By Linda Fisher, Jennifer Hare and Ewen McColl

Members of the dental team are often so focused on looking after their patients that they neglect to look after themselves. Unfortunately, time pressures and managing patient expectations on a daily basis can be depleting. Looking after your own and your team members' wellbeing is crucial not only for us as individuals; it also ensures optimal patient care is facilitated. This article will provide tips for staying well in the context of a busy, often stressful, and demanding work place.

Most people are familiar with the idea of taking exercise and eating well to keep fit and physically healthy, but it is less well known that there are effective strategies that can be used to help to deal with the inevitable work challenges, to promote ‘mind-fitness'. It is well known that when we begin to feel ‘stressed' or depleted in some way we begin to think and feel and behave in particular ways, many of which can be unhelpful.

Whilst this article is written for dental professionals, it is also true to say that each of us only ever works in the context of the wider fabric of our life. Combining a professional life with various challenges across the lifespan, for example, bringing up a young family, caring for elderly relatives, and for women, the menopause, not to mention financial difficulties or problems in our personal relationships, are not to be under-played.

Increasingly it is recognised that both self-awareness and the capacity to draw on a range of coping skills, make an important contribution to our psychological flexibility and emotional agility and thus our capacity to flourish in both our personal and professional lives. This is not to say that these strategies should be used to put up with intolerable work conditions, rather that they can be applied appropriately, systematically and usefully to support the challenges involved in everyday life.

We have chosen to focus on six key tips for wellbeing and very much hope that you will find something in what follows that adds to your repertoire of coping skills and contributes to your wellbeing in all areas of your life! We have also added links for faith and community-based resources for health and wellbeing for ease of access and completeness at the end of this article.

Shine a spotlight on, and celebrate small acts of kindness towards each other and towards patients. These acts of kindness contribute to the concept of the practice as a small community, making all team members feel valued.

1) Cultivate self-awareness

Using a CBT framework to pick up early signs of being under pressure

Using a simple Cognitive Behavioural Therapy (CBT) framework on a regular basis, to break down experience into thoughts, feelings (mood and physiology) and behaviours can provide a structure around which to usefully ‘check-in' with yourself. Recognising early on if you are beginning to feel depleted and need to think about ‘resourcing' yourself more fully, or indeed, if you need to change something about the way that you are working, is easier than allowing difficulties to build up and trying to make changes when you are already becoming overwhelmed.

Signs of ‘stressed' thinking might be focused on not wanting to go to work or how little you are enjoying your work, or you may begin to think in a repetitive, unproductive and uncontrollable way (ruminate) on problems at work or at home.

Emotions may include beginning to feel low or anxious or indecisive on a persistent basis and behavioural change might include disruption to your sleep, being irritable, drinking too much alcohol and no longer doing enjoyable things, for example, seeing friends or family or going to the gym. It is not uncommon for people who feel low and anxious to lack energy and experience other minor physical symptoms. In the worst case scenario, you may begin to have thoughts about wanting to harm yourself in some way, not wanting to wake up in the morning or just not wanting to go on. When things get this bad it is not unusual for people to feel an increasing sense of shame about what is happening to them and to feel isolated from others whom they would normally turn to for support. If you ever begin to feel this way, it is essential that you seek professional help as a matter of urgency (please see links to suggested sources of help at the end of this article).

If you are feeling very anxious or quite low (both of which can be a strong trigger for the so-called ‘negative bias' in human thinking) in order to gain some perspective on whatever it is you are thinking about, it may helpful to ask yourself:

  • What is the worst thing that can happen?

  • What is the best thing that could happen?

  • What is the most likely thing to happen?

2) Focus on the ‘now' in your life

Mindfulness strategies are increasingly recognised as useful in helping people to restore balance and a sense of steadiness in challenging situations. Put simply, developing the capacity to notice when you are getting lost in unhelpful thinking (perhaps overly-anxious or pessimistic thinking, or just repeatedly ‘going around in circles') is the first step in this process. Thinking in unhelpful ways can lower mood or feed into other unpleasant mood states and make you miss what is enjoyable and uplifting in life. Is there really anyone reading this who hasn't ever been preoccupied with a work problem when out with a loved one or friend, and simply ‘missed out' on some of the joy and fun and sense of closeness that has been available to us if only we hadn't been so wrapped up in our thinking? We think it unlikely!

The idea here is that by noticing these unhelpful thinking styles, you ‘step out of' what can become a negative loop elaborated on and complicated by our imaginative thinking. Our minds are extraordinarily clever and of course, we couldn't do without them, but equally, the mind and its thinking can lead us in to all sorts of difficulties and it is useful to know this. Instead, it is possible to choose to focus on the present and the good in our lives. So, the process here is repeatedly bringing the mind back to what is nourishing and helpful for us.

For example, it is possible to learn to use the five senses more fully in an intentional way in any pleasurable situation to help resource and increase our sense of wellbeing. This might take the form of feeling the weight and warmth and smell of beloved pet or a child or grandchild as they sleep in our lap. It might be feeling the sensation of the sun or breeze on our face when we are out walking, noticing the movement and sound of the trees, the colours and patterns of shade of light. Our minds tend to jump around anyway, and the more anxious or low or stressed we are, the ‘jumpier' our minds become. This process of repeatedly bringing awareness to what is supportive of our wellbeing can be thought of as training the ‘attentional muscle' in the brain to help shift focus whenever we feel it would be helpful to do so. And just like a muscle, it takes a while to build up!

3) Connect with other people

Healthy relationships are key to our wellbeing. None of us exists in isolation and our lives are inextricably linked to the lives of others. The quality of the relationships that we have throughout our lives impact us in vital ways, including the capacity to flourish and our longevity. One of the most important ways to care for oneself is to take care of the important relationships we have. In practical terms this means prioritising relationships with our loved ones and trusted friends, the people who we can rely upon and who make us feel good. It can feel as though in the short term, in order to catch up on work, it might be better to delay or cancel social arrangements, but in the longer-term this can lead to the gradual erosion of friendships and the relationships that support wellbeing. It is a rare occasion that any of us reach the end of the to-do list; there is always more to be done. And of course, there comes a time for all of us, when we no longer get to choose which tasks we leave unfinished!

If work seems to be taking over your life, set the alarm on your phone for a time when you (and your practice team) will begin ‘wrapping up' the work day and another for when everyone should have left the building. Commit to the time that you will be home by and let your flatmates/partner/children know. Whilst this may be a challenge in a busy dental practice the benefits to team morale will be worth it, and if you are leading the team this will foster a feeling of value for team members. If you can't make this commitment for five days a week try it for three. See if you can make something like this work for you and your team and seek out allies in this process. Shine a spotlight on, and celebrate small acts of kindness towards each other and towards patients. These acts of kindness contribute to the concept of the practice as a small community, making all team members feel valued. Be prepared to be creative and playful in the service of your own wellbeing and the people that you share your life with, whether those happen to be your colleagues, your patients or family members.

4) Exercise and activity

This is an important part of a wellbeing strategy for all of us, and the endorphins released during exercise are crucial to feelings of wellbeing. There is an amazing array of activities that can be classed as exercise, for example, running, cycling, swimming, walking, yoga, pilates, Thai Chi, Qi Gong, meditation, golf; the list goes on and on! Importantly, a lot of these activities can be done outside or with other people, both factors that we know can enhance the positive effect of the activity itself. In the context of a busy work life, walking in particular confers many psychological and physical health benefits because of the flexibility it offers. A brief period of walking could be fitted in as an individual or team activity where it may offer, in combination with ‘focusing in the now', an opportunity to ‘re-calibrate' and restore oneself at some convenient point in the working day.

Many people use activity as a way of contributing to their mental wellbeing. More physically exerting activities (and these could range from walking to running or cycling depending upon your level of fitness or simply what is required at the time) can be used to work off any anxious energy that may accrue, or indeed to energise oneself. Something more restful and mindful, for example, yoga or Qi Gong may be used to soothe and restore and settle.

5) Sleep

Exercise can also help with sleep provided it is not immediately before you go to bed, when it has a stimulating effect. Likewise, keep an eye on your caffeine intake and eating very late, both of which can interfere with sleep. Alcohol may help you to get off to sleep but sometimes results in wakefulness and dehydration later on. Keep your bedroom dark and not too hot and don't be tempted to check your phone when trying to sleep or on first waking. Try using earplugs if there is a lot of noise pollution where you live. It's also helpful not to vary your wake time too much at the weekend. Lie-ins are helpful, but they can disrupt sleep cycles if you usually get up early on work days. Find the balance of what feels right for you in your life.

6) ‘In the moment' and ‘on the spot': quick strategies to recover ‘balance' in clinic

It is not uncommon to have moments when temporarily and fairly briefly we feel ‘thrown off balance', somehow, and the sense of being a competent professional deserts us. This experience may take various forms: shaking hands, feeling suddenly quite anxious about something in the clinical encounter, a sense of uncertainty about how to proceed, or if patients or colleagues are being challenging and we don't quite know what to say.

Reminding yourself that you are human!

These things happen to everyone and are unpleasant for all of us when they do, but it's important to understand that this is all part of being human! They don't tell us any fundamental truths about us as a person or our capacity as a professional (no matter what our thinking might be leading us to believe!). Equally, it's not our fault, we don't need to blame ourselves or to feel ashamed as though these moments of vulnerability are a personal failing!

Taking a ‘mindful moment' and slowing your breathing

Building on the ideas of the ‘focusing on the now' section above (aka extricating yourself from a vortex of unhelpful thinking) is learning to bring your attention down, out of your thinking mind and to focus on the pattern of fluctuating physical sensations in the body. The examples below need only be brief and if you are having a tough day, don't wait until things feel unbearable, punctuate your day with these brief acts of self-care to resource and restore you.

If you have the chance to have a cup of coffee in between patients, you could try focusing on the sensory qualities involved in holding the cup, the warmth and appearance of the coffee in your cup and the sensations and the flavour of the coffee as you drink. Being present (using all of your senses) for handwashing is very useful. Focus on feeling the temperature and touch of the water on your hands, the smell of the soap and the appearance and the sound of the water as it splashes in the sink.

Alternatively, you could feel into the sensory quality of your feet connecting with the solidity of the ground beneath you and the physicality of your body extending upward, all the way from your feet, through your legs, buttocks and the gentle curve and uplift of the spine to the crown of your head. Then, as best you can, try feeling in to the sense of heaviness and solidity that the body is offering in that moment. Then, when it feels right, see if it's possible for you to slow and slightly deepen your breathing for a few breaths. Slow, regular breathing is part of a physiological ‘calming down' process that can be actively used to help steady oneself and calm the mind.

Try not to get in to a struggle with the breath, though! If it feels like this is beginning to happen or if focusing on the breath is too difficult for you, then try the Mindful Self-Compassion break below. You can explore and experiment and see what techniques or combinations of technique work best for you. There are no hard and fast rules. And don't worry if your mind wanders off in many and multiple directions during the practice of these exercises - that's to be expected. The important thing is to notice this and bring your attention back to the present exercise, time and time again - strengthening that attentional-muscle!

Taking a mindful self-compassion break

This brief practice has three stages and is intended to be used when you are feeling bothered, upset or otherwise troubled (suffering). The idea is that this practice does not necessarily remove what has upset you, but that it is possible to offer yourself some care and comfort because you are upset, as a good friend might do for you if they were present. This is the outline of the practice but it is best to listen to the guidance (link provided below) before doing it on your own so that you know how it unfolds. The first stage is to acknowledge that there is something unpleasant going on for you. The second stage is to call to mind the notion of common humanity and the fact that it is simply part of the human condition to suffer. This is to reduce the sense of isolation, self-blame and disconnection that is sometimes experienced when difficult things happen. The third stage is to use some comforting form of words that enlists us as our own best friend in that moment. In the guidance there is also an option of using some kind of soothing self-touch for comfort. These actions can be brief and discreet, but surprisingly effective, for example, rubbing the back of the hand.

Closing thoughts…

We really hope this article gives some food for thought and complements the other articles in this issue, with practical and useable ideas on these key areas of wellbeing for you and your teams. There are many wonderful resources that expand on these ideas, some of which are included in the resources section at the end.

As you sit here now, having read this article from start to finish, perhaps think about one thing you can first commit to trying, or doing more of, as a starting point. You could even think about inviting other team members to do the same. Write it down… and come back to this in a few days. Reflect on how it went, what helped, what got in the way and what else might be needed to support you taking this intended action. And remember, we are all human!

For urgent concerns related to your wellbeing or safety, your GP or local A&E can help, as well as the following organisations:

Samaritans: call 116123, or visit https://www.samaritans.org/.