Keys to Building a Structured Anxiety Management Programme.
The benefits of managing your patients’ dental anxiety using structured behavioural management techniques across the practice are clear. But thinking about implementing such a programme can feel daunting and beyond a dentist’s reach.
Given the prevalence of dental anxiety today, all practices will have a large corpus of anxious patients whose anxiety is far-reaching enough to affect both their dental attendance and the efficiency with which they can be treated. Yet little help is available for them outside traditional pharmacological management using sedation and anaesthesia. But for the best efforts of a dentist’s reassuring chairside manner, this group go largely untreated. This body of patients, if poorly managed, can have a significant impact on a practice’s productivity through poor attendance, increased cancellations and increased time requirements for treatment.
FEMDA are professionals in the management of dental anxiety. Our experts are qualified clinical psychologists and manage teams of clinical psychologists in both secondary and primary care settings. In total our experts have authored in excess of 350 papers on dental anxiety and anxiety more generally. We have treated thousands of patients and trained and worked with hundreds of dentists helping them to understand dental anxiety better and implement more effective management techniques. Through this experience, we have identified a number of key features of really effective anxiety management programmes.
Anxiety assessments for all.
Practices should build anxiety assessments into their patient onboarding and before every visit. Many patients will not discuss their anxiety (through embarrassment and fear of being judged) and an opportunity will be missed to reduce the impact their anxiety has on their attendance behaviour. Evidence proves that by objectively measuring a patients’ general anxiety and simply discussing it with them will reduce anxiety. It is also best to ask more specific questions about the triggers of anxiety. These can help you tailor a personalised management plan for each patient. This exercise can be paper based but can be easily done digitally and in an engaging way. By assessing all patients you will get a good understanding of anxiety across your practice and how big an impact that anxiety is likely to be having on your practice finances.
Effective communication with anxious patients begins the moment a patient walks into reception. All practice staff should have a good understanding of dental anxiety and how best to communicate with patients. Finding time in a short appointment slot to discuss a patients’ concerns can be difficult. But just by engaging in a couple of minutes of “open” time to discuss a patient’s anxiety can significantly reduce their anxiety (as much as 4 points on the MDAS scale). Through the use of anxiety assessments, you should already have a good understanding of the patient’s anxiety triggers, so this “open” time can be very productive and reassuring. Verbal reassurance can be enhanced by providing a written commitment of what you as a dentist and practice will do to manage their anxiety. This is easy to do with a digital solution.
Provision of self-help resources.
Whilst dentists can organise their practice and behave in an anxiety reducing ways, this will not treat the causes of that patient's anxiety. Treating the root cause of anxiety is more appropriately a job for trained therapists. But for most patients, face to face counselling with a CBT expert is neither practical (qualified therapists are thin on the ground) or cost effective. But the evidence is clear that CBT can produce profound and long lasting improvements in their anxiety.
Indeed, more and more, digital solutions to mental health issues are proving successful. For specific help with dental anxiety, FEMDA has built a patient therapy app called Confidents. It provides patients with a personalised treatment plan using a structured CBT approach which ensures that the patient always feels in control and provides self-help advice and graded exposure to their specific triggers. The benefit of digital therapy is that it is accessible to all your anxious patients and can be delivered in a highly cost effective way allowing you to easily monitor the improvement in patient anxiety.
Facilitating patients’ feelings of control.
There are a number of common factors that trigger different types of anxiety. Arguably, a feeling of loss of control is the biggest cause of anxiety. Dentists that communicate and use techniques to maximise a patients’ feelings of control will manage that patient's anxiety most effectively. The use of stop signals, constant updates on how long treatment will take and what stage the treatment is at all help engender a patients’ feeling of control. Training in communication methods can reinforce best practice techniques can help a dentist manage a patients anxiety. FEMDA runs a number of e-learning courses and sessions that can help dentists develop the most appropriate techniques.
Creating an anxiety reducing environment.
Clearly patients walking into an environment that is noisy and overactive will increase anxiety. But similarly, a sterile, neutral environment may well cause a patient stress. Managing your waiting room smells, noises and visual stimulation can all help calm anxious patients. A significant impact of dental anxiety is the relationship between increasing dental anxiety and the increasing likelihood that a patient will not turn up to an appointment. This can be managed through the use of sympathetic messaging in the run up to a patient’s visit that reassures a patient and can prompt a dialogue between the practice and patient before the appointment if necessary.
Delivering an effective programme of anxiety management relies on a practice’s ability to deliver these cornerstones. We understand that dentists are not expert in these matters and there is a balance to be struck between the ideal for patients and what is practical. That is why FEMDA was created to provide its members with the knowledge and tools to implement a practice wide programme that delivers benefits to both patients and practice.
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