Emotional Resilience: The Armour For Modern Life by Dr Mahrukh Khwaja, with Samantha Morris

Dentaltown Magazine

by Dr Mahrukh Khwaja, with Samantha Morris

Two questions I’ve been pondering lately: Could self-care for health care professionals save lives? And does working within the NHS instil anti-self-care values? Ironically, health care professionals do not prioritise their own mental wellness, leading to inevitable stress, burnout and an array of mental health problems.

Caregivers in the true sense of the word, health care professionals are often very poor detectors of the early signs of burnout in themselves.

An epidemic of stress and burnout
Forty percent of NHS staff report feeling unwell due to work-related stress, according to a 2018 staff survey, with staff sickness costing the NHS £2.4 billion a year.

Dr Mark Toon’s recent research published on stress and burnout amongst UK dentists gives a clear picture of depth of the problem in dentistry: 10% of respondents had thoughts of committing suicide, much greater than the general population (BDJ, 2019).

Isolation, litigation, stress of perfectionism, time pressures and compromise of treatment frustrations, to name a few, are common stress points universal to health care.

What’s the vital ingredient missing in our training?
There seems to be an obvious gap in our education at dental school—a lack of training in psychological and physical well-being. If 99% of our courses are devoted to the patient’s health, why can’t just 1% be devoted to the future health of dentists?

Emotional resilience: the solution to enhancing mental wellness
An educational platform to enhance emotional resilience for health care professions is essential in training our minds to provide the armour needed for modern life. If this content was included in the curriculum at universities, the future generation of staff and patients would greatly benefit. Psychological well-being, increased energy, productivity and connection could all be strengthened.

Overcoming silent guides
My own personal experiences of divorce, depression and burnout led me to personal development. Through this, I discovered two life-changing truths: first, the transformative magic of self-care, and second, how our thoughts shape our lives.

There are silent guides in our mind that foster unhelpful behaviours; our overcritical minds, unforgiving perfectionism, fear of failure, rumination and low self-esteem. Emotional resilience training can help manifest helpful behaviours and reframe our negative thoughts encouraging a kinder compassionate you.

Reframing the negative critic
In this article, I’ll be exploring a common mental block many of us face daily—challenging the negative inner critic and encouraging the positive cheerleader—alongside psychotherapist Samantha Morris. The ‘inner critic’ could be defined as feelings of self-doubt and a breeding ground for low self-confidence. It can certainly prevent you from moving forwards or taking action.

For me, it was negative thoughts during treatment—for example, ‘I’m not good at this’ and ‘I should be better at this by now’. I found these thoughts very distracting and disturbing, and started to associate fear with certain procedures. Ultimately, it made me lack confidence and really dislike dentistry.

The emotions attached to these thoughts can tear you down. I am a pretty relaxed person normally, without an obvious perfectionism drive. I hadn’t experienced anxiety before and so it took me by surprise.

The truth is that whilst positive affirmations and short-term management tips do work for a while, you may end up staring into a mirror and starting to feel critical of your attempts. To really start to see positive and sustainable change, we need to first acknowledge that inner critics and positive cheerleaders are not separate but actually one voice.  

Origins of the critical inner voice, and what story it has to tell
We all have our own unique experiences and stories, and our inner critics will have gradually evolved and been influenced over time. Perhaps you were taught that a certain way of living, being, working, feeling was wrong or right?

Furthermore, our stories and experiences have grown in relation to others, and so our story is a mix of our own and other people’s stories and beliefs. It’s really important to ask: Is this your story, or have you been carrying someone else’s?

Once you have awareness of where your inner critic comes from and its triggers, you no longer have to be chained to your past story and you can begin to positively challenge it. From there, you can choose to explore and to create a new one. 

Through introspection and taking the time to check in with my emotions and thoughts, I discovered that my negative inner criticisms were based on the theme of not being good enough. After becoming more reflective on the specific thoughts, I realised they were the voice of bullies I experienced when I first graduated. A great ‘aha’ moment when all the pieces come together!

First steps in positively challenging the critic
Don’t be too harsh on your inner critic. Have you ever caught yourself being critical of yourself, only then to be more critical of your inner critic? At any one time we can experience the roles of being a rescuer, a victim or an inner critic, and each situation will influence how you respond and to which role you move to next. (Think of this as a triangle of roles.)

Human beings are complex, so it’s easy to think your inner critic as being separate from your cheerleader. However, your inner critic is not separate from your rescuer or victim or cheerleader, so although it’s tempting to want to see the critic as “negative,” it could also be protecting its own/your vulnerability and may have something to say. Think of this as if the bully has often felt bullied itself, and so has also been a victim.

Acknowledge the inner critic and stay with the discomfort. If you try to repress it, push it away or muffle it, it could come back with a double dose of vengeance. However, learn to be kind to yourself and your inner critical voice. Soothe it with positive affirmations, kind words and positive feelings.

Treat your inner critic compassionately. We can sometimes be our worst competition. By distancing ourselves and asking ourselves how we’d treat others, we gain awareness of how critical we’ve been of ourselves and how this is preventing us from realising our own unique potential, and we start to recognise that we have been in pain and have only felt able to express ourselves with defensiveness and criticism.

Positively challenge your inner critic. Look to positively soothe and challenge its words and feelings with instances where you have succeeded in life’s experiences, relationships and at work.

Every time you catch yourself being critical, pause and acknowledge it, be curious about its story, and then ask yourself and explore exactly ‘how true is it?’. If you find this difficult keep a positive ‘big me up book’ which lists both your own and friends and family’s experiences about your character.

These lists can include things you’re proud of, your values, challenges you’ve overcome and character traits. Ask trusted cheerleaders to help you out.

Role models can be helpful, too. A role model may be a person in your life—or perhaps it’s a historical, cultural or public figure, or even a fictional character. Which qualities do you admire? Now ask where these qualities lie within you.

Every time you hit a challenge and your inner critic is feeling moody or sorry for itself, remind yourself of these role models and how they would respond.

Reframing negative thoughts. It can feel isolating when you experience negative thoughts and feel like you’re alone. The act of verbalising the thoughts or journalling, however, could help to question the negative thoughts. Reframing becomes easier.

Below are some common negative thoughts and examples of effective reframes:

  • Before: ‘I am not good enough’. After: ‘How true is that? I am good because of my many good experiences’ or ‘I am worthy of this position’.
  • Before: ‘This is too hard’. After: ‘This may take some time and effort’.
  • Before: ‘I should be better at this by now’. After: ‘I am improving daily’.
  • Before: ‘I’ll never be as good as them’. After: ‘I will work out the steps they used and try it’.
  • Before: ‘I want to give up’. After: ‘I’ll use the strategies I’ve learnt.’
  • Before: ‘I am going to get sued’. After: ‘I work hard to serve patients and they are grateful’.
  • Before: ‘I made a mistake’. After: ‘Mistakes help me grow’.

The concept behind reframing is that with time and effort, a new habit forms and overrides the silent guide that isn’t serving you. Your self-awareness increases so that instead of engaging with a negative thought, leading to a negative emotion, there is space created to allow for you to react in a different way.

Sharing our stories
In a climate where social media creates an idealised version of reality, it’s very easy to get lost in the narratives of ‘I’m not good enough’ and feel alone in those thoughts.

If we want the next generation of dentists to be psychologically healthy, we need to start sharing our vulnerabilities more. We can make a big difference with our stories.

For more information, visit Empowering Women in Dentistry.


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