Wednesday, October 24, 2018

Dealing with dread – a one-person case study


I am normally a pretty happy guy inside. And while all of us have good days and bad days, it has thankfully been a very long time since I was filled with real, live, lay-awake-at-night dread about anything.

That changed earlier this month. A broken tooth turned into a toothache that kept me up all night, and the next day the dentist’s verdict came in: I needed oral surgery to remove two badly decayed teeth, including a fairly complex extraction and a bone graft. Worse, it would be a two week wait until an oral surgeon could get me in.

This was a big, scary deal for me. I hate dental work, and the last time I had an extraction decades ago, it didn’t go very well. (How badly did it go? Well, for starters, I bolted the dental chair and walked up and down the street as an escaped dental patient, due to a bad reaction to the anesthesia.) So I wasn’t a happy camper. And my feelings alternated somewhere between wanting to get this thing over with, and wanting to escape to Peru until my teeth rotted out.

At the same time, I recently retired from nearly a decade of treating hundreds of people for anxiety, including many who were dreading feared events in their life. So I decided to make these last two weeks a one-person case study for what did and didn’t work in situations like this, based on my own experience as a psychotherapist. Here are some of the strategies that worked for me:

1. Distraction. Let’s start with the big one. Distraction is usually a bad thing when you are trying to overcome a fear. (Why? Therapists basically teach people to re-learn their responses to small doses of feared situations, and no learning takes place when you are distracted.) However, distraction is just ducky when you are dreading a short-term situation. For me personally, what worked best was:

·        RV podcasts. I own a motorhome, and discovered that each podcast was a glorious hour of being taken away to a world of camping and life on the road.
·        Keeping busy. I got caught up on work and bills, got some writing done, and even spoke to an audience of 100+ people at Cornell two days before the surgery. All of it helped.
·        Getting sweaty. My beautiful wife is a fitness buff, and going on long walks with her every day helped me get perspective, and also sleep better.

Interestingly, my two favorite pastimes when I am not dreading something – watching baseball on television and listening to music – were of little help. In my case, taking action was much more helpful then trying to be passively entertained while my fears ran amok. Understand that everyone is unique, so take the time to figure out what works for you.

Also, while opinions vary widely on medication – and I don’t normally take anything – in my case a small nip of a mild sedative was great for temporarily re-setting my mood. Your mileage may vary, of course, and always consult with your doctor first.

2. Knowledge is power. Researching the thing you are afraid of can be a double-edged sword. There is unfortunately no filter on what you hear from friends or the Internet, and what you find may or may not be helpful. But sometimes the right nugget of information can be useful.

In my case, a little research went a long way. I am not like most dental phobics: I’m not particularly worried about pain, needles or the like. But I am extremely worried about things like anesthesia and losing control. (So, for example, telling me to strap on a nitrous oxide mask would be like telling you to jump off a bridge.) But I actually found a website called Dental Fear Central, with a page devoted to my exact concerns – and discovered that dental anesthesia does not affect motor nerves. This helped allay my greatest fear, that my mouth and throat going numb would affect being able to breathe or swallow.

(Ironically, when I Googled “dealing with a dreaded situation,” most of what I found was useless piffle. Which is part of the reason why, now that I am more toothsome again, I am writing this article.)

3. Coping tools. If there was a Nobel Prize for dealing with dread, it would go to the people who invented tools such as deep breathing, progressive muscle relaxation, mindful awareness, and cognitive restructuring (a fancy term for rewriting your thoughts in less scary terms). And needless to say, times like this also call for cutting yourself as much slack in your life as possible.

The key thing about coping tools is that no one, including me, ever wants to use them. It is a drag to spend 20 minutes tensing and relaxing your muscles, or writing down your thoughts. But when I would push through and do it anyway, I felt better. So I made time every night to soothe myself with the same tools I often prescribed for my own patients.

4. The human connection. Finally, connecting with other people is an important part of getting support and – sometimes – perspective in a scary situation. My beautiful wife was not only a great source of support, but also a veteran of just about every dental procedure imaginable, so her advice was invaluable. A very kind old classmate who happens to be a successful dentist was a great source of information and comfort as well. And perhaps most importantly, I discussed my fears frankly with the oral surgeon beforehand, so I felt that I had at least some control over the situation.

So how did things turn out in the end? The procedure itself went surprisingly well: I had everything done under local anesthesia, and the oral surgeon did such a great job that I had almost no pain or swelling afterwards – I never even needed to take a single painkiller.

More important, in the two weeks leading up to the procedure, I largely ate, slept and functioned well. Except for a restless night immediately before the early-morning procedure, life went on pretty much as well or better than I expected, particularly given how much I was dreading this. If I were one of my own patients, I would have called this a pretty good clinical outcome.

Best of all, now that this procedure is safely in the rear-view mirror, I can bask in the warm glow of having faced up successfully to a fearful situation – not to mention having a mouth where nothing hurts. So in closing, understand that the right tools and skills can often help carry you to the peace that lies on the other side of a dreaded situation.