Cognitive Behaviour Therapy

Karen Clark
CBT Nurse
Birmingham Community Healthcare Trust
 What is CBT…….

• Some people call it a talking therapy

• Understanding how our fears develop and

what effect fear has on our reactions. These
are our learnt responses our automatic
thoughts

• Understanding these learnt responses, help

us mange our fears differently
What causes dental anxiety

Traumatic experiences

Single event – flashbulb memory

Vicarious learning from

friends / family /media
 Lange 1969
Cognitive
Physical

Behavioral
 Cognitive

Feeling out of control

Feeling trapped

Distortion of events

Catastrophic misinterpretations

Heightened fear response

 Physical

Perspiration
Increased heart rate
Increased respiratory rate
Shallow respiratory function
Pins and needles
Palpitations
Feeling nausea / faint
 Behaviour

Avoidance/poor attendance

Co –operation reduced

Aggressive/ unfocused

Escape/ritualised behaviour
 Case History – Alan

• 62 year old
• Requested to be ‘knocked out’ for
treatment
• Bad experiences as child and adult ++
• Last had treatment 15 yrs ago
• Treatment ‘always painful’ even with
anaesthetic
• MDAS Pre 31/25 Post 6/25
 The CBT process

• Formulation – history, timeline, MDAS

• Collaboration – working together, empathy

• Planned gradual / guided exposure

• Systematic desensitisation
 Modified Dental Anxiety Score

MDAS score above 19 = CBT intervention

1 Not anxious
2 Slightly anxious
3 Fairly anxious
4 Very anxious
5 Extremely anxious
 How would you feel if …….

1 – 5 scores
• you were going for treatment tomorrow
• you were in the waiting room, waiting for
treatment
• you were about to have your tooth
drilled
• you were to have your teeth scaled
• you were about to an injection
Catastrophic thoughts
are real !!!!
 Grading exposure

A = Situation

B = Response

C = Consequence

0 = Extremely relaxed
10 = Extremely anxious
 Remember……

The patient exposes themselves to the fear

I don’t expose the patient to fear
 Attention switching

• Relaxation - zone out / ‘their place’

• Breathing exercises / Diaphragmatic

• Personal journey / music / aromatherapy

• Applied tension
 Limitations of CBT

•Age

•Unable to commit

•Time just not right

•Pain / infection
 Case Study – Janet

• 54 year old
• Last attended GDP 40 yrs ago
• Multiple medical interventions for
Hydrocephalus as a child
(while conscious)
• Anxiety – vibration / sounds / smells
• MDAS Pre 22/25 Post 7/25
 Janet’s comments

• I cannot thank CBT enough. I have

been scared of the Dentist for 40 years.
My CBT Nurse made me feel at ease
and I was able to open my mouth for a
check up, something I thought I would
never be able to do.
I cannot thank you enough to rid me of
these terrible fears
 Case Study - Harriet

• 16 year old
• Needle phobic – unable to have any
vaccinations (Mum also needle phobic)
• Previously attended Dental Hospital for
4 years – no treatment achieved
• MDAS 21/25 Post 10/25
 Harriet's comments

I am so pleased I have been able to have

two fillings done I have even had my
noise pierced. Mum loves it.
I still have to have a tooth extracted but I
think I will be able to do it.
I am going to have my vaccinations soon
too
Build trust not dependence
 Feedback - Callum

I cannot thank you enough for helping

Callum overcome this trauma and I
must tell you he has conquered another
fear by going on climbing courses and
abseiling for his GCSE, it took four
attempts but he did it.
He is much more confident and looking
forward to having his brace fitted.
CBT - 45 pts referred so far

DNR, 1

Declined, 6
Canc, 5

FTA, 5
 Referral information

• 5 Male / 23 female

• Average age 31
Ranging from 15 – 72 yrs

• Average number of CBT apt 5.56

Ranging from 4 - 9
Outcomes so far

Unsuccessful
,1

Successful,
26
 Mandatory
Psychological Supervision
Contact details

Karen Clark
Karen.clark2@nhs.net
0121 612 2385