9.8 Cognitive restructuring
Extreme or negative thinking has been found to contribute to increase anxiety as unhelpful thinking styles undermine an individual’s perceived ability to cope with a situation. Unhelpful thinking style may include extreme or catastrophic thinking about the dental encounter/procedure (e.g. I might ‘choke’ ) or mind reading and jumping to conclusions(e.g. ‘the dentist won’t understand my phobia and will think I am silly’).
Cognitive restructuring refers to a child being taught to recognize the negative thoughts which precipitate their anxiety and replace these with more helpful cognitions. Research has revealed promising results in the use of cognitive strategies to reduce adult’s dental anxiety [15].
Memory restructuring has been tested with children who received local anesthesia at an initial restorative dental visit and has been shown to change local anesthesia- related fears and improved behaviors at subsequent treatment visits [14,23]. Restructuring involves 4 components:
1. visual reminders;
2. positive reinforcement through verbalisation;
3. concrete examples to encode sensory details; and
4. sense of accomplishment
A visual reminder could be a photograph of the child smiling at the initial visit (i.e, prior to the difficult experience). Positive reinforcement through verbalisation could be asking if the
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This is where the patient may revivify a past traumatic experience and start to relive the physical and emotional pain. Under hypnosis it is very important to establish a safe and secure ‘place’ for the patient that they can freely explore their deeper memories without fear. Another advantage of hypnosis is the very relaxed state. A patient in a relaxed state is more open to new ideas of thinking. A session of hypnosis is beneficial for the calm state it creates and it allows the patient in some way to ‘work out’ their