Mindfulness to the rescue for dental professionals

mindfulnessSiobhan Kelleher chats to Mahrukh Khwaja about tackling burnout, building resilience and founding Mind Ninja.

Tell us about your dental journey and how you got interested in mindfulness?

I graduated from King’s College London in 2010 and delved straight into busy general practice life.

I upskilled in restorative dentistry and completed a postgraduate certificate in aesthetic dentistry. My interest, however, has always been what makes people behave the way they do.

So, I snapped up the opportunity to intercalate in psychology BSc as a third-year dental student!

My passion in mental wellbeing specifically blossomed after my own personal experiences of burnout and depression. I was experiencing a rollercoaster of emotions, ruminating over the past and anxious about the future.

This is when I discovered the powerful tool of mindfulness. Not just as a stress reliever but as a superpower in sitting with heavy, negative emotions or thoughts without interacting with them. Tapping into the comfort of being fully present and engaged with life.

When I unearthed the exciting neuroscience research on mindfulness in the last decade, especially around changes in brain shape and structure, I was sold!

I embarked on the most exciting journey of my life. To become an accredited mindfulness teacher, an acceptance and commitment coach and a positive psychologist. I absolutely love learning and hence I am constantly upskilling in my passion in order to help address the poor mental health and high burnout rates amongst dental professionals.

Stress and burnout features heavily in the dental profession – why is this?

A very key and topical question! I think to really understand the complexity of this issue it’s worth examining the research.

A clear picture of high stress and declining mental health in dentistry emerges as we examine the literature (Newton et al, 2006).

Isolation, stress of perfectionism, time pressures and compromise of treatment frustrations appear as common causes of work-related stress for dental professionals (Colin et al, 2019). Along with social media and the pandemic in the mix now.

Consequently, burnout amongst dental professionals is a rapidly rising concern.

The origins of burnout often start at undergraduate level, with greater levels exhibited in dental students compared with the general population (Acharya et al, 2003).

Post training, general dental practitioners (GDPs) report a high prevalence of burnout, between eight to 30%. Burnout is also a risk factor for poor mental health, such as depression and anxiety. GDPs report a higher incidence of suicidal thoughts, 10%, compared to the general population of 5% (Colin et al, 2019).

With these statistics in mind, providing dental professionals with tools to buffer against stress and safeguard their own wellbeing is paramount.

We have services in dentistry for crisis points but no preventive programmes. The pandemic has really shifted the spotlight onto mental health.

This led me to found my wellbeing company, Mind Ninja. A preventive programme in dentistry specifically targeting dental clinician burnout and mental health.

My mission with Mind Ninja is to help all dental professionals lead healthier and happier lives.

How do you think mindfulness can help us in the dental profession and our personal lives?

When we are in a negative mood, for example after a difficult dental case, our brain automatically trawls our memories for past experiences of similar episodes.

This is a basic survival skill of our brain. But this activates the ‘inner critic’ and further lowers our mood due to recalling past episodes of sadness or anxiety.

Our inner critic may say: ‘Look at all the mistakes you made and couldn’t put right’. These automatic negative thoughts trigger a downward spiral of more self-criticism, low mood and negative memories. Although we cannot stop the normal reaction of the brain, we can stop this downward spiral.

Mindfulness reminds us that past episodes of distress are just thoughts. Our worries about the future are just thoughts. They are not reality.

As a profession full of stressors, mindfulness is an excellent antidote.

Looking at the key research findings around mindfulness, we know mindfulness leads to increases in wellbeing and improvements in positive emotions, emotional regulation, self-esteem, empathy and our relationships.

Mindfulness also works at a cognitive level – benefiting our thinking, attention, learning and memory.

In clinical populations, mindfulness is effective in chronic pain management as well as depression.

In terms of what happens to our brain when we practise mindfulness, this habit reduces time spent in the default brain mode, associated with mind wandering and rumination – thinking patterns commonly seen in anxiety and depression.

What’s so exciting to me is the evidence base around mindfulness-based interventions for healthcare professionals. And this is another reason mindfulness features so heavily in my wellbeing training. It provides so many of the ingredients that can help build the muscle of resilience.

If someone is interested in mindfulness, where do they start?

Here are some suggestions you can incorporate within the dental clinic and at home:

  • Mindful living. In this practice, you use routine activities where you are normally in automatic mode, such as brushing your teeth, and focus on that experience using the five senses – sight, smell of the toothpaste, taste, textures of the bristles against your teeth, and the sounds of brushing
  • Mindful eating – for the first three bites become aware of the five senses
  • Mindfulness two minutes. This particular exercise could be very beneficial incorporated in a morning huddle or team debrief at the end of a clinical day. Start in a seated position, shoulders relaxed, hands on thighs and close your eyes. Ground yourself by tuning into your senses. Bring your attention to the inner experience by asking yourself what your internal weather is. Now bring your awareness to the breath. As you notice the mind wandering, which is a very normal quality of the mind, nudge your attention kindly back to the breath
  • Aromatherapy mindfulness. A great antidote for a busy mind. It’s easily employable in-between patients at work and with your nurse or at home. Rub three drops of essential oil, such as lavender, in the palms of your hands and take three deep breaths. Use the scent of the oil to anchor you back to the breath and present. Once again, ensure the exhale is longer than the inhale
  • Mindfulness defusion – to defuse anxious thoughts, notice fearful, anxious thoughts, avoiding pushing them away. Reduce their power by thinking: ‘I notice I’m having a thought that…’ This is excellent in helping you become an observer.

What does the future hold for you?

The future for me feels so abundant, optimistic and focused on creating meaningful changes in the mental health space in dentistry.

My experiences with burnout gave me a very deep connection with the problem I want to resolve and an important insight into the emotional rollercoaster of mental ill health.

Burnout can lead to poor mental health, such as depression and anxiety, and this workplace phenomenon is preventable. For me, the key to changes is prevention across all forums of dentistry.

Mind Ninja has had an incredible first year since it launched in April 2019. I have such big dreams for its future in supporting dentistry.

The pandemic has amplified the appetite for mental wellbeing training. Throughout lockdown, I have supported the dental community with free wellbeing webinars. The topics addressed ranged from burnout to compassion and combat fatigue, work-life balance and building resilience to weather adversities.

I do all training, including positive psychology coaching using the wonders of Zoom technology!

Wellbeing workshops have been moved online with breakout rooms so that participants start implementing positive psychology into their lives.

I look forward to continuing to spread the importance of psychological resilience and mental health first aid training for our community.

To encourage changes in the undergraduate curriculum, I have been closely working pro-bono with dental students.

My resilience workshop with King’s College London led to Mind Ninja being involved with the Dental Leadership Collaborative project at King’s. This implemented the first pilot psychological resilience programme for fifth year students.

I delivered resilience training for students at University of Sheffield and University of Dundee.

It’s an area Mind Ninja will continue to focus on. I believe empowering students with tools early on is essential in prevention.

Mahrukh’s top tips to help you stay on track

  • Growth mindset – approach all your positive habits with a mindset that learning takes effort and perseverance but you will get there
  • Growth buddy – adopt a mindfulness partner to help keep you accountable and on track
  • Cues – these can be visual or auditory but help us to remember to do our new brain exercises. This could be a mindfulness bell for example on our phone at random intervals during the day to remind us to take a moment for a deep breath
  • Piggyback new habits onto existing ones – for example, add a mindful minute at the end of your run or while savouring a cup of tea
  • Small steps add up – the smaller the better when we are introducing new habits. We want to keep encouraging ourselves by successfully achieving small goals. Starting with a one-minute mindfulness practice, for example, is absolutely a great way of introducing moments of slowing down and connecting with the present.

This article first appeared in Irish Dentistry magazine. You can read the latest issue here.

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