I get so anxious that I’m being judged by my patients that I turn to ice

Q:

I’ve been a dental assistant for the past ten years. While the feedback I get is that the work I do is high quality, I find that I constantly question myself. I want the dental patients to feel comfortable, and I do everything I can to ensure that they are, yet I constantly worry that I’m hurting them; I can’t stop thinking about it.

I shared this anxiety with a good friend who told me that she thinks I have OCD and that I need to just accept that sometimes I may end up hurting someone a little. Her advice made me even more nervous!

In addition to being afraid of doing something wrong (although no one has ever said I did anything wrong!) I’m worried that my patients are judging me. When I first meet a person, we get along just fine, but as I see them more frequently, I start to worry that they think I’m weird. Then I start having trouble making small talk with them (which I’m supposed to do as I clean people’s teeth). I become completely self-conscious and freeze up, which only adds to my feelings of stress and anxiety. I wish I just had the confidence to know that I’m doing a good job and that people like me. Or even better — I wish I didn’t care about any of this! Is there a way to help myself?

A: 

I have to say that your friend may be a psychologist at heart — your constant self-doubt and worry are actually characteristic of the condition she “diagnosed” you with: obsessive-compulsive disorder (OCD). To find out whether you’re suffering from low self-esteem, insecurity, anxiety, OCD, something else or nothing at all, you should arrange an assessment with a qualified mental health professional. These conditions have different treatment protocols.

It’s also possible that you’ll receive a diagnosis of social anxiety. This is a disruptive obsessive feeling of being judged negatively by others. Keep in mind that sometimes people have symptoms that are annoying but not characteristic of a mental health disorder — assessment will clarify the situation.

Also, keep in mind that obsessive disorders are pretty common and that many people who have one, commonly have other diagnoses along with it. For instance, a person can have OCD, social anxiety, generalized anxiety disorder (GAD), Tourette’s Disorder, and ADHD all at once! Having one or two things going on at the same time is certainly not unusual.

The good news is that most psychological disorders can be significantly improved with the right treatments. This means there is an answer to your question, “Is there a way to help myself,” and that answer is a definite “Yes!” even if you have a diagnosed disorder or two!

You can also improve even if you have no formal diagnosis, and the best way to do that might still be to work with a professional.

Even before assessment, diagnosis, and professional treatment, you can help yourself by learning about rumination, OCD, and social anxiety. Millions of people have these conditions or something like them. There are plenty of books and resources that explain both the symptoms and the self-help strategies that you can start using right away and that can help even if you don’t have these exact conditions.

An obsessive worry is a nagging concern that will not leave no matter how much evidence you have that everything is fine. Rumination is a thought that just keeps going around and around in your head. Both are very distressing. Fortunately, these mental habits can significantly improve. Cognitive-behavioral therapy (CBT) will be your friend in this regard.

Your worry that you’re failing both professionally and socially is uncomfortable but oddly enough, is your brain’s way of trying to offer you protection from the dreaded thought: “I’m really failing.” Your friend suggested that you have to come to terms with being imperfect. Although you didn’t like that advice, I have to say she was right. Only when you can relax into your “failure” will you be free of the fear of it. In fact, it’s avoidance that causes the worrying habit to persevere day after day, week after week, month after month, and year after year.

Instead of wondering and worrying, answer your “what if” question (“What if I’m hurting someone? What if they don’t like me?”). Acknowledge that these fail experiences will be truly painful (“Yes, that will feel really bad.”). By surviving the imagined disaster again and again, your brain will eventually stop caring about it, just as you’re wishing for.

Exposure therapy is the act of facing the pain you are so desperately trying to avoid. Instead of fleeing from your imperfection, accept it. Face the inevitability of failure and rejection, feel the sadness of it, survive it, move on. Do it again and again. Doing this work with a therapist makes the treatment much more tolerable and subsequent success much more likely. I urge you to take the next steps — contact a professional and put yourself on the path to peace once and for all. You may be delighted to discover that you can be free far faster and easier than you ever thought possible.

(Originally featured in Family First, Issue 972)