Waterloo, Ontario, Canada
To determine the appropriate formal induction technique suitable for a particular patient, let us ask ourselves one question: "At this time, is the patient experiencing acute physical pain or severe psychological distress?"
If the patient is not in immediate severe pain or distress, more permissive techniques such as progressive relaxation enhanced with ego-strengthening phrases are usually sufficient to produce the relaxation necessary to make the procedure comfortable for the patient.
Instructing the patient in a direct manner to take a deep breath, let the eyes close and let the whole body go limp as the breath is forcibly blown out produces a rapid relaxation response. The suggestion that "with each breath you take and with each word I say you relax deeper and deeper until nothing bothers, nothing disturbs" sets up an automatic deepening technique paced by the patient's breathing and the dental surgeon's voice. Specific suggestions can now be incorporated into the verbalization.
If the patient is in acute pain or experiencing severe psychological distress, the short, rapid, authoritarian instructive induction techniques are usually the most successful. For a patient in pain, the top priority is relief as quickly as possible. The patient's mind-set is such that he is less critical and readily accepts suggestions and commands which may under normal circumstances seem to be irrational.
The patient's need for the relief of pain or mental distress dictates the rapidity with which he or she will accept hypnotic suggestions and respond to them.
"I realize you are in extreme discomfort and I can help you. For me to do that you must help me. Listen very carefully to what I say and follow my instructions. Do you understand? [Let the patient commit himself.] Good. Now, look at me and put your finger on the tooth that is hurting. Now, as I touch the area [place a finger on an area adjacent to the tooth where there is no inflammation and gently press], feel the pressure of my finger. The pressure feels good. As the pressure increases, your eyelids become heavy and close. Concentrate only on the pressure. In a few moments you will feel only the pressure. When that happens let this finger [touch and indicate a particular finger on one of the hands] twitch. It will move by itself to indicate to me when you feel only the pressure. [Wait for the ideomotor response.] That's good!
"The more pressure you feel, the more comfortable the tooth feels. Now, relax very deeply and become aware only of the good feeling of the pressure."
At this point the tooth can be surgically removed. The unacceptable feeling of pain has been integrated into the acceptable, pleasant feeling of pressure. Trust the ideomotor signal. Do the procedure. Often, as the forceps are engaged on the tooth in question, the pressure produced by the forceps acts as a deepening cue and causes the patient to go into very deep hypnosis.
OTHER DENTAL SUGGESTIONS FOLLOWING INDUCTION AND DEEPENING
anesthesia and bleeding control. "Nothing bothers, nothing disturbs—you are doing just fine—you are safe, comfortable, enjoying the feeling. Your body is safe, comfortable, totally relaxed, working automatically. You now let yourself flow with that feeling of relaxation so deeply that you need pay no attention to your body anymore.
"As I touch your teeth and the surrounding tissues, those areas become completely numb. Let this finger [indicate a specific finger by touching it] move by itself. It moves by itself when the areas I am touching are completely numb. [Stroke the area until the ideomotor signal is activated.] Good! [Teeth at this point may be surgically removed.] Let the sockets fill and the bleeding stop. Turn it off! [The denture may be fitted and inserted.]
ego-strengthening and teaching self-hypnosis.
"You have done extremely well. Enjoy a feeling of well-being and accomplishment. You now become aware of how good you are at hypnosis. After you leave here today, you can use self-hypnosis for your benefit anytime it is appropriate for you. Go through the same procedure we used today and you will respond as effectively and easily as you did today. Do you understand? Good."
posthypnotic suggestion. "In a few moments, I will ask you to allow yourself to come to complete alertness. After you do, your mouth remains completely comfortable. Your mouth heals rapidly. The denture feels good. You speak clearly. Nothing bothers, nothing disturbs. Do you understand? Good."
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