Should you be hypnotizing your patients?

March 15, 2010 | dentalproductsreport.com
Web exclusive 

Should you be hypnotizing your patients?

Some say it’s a great way to ease your patient’s dental fears and even make yourself more relaxed at chairside.

by Renee Knight, Senior Editor 

Photo:altrendo images/Getty Images

In 20 minutes, Dr. David Grayson was able to help a 7-year-old girl to stop habitually sucking her thumb. He’s helped patients quit smoking, and he’s performed dental procedures without using a drop of anesthetic. He’s eased his patients’ fears and enabled them to get treatment they may otherwise have opted not to receive.

And he’s done it all through clinical hypnosis.

Dr. Grayson has practiced clinical hypnosis in his Parsippany, New Jersey office for about 5 years and is still amazed by what it can do. He’s able to work with patients to help them achieve things they didn’t necessarily know they could achieve. He connects with them on a deeper level, and what he can do for them at chairside really does have a positive effect on their daily lives. Helping that 7-year-old girl break her thumb sucking habit is one example that sticks with Dr. Grayson.

“Here’s a little girl who would have had problems with kids teasing her and making her life hell. In 20 minutes I solved that problem,” Dr. Grayson said. “How could you not love doing that?”

How it works

If you’ve never taken a course or haven’t done any research on your own, forget what you think you know. It’s nothing like what you see on stage or in the movies, Dr. Grayson said. The goal isn’t to have power over your patients or to make them act silly.  

Clinical hypnosis is an extension of the doctor/patient relationship and fosters connectivity between the doctor and the patient, said Dr. Timothy Crowe, who also uses clinical hypnosis in his Chicago practice. Dr. Crowe said every day he practices, he learns more because of this mindset. It facilitates acceptance and commitment to treatment. But it’s important to note that all hypnosis is self hypnosis; patients can’t be hypnotized if they don’t want to be.

So how do they do it? Clinical hypnosis involves the induction of a trance that has been characterized by Dr. Crowe as "mental absorption of an impassioned vision of a desired reality.”

Trance induction is different for every patient, but providing a suggestion of relaxation is a good place to start in most instances. Dr. Crowe asks patients to slowly comfort and settle themselves by looking for and experiencing the soothing stillness that occurs in between their breaths. Other relaxation suggestions include progressive muscle relaxation and the eye roll technique. As the patient manifests the physical and emotional signs of trance, he provides additional deepening suggestions of safety, comfort and control.

Click here for an in-depth look from Dr. Timothy Crowe at how clinical hypnosis works.

After the procedure is completed, Dr. Crowe re-alerts the patient. This includes post-hypnotic suggestion that entails comfort and ease of healing. The patient is acknowledged for cooperating and helping make the procedure successful. Patients often lose track of time, which is known as time distortion, and may not remember or realize treatment has been completed. 

The patient benefits

Clinical hypnosis is a great option for patients who have dental phobias, Dr. Grayson said. If they’re open to it, clinical hypnosis can help them get past their fears, and without the use of medication. It’s also an option for patients who prefer to have treatment without any anesthetic. Drs. Grayson and Crowe both have used hypnosis to perform procedures without anesthetic, and both told stories of others who have done the same.

Clinical hypnosis also makes patients more accepting of treatment, Dr. Crowe said, and thus more compliant. They take responsibility for their oral health and can achieve better outcomes. Patients and the doctor participate in what Dr. Crowe calls “the therapeutic alliance of trust,” which makes them more likely to believe in the process and to follow through with what they need to do to reach their desired result.

"This relieves the doctor of the burden of enabling the noncompliant patient," Dr. Crowe said. "This minimizes the doctor's risk for burnout and lack of job satisfaction while fostering enjoyment for the work and patient contact." 

The benefits to you
Dr. Grayson loves the fact that he can help his patients get past their fears. That by itself, he said, is “tremendously rewarding.” But there are other benefits. Inducing trances also can be relaxing for the clinician.

“If nothing else, it’s emotionally rewarding. My attitude, my outlook on things and the way I react to things have changed,” Dr. Grayson said. “I am in general more calm in my life than I was before.”

Training in behavioral science isn’t something clinicians get in dental school, so they’re left to their own devices when they go into practice, Dr. Crowe said. Clinical hypnosis effectively deals with the behavioral aspects of a dental practice by "mitigating the stress and emotional conflict that occurs within and between the clinician and patient during the rendering of care.”

The clinical hypnosis mindset causes dentists to listen better to their patients, Dr. Crowe said, which causes them to better recognize their needs. This is especially true for patients with dental phobias. 

“Initially I got into this because of the stress I would experience when administering an anesthetic injection,” Dr. Crowe said. “I’d have to ho hum it and overlook what the patient was experiencing. I didn’t appreciate it when myself or patients would white knuckle their way through the procedure. Today I understand clinical hypnosis has a vast array of clinical applications beyond that of rendering a stress- and pain- free local anesthetic injection.”

How patients respond to it
At first, patients can be skeptical and maybe even a little frightened of the thought of clinical hypnosis.

“Once patients know what hypnosis is about, that it’s not harmful, that I’m not making them do anything against their will and that they’re fully in control and basically running the show, I’m just enabling them to do it, I get very little resistance,” Dr. Grayson said. “But some people just don’t want to. And like anything else some people are better at it than others.”

There’s a Hypnosis Induction Profile (HIP) that tells you if a patient is open to hypnosis, Dr. Crowe said. Clinicians should never pressure patients who aren’t a good fit. This may embarrass them and make them even more uncomfortable in the chair. But when a patient is open to it, it's an effective way to get patients more of what they want and less of what they don't want.  

What exactly is clinical hypnosis?
Here’s what you should know about clinical hypnosis:

*Hypnotic trance is an altered state of mind body consciousness featuring absorbed  focused attention and heightened comfort.

*It is not sleep, but like sleep it alters one’s general and peripheral awareness.

 *Modern day researchers have demonstrated, via brain scans, physiologic  measurements and psychological testing, that hypnotic trance changes blood and electrical flow  patterns in the brain and body, while altering the physiology of fight or flight and simultaneously providing enhanced cognitive functioning relative to conflict management. This is referred to as psycho neurological change.
 
*It is instinctual, natural and safe.

*Throughout the millennia of man’s history it has been protective of his welfare fostering his adaptation, fitness and ascent. 

*It is a psychic tool conveying emotional sustenance just as our teeth, another primal tool, convey nutritional sustenance.

*There is cultural  evidence of hypnotic trance within early man's cave paintings dating back 15,000 years.

*Clinical hypnosis is about patient-centered care and the clinician leaving behind  preconceived beliefs to acquire an enlightened mindset of how to care for one self and the patient. It involves accepting help and a commitment to learning how to become unstuck, enabling one to pursue quality of life and sustainable longevity through adaptive health  lifestyle practices.

Source: Dr. Timothy Crowe

How to get involved
Clinical hypnosis isn’t something you can just do; you have to be trained. You have to learn about this dynamic process first hand. Both Drs. Crowe and Grayson are certified with The American Society of Clinical Hypnosis.

"ASCH training is a great cross disciplinarian collegial experience," Dr. Crowe said. "Through this organization, the allied healthcare professions-dentists, clinical psychologists, MDs and RNs- jointly learn clinical hypnosis and its application relative to the care of the mind and body needs of the patient." 

Drs. Grayson and Crowe also teach courses themselves. Dr.  Grayson said while there is in interest, this way of working with patients isn’t for everyone. You really have to want to do it and be committed to the doctor/patient relationship for it to work.

Get your team on board
Remember you have to be trained before you can add clinical hypnosis to your practice, and that means this isn’t something your hygienist or dental assistant can do in your place, That said, your team should be knowledgeable about clinical hypnosis and be able to answer any patient questions that may come up, Dr. Grayson said.

If you don’t make sure all your team members are in line with this mind set, they may say something to a patient that goes against what you’re trying to do.

“At chairside during a surgical procedure I had to pull an assistant aside to say ‘why are you asking the patient if they’re OK? Why aren’t you telling the patient everything is OK, things are going smoothly, isn’t this a wonderful result that’s occurring, as opposed to asking are you OK? Are you alright?,” Dr. Crowe said. “So you want to ratify a positive trance, not a negative one. You want to get the patients on the right track and keep them there.”

Making the distinction
Having trouble getting past what you thought you know about hypnosis? Remember, stage hypnosis is about entertainment; clinical hypnosis is about helping.

Stage hypnotists can look in an audience and quickly determine who is susceptible to suggestion, Dr. Grayson said. Looking around for volunteers and asking a few questions of those volunteers can help them determine who will be willing to cluck like a chicken or bark like a dog. 

But clinical hypnosis isn’t about  entertainment, Dr. Grayson said. It’s serious work that the doctors who perform it are passionate about, and its something that can be so beneficial to your patients.

“We’re not trying to make people look foolish or do amusing things,” Dr. Grayson said. “We’re trying to help people, enable them to get past dental fear or not smoke any more. That’s the difference. We’re about helping people.”

Renee Knight is a senior editor for DPR. Contact her at rknight@advanstar.com. 

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