Holding Pain Part 1
“Holding Pain” - Navigating the Stress Response Through Mindfulness and Music interventions
Part I – Mindfulness & Impact of Stress Response to Well Being for the patient and practitioner
By Bonnie Kowaliuk, MBA(Leadership), RSW, MTA, BMT, BA
How can we as health practitioners create healing spaces in clinical environments that translate into health and well-being for the clients that we serve? How can we create spaces to “hold pain,” whether it be physical, emotional, mental, or spiritual in health disciplines that are mindful of and attuned to the suffering and discomfort of patients? What do healing spaces look and sound like in the field of dentistry? When one reflects upon the space in an average dental clinic, what does one see, hear and experience? Is it sterile, clinical, cold and devoid of the elements that offer comfort, support and a sense of safety and security? How do the healing spaces and practices in the field of dentistry impact the clients who receive health services as well as the providers?
Close your eyes and just listen…listen to the sounds of this space. Feel and notice what goes on from a visceral and tactile place. What are you aware of? Sounds of machines (copiers, printers, x-ray, drills, scrapping, filing), water, talking, distressed patients in other treatment rooms, music…...? What is present?
Step back and reflect on how these sounds and the patient’s state (past and current experiences with pain & stress) impact their receptivity and stress levels relative to dental interventions which can be intrusive and uncomfortable. Now step back and reflect again. How can this be transformed to create a healing, comforting space that affords clients an element of control? Is in an aversive or caring one?
How would you feel if you could administer interventions that allow you to engage in the mindful act of holding pain and discomfort in a supportive, compassionate and caring manner that meets client’s needs where they are at in the moment?
Mindfulness – moments and practice
What is mindfulness? How could this practice be integrated into the realm of dental practice with every patient, with staff and across the profession to reduce stress and anxiety which over time is cumulative and impacts overall well-being relative to burnout and coping strategies from practitioners (dentists and hygienists alike) to patients whom are on the receiving end of interventions outside of their control?
Mindfulness has been defined by Williams Teasdale Segal Kabat-Zinn as “the awareness that emerges through paying attention on purpose in the present moment and non-judgementally to things as they are.” Susan Kouser Greenland defines mindfulness as “the capacity to be alert and open to life experience as it occurs in a non-reactive, resilient and compassionate way.” Jon Kabat Zinn (pioneer of the Mindfulness Based Stressed Reduction Program, based out of the U of
Massachusetts Medical Centre) defines mindfulness as “a state of being that emerges through paying attention on purpose, in the present moment and nonjudgmental to the unfolding of experience, moment by moment.” Goldstein (Mindfulness Stress Reduction Workbook), notes that mindfulness is “about being fully aware of whatever is happening in the present moment, without filters or the lens of judgement.”
So, how does this play out relative to supporting patient care, while being more professional, responsive while at the same time engendering one’s own self-care practice in the moment and long term as a health professional? Let’s explore the current state of stress and anxiety response in Canada and some general facts relative to the science behind stress and social intelligence, in general.
In the ideal world of stress reduction and adaptive functioning a resilient response is designed to address the physiological reaction of the body to a perceived stressful threat. Typical stress response in the body results in the release of cortisol and adrenalin in the hypothalamus resulting in increases in blood pressure, heart rate, increase glucose levels, reduction in digestive and reproductive functioning and changes to the immune system. Consequently, stress puts us at risk for anxiety, depression, digestive issues, headaches, heart disease, sleep problems, weight gain, impaired memory and focus.
Shapiro SL, Schwartz GE, Bonner G. 1998. Effects of mindfulness-based stress reduction on medical and
premedical students. J Behav Med. Dec;21(6):581-99. Photo credit: http://www.mum.edu/brain/brain.html
Goleman, in his book Social Intelligence (2006) notes that “stress handicaps our abilities for learning, for holding information in working memory, for reacting flexibly and creatively, for focused attention at will and for planning and organizing effectively.”
Stress & Anxiety Response – How it presents in the mind and body
Anxiety disorders range from mild to severe impairment, impacting 12% of Canadians or 4.3 million people (Public Health Agency of Canada). Stress affects 23% of Canadians 15 year of age and older while 30 % of adults (35-54 years) are impacted (Stats Can, 2014). Both anxiety and stress have significant impacts on health, well-being, absenteeism, burnout and health care costs across the spectrum.
· Hans Selye’s Stress model (1976) explains stress based on physiological and psychobiology referred to as the General Adaptation Syndrome (GAS) – fight, flight, freeze
· Stressors lead to 3 stage bodily response: Alarm, Resistance and Exhaustion
· The hypothalamic-pituitary adrenal axis system prepares the body to cope with stress
· 2 types of stresses – Eustress & Distress
· Eustress (positive stress) carries potential for growth & competence
· Distress (negative stress) which is uncontrollable, prolonged & overwhelming is destructive
· Adaptive coping contributes to stress response resolution fostering resilience which promotes positive resistance and the capacity to recover quickly
Risk Factors (Compassion Fatigue for Caregivers and Health Care Practioners):
Stress studies have used caregivers as the basis for the sample populations to investigate the role stress has in developing psychological (Guck, Kavan, Elsasser & Barone, 2001) and physical illnesses (Schulz & Beach, 1999).
Physiological Health Risks:
· More disease (Barakat et al. 2007)
· Higher cancer, inflammatory bowel disease, diabetes, & cystic fibrosis (Canning et al, 1996)
· Declines in physical health & premature death (63% higher mortality) (Schultz et al, 2001)
· Increased health-risk behaviors (smoking, use of prescription drugs) (Beach et al, 2000)
· Risk for fatigue and sleep disturbances (Jensen & Given, 1993)
· Lower immune functioning (Kiecolt-Glaser et al, 1996)
· Influenza shots (Kiecolt-Glaser et al, 2003)
· Blood pressure (Cannuscio et al, 2002)
· Altered lipid profiles (Vitaliano et al, 19950
· Higher risk for cardiovascular disease (Lee et al, 2003)
· Arthritis, neglect own care and higher mortality (Schultz et al, 2001)
Psychological Health Risks:
· Of 100 caregivers, 50% suffer from anxiety and insomnia
· 53% from social dysfunction, 52% somatic symptoms
· 48% suffered severe depression
· Psychological areas (Piteealthy & Maguire, 2003, Ferrell et al, 1999, Kurtz et al, 2004)
· Emotional distress higher than that of patients themselves ( Nijboer et al, 1998)
· More distress than patient ( Baider & Kaplan-DeNour, 1998)
· Depression, anxiety, psychosomatic, role restrictions, strains in marital relations, & diminished physical health (Northhouse, 1998)
· Experience emotional reactions more intensely than patients (Lambert, 2012)
· Caregiver strain, feelings of stigma, client dependence, family disruption combined can compromise resiliency (Zauszmiewski et al, 2009)
Risks Factors (specific to dentists and doctors):
Research demonstrates that perfectionistic tendencies (contingent to one’s sense of self-worth) are linked to issues with depression, anxiety, lower self-esteem, unhappiness, decreased life satisfaction result in striving to seek external validation. Mindfulness has the potential to facilitate a nonjudgmental accepting mindset, cultivating self-acceptance without confronting perfectionistic beliefs and ways of being.
This is reflected in risk factors as cited by Jennifer Boyce’s article, Bringing Mindfulness into Dental Practice, that 83% of dentists perceive dentistry as very stressful while 60% believe that it is more stressful than other professions. In 2003, Stats Canada cited that based on health professions by sector, dentists were noted to be #5 relative to self-reported levels of stress. The current educational environment relative to the field of dentistry is not a progressive and proactive in the promotion of wellbeing as Canadian medical and law schools whom are designing programs to support student wellbeing and resiliency. Boyce in a literary review of cited stressors by dental professionals noted the following:
· Coping with difficult/uncooperative, anxious clients
· Running late (cancellations and no shows)
· Causing pain/fear to patients
· Patient dissatisfaction
The lit review also cited outcomes that more than 50% of dentists reported feeling tense, nervous, depressed frequently, very frequently or chronically. From a management perspective, 24% did nothing to address these issues and 13% just coped.
Impact of distressful sound to the client/practitioner in dental settings:
High stress & anxiety – results in a reduction in the discriminatory capacity of the ear to high frequency sounds which contributes to the reduction of attention and auditory processing. The focused, relaxed listener improves the neural feedback loop from ear to brain thus supporting the middle ears capacity to protect from noise and to listen attentively. Imagine the impact that sound alone in dental settings impacts both the capacity of the care giver and patient to engage in active listening, to sustain a presence of mind that supports the effective administration of dental interventions and to support the receptivity of the patient in tolerating the procedure and being engaged in a cooperative and open state with practitioners.
Bonnie Kowaliuk is a registered social worker, accredited music therapist, mindfulness coach, transformational leadership consultant and founder of Senses Mindfulness Coaching. She employs music assisted mindfulness, positive psychology, brain-based approaches to support education and leadership develop with individuals and healthy & education organizations to create meaning, balance and peace in all aspects of their lives. Visit Bonnie’s website at www.sensesmindfulness.com or contact her at 403-519-1959 or firstname.lastname@example.org to discover how music, mindfulness and brain-based approaches to learning and development could support you in your practice.
1. Lovas, J.G., Lovas, D.A., & Lovas P.M. (2008). “Mindfulness and Professionalism in Dentistry.” Journal of Dental Education. 72(9), 998-1009. http://www.jdentaled.org/content/72/9/998.long
2. Lovas, J.G & Neish, N. “Mindfulness in Dentistry.” Dalhousie University, Faculty of Dentistry, Programs, Special Offerings. Retrieved from https://www.dal.ca/faculty/dentistry/programs/special-offerings/mindfuln...
3. Boyce, J. (2014). “How Can Dentists Find Peace – Bringing Mindfulness into the Dental Practice.” Ontario Dentist, Health and Wellness, 44-46. http://getinflow.ca/sites/default/files/uploads/OD_Nov14_FINAL_Health+We...
4. “UK Dental Students Becoming More Mindful.” (2015). https://uknow.uky.edu/uk-healthcare/uk-dental-students-becoming-more-min...
5. Gawel, R. (2015). “Mindful Techniques Reduce Dental Stress.” Dentistry Today, Industry News. http://www.dentistrytoday.com/news/industrynews/item/625-mindful-techniq...
6. Stein, J.M. (2017). “Mindfulness: Bringing the Science of Mindful Living into Dental Hygiene.” Dentistry IQ, Hygiene Dept. http://www.dentistryiq.com/articles/2017/04/mindfulness-bringing-the-sci...
7. Holexa, D., Lovas, J., Neish, N., Belzer, M., & Gold, E. (2011). “Mindfulness: Enhancing the Clinical, Professional, and Personal Outcomes of Dental and Dental Hygiene Students - Mindfulness at U of Dalhousie PPT.” ADEA Workshop, 2011 Annual Session. www.adea.org/2011annualsession/resources/Documents/holexapptfdw.pdf
8. Iorgulescu, G. (2015). “Music Therapy in Dental Medicine.” International Journal of Music and Performing Arts. 3(2), 19-24. http://ijmpa.com/journals/ijmpa/Vol_3_No_2_December_2015/3.pdf
9. Safer, A. (2017). “Navigating anxiety and stress through mindfulness: Cultivating mindfulness and awareness in a community-based setting,” Positive Psychology Conference Series, Workshop Notes. http://positivepsychology.conferenceseries.com/abstract/2017/navigating-...
10. Appukuttan, D.P. (2016). “Strategies to Manage Patients with Dental Anxiety and Dental Phobia: Literature Review.” Journal of Clinical, Cosmetic and Investigational Dentistry. 8, 35-50. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4790493/
11. White, A. (2017). “Mindful Dentistry to Calm and Reduce Patient Stress Spearheaded in Australia by Beacon Cove Dental.” Prweb, News Centre. http://www.prweb.com/releases/mindful/dentistry/prweb12068620.htm
12. Beach, S.R. “Mindful Dentistry.” http://leftbrainbuddha.com/mindful-dentistry/
13. Barbosa, P., Raymond, G., Ziotnick, C., Wilk, J., Toomey III R., Mitchell III J. “Mindfulness-based Stress Reduction Training is Associated with Greater Empathy and Reduced Anxiety for Graduate Health Care Students.” (2013). Education for Health Journal. 26(1), 9-14. http://www.educationforhealth.net/article.asp?issn=1357-6283;year=2013;v...
14. “Mindfulness and Pain – a View from the Dentist’s Chair.” Brilliant Living. https://www.brilliantlivinghq.com/mindfulness-and-pain/
15. Basson, R.A. (2013). “Management and Prevention of Burnout in the Dental Practioner.” Dentistry: An Open Access Journal. 3 (2) 1-4. https://www.omicsonline.org/management-and-prevention-of-burnout-in-the-...