As I begin to write this article, I am flying high above the clouds in an airplane somewhere between Minneapolis and Washington, D.C. I am on a business trip. What is the terrorist threat level today? Are we on an orange alert? I didn't even notice. These national threat alerts have simply become a part of the fabric of our lives. I did drive by the big flashing sign on the freeway to the airport that warns us all to report suspicious activity. Didn't I?
Threats and fears. How mch our lives have changed in just the past few years. No matter how old you are, it certainly is a different world from the one we grew up in. Raising the mass consciousness of fear has become the catalyst for global action of epic proportion. It is safe to say most people are more fearful today than they have ever been.
What we face today can create its own toxic psychic mix. There are the external fears: of terrorist threat, pandemic flu, SARS, HIV, natural disaster, and economic downturns. There are the internal fears: the fear of the unknown, the fear of failure, the fear of not being good enough, fear of losing the things or people you treasure, and the fear of disapproval.
Fear's constant companions are anxiety and stress. Dentists are well trained in how to help patients with their fears pertaining to dental procedures. They may not, however, be so well prepared in coping with their own fears. Professionals who work all day to make the pain and fear of others go away can get caught in the trap of the personal persona where we look and act fearless. When people such as our patients are afraid, they want to be lead or directed by someone who clearly can be trusted, knows what he or she is doing, and is not afraid. We calm, we reassure, and we act fearless. Is this image of fearlessness stopping us from facing our own fears?
Smoke and Fire or Smoke and Mirrors?
We all have fears from time to time. Our lives change, our relationships change, our conditions change. The first step in dealing with fear and anxiety is allowing ourselves to drop a fearless persona, at least to ourselves, and acknowledge our humanness; we all experience fear.
In the middle of the night, when you are alone with your thoughts, what do you think? Our worries and fears will find us from time to time. Intelligent, thinking people, who are alive and aware, pause periodically to reflect on their lives and their place in it and make changes to smooth the way. Inner reflection leads to renewal of spirit. Do you have the courage to make these changes?
Offered in this article are ways that highly skilled and leadership oriented professionals can deal with their own doubts. The first step, and sometimes the hardest for health care professionals, is to acknowledge that you do have doubts and concerns that stem from a fear.
What Do Dentists Fear?
All fears that are deep down and lasting come from our core beliefs about ourselves. These beliefs generally are developed when we are children and define our positive self and our negative self. These positive and negative self definitions are often carried forward into adulthood. Years ago I had the pleasure of being professionally associated with author and lecturer Earnie Larsen. Larsen summed up this principle beautifully this way.
"What we live with we learn. What we learn we practice. What we practice we become. What we become has consequences."
As human beings we work very hard to protect our negative view of ourselves from ever being seen by others. It is where we are most vulnerable. We fear being exposed. In fact, many professionals do not allow themselves to get the help they need for this fear of exposure. We, in fact, because of this type of fear, become the barrier to getting help. We are our own worst enemy.
The field of dentistry tends to draw perfectionists. Close might be fine in a horseshoe tournament, but in dentistry, the requirements are exacting. Since no one is perfect, however, expectations of perfection are never met and lead good people to be hypercritical of themselves and others as they fear that they simply are not good enough. You will know if this is one of your fears by asking yourself these questions. "Do I have the respect and cooperation of my personnel?" Will my family or friends play games or engage in other acts of friendly competition with me?" "Do I feel if I want something done right, that I have to do it myself?" If you answered no to the first two questions and yes to the last, this may be your fear.
Possibly you do too much for others, at the office or at home, or you over-volunteer in other ways give yourself away, or let everyone else make your decisions for you. People pleasers oftentimes give too much because they feel unloved and fear they are not lovable. There is a difference between being a good servant leader and a good citizen and being overly involved or a door mat. Are you feeling like you are drowning in demands? Can you relax? Can you say "no" to some things in life so that you can say "yes" to the things you really want to do?
People with the need to always be in power and control have been helpless and have lived in environments where things felt out of control. The fear of things being out of control is very common for professionals who grew up in the home of an alcoholic or drug abuser or someone who was abusive or mentally ill. Dentists with this fear will answer "yes" to these questions. "Is your office well organized?" "Have you taken aggressive steps to make it so?" "Have you created a work environment where all decisions must go through you?"
Similarly, the overly responsible often are making up for the irresponsibility in their lives and fear not being as good as someone else. They fear failure. They typically ask themselves questions like, "What if after I try it, it doesn't work out, and I look foolish?" Have you every thought, "I am not like other people. I should be able to do this?"
Possibly you leave relationships when the going gets tough. Or you stay in relationships at work or in your personal life far longer than you should. Those fearing abandonment feel not worthy enough. Have you retained an employee you know needed to be let go because of attitude or poor performance, yet kept her or him on so you didn't have to deal with the hassle of terminating employment? Have you left a work setting or relationship abruptly when the situation started to become a challenge? Have you given up on an opportunity to reach a dream by setting your own limitations with the belief that they wouldn't want you?
Fear Stops Us
Fear stops us in our tracks. Fear makes us stay put and not reach for our goals and dreams. Fear limits our growth and development. Fear makes us focus on what we don't want, rather than what we do want. I have even seen fear make people sick.
How often have your worried about something for hours, days, and even weeks for no reason? The circumstance that you feared never manifested, yet you put yourself through so much pain thinking it might. Our minds are so strong that we actually can put ourselves through all the emotional and physical stress of an event even if it doesn't happen. My stepson, Michael, was the first gunner in a combat convoy in Iraq last year. When he was in combat in Iraq it was easy, listening to the new reports, to fear the worst. My husband Greg, did not sleep a full night the whole time Mike was in Iraq. Fear did not help Mike; it did not protect Mike and didn't help Greg. Fear wastes our energy and does not prepare us for anything.
Fear, oftentimes, can make us fail. Golf is a game of concentration. How often haveyou seen a golfer or been a golfer who misses a relatively easy show because you feared you would? The follow-through to dental metaphors is legendary among practitioners in this category.
The self-fulfilling prophecy is real. Think of the most difficult patient you have. How do you prepare to see him or her? If we let our fears take over, we have already set the worst case scenario. Too often our forecast becomes our reality. We fear the patient will come in complaining and never be satisfied. No surprise the patient comes in and is soon complaining and cannot be satisfied. Next time, spend time imagining the best case scenario and see if that becomes a more pleasant experience.
Not dealing with worries and fear can lead to chronic stress that accumulates over time. According to Bruce McEwen, Ph.D., of the Laboratoryof Neuroendocrinology at The Rockefeller University, a leading researcher in the field of neurobiology and psychoneuroendocrinology, cumulative stress effects are showing up in people who are under constant stress. Especially those in caregiver situations. Dr. McEwen's research points to more evidence that the brain is more involved in a person's fear and resulting stress response than previously thought. The brain interprets what is threatening - ie. Your fears - and then regulates the behavioral and physiological responses through the autonomic, immune, and neuroendocrine systems "If the brain is under too much stress for too long," said McEwen, "we can see structural and functional remodeling changes that affect how it functions." In other words, our fears can negatively impact our brain function.
In another review of the current literature on the interactions of the brain, stress, and the endocrine system, more evidence shows how cumulative stress and the occurrence of disease may define age more than chronological aging does - more support for the observation that fears make us sick.
When Does Situational Worry Become a Problem?**
A natural question for many of us is, "How do I know if what I am feeling is normal?"
Consider that any of the following statements reflect a normal and appropriate response to the unprecedented uncertainty that exists at multiple levels:
1. "I'm worried almost all the time, and I feel like I can't make any decisions about the future."
2. "I feel keyed up, and I can't seem to relax."
3. "I like my work, but right now I can't concentrate and I'm not very motivated."
4. "I feel like something bad is going to happen, but I don't know what it is."
In general, anxiety disorders are distinguishable from common, everyday anxiety and worry by symptoms that are very intense, long-lasting, and interfere with daily activities. Steps to help clarify and manage worry include:
1. Ask yourself:
a. What specifically am I worried about?
b. How would it have an impact on me?
c. What are my rational and irrational fears about this situation?
d. What am I able to do about this situation?
e. What are others able to do about this situation?
2. Make sure that you have accurate facts and information. Worry is often based on worst-case-scenario thinking.
3. Try to engage in something you enjoy to interrupt your worry.
4. Try not to worry alone. Talk with someone who is a good listener; tell that person what is worrying you and ask for his or her input.
5. Consider limited your worry to a certain time of the day. For example, you can dedicate 30 minutes a day to worry and save up your worry for that time period only. This form of "thought stopping" and redirection may sound far-fetched, but it is helpful to many people.
How to Stop the Fear Before Fear Stops You
Tip 1. Live in the present moment. To often we take our fears from the past and let them color our future. If we are always basing our future on our past, how can we ever hope to have a new result? Let go of yesterday. Forgive yourself, forgive others, make amends for past mistakes if appropriate, and then let them go. Try to keep you thinking on the here and now and not on what could happen in the future. Each day must be lived one second at a time. If we are focused on the past or the future, we actually miss the living of our lives. Stop and focus on the here and now.
Tip 2. Stop Awfullizing. Change your mind and you change your world. Attitude plays a major role in life satisfaction and living with less worry or fear. American culture, now, tends to be more interested in what's awful than in what is good. That negative thinking can be a downward spiral. Try to keep things in perspective andnot go seeking things that are wrong to support your fears. There is significant healing power in positive thinking.
Tip 3. learn to Go with the Flow. Practice accepting changes in your life as they come versus resisting them. Challenges happen in all our lives. We meet them, time heals much, and we move on. Begin to see the good in all things, and fears will fade away. Even the most difficult things in life often bring a gift.
Tip 4. Live your authentic and genuine self. Living true to yourself instead of trying to be what others want you to be is liberating. How do you want to be remembered? What contribution do you want to make? What do you want your life to stand for? Living an authentic life means following your own dreams and passions and caring less about what others think of you.
Tip 5. Challenge your irrational fears. One of the best exercises I use with clients, and with myself, to deal with fears comes from Lesson 26 in the book A Course in Miracles The exercise calls us to take our fears to the extreme in our minds. I begin by identifying my concern. "I am concerned about __________." Then I go over every possible outcome that could occur. "I am afraid ___________ will happen." I generate as many distressing possibilities as I can imagine. Soon I realize that most of all of these will never happen. I rationalize the irrational. I realize worry is a waste of my time. If something happens, I will deal with it then. Try this exercise. It puts things in perspective.
Tip 6. Faith is the antidote to fear. In the aftermath of the terrorist attacks of September 11, 2001, our organization had the opportunity to counsel many people who had been directly affected by the events of that day; government employees with family members and friends in the Pentagon, corporate clients whohad lost loved ones in the World Trade towers, and others who had family or fiends in airplanes that were used for destruction that day. These wee people who all had experienced their worst fears coming true. How did they cope? For most people, months and years later, the one thing that got them through the trauma and the traumatic loss was their faith in a power greater than themselves. This Power is real in their daily lives, and it is this Power they draw on for protection, guidance, and healing. Some call this God, others Christ, or Allah, or the Great Spirit or the Holy Spirit. Whatever name is used, it is describing the powerful spiritual support people draw on from a faith in the Divine that is greater than oneself. One cannot hold fear if one has faith.
The Space Between Us
As I was preparing this article for you, a friend gave me a beautiful book by author John O'Donohue, a Celtic poet. The title is To Bless the Space Between Us: A Book of Blessings. His blessing for morning*** ends with this stanza that I feel is a fitting way to end this article.
May I have the courage today
To live the life that I would love,
To postpone my dream no longer
But Do at last what I came here for
And waste my heart on fear no more.
If you try these suggestions and notice that things do not improve, it would be an important time to seek professional help. Any time in the process is a good time to consider calling your Minnesota Dentist Wellness Program at 1-800-632-7643. The Minnesota Dentist Wellness Program is a professional consulting and counseling program here to help you. The program is totally confidential and available to you as a Minnesota dentist. It is brought to you by the Minnesota Dental Association, and you do not need to be a member to access this service.
Don't let worry, anxiety, or fears cause you another moment of loss sleep or stress. Call today. We can help.
* Dr. Stein is president and CEO of The Sand Creek Group, Stillwater, Minnesota.
** Adapted from an article byDiane Johnson of The Sand Creek Group.
*** From the Poem "A Morning Offering". Reprinted with permission from the book To Bless the Space Between Us; A Book of Blessings, by John O'Donohue. New York: Doubleday, a division of Random House Books. 2008.