off, which will be in about 2-3 weeks. He also wants to put on my crowns ASAP due to the fact that most of them are 1 1/2 years old or more.

I know that therapy can be a slow process, especially from the sounds of this exposure therapy. At this point in time I feel nowhere near ready to have any work done, but I'm feeling pressured due to the doctor saying this needs to be done ASAP to prevent further problems.

Do you have any advice on how I should approach this?

I don't want my teeth getting any worse, but at the same time I'm terrified of having work done now and making my phobia and anxiety worse.

As it is, he wants to start my dental work in about 3-4 weeks once we know my braces are coming off. We haven't scheduled yet, but I know the work needs to be done soon.

Thanks.

JJ

 

[Tink]

Well, I'm very far from being an expert(!), but here are my thoughts:

There are two things here that can be treated:

A) Your teeth

and

B) Your phobia

…and it might help to consider them separately.

Exposure therapy (or systematic desensitisation) is a phobia treatment - it's aimed at the longer term, so that in future you would be more able to cope with dental appointments and treatments.

Phobic very people often arrive with a lot of dental treatment that needs done now though - especially if you've been avoiding the dentist for a while - so I guess the approach would often be to get the urgent work done with the aid of whatever is necessary to get through it…then move on to addressing the phobia in the longer term.

So yeah, I'd suggest you talk to your dentist about what needs done and when it needs done - tell him what your concerns are - but focus, for now, on doing whatever you need to to just get through the stuff that has to be done now (including sedation or drugs if that's what works for you).

Then later on, once your teeth are stable and there are no urgent problems putting extra pressure on, you can think about treating the underlying problem - your phobia - if that's what you want to do. If you want to try and tackle the phobia itself it's actually better to do it when you're not also worrying about the state of your teeth…it lets you deal with one problem at a time, which is much more manageable.

Your therapist may well also be able to help with more immediate coping techniques to help you get through this initial phase - ask them when you see them! I'm sure they can advise.

If it's done right, with a good, gentle dentist, having treatment just now is unlikely to make your phobia a lot worse - after all, the things our heads come up with to torment us with are often so much worse than the reality of the treatment! You may well find that it's easier to get through than you expect, and this, in it's own way, will set you on the right path for the future. You'll feel proud of yourself for getting it done




Short version: Talk to your dentist, and your therapist. Find out exactly what needs doing, and when, and then tackle one thing at a time. Short term, you need coping techniques. Long term, you can think about actually changing the phobia.



Does that help at all? Would be interested to hear the views of any passing dentist on this! Not a dentist, or a therapist, so it's entirely possible I'm talking bollocks

Tink

 

[JJones86]

Well, I'm very far from being an expert(!), but here are my thoughts:

There are two things here that can be treated:

A) Your teeth

and

B) Your phobia

…and it might help to consider them separately.

Exposure therapy (or systematic desensitisation) is a phobia treatment - it's aimed at the longer term, so that in future you would be more able to cope with dental appointments and treatments.

Phobic very people often arrive with a lot of dental treatment that needs done now though - especially if you've been avoiding the dentist for a while - so I guess the approach would often be to get the urgent work done with the aid of whatever is necessary to get through it…then move on to addressing the phobia in the longer term.

So yeah, I'd suggest you talk to your dentist about what needs done and when it needs done - tell him what your concerns are - but focus, for now, on doing whatever you need to to just get through the stuff that has to be done now (including sedation or drugs if that's what works for you).

Then later on, once your teeth are stable and there are no urgent problems putting extra pressure on, you can think about treating the underlying problem - your phobia - if that's what you want to do. If you want to try and tackle the phobia itself it's actually better to do it when you're not also worrying about the state of your teeth…it lets you deal with one problem at a time, which is much more manageable.

Your therapist may well also be able to help with more immediate coping techniques to help you get through this initial phase - ask them when you see them! I'm sure they can advise.

If it's done right, with a good, gentle dentist, having treatment just now is unlikely to make your phobia a lot worse - after all, the things our heads come up with to torment us with are often so much worse than the reality of the treatment! You may well find that it's easier to get through than you expect, and this, in it's own way, will set you on the right path for the future. You'll feel proud of yourself for getting it done




Short version: Talk to your dentist, and your therapist. Find out exactly what needs doing, and when, and then tackle one thing at a time. Short term, you need coping techniques. Long term, you can think about actually changing the phobia.



Does that help at all? Would be interested to hear the views of any passing dentist on this! Not a dentist, or a therapist, so it's entirely possible I'm talking bollocks

Tink

Hi Tink.

Thank you so much. That really helps a lot. That's why I'm planning on trying the nitrous oxide. The urgent work that needs to be done, I'm planning on having it done in two appointments. The first will be a 2 hour appointment for a deep cleaning and a filling. The second will be to get 4 same day crowns done at once. I'd do it all in one appointment, but I can't keep my mouth open very long due to TMJ problems and pain.

I agree with you. I'd also be interested to hear any views from a dentist on this site.

I'll be sure to ask my therapist and dentist what they think when I meet with them. Both of those appointments are this week.

Thanks again.

JJ

 

[comfortdentist]

I actually would say it can be amazingly effective as long as the patient is willing to trust the practitioner and the doctor never violates that trust. No exceptions.

 

[Tink]

I actually would say it can be amazingly effective as long as the patient is willing to trust the practitioner and the doctor never violates that trust. No exceptions.

Yep. This. Absolutely this ^