Ben Bernstein, Ph.D

Every dentist knows the obvious stresses of practice: patient fears; a tight schedule; staff tensions; meeting overhead demands. Not so obvious are what I call “the hidden stresses.”

As a performance psychologist, I am focused on how stress affects human performance. For the last thirty years, I’ve been a coach, workshop leader, and conference speaker in the dental field, as well as a patient in three dental school clinics. Commonly known as “The Stress Doctor,” I’ve witnessed, first-hand, how stress affects the performance of dentists and dental teams.

In this, the first in a series of articles about stress in dentistry, I’ll examine Hidden Stress #1: The Induced Reaction.

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What is “The Induced Reaction?”

 Many patients fear going to the dentist, many would rather not have to see the dentist at all.

 Mrs. Jones is waiting for her dentist. She is white-knuckling the arms of the dental chair, her brow is creased and her shoulders are hiked up to her ears. The dentist, Dr. Smith, enters the operatory with a cheery, “Hello, Mrs. Jones. Good to see you again!” and then begins the procedure.


You may well be wondering, “So where’s the hidden stress?”

I encourage you to observe Mrs. Jones carefully. You see that she’s death-gripping the chair, scrunching up her forehead, and tensing her shoulders. What’s less obvious is that she’s holding her breath. This triggers her sympathetic nervous system to go into high alert: fight-or-flight. The brain thinks,“You’re dying!”

What may easily elude you is that the dentist, Dr. Smith, is also holding his breath, and his sympathetic system has also ramped up in seconds. In psychology this is called “the induced reaction.”

 I first learned about this phenomenon forty years ago when I opened my private therapy practice. Every morning I’d head out to my office all bright-eyed and bushy-tailed. By evening I’d often return home worn out, harried, sometimes depressed and anxious. My clinical supervisor explained that I had gotten “induced” into the patient’s state. In other words, I was actually experiencing what the patient was experiencing: depression and anxiety.

Healthcare professionals— everyone who deals directly with patients in healthcare—are, by nature, empathetic, caring people. It’s easy for us to feel what the patient is feeling. While this may be helpful diagnostically, it’s not helpful when we get stuck there.

Think of the patient’s anxious state, and the Doctor’s induced reaction, like a riptide at an ocean beach. If you swim into it you’ll get dragged in over your head. Without realizing it, Dr. Smith has gotten induced — dragged into— Mrs. Jones’ anxious state. If he stopped for a moment, he would likely register that he’s feeling uncomfortable at best, anxious at worst.

But Dr. Smith can’t show his uncomfortability like Mrs. Jones. He has to maintain a calm exterior by being gentle and personable.

This sets up a split between how Dr. Smith must appear to his patient and what he’s feeling inside himself. In other words, his friendly, if not placid demeanor, directly contradicts any stress or turmoil he’s experiencing but can’t let out. His  energy is being siphoned off to manage this split. This split is one important cause of exhaustion and burnout in dentists.

The solution: go “sideways”

This scenario comes up in every talk or workshop I offer for dentists and dental teams: How to I appear calm, when I’m all riled up inside? 

 To get out of a riptide you don’t fight it head-on — you go sideways. What does “go sideways” mean in this context?  What does Dr Smith have to do to not get dragged under?  It’s simple: he has to employ the three tools for staying calm:  breathing, grounding, and sensing.

Specifically, I coach dentists to follow this procedure:

Before you enter the operatory, stop for 5 seconds, close your eyes, deeply exhale, and feel your feet on the floor. This will (1) create a space between the last patient you just treated and the one you’re about to greet; (2) put you in the present; (3) get you into your own body.

Once you’re chair side, notice if the patient is holding her breath and if you’re holding yours. Exhale and ground yourself again. This will immediately cut short any induced reaction.

Dr. Carlos Davidovich, a professor of neuro-management and an executive coach, in an interview with Dr. Jesse Green on the podcast The Savvy Dentist,  states,  “Successful leaders know how to balance a right level of empathy with a right level of analytical thinking.”

Keeping the balance, between what’s happening in the patient, and what’s happening in yourself, is critical in finding your work enlivening, suitably challenging, and continually fulfilling.

Please feel free to email me about your experiences and questions related to the induced reaction. You can reach me at:

© Ben Bernstein 2023


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