Articles on fear

Kinesiophobia – the Fear of Movement

Ms. Anuja Dalvi - Pandit, Physiotherapist
Movies have always left a deeper impression on our brains but unfortunately not many will dare to explore a very non-glamorous topic of mental health. We must appreciate the efforts of the makers of the movie Phobia depicting a life suffering from Agoraphobia. But this is not the only phobia that we encounter in the society.Being a Physiotherapist, gives us a chance to observe human movements very closely on a daily basis. And it is not just an observation but a well-researched fact that many of our clients suffering from musculoskeletal aches and pain carry fear of movements. It can be a client refusing to go back to gym after chronic low back pain or someone afraid of playing racket sports in any capacity after a rotator cuff tendinopathy. Every one of them carries some sort of fears and doubts. Many of them find a way through with guidance from appropriate practitioners but many get entangled in their own knitted web of fear.When this fear becomes unreasonable, irrational and debilitating, it is called Kinesiophobia. This can be connected to a feeling of vulnerability and fear of injuring/re-injuring as suggested by Kori et al. Sometimes there is a total apathy towards movements. That is not just during exercise sessions but during daily activities as well, such as walking in the house or working at the kitchen platform.It is very important to understand such behaviours in our clients as it can negatively influence rehabilitation process. Apart from rehab it also creates anxiety and related health issues. In case of an established diagnosis you can always seek help of a Physiotherapist skilled in understanding and managing Kinesiophobia. If needed a clinical psychologist can be approached for further counselling. Physiotherapists can provide a series of graded exercises along with right balance of motivation and empathy to achieve the desired goal.Research till date suggests that Tampa Scale for Kinesiophobia (TSK) given by Miller et al. in 1991 is the best tool to identify people suffering from Kinesiophobia. Clinicians from all the medical fields must start using this little questionnaire which is brief and reliable. The score of the test can be used as an outcome measure to check the progress in rehabilitation. Favourable scores is also an indicator to progress the client through exercise workload.So next time you meet someone catastrophizing the pain, don’t feel troubled but guide them in the right direction.

Dental Fear And You!

Dr. Saif Sayed, Dentist
A routine evening for iSmyle Dental Centre at Kalyani Nagar would be a list of scheduled appointments every hour. There would be patients with their friend or relative sitting in our reception area, ready for their dental treatment to begin.Today was different. At around 5 o’clock in the evening, our receptionist came in and informed us, “Our 6 pm patient has already arrived and looks very worried. He is simply walking around in the reception area and is looking at the wall clock every now and then. He even requested to make the reception area’s air conditioner cooler to make him feel better. Our other patients  looked  at him puzzled and concerned .”Our appointment list shows that this patient, Mr. Rajeev Patil (named changed to protect identity) has an appointment for his wisdom tooth removal. The treatment, which has not even started, was already making him feel uneasy, sweaty and restless.In simple words, Rajeev had dento-phobia, which is fear of dental treatment. Rajeev’s behavior is not unusual or unique. Today more than 75% of our population fear dental treatment, and out of these, 5% have such extreme fear that they avoid dental treatment at all costs, causing complications such as swelling, severe infection and extreme tooth pain.In today’s article, we have mentioned the reason behind Rajeev’s fear for dental treatment, how we made things better for him, how we eventually removed his tooth and calmed him down; thus  we will throw light on dental fear, the reason why most of us avoid going to the dentist, and how each one of us can overcome such a fear.   Reason no. 1(given by Rajeev): “My uncle had a bad dental experience.”A many of us fear dentists and dental treatment because our best friend, spouse, uncle or aunt had a swelling and a lot of pain after a root canal treatment.  We should know the fact that every tooth is different, and infection in different people have different results, not to forget the fact that different people have different reactions to pain. So, if your friend or relative had pain or swelling with their tooth, you may not experience anything and will be fit and fine the next day!Reason no. 2: “Fear of the needle prick.”The most common reason for dental treatment in people is the fact that needles will be inserted inside the mouth and the prick will hurt. This was Rajeev’s main fear. and it took no more than ten minutes for us to make him feel comfortable and give him the dental injection. How did we do this?We simply gave him the Injection Delivery system in his hand to feel it. This made him feel better because he was no longer seeing an unknown object enter his mouth. We also assured him that he will definitely not feel the prick of our injection. We applied an anesthetic gel on his gums to make it numb which made sure that he would not feel like the prick at all! This was followed by our ‘Controlled Local Anesthesia Delivery system’ which ensures the injection is slowly and smoothly administered. We lived up to Rajeev’s expectation of a Painless Injection treatment and this made him instantly relax in our dental chair.Reason 3: “Fear of the unknown”Another fear Rajeev had in his mind was that he did not know what was going on in his mouth. This is surprisingly a very common reason for fear amongst many of us. If we have a bruise/cut on our hand, we see it and we know how the bandage is put over it. This is not the case in our mouth. If we don’t know whether there is a cavity in our mouth and how it is being treated by the dentist, we would naturally fear it.It is important for your dentist to inform you about every dental treatment that you require. This can be through various means. We made it a point to show Rajeev an animated video of the wisdom tooth removal, which gave him a better understanding of the procedure. Apart from this, we clicked pictures of his wisdom tooth with our Intra oral Camera. This showed him exactly where the problem area was, and how damaged his tooth was. Hence, it is important to be completely aware of the situation inside your mouth.The above are major reasons why people avoid visiting to the dentist. Below are some other reasons that might be troubling you:1. Fear of cost: Many people feel that they are being overcharged for a particular dental treatment or been handed with an exorbitant bill after their dental treatment.You must make sure that everything regarding the dental treatment including the costs is thoroughly discussed and sorted out with your dental care provider.2. Gag: are you scared of the gag feeling when you undergo a treatment of a back tooth? is yes, then don’t be! Thanks to the advanced dental materials and techniques, this problem can well be taken care of!3. Some people have had painful encounters with the dental “drill” because they weren't properly numbed (or perhaps not numbed at all). Not surprisingly, if this has happened you are likely to feel terrified of the “drill”.With this article, we only wanted to tell you that you are NOT alone when it comes to fearing dental treatments. We all have fear of something. Overcoming it is what makes you a stronger and a better person mentally and physically!As for Rajeev, he came back with his uncle, assuring him that his tooth won’t hurt and the previous experience was just a bad one. 

Fear of Dentist and Dental Pain

Dr. Swasti Jain, Dentist
The reasons why patients are afraid to visit the dentist are manifold.The dreaded needle is also a big barrier to a patient seeking treatment but can be easily overcome. Many dentists (like me) routinely use surface (topical) anaesthetic in the form of a gel before we begin the numbing procedure with the hypodermic. Together with delivering the anaesthetic very slowly, we can often introduce the needle with the patient not feeling entry at all. Some dentists now even use a method of delivering local anaesthetic electronically, maximising comfort.The fear of being hurt during treatment is also a barrier to a patient seeking help. Modern local anaesthetics are so good these days that providing a tooth is not very inflamed or infected, comfortable dentistry is guaranteed. Many new patients I see as emergencies in pain have usually not attended for treatment for years. They have almost always had a “bad experience” with a dentist many years previously.Some people hate the antiseptic smell of medical and dental offices.Some patients fear the loss of control in the chair, not surprising since the mouth feels a very vulnerable and sensitive part of the body. Most dentists will establish the use of hand signals with the patient at the start of treatment. If not, a lightning quick jab up the dentist’s nose usually halts procedures.Anxiety puts you on edge, compounds the ordeal and you’re left completely drained by it.Even if there isn’t any pain involved, it’s the threat of pain and other triggers of fear that builds up the anxiety and makes for a miserable experience.Some people can’t sleep properly the night before their appointment. They hate feeling so anxious but they can’t shake it. Sedation Dentistry is a great option to reduce anxiety.For the very anxious, simple oral sedation can be provided in practice via Temazepam tablets prescribed by your dentist. If you are really lucky, some dentists can provide inhalation sedation (gas and air) or can refer you to specialist centres for intravenous sedation or in exceptional cases, for general anaesthetic. There really is nothing to be scared of.

The Ways of Dealing With Anger, Depression and Fears of Emotional Abuse

Mr. Azeem Dana, Psychologist
Emotional abuse happens to most of the women, even men, all over the world. Like physical wounds, even emotional abuse wounds are taking too long to heal. Those emotional wounds are so deep that adverse effects of it take time to wear off.It affects physical health as well as the emotional state of mind, relationship with others and behavior. Self-esteem to deal with abusersIn any Psychological Counselling we cannot generalize. The solution has to be found out based on particular situation. And it is true that every issue can be sorted out with a solution. In the case of abuse, it is nothing but part of personality or behaviour. Personality is influenced by psychological, biological and social factors and hence, we call personality is a learned behavior, and whatever a person has learned can either be re-learned or unlearned.In the case of the victim to maintain self esteem, the victim should understand the psychological, biological and social factors from both the end, of being a victim and from the end of abuser. If the Boss or a Relative is abusing, find out the cause for his or her outrage. One reason can be, that the person is not educated, i.e., not knowing what he or she does, or it can be that they are brought-up in such a way influenced by psycho-bio-social factors or it can be the pressure created by others or can be some sort of illness. As a victim, once I understand the abuser, find out what makes me a victim of abuse. Whether I do not remain assertive due to lack of communication skills - like using questions of what, where, when, how and with whom -  to know exactly what other person mean to say or what they expect me to do. Or do I have to get trained in coping skills, so that I can fulfil my responsibility in a better way and if required I can undergo the training to enhance my skills. Or find out if I have to learn time management or share responsibilities, or it can be simply that I have to voice my concern, that is to speak out rather than suffering within, so that the other person understands my concerns better. The ways of dealing with anger, depression and fearsTo deal with anger, fear and depression, I should understand that any emotion that I express is not there just because of current situation. It is a repeated pattern of expression that I have been expressing throughout my life at various situations since my childhood days. So, to deal with any particular emotion, I should know about, or write down, my complete life history and identify the various situations of my life that made me to experience this particular emotion or anger. Then I have to find out the psychological, biological and social factors that made me to experience that particular emotion repeatedly from my childhood days. Once knowing them, find out what is that inner strength or ability that I was lacking to deal with that particular emotion. Then work on to develop that quality within myself.Meditation - Practicing silence of mind by relaxing the physical body- helps to overcome any type of depression, fear and anger by strengthening our mind and will-power.Belief in abilities and self-love to get rid of effects of emotional abuseThe effects of abuse can be overcome by knowing that personality is nothing but a learned behavior, and whenever we want we can change our personality with the help of knowledge – understanding of self and others gained by using our logical mind, will power – to maintain the desire for change, acceptance – without any guilt feelings of whatever has happened in the past, patience - giving time for change, hope, determination, love for self and others. Even if we do not have control over the stressors – person, place,situations - or the abusers, still we can deal with them when we remember ourown inner abilities and strengths, when we have faith in our own self, when weare able to maintain our self respect. To remember this at the time of need,every day morning and evening, practice simple visualization or imagination ofown strengths and abilities that are appreciated by our parents, relatives,friends since our childhood days to till date. The victim can also visualize and see in their mind how they are dealing with their abuser maintaining their self-esteem.Stop being abusedInstead of dealing with the situation by seeing one as a victim and other as an abuser, focus on the cause and solutions. Instead of reacting by revenge, respond to the situations using the logical sense of mind. The points to remember is:1. Try to understand using logical mind - understand the abuser and own self.2. If the abuser is not really an abuser but has real reason, try to make him or her understand, and if required, try to improve the self.3. If you find, the abuser is really an abuser, for his/her own reasons like illness or when you feel out of your control, speak out being assertive or act finding a new job, complaining to police, complaining to mental hospital or move away from the abuser.4. Forgive the abuser by understanding and remove the victim attitude from the self, learn from the past to begin a better future by adding coping abilities to the self. 

Do You Have Exam Phobia?

Dr. Kavita Sagarkar, Psychiatrist
So, what is Exam Phobia! Well, everyone of us has experienced it. Admit it.I know people who are so stressed out before exams  that they have physical symptoms like a headache, loose motion, stomach ache( even a stomach migraine)  and body ache. Exam stress may cause one to go blank during the actual exam like Ghajini. There may be sweating, palpitations that disturb so much that one cannot think straight and end up messing up  the paper. Also, in subsequent exams it becomes worse and the fear intensifies. The person may end up feeling a failure, feeling guilty  and may even be suicidal!Why does this happen ? Exams are an integral part of our growing up. The competition today is very intense. We are tested, judged by a single exam. They may be important in deciding our career. In our perception, exams become like an insurmountable mountain that seems difficult to climb. Sometimes, the failure in previous exams worsens the situation. Sometimes, the person may have a critical parent who makes one feel like a good for nothing with the message that he/ she can never succeed. Let us understand what can be done or rather, undone! After identifying the problem, it is important to de-anchor  from the negative effects of the previous bad exam experiences. This can be done by simple visual/auditory exercises. Close your eyes and relax. Think of your previous exam where you had the fear. Notice if you are visualizing it or having negative thoughts about it.Put the negative images in a helium balloon and let go of these. Take the  thoughts that make you feel fearful and hear them in a sing -song fashion in your head, with the tune of your favorite song!  Notice now that you are able to rid yourself of the stress and feeling calm. Now add  visual exercises to instill confidence. Visualize the time you did well in some exam or sport, something that makes you feel confident and proud of yourself. Associate with these images ie. imagine being  there in that moment or time. Hear the thoughts  that give you confidence. Now, see yourself studying and doing well in your future exams. .  In this way you can  train  the brain to focus on doing well, through different techniques using N.L.P. (Neuro Linguistic Programming). In rare cases, anti anxiety medicines may be added. Yes, you can definitely succeed. All the Best! 

Tips for Overcoming the Fear of General Dentistry

Dr. Ratnika Agarwal, Dentist
Some people fear visiting their dentist so much that the try to live with the pain, decreased function, or less-than-appealing appearance of their smile.  At Smile Up Dental Care & Implant Center, it breaks our hearts knowing this, which is why we strive to provide our customers with compassionate care, cutting edge technology, and green products to help put people at ease.  In addition the following tips may help overcome the fear of a general dentistry visit. Open CommunicationIf you are afraid let your dentist know how you feel! If possible, tell them why – Did you have a bad experience in the past?  Are you concerned there may be even more discomfort? By letting your dentist know, they will be able to address your fears, offer suggestions to prevent them, and explain how new technologies have advanced general dentistry over the years. Medications for Anxiety ControlAlthough non-medicated approaches are preferred, you may have the option of using preferred medical solutions to help you relax during your appointment. Talk to your dentist before your scheduled appointment to determine if this method is appropriate for you. Alternative Relaxation TechniquesAlternative relaxation techniques may help reduce the anxiety. Some suggestions that patients have had success with include:Deep breathing and/or Meditation to “center” yourself and help you relaxListening to music to keep your mind pre-occupiedEarly morning appointments before the stress of the day sets in. Eventually the fear will decrease over time as you get to know all the staff at the dental practice. Schedule Preventative Appointments Before a Dental Issue Arises Starting with a new dentist slowly can help to alleviate some of the fear general dentistry can cause. Instead of waiting until you have a dental problem to see a dentist, build a relationship through non-procedural and preventative appointments.  Basic dental exam with or without a cleaning, or a consultation is a great start. Dentists understand the need for some patients to start slowly, particularly if they are aware of the patient’s fears and anxiety.

Can Dental Problems Lead to Heart Disease?

Dr. Rajat Sachdeva, Dentist
Researchers conducted a new study that showed that the gum diseases and poor oral hygiene leads to an increased risk of heart diseases.Associations all over the world have been conducting studies which shows the relation between bad oral hygiene and gum diseases and heart diseases, however, it is still considered as an insignificant theory that bad oral hygiene contributes to atherosclerosis (narrowing of the blood vessels), stroke or heart diseases.Some researchers have actually discovered that the bacteria that causes gum diseases actually is the same bacteria which also increases heart disease rate or stroke. Few researchers have said that “We wish that associations all over the world will acknowledge the link between oral diseases caused by poor oral hygiene to the increase in heart diseases. This view may change the way how physicians diagnose and treat the heart diseases patients and help to understand the patient in a much better way."Understanding the connection between gum diseases to heart diseases and the dynamics of this relation can lead to more studies and subsequent researches would prove to be revolutionary in the field of dentistry. It will change the view of how a physician looks at patients with heart diseases and could provide careful attention and better diagnosis.Few researchers conducted studies on mice with four different bacterias namely Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Fusobacterium nucleatum , as these are the same bacteria that causes or increases the risk of heart diseases. Researches when found the presence of bacteria in gums, heart, arteries and aorta of the mouse, there was an increases in the cholesterol and inflammation which are associated with the increase of risk factors for heart diseases.The mouth is expected to be gate of the body and that the bacteria entering into the mouth has direct connection between systemic diseases and oral hygiene, study concludes. These studies could help to spread the awareness among the physician about the links between oral health and heart diseases which will help them to diagnose the problem more efficiently, study says.Severe cases of gum diseases leading to tooth loss is found in 15-20% of middle- aged (35-45 years) adults according to the World Health Organization.Having a good understanding about the treatment of gum diseases inpatients with the heart diseases is very important and can lead to more accurate diagnosis of the disease and careful attention to the patient about the oral health against the heart diseases can be given.Bacteria which are present and grow under the gums, on the teeth and the bone supporting the teeth causes the gum diseases. The initial stages during which the disease is spreading is usually without any symptoms and people may not notice the effects of the diseases on gums. Therefore, to keep and maintain the oral hygiene, one must be regular with their dental checkups and follow-ups.

What Is Dental Anxiety and Phobia?

Dr. Saurabh Gupta, Dentist
Some people avoid dental visits inspite of the fact that most dental procedures are not painful. However, just the mere thought of dental examination can make some people feel stressed. Some anxiety or stress about going to a dentist or any doctor is okay. But if the thought of dental visit is terrifying and you would do just about anything to avoid a dental appointment it is not normal. A person with dental phobia will do anything to avoid a dental visit such as bear pain due to gum infections (periodontal disease) or cavities.Highly common, people with dental anxiety have exaggerated or unfounded worries or fears and are stressed before their appointment whereas people with dental phobia panic or have intense fear or dread dental appointments and treatment. At times a person with dental phobia may never see a dentist. People with dental anxiety and phobia are at higher risk of gum and teeth disease, premature tooth loss, and may have to bear emotional costs as well. Discolored or damaged teeth, poor oral hygiene can make a person self-conscious and insecure. Dental anxiety and phobia are very treatable conditions like any other mental disorder.Causes Of Dental Anxiety And PhobiaThere are several reasons of dental anxieties and phobias, but some of the common causes are;Fear of pain especially after a painful previous experienceFeeling of helplessness and loss of control while undergoing treatment in a dental chair,Embarrassment in opening mouth, especially if the dental hygiene is poor, and if a person is self-conscious about the appearance of his or her teeth. SymptomsThere are no specific symptoms that differentiate normal anxiety from phobia. Normally a dental appointment or checkup should not fill you with terror. If it does, then you probably have dental anxiety or phobia. Some symptoms of dental phobia are:You are stressed or have difficulty in sleeping the night before a dental appointmentYou are very anxious and nervous in the doctor’s waiting room.Prospect of a dental visit makes you feel sickYou panic during the dental examination and suddenly find it difficult to breathe.Treatments And Coping MethodsCommunicating With Your DentistGo to a dentist with whom you feel comfortable with, who listens to you, understands your concerns, and gives you adequate time. Talk to your dentist about your concerns and fears. Most dental treatment can be made painless.If you actively participate in planning your treatment with your doctor it can give you a feeling of control that can help you to feel less anxious.Understand about the procedures and ask if the treatment can be done over a few sittings than one appointment. Know in advance what's happening at every stage of the procedure so that you can prepare yourself and you won't be taken by surprise.If you are worried about pain, ask the dentist the types of pain control available and what will be best for you.To help lower your anxiety during the appointment, ask your dentist to explain what's happening at every stage of the procedure.You can request your dentist to stop for a while during treatment if you feel panicky or anxious.Don’t be embarrassed to discuss your fears as many people have are afraid of dental procedures. If your dentist is aware about your concerns he or she will be better address your problem in a better way.DistractionYou can try to reduce your stress during a dental appointment by using a distraction such as engaging in something pleasant that you like such as listening to music or watching TV.Pain ControlFear of pain especially after a painful previous experience is a major cause of anxiety or phobia. Currently many medications and techniques are available that can reduce or eliminate pain during most procedures. If you are worried about pain ask the dentist the types of pain control available and what will be best for you. If you are comforted that the procedure won’t be painful it can help to reduce your anxiety.Relaxation TechniquesRelaxation techniques can help to lower your anxiety during a dental appointment or procedure. Some of the common and effective relaxation techniques that can help you include deep breathing, music therapy, yoga, meditation. These techniques are easy to learn. You can consult a therapist for them, but remember that you have to practice it regularly in order for them to be effective. Certain alternative therapies such as acupuncture and acupressure can also be useful. SedationIf you are really anxious and tense then you may request your dentist to give you sedatives such as diazepam (Valium) to relax the central nervous system and help feel calmer.TherapyIf your anxiety or phobia is so extreme that you avoid dentist even if you have painful tooth consult a psychologist. Psychologists and psychiatrists can counsel or give cognitive therapy, or if needed medication to overcome fear.